Wh at y ou n eed to k now abou t th e .. .

Su rgeo n Ge nera l’s Repo rt o n

Ph ysic al A ctiv ity and Heal th

Ch arle s B. Corb in, Robe rt P . Pa ngra zi

ARI ZONA STA TE UNI VERS ITY

ORIGINALLY PUBLISHED AS SERIES 2, NUMBER 6, OF THE PCPFS RESEARCH DIGEST.

Note: Portions of this material, including the conclusions, have been taken from the Surgeon General’s Report on

Physical Activity and Health.

HI GHLI GHT

“B y m a kin g t h e re la t i vely sm a ll ch a n ge fr om a n in a ct i ve

li fest yle t o on e t h a t in clu d es m o d era t e bu t re gu la r p h ysic a l

a c t ivi t y, ev en t h e m o st se d en t a ry Am eric a n s ca n p r even t d i sea s e

a n d p r em a t u re d e a t h a n d im p rov e t h eir qu a lit y of li fe.” 

Fl oren ce G riff it h Joyn er a n d T om M cMil len , 

Co -Ch a irs, Pre sid e n t ’s Cou n cil on Ph ys ica l Fit n ess & S p ort s

WH AT I S TH E SU RGEO N GE NERA L’S REPO RT O N

PH YSIC AL A CTIV ITY AND HEAL TH?

In 1964, the Surgeon General began alerting the nation to the hazards of smoking.

Subsequently, several other reports addressing tobacco’s effects on health were released. In

1988, the Surgeon General’s Report on Nutrition and Health was released. These reports have

had a great impact on the behaviors of American citizens. The reports on tobacco did much

to change the social norm concerning smoking. Similarly, the report on nutrition and health

focused national attention on the need for sound nutrition. Now, under the leadership of

Department of Health and Human Services Secretary Donna E. Shalala, the Office of the

Surgeon General has released a report on physical activity and health. The main purpose of

the Surgeon General’s Report on Physical Activity and Health is to summarize existing

research showing the benefits of physical activity in preventing disease and to draw

conclusions that can be useful to Americans who are interested in improving their health.

This hallmark report will provide impetus for an active lifestyle just as other health-related

behaviors were encouraged through previous Surgeon Generals’ reports.
WH Y WA S TH E RE PORT DON E NO W?

In recent years, scientific evidence linking physical activity and health and organizational

statements supporting the value of regular physical activity have increased. The American

Heart Association (AHA) in 1992 identified physical inactivity as a major risk factor for

coronary heart disease. The 1995 National Institutes of Health (NIH) Consensus Development

Conference on Physical Activity and Cardiovascular Health confirmed the importance of

physical activity for cardiovascular health. In 1995, the American College of Sports Medicine

(ACSM) and the Centers for Disease Control and Prevention (CDC) recommended that all

Americans accumulate at least 30 minutes of moderate-intensity physical activity on most,

preferably all, days of the week. These actions and others like them are based on a growing

body of research showing the health benefits of regular physical activity.

“This landmark review of the research on physical activity—the most comprehensive ever—

has the potential to catalyze a new physical activity and fitness movement in the

United States.”

Donna E. Shalala,

Secretary of Health and

Human Services

WH O PR EPAR ED T HE R EPOR T?

In July 1994, the Office of the Surgeon General authorized the CDC to serve as lead agency

in preparing the first Surgeon General’s Report on Physical Activity and Health. The CDC

was joined in this effort by the President’s Council on Physical Fitness and Sports (PCPFS) as

a collaborative partner representing the Office of the Surgeon General. Because of the wide

interest in the health effects of physical activity, the report was planned collaboratively with

representatives from the Office of the Surgeon General, the Office of Public Health and

Science (Office of the Secretary), the NIH, and many other government agencies. CDC’s

nonfederal partners—including the American Alliance for Health, Physical Education,

Recreation, and Dance; the ACSM; and the AHA—provided consultation throughout the

developmental process. Dr. Steven Blair served as the Senior Scientific Editor, and Dr. Adele

Franks served as Scientific Editor. Each chapter was written and reviewed by top scholars in

exercise science.

WH AT D OES THE REPO RT I NCLU DE?

The report’s main purpose is to summarize existing literature on the role of physical activity

in preventing disease and on the status of attempts to increase physical activity among

Americans of all ages. Any report on a topic this broad must restrict its scope to keep the

message clear. The report concentrates on endurance-type physical activity (activity involving

repeated use of large muscles, such as walking or bicycling) because the health benefits of

this type of activity have been studied extensively. While the report acknowledges the

importance of other types of activities (strength training, activities for special populations), it

does not emphasize these. The content is presented as follows:

1. Introduction, Summary, and Chapter Conclusions
2. Historical Background and Evolution of Physical Activity Recommendations

3. Physiologic Responses and Long-Term Adaptations to Exercise

4. The Effects of Physical Activity on Health and Disease

5. Patterns and Trends in Physical Activity

6. Understanding and Promoting Physical Activity

WH AT D OES THE REPO RT C ONCL UDE? (C hapt er 1 )

The main message is that Americans can substantially improve their health and quality of

life by including moderate amounts of physical activity in their daily lives. The report

emphasizes that most Americans can achieve health benefits from physical activity even if

they dislike vigorous exercise or previously were discouraged because of the difficulty in

adhering to a program of vigorous exercise.

There is increasing agreement from the ACSM/ CDC statement, the NIH Consensus

Conference, and now the Surgeon General’s Report concerning what physical activity should

be recommended to enhance health and fitness. It is a two-level recommendation. First,

sedentary individuals can realize major health gains by including regular, moderate activity in

their lives. Next, individuals who already include moderate activity in their daily lives can see

additional health and fitness improvement if they increase the duration of their moderate

activity and/or include vigorous activities 3–5 days per week.

Ma jor Conc lusi ons of t he S urge on G ener al’s Rep ort

■ People of all ages, both male and female, benefit from regular physical activity.

■ Significant health benefits can be obtained by including a moderate amount of

physical activity (e.g., 30 minutes of brisk walking or raking leaves, 15 minutes of

running, or 45 minutes of playing volleyball) on most, if not all, days of the week.

Through a modest increase in daily activity, most Americans can improve their

health and quality of life.

■ Additional health benefits can be gained through greater amounts of physical

activity. People who can maintain a regular regimen of activity that is of longer

duration or of more vigorous intensity are likely to derive the greater benefit.

■ Physical activity reduces the risk of premature mortality in general and of coronary

heart disease, hypertension, colon cancer, and diabetes mellitus, in particular.

Physical activity also improves mental health and is important for the health of

muscles, bones, and joints.

■ More than 60% of American adults are not regularly physically active. In fact, 25%

of all adults are not active at all.

■ Nearly half of American youths 12–21 years of age are not vigorously active on a

regular basis. Moreover, physical activity declines dramatically during adolescence.

■ Daily enrollment in physical education classes has declined among high school

students from 42% in 1991 to 25% in 1995.
■ Research on understanding and promoting physical activity is at an early stage, but

some interventions to promote physical activity through schools, worksites, and

health care settings have been evaluated and found to be successful.

WH AT D OES THE REPO RT S AY A BOUT THE 

EV OLUT ION OF T HE S TUDY OF PHYS ICAL ACT IVIT Y

AS IT RELA TES TO H EALT H? (C hapt er 2 )

Chapter 2 offers a historical perspective tracing the importance of physical health from

Greco-Roman times to the present, including the role of physical activity in Eastern countries.

From the 16th century to the early 1900s, concepts were developed in Europe that formed the

basis for early American beliefs about exercise and health. Postwar research by prominent

physical educators and physicians led to the current epidemiological, descriptive, and

experimental research that provides the foundation for this report. This chapter defines terms,

describes measurement techniques, and summarizes previous recommendations on physical

activity and health.

Co nclu sion s of Cha pter 2: Hist oric al B ackg roun d an d

Ev olut ion

of Phy sica l Ac tivi ty R ecom mend atio ns

■ Physical activity for better health and well-being has been an important theme

throughout much of Western history.

■ Public health recommendations have evolved from emphasizing vigorous activity

for cardiorespiratory fitness to including the option of moderate levels of activity

for numerous health benefits.

■ Recommendations from experts agree that for better health, physical activity

should be performed regularly. The most recent recommendations advise people

of all ages to include a minimum of 30 minutes of physical activity of moderate

intensity (such as brisk walking) on most, if not all, days of the week. It is also

acknowledged that for most people, greater health benefits can be obtained by

engaging in physical activity of more vigorous intensity or of longer duration.

■ Experts advise previously sedentary people embarking on a physical activity

program to start with short durations of moderate-intensity activity and gradually

increase the duration or intensity until the goal is reached.

■ Experts advise consulting with a physician before beginning a new physical activity

program for people with chronic diseases, such as cardiovascular disease and

diabetes mellitus, or for those who are at high risk for these diseases. Experts also

advise men over age 40 and women over age 50 to consult a physician before they

begin a vigorous activity program.
■ Recent recommendations from experts also suggest that cardiorespiratory

endurance activity should be supplemented with strength-developing exercises at

least twice per week for adults, in order to improve musculoskeletal health, maintain

independence in performing the activities of daily life, and reduce the risk of

falling.

WH AT D OES THE REPO RT S AY A BOUT HOW THE 

BO DY R ESPO NDS TO P HYSI CAL ACTI VITY , BO TH

OV ER T HE S HORT AND THE LON G TE RM? (C hapt er 3 )

This chapter provides an overview of how the body responds to an episode of exercise and

adapts to exercise training and detraining. The discussion focuses on aerobic or

cardiorespiratory endurance exercise (e.g., walking, jogging, running, cycling, swimming,

dancing, and in-line skating) and resistance exercise (e.g., strength-developing exercises). It

does not address training for speed, agility, or flexibility. In discussing the multiple effects of

exercise, this overview orients the reader to the physiologic basis for the relationship between

physical activity and health.

Conclusions of Chapter 3: Physiologic Responses and LongTerm Adaptations to Exercise

■ Physical activity has numerous beneficial physiologic effects. Most widely

appreciated are its effects on the cardiovascular and musculoskeletal systems, but

benefits on the functioning of metabolic, endocrine, and immune systems are also

considerable.

■ Many of the beneficial effects of exercise training—from both endurance and

resistance activities—diminish within two weeks if physical activity is substantially

reduced, and effects disappear within two to eight months if physical activity is not

resumed.

■ People of all ages, both male and female, undergo beneficial physiologic

adaptations to physical activity.

WH AT D OES THE REPO RT S AY A BOUT THE EFF ECTS 

OF PHY SICA L AC TIVI TY O N SP ECIF IC H EALT H

CO NCER NS? (C hapt er 4 )

This chapter examines how physical activity and cardiorespiratory fitness relate to a variety of

health problems. The primary focus is on diseases and conditions for which sufficient data

exist to evaluate an association with physical activity, the strength of su ch re lati onsh ips, an d

th eir po tent ial bi olog ic me chan isms . Mu ch of th e re sear ch su mmar ized is ba sed on 

st udie s th at ha d on ly wh ite me n as pa rtic ipan ts. It re main s to be cl arif ied wh ethe r th e

re lati onsh ips de scri bed he re ar e th e sa me fo r wo me n, ra cial an d et hnic mi nori ties , an d

pe ople wi th di sabi liti es.
The findings are based on studies comparing activity levels of people who have or

develop diseases and those who do not; studies that follow populations forward in time to

observe how physical activity habits affect disease occurrence or death; case-control studies

that compare groups of people who have a disease with those who do not; cross-sectional

studies that assess the association between physical activity and disease at the same point in

time; and clinical trials that attempt to alter physical activity patterns and assess whether

disease occurrence is modified as a result.

Many of these topics are discussed in other papers in this book including health benefits

of activity related to children, adolescents and women, obesity and weight control, low back

function, cancer, and osteoporosis, to name a few.

Co nclu sion s of Cha pter 4: The Effe cts of P hysi cal Acti vity on

He alth and Dis ease 

Overall Mortality

1. Higher levels of regular physical activity are associated with lower mortality rates

for both older and younger adults.

2. Even those who are moderately active on a regular basis have lower mortality rates

than those who are least active.

Cardiovascular Diseases

1. Regular physical activity or cardiorespiratory fitness decreases the risk of

cardiovascular disease mortality in general and of coronary heart disease mortality

in particular. Existing data are not conclusive regarding a relationship between

physical activity and stroke.

2. The level of decreased risk of coronary heart disease attributable to regular

physical activity is similar to that of other lifestyle factors, such as keeping free

from cigarette smoking.

3. Regular physical activity prevents or delays the development of high blood

pressure, and exercise reduces blood pressure in people with hypertension.

Cancer

1. Regular physical activity is associated with a decreased risk of colon cancer.

2. There is no association between physical activity and rectal cancer. Data are too

sparse to draw conclusions regarding a relationship between physical activity and

endometrial, ovarian, or testicular cancers.

3. Despite numerous studies on the subject, existing data are inconsistent regarding an

association between physical activity and breast or prostate cancers.

Non–Insulin-Dependent Diabetes Mellitus

1. Regular physical activity lowers the risk of developing non-insulin-dependent

diabetes mellitus.

Osteoarthritis

1. Regular physical activity is necessary for maintaining normal muscle strength, joint

structure, and joint function. In the range recommended for health, physical

activity is not associated with joint damage or development of osteoarthritis and

may be beneficial for many people with arthritis.
2. Competitive athletics may be associated with the development of osteoarthritis later

in life, but sports-related injuries are the likely cause.

Osteoporosis

1. Weight-bearing physical activity is essential for normal skeletal development

during childhood and adolescence and for achieving and maintaining peak bone

mass in young adults.

2. It is unclear whether resistance- or endurance-type physical activity can reduce the

accelerated rate of bone loss in postmenopausal women in the absence of estrogen

replacement therapy.

Falling

1. There is promising evidence that strength training and other forms of exercise in

older adults preserve the ability to maintain independent living status and reduce

the risk of falling.

Obesity

1. Low levels of activity, resulting in fewer kilocalories used than consumed,

contribute to the high prevalence of obesity in the United States.

2. Physical activity may favorably affect body fat distribution.

Mental Health

1. Physical activity appears to relieve symptoms of depression and anxiety and

improve mood.

2. Regular physical activity may reduce the risk of developing depression, although

further research is needed on this topic.

Health-Related Quality of Life

1. Physical activity appears to improve health-related quality of life by enhancing

psychological well-being and by improving physical functioning in persons

compromised by poor health.

Adverse Effects

1. Most musculoskeletal injuries related to physical activity are believed to be

preventable by gradually working up to a desired level of activity and by avoiding

excessive amounts of activity.

2. Serious cardiovascular events can occur with physical exertion, but the net effect of

regular physical activity is a lower risk of mortality from cardiovascular disease.

“Because physical activity is so directly related to preventing disease and

premature death and to maintaining a high quality of life, we must accord it the

same level of attention that we give other public health practices that affect the

entire nation.”

Audrey F. Manley, Surgeon General (Acting)
WH AT D OES THE REPO RT S AY A BOUT PAT TERN S

AN D TR ENDS IN ACTI VITY AMO NG A MERI CANS ?

(C hapt er 5 )

This chapter documents patterns and trends of reported leisure-time physical activity of adults

and adolescents in the United States and compares the findings to the goals set by Healthy

People 2000, the national goals for disease prevention and health promotion. The

information is based on cross-sectional data from national- and state-based surveillance

systems sponsored by CDC that track health behaviors, including leisure-time physical

activity.

Co nclu sion s of Cha pter 5: Patt erns and Tre nds in P hysi cal

Ac tivi ty

Adults

1. Approximately 15% of U.S. adults engage regularly (3 times a week for at least 20

minutes) in vigorous physical activity during leisure time.

2. Approximately 22% of adults engage regularly (5 times a week for at least 30

minutes) in sustained physical activity of any intensity during leisure time.

3. About 25% of adults report no physical activity at all in their leisure time.

4. Physical inactivity is more prevalent among women than men, among blacks and

Hispanics than whites, among older than younger adults, and among the less

affluent than the more affluent.

5. The most popular leisure-time physical activities among adults are walking and

gardening or yardwork.

Adolescents and Young Adults

1. Only about one-half of U.S. young people (ages 12–21 years) regularly participate

in vigorous physical activity. One-fourth report no vigorous physical activity.

2. Approximately one-fourth of young people walk or bicycle (i.e., engage in light to

moderate activity) nearly every day.

3. About 14% of young people report no recent vigorous or light-to-moderate physical

activity. This indicator of inactivity is higher among females than males and among

black females than white females.

4. Males are more likely than females to participate in vigorous physical activity,

strengthening activities, and walking or bicycling.

5. Participation in all types of physical activity declines strikingly as age or grade in

school increases.

6. Among high school students, enrollment in physical education remained

unchanged during the first half of the 1990s. However, daily attendance in physical

education declined from approximately 42% to 25%.

7. The percentage of high school students who were enrolled in physical education

and who reported being physically active for at least 20 minutes in physical

education classes declined from approximately 81% to 70% during the first half of

this decade.
8. Only 19% of all high school students report being physically active for 20 minutes

or more in daily physical education classes.

WH AT D OES THE REPO RT S AY A BOUT PRO MOTI NG

PH YSIC AL A CTIV ITY AND UNDE RSTA NDIN G WH Y

PE OPLE ARE AC TIVE OR SEDE NTAR Y? (C hapt er 6 )

As the benefits of moderate, regular physical activity have become more widely recognized,

the need to find ways to promote this healthful behavior has become increasingly important.

Because theories and models of human behavior can guide the development and refinement

of intervention efforts, various behavioral and social science theories and models that have

been used to guide much of the research on physical activity are described. This chapter

reviews factors influencing physical activity and describes research methods to improve

participation in regular physical activity among children, adolescents, and adults. To put in

perspective the difficulty of increasing individual participation in physical activity, the chapter

examines societal barriers to engaging in physical activities and describes existing resources

that can increase opportunities for activity.

The Surgeon General’s Report clearly states that a moderate amount of physical activity

on a regular basis can improve one’s health and quality of life. A moderate amount of

physical activity is roughly equivalent to physical activity that uses approximately 150

calories of energy per day or 1,000 calories per week.

Fortunately, as the following table shows, moderate physical activity can be achieved in a

variety of ways. Individuals can select activities that they can fit into their daily routine and

enjoy throughout their lives.

Co nclu sion s of Cha pter 6: Unde rsta ndin g an d Pr omot ing

Ph ysic al A ctiv ity

1. Consistent influences on physical activity patterns among adults and young people

include confidence in one’s ability to engage in regular physical activity (e.g., selfefficacy), enjoyment of physical activity, support from others, positive beliefs

concerning the benefits of physical activity, and lack of perceived barriers to being

physically active.

2. For adults, some interventions have been successful in increasing physical activity

in communities, worksites, and health care settings, and at home.

3. Interventions targeting physical education in elementary school can substantially

increase the amount of time students spend being physically active in physical

education class.

Ex ampl es o f Ac tivi ties Exp endi ng 1 50 C alor ies
LESS VIGOROUS, MORE TIME

Washing and waxing a car for 45–60 minutes

Washing windows or floors for 45–60 minutes

Playing volleyball for 45 minutes

Playing touch football for 30–45 minutes

Gardening for 30–45 minutes

Wheeling self in wheelchair for 30–40 minutes

Walking 13/

4 miles in 35 minutes (20 min/mile)

Basketball (shooting baskets) for 30 minutes

Bicycling 5 miles in 30 minutes

Dancing fast (social) for 30 minutes

Pushing a stroller 11/

2 miles in 30 minutes

Raking leaves for 30 minutes

Walking 2 miles in 30 minutes (15 min/mile)

Water aerobics for 30 minutes

Swimming laps for 20 minutes

Wheelchair basketball for 20 minutes

Basketball (playing a game) for 15–20 minutes

Bicycling 4 miles in 15 minutes

Jumping rope for 15 minutes

Running 11/

2 miles in 15 minutes (10 min/mile)

Shoveling snow for 15 minutes

Stairwalking for 15 minutes

MORE VIGOROUS, LESS TIME

For people who are unable to set aside a block of time as listed with the activities

above, shorter episodes are clearly better than no activity. Both the CDC/ACSM

recommendation and the NIH Consensus Conference Statement encourage the

accumulation of short bouts of activity throughout the day when longer bouts are not

possible.
CO MMEN TS F ROM THE PRES IDEN T’S COUN CIL ON

PH YSIC AL F ITNE SS A ND S PORT S

Since its establishment in 1956, the PCPFS has promoted physical activity, fitness, and sports

for all Americans. The President’s Council has held physical activity and fitness clinics,

implemented programs that reach millions of individuals each year, conducted extensive

public service advertising campaigns, and provided grassroots support for educators, parents,

and community leaders. Based on this history and experience in helping our nation become

more physically active, the PCPFS offers the following:

Pa ren t s. What children do when they are young greatly influences what they do when they

grow older. Be active with your children. Be active yourself—children model what they see.

Be involved in school and community programs that promote activity. Maintain your interest

when your children become teens. Encourage children and teens to do active work around

home, to walk more, and to be active as part of their normal lifestyle. Plan special family

events that involve physical activity.

Sc h ool bo a rd s a n d su p eri n t en d en t s. Just as many employers now recognize the

importance of corporate fitness and wellness programs, school officials are beginning to

realize that their teachers, staff, and students all can benefit from physical activity. Schools

need scheduled time in which employees and students can be active. As worksite programs

have demonstrated, giving workers time off for physical activity results in fewer absences,

increased productivity, and reduced health care costs. Support daily, quality physical

education in all schools. Recess in elementary schools, physical activity breaks in schools,

fitness facilities in schools, and activity opportunities before or after school are essential if

lifetime activity is to become a reality. School administrators and school board officials must

monitor programs to ensure quality programs.

Youth sport coaches and recreation workers. Youth sports provide children with regular

activity and enjoyment. It is important for those who work in these programs to

understand that how children are treated today can affect whether they will stay active

later in life. Avoid using exercise as punishment—help young people to enjoy physical

activity! Make participation fun—not a situation in which criticism is common.

Enjoyment and personal success are the keys to a lifetime of activity. Many children

drop out of sports in their teens because they lack success or do not enjoy the

activities. Modify or create new programs to involve more teens.

Ph ysic a l ed u ca t ion t e a ch e rs. Develop programs that focus on teaching lifetime

activities and self-management skills necessary for an active lifestyle. Programs such as those

outlined in the Surgeon General’s Report are encouraged. Physical education classes should

provide for lifetime activity needs for students and be guided by the following points:

1. education need not be a physical training class where students are forced to do

regimented activities;

2. classes should encourage out-of-school as well as in-class activity, and

3. at the secondary level, physical education concepts should be taught in a classroom as

well as in a gymnasium.
Em p loy ers. Worksite fitness and health programs provide benefits for employees and

employers. It is to the employers’ benefit to find ways they can help employees become

more physically active. Quality personnel, activity options, accessibility, and social support are

important aspects of motivation to begin and continue activity.

Pu blic of fici a ls. There can never be too many public opportunities for physical activity.

Biking trails, parks, fitness courses, sidewalks, and swimming pools are facilities that can be

provided to promote active lifestyles. Support legislation to promote activity in schools and in

the workplace and funding for preventive programs including research related to activity and

health.

Ph ysic ia n s a n d h e a lt h p r ofes sion a ls. Physicians and allied health professionals

can play a major role in encouraging patients to become more physically active. All health

care givers are encouraged to make activity promotion a part of their regular practice.

In su ra n ce co m p a n ies. Insurance companies have a unique opportunity to play a

major role in improving Americans’ health by rewarding active behavior. Offer preventive

programs that promote active behavior and consider reducing premiums for physically active

individuals.

All Americans. Most of us know that physical activity is good for our health. But many

may not know just how important regular physical activity is to preventing the

development of chronic diseases and improving our quality of life. The Surgeon

General’s Report on Physical Activity and Health makes it clear that some physical

activity is better than none—even if it is a moderate amount. We encourage each

person to perform daily activity that expends about 150 calories of energy. Find an

activity that you enjoy and make it part of your daily plan. If this is too much, start

with less activity and do it each day or do the activity several days a week as a

starter. Remember—participating in some activity is better than doing nothing at all—

and more is even better!