Introducing the Physical Activity Guidelines for Americans , 2 nd edition

1. Introducing the Physical Activity Guidelines for Americans, 2nd edition Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

2. Promoting Physical Activity

3. Why We Need to Promote Physical Activity in Adults Percentage of U.S. Adults Ages 18 Years or Older Who Met the Aerobic and Muscle-Strengthening Guidelines, 2008–2016 Impact of Optimizing Physical Activity: • Reduce health care costs • Prevent and reduce morbidity and premature mortality • Improved wellness and quality of life

4. Why We Need to Promote Physical Activity in Youth Percentage of U.S. High School Students Who Met the Aerobic Physical Activity and Muscle-Strengthening Guidelines, 2011–2015 Impact of Optimizing Physical Activity: • Develop life-long skills and positive attitude towards movement • Optimize brain health • Minimize chronic disease risk

5. Everyone Has a Role to Play, Every Setting Counts! See the National Physical Activity Plan for objectives and strategies for each of the nine sectors at http://www.physicalactivityplan.org/index.html

6. Background and Development Process

7. This is the 2nd edition of Physical Activity Guidelines. 2008 2018

8. The Guidelines were developed from an independent scientific review of the evidence.

9. Many stakeholders contributed to the Guidelines.

10. Defining Terms

11. Aerobic Activity (endurance, cardio) Activity in which the body’s large muscles move in a rhythmic manner for a sustained period of time. • Examples: • Brisk walking • Running/jogging • Swimming • Bicycling • Soccer • Tennis

12. Aerobic Activity: 3 components of recommendations • Intensity = how hard • Absolute: comparison of energy expenditure during activity to that at rest (METS) • Relative: subjective rating of effort from 0-10 (RPE) • Frequency = how often (per week) • Duration = how long is a session (min)

13. Defining Intensity

14. Intensity should be customized for client – these charts are suggestions

15. Muscle-Strengthening Activity Activity that increases skeletal muscle strength, power, endurance, and mass. • Examples: • Lifting weights • Using resistance bands • Bodyweight exercises • Carrying heavy loads • Heavy gardening • Yoga (some forms)

16. Muscle-Strengthening Activity: 3 components of recommendations • Intensity = how much weight or force is used • Relative: compared to how much a person is able to lift • Absolute: actual weight (e.g. 10 kg) • Frequency = how often • Sets and repetitions = how many times

17. Bone-Strengthening (weight-bearing) Activity Activity that produces an impact or tension force on the bones that promotes bone growth and strength. • Examples: • Running • Jumping Rope • Lifting Weights • Plyometrics • Bone-strengthening activities can be aerobic and muscle strengthening as well.

18. Multicomponent Physical Activity More than one type of activity blended together, such as aerobic, muscle-strengthening, and balance training. • Examples: • Home workout video • Structured class • Ballroom dancing • Yoga • Tai chi • Gardening

19. What’s New In the Physical Activity Guidelines for Americans

20. What’s New: Physical Activity Guidelines for Americans, 2nd edition • Expanded science base • New to this edition: • Guidance for preschool-aged children (3-5 years) • Discussion of sedentary behavior • Removal of 10-minute bout length requirement • Evidence for even more health benefits – including immediate effects • Tested strategies for physical activity promotion

21. Relationship Among Moderate-to-Vigorous Physical Activity, Sitting Time, and Risk of All-Cause Mortality in Adults Move More and Sit Less Conclusions: • High volumes of physical activity minimize the risk of excess sedentary behavior • Minimizing sedentary behavior helps, but people still need physical activity • Most people would benefit from interventions that address both risk factors

22. Any Activity Counts Relationship of Moderate-to-Vigorous Physical Activity to All-Cause Mortality Conclusions • No lower threshold for benefits from physical activity • Most benefits are attained with at least 150-300 minutes of moderate physical activity per week • No upper limit where benefits end

23. Benefits of Physical Activity for Youth • Improved bone health (ages 3 through 17 years) • Improved weight status (ages 3 through 17 years) • Improved cardiorespiratory and muscular fitness (ages 6 through 17 years) • Improved cardiometabolic health (ages 6 through 17 years) • Improved cognition (ages 6 to 13 years)* • Reduced risk of depression (ages 6 to 13 years) *New health benefit

24. Benefits of Physical Activity for Adults and Older Adults • Lower risk of all-cause mortality • Lower risk of cardiovascular disease mortality • Lower risk of cardiovascular disease (including heart disease and stroke) • Lower risk of hypertension • Lower risk of type 2 diabetes • Lower risk of adverse blood lipid profile • Lower risk of cancers of the bladder,* breast, colon, endometrium,* esophagus,* kidney,* lung,* and stomach* • Improved cognition* • Reduced risk of dementia (including Alzheimer’s disease)* • Improved quality of life • Reduced anxiety • Reduced risk of depression • Improved sleep • Slowed or reduced weight gain • Weight loss, particularly when combined with reduced calorie intake • Prevention of weight regain following initial weight loss • Improved bone health • Improved physical function • Lower risk of falls (older adults) • Lower risk of fall-related injuries (older adults)* *New health benefit

25. New Health Benefits

26. Brain Health

27. Brain Health, cont.

28. Key Guidelines

29. Key Guidelines for Preschool-Aged Children (3-5 yrs.) • Limited data prevents specific guidelines • Encourage active unstructured play and structured activities to learn motor skills • Adult caregivers should provide the opportunity and encouragement

30. Key Guidelines for School-Aged Children and Adolescents (6-17 yrs.) • At least 60 minutes per day of combination of all types; most is aerobic • Muscle- and bone-strengthening should be counted towards total minutes • Adult caregivers should provide the opportunity and encouragement • Focus on enjoyment and variety

31. Key Guidelines for Adults • Sit more, move less, some activity is better than none • Spread activity throughout week for health benefits and to reduce injury/fatigue • Additional activity produces additional benefits; more may be necessary for weight management Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

32. Key Guidelines for Older Adults • Same as Adults with several additions • If limitations, do as much as “abilities and conditions allow” • Wide range of abilities means advice about intensity level needs to be tailored to client or audience Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

33. Weight Status and Weight Management Comments • Weight-neutral messages on benefits of activity: • “The health benefits of physical activity are generally independent of weight.” (pg. 31) • “Physically active people of all body weights (normal weight, overweight, obesity) also have a lower risk of all-cause mortality than do inactive people.” (pg. 35) • Role of activity in weight loss: • Key role in weight maintenance, weight loss, and maintenance of weight loss • May need more than the guidelines for these outcomes • Both aerobic and muscle-strengthening activities are vital • All intensities burn calories; higher intensities save time • Ideally pair with nutrition/food changes Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

34. Safety Considerations

35. General notes on safety • “Be confident that physical activity is safe for almost everyone” • No need for HCP consult if healthy and symptom free • Choose activities mindfully, consider: • Age and prior injuries • Client’s goals and starting fitness level • “Start low and go slow” approach to reduce the risk of musculoskeletal injuries from overload • Variety reduces risk of overuse injuries • Correct gear, safe equipment, and safe environments • Inherent safety of choices Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

36. Key Guidelines for Pregnancy in Adults • Guidelines are the same as for non-pregnant adults • Safety notes: • Activity has many benefits, minimal risks • Be under the care of a provider who can monitor progress of pregnancy and physical activity • Avoid exercises that are risky – lying on the back (2nd and 3rd trimester), contact sports, risk of falls or abdominal trauma • If beginning, start low and go slow approach • Vigorous-intensity is OK if done prior to pregnancy Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

37. Key Guidelines for Adults with Chronic Health Conditions and Adults with Disabilities • Guidelines are the same as for adults without health conditions or disabilities • Safety notes: • Activity has many benefits, minimal risks • If not able to meet guidelines, engage according to abilities; avoid inactivity • Be under the care of a provider who can advise on whether modifications are needed to minimize risks Information adapted from the Physical Activity Guidelines for Americans, 2nd edition. Available at health.gov/PAGuidelines.

38. Promoting the Guidelines

39. Is Physical Activity Promotion in YOUR Scope of Practice? Yes, Maybe, No, It Depends! Toolkit can assist in determining your SOP: • healthysd.gov/wp-content/uploads/2014/12/WM-EIM-Toolkit2013FINAL.pdf SOP/SOPP documents for NDTRs and RDNs: • Include physical activity comments • Suggest certifications to expand SOP

40. Exercise is Medicine Credential (“new” Toolkit) • Website: • https://exerciseismedicine.org • Health care providers’ action guide • EIM Credential • NDTRs and RDNs: Level 1 Certification for working with “individuals at low or moderate risk who have been cleared for independent exercise.” • $100 for 5 CPEs, Certificate of Completion • Higher level certifications for people with exercise backgrounds/training • See https://www.todaysdietitian.com/newarchives/0817p50.shtml

41. What Works to Increase Physical Activity?

42. Move Your Way Campaign • Vision: Consumer-focused campaign to promote physical activity recommendations in the second edition of the Physical Activity Guidelines • Purpose: • Raise awareness of recommendations • Change behavior among consumers • Target audiences: physical activity contemplators, or those who are not yet meeting the recommendations in the Physical Activity Guidelines and health professionals (as conduit to consumers)

43. Move Your Way Campaign Resources Interactive tools Posters and factsheets Series of videos

44. Move Your Way Web Badges and Widget Content can be added to your digital platform and HHS will update the web badge and widget content automatically. • Move Your Way Activity Planner web badge links people to the HHS interactive tool to help them build a personalized weekly activity plan. • Move Your Way Activity Planner widget lets people start personalizing their weekly activity plan right on your website. Then it links them to the HHS interactive tool to continue building their plan. • Move Your Way Parent Interactive Graphicweb badge links parents to the HHS interactive infographic to see how their kids can get 60 minutes of activity a day.

45. Conclusions Physical activity is a cost-effective strategy for improving short- and long-term health and wellness in all stages of the life span. Providing basic physical activity opportunities, encouragement, and information for healthy children and adults may be within your scope of practice Consider increasing your scope and/ referral network to serve populations and clients with additional needs

46. Additional Resources • PA Guidelines: • https://health.gov/PAGuidelines • Move your way materials: • https://health.gov/paguidelines/moveyourway/ • Exercise is Medicine: • https://exerciseismedicine.org • Park Rx: • National and State programs to promote recreation • https://parks.state.wa.us/1137/ParkRx