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Title: www'opraonline'org

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www.opraonline.org

Developing an Ohio State Physical Activity Plan
-
Ohio Parks Recreation Association
Columbus, OH
July 2007

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My somewhat unique perspective . . .
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Brockport NY
Erie Canal Towpath Trail
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A.D. Oliver Middle School, Brockport, NY
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Working agenda

Introductions
Presentation
The real epidemic (physical inactivity).
Overcoming stickiness.
Where we are so far.
QA and getting your buy-in (or not).
What are you already doing?
A path forward
Maximizing current efforts
Anything to add?
Specific objectives or measurable outcomes.
Next steps?

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US Obesity EpidemicOgden et. al. (JAMA 288,
14 Oct. 2002)
Americas looming chronic disease apocalypse . .
.
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US Youth Overweight RatesJAMA 288 (14) Oct 9,
2002.
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Diabetes Prevention Program (DPP
New.Eng.J.Med., Feb. 7, 2002)

Compared three treatments for nationwide cohort
(3,000) at risk for developing diabetes
(elevated fasting glucose).
Control Standard exercise and nutrition
counseling placebo.
Standard plus drug treatment Metformin
Intensive lifestyle change Nutritional training,
150 min./week physical activity.

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Diabetes Risk Reduction(Diabetes Prevention
Program NEJM, Feb. 7, 2002)
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Our thoughtChange the conversation. Its not
just an obesity epidemic. Its an epidemic of
physical inactivity and poor nutrition.
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The Question How much physical activity is
enough?
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Surgeon Generals Report on Physical Activity
Health, 1996

30 minutes of moderately vigorous physical
activity.
Most (all) days of the week.
Can be broken up.
Reduced risk for CVD, diabetes, osteoporosis,
obesity, dementia, clinical depression, a growing
list of cancers.

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ACSM Fitness GuidelinesAmerican College of
Sports Medicine, 2000

Aerobic activity 3 to 5 days/week.
20 to 60 minutes, at Target Heart Rate (THR 60
to 90 of maximum heart rate).
Resistance training.
Routine flexibility maintenance.

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Physical activity recommendation for
adolescents(1994 consensus conf.)

Physically active every day as part of lifestyle
(at least 60 minutes, moderate intensity).
Some vigorous activity at least 20 minutes,
three days/week.

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Physical Activity in the US (MMWR 50 (09)
166-9 Mar. 9, 2001)
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US Youth Physical Activity Rates(CDC Youth Risk
Behavior Survey)
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But in the end . . . Its a matter of personal
choice, isnt it?
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Estimated Cost of Inactivity and Poor Nutrition
nationally 78.5 billion/year

Ohio total 3.304 billion/yr.
Public (taxes) Medicaid, Medicare 1.75 bill.
Private (insurers, hospitals) 1.55 bill.

State Level Estimates of Annual Medical
Expenditures Attributable to Obesity, Finkelstein
et.al., Obesity Research 200412(1)1824 www.cdc
.gov/nccdphp/dnpa
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The Stickiness Problem.
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Exercise ParticipationEffect of Short Bouts,
Home Treadmills(Jakicic et.al., JAMA 282, 16)
?
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Exercise ParticipationEffect of Short Bouts,
Home Treadmills(Jakicic et.al., JAMA 282, 16)
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Self-help vs. CommercialWeight Loss Programs
(Heshka et.al., JAMA 289, 14 April 9, 2003)
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Did these people exercise?
Lowell Natl Hist. Park, Lowell, MA
Its about dramatic decreases in routine, daily
physical activity!
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Pedometer-based lifestyle activity promotion

Measure steps all day.
Determine your average daily steps.
Increase by only
10-20 a week.
Keep gradually increasing . . .

Key to Success Keep a record!
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How has advising people to take the stairs . .
.worked?
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Energy ExpenditureLifestyle vs. Structured
Activity(Dunn et.al., JAMA 281, 4)
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An approach to increasing physical activity . .
.

P.A.P.P.I. (?)

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Physical Activity Promotion through Predator
Introduction
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Social Ecology ModelDeterminants of behavior
changeSallis, Owen, Physical Activity and
Behavioral Medicine.

Individual (readiness, efficacy)
Interpersonal (family, friends)
Institutional (school, work, HMO)
Community (networks, local govt)
Public Policy (transport, land use)

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Socio-ecological success tobacco

Individual education, medication
Interpersonal 2nd hand smoke, kids
Institutional work place bans
Community smoke free policies
Public Policy taxes, enforcement, advertising
bans, SGs warning label.

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vs.
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The ideal trip decision hierarchy
Nearly 25 of trips are less than or equal
to one mile. (1995, Natl Personal Transport.
Survey)

Walk
Bike
Transit
Drive
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So, what makes stickier places?

Destinations within walk bike distance?
Sidewalks, trails, bike lanes, crossings?
Inviting settings for bikes pedestrians?
Is it safe?

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A prescription in four easy pieces.

Land use mix.
Network of bike pedestrian facilities.
Site design and details.
Safety.

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Land use.
Civic anchors in town.
Smaller lot sizes . . .
Mixed use, multi-family.
. . . shared open space.
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Convenience of Destinations and Walking for Older
WomenKing et.al., AJHP 18(1) Sep. 2003.
Proximal destinations mattter!
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Network of facilities

Presence of sidewalks, paths.
Shorter blocks, more intersections.
Access to trail, park, greenway, transit.

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Transit riders are physically active. Besser,
Dannenberg, Amer. J. Prev. Med., 29 (4), Nov.
2005.
Just during the daily walk to transit

Half of transit riders walk at least 19 mins.
29 get at least 30 mins. of activity.
Minorities, poor (income lt15k/yr.), denser
urban dwellers more likely to get 30 mins./day
due to transit trips.

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Site design
Where would you prefer to shop on foot?
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Site design.

Pedestrian friendly architecture is near the
sidewalk, not set back.
Access comfort, trees, benches, lighting,
aesthetics, human scale design.
Details bike parking, open space, plantings,
matls. . .

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Safety.

Engineering can dramatically improve safety.
Increasing ped and bike trips decreases overall
accident fatality rates.

(Jacobsen et.al., Transportation Safety)
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Neighborhood mini-circles replace 4-way stops.
Slow traffic, maintain flow on residential
streets.
Narrowing crossings, increasing visibility all
decrease risk.
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Suburbanization of AmericaUS population shift,
1950-1996(after Bowling Alone, R. Putnam, 2000)
But what about rural areas . . . ?

Suburbia is steadily consuming the landscape . . .

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Outside State College . . .
2. Rural areas are where we can affect the shape
of development before its done!
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Consider the benefits.

Environmental
Reduced traffic air, water, noise pollution.

Education, schools
Increased safety.
Reduced transportation costs and infrastructure.
More community engagement schools as
neighborhood centers.

Safety
Kids, elderly mobility.
Crime deterrent.

Economic
Residents shop locally more stable tax base.
Healthy employees, low turnover, happy
employers.
Healthy housing values
(NAHB NAR surveys).

Or more simply Which generates more tax revenue?
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So how to get there?
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Will the As carry the day?

Single-use zoning, cheap oil, GI Bill, Highway
system.
Show me the money.
New is always scary.
In general, our society prefers incentives
market tools over rules regulation.

Accident?
Altruism?
Arm-twisting?
Authority?

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Three Ps for sticky change

Programs Build awareness, support, skills,
plans encourage change.
Projects Models of an environment for routine
physical activity.
Policies Rewrite the rules so the changes stick
and its easiest and most economical to build it
right.

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Programs
Media, community workshops, activism training.
Walking School Bus Safe Routes to
School. www.saferoutesinfo.org

www.americaonthemove.org

Active- commute incentives E.g., eliminate free
parking, health benefit discount.
Pedometer promotions E.g. Add 2,000 steps a day.
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Stickier Schools Safe Routes to School programs.

Engineer safer facilities (sidewalks, paths, .
Educate for safe bike, pedestrian, driver
skills.
Enforce safe speeds, better behavior,
pick-up/drop-off.
Encourage more walking and cycling make it fun!
www.saferoutesinfo.org

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Projects
Schools PE, play space, bike racks, access.
Parks rec Open space, rec. facilities, greenway
s trails.
Work sites Bike parking, lockers, showers
walking paths.

Municipalities Traffic calming, mixed use,
sidewalks, improved crossings.

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Not all projects are costly . . .
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Policies
Schools Siting, district lines, bus driving
policies.
DPW standards snow removal, maintenance . . .
Zoning Mixed use, site standards, setbacks, open
space, parking.
www.completestreets.org
Work sites Health insurance, parking transit,
flex time, rewards.
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Lincoln-Lancaster County, NE, Joint Committee on
Land Use Health(County Health Planning
Boards)

Physical activity impacts
Grid network of streets.
Sidewalks in and out.
Homes front the street.
Open space, trail?

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Health Care industry is already seeing the
economic opportunity.

UnitedHealthCares High Deductible (2,500) plan.
Earn 500 reductions for
Not smoking.
Body Mass Index lt 27.5
Blood pressure lt 130/85
Cholesterol LDL lt 130 mg/dL

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This guy is a new model of success!
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The process so far

Dec. 2006 steering group.
Feb. 2007 Ohio P.A. Summit at annual OPRA
conference (Cleveland).
Mar.-May 2007 Five regional summits statewide.
June 2007 Convene a writing team.
Goal Completed plan by February 2008.

Intrepid pedestrians in Cleveland, Feb. 2007
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Four focal areas.

Promotion outreach. Educate, advocate,
collaborate for effect.
Schools, education. PE, recess, facilities,
active travel to from.
Work sites. Institutionalize incentives
support.
Transport development. Active living designs
are the rule sprawl urban decay are the
exception.

Cleveland, Feb. 2007
63
Current outcome measures