Physical Activity Policies are Healthy Public Policies

The modern-day sedentary lifestyle, along with its consequent metabolic and cardiovascular complications has now achieved substantial public health prominence. This public health burden is not clustered solely among industrialized nations, but is now observed in developing countries as well. Public health policy has been an important component of health advances over the past century in the areas of sanitation, immunization, work place safety, automobile safety, and most recently, tobacco use. Unfortunately, the application of research to policy efforts toward the promotion of an active lifestyle has yet to be fully realized.

Global estimates of reported physical inactivity (i.e., failing to achieve World Health Organization (WHO) recommendations of 150 min/week of moderate-intensity activity for adults and 60 min/day of moderate- to vigorous-intensity activity for children and adolescents) are about 31% among adults and 80% among adolescents aged 15-17 years.¹ Moreover, the population all-cause mortality risk attributable to being physically inactive (9%) is similar to that of smoking (9%) and greater than that of obesity (5%).² Thus, physical inactivity has emerged as a significant public health threat in its own right (rather than as a factor co-existing with obesity); yet physical activity policy lags far behind policies directed at smoking or at obesity control.

The Toronto Charter for Physical Activity was launched in May of 2010 by the International Society for Physical Activity and Health as a call to creating and implementing national policies and action plans to increase population physical activity. This call for an action plan is also stated in the recent United Nations General Assembly Political Declaration on the Prevention and Control of Non-communicable Diseases, which reaffirmed the need for a Global Action Plan for Diet, Physical Activity, and Health, and calls for a “whole-of-government and whole-of-society effort” in addressing the challenges of implementing it. Our own National Physical Activity Plan provides a comprehensive set of evidence-based practices, and initiatives directed toward increasing population levels of physical activity in the United States. Again, the charge is one comprising government commitment and leadership, as well as multiple sector (public health; health care; academia; mass media; business and industry; not-for-profit organizations; recreation, fitness, and sports; and transportation/community planning) approaches to achieving a healthy and active lifestyle. It acknowledges and utilizes the contributions of the relevant stake-holders (i.e., individuals, families, and communities). Sadly, although a large proportion of WHO member states report having a physical activity action plan, many of these plans are not operational.

The physical activity movement has gained tremendous momentum over the past several decades; although, most of the advances in this area have to do with behavioral theories that guide physical activity at the individual level. Perhaps the most productive theoretical framework for physical activity promotion to date has been the Ecological Model. This model considers the inter-relations among physical, sociocultural, and environmental factors known to influence individual behavior. Within the ecological framework, policy can positively influence risk conditions (such as the lack of sidewalks or of physical education classes), which then affect everyone equally. In that way, policy changes can be more sustainable than strategies simply directed toward individual behavior. Policy can be legislative action, organized guidance, or simply a commonly-accepted rule. Policies can affect change by creating more opportunities to be active by the design of a community or a building, they can regulate at the state level the quantity and quality of physical education provided in the schools, they can promote national campaigns, and they can provide funding to promote physical activity from the federal to the local levels.³

There are many challenges to implementing policies for promoting physical activity, however. Many societies (and individual citizens) continue to feel reluctance about the regulation of what is considered to be a personal choice about whether or not to be physically active. In fact, many may not recognize the negative consequences of their choice to be sedentary to the population at large. Moreover, while citizens may enthusiastically support the need for more green space, bicycling lanes, and sidewalk connectivity, they may be less enthusiastic about the increase in local or state taxes that would be necessary to build and maintain them. Policy implementation also takes time. Due to administrative changes, competing demands, loss of funding, and shifting priorities, policy efforts that may begin in earnest can stop abruptly.³ The evaluation of policy changes also takes time and many funders are interested in immediate outcomes of success, rather than in health outcomes that may take years to actualize (reduction in obesity, diabetes or cardiovascular disease prevalence). As stated previously, carefully coordinated policy efforts among multiple community sectors can help to reduce these challenges to policy implementation.

So, imagine if 80% of adolescents world-wide reported cigarette smoking, rather than not meeting guidelines for physically activity. Given what we now know about the relation of this hazard to health and function across the lifespan, what would it take to enact policies to reduce this global threat? Most public health practitioners agree that (similar to tobacco control) a significant cultural shift in attitudes about the toxicity of physical inactivity must first occur. Practitioners also agree that new policies may be most successful when enacted locally, in settings where people spend the majority of their time (i.e., schools and workplaces) and with the consensus of the primary stakeholders involved (i.e., parents, students, workers). Finally, we need to remember that some of the most successful public health strategies have been passive strategies that bypass human choice (think automobile design and airbags; weekly garbage removal; and water fluoridation) or that make the default choice the healthy choice (offering only healthy snacks in vending machines or making stairways the more prominent and efficient choice than the elevator). We cannot ignore the opportunity to leverage on past public health successes in enacting physical activity policies. Physical activity policies are, in fact, obesity, diabetes, cardiovascular and other non-communicable disease prevention policies, and they have a far greater return on investment than policies directed at treatment or curative actions. In creating and enacting such policies, consensus and capacity building are key elements of success among a number of traditional and non-traditional public health partners, as well as among the stakeholders. This is what it would take to initiate a major social movement that would recognize the vital role of physical activity policy in improving public health.

Loretta DiPietro is Professor and Chair of the Department of Exercise and Nutrition Sciences, the Milken Institute School of Public Health at The George Washington University. Dr. DiPietro received her training in epidemiology at Yale University. For nearly three decades, her research has focused on physical activity, and she has worked very hard to combine the two disciplines of epidemiology and physiology to better understand the mechanistic underpinnings of the benefits of exercise. Dr. DiPietro is recognized internationally as a leader in the field of physical activity and aging. An accomplished and widely published researcher, she has been awarded numerous grants from the National Institutes of Health and the American Cancer Society, and has been invited to lecture around the world. She is a current Fellow of the American College of Sports Medicine and the Editor-in-Chief of the Journal of Physical Activity and Health. Dr. DiPietro is a former Epidemic Intelligence Service (EIS) Officer in the Commissioned Corps of the United States Public Health Service. She joined the GW SPH in 2008 from Yale University School of Medicine, where she was associate professor of epidemiology and public health and a fellow at the John B. Pierce Laboratory.