Physical Activity Strategies – Where We Are, Where We’re Going

1. Physical Activity Strategies – Where We Are, Where We’re Going Chris Reinold Jacqueline N. Epping U.S. Centers for Disease Control and Prevention Division of Nutrition, Physical Activity and Obesity State Orientation Meeting November 12, 2008

2. Background Review of Efforts to Reduce Obesity Problem goals and objectives Strategy development - Targets - Strategies: policy and environmental change Implementation - Multi-sectoral - Evaluation

3. Background Review of Efforts to Reduce Obesity Problem goals and objectives Strategy development - Targets - Strategies: policy and environmental changeImplementation - Multi-sectoral - Evaluation

4. Background Review of Efforts to Reduce Obesity Problem goals and objectives Strategy development - Targets - Strategies: policy and environmental change – change in emphasis from last funding cycle Implementation - Multi-sectoral - Evaluation

5. Background Review of Efforts to Reduce Obesity Problem goals and objectives Strategy development - Targets - Strategies: policy and environmental change – change in emphasis from last funding cycle Implementation - Multi-sectoral - Evaluation

6. Background on Behavioral Target Strategies What counts as credible evidence? TA manual definitions: Intervention strategies Intervention Intervention examples All things considered

7. The Community Guide: Intervention Categories and Strategies • Informational Approaches Community wide campaigns Point-of-decision prompts • Behavioral and Social Approaches Individual behavior change Enhanced school-based PE Social support interventions • Environmental and Policy Approaches Creation of or enhanced access to PA Community-scale urban design/land use Street scale urban design/land use

8. The Community Guide: A Tool for Evidence-Based Public Health Set of recommendations based on systematic reviews of literature Population-based prevention strategies DHHS initiative, CDC staff support Independent Task Force on Community Preventive Services

9. The Community Guide Uses A Systematic Approach Form team Develop conceptual framework Define, group and select interventions to be evaluated Search for and collect evidence of effectiveness Evaluate quality of studies Summarize evidence Consider economics, feasibility, and harms Translate evidence into recommendations

10. Intervention Categories Informational Approaches Behavioral and Social Approaches Environmental and Policy Approaches

11. Informational Approaches Community-wide campaigns Point-of-decision prompts Mass media campaigns Classroom-based health education

12. Community-wide Campaigns Multi-component, multi-sector Transmitted through diverse media Directed at large audiences 6 weeks – several years

14. BC Walks Results Exposure to campaign - 78% Participant behavior change - 16% (nonactive to active) vs. 11% in comparison county Increase in walking time - 47% of BC respondents reported any increase in total weekly walk time vs. 35% in comparison county 10,800 people pledged to walk

15. Informational Approaches Community-wide campaigns Point-of-decision prompts Mass media campaigns Classroom-based health education Information provision Decision making skills

16. “Point-of-Decision” Prompts Motivational signs placed by elevators and escalators Encourage stair use for health/weight control Single component

17. CDC’s StairWELL to Better Health

18. The CDC Stairwell Project Sequential environmental changes – new painting/carpet; artwork; motivational signs; music Proximity sensors – counters Results: Motivational signs/music – 8.9% increase for both, independently assessed

20. Before After

21. Informational Approaches Community-wide campaigns Point-of-decision prompts Mass media campaigns Classroom-based health education Information provision Decision making skills Usually multi-component

22. Summary: Informational Approaches Strongly recommended Community-wide campaigns Recommended Point-of-decision prompts Insufficient evidence Mass media campaigns Classroom-based health education

23. Intervention Categories Informational Approaches Behavioral and Social Approaches Environmental and Policy Approaches

24. Behavioral and Social Approaches School-based physical education (PE) curricula and policy Individually-adapted health behavior change Social support in community setting College-based health education and PE Classroom-based health education to reduce television viewing and video game playing Family-based social support

25. School-based PE Curricula and Policy

26. PE Classes Modified increased time in MVPA by: Adding new classes (policy) Lengthening existing classes (policy) Increasing MVPA during existing classes (curricula and teaching practices)

27. CATCH PE Increase MVPA to 40% Teacher training and on-site TA Policy – PE 90 minutes/3x wk Curriculum – activity selection & modification Teaching and class management strategies

28. Behavioral and Social Approaches School-based physical education (PE) curricula and policy Individually-adapted health behavior change Social support in community setting College-based health education and PE Classroom-based health education to reduce television viewing and video game playing Family-based social support

29. Multi-component Incorporate PA into daily routine May include: goal setting, social support, behavioral reinforcement through self-reward, structured problem solving, relapse prevention Delivered in group settings or mail or telephone Individually-adapted Health Behavior Change Programs

30. Individually-adapted Health Behavior Change Programs

31. PEP – APersonal Energy Plan 12 week self-directed worksite program Targets stages of change Coordinator kit & promo materials Worksites can add activities revised/expanded Cooper Institute

32. Behavioral and Social Approaches School-based physical education (PE) curricula and policy Individually-adapted health behavior change Social support in community setting College-based health education and PE Classroom-based health education to reduce television viewing and video game playing Family-based social support

33. Social Support Interventions in Community Settings

34. Social Support Creating buddy system, Making contracts Forming walking or other groups

36. Summary: Behavioral and Social Approaches Strongly recommended School-based PE curricula and policy Individually-adapted health behavioral change Social support interventions in community settings Insufficient evidence College-based health education and PE Classroom-based health education to reduce television viewing and video game playing Family-based social support

37. Intervention Categories Informational Approaches Behavioral and Social Approaches Environmental and Policy Approaches

38. Environmental and Policy Approaches Creation of/enhanced access to places for PA combined with informational outreach Community-scale urban design and land use Street-scale urban design and land use Transportation policies and practices

39. Creation of/Enhanced Access to Places for Physical Activity Combined with Informational Outreach Multi-component Built environment – trails/facilities access Reducing barriers - safety, affordability Training & incentives Site-specific programs, workshops, seminars, etc.

40. Kona, HI Maka’eo Walking/Jogging Path

41. Community-scale Urban Design and Land Use Policies and Practices Urban design and land use policies and practices that support physical activity in geographic areas, generally several square kilometers in area or more.

42. Community-scale Urban Design and Land Use Community level changes to: Decrease motor vehicle traffic Increase mixed land use and density Done through zoning regulations and building codes

43. Community Design

44. Promoting Healthy Built Environments

45. Street-scale Urban Design and Land Use Policies and Practices Urban design and land use policies that support physical activity in small geographic areas, generally limited to a few blocks.

46. Street-scale Urban Design and Land Use Street-level changes Traffic calming structures Improved lighting Aesthetic enhancements

49. Transportation Policies and Practices Transportation policies and practices that encourage and facilitate walking and bicycling for transportation

50. Intervention Characteristics Policy measures, e.g. roadway design standards Expanding public transportation services Subsidizing public transportation Providing bicycle lanes and racks Increasing the cost of parking