# Lentis/Public Health Responds to Physical Inactivity
## Physical Inactivity in the United States

While there is no standard definition of "physical inactivity," according to the National Institute of Health (NIH) website, an inactive lifestyle consists of sitting or lying down with little to no exercise. The World Health Organization (WHO) recognized inactivity as a global epidemic and introduced the ACTIVE program. Only 51.7% of adults and 24% of children meet the Center for Disease Control and Prevention (CDC) recommendations. As inactivity rates rise, the number of overweight individuals increases. Over the past fifty years, many aspects of daily life contribute to decreased activity and sedentary lifestyles.

## Causes of Physical Inactivity
### Cars and Public Transportation

A prominent cause of physical inactivity is the increased miles traveled by car. Widespread vehicle ownership and the influx of civilians into suburban areas increased dependency on privately own vehicles. The explosion of transportation infrastructure fostered a cycle of inactivity. Since farther destinations are easily accessible, individuals spend more time commuting. Food delivery services, like GrubHub, and ride sharing, like Lyft and Uber, reduce driver and user activity.

### Internet

Most Americans utilize the internet daily. Links exist between internet use, sedentism, and obesity. On average, 24 hours are spent online per week. The internet made entertainment, information, goods, and services highly accessible. Online shopping eliminated the need to physically go to stores; with its' popularity among Millennials and Generation Z, companies continue to expand their e-commerce platforms to increase profits. Portable devices, such as mobile devices and tablets, permit constant internet access. This encourages individuals to spend time on computers.

### Media

American adults spend an average of eleven hours daily consuming media. With 96.5% of households owning televisions, the average American spends about eight hours watching TV per day. Expanded streaming services with on demand access to shows, like Hulu and Netflix, encourage binge watching. Increasing time spent on social media, radio, web services, TV/movies, and gaming comes at the expense of physical activity. In the last decade, video gaming saw annual growth rates exceeding 10.3%. The gaming trend has led to a rise in number of individual gamers, spending an average two hours daily on gaming. Video games appeal to a broad range of age groups and genders. Developers attract gamers with graphics, story lines, role play, and mindless entertainment.

### Urbanization

Although cities are generally walkable, urbanization has reduced activity. Cities' unsafe perception meant individuals are less likely to walk, especially in low-lit areas. Transportation, pollution, and overcrowding reduce the desire to be outside. With fewer green spaces or outdoor parks, individuals lack outdoor recreational areas.

### Industrialization

Sedentary lifestyles are prevalent in all modern-postindustrial societies. By decreasing farming, industrial agriculture and processing broke the link between food acquisition and activity. Industrialization permitted development of transportation networks and urban environments. Urbanization changed how individuals spend their workday and moved work from rural settings. Automation decreased the need for skilled, manual labor. Increased demand for desk jobs directly correlates with an increased in low activity jobs. Since the 1950s, 83% of Americans now work sedentary jobs.

### Disability

34 million Americans, ages 18 or older, have a physical or intellectual disability that prevents them from walking, using stairs, or running errands alone. Sedentary lifestyles are endemic to the elderly. Lack of physical activity when young, muscle weakening, and general loss of mobility can lead to painful joints, reduced strength, and reduced dexterity when older, hindering their ability to maintain active lifestyles. With over 40% of people ages 50 to 64 reporting difficulty performing physical tasks, disabilities are increasingly prevalent among the middle aged.

### Inactivity in Children vs. Adults

The primary cause of inactivity in children is low energy recreational activities. Video gaming, television, and education influence their sedentary lifestyles. The average child spends roughly 85% of their day seated. Decreasing recess and physical education programs, children are less likely to be active during the school day or participate in after school sports. Because healthy lifestyle habits are best established at a young age, many efforts to increase activity target children.
Workplace inactivity is the main cause of reduced activity in adults. With steadily increasing workweek hours, office workers sit mostly all day. After work, individuals spend their leisure time interacting with media.

## Impact of physical inactivity
### Physical disease

Physical inactivity and sedentary lifestyles contribute to the obesity epidemic. Sedentary lifestyles lead to later health consequences. Food and beverage companies fund research that supports inactivity as the main cause of obesity to maintain a market for their products and advance sales. Inactivity is a leading cause for the spread of noncommunicable diseases. According to the American Heart Association (AHA) in 1992, physical inactivity was classified as the fourth largest contributor to coronary heart disease. Decreasing inactivity by 25% will prevent 1.3 million deaths and increase life expectancy.

### Depression and mental health

Abnormal physical activity can impact hormone regulation and mood. Exercise releases endorphins and neurotransmitters in the brain that maintain a healthy chemical environment. Inactivity increases the incidence of depression, which can discourage activity. In contrast, physical activity can elevate mood and cognitive function.

## Evolution of guidelines

According to the physical activity guidelines (PAG) from the U.S. Department of Health and Human Services (HHS), children (6 – 17 years) should have at least 1 hour of moderate to vigorous physical activity everyday. Adults (18 – 64 years) should have 2.5 hours of moderate physical activity per week, or 1 hour and 15 minutes of vigorous activity.
Originally in 1972, the AHA set guidelines for physical activity aimed at improving aerobic performance. The guidelines centered on a link between high aerobic capacity and a decreased risk of cardiovascular disease (CVD). Physicians prescribed physical activity to increase fitness and subsequently reduce the risk of obtaining CVD. However, this approach was ineffective at encouraging healthy, sedentary adults to exercise.
Throughout the 1980s and 1990s, the American College of Sports Medicine (ACSM) and the CDC conducted research to find ways of encouraging participation in physical activity for everyone. A panel of scientists compiled relevant physiological, epidemiological, and clinical evidence showing the importance of living an active lifestyle. The results shifted the HHS's guidelines in 1995 to a health-conscious approach rather than a fitness approach. These guidelines emphasized, previously neglected, moderate levels of physical activity.
Since 1995, PAG remained mostly unchanged. In 2007, the guidelines included both moderate and vigorous levels of activity, and in 2008 the PAG extended to children. Since 2008 the guidelines the HHS follows today are unchanged.

## Initiatives
### Active Play Initiatives
##### NFL Fuel Up to Play 60

The NFL Play 60 and Fuel Up to Play 60 programs were established in 2007. The National Football League (NFL) partnered with the United States Department of Agriculture (USDA) and National Dairy Council (NDC) to increases physical activity and healthy eating in school age children. The NFL champions the Play 60 movement to boosts public relations and the NFL brand. Children recognize NFL athletes as the face of the program. This raises revenue through increases in viewership and merchandise sales. The Play 60 program is a platform that the NDC can advertise the importance of milk in healthy diets. This maintains a robust dairy economy. Influenced largely by lobbies, the USDA uses the program to promote the general health of the public.

##### Fitness Technology

The fitness technology and wearables industries are expanding. Companies like FitBit, Garmin, and Polar are projected to earn $2.57 billion in profits by the end of 2018. Wearables encourage activity through behavioral reinforcement. The gamification of physical activity through phone applications enhances the cognitive factors that drive motivation. These devices engage users and enable the integration of activity into daily life through goal setting and feedback mechanisms.

### Regulatory Initiatives
##### CDC Guide

The CDC produced a physical activity program that pushes for the nationally recommended sixty minutes of activity in schools. The CDC believes time spent on physical education has no adverse effects on students' academic achievements. School systems view participation as necessary to receive federal funding and national accreditation for physical education. The CDC wants to increase agency attention to garner funding for research.

##### Physical Education in Schools

Many schools systems required some form of physical activity/education. Either as a class, recess, or free period, the designated sixty minutes allow students out of the classroom setting. Both public and private school systems have after-school programs and sports. School systems provide these programs to boost enrollment numbers. School systems look to maintain and receive local and federal funding to cover expenditures. However, school systems may perceive physical education and after-school programs as costly (equipment, teachers, maintenance, etc.) and would rather fund other purchases like computers or building repairs.

### Built Environment Changes
##### Complete Streets

Founded in 2005, the National Complete Streets Coalition includes partners like American Association of Retired Persons (AARP), Blue Cross Blue Shield Minnesota, and National Association of Realtors. Complete Streets is a program and transportation policy that defines new street and road planning. The policy mandates that streets be "planned, designed, operated, and maintained for access to users of all ages and abilities regardless of their mode of transportation."
The aim is to expand the usage of streets by making them accessible to more than just driving cars by having crosswalks, bus lanes, and bike paths. The coalition aims to generate grants, funding, and government subsidies for future infrastructure and neighborhood development. Local municipalities use this policy to increase their livability score and population numbers with attractive neighborhood planning. Realtors want sell more homes and increase their publicity.

##### Safe Routes to School

Safe Routes to School is a program that encourages and enables students to walk or bike to school and use transportation alternatives that encourage a healthy/active lifestyle. This program targets communities and neighborhoods that immediately surround any school building (typically constrained to 1-1.5 mile radius). Local municipalities and school systems promote Safe Routes to School as a way to reduce spending on student transportation (via reduced fuel spending, buying less busses, hiring less staff, etc.). Local and State governments want to garner new federal and state funding towards building new schools, communities, and infrastructure to raise livability and population. Parents view this program as a determinate for moving and raising families. Realtors aim to sell more homes, increase publicity, and garner new customers.

## Conclusion

Advancements in technology have enabled inactivity. Although efficient, these technologies have caused an unintended consequence of sedentary living within the general population. Technology has shifted human behavior. Physical activity is no longer a mandate; it is now a choice. For example, cars allow people to drive anywhere they want rather than walk.
To limit the negative impacts of a technologically advanced society such as the U.S., people must learn to use technology as a tool rather than a dependency. For instance, if a person can choose to walk or drive, within reason, the former should be taken for improving health. There are many factors that can influence a person to either use or not use a technology, and to properly weigh each alternative, people must not only consider the convenience that technologies grant.
Initiatives to encourage physical activity may be implemented at different scales. Individual initiatives such as wearable devices can motivate people to set personal fitness goals. Local and national initiatives such as the NFL's Fuel Up and Play 60 can influence entire communities to stay active by partnering with schools and corporations.
This study focused on physical inactivity in the United States. Future research must address the prevalence and response to physical inactivity in other cultures. The effectiveness of various initiatives should be studied further. Analysis of social factors that guide public acceptance can be used to explain their relative success rates.

## References

* 1 2 Medlineplus. (June 27, 2017.) Health Risks of an Inactive Lifestyle. Retrieved from https://medlineplus.gov/healthrisksofaninactivelifestyle.html
* ↑ ODPHP. (2018, November 07). How Active are American Youth? Retrieved from https://health.gov/news/blog-bayw/2018/10/how-active-are-american-youth-new-findings-from-the-2018-u-s-report-card-on-physical-activity-for-children-and-youth/
* ↑ (September, 2018.) Physical Inactivity in the United States. Retrieved from https://stateofobesity.org/physical-inactivity/
* ↑ Brownson RC, Boehmer TK, Luke DA. "Declining rates of physical activity in the United States: what are the contributors?" ncbi.nlm.nih.gov. Retrieved November 26, 2018.
* ↑ Puentes, R. (2-17, September 18). How Commuting Is Changing. Retrieved from https://www.usnews.com/opinion/economic-intelligence/articles/2017-09-18/what-new-census-data-reveal-about-american-commuting-patterns
* ↑ Kahn, J. (2015, May 18). Uber Unhealthy: The Challenge of Sedentary Occupations. Retrieved from https://www.huffpost.com/entry/uber-unhealthy-the-challenge-of-sedentary-occupations_b_7305534
* ↑ Condliffe, J. (2018, January 23). The average American spends 24 hours a week online. Retrieved from https://www.technologyreview.com/the-download/610045/the-average-american-spends-24-hours-a-week-online/
* ↑ Nielsen. (2018, July 31). Time Flies: U.S. Adults Now Spend Nearly Half a Day Interacting with Media. Retrieved from https://www.nielsen.com/us/en/insights/news/2018/time-flies-us-adults-now-spend-nearly-half-a-day-interacting-with-media.print.html
* ↑ Koblin, J. (2017, December 21). How Much Do We Love TV? Let Us Count the Ways. Retrieved from https://www.nytimes.com/2016/07/01/business/media/nielsen-survey-media-viewing.html
* ↑ Unterman, Phoebe. (November 9, 2017.) The Gaming Industry's Rise to the Top. Retrieved from https://www.marketplace.org/2017/11/06/world/make-me-smart-kai-and-molly/blog-gaming-industrys-rise-top
* ↑ WHO. (2014, October 06). Physical Inactivity: A Global Public Health Problem. Retrieved from https://www.who.int/dietphysicalactivity/factsheet_inactivity/en/
* ↑ Physical Inactivity from the Viewpoint of Evolutionary Medicine Sylvia Kirchengast
* ↑ Health Risks of a Sedentary Lifestyle. (2017, April 13). Retrieved from https://www.lifespanfitness.com/workplace/resources/articles/health-risks-of-a-sedentary-lifestyle
* ↑ Bialik, K. (2017, July 27). 7 facts about Americans with disabilities. Retrieved from http://www.pewresearch.org/fact-tank/2017/07/27/7-facts-about-americans-with-disabilities/
* ↑ Gregorian, C. B. (2010, June 04). Disabilities strike the middle-aged: Sedentary lifestyle, obesity among major reasons. Retrieved from https://m
* ↑ Kaiser Foundation. (2010, January 10). Generation M2: Media in the Lives of 8- to 18-Year-Olds. Retrieved from https://www.kff.org/other/event/generation-m2-media-in-the-lives-of/
* ↑ ODPHP. (n.d.) Physical Activity Guidelines Advisory Committee Report. Retrieved from https://health.gov/paguidelines/2008/report/D_background.aspx#ref12
* ↑ Paluska, S. A., & Schwenk, T. L. (2012, September 24). Physical Activity and Mental Health. Retrieved from https://link.springer.com/article/10.2165/00007256-200029030-00003
* ↑ HHS. (2008). Physical Activity Guidelines for Americans. Retrieved from https://health.gov/paguidelines/2008/pdf/fs_prof.pdf
* ↑ ODPHP. (July 14, 2016). History of Physical Activity Recommendations and Guidelines for Americans. Retrieved from https://health.gov/paguidelines/second-edition/meetings/1/History-of-Physical-Activity-Recommendations-and-Guidelines-for-Americans.pdf
* ↑ NFL Play 60. (2018). Retrieved from http://www.nfl.com/play60
* ↑ Sullivan, A., & Lachman, M. (2016, December 20). Behavior Change with Fitness Technology in Sedentary Adults: A Review of the Evidence for Increasing Physical Activity. Retrieved from https://www.frontiersin.org/articles/10.3389/fpubh.2016.00289/full
* ↑ CDC. (September 25, 2015). Comprehensive School Physical Activity Program (CSPAP). Retrieved from https://www.cdc.gov/healthyschools/physicalactivity/cspap.htm
* ↑ CDC. (June 26, 2018). Physical Education. Retrieved from https://www.cdc.gov/healthyschools/physicalactivity/physical-education.htm
* ↑ Smart Growth America. (2018). What are Complete Streets?. Retrieved from https://smartgrowthamerica.org/program/national-complete-streets-coalition/publications/what-are-complete-streets/
* ↑ CDC. (October 19, 2018). Safe Routes to School (SRTS). Retrieved from https://www.cdc.gov/policy/hst/hi5/saferoutes/index.html
* ↑ Pedestrian and Bicycle Information Center. (n.d.) SRTS Guide: Around the School. Retrieved from http://guide.saferoutesinfo.org/engineering/the_school_zone.cfm