Michael Pratt

Environmental and policy interventions to promote physical activity.

BACKGROUND Because most adults in industrialized countries do not meet physical activity guidelines, population-wide interventions are needed. Environmental and policy interventions are based on ecological models of behavior and have the potential to influence entire populations. Ecological models are particularly applicable to physical activity because the behavior must be done in specific physical settings. Cross-sectional data indicate that environmental and policy variables are associated with physical activity behaviors of young people and adults. METHOD Seven published evaluations of environmental and policy interventions to increase physical activity were reviewed. RESULTS Two studies showed that placing signs encouraging stair use can be effective. Quasi-experimental evaluations provided limited evidence that broad environmental changes can be effective. Large-scale policy interventions are currently being conducted in several countries. PROPOSED MODEL: A model describing the development of policy and environmental interventions is proposed, in the hope of stimulating more research in this area. Advocacy or planning groups identify and work with agencies that control policies and environments that can be altered to increase physical activity. Educational and policy/environmental interventions are seen as complementary. CONCLUSION Lack of conceptual models and the inherent difficulties of evaluation have hampered research on environmental and policy interventions. Further research is needed, and practitioners and researchers should work together to evaluate programs.

Levels of physical activity and inactivity in children and adults in the United States: current evidence and research issues.

PURPOSE The purpose was to describe current levels of physical activity and inactivity among adults and young people in the United States. METHODS Estimates of participation in regular physical activity were derived from three national surveys for adults (National Health Interview Survey, National Health and Nutrition Examination Survey, and the Behavioral Risk Factor Surveillance System) and from the Youth Risk Behavior Survey for high school students. RESULTS Overall, 63.8% of high school students surveyed on the 1997 YRBS reported participating in vigorous physical activity for at least 20 min on 3 or more days per week. Participation in vigorous activity was higher for boys (72.3%) than girls (53.5%), whites (66.8%) compared with blacks (53.9%) and Hispanics (60.4%), and decreased with advancing grade. Among adults, 27.7% meet recommended levels of either moderate or vigorous physical activity, whereas 29.2% report no regular physical activity outside of their work. Gender differences in participation in physical activity are less pronounced than in youth, and age-related patterns were complex. Whites are more active than blacks and Hispanics, and persons with higher family incomes and more education report being more physically active. There have been only minor changes in reported participation in leisure time physical activity over the past 15 yr. CONCLUSION National estimates of physical activity appear to be reliable and valid for adults but may be less so for adolescents and are poor measures for children. Research is needed to determine the role that objective monitoring with accelerometers may play in surveillance. Reliable and valid measures of occupational, household, and transportation-related physical activity and sedentary behaviors are needed to better characterize the range of activity that is associated with health.

Higher direct medical costs associated with physical inactivity.

ABSTRACT BACKGROUND: The benefits of physical activity in reducing morbidity and mortality are well-established, but the effect of physical inactivity on direct medical costs is less clear. OBJECTIVE: To describe the direct medical expenditures associated with physical inactivity. DESIGN: Cross-sectional stratified analysis of the 1987 National Medical Expenditures Survey that included US civilian men and nonpregnant women aged 15 and older who were not in institutions in 1987. Main outcome measure was direct medical costs. RESULTS: For those 15 and older without physical limitations, the average annual direct medical costs were

The economic burden of physical inactivity: a global analysis of major non-communicable diseases

1,019 for those who were regularly physically active and

Cost Effectiveness of Community-Based Physical Activity Interventions

1,349 for those who reported being inactive. The costs were lower for active persons among smokers (

Physical activity in relation to urban environments in 14 cities worldwide : a cross-sectional study

1,079 vs

Preventing cardiovascular disease through community-based risk reduction : The bootheel heart health project

1,448) and nonsmokers (

Physical Activity Interventions in Latin America A Systematic Review

953 vs

The implications of megatrends in information and communication technology and transportation for changes in global physical activity

1,234) and were consistent across age-groups and by sex. Medical care use (hospitalizations, physician visits, and medications) was also lower for physically active people than for inactive people. CONCLUSION: The mean net annual benefit of physical activity was

A Framework for Physical Activity Policy Research

330 per person in 1987 dollars. Our results suggest that increasing participation in regular moderate physical activity among the more than 88 million inactive Americans over the age of 15 might reduce annual national medical costs by as much as