Introducing the Physical Activity Guidelines for Americans 2

Introducing the Physical Activity Guidelines for Americans, 2 nd edition Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Promoting Physical Activity Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Why We Need to Promote Physical Activity in Adults Percentage of U. S. Adults Ages 18 Years or Older Who Met the Aerobic and Muscle-Strengthening Guidelines, 2008– 2016 Impact of Optimizing Physical Activity: • Reduce health care costs • Prevent and reduce morbidity and premature mortality • Improved wellness and quality of life Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Why We Need to Promote Physical Activity in Youth Percentage of U. S. High School Students Who Met the Aerobic Physical Activity and Muscle-Strengthening Guidelines, 2011– 2015 Impact of Optimizing Physical Activity: • Develop life-long skills and positive attitude towards movement • Optimize brain health • Minimize chronic disease risk Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Everyone Has a Role to Play, Every Setting Counts! Healthcare Business and Industry Community Recreation, Fitness, and Parks Education Faith. Based Settings Mass Media Public Health Sports See the National Physical Activity Plan for objectives and strategies for each of the nine sectors at http: //www. physicalactivityplan. org/index. html Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Background and Development Process Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

This is the 2 nd edition of Physical Activity Guidelines. 2008 2018 Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

The Guidelines were developed from an independent scientific review of the evidence. Appointment of PAG Advisory Committee Review of the current science PAGAC Scientific Report Development of Physical Activity Guidelines Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines. Implemented in federal programs and initiatives

Many stakeholders contributed to the Guidelines. Public comment Scientific Report Federal agency comment PAG 2 nd edition Peer review Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Defining Terms Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Aerobic Activity (endurance, cardio) Activity in which the body’s large muscles move in a rhythmic manner for a sustained period of time. • Examples: o Brisk walking o Running/jogging o Swimming o Bicycling o Soccer o Tennis Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Aerobic Activity: 3 components of recommendations • Intensity = how hard o Absolute: comparison of energy expenditure during activity to that at rest (METS) o Relative: subjective rating of effort from 0 -10 (RPE) • Frequency = how often (per week) • Duration = how long is a session (min) Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Defining Intensity Moderate Intensity • Absolute scale: 3. 0 -5. 9 METs • Relative scale: 5 or 6 on a scale of 0 to 10 Vigorous Intensity • Absolute scale: 6. 0 or more METs • Relative scale: begins at a 7 or 8 on a scale of 0 to 10 Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Intensity should be customized for client – these charts are suggestions Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Muscle-Strengthening Activity that increases skeletal muscle strength, power, endurance, and mass. • Examples: o Lifting weights o Using resistance bands o Bodyweight exercises o Carrying heavy loads o Heavy gardening o Yoga (some forms) Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Muscle-Strengthening Activity: 3 components of recommendations • Intensity = how much weight or force is used o Relative: compared to how much a person is able to lift o Absolute: actual weight (e. g. 10 kg) • Frequency = how often • Sets and repetitions = how many times Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Bone-Strengthening (weight-bearing) Activity that produces an impact or tension force on the bones that promotes bone growth and strength. • Examples: o Running o Jumping Rope o Lifting Weights o Plyometrics • Bone-strengthening activities can be aerobic and muscle strengthening as well. Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Multicomponent Physical Activity More than one type of activity blended together, such as aerobic, musclestrengthening, and balance training. • Examples: o Home workout video o Structured class o Ballroom dancing o Yoga o Tai chi o Gardening Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

What’s New In the Physical Activity Guidelines for Americans Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

What’s New: Physical Activity Guidelines for Americans, 2 nd edition • Expanded science base • New to this edition: – Guidance for preschool-aged children (3 -5 years) – Discussion of sedentary behavior – Removal of 10 -minute bout length requirement – Evidence for even more health benefits – including immediate effects – Tested strategies for physical activity promotion Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Move More and Sit Less Conclusions: • High volumes of physical activity minimize the risk of excess sedentary behavior • Minimizing sedentary behavior helps, but people still need physical activity • Most people would benefit from interventions that address both risk factors Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines. Relationship Among Moderate-to. Vigorous Physical Activity, Sitting Time, and Risk of All-Cause Mortality in Adults

Any Activity Counts Conclusions Relationship of Moderate-to-Vigorous Physical Activity to All-Cause Mortality • No lower threshold for benefits from physical activity • Most benefits are attained with at least 150 -300 minutes of moderate physical activity per week • No upper limit where benefits end Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Benefits of Physical Activity for Youth • • • Improved bone health (ages 3 through 17 years) Improved weight status (ages 3 through 17 years) Improved cardiorespiratory and muscular fitness (ages 6 through 17 years) Improved cardiometabolic health (ages 6 through 17 years) Improved cognition (ages 6 to 13 years)* Reduced risk of depression (ages 6 to 13 years) *New health benefit Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Benefits of Physical Activity for Adults and Older Adults • Lower risk of all-cause mortality • Lower risk of cardiovascular disease (including heart disease and stroke) • • Lower risk of hypertension Lower risk of type 2 diabetes • • • Improved quality of life • • • Prevention of weight regain following initial weight loss Lower risk of adverse blood lipid profile Lower risk of cancers of the bladder, * breast, colon, endometrium, * esophagus, * kidney, * lung, * and stomach* • Improved cognition* • Reduced risk of dementia (including Alzheimer’s disease)* Reduced anxiety Reduced risk of depression Improved sleep Slowed or reduced weight gain Weight loss, particularly when combined with reduced calorie intake Improved bone health Improved physical function Lower risk of falls (older adults) Lower risk of fall-related injuries (older adults)* *New health benefit Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

New Health Benefits Short Term Benefits • • • Improve quality of life Reduce anxiety Reduce blood pressure Improve insulin sensitivity Improve sleep outcomes Long Term Benefits Disease Management • For youth, improve cognition • For adults, prevent 8 types of cancer (previously 2) • For adults, reduce risk of dementia, including Alzheimer’s disease • For older adults, lowers risk of injuries from falls • For pregnant women, reduces the risk of postpartum depression. • For all groups, reduces the risk of excessive weight gain • Decrease pain of osteoarthritis • Reduce disease progression for hypertension • Reduce disease progression for type 2 diabetes • Reduce symptoms of anxiety and depression • Improve cognition for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Brain Health Outcome Population Benefit Cognition Children ages 6 to 13 years Improved cognition (performance on academic achievement tests, executive function, processing speed, memory) Cognition Adults Reduced risk of dementia (including Alzheimer’s disease) • Cognition Adults older than age 50 years Improve cognition (executive function, attention memory, crystallized intelligence, * processing speed) • Quality of life Adults Improved quality of life • Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines. Acute Habitual • •

Brain Health, cont. Outcome Population Benefit Depressed mood and depression Children ages 6 to 17 years and adults Reduced risk of depression Reduced depressed mood Anxiety Adults Reduced short-term feeling of anxiety (state anxiety) Anxiety Adults Reduced long-term feeling and signs of anxiety disorders • Sleep Adults Improved sleep outcomes (increased sleep efficiency, sleep quality, deep sleep; reduced daytime sleepiness frequency of use of medication to aid sleep • Sleep Adults Improved sleep outcomes that increase with duration of acute episode Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines. Acute Habitual • • •

Key Guidelines Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for Preschool-Aged Children (3 -5 yrs. ) Type Aerobic – All Intensities Muscle Strengthening Amount 3 Hours/Day Bone Strengthening ü Limited data prevents specific guidelines ü Encourage active unstructured play and structured activities to learn motor skills ü Adult caregivers should provide the opportunity and encouragement Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for School-Aged Children and Adolescents (6 -17 yrs. ) Type Aerobic – Moderate Intensity Aerobic – Vigorous Intensity Muscle Strengthening Bone Strengthening ü ü Amount ≥ 60 min/d vigorous at least 3 x/wk. 3 days/wk. At least 60 minutes per day of combination of all types; most is aerobic Muscle- and bone-strengthening should be counted towards total minutes Adult caregivers should provide the opportunity and encouragement Focus on enjoyment and variety Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for Adults Type Amount Aerobic – Moderate Intensity 150 -300 min/wk. *OR* Aerobic – Vigorous Intensity Muscle Strengthening 75 -150 min/wk. ≥ 2 days/wk. ü Sit more, move less, some activity is better than none ü Spread activity throughout week for health benefits and to reduce injury/fatigue ü Additional activity produces additional benefits; more may be necessary for weight management Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for Older Adults Type Amount Aerobic – Moderate Intensity 150 -300 min/wk. *OR* Aerobic – Vigorous Intensity Muscle Strengthening 75 -150 min/wk. ≥ 2 days/wk. Multicomponent *Included* ü Same as Adults with several additions ü If limitations, do as much as “abilities and conditions allow” ü Wide range of abilities means advice about intensity level needs to be tailored to client or audience Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Weight Status and Weight Management Comments ü Weight-neutral messages on benefits of activity: ü “The health benefits of physical activity are generally independent of weight. ” (pg. 31) ü “Physically active people of all body weights (normal weight, overweight, obesity) also have a lower risk of all-cause mortality than do inactive people. ” (pg. 35) ü Role of activity in weight loss: ü Key role in weight maintenance, weight loss, and maintenance of weight loss ü May need more than the guidelines for these outcomes ü Both aerobic and muscle-strengthening activities are vital ü All intensities burn calories; higher intensities save time ü Ideally pair with nutrition/food changes Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Safety Considerations Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

General notes on safety ü “Be confident that physical activity is safe for almost everyone” ü No need for HCP consult if healthy and symptom free ü Choose activities mindfully, consider: ü Age and prior injuries ü Client’s goals and starting fitness level ü “Start low and go slow” approach to reduce the risk of musculoskeletal injuries from overload ü Variety reduces risk of overuse injuries ü Correct gear, safe equipment, and safe environments ü Inherent safety of choices Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for Pregnancy in Adults ü Guidelines are the same as for non-pregnant adults ü Safety notes: ü Activity has many benefits, minimal risks ü Be under the care of a provider who can monitor progress of pregnancy and physical activity ü Avoid exercises that are risky – lying on the back (2 nd and 3 rd trimester), contact sports, risk of falls or abdominal trauma ü If beginning, start low and go slow approach ü Vigorous-intensity is OK if done prior to pregnancy Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Key Guidelines for Adults with Chronic Health Conditions and Adults with Disabilities ü Guidelines are the same as for adults without health conditions or disabilities ü Safety notes: ü Activity has many benefits, minimal risks ü If not able to meet guidelines, engage according to abilities; avoid inactivity ü Be under the care of a provider who can advise on whether modifications are needed to minimize risks Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Promoting the Guidelines Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Is Physical Activity Promotion in YOUR Scope of Practice? • Yes, Maybe, No, It Depends! • Toolkit can assist in determining your SOP: • healthysd. gov/wp- content/uploads/2014/12/WM-EIMToolkit 2013 FINAL. pdf • SOP/SOPP documents for NDTRs and RDNs: • Include physical activity comments • Suggest certifications to expand SOP Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Exercise is Medicine Credential (“new” Toolkit) • Website: – https: //exerciseismedicine. org • Health care providers’ action guide • EIM Credential – NDTRs and RDNs: Level 1 Certification for working with “individuals at low or moderate risk who have been cleared for independent exercise. ” – $100 for 5 CPEs, Certificate of Completion – Higher level certifications for people with exercise backgrounds/training – See https: //www. todaysdietitian. com/newarchives/0817 p 50. shtml Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

What Works to Increase Physical Activity? For Individuals or Small Groups • Guidance from peers or professionals • Support from others • Technology For Communities • • • Point of decision prompts School policies and practices Access to indoor or outdoor recreation facilities or outlets Community-wide campaigns Community design Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Move Your Way Campaign • Vision: Consumer-focused campaign to promote physical activity recommendations in the second edition of the Physical Activity Guidelines • Purpose: o Raise awareness of recommendations o Change behavior among consumers • Target audiences: physical activity contemplators, or those who are not yet meeting the recommendations in the Physical Activity Guidelines and health professionals (as conduit to consumers) Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Move Your Way Campaign Resources Interactive tools Posters and factsheets Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines. Series of videos

Move Your Way Web Badges and Widget Content can be added to your digital platform and HHS will update the web badge and widget content automatically. • Move Your Way Activity Planner web badge links people to the HHS interactive tool to help them build a personalized weekly activity plan. • Move Your Way Activity Planner widget lets people start personalizing their weekly activity plan right on your website. Then it links them to the HHS interactive tool to continue building their plan. • Move Your Way Parent Interactive Graphic web badge links parents to the HHS interactive infographic to see how their kids can get 60 minutes of activity a day. Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.

Conclusions • Physical activity is a cost-effective strategy for improving short- and long-term health and wellness in all stages of the life span. • Providing basic physical activity opportunities, encouragement, and information for healthy children and adults may be within your scope of practice • Consider increasing your scope and/ referral network to serve populations and clients with additional needs

Additional Resources • PA Guidelines: – https: //health. gov/PAGuidelines • Move your way materials: – https: //health. gov/paguidelines/moveyourway/ • Exercise is Medicine: – https: //exerciseismedicine. org • Park Rx: – National and State programs to promote recreation – https: //parks. state. wa. us/1137/Park. Rx Information adapted from the Physical Activity Guidelines for Americans, 2 nd edition. Available at health. gov/PAGuidelines.