A Healthier Future for West Virginia - Healthy People 2010

22 - Physical Activity and Fitness

Objectives | References

Background

There is a magic bullet for health. It is physical activity. When challenged with a physical task, the human body responds through a series of changes that involve most, if not all, of its systems. When the body engages in physical activity several or more times per week, it undergoes changes that increase its efficiency and capacity.

According to the 1996 Surgeon General's Report on Physical Activity and Health, moderate exercise has been shown to bolster the function of certain components of the human immune system, possibly decreasing the incidence of some infections and even certain types of cancers. Both moderate and intense levels of activity reduced overall risk of death even late in life. In a number of studies, sedentary people experienced between a 1.2- to 2-fold increased risk of dying during the follow-up interval than their physically active counterparts.

The more activity you get, the lower your risk of heart disease, the number one killer in the nation. Physical activity also vastly reduces your risk of developing other chronic diseases or conditions associated with cardiovascular problems.

The Surgeon General's report also states that persons with low cardiorespiratory fitness had up to a 52% higher risk of later developing high blood pressure than their peers. Physical inactivity has been found to be significantly associated with the development of Type 2 diabetes (Non-Insulin-Dependent Diabetes Mellitus, or NIDDM). In one study, women aged 55-69 who had high levels of physical activity were found to be half as likely to develop NIDDM as their sedentary peers.

Obesity, a major public health problem in the United States, plays a central role in the development of a number of chronic diseases, including diabetes, high blood pressure, osteoarthritis, and various cancers. According to data from the 1998 Behavioral Risk Factor Surveillance System (BRFSS), West Virginia ranked first in the nation in that year in adult obesity prevalence. In several different studies, people with higher levels of physical activity or fitness reported lower weight. In spite of these profound benefits, physical activity levels continue to decline.

West Virginians have become increasingly inactive, with sedentary lifestyle increasing from 61% in 1984 to 70% in 1998. Continuing at that rate, the percentage of West Virginians qualifying as sedentary could rise to 74% by the year 2010.

Sedentary lifestyle is defined as not engaging in leisure-time physical activity for at least 20 minutes at least 3 times per week. According to the 1996 BRFSS, the highest percentage of sedentary lifestyle was found among adults with less than 12 years of education (84%), as compared to those with four or more years of college (47%) and lower household income levels (76.8% for <$15,000 compared to 48.5% for $50,000+). For the most part, individuals were increasingly sedentary as they got older (61.0% at age 18-24, 76.8% at 65+), and women (68.2%) were slightly more sedentary than men (66.9%).

Nationally, in 1998 WV ranked among the least active states (third from the bottom), with 43.7% of our population reporting no physical activity in the previous month, compared to an overall national median of 27.7%. Fourteen percent (13.5%) of West Virginians reported regular, sustained activity levels compared to a 20.4% national median. Only 7.3% claimed vigorous activity levels, compared to 13.3% nationally. Aggregated 1990-98 BRFSS data showed minority women to be the least active group (49.1%), followed by Caucasian women (42.9%), Caucasian men (41.7%), and black males (38.9%). Given the impact of physical activity on health and well-being, the implications and associated costs of such an inactive population is alarming.

Technological advances and cultural trends have moved us from an active, agrarian or industrial society to a technological one that demands little of us physically. Sitting time increases as we commute to suburbia or a consolidated school, explore and utilize computer technology, and watch added channels or videos on television. Automated functions at home and at work comprehensively reduce the amount of physical effort required in even the most minute aspects of our lives. The cumulative daily loss of both large and small movement adds up to a massive decrease in calorie expenditure, which sets us up for weight gain. It also decreases the amount of positive internal changes our bodies would be making in response to movement. Our bodies grow more unfit and unhealthy as we demand progressively less of them.

The trend is only getting worse. Computer software is now available for preschoolers and youth. Media consumption (TV, video, games, and computer time combined) is up to five hours per day nationally, as reported by the Centers for Disease Control and Prevention (CDC). Studies indicate that 77% of 6th graders have a TV in their bedroom. Studies have also shown a direct correlation between hours of media consumption and youth obesity levels. According to the CDC, interventions directed at reducing youth TV time have demonstrated a positive impact on weight management.

Physical education and recess have been dropped or reduced in the school curriculum in response to pressures to increase academic test scores or add new topic areas. This may leave the lunch period as the only physical activity time in the school day, and that might be as little as 15 minutes. Safety concerns have reduced free-range after-school play in certain communities, as well as put a damper on walking to school as an option, even in areas where it might be possible. The substantial decline in youth physical activity levels raises serious concern about the development of chronic diseases at a much younger age than preceding generations.

The 1998-99 School Nurse Needs Assessment reports the observed number of obese youth in our state increased dramatically between 1996-97 and 1998-99. In 1979, Type 2 diabetes (formerly known as "adult onset diabetes," which is associated with obesity) began the unheard of -- moving into youth populations. Four cases of Type 2 diabetes in children have been recently diagnosed in one county alone. Increasing youth physical activity levels increases calorie burning both when active and at rest, a positive deterrent for weight gain.

Keeping physical activity alive in schools continues to be a problem as multiple priorities vie for precious school-day minutes. Viewed as a national issue, increasing the proportion of schools that require daily physical education for all students is one of the U.S. Healthy People 2010 Physical Activity objectives. Findings suggest that the quantity and, in particular, the quality of school physical education programs have a significant effect on the health-related fitness of children and adolescents.

In West Virginia, a 40% student passage rate on the President's Physical Fitness Test is required for school accreditation, and conducting the test is required by state law. Passage rates have increased 30% in the past six years. However, conducting the President's Physical Fitness Test does not ensure a quality physical education program or even frequent physical activity. Although the basics for quality physical education are laid out in the state's instructional goals and objectives, the infrastructure lacks certified teachers and adequate facilities to provide a daily physical education program. There is the additional problem of time constraints within the public school schedule for the needed classes. At the county level, there is a lack of professional and curricular development opportunities for instructors currently teaching physical education.

Our communities have moved away from natural opportunities to achieve a more physically active lifestyle. Urban sprawl, or the spread of low-density development beyond the edge of service and employment, has increased dependence on the automobile. Even short trips are automobile driven as new development does not include accommodations for pedestrians or alternative forms of transportation. Sprawl communities spring up with isolated units for living, shopping, or school, as opposed to an integrated community network interconnected with streets, sidewalks, parks, schools, and churches that would encourage and enhance opportunities for physical activity.

Rural West Virginia communities face additional barriers. These include lack of facilities for recreation, lack of funding for facilities, sharply winding roads with no shoulders, which make walking and biking dangerous if not impossible, and a geographical sense of separateness that makes community-building a greater challenge.

As our culture continues to progress, going out of our way to be physically active will be more and more crucial, as will finding ways to build movement back in to our daily lives. The 1996 release of Physical Activity and Health: A Report of the Surgeon General added a new lifestyle focus to previous physical activity recommendations. This reflected both the need for something attainable by our increasingly sedentary population and recent research that indicated even moderate levels of physical activity, achieved on a regular basis, could lead to significant cardiorespiratory and health-related benefits, especially among the unfit. The recommendations also acknowledge that persons attaining this minimum could gain even greater benefits by increasing either the duration or intensity of the activity.

The Surgeon General's recommendations include:
• All people over the age of two years should accumulate at least 30 minutes of endurance-type physical activity, of at least moderate intensity, on most -- preferably all -- days of the week. This activity can be in a single session or "accumulated" in bouts of 8-10 minutes each.
• Additional benefits can be achieved by increasing the time spent in moderate-intensity activity, or by being more vigorous.
• Men over age 40, women over age 50, and persons with known health risks or problems should consult a physician before beginning a program of vigorous activity to which they are unaccustomed.
• Strength-developing activities (resistance training) should be performed at least twice per week, with one or two sets of 8-12 repetitions, in a variety of exercises (at least 8-10) that use the major muscle groups of the legs, trunk, arms and shoulders.

The Objectives

FLAGSHIP OBJECTIVE
OBJECTIVE 22.1. Reduce to 37% the proportion of people aged 18 and older who engage in no leisure-time physical activity. (Baseline: 43.7% in 1998)

Data Source: West Virginia Bureau for Public Health (WVBPH), Office of Epidemiology and Health Promotion (OEHP), Behavioral Risk Factor Surveillance System (BRFSS)

OBJECTIVE 22.2. Increase to at least 17% the proportion of people aged 18 and older who engage regularly, preferably daily, in sustained physical activity for at least 30 minutes per day. (Baseline: 13.5% in 1998)

Data Source: WVBPH, OEHP, BRFSS

OBJECTIVE 22.3. (Developmental) Increase the proportion of WV's public and private elementary, middle/junior high, and senior high schools that provide daily lifetime fitness enhancing activities, including quality daily physical education (K-12) and recess (K-5), for all students during school hours. (Baseline data available in 2002)

Data Source: WV Department Of Education (WVDOE), Office of Healthy Schools (OHS), SHEP Survey

OBJECTIVE 22.4. Increase to 30% the proportion of adolescents who engaged in moderate physical activity for at least 30 minutes on five or more of the previous seven days. (Baseline: 25.4% in 1999)

Data Source: WVDOE, OHS, West Virginia Youth Risk Behavior Survey

OBJECTIVE 22.5. (Developmental) Increase the proportion of WV's public elementary, middle/junior high, and senior high schools that provide access to their outdoor and indoor physical activity spaces and facilities for young people and adults outside of normal school hours (i.e., before and after the school day, on weekends, and during summer and other vacations). (Baseline data available in 2002)

Data Source: WVDOE, OHS, SHEP Survey

OBJECTIVE 22.6. (Developmental) Increase the proportion of respondents who report using available community facilities (sidewalks, school tracks, walking trails, roads, malls, recreation areas, etc.) to achieve regular physical activity. (Baseline data available in 2002)

Data Source: WVBPH, OEHP, BRFSS

OBJECTIVE 22.7. Increase to 60% the proportion of respondents who reported receiving advice and/or counseling from their primary and/or allied health care providers regarding their physical activity practices. (Baseline: 52.3% [provisional] in 1999)

Data Source: WVBPH, OEHP, BRFSS

Meeting the Objectives

Health Promotion Channels for Achieving Objectives:

• Worksites
• Schools
• Public Health Programs
• Networks
• Health Care System
• Higher Education

The WV Bureau for Public Health's Cardiovascular Health Program has received a five-year core capacity building grant from the CDC. This provides funding for developing state infrastructure related to cardiovascular disease. Of particular interest to this chapter is the addition of the position of a state physical activity coordinator, which will allow a directed focus on, plan development for, and implementation of issues related specifically to meeting the Healthy People 2010 Physical Activity objectives. The coordinator will work with the West Virginia Coalition for Physical Activity (WVCfPA) and additional public and private entities to develop a statewide framework and strategies for meeting the objectives.

The mission of the WVCfPA is to "improve the health of all West Virginians by promoting a physically active lifestyle." Members of the Coalition have included representatives from state and local agencies, higher education, schools, community organizations, hospitals, fitness and health care centers, and worksite wellness programs. Several members have received national recognition in their respective professions in the field of physical activity.

One of the WVCfPA's most significant accomplishments and ongoing events is the Walk Across West Virginia, an annual event begun in 1995 in which groups collectively log the mileage it would take to travel the distance across the state. The Walk Across WV is implemented in the month of May in the health promotion channels that make up the broad-based approach to reaching state residents, i.e., schools, higher education, worksites, wellness centers, community groups, churches, homemakers, hospitals, weight management centers, and senior citizen groups. By adapting the Walk Across West Virginia to address environmental and policy issues related to physical activity, we have a grass-roots means of educating the public and preparing for change.

Much needs to occur to reverse the alarming increase in sedentary lifestyle. Beyond individual behavior change, our environments need restructuring to facilitate physical activity. Opportunities include adding sidewalks into existing communities or into new developments, making taking the stairs obvious, safe, and easily accessible, providing zoning to guarantee walking and bicycle paths and recreation areas, and keeping existing facilities such as school playgrounds and ballfields open to the public. Our state trail system needs to be developed and expanded to interlock and interconnect communities in such a way that walking or biking for recreation or transportation could be safely accomplished. Implementation of the WV State Trails Plan is a necessary component of this development.

One example of policy direction on the national level is the passage of the 1998 Transportation Equity Act for the 21st Century (TEA-21). Section 1202 of TEA-21 states that "Bicycle transportation facilities and pedestrian walkways shall be considered, where appropriate, in conjunction with all new construction and reconstruction of transportation projects, except where bicycle and pedestrian use are not permitted." The Transportation Enhancements Program is perhaps the most popular use of funds for bicycle and pedestrian purposes. Each state is required to set aside 10% of its surface transportation funds for Transportation Enhancement activities. Making full use of available funding for bicycle and pedestrian issues could greatly increase physical activity opportunities in our local communities.

In December 2000 the U.S. Congress passed what is referred to as the PEP Bill, or Physical Education for Progress Act, as an amendment to Title X of the Elementary and Secondary Education Act of 1965. This landmark bill provides funding for "initiating, expanding, and improving physical education programs for kindergarten through grade 12 students by 1) providing equipment and support to enable students to actively participate in physical education activities and 2) providing funds for staff and teacher training and education." Five million dollars are allocated for national grant distribution by the U.S. Department of Education in 2001. That figure has the potential to grow to $100,000,000 from 2003-2005 if early grants prove successful. Ensuring that as many West Virginia schools as possible apply, and hopefully receive, PEP funding to expand or enhance their existing physical education programs will be a key pursuit of the WV Burea for Public Health Physical Acitivity program and partners in the coming years.

State and local school policies need to be restructured to guarantee access to quality physical activity/education programs that enhance lifetime fitness skills as well as increasing individual fitness levels for all youth at all times of the year, regardless of age or ability level. Reimbursement issues related to health care provider counseling for physical activity (primary prevention of disease) need to be addressed in order to enhance delivery of effective messages to patients regarding physical activity as a component of their treatment regimen.

Cultural trends, including mass media, fast foods, and technology need to be examined carefully for their silent but deadly impact on our physical well-being. They sweep us rapidly forward without thought into unhealthful behaviors, skyrocketing our early potential for chronic disease.

The Cardiovascular Health Program at the WVBPH will serve as the lead entity in leading the initiatives to reach the objectives. Other collaborating entities include:

• WV Coalition for Physical Activity
  
• WV Office of Healthy Schools
  
• West Virginia University (WVU) Prevention Research Center
  
• WV Trails Coalition
  
• Wellness Council of WV
  
• WV Department of Transportation
  
• WV Department of Tourism
  
• Charleston Area Medical Center
  
• Marshall University
  
• St. Mary's Hospital
  
• WV Alliance for Health, Physical Education, Recreation, and Dance (WVAHPERD)
  
• WV Department of Parks and Recreation
  
• Community Health Promotion Specialists, WVBPH
  
• Office of Epidemiology and Health Promotion, Health Statistics Center, WVBPH
  
• Diabetes Control Program, WVBPH
  
• Osteoporosis Prevention Program, WVBPH
  
• Tobacco Prevention Program, WVBPH

Work Group Members

Cathy Cleland, Work Group Co-Leader, Physical Activity Coordinator, Cardiovascular Health Program, WVBPH
Jessica G. Wright, RN, MPH, CHES, Work Group Co-Leader, Chronic Disease Director, WVBPH
Anne Bolyard, MS, Community Health Promotion Program, WVBPH
Elizabeth Bolyard, Faculty Coordinator, Student Health Advisory Board, Herbert Hoover High School
Carolyn Crislip-Tacy, EdD, Teacher Education and Physical Education, Fairmont State College
Jacquelyn A. Copenhaver, Rivers and Bridges Rural Health Education Partnership (RHEP) Consortium, Scarbro, WV
Patti Crawford, MS, Health Promotion Specialist, WV School of Osteopathic Medicine
Larry Gillespie, MA, Education Administration. Principal, Clay County Middle School
Paul Gordon, PhD, MPH, Physical Activity Epidemiologist, School of Medicine, Division of Exercise Physiology, WVU
Sarita Gumm, Certified Personal Trainer, Logan County Livewell Project Coordinator
Debbie Holcomb, MS, American Cancer Society
India Hosch, PhD, RNC, CDDN, School Nurse, Raleigh County
Brenda Isaacs, RN, BSN, MA, Lead School Nurse, Kanawha County Schools
Mary E. Perry, MA, Acting Bicycle/Pedestrian Coordinator, WV Division of Highways
Steve Putnam, MS, Tucker County Wellness Center
John Ray, MEd, Coordinator, Health and Physical Education, WV Office of Healthy Schools
Melody Reed, RN, Clay Organized for Wellness (COW)
Rick Robinson, MS, Exercise Specialist; Assistant Director, Exercise Physiology Lab, Marshall University. President, WVCfPA
Randall Swain, MD, HealthScope
Parr Thacker, RHEP Site Coordinator, Fort Gay Primary Care Center
Susan Schmidt, MD, Clinic Director, St. George Medical Clinic, Inc., Tucker County
Nancy O'Hara Tompkins, PhD, Assistant Professor, Department of Community Medicine, Prevention Research Center, WVU
Butch Varney, MA, Physical Education Specialist, Ravenswood Grade School and Fairplain Elementary School, Jackson County

References/Resources

CDC. Division of Diabetes Translation. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Public Health Service, 1988-94.

Deitz WH, Gortmaker SL. "Television and media viewing impact on youth obesity levels." Pediatrics 75 (1985): 807-12.

Sierra Club Sprawl Report. October 1999.
www.sierraclub.org/transportation/sprawl/Sprawl_report/what.html

Gortmaker SL et al. "Prevalence of obesity by hours of TV per day." Archives of Pediatric and Adolescent Medicine 150 (1996): 356-62.

Robinson, TN. "Reducing children's television viewing to prevent obesity." JAMA 282 (1999): 1561-7.

U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition, in Two Volumes). Washington, DC: Government Printing Office, January 2000.

Wechsler, Howell, EdD, MPH. "Making the case: why schools should promote physical activity and healthy eating and prevent tobacco use." Physical Activity, Nutrition and Tobacco Training for National School and Public Health Professionals. Charleston, WV: Department of Education, Office of Healthy Schools, May 2000.

West Virginia Bureau for Public Health Behavior Risk Factor Survey. Charleston, WV: Department of Health and Human Resources, 1996, 1998.

West Virginia Office of Healthy Schools. President's Physical Fitness Test results. Charleston, WV: Department of Education, 1993-99.

West Virginia Office of Healthy Schools. WV School Nurse Needs Assessment results. Charleston, WV: Department of Education, 1996-97, 1998-99.

For More Information

Physical Activity Program
Office of Epidemiology and Health Promotion
350 Capitol Street, Room 319
Charleston, WV 25301-3715
Phone: (304) 558-0644/Fax: (304) 558-1553
Visit the WV Physical Activity website at:
www.healthywv.org under Physical Activity

This page was last updated June 27, 2001.
For additional information about HP2010, contact Chuck Thayer at (304) 558-0644 or Chuck.E.Thayer@wv.gov