Increasing Exercise Adherence t hrough Environmental Interventions

1. IncreasingExercise Adherencethrough Environmental Interventions

2. Environmental Influences on Eating & Physical Activity (French, Story, & Jeffrey, 2001) • Consumption of daily fat doubled from 1909 to 1998. • Added fats and oils in cooking increased 22% over the last decade • Availability of fruits and vegetables increased 19% between 1970 and 1995 • American consumed more fruit and vegetables (24%) and consumption of softdrinks • Decrease in milk consumption from 31 to 24 gallons per person but cheese consumption rose. • Eating out increased 88% and number of fast-food restaurants grew 147% between 1977 to 1995 • Major strategy of food industry is to “supersize” and “monster” meals. • TV is 98% of every household and average adults watches 2 hrs of TV per day; 6 minutes of commercials per hour; there was 11 billion dollars spent in 1997 on food advertisement. • Most people eat while watching TV which contributed to higher energy intake. • Watching TV is the main leisure time activity (15 hour averaged per week). • TV watching has increased 44% from 1965 • Communting (riding in a car) to work was 77% in 1970 to 87% in 1990 and there was a decline in walking and bicycling to work. • Number of health club memberships and availability has increased. • Sporting goods and bicycle shops have increased. • Labor saving devices have reduced physical activity levels in U.S. • Bicycling for transportation has decreased in the US

3. Environmental Interventions Refers to the people’s transactions with their physical and sociocultural environments (Sallis, et. al.,1996). Major strategy (intervention) used by the government, cities, states, and nations to promote and increase physical activity in it’s citizens. Most if not all the environmental interventions designed, developed, and delivered is based on the social ecological model.

4. Social-Ecological Model

5. Environments & PA Behavior Environments effect PA behavior in several ways: a) promoting, or demanding action, e.g., these environments are designed for activity such as, sports fields, gyms, health clubs, & YMCAs. b) discouraging or prohibiting. e.g., these environments are designed to restrict or prohibit activity such as classrooms, workplaces, theaters, offices, highways, and living rooms. ** The assumption is PA takes place in specific physical environments influences the amount and type of the activity.

6. Environment Interventions & Creating Supportive Environments All environmental interventions are directed toward creating supportive environments. -The more supportive environments that can be designed, developed, and delivered results in a higher physical activity in the population. - A supportive environments include settings, facilities, and programs. - Setting are neighborhoods, schools, and worksites. -Facilities are health clubs, cycling paths, parks, etc. -Programs are aerobic classes, sport teams, supervised recreation, walking clubs or unsupervised activities they can do on their own.

7. Supportive Environments • Design building to promote PA* • Cities build walking and bicycling for commuting to work, shopping, and for routine activities. • Offer privileges to employees, who demonstrate their involvement in PA activities. • Employers in Palo Alto reimburse employees who walk or bicycle to work. • Health insurance provides discounts based on fitness levels. • Government removes subsidies for companies who rely on sedentary behaviors (e.g. car and oil companies) • Government increases subsidies for industries that promote PA (e.g. sporting goods.) • Schools should provide daily PA for their students

8. Environmental Interventions Environmental interventions should be put in place before educational interventions are attempted. - Media campaign to promote walking is irrelevant to people in cities where the side walks are not required and poorly maintained. -Duluth major encouraging people to ride to work is irrelevant to the citizens because the highways and roads do not have bike lanes. -UMD encourages the students to walk to school is irrelevant to the students because no one removes snow from their sidewalks in a timely manner.

9. Facts • CDC determined that improving places to be active can result in a 25% increase in the percentage of people who exercise. • 43% of people with safe places to walk within 10 minutes of home met recommended activity levels. • 37% of people living in walkable neighborhoods met PA recommendation compared to 18% of those in low walkable neighborhoods. • Studies have proven that if one develops just one new trial it resulted in a higher walking percentage. • People who live in neighborhoods with a mix shop of businesses with a easy walking distance have a 35% lower risk of obesity.

10. Interventions (text) • Signage & Stairwell Interventions • Neighborhood • Trials & Parks

11. Use the stairwell not escalator • http://www.biertijd.com/mediaplayer/?itemid=16297/ • Make your stairwell into a piano!

12. Stairwell Interventions • Signage • StairWELL intervention is a point-of-decision prompt to motivate people to use the stairs rather than an elevator • Design of signage includes 4 major things • www.cdc.gov/nccdphp/dnpa/hwi/toolkeits/stairwell/motivational_signs.htm#Message%20Ideas • Hallways and stairwells • Wide • Carpeted and rubber treaded stairs • Well lighted • Include art or paintings on the wall and music

13. Neighborhood • Trail usage is directly correlated to neighborhood characertistics (Lindsey, et at., 2006). • Low income people are highly concerned with safety, lack of sidewalks, and cost of using recreational facilities. • Moderate income are highly concerned with location of the recreational facilities, safety but not the cost of using recreational facilities. • Families from lower SES that perceive more neighborhoods hazards. There perception of their neighborhood affects children’s PA level (Romero et al., 2001) • Perceived aesthetics, convenience, access to service, and traffic associated with one neighborhood impacts neighborhood (Humpel et al, 2004) • People are more active in neighborhoods with “traditional designsJ” (Orleans et al, 2003) • People are more active in neighborhoods that has greater land use mix, higher residential density and high street connectivity (Atkinson, et al, 2005) • High walkability neighborhood produces more people who meet daily PA recommended levels

14. Environmental Variables Associated with Children’s PA level Being outdoors Safe parks Low crime rate in cities and neighborhoods Increased opportunities for winter activities Increase PA opportunities outside school Substantial amount of PA takes place in organized sport or activity classes Decrease time spent in sedentary behavior at home and school. Cutback on mandatory physical education and physical education programs taught by untrained individuals, and PE programs that have little actual physical activity

15. Environmental Variables & Overweight & Obesity • Ease of access to highly palatable, inexpensive high fat foods in fast food restaurants and “super sizing” of the menu • Strategy is: • Reduce portion size at fast food restaurants • Increase availability and development of low in fat and low density energy palatable food • Increase PA in the one’s daily routine

16. Environmental Variables Related to trial & parks • Parks that are esthetically pleasing and have tree-lined walking paths increases PA use. • Parks need to be close to shops • Reduce the use of organized sport team usage of parks. • Provide walking and bike paths across the entire city connecting the various parks. • Paths and sidewalks needs to maintained • Separate paths for bikers and walkers.

17. Environmental Variables related to Land Use • Mixed use developments (mixing housing, retail business, and entertainment) are associated with increase PA levels. • In areas where mass transit is available there is an increase in PA activity.

18. Designing for Active Recreation • Better access to facilities, parks, and trails. • Friendliness of neighborhoods are linked to PA levels • Safe places encourages activity • Lower the crime rate • Walkable neighborhoods • Promote Activity-friendly environments

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