What Can We Do to Increase Physical Activity in Youth?

What Can We Do to Increase Physical Activity in Youth?

William H. Dietz MD, PhDConsultant, Institute of Medicine

Senior AdviserRobert Wood Johnson Foundation

Obesity Trends in Children < 5yo Pediatric Nutrition Surveillance System

Obesity Trends in Youth over the Past 12 Years

Ogden et al. 2012, NCHS data brief

Childhood Obesity: Signs of Progress

NYCNYC

Kearney, NEKearney, NE

Vance, NCVance, NC

Anchorage, AKAnchorage, AK

Fitchburg, MAFitchburg, MA

CaliforniaCalifornia

Chula Vista, CAChula Vista, CA

West West VirginiaVirginia

Philadelphia, PAPhiladelphia, PA

Somerville, MASomerville, MA

New New MexicoMexico

El Paso, TXEl Paso, TX MississippiMississippi

Energy Deficits Necessary to Achieve the HP 2010 (Prevalence = 5%) by 2020

Age Deficit2-5 yo 33 Kcal/d6-11 yo 149 Kcal/d12-19 yo 177 Kcal/d

Wang YC et al. Am J Prev Med 2012; 42:437

Effects of Physical Activity on Morbidity and Mortality across the Life Span

Physical Activity In Childhood

Physical Activity In Childhood

Physical Activity in Adolescence

Physical Activity in Adolescence

Physical Activity in Adulthood

Physical Activity in Adulthood

Morbidity in Childhood

Morbidity in Childhood

Morbidity in AdolescenceMorbidity in Adolescence

Morbidity in Adults

Morbidity in Adults

Mortality in Adults

Mortality in AdultsHallal et al. Sports Med 2006;36:1019

7

Physical Activity Guidelines – Children and Adolescents (ages 6–17)

• 1 hour (60 minutes) or more of daily physical activity that is at least moderate:– Most of the 1 or more hours a day should be either

moderate- or vigorous-intensity aerobic physical activity

– Do vigorous-intensity physical activity at least 3 days a week

http://www.health.gov/paguidelines

8

- Include muscle-strengthening activities at least 3 days a week

- Include bone-strengthening activities at least 3 days a week

• Physical activities should be age appropriate, enjoyable, and offer variety

http://www.health.gov/paguidelines

Key Guidelines – Children and Adolescents (ages 6-17) (cont.)

% High School Students Achieving 60’ MVPA - YRBS 2011

CDC. Youth Risk Behavior Surveillance. MMWR 2012; 61:1

Average Minutes/d of Accelerometer- Measured MVPA

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Opportunities for School-wide Physical Activity

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Decline in Active Transportation to and from School in 1969 and 2001; Nationwide Personal Transportation

Survey

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Opportunities for School-wide Physical Activity

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Frequency of School PE – SHPPS 2006

Daily PE PE 3d/w

Elementary 4% 14%

Middle 8% 15%

High School 2% 3%

Note: No school level data in 2012 SHPPS

Lee SM et al. J School Health 2007;77:435

Changes in Required or Recommended Recess 2006-2012

33%

38%

%

Lee SM et al. J School Health 2007;77:435; Lee SM et al. SHPPS 2012www.cdc.gov/healthyyouth/SHPPS/2012

Percent of Schools that Do Not Provide Recess to First Grade Students

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Changes in Activity Breaks SHPPS 2006-2012

Lee SM et al. J School Health 2007;77:435; Lee SM et al. SHPPS 2012www.cdc.gov/healthyyouth/SHPPS/2012

% of Schools

Energy Costs of Opportunities for PA in Schools

11

17

27

33

37

Bassett DR et al. PCFSN Research Digest March 2013; Series 14 #1

Evidence of Effectiveness of School Programs for PA

School-based PA interventions•Increases duration of PA for 5 - 45’/day•Decreases TV time from 5 – 60’/day

•Increases VO2 max

•Participants 3 times more likely to engage in MVPA

Dobbins M et al. School-based PA programs for promoting PA and fitness in children and adolescents aged 6-18. Cochrane Rev 2013

Opportunities for School-wide Physical Activity

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Percent of Boys and Girls Participating in Sports 1971-2011

Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Participation in Interscholastic Sports by Boys and Girls by Availability of Sports Facilities 2009-2011

Colabianchi N. Bridging the Gap in Kohl HW III, Cook HC. Educating the Student Body, IOM 2013.

Healthy Kids Out of School: Drink Right, Snack Smart, Move More

Strategies to Increase Physical Activity in Youth

• Implement the Physical Activity Guidelines Midcourse Report

• Mobilize parents• Convene all relevant groups to develop and

implement a strategic plan• Improve the research base that links PA to

behavior and academic performance• Use QRIS, state, and local policies to

implement PA standards in ECE• Engage health providers at all levels in

Exercise is Medicine

Strategies to Increase Physical Activity Among Youth – PAG Midcourse Report

Sufficient evidence •Multi-component PA in schools•Physical education programSuggestive evidence •Active transportation•Early Care and Education•Built environmentEmerging evidence•Activity breaks

Strategies to Increase Physical Activity in Youth

• Implement the Physical Activity Guidelines Midcourse Report

• Mobilize parents• Convene all relevant groups to develop and

implement a strategic plan• Improve the research base that links PA to

behavior and academic performance• Use QRIS, state, and local policies to

implement PA standards in ECE• Engage health providers at all levels in

Exercise is Medicine

Parental Support for Physical Education

• A majority believe that PE is as important as other subjects (CDC 2010)

• Over 90% believe there should be more PE in schools (HSPH 2003)

• Over 75% think more PE could help prevent or control childhood obesity (NASPE 2009)

• 95% believe that daily PA helps children do better academically and should be part of K-12 curriculum (NASPE 2003)

National Physical Activity Plan – Strategy 2Tactics

• Binding requirements for Pre K-12 standards-based PE that address curriculum time, class size and employment of certified PE teachers

• Local, state and national standards for high levels of PA in PE

• Federal legislation to require school accountability for the quality and quantity of PE programs

National Physical Activity Plan – Strategy 2Tactics

• Local state and federal funding to assure that schools have the necessary resources, especially for under-resourced schools

• State-level policies to monitor quality and quantity of PA and PE programs

• Require school districts to collect, monitor and track fitness data including BMI

Strategies to Increase Physical Activity in Youth

• Implement the Physical Activity Guidelines Midcourse Report

• Mobilize parents• Convene all relevant groups to develop and

implement a strategic plan• Improve the research base that links PA to

behavior and academic performance• Use QRIS, state, and local policies to

implement PA standards in ECE• Engage health providers at all levels in

Exercise is Medicine

Children in Early Care and Education Programs

In 2001, 73% of preschool children ages 3-5 years old (8.6 In 2001, 73% of preschool children ages 3-5 years old (8.6 million children) participated in at least one weekly million children) participated in at least one weekly non-parental care arrangementnon-parental care arrangement

Nearly 60% of children 3-4 years with employed mothers Nearly 60% of children 3-4 years with employed mothers participate in center-based careparticipate in center-based care

41% of preschool children are in child care for 35 or more 41% of preschool children are in child care for 35 or more hours/weekhours/week

Capizzano J et al. www.urban .org/url.cfm?ID=309438; www.urban .org/url.cfm?Capizzano J et al. www.urban .org/url.cfm?ID=309438; www.urban .org/url.cfm?ID=309439ID=309439

Strategies to Increase Physical Activity in Early Care and Education

• Provide portable play equipment on playgrounds and play spaces

• Train staff in delivery of structured PA and increase PA session time

• Integrate PA into teaching and learning activities

• Increase outdoor time

Physical Activity Guidelines Midcourse Report. www.health.gov/guidelines

Strategies to Increase Physical Activity in Youth

• Implement the Physical Activity Guidelines Midcourse Report

• Mobilize parents• Convene all relevant groups to develop and

implement a strategic plan• Improve the research base that links PA to

behavior and academic performance• Use QRIS, state, and local policies to

implement PA standards in ECE• Engage health providers at all levels in

Exercise is Medicine

PA Counseling by Pediatricians

• Over 60% of pediatricians and family practitioners ask specific questions about the dose of PA1

• Overweight and obese patients more likely to receive PA counseling2

• Physician’s BMI predicts likelihood of counseling3

1. Huang T, et al. Am J Prev Med 2011;41:24-32

2. Liang L, et al. Pediatrics 2012;130:67

3. Bleich SN et al. Obesity 2012;20:999

Five Conditions for Collective Success

Common agenda

Shared measurement systems

Mutually reinforcing activities

Continuous communication

Backbone support for ongoing actions

Kania J and Kramer M. Collective impact. Stanford Social Innovation Review 2100 (winter); 59