By Susan J. Blumenthal, M.D.
Written in Collaboration with Daranee Yongpradit
This year's theme for National Public Health Week (April 2-8), A Healthier America Begins Today: Join the Movement, focuses attention on five key issues for public health: 1) active living and healthy eating; 2) alcohol, tobacco and other drugs; 3) communicable diseases; 4) reproductive and sexual health; and 5) mental and emotional well-being. Each day of the week is addressing one of these critical areas and today, the spotlight is on promoting active living.
With modern conveniences such as computers, cars and other technological advances resulting in increased sedentary behavior as well as long hours spent sitting at a desk working or studying in school, physical activity has significantly declined in the United States. In 2008, the Centers for Disease Control and Prevention (CDC) estimated that leisure-time physical inactivity is 19.1 percent for 18- to 24-year-olds, 22.5 percent for 25- to 34-year-olds, 24.0 percent for 35- to 44-year-olds, 26.9 percent for 45- to 64-year-olds, and 32.7 percent for people over age 65. Lack of physical activity is a major contributory factor to the dramatic increase in obesity rates in America, with two-thirds of adults and one-third of children currently overweight or obese. Moreover, according to a study published last year in The Lancet, it is projected that half of Americans will be obese by 2030. Rising obesity rates are leading to a chronic disease epidemic in the United States with spiraling health care costs and lost productivity in the workplace.
When many people think about obesity, they assume that food is the most important factor. However, science has revealed that physical activity is an independent risk factor as well. Physical activity captures all activities involving bodily movements such as exercise, biking, walking, recreational activities, gardening, and household chores. Regular participation in these activities carries the added benefits of weight management and improved cardiovascular health, stronger bones and muscles, and reduced anxiety and stress.
The question of why physical inactivity has become a serious public health problem in the United States must take into consideration several factors. One often missed but major contributor to physical inactivity (and subsequently to the obesity epidemic) is the American workplace. A study released last year found that in the early 1960s, almost half of the jobs in the U.S. labor market required at least moderate physical activity; today, less than 20 percent of jobs require this level of activity as the country has moved from the industrial age to occupations in the information age and a service economy. This shift in the American work culture has resulted in an average loss of 120 to 140 calories a day, an amount people would have been expended were they more active, which has paralleled the U.S. population's weight gain over the past five decades. Other research has suggested that changes in commuting patterns to work and a decreased reliance on public transportation have also contributed to the problem of physical inactivity.
As a result, businesses have begun to offer workplace wellness programs in an effort to encourage employees to engage in physical activity to increase their well-being and productivity as well as reduce health-care costs for the company. Subsidized gym memberships, public transit credits, and lower insurance premiums for non-smokers are a few examples of the types of incentives being offered.
Additionally, for young children and adolescents, school budget cuts across the nation combined with a greater focus on academic performance has resulted in a reduction or elimination of many school physical education programs. The current recommendation from the U.S. Department of Health and Human Services is that children and adolescents should engage in at least 60 minutes of physical activity daily. However, a 2009 survey found that only 18 percent of high school students had participated in at least 60 minutes of physical activity each day, while only 33 percent attended physical education class daily.
Mandated physical education from kindergarten through 12th grade has declined in recent years due to issues such as costs of hiring new teachers, extension of the school day, and cuts in other areas such as art and music. When challenged to choose between hiring a science teacher or a gym teacher, many school administrators decide that physical activity is not as important as other components of the curriculum. P.E. programs seem to have become a "luxury" rather than a necessity in children's education.
To ensure adequate levels of physical activity for their students during a time of budget cuts, teachers are finding creative ways to incorporate exercise for kids into a full curriculum, and students are often eager to join in. Fitness clubs meeting before or after school have become quite popular. At one school in New York City, 40 students have voluntarily appeared every morning at 7 a.m. for a running club. During break time within the classroom, teachers lead students in stretching, squats, or jumping jacks, and relate the movements to the curriculum. For example, while learning about fractions in math class, children stand when they read the numerator, and then bend their knees when they discuss the denominator.
Furthermore, the recent surge in "exergaming," a term used to describe video games that also serve as a type of exercise, is providing an innovative approach to promoting physical activity. Video games for interactive boxing and dancing get people up and moving, sometimes burning energy at levels comparable to moderate forms of exercise. Some schools have set up exergaming stations, and these interactive exercise sessions have been very popular among students, especially encouraging less athletic, often obese or overweight students to become more active. While these approaches do not solve the problem of physical inactivity for all Americans, they provide creative alternatives to traditional fitness activities and offer an exciting way to reduce sedentary time as well as promote physical activity.
Developed as a health in all policies approach by an expert panel of representatives from health organizations including the CDC, American Cancer Society, and American Heart Association, the National Physical Activity Plan (NPAP) includes a set of policies, programs, and initiatives that aim to increase physical activity for all Americans. Steps that must be taken to support physically active lifestyles include building bicycling paths, safe walking paths, and renovating parks. NPAP should not be left to sit on the shelf; implementation is essential for a healthier America. First lady Michelle Obama's Let's Move Campaign is focused on improving children's health and reducing obesity by promoting physical activity as well as healthy nutrition. Everyone has a role to play in reducing childhood obesity and promoting healthy behavior, including parents and caregivers, elected officials from all levels of government, schools, health care professionals, faith-based and community-based organizations, and private sector companies.
This National Public Health Week is a great time to begin moving toward a more active lifestyle. Social responsibility with programs like the National Plan for Physical Activity and the Let's Move Campaign are critical to improving public health. But personal responsibility is also a cornerstone. Physical activity is one of the very best things you can do to improve your health. Aim for 30 to 60 minutes of physical activity on most days of the week. Pick activities you like -- take stairs instead of elevators, dance, garden, take a power walk instead of a power lunch. Try a pedometer -- and aim for 10,000 steps every day! Do strength training as well. Have fun. Join a group for walking or running with friends and family. By doing so, you will take an important step toward a healthier future for you and for our nation.
Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, Chair of the Global Health Program at the Meridian International Center, and Senior Policy and Medical Advisor at amfAR, The Foundation for AIDS Research. Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, and as Chief of the Behavioral Medicine and Basic Prevention Research Branch at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. She is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named as a Rock Star of Science by the Geoffrey Beene Foundation and GQ magazine.
Daranee Yongpradit is currently a MSPH student in Human Nutrition at the Johns Hopkins Bloomberg School of Public Health. She serves as a Health Policy Fellow at the Center for the Presidency and Congress in Washington, D.C.
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