The Other Half of the Obesity Epidemic: Physical Inactivity

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The Other Half of the Obesity EpidemicPhysical
Inactivity

• Mark Fenton
• Pedestrian and Bicycle Information Center
• Univ. of North Carolina
• mark.fenton_at_verizon.net

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ACSM Fitness GuidelinesAmerican College of
Sports Medicine, 2000

• Aerobic activity 3 to 5 days/week.
• 20 to 60 minutes, at 60 to 90 of maximum heart
  rate.
• Resistance training.
• Routine flexibility exercises.

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Point 1Its not just an obesity epidemic. Its
an epidemic of physical inactivity.
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The Obesity Epidemic in the USFlegal et. al.
(JAMA 288, 14 Oct. 2002)
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First Law

• EIN EOUT ESTORED

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Surgeon Generals 1996 Activity Recommendation

• 30 minutes of activity
• Most days of the week.
• Can be broken up.
• Reduced risk for CVD, diabetes, osteoporosis,
  obesity, clinical depression, some forms of
  cancer.

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Physical Activity in the US (MMWR 50 (09)
166-9 Mar. 9, 2001)
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Point 2. Its not just about individual behavior
change.

• For population level impact, we cant just focus
  on changing individuals.

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I get all the physical activity I need right
here! Yee-haa!
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Exercise ParticipationEffect of Short Bouts,
Home Treadmills(Jakicic et.al., JAMA 282, 16)
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Energy ExpenditureLifestyle vs. Structured
Activity(Dunn et.al., JAMA 281, 4)
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Self-help vs. CommercialWeight Loss Programs
(Heshka et.al., JAMA 289, 14 April 9, 2003)
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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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Perhaps a better approachto increasingphysical
activity . . .
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Does your exercise . . .

• Cost more than 100 to get started?
• Cost more than 10 each time?
• Need special equipment or instruction?
• Require you to go somewhere special?
• Need other people to take part?
• Not provide much enjoyment?
• Allow you to do it at work?
• Have a high risk of injury?

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Point 3. The better way

• A socio-ecological approach to increasing
  physical activity.

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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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S.E. Model of success tobacco

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

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Point 4. The Vision

• Reintegrate physical activity into the lives of
  all Americans.

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Transportation Well walk and bike, if we have
places to do it.
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But we still build mostly this
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US Walking Trips 1977-1995National Personal
Transportation Survey, USDOT
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US Auto Trips 1977-1995National Personal
Transportation Survey, USDOT
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Do incidental walking trips matter? Imagine

• Eliminate 20 minutes of walking, 5 days a week
  (and dont change your diet)
• Gain 3 lbs./year
• (thats 30 lbs./decade!)

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Simplified elements of pedestrian and bicycle
friendly settings

• Network.
• Land use.
• Safety.
• Site Design.
• Commitment.

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Walkable, bikable places have

• Continuous networks of footpaths, multi-use
  trails, and sidewalks.

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Walkable, bikable places have

• Compact, dense, and diverse
• development and zoning.

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Walkable, bikable places are

• Safe for all cyclists and pedestrians (not just
  skilled ones).

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Walkable, bikable places are

• Aesthetically pleasing and functional for
  pedestrians and bicylists.

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Walkable, bikable places have

• A civic commitment to walking and cycling, from
  top to bottom.

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Point 5. Tactics to launch change

• Pedometer programs.
• Community checklists.
• Trail building initiatives.
• Walk to school programs.
• Community-wide workshops.

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A. Play (and learn) with Pedometers.

• How many steps?
• 10,000 for long-term health
• 12,000 - 15,000 for weight loss
• 3,000 fast for fitness

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Pedometers 20 Boost Approach

• Because not everyone starts at 5,000 steps per
  day.
• Begin by measuring baseline first!

Key to Success Keep a record!
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Reading Analog Pedometers
Big hand100s Little hand 1000s of steps
How many steps?
3,620
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• B. Walk Bike-ability checklists
• Room to walk/ride?
• Able to cross?
• Traffic a problem?
• Safe, pleasant?
• Accommodating?
• Ample destinations?
• www.pedbikeinfo.org

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C. Trails and greenways.

• Create inter-disciplinary coalitions.
• Seek early successes . . .
• . . .but work toward a visionary plan.

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Functional, not just recreational trails.
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Support walking and cycling to school.
Walk to School Day Oct. 8, 2003.
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No one walks to school anymore . . . Parent
reported MMWR Aug. 2002, 4(32)701-704

• Active trips to school 14
• (Walking 11 cycling 3)
• Less than or equal to a mile
• 31 of trips.

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What benefits accrue to kids who walk?

• Healthier, more fit.
• More alert, better performance.
• Better navigation, social skills and development.
• Maybe better drivers?
• They like it!

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One Day Events

• Build awareness.
• Increase demand.
• Launch coalitions.
• Remember the fun!

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On-going Safe Routes Programs

• Walking checklists.
• Designate safe routes.
• Promote and encourage.
• Safety education, enforcement.
• Launch walking school busses.

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Walking School Busses
Children joined by parents, retirees, older
kids. Some formal, some not.
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Infrastructure Improvements

• Sidewalks, trails, pathways, crossings.
• Improve facilities crossing guards slow
  traffic.
• Relocate drop-off areas no idle policies
  car-free zones.

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Figure out where you are, and move up!

• One day event.
• On-going promotion.
• Infrastructure improvements.

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Start with the Three Ps . . .

• Principal (school admin.)
• Parents (PTO/PTA).
• Police (safety).

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InternationalWalk to School Day

• October 8, 2003.
• www.walktoschool.org
• www.cawalktoschool.com
• www.dhs.ca.gov/routes2school

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Individualhealth risk assessments

• Blood pressure.
• Cholesterol profile.
• Blood glucose.
• Body mass index (weight).

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Communityhealth risk assessment

• Network.
• Land use.
• Safety.
• Site Design.
• Commitment.

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E. Walkable Community Workshops
National Center for Bicycling and Walking
www.bikewalk.org
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Resources

• www.bikewalk.org
• www.pedbikeinfo.org
• www.walktoschool.org
• www.activelivingbydesign.org
• www.cdc.gov/nccdphp/dnpa/
• physical/trails.htm