# ![](media/image1.wmf){width="2.3986111111111112in" height="2.2930555555555556in"} {#section .Chapter-#}

# 22 {#section-1 .Chapter-#}

# Physical Activity and Fitness

Co-Lead Agencies: Centers for Disease Control and Prevention\
President's Council on Physical Fitness and Sports

### Contents {#contents .Heading-Special}

[Goal Page 22-3](#goal)

[Overview Page 22-3](#overview)

[Issues and Trends Page 22-3](#issues-and-trends)

[Disparities Page 22-4](#disparities)

[Opportunities Page 22-6](#opportunities)

[Interim Progress Toward Year 2000 Objectives Page
22-6](#interim-progress-toward-year-2000-objectives)

[Healthy People 2010---Summary of Objectives Page
22-7](#healthy-people-2010summary-of-objectives)

[Healthy People 2010 Objectives Page
22-8](#healthy-people-2010-objectives)

[Physical Activity in Adults Page 22-8](#physical-activity-in-adults)

[Muscular Strength/Endurance and Flexibility Page
22-13](#muscular-strengthendurance-and-flexibility)

[Physical Activity in Children and Adolescents Page
22-17](#physical-activity-in-children-and-adolescents)

[Access Page 22-25](#access)

[Related Objectives From Other Focus Areas Page
22-33](#related-objectives-from-other-focus-areas)

[Terminology Page 22-35](#terminology)

[References Page 22-36](#references)

##   {#section-2 .unnumbered}

## Goal

Improve health, fitness, and quality of life through daily physical
activity.

## Overview

The 1990s brought a historic new perspective to exercise, fitness, and
physical activity by shifting the focus from intensive vigorous exercise
to a broader range of health-enhancing physical activities. Research has
demonstrated that virtually all individuals will benefit from regular
physical activity.[^1] A Surgeon General's report on physical activity
and health concluded that moderate physical activity can reduce
substantially the risk of developing or dying from heart disease,
diabetes, colon cancer, and high blood pressure.Error: Reference source
not found Physical activity also may protect against lower back pain and
some forms of cancer (for example, breast cancer), but the evidence is
not yet conclusive.[^2]**^,^** [^3]

### Issues and Trends

On average, physically active people outlive those who are
inactive.[^4]**^,^** [^5]**^,^** [^6]**^,^** [^7]**^,^** [^8] Regular
physical activity also helps to maintain the functional independence of
older adults and enhances the quality of life for people of all
ages.[^9]**^,^** [^10]**^,^** [^11]

The role of physical activity in preventing coronary heart disease (CHD)
is of particular importance, given that CHD is the leading cause of
death and disability in the United States. Physically inactive people
are almost twice as likely to develop CHD as persons who engage in
regular physical activity. The risk posed by physical inactivity is
almost as high as several well-known CHD risk factors, such as cigarette
smoking, high blood pressure, and high blood cholesterol. Physical
inactivity, though, is more prevalent than any one of these other risk
factors. People with other risk factors for CHD, such as obesity and
high blood pressure, may particularly benefit from physical activity.

Regular physical activity is especially important for people who have
joint or bone problems and has been shown to improve muscle function,
cardiovascular function, and physical performance.[^12] However, people
with arthritis (20 percent of the adult population) are less active than
those without arthritis.[^13] People with osteoporosis, a chronic
condition affecting more than 25 million people in the United States,
may respond positively to regular physical activity, particularly
weight-bearing activities, such as walking,[^14] and especially when
combined with appropriate drug therapy and calcium intake. Increased
bone mineral density has been positively associated with aerobic
fitness, body composition, and muscular strength.[^15]

Although vigorous physical activity is recommended for improved
cardiorespiratory fitness, increasing evidence suggests that moderate
physical activity also can have significant health benefits, including a
decreased risk of CHD. For people who are inactive, even small increases
in physical activity are associated with measurable health benefits. In
addition, moderate physical activity is more readily adopted and
maintained than vigorous physical activity.[^16] As research continues
to illustrate the links between physical activity and selected health
outcomes, people will be able to choose physical activity patterns
optimally suited to individual preferences, health risks, and
physiologic benefits.

For individuals who do not engage in any physical activity during their
leisure time, taking the first step toward developing a pattern of
regular physical activity is important. Unfortunately, few individuals
engage in regular physical activity despite its documented benefits.
Only about 23 percent of adults in the United States report regular,
vigorous physical activity that involves large muscle groups in dynamic
movement for 20 minutes or longer 3 or more days per week. Only 15
percent of adults report physical activity for 5 or more days per week
for 30 minutes or longer, and another 40 percent do not participate in
any regular physical activity.

Public education efforts need to address the specific barriers that
inhibit the adoption and maintenance of physical activity by different
population groups. Older adults, for example, need information about
safe walking routes. Persons with foot problems need to learn about
proper foot care and footwear in order to reach appropriate activity
levels. People with CHD and other chronic conditions must understand the
importance of regular physical activity to maintain physical function.
Each person should recognize that starting out slowly with an activity
that is enjoyable and gradually increasing the frequency and duration of
the activity are central to the adoption and maintenance of physical
activity behavior. Along with the public education efforts, public
programs in a variety of settings (recreation centers, worksites, health
care settings, and schools) need to be developed, evaluated, and shared
as potential models. The availability of group activities in the
community is important for many.

### Disparities

Disparities in levels of physical activity exist among population
groups. The proportion of the population reporting no leisure-time
physical activity is higher among women than men, higher among African
Americans and Hispanics than whites, higher among older adults than
younger adults, and higher among the less affluent than the more
affluent. Participation in all types of physical activity declines
strikingly as age or grade in school increases. In general, persons with
lower levels of education and income are least active in their leisure
time. Adults in North Central and Western States tend to be more active
than those in the Northeastern and Southern States. People with
disabilities and certain health conditions are less likely to engage in
moderate or vigorous physical activity than are people without
disabilities. Health promotion efforts need to identify barriers to
physical activity faced by particular population groups and develop
interventions that address these barriers.
**^Error:\ Reference\ source\ not\ found^**

Data demonstrate that major decreases in vigorous physical activity
occur during grades 9 through 12. This decrease is more profound for
girls than for boys, whether the measure is engaging in vigorous
physical activity in general or in team sports. The President's Council
on Physical Fitness and Sports concluded that because of the physical
health and emotional benefits of physical activity, it should have an
increasingly important role in the lives of girls.[^17] Adolescents'
interest and participation in physical activity differ by gender.Error:
Reference source not found Therefore, strategies to increase the amount
of physical activity for boys and girls must address these differences
and must begin before the disparities in levels of physical activity
manifest themselves. Compared to boys, girls are less likely to
participate in team sports but more likely to participate in aerobics or
dance. Often girls and boys perceive different benefits from physical
activity, with boys viewing such activity as competition and girls as
weight management. These factors must be considered in developing
programs to address the needs of girls. Because boys are more likely
than girls to have higher self-esteem and greater physical strength,
programs addressing the needs of girls should provide instruction and
experiences that increase their confidence and their opportunities to
participate in activities, as well as social environments that support
involvement in a range of physical activities.Error: Reference source
not found![](media/image2.wmf){width="4.697916666666667in"
height="4.704166666666667in"}

### Opportunities

The Healthy People 2010 objectives offer opportunities to ensure that
physical activity and fitness become part of regular healthy behavioral
patterns. Encouraging any type or amount of physical activity in leisure
time can provide important health benefits, compared to a sedentary
lifestyle.

Activities that promote strength and flexibility are important because
they may protect against disability, enhance functional independence,
and encourage regular physical activity participation. These benefits
are particularly important for older people---a good quality of life
means being functionally independent and being able to perform the
activities of daily living.

Young people are at particular risk for becoming sedentary as they grow
older. Therefore, encouraging moderate and vigorous physical activity
among youth is important. Because children spend most of their time in
school, the type and amount of physical activity encouraged in schools
are important components of a fitness program and a healthy lifestyle.

The major barriers most people face when trying to increase physical
activity are time, access to convenient facilities, and safe
environments in which to be active. Counseling by primary care providers
about the need to participate in physical activity also is an important
way to change behavior. In addition, facilities need to be accessible to
people with disabilities.

## Interim Progress Toward Year 2000 Objectives

Of the 13 physical activity and fitness objectives, 1 has been
met---increasing worksite fitness programs. Four objectives show solid
gains, indicating that the message about increased physical activity is
reaching some segments of the population. The message that a sedentary
lifestyle plays a role in both overweight and weight loss needs to be
addressed better, as does the role primary care providers can play in
counseling individuals to increase their daily activities. Both the
quantity and quality of school physical education have slipped. Data to
evaluate access and availability of community fitness facilities are not
available.

Note: Unless otherwise noted, data are from the Centers for Disease
Control and\
Prevention, National Center for Health Statistics, *Healthy People 2000
Review, 1998--99*.

## Healthy People 2010---Summary of Objectives

### Physical Activity and Fitness {#physical-activity-and-fitness-1 .Heading-Special-Sub}

**Goal:** Improve health, fitness, and quality of life through daily
physical\
activity.

+---------+------------------------------------------------------------+
| **N     | ####### Objective Short Title                              |
| umber** |                                                            |
+---------+------------------------------------------------------------+
| **P     |                                                            |
| hysical |                                                            |
| A       |                                                            |
| ctivity |                                                            |
| in      |                                                            |
| A       |                                                            |
| dults** |                                                            |
+---------+------------------------------------------------------------+
| 22-1    | No leisure-time physical activity                          |
+---------+------------------------------------------------------------+
| 22-2    | Moderate physical activity                                 |
+---------+------------------------------------------------------------+
| 22-3    | Vigorous physical activity                                 |
+---------+------------------------------------------------------------+
| **M     |                                                            |
| uscular |                                                            |
| Stre    |                                                            |
| ngth/En |                                                            |
| durance |                                                            |
| and     |                                                            |
| Flexib  |                                                            |
| ility** |                                                            |
+---------+------------------------------------------------------------+
| 22-4    | Muscular strength and endurance                            |
+---------+------------------------------------------------------------+
| 22-5    | Flexibility                                                |
+---------+------------------------------------------------------------+
| **P     |                                                            |
| hysical |                                                            |
| A       |                                                            |
| ctivity |                                                            |
| in      |                                                            |
| C       |                                                            |
| hildren |                                                            |
| and     |                                                            |
| Adoles  |                                                            |
| cents** |                                                            |
+---------+------------------------------------------------------------+
| 22-6    | Moderate physical activity in adolescents                  |
+---------+------------------------------------------------------------+
| 22-7    | Vigorous physical activity in adolescents                  |
+---------+------------------------------------------------------------+
| 22-8    | Physical education requirement in schools                  |
+---------+------------------------------------------------------------+
| 22-9    | Daily physical education in schools                        |
+---------+------------------------------------------------------------+
| 22-10   | Physical activity in physical education class              |
+---------+------------------------------------------------------------+
| 22-11   | Television viewing                                         |
+---------+------------------------------------------------------------+
| **A     |                                                            |
| ccess** |                                                            |
+---------+------------------------------------------------------------+
| 22-12   | School physical activity facilities                        |
+---------+------------------------------------------------------------+
| 22-13   | Worksite physical activity and fitness                     |
+---------+------------------------------------------------------------+
| 22-14   | Community walking                                          |
+---------+------------------------------------------------------------+
| 22-15   | Community bicycling                                        |
+---------+------------------------------------------------------------+

## Healthy People 2010 Objectives

### Physical Activity in Adults

22-1. Reduce the proportion of adults who engage in no\
leisure-time physical activity.

**Target:** 20 percent.

**Baseline:** 40 percent of adults aged 18 years and older engaged in no
leisure-time physical activity in 1997 (age adjusted to the year 2000
standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Adults Aged 18 Years and Older, 1997**       | **No Leisure-Time   |
|                                                | Physical Activity** |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 40                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 46                  |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 42                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 42                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | 41                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 52                  |
+------------------------------------------------+---------------------+
| > White                                        | 38                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 54                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 38                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 52                  |
+------------------------------------------------+---------------------+
| > White                                        | 36                  |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 43                  |
+------------------------------------------------+---------------------+
| > Male                                         | 36                  |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 years and older)  |                     |
+------------------------------------------------+---------------------+
| > Less than 9th grade                          | 73                  |
+------------------------------------------------+---------------------+
| > Grades 9 through 11                          | 59                  |
+------------------------------------------------+---------------------+
| > High school graduate                         | 46                  |
+------------------------------------------------+---------------------+
| > Some college or AA degree                    | 35                  |
+------------------------------------------------+---------------------+
| > College graduate or above                    | 24                  |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 39                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 43                  |
+------------------------------------------------+---------------------+
| **Disability status**                          |                     |
+------------------------------------------------+---------------------+
| > Persons with disabilities                    | 56                  |
+------------------------------------------------+---------------------+
| > Persons without disabilities                 | 36                  |
+------------------------------------------------+---------------------+
| **Select populations**                         |                     |
+------------------------------------------------+---------------------+
| Age groups                                     |                     |
+------------------------------------------------+---------------------+
| > 18 to 24 years                               | 31                  |
+------------------------------------------------+---------------------+
| > 25 to 44 years                               | 34                  |
+------------------------------------------------+---------------------+
| > 45 to 64 years                               | 42                  |
+------------------------------------------------+---------------------+
| > 65 to 74 years                               | 51                  |
+------------------------------------------------+---------------------+
| > 75 years and older                           | 65                  |
+------------------------------------------------+---------------------+
| > Persons with arthritis symptoms              | 43                  |
+------------------------------------------------+---------------------+
| > Persons without arthritis symptoms           | 38                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

22-2. Increase the proportion of adults who engage regularly, preferably
daily, in moderate physical activity for at least 30 minutes per day.

**Target:** 30 percent.

**Baseline:** 15 percent of adults aged 18 years and older engaged in
moderate physical activity for at least 30 minutes 5 or more days per
week in 1997 (age adjusted to the year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------+----------------+----------------+
| **Adults Aged 18 Years and Older,  | **22-2.\       | **20 Minutes   |
| 1997**                             | 30 Minutes of\ | of\            |
|                                    | Activity 5 or  | Activity 3 or  |
|                                    | More\          | More\          |
|                                    | Days per       | Days per       |
|                                    | Week**         | Week\***       |
+====================================+================+================+
|                                    | Percent        |                |
+------------------------------------+----------------+----------------+
| > **TOTAL**                        | 15             | 31             |
+------------------------------------+----------------+----------------+
| **Race and ethnicity**             |                |                |
+------------------------------------+----------------+----------------+
| > American Indian or Alaska Native | 13             | 25             |
+------------------------------------+----------------+----------------+
| > Asian or Pacific Islander        | 15             | 30             |
+------------------------------------+----------------+----------------+
| > Asian                            | 15             | 30             |
+------------------------------------+----------------+----------------+
| > Native Hawaiian and other        | 11             | 31             |
| > Pacific\                         |                |                |
| > Islander                         |                |                |
+------------------------------------+----------------+----------------+
| > Black or African American        | 10             | 23             |
+------------------------------------+----------------+----------------+
| > White                            | 15             | 32             |
+------------------------------------+----------------+----------------+
|                                    |                |                |
+------------------------------------+----------------+----------------+
| > Hispanic or Latino               | 11             | 23             |
+------------------------------------+----------------+----------------+
| > Not Hispanic or Latino           | 15             | 32             |
+------------------------------------+----------------+----------------+
| > Black or African American        | 10             | 22             |
+------------------------------------+----------------+----------------+
| > White                            | 16             | 33             |
+------------------------------------+----------------+----------------+
| **Gender**                         |                |                |
+------------------------------------+----------------+----------------+
| > Female                           | 13             | 30             |
+------------------------------------+----------------+----------------+
| > Male                             | 16             | 31             |
+------------------------------------+----------------+----------------+
| **Education level** (aged 25 years |                |                |
| and older)                         |                |                |
+------------------------------------+----------------+----------------+
| > Less than 9th grade              | 7              | 13             |
+------------------------------------+----------------+----------------+
| > Grades 9 through 11              | 11             | 21             |
+------------------------------------+----------------+----------------+
| > High school graduate             | 14             | 28             |
+------------------------------------+----------------+----------------+
| > Some college or AA degree        | 17             | 34             |
+------------------------------------+----------------+----------------+
| > College graduate or above        | 17             | 38             |
+------------------------------------+----------------+----------------+
| **Geographic location**            |                |                |
+------------------------------------+----------------+----------------+
| > Urban                            | 15             | 31             |
+------------------------------------+----------------+----------------+
| > Rural                            | 15             | 30             |
+------------------------------------+----------------+----------------+
| **Disability status**              |                |                |
+------------------------------------+----------------+----------------+
| > Persons with disabilities        | 12             | 23             |
+------------------------------------+----------------+----------------+
| > Persons without disabilities     | 16             | 33             |
+------------------------------------+----------------+----------------+
| ###### Select populations          |                |                |
+------------------------------------+----------------+----------------+
| Age groups                         |                |                |
+------------------------------------+----------------+----------------+
| > 18 to 24 years                   | 17             | 36             |
+------------------------------------+----------------+----------------+
| > 25 to 44 years                   | 15             | 31             |
+------------------------------------+----------------+----------------+
| > 45 to 64 years                   | 14             | 30             |
+------------------------------------+----------------+----------------+
| > 65 to 74 years                   | 16             | 31             |
+------------------------------------+----------------+----------------+
| > 75 years and older               | 12             | 23             |
+------------------------------------+----------------+----------------+
| > Persons with arthritis symptoms  | 15             | 29             |
+------------------------------------+----------------+----------------+
| > Persons without arthritis        | 15             | 32             |
| > symptoms                         |                |                |
+------------------------------------+----------------+----------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

\*Data for 20 minutes of activity 3 or more days per week are displayed
to further characterize the issue.

Note: The table above may have continued from the previous page.

22-3. Increase the proportion of adults who engage in vigorous physical
activity that promotes the development and\
maintenance of cardiorespiratory fitness 3 or more days per week for 20
or more minutes per occasion.

**Target:** 30 percent.

**Baseline:** 23 percent of adults aged 18 years and older engaged in
vigorous physical activity 3 or more days per week for 20 or more
minutes per occasion in 1997 (age adjusted to the year 2000 standard
population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Adults Aged 18 Years and Older, 1997**       | **Vigorous Physical |
|                                                | Activity**          |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 23                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 19                  |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 17                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 16                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | 24                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 17                  |
+------------------------------------------------+---------------------+
| > White                                        | 24                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 16                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 24                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 17                  |
+------------------------------------------------+---------------------+
| > White                                        | 25                  |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 20                  |
+------------------------------------------------+---------------------+
| > Male                                         | 26                  |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 years and older)  |                     |
+------------------------------------------------+---------------------+
| > Less than 9th grade                          | 6                   |
+------------------------------------------------+---------------------+
| > Grades 9 through 11                          | 12                  |
+------------------------------------------------+---------------------+
| > High school graduate                         | 18                  |
+------------------------------------------------+---------------------+
| > Some college or AA degree                    | 24                  |
+------------------------------------------------+---------------------+
| > College graduate and above                   | 32                  |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 24                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 21                  |
+------------------------------------------------+---------------------+
| **Disability status**                          |                     |
+------------------------------------------------+---------------------+
| > Persons with disabilities                    | 13                  |
+------------------------------------------------+---------------------+
| > Persons without disabilities                 | 25                  |
+------------------------------------------------+---------------------+
| **Select populations**                         |                     |
+------------------------------------------------+---------------------+
| Age groups                                     |                     |
+------------------------------------------------+---------------------+
| > 18 to 24 years                               | 32                  |
+------------------------------------------------+---------------------+
| > 25 to 44 years                               | 27                  |
+------------------------------------------------+---------------------+
| > 45 to 64 years                               | 21                  |
+------------------------------------------------+---------------------+
| > 65 to 74 years                               | 13                  |
+------------------------------------------------+---------------------+
| > 75 years and older                           | 6                   |
+------------------------------------------------+---------------------+
| > Persons with arthritis symptoms              | 21                  |
+------------------------------------------------+---------------------+
| > Persons without arthritis symptoms           | 24                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

The adoption and maintenance of regular physical activity represent an
important component of any health regime and provide multiple
opportunities to improve and maintain health. Because the highest risk
of death and disability is found among those who do no regular physical
activity, engaging in any amount of physical activity is preferable to
none. Physical activity should be encouraged as part of a daily routine.
While moderate physical activity for at least 30 minutes a day is
preferable, intermittent physical activity also increases caloric
expenditure and may be important for those who cannot fit 30 minutes of
sustained activity into their daily schedules. For even greater health
benefits, vigorous physical activity is necessary. For most persons, the
greatest opportunity for physical activity is associated with leisure
time, because few occupations today provide sufficient vigorous or
moderate physical activity to produce health benefits.

Engaging in moderate physical activity for at least 30 minutes per day
will help ensure that sufficient calories are used to provide health
benefits. A minimum level of intensity (for example, a brisk walk for 30
minutes per day) would, for most persons, result in an energy
expenditure of about 600 to 1,100 calories per week.[^18] If calorie
intake remains constant, this expenditure translates into a weight loss
of roughly one-sixth to one-third pound per week. Increases in daily
activity to ensure a weekly expenditure of 1,000 calories would have
significant individual and public health benefit for CHD prevention and
deaths from all causes, especially for persons who are sedentary.
Furthermore, this level of activity is feasible for most people even
though the relative intensity of any activity will vary by age. Starting
out slowly and gradually increasing the frequency and duration of
physical activity is the key to successful behavior change. In the case
of walking, the message becomes, "If you are not used to daily walking,
then walk slowly and take short, frequent walks, gradually increasing
distance and speed."

### Muscular Strength/Endurance and Flexibility

22-4. Increase the proportion of adults who perform physical\
activities that enhance and maintain muscular strength\
and endurance.

**Target:** 30 percent.

**Baseline:** 18 percent of adults aged 18 years and older performed
physical\
activities that enhance and maintain strength and endurance 2 or more
days per week in 1998 (age adjusted to the year 2000 standard
population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+-----------------------------------------------+----------------------+
| **Adults Aged 18 Years and Older, 1998        | **Strengthening and  |
| (unless noted)**                              | Endurance\           |
|                                               | Exercises**          |
+===============================================+======================+
|                                               | Percent              |
+-----------------------------------------------+----------------------+
| > **TOTAL**                                   | 18                   |
+-----------------------------------------------+----------------------+
| ###### Race and ethnicity                     |                      |
+-----------------------------------------------+----------------------+
| > American Indian or Alaska Native            | 18                   |
+-----------------------------------------------+----------------------+
| > Asian or Pacific Islander                   | 17                   |
+-----------------------------------------------+----------------------+
| > Asian                                       | 17                   |
+-----------------------------------------------+----------------------+
| > Native Hawaiian and other Pacific Islander  | 19                   |
+-----------------------------------------------+----------------------+
| > Black or African American                   | 16                   |
+-----------------------------------------------+----------------------+
| > White                                       | 18                   |
+-----------------------------------------------+----------------------+
|                                               |                      |
+-----------------------------------------------+----------------------+
| > Hispanic or Latino                          | 13                   |
+-----------------------------------------------+----------------------+
| > Not Hispanic or Latino                      | 18                   |
+-----------------------------------------------+----------------------+
| > Black or African American                   | 15                   |
+-----------------------------------------------+----------------------+
| > White                                       | 19                   |
+-----------------------------------------------+----------------------+
| **Gender**                                    |                      |
+-----------------------------------------------+----------------------+
| > Female                                      | 14                   |
+-----------------------------------------------+----------------------+
| > Male                                        | 21                   |
+-----------------------------------------------+----------------------+
| **Education level** (aged 25 years and older) |                      |
+-----------------------------------------------+----------------------+
| > Less than 9th grade                         | 4                    |
+-----------------------------------------------+----------------------+
| > Grades 9 through 11                         | 8                    |
+-----------------------------------------------+----------------------+
| > High school graduate                        | 11                   |
+-----------------------------------------------+----------------------+
| > Some college or AA degree                   | 19                   |
+-----------------------------------------------+----------------------+
| > College graduate and above                  | 26                   |
+-----------------------------------------------+----------------------+
| ###### Geographic location                    |                      |
+-----------------------------------------------+----------------------+
| > Urban                                       | 19                   |
+-----------------------------------------------+----------------------+
| > Rural                                       | 15                   |
+-----------------------------------------------+----------------------+
| **Disability status**                         |                      |
+-----------------------------------------------+----------------------+
| > Persons with disabilities                   | 14 (1997)            |
+-----------------------------------------------+----------------------+
| > Persons without disabilities                | 20 (1997)            |
+-----------------------------------------------+----------------------+
| **Select populations**                        |                      |
+-----------------------------------------------+----------------------+
| Age groups                                    |                      |
+-----------------------------------------------+----------------------+
| > 18 to 24 years (not age adjusted)           | 28                   |
+-----------------------------------------------+----------------------+
| > 25 to 44 years (not age adjusted)           | 21                   |
+-----------------------------------------------+----------------------+
| > 45 to 64 years (not age adjusted)           | 14                   |
+-----------------------------------------------+----------------------+
| > 65 to 74 years (not age adjusted)           | 10                   |
+-----------------------------------------------+----------------------+
| > 75 years and older (not age adjusted)       | 7                    |
+-----------------------------------------------+----------------------+
| > Persons with arthritis symptoms             | 18                   |
+-----------------------------------------------+----------------------+
| > Persons without arthritis symptoms          | 18                   |
+-----------------------------------------------+----------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

22-5. Increase the proportion of adults who perform physical\
activities that enhance and maintain flexibility.

**Target:** 43 percent.

**Baseline:** 30 percent of adults aged 18 years and older did
stretching exercises in the past 2 weeks in 1998 (age adjusted to the
year 2000 standard population).

**Target setting method:** Better than the best.

**Data source:** National Health Interview Survey (NHIS), CDC, NCHS.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Adults Aged 18 Years and Older, 1998 (unless | **Stretching\       |
| noted)**                                       | Exercises**         |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 30                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | 26                  |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | 34                  |
+------------------------------------------------+---------------------+
| > Asian                                        | 34                  |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | 42                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 26                  |
+------------------------------------------------+---------------------+
| > White                                        | 30                  |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | 22                  |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | 31                  |
+------------------------------------------------+---------------------+
| > Black or African American                    | 27                  |
+------------------------------------------------+---------------------+
| > White                                        | 31                  |
+------------------------------------------------+---------------------+
| ###### Gender                                  |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 30                  |
+------------------------------------------------+---------------------+
| > Male                                         | 30                  |
+------------------------------------------------+---------------------+
| **Family income level**                        |                     |
+------------------------------------------------+---------------------+
| > Below poverty                                | 21                  |
+------------------------------------------------+---------------------+
| > Near poverty                                 | 24                  |
+------------------------------------------------+---------------------+
| > Middle/high income                           | 34                  |
+------------------------------------------------+---------------------+
| **Education level** (aged 25 years and older)  |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 16                  |
+------------------------------------------------+---------------------+
| > High school graduate                         | 23                  |
+------------------------------------------------+---------------------+
| > At least some college                        | 36                  |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 32                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 25                  |
+------------------------------------------------+---------------------+
| **Disability status**                          |                     |
+------------------------------------------------+---------------------+
| > Persons with activity limitations            | 29 (1995)           |
+------------------------------------------------+---------------------+
| > Persons without activity limitations         | 31 (1995)           |
+------------------------------------------------+---------------------+
| **Select populations**                         |                     |
+------------------------------------------------+---------------------+
| Age groups                                     |                     |
+------------------------------------------------+---------------------+
| > 18 to 24 years                               | 36                  |
+------------------------------------------------+---------------------+
| > 25 to 44 years                               | 32                  |
+------------------------------------------------+---------------------+
| > 45 to 64 years                               | 28                  |
+------------------------------------------------+---------------------+
| > 65 to 74 years                               | 24                  |
+------------------------------------------------+---------------------+
| > 75 years and older                           | 22                  |
+------------------------------------------------+---------------------+
| > Persons with arthritis symptoms              | DNA                 |
+------------------------------------------------+---------------------+
| > Persons without arthritis symptoms           | DNA                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

All adults could benefit from physical activities designed to ensure
functional independence throughout life. The specific physical fitness
components that provide continued physical function as persons age
include muscular strength/endurance and flexibility. Examples of these
activities include weight training, resistance activities (using elastic
bands or dumbbells), and stretching exercises (such as static
stretching, yoga, or T'ai Chi Chuan).

Effective treatment of many chronic diseases and disorders has resulted
in more years of life, but many of these extra years are spent with
disabling conditions that prevent independent living and reduce the
quality of life. Strengthening activities, while important for all age
groups, are particularly important for older adults. Muscle strength
declines with age, and there is a demonstrated relationship between
muscle strength and physical function.[^19] Age-related loss of strength
may be lessened by strengthening exercises, enabling an individual to
maintain a threshold level of strength necessary to perform basic
weight-bearing activities, such as walking.[^20]**^,^** [^21] Strength
training also has been shown to preserve bone density in postmenopausal
women.Error: Reference source not found

Physical activities that improve muscular strength/endurance and
flexibility also improve the ability to perform tasks of daily living
and may improve balance, thus preventing falls.Error: Reference source
not found Activities of daily living have been identified as a scale to
measure dependencies in basic self-care and other functions important
for independent living and to avoid institutionalization. The
performance of routine daily activities is particularly important to
maintaining functional independence and social integration in older
adults.Error: Reference source not found

Although flexibility may appear to be a minor component of physical
fitness, the consequence of rigid joints affects all aspects of life,
including walking, stooping, sitting, avoiding falls, and driving a
vehicle. Lack of joint flexibility may adversely affect quality of life
and will lead to eventual disability.[^22] Activities such as static
stretching or T'ai Chi Chuan routines, which consist of slow, graceful
movements with low impact, have great promise for maintaining
flexibility and can be appropriate for adults of any age.[^23]
Increasing public awareness of all these potential benefits of muscle
strengthening and flexibility activities---and developing and making
quality programs available and accessible---may encourage the pursuit of
activities that promote muscular strength/endurance and flexibility.

### Physical Activity in Children and Adolescents

22-6. Increase the proportion of adolescents who engage\
in moderate physical activity for at least 30 minutes on\
5 or more of the previous 7 days.

**Target:** 35 percent.

**Baseline:** 27 percent of students in grades 9 through 12 engaged in
moderate physical activity for at least 30 minutes on 5 or more of the
previous 7 days in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

+-----------------------------+------------+------------+------------+
| **Students in Grades 9\     | **Moderate |            |            |
| Through 12, 1999 (unless    | Physical   |            |            |
| noted)**                    | Activity** |            |            |
+=============================+============+============+============+
|                             | **22-6.\   | **F        | *          |
|                             | Both\      | emales\*** | *Males\*** |
|                             | Genders**  |            |            |
+-----------------------------+------------+------------+------------+
|                             | Percent    |            |            |
+-----------------------------+------------+------------+------------+
| > **TOTAL**                 | 27         | 24         | 29         |
+-----------------------------+------------+------------+------------+
| **Race and ethnicity**      |            |            |            |
+-----------------------------+------------+------------+------------+
| > American Indian or        | DSU        | DSU        | DSU        |
| > Alaska\                   |            |            |            |
| > Native                    |            |            |            |
+-----------------------------+------------+------------+------------+
| > Asian or Pacific Islander | DSU        | DSU        | DSU        |
+-----------------------------+------------+------------+------------+
| > Asian                     | DSU        | DSU        | DSU        |
+-----------------------------+------------+------------+------------+
| > Native Hawaiian and other | DSU        | DSU        | DSU        |
| > Pacific Islander          |            |            |            |
+-----------------------------+------------+------------+------------+
| > Black or African American | 17         | 17         | 24         |
+-----------------------------+------------+------------+------------+
| > White                     | 27         | 27         | 31         |
+-----------------------------+------------+------------+------------+
|                             |            |            |            |
+-----------------------------+------------+------------+------------+
| > Hispanic or Latino        | 21         | 17         | 26         |
+-----------------------------+------------+------------+------------+
| > Not Hispanic or Latino    | 27         | 25         | 30         |
+-----------------------------+------------+------------+------------+
| > Black or African American | 21         | 18         | 24         |
+-----------------------------+------------+------------+------------+
| > White                     | 29         | 26         | 32         |
+-----------------------------+------------+------------+------------+
| **Parents' education        |            |            |            |
| level**                     |            |            |            |
+-----------------------------+------------+------------+------------+
| > Less than high school     | 25 (1997)  | 25 (1997)  | 24 (1997)  |
+-----------------------------+------------+------------+------------+
| > High school graduate      | 21 (1997)  | 20 (1997)  | 21 (1997)  |
+-----------------------------+------------+------------+------------+
| > At least some college     | 20 (1997)  | 19 (1997)  | 20 (1997)  |
+-----------------------------+------------+------------+------------+
| ###### Select populations   |            |            |            |
+-----------------------------+------------+------------+------------+
| Grade levels                |            |            |            |
+-----------------------------+------------+------------+------------+
| > 9th grade                 | 28         | 26         | 31         |
+-----------------------------+------------+------------+------------+
| > 10th grade                | 26         | 25         | 27         |
+-----------------------------+------------+------------+------------+
| > 11th grade                | 25         | 21         | 29         |
+-----------------------------+------------+------------+------------+
| > 12th grade                | 27         | 24         | 29         |
+-----------------------------+------------+------------+------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

\*Data for females and males are displayed to further characterize the
issue.

22-7. Increase the proportion of adolescents who engage in\
vigorous physical activity that promotes cardiorespiratory fitness 3 or
more days per week for 20 or more minutes per occasion.

**Target:** 85 percent.

**Baseline:** 65 percent of students in grades 9 through 12 engaged in
vigorous physical activity 3 or more days per week for 20 or more
minutes per occasion\
in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

Note: The table below may continue to the following page.

+-----------------------------+------------+------------+------------+
| **Students in Grades 9\     | **Vigorous |            |            |
| Through 12, 1999 (unless    | Physical   |            |            |
| noted)**                    | Activity** |            |            |
+=============================+============+============+============+
|                             | **22-7.\   | **F        | *          |
|                             | Both\      | emales\*** | *Males\*** |
|                             | Genders**  |            |            |
+-----------------------------+------------+------------+------------+
|                             | Percent    |            |            |
+-----------------------------+------------+------------+------------+
| > **TOTAL**                 | 65         | 57         | 72         |
+-----------------------------+------------+------------+------------+
| ###### Race and ethnicity   |            |            |            |
+-----------------------------+------------+------------+------------+
| > American Indian or        | DSU        | DSU        | DSU        |
| > Alaska\                   |            |            |            |
| > Native                    |            |            |            |
+-----------------------------+------------+------------+------------+
| > Asian or Pacific Islander | DSU        | DSU        | DSU        |
+-----------------------------+------------+------------+------------+
| > Asian                     | DSU        | DSU        | DSU        |
+-----------------------------+------------+------------+------------+
| > Native Hawaiian and other | DSU        | DSU        | DSU        |
| > Pacific Islander          |            |            |            |
+-----------------------------+------------+------------+------------+
| > Black or African American | 56         | 49         | 64         |
+-----------------------------+------------+------------+------------+
| > White                     | 68         | 60         | 75         |
+-----------------------------+------------+------------+------------+
|                             |            |            |            |
+-----------------------------+------------+------------+------------+
| > Hispanic or Latino        | 61         | 50         | 72         |
+-----------------------------+------------+------------+------------+
| > Not Hispanic or Latino    | 65         | 58         | 73         |
+-----------------------------+------------+------------+------------+
| > Black or African American | 56         | 47         | 65         |
+-----------------------------+------------+------------+------------+
| > White                     | 67         | 60         | 75         |
+-----------------------------+------------+------------+------------+
| #####                       |            |            |            |
| # Parents' education level  |            |            |            |
+-----------------------------+------------+------------+------------+
| > Less than high school     | 50 (1997)  | 43 (1997)  | 60 (1997)  |
+-----------------------------+------------+------------+------------+
| > High school graduate      | 54 (1997)  | 45 (1997)  | 62 (1997)  |
+-----------------------------+------------+------------+------------+
| > At least some college     | 68 (1997)  | 57 (1997)  | 75 (1997)  |
+-----------------------------+------------+------------+------------+
| ####### Select populations  |            |            |            |
+-----------------------------+------------+------------+------------+
| ###### Grade levels         |            |            |            |
+-----------------------------+------------+------------+------------+
| > 9th grade                 | 73         | 68         | 77         |
+-----------------------------+------------+------------+------------+
| > 10th grade                | 65         | 56         | 73         |
+-----------------------------+------------+------------+------------+
| > 11th grade                | 58         | 49         | 67         |
+-----------------------------+------------+------------+------------+
| > 12th grade                | 61         | 52         | 71         |
+-----------------------------+------------+------------+------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

\*Data for females and males are displayed to further characterize the
issue.

Note: The table above may have continued from the previous page.

22-8. Increase the proportion of the Nation's public and private schools
that require daily physical education for all\
students.

Target and baseline:

  ------------ --------------------------------- ------------- -------------
  Objective    Increase in Schools Requiring     1994\         2010\
               Daily Physical Activity for All   Baseline      Target
               Students                                        

                                                 *Percent*     

  **22-8a.**   Middle and junior high schools    17            25

  **22-8b.**   Senior high schools               2             5
  ------------ --------------------------------- ------------- -------------

**Target setting method:** 47 percent improvement for middle and junior
high schools; 150 percent improvement for senior high schools.

**Data source:** School Health Policies and Programs Study (SHPPS), CDC,
NCCDPHP.

22-9. Increase the proportion of adolescents who participate\
in daily school physical education.

**Target:** 50 percent.

**Baseline:** 29 percent of students in grades 9 through 12 participated
in daily school physical education in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

+-----------------------------+-------------+------------+------------+
| **Students in Grades 9\     | **Daily     |            |            |
| Through 12, 1999 (unless    | School      |            |            |
| noted)**                    | Physical    |            |            |
|                             | Education** |            |            |
+=============================+=============+============+============+
|                             | **22-9.\    | **F        | *          |
|                             | Both\       | emales\*** | *Males\*** |
|                             | Genders**   |            |            |
+-----------------------------+-------------+------------+------------+
|                             | Percent     |            |            |
+-----------------------------+-------------+------------+------------+
| > **TOTAL**                 | 29          | 26         | 32         |
+-----------------------------+-------------+------------+------------+
| **Race and ethnicity**      |             |            |            |
+-----------------------------+-------------+------------+------------+
| > American Indian or        | DSU         | DSU        | DSU        |
| > Alaska\                   |             |            |            |
| > Native                    |             |            |            |
+-----------------------------+-------------+------------+------------+
| > Asian or Pacific Islander | DSU         | DSU        | DSU        |
+-----------------------------+-------------+------------+------------+
| > Asian                     | DSU         | DSU        | DSU        |
+-----------------------------+-------------+------------+------------+
| > Native Hawaiian and other | DSU         | DSU        | DSU        |
| > Pacific Islander          |             |            |            |
+-----------------------------+-------------+------------+------------+
| > Black or African American | 28          | 25         | 33         |
+-----------------------------+-------------+------------+------------+
| > White                     | 28          | 26         | 31         |
+-----------------------------+-------------+------------+------------+
|                             |             |            |            |
+-----------------------------+-------------+------------+------------+
| > Hispanic or Latino        | 40          | 36         | 45         |
+-----------------------------+-------------+------------+------------+
| > Not Hispanic or Latino    | 28          | 25         | 30         |
+-----------------------------+-------------+------------+------------+
| > Black or African American | 29          | 26         | 33         |
+-----------------------------+-------------+------------+------------+
| > White                     | 28          | 26         | 31         |
+-----------------------------+-------------+------------+------------+
| #####                       |             |            |            |
| # Parents' education level  |             |            |            |
+-----------------------------+-------------+------------+------------+
| > Less than high school     | 29 (1997)   | 28 (1997)  | 30 (1997)  |
+-----------------------------+-------------+------------+------------+
| > High school graduate      | 24 (1997)   | 22 (1997)  | 27 (1997)  |
+-----------------------------+-------------+------------+------------+
| > At least some college     | 28 (1997)   | 25 (1997)  | 30 (1997)  |
+-----------------------------+-------------+------------+------------+
| ###### Select populations   |             |            |            |
+-----------------------------+-------------+------------+------------+
| Grade levels                |             |            |            |
+-----------------------------+-------------+------------+------------+
| > 9th grade                 | 42          | 40         | 44         |
+-----------------------------+-------------+------------+------------+
| > 10th grade                | 30          | 28         | 33         |
+-----------------------------+-------------+------------+------------+
| > 11th grade                | 20          | 17         | 24         |
+-----------------------------+-------------+------------+------------+
| > 12th grade                | 20          | 17         | 24         |
+-----------------------------+-------------+------------+------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

\*Data for females and males are displayed to further characterize the
issue.

22-10. Increase the proportion of adolescents who spend at least 50
percent of school physical education class time being physically active.

**Target:** 50 percent.

**Baseline:** 38 percent of students in grades 9 through 12 were
physically active\
in physical education class more than 20 minutes 3 to 5 days per week in
1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

+-----------------------------+-------------+------------+-------------+
| **Students in Grades 9\     | *           |            |             |
| Through 12, 1999 (unless    | *Physically |            |             |
| noted)**                    | Active in   |            |             |
|                             | Physical\   |            |             |
|                             | Education   |            |             |
|                             | Classes**   |            |             |
+=============================+=============+============+=============+
|                             | **22-10.\   | **F        | **Males\*** |
|                             | Both\       | emales\*** |             |
|                             | Genders**   |            |             |
+-----------------------------+-------------+------------+-------------+
|                             | Percent     |            |             |
+-----------------------------+-------------+------------+-------------+
| > **TOTAL**                 | 38          | 32         | 45          |
+-----------------------------+-------------+------------+-------------+
| **Race and ethnicity**      |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > American Indian or        | DSU         | DSU        | DSU         |
| > Alaska\                   |             |            |             |
| > Native                    |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > Asian or Pacific Islander | DSU         | DSU        | DSU         |
+-----------------------------+-------------+------------+-------------+
| > Asian                     | DSU         | DSU        | DSU         |
+-----------------------------+-------------+------------+-------------+
| > Native Hawaiian and other | DSU         | DSU        | DSU         |
| > Pacific Islander          |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > Black or African American | 32          | 24         | 41          |
+-----------------------------+-------------+------------+-------------+
| > White                     | 40          | 33         | 46          |
+-----------------------------+-------------+------------+-------------+
|                             |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > Hispanic or Latino        | 41          | 35         | 47          |
+-----------------------------+-------------+------------+-------------+
| > Not Hispanic or Latino    | 38          | 31         | 45          |
+-----------------------------+-------------+------------+-------------+
| > Black or African American | 32          | 25         | 37          |
+-----------------------------+-------------+------------+-------------+
| > White                     | 40          | 33         | 45          |
+-----------------------------+-------------+------------+-------------+
| #####                       |             |            |             |
| # Parents' education level  |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > Less than high school     | 28 (1997)   | 25 (1997)  | 32 (1997)   |
+-----------------------------+-------------+------------+-------------+
| > High school graduate      | 29 (1997)   | 24 (1997)  | 35 (1997)   |
+-----------------------------+-------------+------------+-------------+
| > At least some college     | 33 (1997)   | 27 (1997)  | 37 (1997)   |
+-----------------------------+-------------+------------+-------------+
| ###### Select populations   |             |            |             |
+-----------------------------+-------------+------------+-------------+
| Grade levels                |             |            |             |
+-----------------------------+-------------+------------+-------------+
| > 9th grade                 | 55          | 48         | 62          |
+-----------------------------+-------------+------------+-------------+
| > 10th grade                | 41          | 35         | 47          |
+-----------------------------+-------------+------------+-------------+
| > 11th grade                | 29          | 24         | 35          |
+-----------------------------+-------------+------------+-------------+
| > 12th grade                | 24          | 16         | 32          |
+-----------------------------+-------------+------------+-------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

\*Data for females and males are displayed to further characterize the
issue.

22-11. Increase the proportion of adolescents who view television 2 or
fewer hours on a school day.

**Target:** 75 percent.

**Baseline:** 57 percent of students in grades 9 through 12 viewed
television 2 or fewer hours per school day in 1999.

**Target setting method:** Better than the best.

**Data source:** Youth Risk Behavior Surveillance System (YRBSS), CDC,
NCCDPHP.

Note: The table below may continue to the following page.

+--------------------------------------------------+-------------------+
| **Students in Grades 9 through 12, 1999**        | **Television 2 or |
|                                                  | Fewer Hours\      |
|                                                  | per School Day**  |
+==================================================+===================+
|                                                  | Percent           |
+--------------------------------------------------+-------------------+
| > **TOTAL**                                      | 57                |
+--------------------------------------------------+-------------------+
| **Race and ethnicity**                           |                   |
+--------------------------------------------------+-------------------+
| > American Indian or Alaska Native               | DSU               |
+--------------------------------------------------+-------------------+
| > Asian or Pacific Islander                      | DSU               |
+--------------------------------------------------+-------------------+
| > Asian                                          | DSU               |
+--------------------------------------------------+-------------------+
| > Native Hawaiian and other Pacific Islander     | DSU               |
+--------------------------------------------------+-------------------+
| > Black or African American                      | 28                |
+--------------------------------------------------+-------------------+
| > White                                          | 66                |
+--------------------------------------------------+-------------------+
|                                                  |                   |
+--------------------------------------------------+-------------------+
| > Hispanic or Latino                             | 48                |
+--------------------------------------------------+-------------------+
| > Not Hispanic or Latino                         | DNA               |
+--------------------------------------------------+-------------------+
| > Black or African American                      | 26                |
+--------------------------------------------------+-------------------+
| > White                                          | 66                |
+--------------------------------------------------+-------------------+
| **Gender**                                       |                   |
+--------------------------------------------------+-------------------+
| > Female                                         | 59                |
+--------------------------------------------------+-------------------+
| > Male                                           | 56                |
+--------------------------------------------------+-------------------+
| ###### Parents' education level                  |                   |
+--------------------------------------------------+-------------------+
| > Less than high school                          | DNC               |
+--------------------------------------------------+-------------------+
| > High school graduate                           | DNC               |
+--------------------------------------------------+-------------------+
| > At least some college                          | DNC               |
+--------------------------------------------------+-------------------+
| ###### Select populations                        |                   |
+--------------------------------------------------+-------------------+
| ###### Grade levels                              |                   |
+--------------------------------------------------+-------------------+
| > 9th grade                                      | 49                |
+--------------------------------------------------+-------------------+
| > 10th grade                                     | 54                |
+--------------------------------------------------+-------------------+
| > 11th grade                                     | 62                |
+--------------------------------------------------+-------------------+
| > 12th grade                                     | 67                |
+--------------------------------------------------+-------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: The table above may have continued from the previous page.

The health benefits of moderate and vigorous physical activity are not
limited to adults. Physical activity among children and adolescents is
important because of the related health benefits (cardiorespiratory
function, blood pressure control, and weight management) and because a
physically active lifestyle adopted early in life may continue into
adulthood. Even among children aged 3 to 4 years, those who were less
active tended to remain less active after age 3 years than most of their
peers.[^24] These findings highlight the need for parents, educators,
and health care providers to become positive role models and to be
involved actively in the promotion of physical activity and fitness in
children and adolescents.

Many children are less physically active than recommended, and physical
activity declines during adolescence.[^25]**^,^** [^26] One study found
that one-quarter of U.S. children spend 4 hours or more watching
television daily.[^27] Schools are an efficient vehicle for providing
physical activity and fitness instruction because they reach most
children and adolescents. Participation in school physical education
ensures a minimum amount of physical activity and provides a forum to
teach physical activity strategies and activities that can be continued
into adulthood. Findings suggest that the quantity and, in particular,
the quality of school physical education programs have a significant
positive effect on the health-related fitness of children and
adolescents by increasing their participation in moderate to vigorous\
activities.[^28]**^,^** [^29]

Studies have shown that spending 50 percent of physical education class
time on physical activity is an ambitious but feasible target. Being
active for at least half of physical education class time on at least
half of the school days would provide a substantial portion of the
physical activity time recommended for adolescents.[^30] To achieve the
benefits of school-based physical education equitably for all children,
daily adaptive physical education programs should be available for
children with special needs. School physical education requirements also
are recommended for students in preschool and postsecondary
programs.[^31]

Physical education is the primary source of physical activity and
fitness instruction. Health education and other courses, however, can
highlight the importance of physical activity as a component of a
healthy lifestyle. A well-designed health education curriculum can help
students develop the knowledge, attitudes, behavioral skills, and
confidence needed to adopt and maintain physically active
lifestyles.Error: Reference source not found To maximize classroom time,
instruction on physical activity also can be integrated into the lesson
plans of other school subjects, such as mathematics, biology, and
language arts. Programs that have included classroom instruction in
physical activity have been effective in enhancing students' physical
activity-related knowledge,[^32] attitudes,[^33] behavior,[^34] and
physical fitness.[^35] (See Focus Area 7. Educational and
Community-Based Programs.)

### Access

22-12. (Developmental) Increase the proportion of the Nation's public
and private schools that provide access to their physical activity
spaces and facilities for all persons\
outside of normal school hours (that is, before and after the school
day, on weekends, and during summer and other vacations).

**Potential data source:** School Health Policies and Programs Study
(SHPPS), CDC, NCCDPHP.

22-13. Increase the proportion of worksites offering employer-sponsored
physical activity and fitness programs.

**Target:** 75 percent.

**Baseline:** 46 percent of worksites with 50 or more employees offered
physical activity and/or fitness programs at the worksite or through
their health plans in 1998--1999.

+---------------------+--------------+-----------------+--------------+
| Worksite Size       | Worksite or  | Health Plan     | Worksite     |
|                     | Health Plan  |                 |              |
+=====================+==============+=================+==============+
|                     | *Percent*    |                 |              |
+---------------------+--------------+-----------------+--------------+
| Total (50 or more   | 46           | 22              | 36           |
| employees)          |              |                 |              |
+---------------------+--------------+-----------------+--------------+
| 50 to 99 employees  | 38           | 21              | 24           |
+---------------------+--------------+-----------------+--------------+
| 100 to 249          | 42           | 20              | 31           |
| employees           |              |                 |              |
+---------------------+--------------+-----------------+--------------+
| 250 to 749          | 56           | 25              | 44           |
| employees           |              |                 |              |
+---------------------+--------------+-----------------+--------------+
| 750 or more         | 68           | 27              | 61           |
| employees           |              |                 |              |
+---------------------+--------------+-----------------+--------------+
| Less than 50        | ######## D   |                 |              |
| employees           | evelopmental |                 |              |
+---------------------+--------------+-----------------+--------------+

**Target setting method:** Better than the best.

**Data source:** National Worksite Health Promotion Survey, Association
for\
Worksite Health Promotion (AWHP).

Participation in regular physical activity depends, in part, on the
availability and proximity of community facilities and on environments
conducive to physical activity. Studies of adult participation in
physical activity have found that use generally decreases as facility
distance from a person's residence increases.[^36] People are unlikely
to use community resources located more than a few miles away by car or
more than a few minutes away by biking or walking.

One of the major barriers to youth participation in sports is lack of
enough sports facilities.[^37] Increased access to community physical
activity facilities would, therefore, help increase youth physical
activity. The availability of school facilities for physical activity
programs also may be beneficial for crime and violence prevention and
other social programs,Error: Reference source not found because most
juvenile crime is committed between 3 and 8 p.m.

Schools need to work with community coalitions and community-based
physical activity programs to take maximum advantage of school
facilities for the benefit of children and adolescents and the community
as a whole. The needs of all community members, including senior
citizens and people with disabilities, need to be considered.

Worksite physical activity and fitness programs provide a mechanism for
reaching large numbers of adults and have at least short-term
effectiveness in increasing the physical activity and fitness of program
participants.[^38] Such programs should be provided in a culturally and
linguistically competent manner. Evidence that worksite programs are
cost-effective is growing. Such programs may even reduce employer costs
for insurance premiums, disability benefits, and medical expenses.[^39]
Additional benefits for employers include increased productivity,
reduced absenteeism, reduced employee turnover, improved morale,
enhanced company image, and enhanced recruitment. Including family
members and retirees in worksite programs can further increase benefits
to employers and the community.Error: Reference source not found

As purchasers of group health and life insurance plans, employers can
design employee benefit packages that include coverage for fitness club
membership fees and community-based fitness classes. Employers also can
offer reduced insurance premiums and rebates for employees who
participate regularly in worksite fitness programs or who can document
participation in regular physical activity.

22-14. Increase the proportion of trips made by walking.

Target and baseline:

  ------------------------------------------------------------------------------
  Objective     Increase in Trips\      Length of Trip   1995\        2010\
                Made by Walking                          Baseline\*   Target
  ------------- ----------------------- ---------------- ------------ ----------
                                        *Percent*                     

  **22-14a.**   Adults aged 18 years    Trips of 1 mile\ 17           25
                and older               or less                       

  **22-14b.**   Children and            Trips to school  31           50
                adolescents\            of\                           
                aged 5 to15 years       1 mile or less                
  ------------------------------------------------------------------------------

\*Age adjusted to the year 2000 standard population.

**Target setting method:** 47 percent improvement for 22-14a and 68
percent improvement for 22-14b. (Better than the best will be used when
data are available.)

**Data source:** Nationwide Personal Transportation Survey (NPTS), DOT.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Adults Aged 18 Years and Older, 1995**       | **22-14a.\          |
|                                                | Trips of 1 Mile or  |
|                                                | Less Made by        |
|                                                | Walking\            |
|                                                | **                  |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 17                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DNC                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DNC                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | DNC                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 17                  |
+------------------------------------------------+---------------------+
| > Male                                         | 16                  |
+------------------------------------------------+---------------------+
| **Education level**                            |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 20                  |
+------------------------------------------------+---------------------+
| > High school graduate                         | 14                  |
+------------------------------------------------+---------------------+
| > At least some college                        | 18                  |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 18                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 9                   |
+------------------------------------------------+---------------------+
| ###### Select populations                      |                     |
+------------------------------------------------+---------------------+
| ###### Age groups                              |                     |
+------------------------------------------------+---------------------+
| > 18 to 24 years                               | 22                  |
+------------------------------------------------+---------------------+
| > 25 to 44 years                               | 17                  |
+------------------------------------------------+---------------------+
| > 45 to 64 years                               | 14                  |
+------------------------------------------------+---------------------+
| > 65 to 74 years                               | 16                  |
+------------------------------------------------+---------------------+
| > 75 years and older                           | 19                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Children and Adolescents Aged 5 to 15 Years, | **22-14b.\          |
| 1995**                                         | Trips to School of  |
|                                                | 1 Mile or Less Made |
|                                                | by Walking\         |
|                                                | **                  |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 31                  |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DNC                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DNC                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | DNC                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 27                  |
+------------------------------------------------+---------------------+
| > Male                                         | 35                  |
+------------------------------------------------+---------------------+
| **Parents' education level**                   |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | DNC                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | DNC                 |
+------------------------------------------------+---------------------+
| > At least some college                        | DNC                 |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 32                  |
+------------------------------------------------+---------------------+
| > Rural                                        | 27                  |
+------------------------------------------------+---------------------+
| ####### Select populations                     |                     |
+------------------------------------------------+---------------------+
| Age groups                                     |                     |
+------------------------------------------------+---------------------+
| > 5 to 9 years                                 | 27                  |
+------------------------------------------------+---------------------+
| > 10 to 15 years                               | 35                  |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Walking is a very popular form of physical activity in the United
States; however, people need the opportunity to walk safely. Over 75
percent of all trips less than 1 mile were made by automobile in
1995.[^40] In addition, the number of walking trips as a percentage of
all trips taken (of any distance) has declined over the years. Walking
trips made by adults dropped from 9.3 percent in 1977 to 7.2 percent in
1990 and again to 5.4 percent in 1995. Walking has declined even more
sharply for children.Error: Reference source not found These declines
have negative implications for the health of adults and children.

22-15. Increase the proportion of trips made by bicycling.

Target and baseline:

  ----------------------------------------------------------------------------------
  Objective     Increase in Trips\     Activity       1995\              2010\
                Made by Bicycling                     Baseline\*         Target
  ------------- ---------------------- -------------- ------------ ----- -----------
                                       *Percent*                         

  **22-15a.**   Adults aged 18 years   Trips of 5     0.6          2.0   
                and older              miles\                            
                                       or less                           

  **22-15b.**   Children and           Trips to       2.4          5.0   
                adolescents\           school of\                        
                aged 5 to15 years      2 miles or                        
                                       less                              
  ----------------------------------------------------------------------------------

\*Age adjusted to the year 2000 standard population.

**Target setting method:** 233 percent improvement for 22-15a and 108
percent improvement for 22-15b. (Better than the best will be used when
data are\
available.)

**Data source:** Nationwide Personal Transportation Survey (NPTS), DOT.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Adults Aged 18 Years and Older, 1995**       | **22-15a.\          |
|                                                | Trips of 5 Miles or |
|                                                | Less Made by\       |
|                                                | Bicycling\          |
|                                                | **                  |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 0.6                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DNC                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DNC                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | DNC                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
| ###### Gender                                  |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 0.3                 |
+------------------------------------------------+---------------------+
| > Male                                         | 0.9                 |
+------------------------------------------------+---------------------+
| **Education level**                            |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | 0.6                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | 0.5                 |
+------------------------------------------------+---------------------+
| > At least some college                        | 0.6                 |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 0.6                 |
+------------------------------------------------+---------------------+
| > Rural                                        | 0.3                 |
+------------------------------------------------+---------------------+
| ###### Age groups                              |                     |
+------------------------------------------------+---------------------+
| > 18 to 24 years                               | 1.4                 |
+------------------------------------------------+---------------------+
| > 25 to 44 years                               | 0.6                 |
+------------------------------------------------+---------------------+
| > 45 to 64 years                               | 0.3                 |
+------------------------------------------------+---------------------+
| > 65 to 74 years                               | 0.3                 |
+------------------------------------------------+---------------------+
| > 75 years and older                           | 0.1                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Note: The table below may continue to the following page.

+------------------------------------------------+---------------------+
| **Children and Adolescents Aged 5 to 15 Years, | **22-15b.\          |
| 1995**                                         | Trips to School of  |
|                                                | 2 Miles or Less     |
|                                                | Made by Bicycling\  |
|                                                | **                  |
+================================================+=====================+
|                                                | Percent             |
+------------------------------------------------+---------------------+
| > **TOTAL**                                    | 2.4                 |
+------------------------------------------------+---------------------+
| **Race and ethnicity**                         |                     |
+------------------------------------------------+---------------------+
| > American Indian or Alaska Native             | DNC                 |
+------------------------------------------------+---------------------+
| > Asian or Pacific Islander                    | DNC                 |
+------------------------------------------------+---------------------+
| > Asian                                        | DNC                 |
+------------------------------------------------+---------------------+
| > Native Hawaiian and other Pacific Islander   | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
|                                                |                     |
+------------------------------------------------+---------------------+
| > Hispanic or Latino                           | DNC                 |
+------------------------------------------------+---------------------+
| > Not Hispanic or Latino                       | DNC                 |
+------------------------------------------------+---------------------+
| > Black or African American                    | DNC                 |
+------------------------------------------------+---------------------+
| > White                                        | DNC                 |
+------------------------------------------------+---------------------+
| **Gender**                                     |                     |
+------------------------------------------------+---------------------+
| > Female                                       | 1.7                 |
+------------------------------------------------+---------------------+
| > Male                                         | 3.2                 |
+------------------------------------------------+---------------------+
| **Parents' education level**                   |                     |
+------------------------------------------------+---------------------+
| > Less than high school                        | DNC                 |
+------------------------------------------------+---------------------+
| > High school graduate                         | DNC                 |
+------------------------------------------------+---------------------+
| > At least some college                        | DNC                 |
+------------------------------------------------+---------------------+
| **Geographic location**                        |                     |
+------------------------------------------------+---------------------+
| > Urban                                        | 2.6                 |
+------------------------------------------------+---------------------+
| > Rural                                        | 1.1                 |
+------------------------------------------------+---------------------+
| ###### Select populations                      |                     |
+------------------------------------------------+---------------------+
| Age groups                                     |                     |
+------------------------------------------------+---------------------+
| > 5 to 9 years                                 | 1.6                 |
+------------------------------------------------+---------------------+
| > 10 to 15 years                               | 3.0                 |
+------------------------------------------------+---------------------+

DNA = Data have not been analyzed. DNC = Data are not collected. DSU =
Data are statistically unreliable.

Note: Age adjusted to the year 2000 standard population.

Note: The table above may have continued from the previous page.

Bicycling is another form of transportation that may be used by both
children and adults for distances that may not be feasible, practical,
or efficient to cover by walking. If the environment does not provide
safe opportunities for physical activities such as walking and
bicycling, adults and children likely will spend more time engaging in
sedentary activities indoors. (See Focus Area 8. Environmental Health.)
Sedentary activities such as watching television, playing video games,
and using personal computers have contributed to increases in the cases
of overweight individuals.Error: Reference source not found

## Related Objectives From Other Focus Areas

1\. Access to Quality Health Services

1-2. Health insurance coverage for clinical preventive services

1-3. Counseling about health behaviors

2\. Arthritis, Osteoporosis, and Chronic Back Conditions

2-2. Activity limitations due to arthritis

2-3. Personal care limitations

2-8. Arthritis education

2-9. Cases of osteoporosis

2-11. Activity limitations due to chronic back conditions

3\. Cancer

3-5. Colorectal cancer deaths

3-7. Prostate cancer deaths

3-9. Sun exposure and skin cancer

3-10. Provider counseling about cancer prevention

4\. Chronic Kidney Disease

4-8. Medical therapy for persons with diabetes and proteinuria

5\. Diabetes

5-1. Diabetes education

5-2. New cases of diabetes

5-3. Overall cases of diagnosed diabetes

5-4. Diagnosis of diabetes

5-5. Diabetes deaths

5-6. Diabetes-related deaths

5-7. Cardiovascular disease deaths in persons with diabetes

6\. Disability and Secondary Conditions

6-2. Feelings and depression among children with disabilities

6-3. Feelings and depression interfering with activities among adults
with\
disabilities

6-4. Social participation among adults with disabilities

6-9. Inclusion of children and youth with disabilities in regular
education\
programs

6-10. Accessibility of health and wellness programs

6-12. Environmental barriers affecting participation in activities

6-13. Surveillance and health promotion programs

7\. Educational and Community-Based Programs

7-2. School health education

7-3. Health-risk behavior information for college and university
students

7-5. Worksite health promotion programs

7-6. Participation in employer-sponsored health promotion activities

7-7. Patient and family education

7-9. Health care organization sponsorship of community health promotion\
activities

7-10. Community health promotion programs

7-11. Culturally appropriate and linguistically competent community
health\
promotion programs

7-12. Older adult participation in community health promotion activities

8\. Environmental Health

8-1. Harmful air pollutants

8-2. Alternative modes of transportation

8-9. Beach closings

8-20. School policies to protect against environmental hazards

9\. Family Planning

9-11. Pregnancy prevention education

11\. Health Communication

11-1. Households with Internet access

11-4. Quality of Internet health information sources

12\. Heart Disease and Stroke

12-1. Coronary heart disease (CHD) deaths

12-7. Stroke deaths

12-9. High blood pressure

12-10. High blood pressure control

12-11. Action to help control blood pressure

12-13. Mean total blood cholesterol levels

12-14. High blood cholesterol levels

12-16. LDL-cholesterol level in CHD patients

15\. Injury and Violence Prevention

15-1. Nonfatal head injuries

15-2. Nonfatal spinal cord injuries

15-13. Deaths from unintentional injuries

15-14. Nonfatal unintentional injuries

15-16. Pedestrian deaths

15-18. Nonfatal pedestrian injuries

15-21. Motorcycle helmet use

15-23. Bicycle helmet use

15-24. Bicycle helmet laws

15-27. Deaths from falls

15-28. Hip fractures

15-29. Drownings

15-31. Injury protection in school sports

16\. Maternal, Infant, and Child Health

16-3. Adolescent and young adult deaths

16-12. Weight gain during pregnancy

17\. Medical Product Safety

17-2. Linked, automated information systems

17-3. Provider review of medications taken by patients

17-5. Receipt of oral counseling about medications from prescribers and\
dispensers

18\. Mental Health and Mental Disorders

18-5. Eating disorder relapses

18-7. Treatment for children with mental health problems

18-9. Treatment for adults with mental disorders

19\. Nutrition and Overweight

19-1. Healthy weight in adults

19-2. Obesity in adults

19-3. Overweight or obesity in children and adolescents

19-16. Worksite promotion of nutrition education and weight management

20\. Occupational Safety and Health

20-1. Work-related injury deaths

20-2. Work-related injuries

20-3. Overextension or repetitive motion

20-9. Worksite stress reduction programs

23\. Public Health Infrastructure

23-2. Public access to information and surveillance data

23-5. Data for Leading Health Indicators, Health Status Indicators,\
and Priority Data Needs at Tribal, State, and local levels

23-17. Population-based prevention research

24\. Respiratory Diseases

24-1. Deaths from asthma

24-2. Hospitalizations for asthma

24-3. Hospital emergency department visits for asthma

24-4. Activity limitations

24-5. School or work days lost

24-6. Patient education

24-7. Appropriate asthma care

25\. Sexually Transmitted Diseases

25-11. Responsible adolescent sexual behavior

25-12. Responsible sexual behavior messages on television

26\. Substance Abuse

26-9. Substance-free youth

26-14. Steroid use among adolescents

26-17. Perception of risk associated with substance abuse

26-23. Community partnerships and coalitions

27\. Tobacco Use

27-1. Adult tobacco use

27-2. Adolescent tobacco use

27-3. Initiation of tobacco use

27-4. Age at first tobacco use

27-5. Smoking cessation by adults

27-7. Smoking cessation by adolescents

28\. Vision and Hearing

28-9. Protective eyewear

## Terminology

(A listing of abbreviations and acronyms used in this publication
appears in Appendix H.)

**Aerobic:** Conditions or processes that occur in the presence of, or
requiring, oxygen.[^41]

**Energy expenditure:** The energy cost to the body of physical
activity, usually measured in kilocalories.Error: Reference source not
found

**Functional independence:** The ability to perform successfully and
safely activities related to a daily routine with sufficient energy,
strength/endurance, flexibility, and coordination.

**Physical activity:** Bodily movement that is produced by the
contraction of skeletal muscle and that substantially increases energy
expenditure.Error: Reference source not found

> **Moderate physical activity:** Activities that use large muscle
> groups and are at least equivalent to brisk walking. In addition to
> walking, activities may include swimming, cycling, dancing, gardening
> and yardwork, and various domestic and occupational activities.
>
> **Vigorous physical activity:** Rhythmic, repetitive physical
> activities that use large muscle groups at 70 percent or more of
> maximum heart rate for age. An exercise heart rate of 70 percent of
> maximum heart rate for age is about 60 percent of maximal
> cardiorespiratory capacity and is sufficient for cardiorespiratory
> conditioning. Maximum heart rate equals roughly 220 beats per minute
> minus age. Examples of vigorous physical activities include
> jogging/running, lap swimming, cycling, aerobic dancing, skating,
> rowing, jumping rope, cross-country skiing, hiking/backpacking,
> racquet sports, and competitive group sports (for example, soccer and
> basketball).

**Physical fitness:** A set of attributes that persons have or achieve
that relates to the ability to perform physical activity.Error:
Reference source not found Performance-related components of fitness
include agility, balance, coordination, power, and speed.[^42]
Health-related components of physical fitness include body composition,
cardiorespiratory function, flexibility, and muscular
strength/endurance.**^Error:\ Reference\ source\ not\ found^**

> **Agility:** Ability to start, stop, and move the body quickly and in
> different directions.
>
> **Balance:** Ability to maintain a certain posture or to move without
> falling.
>
> **Body composition:** The relative amount of body weight that is fat
> and nonfat.
>
> **Cardiorespiratory function:** A health-related component of physical
> fitness that relates to the ability of the circulatory and respiratory
> systems to supply oxygen during physical activity.
>
> **Coordination:** Ability to do a task integrating movements of the
> body and different parts of the body.
>
> **Exercise (exercise training):** Planned, structured, and repetitive
> bodily movement done to improve or maintain one or more components of
> physical fitness.
>
> **Flexibility:** Ability to move a joint through the full range of
> motion without discomfort or pain.
>
> **Muscular endurance:** Ability of the muscle to perform repetitive
> contractions over a prolonged period of time.
>
> **Muscular strength:** Ability of the muscle to generate the maximum
> amount of force.
>
> **Power:** Ability to exert muscular strength quickly.
>
> **Speed:** Ability to move the whole body quickly.

**Sedentary:** Denotes a person who is relatively inactive and has a
lifestyle characterized by a lot of sitting.Error: Reference source not
found

## References

[^1]: U.S. Department of Health and Human Services. *Physical Activity
    and Health: A Report of the Surgeon General*. Atlanta, GA: Centers
    for Disease Control and Prevention (CDC), National Center for
    Chronic Disease Prevention and Health Promotion, 1996.

[^2]: Frost, H.; Moffett, J.A.K.; Moser, J.S.; et al. Randomized
    controlled trial for evaluation of fitness programme for patients
    with chronic low back pain. *British Medical Journal* 310:151-154,
    1995.

[^3]: McTiernan, A.; Stanford, J.L.; Weiss, N.S.; et al. Occurrence of
    breast cancer in relation to recreational exercise in women age
    50-64 years. *Epidemiology* 7(6):598-604, 1996.

[^4]: Kujala, U.M.; Kaprio, J.; Sarna, S.; et al. Relationship of
    leisure-time physical activity and mortality: The Finnish twin
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    279(6):440-444, 1998.

[^5]: Paffenbarger, R.S.; Hyde, R.T.; Wing, A.L.; et al. The association
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[^6]: Sherman, S.E.; D'Agostino, R.B.; Cobb, J.L.; et al. Physical
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[^7]: Kaplan, G.A.; Strawbridge, W.J.; Cohen, R.D.; et al. Natural
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[^8]: Kushi, L.H.; Fee, R.M.; Folsom, A.R.; et al. Physical activity and
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[^9]: Nelson, M.E.; Fiatarone, M.A.; Morganti, C.M.; et al. Effects of
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[^10]: LaCroix, A.Z.; Guralnik, J.M.; Berkman, L.F.; et al. Maintaining
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[^12]: Stenstrom, C.H. Home exercise in rheumatoid arthritis functional
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[^13]: CDC. Prevalence of leisure-time physical activity among persons
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[^14]: National Institutes of Health. Optimal calcium intake. In: *NIH
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[^15]: Snow‑Harter, C.; Shaw, J.M.; and Matkin, C.C. Physical activity
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[^16]: Pate, R.R.; Pratt, M.; Blair, S.N.; et al. Physical activity and
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[^17]: President's Council on Physical Fitness and Sports. *Physical
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[^18]: Stofan, J.R.; DiPietro, L.; Davis, D.; et al. Physical activity
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[^19]: Brown, M.; Sinacore, D.R.; and Host, H.H. The relationship of
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[^20]: Tseng, B.S.; Marsh, D.R.; Hamilton, M.T.; et al. Strength and
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[^21]: Evans, W.J. Effects of exercise on body composition and
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[^22]: Cunningham, D.A.; Paterson, D.H.; Hinmann, J.E.; et al. P.A.
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[^23]: Lan, C.; Lai, J.S.; Chen, S.Y; et al. 12-month Tai Chi training
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[^24]: Pate, R.R.; Baranowski, T.; Dowda, M.; et al. Tracking of
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[^25]: Pate, R.R.; Long, B.J.; and Heath, G. Descriptive epidemiology of
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[^26]: CDC. Youth risk behavior surveillance---United States, 1997.
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[^27]: Anderson, R.E.; Crespo, C.J.; Bartlett, S.J.; et al. Relationship
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