# Presentation: 697005

## Focus Area 22:Physical Activity and Fitness  Richard J. KleinNational Center for Health Statistics Progress ReviewJune 26, 2008

## Decreases the risk of obesity and chronic diseases, including osteoporosis
Better control of body weight, blood pressure, blood glucose, and cholesterol 
Improved mood and feelings of well-being 
Enhances independent living among older adults
Improves quality of life for people of all ages

**Better control of body weight, blood pressure, blood glucose, and cholesterol **
**Improved mood and feelings of well-being **
**Enhances independent living among older adults**
**Improves quality of life for people of all ages**

**Physical Activity and Fitness Benefits**

**Notes:**
Decreases the risk of obesity and chronic diseases: CVD, high blood pressure, diabetes, colon cancer, and osteoporosis
Builds and maintains healthy bones and muscles, controls weight, builds lean muscle, reduces fat, reduces blood pressure, and improves blood glucose and cholesterol control
Reduces feelings of depression and anxiety and promotes psychological well-being 

## Highlighted Objectives

**22-1.****	****   No physical activity**
**22-2.****	****   Moderate or vigorous physical activity for adults**
**22-7.****	****   Vigorous physical activity for adolescents**

**Highlighted Objectives**

**Environmental intervention and programs**

**22-9. ****	****   Participation in daily physical education in schools**
**22-10. ****	****   Physical activity in physical education class**
**22-11. ****	****   Television viewing **

**Organizational policy**

**22-8**** ****a,**** ****b.  Physical education requirement in schools**
**22-12. ****	****   Access to school physical activity facilities**

- Improving

- Getting worse

- Little or no change*

- Baseline only

- Target met

- Note: *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

## Leisure Time Physical Activity 

**Leisure Time Physical Activity **
**Among Adults**

- Note:  Data are for ages 18 years and over, age adjusted to the 2000 standard population. Regular leisure-time physical activity is a moderate/vigorous physical activity (moderate activity 30+ minutes/5+ times per week or vigorous activity   20+ minutes/3+ times per week).** **
- Source: National Health Interview Survey (NHIS), NCHS, CDC.

**Objs. 22-1,** **2**

**Notes:**
1997
None - 40
Some - 28
Moderate/Vigorous - 32

2006
None - 39
Some - 30
Moderate/Vigorous - 31

## No Leisure Time Physical Activity 

**0**

**Percent**

**40**

**20**

**80**

**60**

**Total**

**25-44 years**

**Female**

**75 years +**

**Male**

**18-24 years **

**45-64 years**

**65-74 years**

**No Leisure Time**** ****Physical Activity **
**Among Adults **

- Note:  Data are for ages 18 years and over. Except for age-specific estimates data are age adjusted to the 2000 standard population. I = 95% confidence interval.
- Source: National Health Interview Survey (NHIS), NCHS, CDC.

**Obj. 22-1**

**2010 Target: 20**

**Notes:**
The percent of adults reporting no leisure-time physical activity has declined for all adults (total), females, and for people ages 45+.   

##  No Leisure Time Physical Activity 

**Hispanic**

** ****No Leisure Time**** ****Physical Activity **
**Among Adults, 2006**

**Total**

**White**

**American Indian**

**Asian**

**Black                    **

**Some college**

**High school graduate**

**College graduate or higher**

**Obj. 22-1**

**   ****Decrease Desired**

**  ****Percent**

- Note: Except for education levels, data are for adults 18 years and over; education-level data are for adults 25 years and over. Data are** **age adjusted to the 2000 standard population.** **American Indian includes Alaska Native.  The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. I = 95% confidence interval.
- Source: National Health Interview Survey (NHIS), NCHS, CDC.

**2010 Target: 20**

**Less than high school**

**Notes:**
(Describe slide)  
 2001 data are preliminary. 

## Regular Leisure Time Physical Activity Among Adults

**0**

**Percent**

**60**

**20**

**40**

**80**

**Total**

**25-44 years**

**Female**

**75 years +**

**Male**

**18-24 years **

**45-64 years**

**65-74 years**

- Age-adjusted percent

**Regular Leisure Time**** ****Physical Activity Among Adults**

- Note: Except for age-specific estimates, data are for adults 18 years and over and are age adjusted to the 2000 standard population. Regular leisure-time physical activity is a moderate or vigorous physical activity (moderate activity 30+ minutes/5+ times per week or vigorous activity 20+ minutes/3+ times per week). I = 95% confidence interval.
- Source: National Health Interview Survey (NHIS), NCHS, CDC.

**Obj. 22-2**

**2010 Target: 50**

**Notes:**
There has been no significant change in the percent of adults reporting moderate leisure-time physical activity.  

##  Regular Leisure Time Physical 

**Hispanic**

** ****Regular ****Leisure Time**** ****Physical **
**Activity Among Adults, 2006**

**Total**

**White**

**American Indian**

**Asian**

**Black                    **

**Some college**

**High school graduate**

**College graduate or higher**

**Obj. 22-2**

**Percent**

- Note: Except for education levels, data are for adults 18 years and over; education-level data are for adults 25 years and over. Data are age adjusted to the 2000 standard population. Regular leisure-time physical activity is moderate or vigorous physical activity (moderate activity 30+ minutes/5+ times per week or vigorous activity 20+ minutes/3+ times per week). American Indian includes Alaska Native. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Respondents were asked to select one or more races. Data for the single race categories are for persons who reported only one racial group. I = 95% confidence interval.  Source: National Health Interview Survey (NHIS), NCHS, CDC.

**2010 Target: 50**

**Less than high school**

**Notes:**
(Describe slide)  
 2001 data are preliminary. 

## Likelihood of Selected Health Problems by 

**Leisure Time Physical ****Activity**** Level, 2006**

- Note:  Data are for adults 18 years and older. Odds ratios are adjusted for sex, age, race/ethnicity, educational, and poverty status.
- Data are age adjusted to the 2000 standard population. Inactive is no moderate or vigorous  physical activity; some activity is physical activity
- less than the regular activity. Regular activity is a moderate (30+ min /5+ time per week) or vigorous activity (20+ min/ 3+ times per week)  or
- both. Serious psychological distress includes negative moods during the past 30 days: sad, nervous, restless, hopeless, feeling everything is an
- effort, and worthless. I = 95% confidence interval.
- Source: National Health Interview Survey (NHIS), NCHS, CDC.

**Odds Ratio**

**Diagnosed diabetes**

**Fair or poor health**

**Serious psychological distress **

**Inactive**

**Some activity**

**Regular activity**

## Regular Vigorous Physical Activity Among Adolescents

**0**

**Percent**

**40**

**20**

**Total**

**White**

**Female**

**Hispanic**

**Male**

**Black**

**60**

**80**

**100**

**Regular Vigorous Physical Activity Among Adolescents**

- Note: Data are for students in grades 9 through 12. The categories black and white exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. Persons were asked to select one or more races. The categories black and white include persons who reported only one racial group. Regular vigorous physical activity is a regular activity 20+ minutes on 3+ of the past 7 days that make students sweat or breathe hard. I = 95% confidence interval.
- Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

**Obj. 22-7**

- Percent

- 2010 Target

**2010 Target: 85**

## Physical activity monitor component of NHANES 2003-06
Measures intensity and duration of common activities such as walking and running
Has a pedometer (step-counter) feature
Worn over the right hip on an elasticized       belt for 7 days
More than 12,000 persons 6+ years wore accelerometers. 
Results may be linked to interview, health (BMI, functional status, bone status, blood pressure, etc.), and laboratory data.

**Physical Activity Measured by Accelerometer**

**Physical activity monitor component of NHANES 2003-06**
**Measures intensity and duration of common activities such as walking and running**
**Has a pedometer (step-counter) feature**
**Worn over the right hip on an elasticized       belt for 7 days**
**More than 12,000 persons 6+ years wore accelerometers. **
**Results may be linked to interview, health (BMI, functional status, bone status, blood pressure, etc.), and laboratory data.**

**Notes:**
Physical activity has a protective effect on our health.  NHANES data have documented the problem of overweight and obesity in this country.  Determining the activity patterns of adults and children is more challenging.  Many physical activities are part of the daily routine, and therefore difficult to recall and report.  
Getting reasonable reports about the activity of children is particularly challenging because kids find it particularly hard to estimate frequency and duration of activities, and proxies (usually parents) may not observe the children for much of the day.  Until recently, we have not had a feasible way to measure activity levels in the general population because the equipment has been too bulky, expensive, and complicated to use.  Now we have a tool we can use.
Accelerometers count steps and the information on activity intensity and duration can be used to tell us how long people perform light, moderate, and vigorous activity.
When worn on the hip, the monitor primarily measures body movements such as walking or jogging—activities where one’s body moves a distance.  Walking and similar types of activity are the main source of physical activity for most individuals.  The activity monitors are powered by a watch battery and are completely safe to wear.

## Recommended Levels of Physical Activity 

**Percent**

**6-11 years **

**12-15 years  **

**16-19 years**

**6-11 years**

**12-15 years**

**16-19 years**

**16-19 years**

**20-59 years  **

**60+ years**

**16-19 years**

**20-59 years **

**60**** ****+ years**

**Recommended Levels of Physical Activity **

_**60+ min/5-7 days**_

_**30+ min/5-7 days**_

**0**

**20**

**30**

**10**

**60**

**40**

**50**

**Female**

**Female**

**Male**

**Male**

- Note: Adherence: for ages 6–19 years - 60 or more minutes of moderate- or greater-intensity activity on 5 of 7 days; for ages 16 years and older –
- 30 or more minutes of moderate- or greater-intensity activity on 5 of 7 days, accumulated in 10-min “bouts.” I = 95% confidence interval.
- Source: Troiano, RP, et al. Physical Activity in the United States Measured by Accelerometer. Medicine & Science in Sports & Exercise. 2008, 40(1): 181-188.
- National Health and Nutrition Examination Survey (NHANES), NCHS, CDC.

## Daily Physical Education Requirement in Schools

**2000**

**Senior high schools**

**2006**

**Daily Physical Education Requirement in Schools**

**Obj. 22-8a,**** ****b**

- Note: Data are for public and private middle, junior, and senior high schools.
- Source: School Health Policies and Programs Study (SHPPS), NCCDPHP, CDC

**2010 Target: 9.4**

**2010 Target: 14.5**

**Percent**

**Notes:**
Number of public and private middle, junior, and senior high schools for which physical education (PE) is offered 5 days a week, and the number of years of required PE equals the number of grades in the school. 	

## Participation in Daily Physical Education 

**Participation in Daily Physical Education **
**in Schools**

- Note:  Data are for students in grades 9 through 12.
- I = 95% confidence interval.
- Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

**Percent**** **

**Obj. 22-9**

**9****th**** grade**

**10****th**** grade**

**Total**

**11****th**** grade**

**12****th**** grade**

**2010 Target: 50**

**1999**

**2007**

**Notes:**

Number of students in grades 9 through 12 who report participating in physical education classes five times per week. 	

## Physical Activity in Physical Education Class

- Note:  Data are for students in grades 9 through 12 enrolled in physical education class. Physical activity in physical education class includes 21+ minutes
- exercising or playing sports 3 to 5 times a week. I = 95% confidence interval.
- Source: Youth Risk Behavior Surveillance System (YRBSS), NCCDPHP, CDC.

**Percent**** **

**Obj. 22-10**

**9****th**** grade**

**10****th**** grade**

**Total**

**11****th**** grade**

**12****th**** grade**

**2010 Target: 50**

**Notes:**

Number of students in grades 9 through 12 who report spending 21 or more minutes exercising or playing sports in physical education class three to five times a week. 	

## Community Access to School Physical Activity Facilities

**Community Access to School Physical Activity Facilities**

**Obj. 22-12**

- Note: Data are for public and private elementary, middle/junior, and senior high schools, that provide access to their physical activity spaces and facilities for all persons outside of normal school hours.
- Source: School Health Policies and Programs Study (SHPPS), NCCDPHP,** **CDC.

**2010 Target: 50**

**2006**

**Percent**

**Notes:**

Number of public and private elementary, middle/junior, and senior high schools that provide community access to their physical activity or athletic facilities in non school time. 

## Adolescents Who View Television 

**Two or Fewer Hours on a School Day**

- Note: Data are for students in grades 9 through 12. The categories black and white exclude persons of Hispanic origin.
- Persons of Hispanic origin may be any race. Persons were asked to select one or more races. The categories black and white
- include persons who reported only one racial group. I = 95% confidence interval.
- Source: Youth Risk Behavior Surveillance System, NCCDPHP, CDC.

**Percent**** **

**Obj. 22-11**

**Female**

**Male**

**Total**

**Black**

**Hispanic**

**2010 Target: 75**

**1999**

**2007**

**White**

**Notes:**

Number of students in grades 9 through 12 who report watching TV for 2 or fewer hours on an average school day. 	

## Physical Activity and Fitness Objectives

***Physical Activity among Adults***

- 22-1. No leisure time physical activity
- 22-2. Moderate regular physical activity
- 22-3. Vigorous physical activity
- 22-4. Muscular strength and endurance
- 22-5. Flexibility

***Physical Activity among Adolescents***

- 22-6. Moderate physical activity
- 22-7. Vigorous physical activity
- 22-8. Physical education
-           requirement in schools
-            a. Middle/junior high schools
-            b. Senior high schools

- 22-9. Participation in daily school PE
- 22-10. Physical activity in PE class
- 22-11. Television viewing
- 22-12. Access to school physical
-             activity facilities

***Worksites and Communities***

- 22-13. Worksite physical activity and
-             fitness programs
- 22-14. Community walking
-    	a. Adults
-    	b. Children and adolescents
- 22-15. Community bicycling
-    	a. Adults
-    	b. Children and adolescents

- Getting worse

- Baseline only

- Note: *Percent of targeted change achieved is between -10% and 10%, and/or change not statistically significant.

## Time / intensity
Recall period / accuracy
Question order
“Leisure” / “work” / “incidental”
Self-report / measured
No standard methodology
Changes in measurement over time

**Time / intensity**
**Recall period / accuracy**
**Question order**
**“****Leisure” / “work” / “incidental”**
**Self-report / measured**
**No standard methodology**
**Changes in measurement over time**

## Individual physical activity behaviors for adolescents and adults are essentially unchanged. 
Physical education requirements levels in middle and junior school remain low. Senior high school levels are very low and have declined. 
Most high school students do not participate in daily physical education.    
Disparities persist for many objectives. 
Complex measurement issues 

**Physical education requirements levels in middle and junior school remain low. Senior high school levels are very low and have declined. **
**Most high school students do not participate in daily physical education.    **
**Disparities persist for many objectives. **
**Complex measurement issues **

**Summary**

## Acknowledgements

**Acknowledgements**

**Asel Ryskulova****	**
**CDC/National Center for Health Statistics**
**avr0@cdc.gov**
- Contributors:
- Sandra Ham, CDC/NCCDPHP
- Jane Wargo, DHHS/OS/OPHS
- Christine Spain, DHHS/OS/OPHS
- Sarah Lee, CDC/NCCDPHP
- Timothy McManus,** **CDC/NCCDPHP
- Ellis Davis, HHS/ODPHP

- Elizabeth Jackson, CDC/NCHS
- Leda Gurley, CDC/NCHS
- Charlotte Schoenborn, CDC/NCHS
- Margaret Mc Dowel, CDC/NCHS
- Lesley Agress, CDC/NCHS
- Christopher Barrett, HHS/ODPHP

## Progress review data and slides

**Progress review data and slides**
**can be found on the web at:**

**http://www.cdc.gov/nchs/hphome.htm**