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Introduction

Tobacco and Cardiovascular Disease

Physical Activity and Cardiovascular Disease

Diet and Cardiovascular Disease

Summary

	Physical Inactivity and CVD

Community Strategies

Communities can play a leadership role in CVD prevention. Research shows us that one of the most effective ways to have measurable impact on our communities is to target all levels of social structure with behavioral and environmental change strategies. The purpose of this section is to help guide the choice of community changes that your group will seek in each relevant sector of the community. To address the mission of reducing risks for CVD, your group may seek to change programs, policies, and practices within schools, health care settings, worksites, or the broader community.

• Awareness strategies focus on informing the public about health issues, concerns, and/or solutions.
• Knowledge and skill-based strategies educate the public about causes, symptoms, strategies, etc., of public health issues.
• Providing opportunities and supportive environments promotes and encourages healthy behavior.
• Policy and regulation means establishing mandates that promote healthy behaviors.

Why Policy and Environmental Approaches:

Public recognition of the importance of and a desire for physical activity are high. However, physical inactivity is a complex habit that has proved difficult to modify by using individually focused approaches to behavior change. Policy and environmental approaches may arguably have a greater impact because they influence the whole culture and are less costly and more enduring.

Public health policies that invoke passive intervention are often more successful in achieving population wide changes than those requiring active decision making by individuals. Examples of passive approaches to promoting physical activity include restricting downtown centers to foot or bicycle traffic, placing parking lots a suitable distance from buildings, and making stairways more convenient and as safe as elevators or escalators. Also, new communities can be planned with businesses and schools built adjacent to residential areas and connected by networks of bicycling and walking paths as well as public transportation.

Zoning and Land Use:

Physical activity can be fostered through public policies that enhance recreational space outdoors. Increased environmental awareness has led to zoning restrictions in many communities to protect open spaces for recreational use. The Intermodel Surface Transportation Efficiency Act (ISTEA) provides federal funds for bicycle/pedestrian transportation projects. Authority is given to states to dispense funds, and each state is required to assign a coordinator. West Virginia has been the recipient of ISTEA funding in the past; however, reauthorization of ISTEA from Congress will need to be established for continued support for future trail development.

The West Virginia Trails Coalition has been active in promoting trail development across the state. The coalition is beginning the coordination of a statewide trails plan. This collaboration of resources toward trails development in our state is a great example of nontraditional partners working towards policy and environmental changes for physical activity.

Building Construction and Facilities Development:

Facilities to promote physical activity can take two general forms: those made available for participation in programmed or discretionary physical activity during leisure time and those that encourage increases in more routine forms of physical activity. Facilities should be convenient, affordable, comfortable, and safe to encourage regular physical activity. Proximity to home or worksite is particularly important, as is the availability of on-site showering and changing facilities.

Regulations governing building construction can be used to encourage increases in energy expenditure. Examples of "physical-activity-friendly" (energy-expenditure-inducing) buildings include those that make stairs attractive, safe, and readily accessible. Similarly, buildings that provide nearby walking paths or par courses, well-lighted and secure parking lots at a distance, and easy to use areas for securing bicycles are measures that promote physical activity.

A missing, but critical aspect of legislative policy is an overarching, long-term plan on which to build and direct state and national policy initiatives in the physical activity arena. Such a policy or plan would focus on developing an infrastructure to support sustainable increases in routine, transportation-based, or task-oriented forms of physical activity.

Individual Responsibility

• *Set a visible example.
• *Use your influence to change norms that support active lifestyles incorporate activity breaks; push building regulations to accommodate shower facilities, well-lighted stairways, walkways around the building, etc).
• *Empower and support others to be physically active (offer to babysit, do chores so that spouse has time to exercise, use family walks as your quality time together, etc).
• *Be open to other's ideas about physical activity.
• * Limit sedentary activities such as television, computer use, etc.
• * Praise others' efforts.

Channels:

Schools are a key intervention channel for influencing healthier behaviors in a positive way. Elementary and secondary schools provide a structured opportunity to reach youth with interventions and health messages that can set the stage for a healthy lifestyle now and in the future.

Health care settings have the unique opportunity to promote positive lifestyle behaviors. Role modeling of positive lifestyle behaviors could perhaps be the most influential role a provider can have on clients.

The worksite channel is composed of those activities through which employers, unions and insurers try to influence the health of workers in a positive fashion.

All these "channels" together are parts of the broader community. The community as an entity can, in turn, promote health for all its members. The above listed channels are only a few examples of channels for which interventions can take place.

Schools;

• mandate daily physical education K-12 (physical fitness guidelines to graduate from elementary, middle and high school)
• Integrate physical activity into K-12 curriculum
• Increase the duration and intensity of actual physical activity in physical education classes
• Increase the variety of physical activities in PE classes to expand student participation
• Increase the amount of physical activity students expend in their daily school routine (steps, nature walks, stretch breaks)
• Expand access to gyms and playgrounds
• Increase opportunities for participation (expanded intramurals, subsidized dance classes, weekend activity events
• Provide incentives for participation in PA with friends, family, and teachers

Worksites:

• Enact policies which support health promotion and rewards improved health status
• Reduce health insurance premiums for employees who exercise regularly
• Provide incentives to employees to walk or cycle to work
• seek tax rebates for purchase of worksite exercise equipment and facilities
• offer employees flex-time or longer lunch hours for physical activity
• Establish employee of the month rewards for employees who show progress towards health and fitness goals;
• Sponsor teams that encourage physical activity among men, women, and families
• Establish a worksite garden
• Create walking trails around or near worksites;
• share costs of membership fees for health facilities and clubs
• Provide signs encouraging use of stairs and trails.

Health care:

• Make physical fitness assessment and counseling part of the medical chart and work-up protocols;
• Establish reimbursement for physical activity counseling
• Sponsor community physical fitness campaigns;
• Establish physical activity programs into medical and allied health professional
• preparation;
• Create lower health insurance rates for persons who exercise;
• Provide incentives for employees to exercise.
• Public Health Programs/ Networks (broad community)
• Provide information about public facilities (trails, tennis courts, etc)
• Increase community events that promote exercise
• Enhance fitness opportunities in the churches
• Establish an "idea column" in the local paper to identify innovative ways people incorporate physical activity into their routine
• Increase the number of sidewalks and bike paths in proportion to roadways
• Increase lighting, proximity, attractiveness, and surveillance of public parks
• Connect walkways and bike paths to neighborhoods, businesses, residential areas, and worksites;
• Utilize schools and malls for safe exercise facilities
• Provide public recognition for programs that promote PA throughout lifespan
• Provide zoning, tax rebates, and other financial incentives to encourage use of land for recreation
• Subsidize cost of recreational facilities;

higher education:

• Train all professionals on policy interventions for physical activity (teachers, architects, highway people, etc)
• Train physical education teachers on lifetime skills
• Train all teachers on incorporation of wellness issues cross curriculum
• increase professors' role modeling of physical activity

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