Physical Activity: Moving Toward Obesity Solutions

In 2015, the National Academy of Med-icine hosted a 2-day public workshop in Washington, DC, entitled “Physical Activity: Moving Toward Obesity Solutions.” Experts from around the world summarized the science demonstrating physical activity’s (PA) impact in the prevention and treatment of overweight and obesity, and highlighted innovative strategies for promoting PA across all segments of the population. In addition to demonstrating current science supporting the benefits of PA (discussed in the February issue), researchers at the workshop presented strategies and considerations for promoting physical activity among adults, school-age children and community organizations.

Promoting PA

Russell R. Pate, PhD, professor and principal investigator for the Children’s Physical Activity Research Group at the University of South Carolina, introduced concepts for promoting PA among different segments of the population. His key points:

• Physical activity is a complex behavior, not a simple construct. It takes many forms, is performed for many reasons and is influenced by many factors.
• A single intervention strategy is unlikely to be effective.
• There is strong evidence to support

1. community-wide intervention campaigns;

2. school-based physical education, social-support interventions in community settings and individually adapted health behavior change programs; and

3. the creation of, or enhanced access to, places to be physically active.

Policy Strategies for Promoting PA

Ginny Ehrlich, EdD, director and senior program officer for the childhood obesity team at the Robert Wood Johnson Foundation, moderated a panel that focused on the potential impact of policy on different sectors. Amy Eyler, PhD, assistant professor of public health at Washington University in St. Louis, and Jamie Chriqui, PhD, MHS, professor of health policy and administration at the University of Illinois at Chicago, made these points:

• Policies can improve access in communities through design; funding from
  
  Let’s Move!
  
  and other government-sponsored initiatives can make this possible.
• Incorporation of PA policies in health care should include implementation of PA counseling, exercise prescriptions and provider training.
• PA policies in transportation should focus on active-transportation options, such as creating safe routes to school, planning and zoning with PA in mind, and emphasizing public transit.
• Policies to build, maintain, connect, update or promote trails and other public spaces can facilitate physical activity.
• Comprehensive policies that involve several different sectors of society will have a greater impact than those focused solely on change within one sector.

Community Strategies for Promoting PA

Jim Sallis, PhD, distinguished professor in the department of family medicine and public health at the University of California, San Diego, and Abby C. King, MD, PhD, professor of health research and policy and of medicine at the Stanford Prevention Research Center, shared how living communities and technology can impact health on a larger scale:

• People in walkable communities are active about 7 additional minutes per day, which translates to about 2.9 pounds (1.3 kilograms) burned per year.
• “Complete streets” incorporate space for cars, cyclists, pedestrians and mass transit.
• Looking at the “micro” level, there are certain factors that positively correlate to more active living, including streetlights, benches, sidewalks, buffers (areas between the sidewalk and traffic flow) and curb cuts.
• Technology is often cited as a cause of the decrease in PA, but there are ways to leverage technology as a solution.
• Smartphone apps and wearable devices passively assess PA and may provide real-time feedback for behavior change, although few employ research-based strategies to enhance motivation and behavior over time.
• Using simple technology can help low-income individuals identify neighborhood features that help or hinder active living and healthy eating. Doing so allows residents to prioritize issues and then build community partnerships—a “bottom-up” approach in contrast to “top-down” policy change.

Institutional Strategies for Promoting PA

Linda Meyers, PhD, director of the Food and Nutrition Board at the American Society or Nutrition, led a panel that shed light on the challenges of incorporating PA into schools and workplaces. Experts Allison Nihiser, MPH, health scientist at the Centers for Disease Control and Prevention, and Nico Pronk, PhD, FACSM, FAWHP, vice president and chief science officer at HealthPartners Inc., offered these insights:

• Evidence-based support exists for school-based PA interventions, including physical education and active transport to and from school.
• Involving the family and overall community is essential to helping kids achieve PA goals (i.e., 60 minutes per day).
• A comprehensive school physical education program has five components that should be examined collectively: physical education, PA during school, PA after school, family and community engagement, and staff involvement.
• Considering the shift toward more sedentary job types, technology-based careers and remote-access jobs, there is a significant need for PA and movement in the workplace.
• Obesity rates in the U.S. workforce have approximately doubled in the past 30 years, with the downward trend in energy expenditure at work accounting for nearly 80% of the increase.
• PA is associated with 4.7% lower healthcare charges per active day per week; and physical inactivity, overweight and obesity combined are associated with 23% of health plan charges.
• Productivity and workplace performance increase with PA.
• Identifying barriers to PA can be as important as creating opportunities.
• Companies should strive to make being active possible, simple, socially rewarding, financially rewarding, personally relevant, organizationally relevant and community connected.

Innovative Solutions

Despite challenges, there are several entities that have succeeded in implementing innovative PA solutions. In a panel discussion led by Harold W. Kohl, III, PhD, professor of epidemiology at the University of Texas Health Science Center and the University of Texas at Austin; Linda Fondren, founder of Shape Up Sisters!; Sean Hinkle, chief program officer at DC Scores; and Marisa Molina of the Institute for Behavioral and Community Health in San Diego concluded the event by sharing these thoughts:

• Community-based efforts can include elected officials, churches, restaurants, gyms and hospitals.
• Unique interventions work best. For example, DC Scores combines soccer, poetry and service learning to help kids develop self-expression, fitness and a sense of community.
• Strategic partnerships can create sustainability for PA programs by lowering the costs of certain activities or by opening experiences to residents.
• Partnerships with the healthcare community can help drive the neediest individuals to take part in a program.