Meeting the Aerobic and Muscle-Strengthening Physical Activity Guidelines Among Older US Adults, National Health Interview Survey 1998-2018.

The Physical Activity Guidelines for Americans, second edition, recommends older adults participate in ≥150 minutes per week of moderate-intensity equivalent aerobic activity and ≥2 days per week of muscle-strengthening activity. We estimated prevalence and trends of meeting the guidelines among US adults aged ≥65 years from 1998 to 2018. Using the 1998-2018 National Health Interview Survey, we estimated the prevalence of meeting aerobic, muscle-strengthening, and combined physical activity guidelines stratified by age group, sex, race and ethnicity, and education level. Within age groups, we calculated prevalence differences by sociodemographic categories. Prevalence of meeting each guideline increased for all age groups and most sociodemographic subgroups. The increased magnitude of meeting the combined guideline from 1998-2000 to 2016-2018 differed across levels of educational attainment for most age groups. Despite increasing over time, the prevalence among older adults of meeting physical activity guidelines remains low (range for combined guideline: 7.2%-17.2%).

Systematic Review Protocol to Evaluate the Evidence Informing the Physical Activity Guidelines for Americans Midcourse Report: Implementation Strategies for Older Adults.

The Physical Activity Guidelines for Americans (Guidelines) advises older adults to be as active as possible. Yet, despite the well documented benefits of physical activity just 12.8% of those ages 65 and older meet the Guidelines. To address this, the U.S. Department of Health and Human Services (HHS) developed a Midcourse Report focused on effective strategies to improve older adult physical activity behaviors. The first step in this process was a systematic literature review. A literature review team was contracted to examine the evidence on key settings and effective behavioral intervention strategies, as well as effective policy, systems, and environmental (PSE) approaches, to improve physical activity among older adults. The PSE search employed an equity-centered framework adapted to researching PSE approaches for improving physical activity outcomes in older adults. Sixteen thousand eight hundred and eighty-three titles and abstracts were screened, and 734 full articles were reviewed for inclusion. Of those, 64 original research articles were included for the final review to answer two questions, one (plus 5 sub-questions) focused on Settings/Strategies literature (45 studies) and one (plus 2 sub-questions) focused on PSE literature (19 studies). The literature review process identified key settings and evidence-based strategies to support older adults in becoming more physically active, and provides a foundation for the Physical Activity Guidelines for Americans Midcourse Report: Implementation Strategies for Older Adults. More research is needed to address how factors related to equity and psychosocial constructs influence physical activity behaviors among older adults.

Virtual Workshops as an Effective and Engaging Policy Implementation Strategy: Lessons From the National Youth Sports Strategy.

BACKGROUND.: Implementation is an important piece of effective policymaking, but connecting local organizations with federal policy can be challenging. A virtual workshop structure can help engage implementation partners, especially when in-person events are not possible. The workshops described here leveraged virtual outreach and facilitation methods to foster community engagement, forge connections, and build relationships at the regional, state, and local levels. METHODS.: This article focuses on five virtual workshops. The planning phase consisted of selecting the geographic scope of each workshop, developing outreach and facilitation materials, and supporting event logistics. The execution and summary phase included tailoring materials, hosting the events, and producing follow-up materials. Networking, resource sharing, collaboration, and active facilitation were employed to promote engagement. RESULTS.: Registration for the virtual workshops included 223 individuals representing organizations in 28 states. Participants shared 133 resources. In a post-event evaluation, 93% of respondents indicated they could identify at least one new resource to support their efforts to increase youth sports participation in their community, and 94% indicated they plan to follow up and explore potential partnerships/collaborations with others they met or heard from at the workshop. Networking and resource sharing were identified as the most useful aspects of the workshops. CONCLUSIONS.: With careful planning and collaboration, virtual workshops represent a useful community engagement mechanism to bring policy into practice. Creating events focused on the participant experience supports health promotion professionals, engages communities, and takes a policy off the page and out to the people.

Association of Muscle-Strengthening and Aerobic Physical Activity With Mortality in US Adults Aged 65 Years or Older.

This cohort study uses national data to explore the dose-response association between guideline-recommended physical activity and mortality in older adults.

Understanding the Impact of Move Your Way Campaign Exposure on Key Physical Activity Outcomes - Results from a Multi-site Pilot Evaluation.

The Move Your Way® campaign was developed to encourage physical activity contemplators to get active. A pilot test of campaign implementation was conducted and evaluated in eight communities between March and October 2020. A web-based, cross-sectional survey of adults collected pilot campaign outcome data after campaign implementation. Differences in outcomes between exposed and unexposed groups across the communities were compared. A total of n = 5,140 responded to the survey. Across eight communities, those who reported campaign exposure had 7.2 (95% CI, 6.1-8.6) greater odds of being aware of the Physical Activity Guidelines for Americans (Guidelines) compared to unexposed respondents. Additionally, they had greater odds of identifying the correct aerobic and muscle-strengthening dosages and had 1.4 (95% CI, 1.1-1.6) greater odds of reporting meeting both the aerobic and muscle-strengthening Guidelines. In this pilot evaluation, reported exposure to Move Your Way is associated with higher odds of being aware of the Guidelines, knowing recommended dosages, likelihood of becoming more active in the future, higher physical activity self-efficacy, making a recent physical activity behavior change, and higher physical activity levels. The Move Your Way campaign can be used in communities to promote physical activity.

Responses to the Physical Activity Guidelines and Dissemination Strategies for Behavior Change in a Representative Sample of US Adults.

BACKGROUND: Dissemination of the Physical Activity Guidelines for Americans (Guidelines) is needed, but how individuals respond to the Guidelines is not well understood. This surveillance study describes US adults' reported responses to and information sources for hearing about the Guidelines and explores relationships between how respondents heard about the Guidelines and their reported response(s). METHODS: Data were analyzed from the population-based 2019 Health Information National Trends Survey 5 Cycle 3. Population-weighted proportions of response were calculated. Among those who had heard about the Guidelines, binary logistic regressions examined associations between the reported response(s) and the information source and number of sources reported. RESULTS: The analytical sample included 5047 adults. Nearly 65% of US adults reported hearing about the Guidelines, and 29% reported a behavioral response (eg, increased physical activity). Hearing about the Guidelines through health professionals (adjusted odds ratio = 2.30, 95% confidence interval, 1.45-3.65) or social media (adjusted odds ratio = 1.89, 95% confidence interval, 1.20-2.96) (vs other sources) was associated with reporting increasing physical activity. Hearing from multiple sources (vs one source) was associated with reporting increasing physical activity (adjusted odds ratio = 1.97, 95% confidence interval, 1.18-3.31). CONCLUSION: Findings suggest dissemination of the Guidelines across multiple channels may promote greater changes in physical activity.

Disparities in Youth Sports Participation in the U.S., 2017-2018.

INTRODUCTION: In 2019, the National Youth Sports Strategy was released and called for regular analysis, interpretation, and dissemination of U.S. youth sports surveillance data. The purpose of this study is to provide the recent national estimates of U.S. youth aged 6-17 years who participate in sports and examine the differences in participation by demographic characteristics, overall and across age groups. METHODS: Nationally representative data on parent-reported youth sports participation from the 2017-2018 National Survey of Children's Health (n=36,779) were analyzed in 2019. The prevalence and 95% CIs of youth sports participation were estimated by demographic characteristics, overall and by age group. Investigators assessed the significant (p<0.05) differences and trends in participation using pairwise t-tests and orthogonal polynomial contrasts and effect modification by age group using logistic regression models. RESULTS: Overall, 57.7% (95% CI=56.6, 58.9) of U.S. youth participated in sports. Participation was highest among youth who were aged 10-13 years, male, and white, non-Hispanic and increased with increasing parent/caregiver education and household income (all p<0.05). Differences in participation by demographic characteristics were more pronounced among younger youth. For example, prevalence by household income level ranged from 32.7% to 79.9% among children aged 6-9 years and from 41.6% to 67.2% among youth aged 14-17 years. CONCLUSIONS: Although nearly 6 in 10 U.S. youth participate in sports, substantial disparities exist, especially among younger children. Identifying and overcoming the barriers may help increase youth sports participation in the U.S.

Understanding Contemplators' Knowledge and Awareness of the Physical Activity Guidelines.

BACKGROUND: The Office of Disease Prevention and Health Promotion completed research to understand factors that could encourage Americans to follow the Physical Activity Guidelines for Americans, second edition, released in 2018. This study describes survey research assessing demographic characteristics that might be related to knowledge and awareness of the guidelines. METHODS: An online survey of 2050 adult physical activity contemplators assessed knowledge of physical activity, awareness of the guidelines, and knowledge of dosage recommendations. Univariate and bivariate analyses were performed, and demographic differences in knowledge and awareness were analyzed using Pearson chi-square tests and Fisher exact tests. RESULTS: Respondents had medium to high knowledge of physical activity, although knowledge varied significantly by socioeconomic factors. Knowledge of dosage recommendations was very low, with 2% and 3% of respondents correctly identifying recommended moderate- and vigorous-intensity doses, respectively. Only 22% were aware of the guidelines; awareness was greater among those with a higher education or income and those without a disability. CONCLUSIONS: These findings guided the development of the Office of Disease Prevention and Health Promotion's Move Your Way campaign and reinforced the need to raise awareness of the guidelines and promote behavior change among physical activity contemplators-particularly those from lower socioeconomic groups.

The Move Your Way Campaign: Encouraging Contemplators and Families to Meet the Recommendations From the Physical Activity Guidelines for Americans.

BACKGROUND: The Move Your Way campaign, developed by the Office of Disease Prevention and Health Promotion, aims to improve Americans' adherence to the Physical Activity Guidelines for Americans. This article describes the research that informed the campaign's products, messaging, and strategy. METHODS: A mixed-methods approach was used to understand participants' preferences for physical activity messages and information seeking. Two rounds (round 1 [n = 95] and round 2 [n = 73]) of focus groups and an online survey (n = 2050) were conducted with adult physical activity contemplators. A third round (n = 84) of focus groups was conducted with children, teens, and parents of young children. RESULTS: Adults, parents, teens, and children preferred messages that reflected diverse examples of activities; most participants disliked "one-size-fits-all" recommendations. Adults and parents preferred messages that emphasized specific health benefits over generic messages about overall health. Although some participants preferred getting physical activity information from digital search tools and social media platforms, many preferred getting this information from family members and friends. CONCLUSION: The Office of Disease Prevention and Health Promotion translated these findings into 3 themes used for Move Your Way implementation: (1) leverage social and community connections, (2) emphasize representation through inclusion and diversity, and (3) customize physical activity recommendations to make them more achievable.

Daily Step Counts for Measuring Physical Activity Exposure and Its Relation to Health.

PURPOSE: A systematic primary literature review was conducted to evaluate the relationship of physical activity-as measured by daily step counts-with all-cause mortality, cardiovascular disease mortality, incident cardiovascular disease, and type 2 diabetes mellitus; to evaluate the shape of dose-response relationships; and to interpret findings in the context of development of the Physical Activity Guidelines for Americans, Second Edition. METHODS: A primary literature search encompassing 2011 to March 2018 for existing literature reporting on these relationships was conducted. RESULTS: Eleven pertinent articles were identified. Seven longitudinal studies examined the relationship between daily step counts and mortality, disease incidence, or risk. Two studies examined objectively measured steps per day and all-cause mortality; one was restricted to a relatively small elderly population. One study examined cardiovascular events, defined as cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. The other four longitudinal studies addressed incident type 2 diabetes. All longitudinal studies reported an inverse relationship between steps per day and outcome risk. In one study, 531 cardiovascular events occurred during more than 45,000 person-years of follow-up. Before intervention, each increment of 2000 steps per day up to 10,000 steps was associated with a 10% lower cardiovascular event rate. Also, for every increase of 2000 steps per day over baseline, there was an 8% yearly reduction in cardiovascular event rate in individuals with impaired glucose tolerance. CONCLUSIONS: Daily step count is a readily accessible means by which to monitor and set physical activity goals. Recent evidence supports previously limited evidence of an inverse dose-response relationship of daily steps with important health outcomes, including all-cause mortality, cardiovascular events, and type 2 diabetes. However, more independent studies will be required before these observations can be translated into public health guidelines.

Association between Bout Duration of Physical Activity and Health: Systematic Review.

PURPOSE: This study aimed to conduct a systematic literature review to determine whether physical activity episodes of <10 min in duration have health-related benefits or, alternatively, if the benefits are only realized when the duration of physical activity episodes is ≥10 min. METHODS: The primary literature search was conducted for the 2018 Physical Activity Guidelines Advisory Committee Report and encompassed literature through June 2017, with an additional literature search conducted to include literature published through March 2018 for inclusion in this systematic review. RESULTS: The literature review identified 29 articles that were pertinent to the research question that used either cross-sectional, prospective cohort, or randomized designs. One prospective cohort study (N = 4840) reported similar associations between moderate to vigorous physical activity (MVPA) and all-cause mortality when examined as total MVPA, MVPA in bouts ≥5 min in duration, or MVPA in bouts ≥10 min in duration. Additional evidence was identified from cross-sectional and prospective studies to support that bouts of physical activity <10 min in duration are associated with a variety of health outcomes. Randomized studies only examined bouts of physical activity ≥10 min in duration. CONCLUSIONS: The current evidence, from cross-sectional and prospective cohort studies, supports that physical activity of any bout duration is associated with improved health outcomes, which includes all-cause mortality. This may suggest the need for a contemporary paradigm shift in public health recommendations for physical activity, which supports total MVPA as an important lifestyle behavior regardless of the bout duration.

High-Intensity Interval Training for Cardiometabolic Disease Prevention.

PURPOSE: The 2018 Physical Activity Guidelines Advisory Committee systematically searched existing literature reviews to assess the relationship between high-intensity interval training (HIIT) and reduction in cardiometabolic disease risk. METHODS: Duplicate independent screenings of 260 articles identified from PubMed®, Cochrane Library, and CINAHL databases yielded suitable data from one systematic review and two meta-analyses. Search terms included a combination of "high intensity" "physical activity/exercise" and "interval training" and outcome-specific terms. The quality of the included reviews was assessed using a tailored version of the AMSTARExBP report on quality. Exposure Subcommittee members graded scientific evidence strength based on a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. RESULTS: Moderate evidence indicates that HIIT can improve insulin sensitivity, blood pressure, and body composition in adults with group mean ages ranging from ~20 to ~77 yr. These HIIT-induced improvements in cardiometabolic disease risk factors are comparable with those resulting from moderate-intensity continuous training, and they are more likely to occur in adults at higher risk of cardiovascular disease and diabetes than in healthy adults. Moderate evidence also indicates that adults with overweight or obesity classification are more responsive than adults with normal weight to HIIT-related improvements in insulin sensitivity, blood pressure, and body composition. Insufficient evidence was available to determine whether a dose-response relationship exists between the quantity of HIIT performed and several risk factors for cardiovascular disease and diabetes, or whether the effects of HIIT on cardiometabolic disease risk factors are influenced by age, sex, race/ethnicity, or socioeconomic status. CONCLUSIONS: HIIT by adults, especially those with overweight and obesity classification, can improve insulin sensitivity, blood pressure, and body composition, comparable with those resulting from moderate-intensity continuous training.

Physical Activity to Prevent and Treat Hypertension: A Systematic Review.

PURPOSE: This systematic umbrella review examines and updates the evidence on the relationship between physical activity (PA) and blood pressure (BP) presented in the 2008 Physical Activity Guidelines Advisory Committee Scientific Report. METHODS: We performed a systematic review to identify systematic reviews and meta-analyses involving adults with normal BP, prehypertension, and hypertension published from 2006 to February 2018. RESULTS: In total, 17 meta-analyses and one systematic review with 594,129 adults ≥18 yr qualified. Strong evidence demonstrates: 1) an inverse dose-response relationship between PA and incident hypertension among adults with normal BP; 2) PA reduces the risk of cardiovascular disease (CVD) progression among adults with hypertension; 3) PA reduces BP among adults with normal BP, prehypertension, and hypertension; and 4) the magnitude of the BP response to PA varies by resting BP, with greater benefits among adults with prehypertension than normal BP. Moderate evidence indicates the relationship between resting BP and the magnitude of benefit does not vary by PA type among adults with normal BP, prehypertension, and hypertension. Limited evidence suggests the magnitude of the BP response to PA varies by resting BP among adults with hypertension. Insufficient evidence is available to determine if factors such as sex, age, race/ethnicity, socioeconomic status, and weight status or the frequency, intensity, time, and duration of PA influence the associations between PA and BP. CONCLUSIONS: Future research is needed that adheres to standard BP measurement protocols and classification schemes to better understand the influence of PA on the risk of comorbid conditions, health-related quality of life, and CVD progression and mortality; the interactive effects between PA and antihypertensive medication use; and the immediate BP-lowering benefits of PA.

Physical Activity, All-Cause and Cardiovascular Mortality, and Cardiovascular Disease.

PURPOSE: Conduct a systematic umbrella review to evaluate the relationship of physical activity (PA) with all-cause mortality, cardiovascular mortality, and incident cardiovascular disease (CVD); to evaluate the shape of the dose-response relationships; and to evaluate these relationships relative to the 2008 Physical Activity Guidelines Advisory Committee Report. METHODS: Primary search encompassing 2006 to March, 2018 for existing systematic reviews, meta-analyses, and pooled analyses reporting on these relationships. Graded the strength of evidence using a matrix developed for the Physical Activity Guidelines Advisory Committee. RESULTS: The association of self-reported moderate-to-vigorous physical activity (MVPA) on all-cause mortality, CVD mortality, and atherosclerotic CVD-including incident coronary heart disease, ischemic stroke and heart failure-are very similar. Increasing MVPA to guidelines amounts in the inactive US population has the potential to have an important and substantial positive impact on these outcomes in the adult population. The following points are clear: the associations of PA with beneficial health outcomes begin when adopting very modest (one-third of guidelines) amounts; any MVPA is better than none; meeting the 2008 PA guidelines reduces mortality and CVD risk to about 75% of the maximal benefit obtained by physical activity alone; PA amounts beyond guidelines recommendations amount reduces risk even more, but greater amounts of PA are required to obtain smaller health benefits; and there is no evidence of excess risk over the maximal effect observed at about three to five times the amounts associated with current guidelines. When PA is quantified in terms of energy expenditure (MET·h·wk), these relationships hold for walking, running, and biking. CONCLUSIONS: To avoid the risks associated with premature mortality and the development of ischemic heart disease, ischemic stroke, and all-cause heart failure, all adults should strive to reach the 2008 Physical Activity Guidelines for Americans.