National agenda: goals & priorities.

Every ten years the United States Department of Health and Human Services issues a document for improving the public health of the following decade. Healthy People 2000 currently serves as the target for achieving a healthier nation. The physical activity strategies provide benchmarks of the 1990 status and targets for improving health through physical activity. NRPA assisted in drafting the original document making certain that it included the development of recreational paths and access to facilities.

Oversight Team Gives Briefing

The President's Council on Physical Fitness and Sport is the lead Federal agency for achieving the Healthy People 2000 physical activity objectives and NRPA serves on the oversight review team. Recently, the Assistant Secretary of Health was briefed by the oversight team on progress achieved at the midcourse review. The following is a summary of the report given earlier this year by the Healthy People 2000 Coordinator, Christine Spain.

As many as 250,000 deaths per year in the United States can be attributed to lack of regular physical activity. Medical evidence demonstrates that physical activity reduces the risk of many diseases including hypertension, cancer, osteoporosis, and diabetes, as well as improving many of the biological measures associated with health and psychological functioning. Regular physical activity and musculoskeletal fitness are important to the maintenance of healthy, independent living as people grow older. Clearly then, one of the most important public health challenges is moving our society from sedentary to active.

Although evidence has been accumulating about the benefits of physical activity, several societal trends involve more sedentary lifestyles. In the "information age," more and more individuals sit in front of computer screens for large portions of their work day. Public schools, hard pressed for financial resources, devote fewer of their financial resources to physical activity instruction, playgrounds and after school sports programs. Likewise, communities strapped for funding often have less to invest in parks and recreation facilities and the staff who maintain and operate them. Because of increased rates in violent crime, many people are afraid to exercise in their own neighborhoods. And children and youth find watching television or playing video games easier than individual or group physical activity.

The public health, medical, and mental health communities are increasingly recognizing the importance of physical activity and fitness. Recent consensus conferences have recommended improving adult and adolescent physical activity and addressed the roles played by health professionals, public health agencies, schools, employers, community planners, and individuals and their families. These conferences have noted the unique issues in promoting physical activity among economically disadvantaged populations. these recommendations, coupled with attention to each of the objectives tracked in this midcourse review, should help us move toward a more healthy and vibrant nation.

Review of Progress

Among the objectives proceeding toward the year 2000 target is the coronary heart disease death rate, which has been declining steadily. Both objectives for increased moderate and vigorous physical activity among adults are showing progress. However, there has been no reduction in the percent of adults who engage in leisure time physical activity. There is some improvement in the percent of adults improving muscular strength as measured by weight lifting. For a number of the physical activity objectives, there are no data available on children age six through high school. The Youth Behavioral Risk Surveillance System (YRBSS) data show that students in grades 9-12 are engaged in stretching and strengthening activities four or more times per week.

For preferred body weight, one in five teenagers and one in three adults are overweight. Me data from 1988-1991 indicate that in the United States, obesity has increased among children, adolescents and adults. Obesity is of particular concern for special population groups including low-income and certain racial and ethnic populations. Despite improvements in the American diet, the prevalence of obesity has increased. Another objective that is losing ground is the percentage of overweight adults who are engaging in weight loss practices. For both males and females, the proportion adopting sound dietary practices combined with regular physical activity to attain an appropriate body weight has declined.

Work site fitness programs have the potential for engaging employees in physical activity by providing information, incentives and access to programs, equipment and facilities. Work sites with 50 or more employees were surveyed in both 1985 and 1992 to asses the extent to which they offer activities that promote fitness. For two groups of employers (50-99 employees and 100-249 employees) the percentage with fitness programs more than doubled. Work sites with larger employee numbers also demonstrated impressive gains.

The 1992 Primary Care Providers Survey provides information on the extent to which providers inquire about exercise habits and formulate an exercise plan. Internists reported routinely inquiring about exercise habits of 40% of their patients and formulating an exercise plan for 25%. Nurse practitioners reported routinely inquiring about exercise habits of 30% of their patients and formulating an exercise plan for 14%. Even lower levels were evident in other groups of providers, see table 1 for a break down.

Table 1

                               Inquire about     Formulate
Provider                       Exercise Habits   Exercise Plan

Internists                     40%               25%
Nurse Practitioners            30%               14%
Pediatricians                  16%               16%
Obstetricians/Gynecologists    14%               13%
Family Practitioners           19%               18%

The realities of decreasing levels of leisure time physical activity should be an indication for the park and recreation profession to expand their target audience beyond those individuals who are motivated to participate in recreational sport, fitness and exercise. An increased emphasis should be put on ways to assist the physically inactive public to enhance their personal lifestyle choices with fun, enjoyable recreation, that offers physical enrichment. The Active Living/healthy Lifestyles repositioning project will help local agencies assist in achieving the Healthy People 2000 target objectives.