Module 7: Physical Activity

Content:

This Module contains 7 Lessons:
  • Lesson 1: Relationship between Physical Activity and Health
  • Lesson 2: Aerobic, Muscle-strengthening, and Bone-strengthening Activity
  • Lesson 3: Health Benefits
  • Lesson 4: Dealing with Inactivity
  • Lesson 5: Safe and Active
  • Lesson 6: Pregnancy and People with Disabilities
  • Lesson 7: Community Efforts to Promote Physical Activity

Objectives:

Students will be able to:
  • Describe the health benefits of physical activity
  • Explain the differences between aerobic and muscle-strengthening physical activity


Lesson 1: The Relationship between Physical Activity and Health



Learning Activity 1.1:
Find out how much you already know about physical activity by completing this ungraded quiz. Do you know more or less than you thought?


All Americans should be regularly physically active to improve overall health and fitness and to prevent many adverse health outcomes. The benefits of physical activity occur in generally healthy people, in people at risk of developing chronic diseases, and in people with current chronic conditions or disabilities. The Physical Activity Guidelines for Americans (2008) gives guidance on the amount of physical activity that will provide health benefits for all Americans. In addition to presenting the Guidelines, this Module gives an overview of research findings on physical activity and health.
Physical activity affects many health conditions, and the specific amounts and types of activity that benefit each condition vary. One consistent finding from research studies is that once the health benefits from physical activity begin to accrue, additional amounts of activity provide additional benefits.
Although some health benefits seem to begin with as little as 60 minutes (1 hour) a week, research shows that a total amount of 150 minutes (2 hours and 30 minutes) a week of moderate-intensity aerobic activity, such as brisk walking, consistently reduces the risk of many chronic diseases and other adverse health outcomes.


Learning Activity 1.2: Watch this video about The Physical Activity Guidelines for Americans.


Examining the Relationship between Physical Activity and Health
Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.http://www.health.gov/paguidelines/guidelines/

In many studies covering a wide range of issues, researchers have focused on exercise, as well as on the more broadly defined concept of physical activity. Exercise is a form of physical activity that is planned, structured, repetitive, and performed with the goal of improving health or fitness. So, although all exercise is physical activity, not all physical activity is exercise.


Quick Review: What is the difference between physical activity and exercise?


Studies have examined the role of physical activity in many groups—men and women, children, teens, adults, older adults, people with disabilities, and women during pregnancy and the postpartum period. These studies have focused on the role that physical activity plays in many health outcomes, including:
  • Premature (early) death;
  • Diseases such as coronary heart disease, stroke, some cancers, type 2 diabetes, osteoporosis, and depression;
  • Risk factors for disease, such as high blood pressure and high blood cholesterol;
  • Physical fitness, such as aerobic capacity, and muscle strength and endurance
  • Functional capacity (the ability to engage in activities needed for daily living);
  • Mental health, such as depression and cognitive function; and
  • Injuries or sudden heart attacks.
These studies have also prompted questions as to what type and how much physical activity is needed for various health benefits. To answer this question, investigators have studied three main kinds of physical activity: aerobic, muscle-strengthening, and bone-strengthening.


Lesson 2: Aerobic, Muscle-strengthening and Bone-strengthening Activity

Aerobic, Muscle-strengthening and Bone-strengthening Activity

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services,http://www.health.gov/paguidelines/guidelines/

Aerobic activities, also called endurance activities, are physical activities in which people move their large muscles in a rhythmic manner for a sustained period. Running, brisk walking, bicycling, playing basketball, dancing, and swimming are all examples of aerobic activities. Aerobic activity makes a person's heart beat more rapidly to meet the demands of the body's movement. Over time, regular aerobic activity makes the heart and cardiovascular system stronger and fitter.
Aerobic physical activity has these components:
  • Frequency
  • Intensity, or how hard a person works to do the activity. The intensities most often examined are moderate intensity (equivalent in effort to brisk walking) and vigorous intensity (equivalent in effort to running or jogging);
  • Duration, or how long a person does an activity in any one session.
Although these components make up a physical activity profile, research has shown that the total amount of physical activity (minutes of moderate–intensity physical activity, for example) is more important for achieving health benefits than is any one component (frequency, intensity, or duration).


Quick Review: Which is the more important for achieving health benefits from aerobic activity: 1) total minutes or 2) how vigorous the activity is?


Key Guidelines for Adults

All adults should avoid inactivity. Some physical activity is better than none, and adults who participate in any amount of physical activity gain some health benefits.
For substantial health benefits, adults should do at least 150 minutes (2 hours and 30 minutes) a week of moderate-intensity, or 75 minutes (1 hour and 15 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week.
For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes (5 hours) a week of moderate-intensity, or 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity beyond this amount.
Adults should also do muscle-strengthening activities that are moderate or high intensity and involve all major muscle groups on 2 or more days a week, as these activities provide additional health benefits.

How Much Total Activity a Week?

When adults do the equivalent of 150 minutes of moderate-intensity aerobic activity each week, the benefits are substantial. These benefits include lower risk of premature death, coronary heart disease, stroke, hypertension, type 2 diabetes, and depression.
Not all health benefits of physical activity occur at 150 minutes a week. As a person moves from 150 minutes a week toward 300 minutes (5 hours) a week, he or she gains additional health benefits. Additional benefits include lower risk of colon and breast cancer and prevention of unhealthy weight gain.
Also, as a person moves from 150 minutes a week toward 300 minutes a week, the benefits that occur at 150 minutes a week become more extensive. For example, a person who does 300 minutes a week has an even lower risk of heart disease or diabetes than a person who does 150 minutes a week.
The benefits continue to increase when a person does more than the equivalent of 300 minutes a week of moderate-intensity aerobic activity. For example, a person who does 420 minutes (7 hours) a week has an even lower risk of premature death than a person who does 150 to 300 minutes a week. Current science does not allow identifying an upper limit of total activity above which there are no additional health benefits.

How Many Days a Week and for How Long?

Aerobic physical activity should preferably be spread throughout the week. Research studies consistently show that activity performed on at least 3 days a week produces health benefits. Spreading physical activity across at least 3 days a week may help to reduce the risk of injury and avoid excessive fatigue.
Both moderate- and vigorous-intensity aerobic activity should be performed in episodes of at least 10 minutes. Episodes of this duration are known to improve cardiovascular fitness and some risk factors for heart disease and type 2 diabetes.

How Intense?

The Guidelines for adults focus on two levels of intensity: moderate-intensity activity and vigorous–intensity activity. To meet the Guidelines, adults can do either moderate-intensity or vigorous-intensity aerobic activities, or a combination of both. It takes less time to get the same benefit from vigorous-intensity activities as from moderate-intensity activities. A general rule of thumb is that 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity. For example, 30 minutes of moderate-intensity activity a week is roughly the same as 15 minutes of vigorous-intensity activity.
A person doing moderate-intensity aerobic activity can talk, but not sing, during the activity. A person doing vigorous intensity activity cannot say more than a few words without pausing for a breath.

Examples of Different Aerobic Physical Activities and Intensities

Moderate Intensity
  • Walking briskly (3 miles per hour or faster, but not race-walking)
  • Water aerobics
  • Bicycling slower than 10 miles per hour
  • Tennis (doubles)
  • Ballroom dancing
  • General gardening
Vigorous Intensity
  • Racewalking, jogging, or running
  • Swimming laps
  • Tennis (singles)
  • Aerobic dancing
  • Bicycling 10 miles per hour or faster
  • Jumping rope
  • Heavy gardening (continuous digging or hoeing, with heart rate increases)
  • Hiking uphill or with a heavy backpack

Muscle-strengthening Activity

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.http://www.health.gov/paguidelines/guidelines/

This kind of activity, which includes resistance training and lifting weights, causes the body's muscles to work or hold against an applied force or weight. These activities often involve relatively heavy objects, such as weights, which are lifted multiple times to train various muscle groups. Muscle-strengthening activity can also be done by using elastic bands or body weight for resistance (climbing a tree or doing push-ups, for example).
Muscle-strengthening activity also has three components:
  • Intensity, or how much weight or force is used relative to how much a person is able to lift;
  • Frequency, or how often a person does muscle strengthening activity; and
  • Repetitions, or how many times a person lifts a weight (analogous to duration for aerobic activity). The effects of muscle-strengthening activity are limited to the muscles doing the work. It's important to work all the major muscle groups of the body: the legs, hips, back, abdomen, chest, shoulders, and arms.
Muscle-strengthening activities provide additional benefits not found with aerobic activity. The benefits of muscle-strengthening activity include increased bone strength and muscular fitness. Muscle-strengthening activities can also help maintain muscle mass during a program of weight loss.
Muscle-strengthening activities make muscles do more work than they are accustomed to doing. That is, they overload the muscles. Resistance training, including weight training, is a familiar example of muscle-strengthening activity. Other examples include working with resistance bands, doing calisthenics that use body weight for resistance (such as push-ups, pull-ups, and sit-ups), carrying heavy loads, and heavy gardening (such as digging or hoeing).
Muscle-strengthening activities count if they involve a moderate to high level of intensity or effort and work the major muscle groups of the body: the legs, hips, back, chest, abdomen, shoulders, and arms. Muscle strengthening activities for all the major muscle groups should be done at least 2 days a week.
No specific amount of time is recommended for muscle strengthening, but muscle-strengthening exercises should be performed to the point at which it would be difficult to do another repetition without help. When resistance training is used to enhance muscle strength, one set of 8 to 12 repetitions of each exercise is effective, although two or three sets may be more effective. Development of muscle strength and endurance is progressive over time. Increases in the amount of weight or the days a week of exercising will result in stronger muscles.

Learning Activity 2.1: Watch some of the following videos to view muscle strengthening exercises:

Bone-Strengthening Activity

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services .http://www.health.gov/paguidelines/guidelines/
This kind of activity (sometimes called weight-bearing or weight-loading activity) produces a force on the bones that promotes bone growth and strength. This force is commonly produced by impact with the ground. Examples of bone-strengthening activity include jumping jacks, running, brisk walking, and weight-lifting exercises. As these examples illustrate, bone-strengthening activities can also be aerobic and muscle strengthening.


Quick Review: What physical activity is both muscle-strengthening and bone-strengthening?

Lesson 3: Health Benefits of Physical Activity

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.http://www.health.gov/paguidelines/guidelines/

Studies clearly demonstrate that participating in regular physical activity provides many health benefits. Many conditions affected by physical activity occur with increasing age, such as heart disease and cancer. Reducing risk of these conditions may require years of participation in regular physical activity. However, other benefits, such as increased cardiorespiratory fitness, increased muscular strength, and decreased depressive symptoms and blood pressure, require only a few weeks or months of participation in physical activity.

Learning Activity 3.1: Watch this video - What is the single best thing we can do for our health?

Health Benefits of Physical Activity—Major Research Findings

  • Regular physical activity reduces the risk of many adverse health outcomes.
  • Some physical activity is better than none.
  • For most health outcomes, additional benefits occur as the amount of physical activity increases through higher intensity, greater frequency, and/or longer duration.
  • Most health benefits occur with at least 150 minutes a week of moderate-intensity physical activity, such as brisk walking. Additional benefits occur with more physical activity.
  • Both aerobic (endurance) and muscle-strengthening (resistance) physical activity are beneficial.
  • Health benefits occur for children and adolescents, young and middle-aged adults, older adults, and those in every studied racial and ethnic group.
  • The benefits of physical activity far outweigh the possibility of adverse outcomes.


Quick Review: How many minutes per week does it take to get the health benefits of physical activity?

The Beneficial Effects of Increasing Physical Activity: It's About Overload, Progression, and Specificity

Overload is the physical stress placed on the body when physical activity is greater in amount or intensity than usual. The body's structures and functions respond and adapt to these stresses. For example, aerobic physical activity places a stress on the cardiorespiratory system and muscles, requiring the lungs to move more air and the heart to pump more blood and deliver it to the working muscles. This increase in demand increases the efficiency and capacity of the lungs, heart, circulatory system, and exercising muscles. In the same way, muscle–strengthening and bone-strengthening activities overload muscles and bones, making them stronger.
Progression is closely tied to overload. Once a person reaches a certain fitness level, he or she progresses to higher levels of physical activity by continued overload and adaptation. Small, progressive changes in overload help the body adapt to the additional stresses while minimizing the risk of injury.
Specificity means that the benefits of physical activity are specific to the body systems that are doing the work. For example, aerobic physical activity largely benefits the body's cardiovascular system.
The health benefits of physical activity are seen in children and adolescents, young and middle-aged adults, older adults, women and men, people of different races and ethnicities, and people with disabilities and chronic conditions. The health benefits of physical activity are generally independent of body weight. Adults of all sizes and shapes gain health and fitness benefits by being habitually physically active. The benefits of physical activity also outweigh the risk of injury and sudden heart attacks, two concerns that prevent many people from becoming physically active.
Quick Review: Who benefits most from being habitually physically active: overweight men, obese women, average weight men and women?
The following sections provide more detail on what is known from research studies about the specific health benefits of physical activity and how much physical activity is needed to get the health benefits.

Premature Death

Strong scientific evidence shows that physical activity reduces the risk of premature death (dying earlier than the average age of death for a specific population group) from the leading causes of death, such as heart disease and some cancers, as well as from other causes of death. This effect is remarkable in two ways:
First, only a few lifestyle choices have as large an effect on mortality as physical activity. It has been estimated that people who are physically active for approximately 7 hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week.
Second, it is not necessary to do high amounts of activity or vigorous-intensity activity to reduce the risk of premature death. Studies show substantially lower risk when people do 150 minutes of at least moderate-intensity aerobic physical activity a week.
Research clearly demonstrates the importance of avoiding inactivity. Even low amounts of physical activity reduce the risk of dying prematurely. The most dramatic difference in risk is seen between those who are inactive (30 minutes a week) and those with low levels of activity (90 minutes or 1 hour and 30 minutes a week).

All adults can gain this health benefit of physical activity. Age, race, and ethnicity do not matter. Men and women younger than 65 years as well as older adults have lower rates of early death when they are physically active than when they are inactive. Physically active people of all body weights (normal weight, overweight, obese) also have lower rates of early death than do inactive people.

Cardiorespiratory Health

The benefits of physical activity on cardiorespiratory health are some of the most extensively documented of all the health benefits. Cardiorespiratory health involves the health of the heart, lungs, and blood vessels.
Heart diseases and stroke are two of the leading causes of death in the United States. Risk factors that increase the likelihood of cardiovascular diseases include smoking, high blood pressure (called hypertension), type 2 diabetes, and high levels of certain blood lipids (such as low-density lipoprotein, or LDL, cholesterol). Low cardiorespiratory fitness also is a risk factor for heart disease.
People who do moderate- or vigorous-intensity aerobic physical activity have a significantly lower risk of cardiovascular disease than do inactive people. Regularly active adults have lower rates of heart disease and stroke, and have lower blood pressure, better blood lipid profiles, and fitness. Significant reductions in risk of cardiovascular disease occur at activity levels equivalent to 150 minutes a week of moderate-intensity physical activity. Even greater benefits are seen with 200 minutes (3 hours and 20 minutes) a week. The evidence is strong that greater amounts of physical activity result in even further reductions in the risk of cardiovascular disease.
Moderate-intensity physical activity is safe for generally healthy women during pregnancy. It increases cardiorespiratory fitness without increasing the risk of early pregnancy loss, preterm delivery, or low birth weight. Physical activity during the postpartum period also improves cardiorespiratory fitness.
Metabolic Health
Regular physical activity strongly reduces the risk of developing type 2 diabetes as well as the metabolic syndrome. The metabolic syndrome is defined as a condition in which people have some combination of high blood pressure, a large waistline (abdominal obesity), an adverse blood lipid profile (low levels of high-density lipoprotein [HDL] cholesterol, raised triglycerides), and impaired glucose tolerance.
People who regularly engage in at least moderate intensity aerobic activity have a significantly lower risk of developing type 2 diabetes than do inactive people. Although some experts debate the usefulness of defining the metabolic syndrome, good evidence exists that physical activity reduces the risk of having this condition, as defined in various ways. Lower rates of these conditions are seen with 120 to 150 minutes (2 hours to 2 hours and 30 minutes) a week of at least moderate-intensity aerobic activity. As with cardiovascular health, additional levels of physical activity seem to lower risk even further. In addition, physical activity helps control blood glucose levels in persons who already have type 2 diabetes.
Physical activity also improves metabolic health in youth. Studies find this effect when young people participate in at least 3 days of vigorous aerobic activity a week. More physical activity is associated with improved metabolic health, but research has yet to determine the exact amount of improvement.
Physical Activity in a Weight-Control Plan: Obesity and Energy Balance
Along with appropriate dietary intake, physical activity is an important part of maintaining healthy weight, losing weight, and keeping extra weight off once it has been lost. Physical activity also helps reduce abdominal fat and preserve muscle during weight loss. Adults should aim for a healthy, stable body weight. The amount of physical activity necessary to achieve this weight varies greatly from person to person.
The first step in achieving or maintaining a healthy weight is to meet the minimum level of physical activity in the Guidelines. For some people this will result in a stable and healthy body weight, but for many it may not.
The health benefits of physical activity are generally independent of body weight. The good news for people needing to lose weight is that regular physical activity provides major health benefits, no matter how their weight changes over time.
People who are at a healthy body weight but slowly gaining weight can either gradually increase the level of physical activity (toward the equivalent of 300 minutes a week of moderate-intensity aerobic activity), or reduce caloric intake, or both, until their weight is stable. By regularly checking body weight, people can find the amount of physical activity that works for them.
Many adults will need to do more than the 150 minutes a week of moderate-intensity aerobic physical activity as part of a program to lose weight or keep it off. These adults should do more physical activity and/or further reduce their caloric intake. Some people will need to do the equivalent of 300 or more minutes of moderate-intensity physical activity a week to meet their weight-control goals. Combined with restricting caloric intake, these adults should gradually increase minutes or the intensity of aerobic physical activity per week, to the point at which the physical activity is effective in achieving a healthy weight.
It is important to remember that all activities—both baseline and physical activity—“count” for energy balance. Active choices, such as taking the stairs rather than the elevator or adding short episodes of walking to the day, are examples of activities that can be helpful in weight control.
For weight control, vigorous-intensity activity is far more time-efficient than moderate-intensity activity. For example, an adult who weighs 165 pounds (75 kg) will burn 560 calories from 150 minutes of brisk walking at 4 miles an hour (these calories are in addition to the calories normally burned by a body at rest). That person can burn the same number of additional calories in 50 minutes by running 5 miles at a 10 minutes-per-mile pace.
Quick Review: If you wanted to use physical activity for weight loss and control, which approach would make most the sense for you personally: increased intensity or increased minutes per week? Why?
Over short periods of time, such as a year, research shows that it is possible to achieve weight stability by doing the equivalent of 150 to 300 minutes (5 hours) a week of moderate-intensity walking at about a 4 mile-an-hour pace. Muscle-strengthening activities may help promote weight maintenance, although not to the same degree as aerobic activity.
People who want to lose a substantial (more than 5 percent of body weight) amount of weight and people who are trying to keep a significant amount of weight off once it has been lost need a high amount of physical activity unless they also reduce their caloric intake. Many people need to do more than 300 minutes of moderate-intensity activity a week to meet weight–control goals.

Musculoskeletal Health

Bones, muscles, and joints support the body and help it move. Healthy bones, joints, and muscles are critical to the ability to do daily activities without physical limitations.
Preserving bone, joint, and muscle health is essential with increasing age. Studies show that the frequent decline in bone density that happens during aging can be slowed with regular physical activity. These effects are seen in people who participate in aerobic, muscle–strengthening, and bone-strengthening physical activity programs of moderate or vigorous intensity. The range of total physical activity for these benefits varies widely. Important changes seem to begin at 90 minutes a week and continue up to 300 minutes a week.
Hip fracture is a serious health condition that can have life-changing negative effects for many older people. Physically active people, especially women, appear to have a lower risk of hip fracture than do inactive people. Research studies on physical activity to prevent hip fracture show that participating in 120 to 300 minutes a week of physical activity that is of at least moderate intensity is associated with a reduced risk. It is unclear, however, whether activity also lowers risk of fractures of the spine or other important areas of the skeleton.
Building strong, healthy bones is also important for children and adolescents. Along with having a healthy diet that includes adequate calcium and vitamin D, physical activity is critical for bone development in children and adolescents. Bone-strengthening physical activity done 3 or more days a week increases bone-mineral content and bone density in youth.
Regular physical activity also helps people with arthritis or other rheumatic conditions affecting the joints. Participation in 130 to 150 minutes (2 hours and 10 minutes to 2 hours and 30 minutes) a week of moderate-intensity, low-impact physical activity improves pain management, function, and quality of life. Researchers don't yet know whether participation in physical activity, particularly at low to moderate intensity, reduces the risk of osteoarthritis. Very high levels of physical activity, however, may have extra risks. People who participate in very high levels of physical activity, such as elite or professional athletes, have a higher risk of hip and knee osteoarthritis, mostly due to the risk of injury involved in competing in some sports.
Progressive muscle-strengthening activities increase or preserve muscle mass, strength, and power. Higher amounts (through greater frequency or higher weights) improve muscle function to a greater degree. Improvements occur in younger and older adults. Resistance exercises also improve muscular strength in persons with such conditions as stroke, multiple sclerosis, cerebral palsy, spinal cord injury, and cognitive disability. Though it doesn't increase muscle mass in the same way that muscle-strengthening activities do, aerobic activity may also help slow the loss of muscle with aging.

Functional Ability and Fall Prevention

Functional ability is the capacity of a person to perform tasks or behaviors that enable him or her to carry out everyday activities, such as climbing stairs or walking on a sidewalk. Functional ability is key to a person's ability to fulfill basic life roles, such as personal care, grocery shopping, or playing with the grandchildren. Loss of functional ability is referred to as functional limitation.
Middle-aged and older adults who are physically active have lower risk of functional limitations than do inactive adults. It appears that greater physical activity levels can further reduce risk of functional limitations.
Older adults who already have functional limitations also benefit from regular physical activity. Typically, studies of physical activity in adults with functional limitations tested a combination of aerobic and muscle strengthening activities, making it difficult to assess the relative importance of each type of activity. However, both types of activity appear to provide benefit.
In older adults at risk of falls, strong evidence shows that regular physical activity is safe and reduces this risk. Reduction in falls is seen for participants in programs that include balance and moderate-intensity muscle-strengthening activities for 90 minutes a week plus moderate-intensity walking for about an hour a week. It's not known whether different combinations of type, amount, or frequency of activity can reduce falls to a greater degree. Tai chi exercises also may help prevent falls.

Mental Health

Physically active adults have lower risk of depression and cognitive decline (declines with aging in thinking, learning, and judgment skills). Physical activity also may improve the quality of sleep. Whether physical activity reduces distress or anxiety is currently unclear.
Mental health benefits have been found in people who do aerobic or a combination of aerobic and muscle– strengthening activities 3 to 5 days a week for 30 to 60 minutes at a time. Some research has shown that even lower levels of physical activity also may provide some benefits.
Regular physical activity appears to reduce symptoms of anxiety and depression for children and adolescents. Whether physical activity improves self-esteem is not clear.

Adverse Events

Some people hesitate to become active or increase their level of physical activity because they fear getting injured or having a heart attack. Studies of generally healthy people clearly show that moderate-intensity physical activity, such as brisk walking, has a low risk of such adverse events.
The risk of musculoskeletal injury increases with the total amount of physical activity. For example, a person who regularly runs 40 miles a week has a higher risk of injury than a person who runs 10 miles each week. However, people who are physically active may have fewer injuries from other causes, such as motor vehicle collisions or work-related injuries. Depending on the type and amount of activity that physically active people do, their overall injury rate may be lower than the overall injury rate for inactive people.
Participation in contact or collision sports, such as soccer or football, has a higher risk of injury than participation in non-contact physical activity, such as swimming or walking. However, when performing the same activity, people who are less fit are more likely to be injured than people who are fitter.
Cardiac events, such as a heart attack or sudden death during physical activity, are rare. However, the risk of such cardiac events does increase when a person suddenly becomes much more active than usual. The greatest risk occurs when an adult who is usually inactive engages in vigorous-intensity activity (such as shoveling snow). People who are regularly physically active have the lowest risk of cardiac events both while being active and overall.
The bottom line is that the health benefits of physical activity far outweigh the risks of adverse events for almost everyone.


Lesson 4: Dealing with Inactivity

Dealing with Inactivity

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.http://www.health.gov/paguidelines/guidelines/

Inactive adults or those who don't yet do 150 minutes of physical activity a week should work gradually toward this goal. The initial amount of activity should be at a light or moderate intensity, for short periods of time, with the sessions spread throughout the week. The good news is that “some is better than none.”
People gain some health benefits even when they do as little as 60 minutes a week of moderate-intensity aerobic physical activity.
To reduce risk of injury, it is important to increase the amount of physical activity gradually over a period of weeks to months. For example, an inactive person could start with a walking program consisting of 5 minutes of slow walking several times each day, 5 to 6 days a week. The length of time could then gradually be increased to 10 minutes per session, 3 times a day, and the walking speed could be increased slowly.
Muscle-strengthening activities should also be gradually increased over time. Initially, these activities can be done just 1 day a week starting at a light or moderate level of effort. Over time, the number of days a week can be increased to 2, and then possibly to more than 2. Each week, the level of effort (intensity) can be increased slightly until it becomes moderate to high.

Flexibility Activities

Flexibility is an important part of physical fitness. Some types of physical activity, such as dancing, require more flexibility than others. Stretching exercises are effective in increasing flexibility, and thereby can allow people to more easily do activities that require greater flexibility. For this reason, flexibility activities are an appropriate part of a physical activity program, even though they have no known health benefits and it is unclear whether they reduce risk of injury. Time spent doing flexibility activities by themselves does not count toward meeting the aerobic or muscle-strengthening guidelines (Physical Activity Guidelines for Americans).

Warm-up and Cool-down

Warm-up and cool-down activities are an acceptable part of a person's physical activity plan. Commonly, the warm-up and cool-down involve doing an activity at a slower speed or lower intensity. A warm-up before moderate- or vigorous-intensity aerobic activity allows a gradual increase in heart rate and breathing at the start of the episode of activity. A cool-down after activity allows a gradual decrease at the end of the episode. Time spent doing warm-up and cool-down may count toward meeting the aerobic activity Guidelines if the activity is at least moderate intensity (for example, walking briskly as a warm-up before jogging). A warm-up for muscle-strengthening activity commonly involves doing exercises with lighter weight.
Getting and Staying Active: Real-Life Examples
Adults can meet the Physical Activity Guidelines in all sorts of ways and with many types of physical activity. The choices of types and amounts of physical activity depend on personal health and fitness goals.


Here are three examples.
Jean: An Inactive Middle-Aged Woman
Her goals: Jean sets a goal of doing 1 hour a day of moderate-intensity aerobic activity on 5 days a week (a total of 300 minutes a week). Weighing 220 pounds, Jean is obese and wants to lose about 1 pound of weight each week.
Starting out: Jean cuts back on her caloric intake and starts walking 5 minutes in the morning and 5 minutes in the evening most days of the week. She walks at a 2.5 mile-an-hour pace. Although physical activity tables show this to be light-intensity activity, for her level of fitness and fatness, it is appropriate moderate–intensity activity.
Making good progress: Two months later, Jean is comfortably walking 30 to 40 minutes at moderate intensity to and from her bus stop every day. She then adds variety to her activity by alternating among walking, riding a stationary cycle, and low-impact aerobics. She also begins muscle-strengthening activities, using elastic bands twice each week.
Reaching her goal: Eventually, Jean works up to 300 minutes a week of moderate-intensity aerobic activity, including her brisk walks to and from the bus stop. She has lost 40 pounds of weight in 1 year, with most of the weight loss occurring the previous 6 months when she mastered her diet and was able to do greater amounts of physical activity.
Douglas: An Active Middle-Aged Man
His goal and current activity pattern: Douglas was a soccer player in his youth. His goal is to get back into shape by becoming a regular recreational runner. In addition to his job operating heavy equipment, he walks 30 to 40 minutes a day on 5 days each week. He also lifts weights 2 days a week.
Starting out: Douglas starts a walk/jog program with a co-worker and plans to gradually replace walking with jogging and then running. The first week he goes out on 5 days, walking for 25 minutes and jogging for 5 minutes.
Making good progress: Each week, Douglas gradually increases the time spent jogging (vigorous-intensity activity) and reduces the time spent walking (moderate–intensity activity). He also continues his weight-lifting program.
Reaching his goal: Eventually, Douglas is running 30 to 45 minutes 4 days a week and lifting weights 2 days a week. He goes for a 1-hour bicycle ride on most weekends.
Anita
Her goals and current activity pattern: Anita plays league basketball (vigorous-intensity activity) 4 days each week for 90 minutes each day. She wants to reduce her risk of injury from doing too much of one kind of activity (this is called an overuse injury).
Starting out: Anita starts out by cutting back her basketball playing to 3 days each week. She begins to bicycle to and from campus (30 minutes each way) instead of driving her car. She also joins a yoga class that meets twice each week.
Reaching her goal: Eventually, Anita is bicycling 3 days each week to and from campus in addition to playing basketball. Her yoga class helps her to build and maintain strength and flexibility.


Achieving Target Levels of Physical Activity: Possibilities Are Endless

These examples show how it's possible to meet the Guidelines by doing moderate-intensity or vigorous-intensity activity or a combination of both. Physical activity at this level provides substantial health benefits.
  • Ways to get the equivalent of 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic physical activity a week plus muscle-strengthening activities:
  • Thirty minutes of brisk walking (moderate intensity) on 5 days, exercising with resistance bands (muscle strengthening) on 2 days;
  • Thirty minutes of brisk walking on 2 days, 60 minutes (1 hour) of social dancing (moderate intensity) on 1 evening, 30 minutes of mowing the lawn (moderate intensity) on 1 afternoon, heavy gardening (muscle strengthening) on 2 days;
  • Thirty minutes of an aerobic dance class on 1 morning (vigorous intensity), 30 minutes of running on 1 day (vigorous intensity), 30 minutes of brisk walking on 1 day (moderate intensity), calisthenics (such as sit-ups, push-ups) on 3 days (muscle strengthening);
  • Thirty minutes of biking to and from work on 3 days (moderate intensity), playing softball for 60 minutes on 1 day (moderate intensity), using weight machines on 2 days (muscle-strengthening on 2 days); and
  • Forty-five minutes of doubles tennis on 2 days (moderate intensity), lifting weights after work on 1 day (muscle strengthening), hiking vigorously for 30 minutes and rock climbing (muscle strengthening) on 1 day.


Learning Activity 4.1: Find out what kind of physical activity suits you the best at the BAM website. (http://www.bam.gov/sub_physicalactivity/physicalactivity_misfit.asp)

Personalize the Benefits of Regular Physical Activity

Adults need to identify benefits of personal value to them. For many people, the health benefits, which are the focus of the Physical Activity Guidelines for Americans, are compelling enough. For others, different reasons are key motivators to be active. For example, physical activity:
  • Provides opportunities to enjoy recreational activities, often in a social setting;
  • Improves personal appearance;
  • Provides a chance to help a spouse lose weight;
  • Improves the quality of sleep;
  • Reduces feelings of low energy; and
  • Gives older adults a greater opportunity to live independently in the community.

Set Personal Goals for Physical Activity

The Guidelines alone don’t provide enough information for individuals to decide the types and amounts of activity that are appropriate for them. Individuals should set goals for activity that allow them to achieve benefits they value. Simple goals are fine. For example, a brisk walk in the neighborhood with friends for 45 minutes 3 days a week and walking to lunch twice a week may be just the right approach for someone who wants to increase both physical activity and social opportunities.
In setting goals, people can consider doing a variety of activities and try both indoor and outdoor activities. In particular, public parks and recreation areas in the United States offer opportunities to experience nature and be physically active at the same time.
The best physical activity is the one that is enjoyable enough to do regularly.


Learning Activity 4.2: Watch this video about getting started with physical activity: Tools and Tips to Increase Your Physical Activity
  • Can you use any of these tips?

Optional Learning Activities:

Try this interactive online tool if you want help scheduling your own physical activity calendar.
Download a printable Activity Log to keep track of your activities, if desired. More tips about scheduling your physical activity are available at Adult Guidelines.

Lesson 5: Safe and Activity


Be Safe and Active

Source: The Physical Activity Guidelines for Americans, Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services. http://www.health.gov/paguidelines/guidelines/

Although physical activity has many health benefits, injuries and other adverse events do sometimes happen. The most common injuries affect the musculoskeletal system (the bones, joints, muscles, ligaments, and tendons). Other adverse events can also occur during activity, such as overheating and dehydration. On rare occasions, people have heart attacks during activity.
The good news is that scientific evidence strongly shows that physical activity is safe for almost everyone. Moreover, the health benefits of physical activity far outweigh the risks.
Still, people may hesitate to become physically active because of concern they’ll get hurt. For these people, there is even more good news: They can take steps that are proven to reduce their risk of injury and adverse events.
The Guidelines in this module provide advice to help people do physical activity safely. Most advice applies to people of all ages. Specific guidance for particular age groups and people with certain conditions is also provided.

Physical Activity is Safe for Almost Everyone

Most people are not likely to be injured when doing moderate-intensity activities in amounts that meet the Physical Activity Guidelines. However, injuries and other adverse events do sometimes happen. The most common problems are musculoskeletal injuries. Even so, studies show that only one such injury occurs for every 1,000 hours of walking for exercise, and fewer than four injuries occur for every 1,000 hours of running.
Both physical fitness and total amount of physical activity affect risk of musculoskeletal injuries. People who are physically fit have a lower risk of injury than people who are not. People who do more activity generally have a higher risk of injury than people who do less activity. So what should people do if they want to be active and safe? The best strategies are to:
  • Be regularly physically active to increase physical fitness; and
  • Follow the other guidance in this Module (especially increasing physical activity gradually over time) to minimize the injury risk from doing medium to high amounts of activity.
  • Following these strategies may reduce overall injury risk. Active people are more likely to have an activity related injury than inactive people. But they appear less likely to have non-activity-related injuries, such as work-related injuries or injuries that occur around the home or from motor vehicle crashes.

Key Guidelines for Safe Physical Activity

To do physical activity safely and reduce risk of injuries and other adverse events, people should:
  • Understand the risks and yet be confident that physical activity is safe for almost everyone.
  • Choose to do types of physical activity that are appropriate for their current fitness level and health goals, because some activities are safer than others.
  • Increase physical activity gradually over time whenever more activity is necessary to meet guidelines or health goals. Inactive people should “start low and go slow” by gradually increasing how often and how long activities are done.
  • Protect themselves by using appropriate gear and sports equipment, looking for safe environments, following rules and policies, and making sensible choices about when, where, and how to be active.
  • Be under the care of a health-care provider if they have chronic conditions or symptoms. People with chronic conditions and symptoms should consult their health-care provider about the types and amounts of activity appropriate for them.

Choose Appropriate Types and Amounts of Activity

People can reduce their risk of injury by choosing appropriate types of activity. The safest activities are moderate intensity and low impact, and don’t involve purposeful collision or contact.
Walking for exercise, gardening or yard work, bicycling or exercise cycling, dancing, swimming, and golf are activities with the lowest injury rates. In the amounts commonly done by adults, walking (a moderate–intensity and low-impact activity) has a third or less of the injury risk of running (a vigorous-intensity and higher impact activity).
The risk of injury for a type of physical activity can also differ according to the purpose of the activity. For example, recreational bicycling or bicycling for transportation leads to fewer injuries than training for and competing in bicycle races.
People who have had a past injury are at risk of injuring that body part again. The risk of injury can be reduced by performing appropriate amounts of activity and setting appropriate personal goals. Performing a variety of different physical activities may also reduce the risk of overuse injury.
The risk of injury to bones, muscles, and joints is directly related to the gap between a person’s usual level of activity and a new level of activity.

Learning Activity 5.1: Find out more about specific physical activities that might interest you: Physical Activity Cards (http://www.bam.gov/sub_physicalactivity/physicalactivity_activitycards.html)

Increase Physical Activity Gradually Over Time

Scientific studies indicate that the risk of injury to bones, muscles, and joints is directly related to the gap between a person’s usual level of activity and a new level of activity. The size of this gap is called the amount of overload. Creating a small overload and waiting for the body to adapt and recover reduces the risk of injury. When amounts of physical activity need to be increased to meet the Guidelines or personal goals, physical activity should be increased gradually over time, no matter what the person’s current level of physical activity.
Scientists have not established a standard for how to gradually increase physical activity over time. The following recommendations give general guidance for inactive people and those with low levels of physical activity on how to increase physical activity:
Use relative intensity (intensity of the activity relative to a person’s fitness) to guide the level of effort for aerobic activity.
Generally start with relatively moderate-intensity aerobic activity. Avoid relatively vigorous-intensity activity, such as shoveling snow or running. Adults with a low level of fitness may need to start with light activity, or a mix of light- to moderate-intensity activity.
First, increase the number of minutes per session (duration), and the number of days per week (frequency) of moderate-intensity activity. Later, if desired, increase the intensity.
Pay attention to the relative size of the increase in physical activity each week, as this is related to injury risk. For example, a 20-minute increase each week is safer for a person who does 200 minutes a week of walking (a 10 percent increase), than for a person who does 40 minutes a week (a 50 percent increase).
The available scientific evidence suggests that adding a small and comfortable amount of light- to moderate–intensity activity, such as 5 to 15 minutes of walking per session, 2 to 3 times a week, to one’s usual activities has a low risk of musculoskeletal injury and no known risk of severe cardiac events. Because this range is rather wide, people should consider three factors in individualizing their rate of increase: age, level of fitness, and prior experience.
The amount of time required to adapt to a new level of activity probably depends on age. Youth and young adults probably can safely increase activity by small amounts every week or 2. Older adults appear to require more time to adapt to a new level of activity, in the range of 2 to 4 weeks.

Level of Fitness

Less fit adults are at higher risk of injury when doing a given amount of activity, compared to fitter adults. Slower rates of increase over time may reduce injury risk. This guidance applies to overweight and obese adults, as they are commonly less physically fit.
Prior Experience
People can use their experience to learn to increase physical activity over time in ways that minimize the risk of overuse injury. Generally, if an overuse injury occurred in the past with a certain rate of progression, a person should increase activity more slowly the next time.

Take Appropriate Precautions

Taking appropriate precautions means using the right gear and equipment, choosing safe environments in which to be active, following rules and policies, and making sensible choices about how, when, and where to be active.

Use Protective Gear and Appropriate Equipment

Using personal protective gear can reduce the frequency of injury. Personal protective gear is something worn by a person to protect a specific body part. Examples include helmets, eyewear and goggles, shin guards, elbow and knee pads, and mouth guards.
Using appropriate sports equipment can also reduce risk of injury. Sports equipment refers to sport or activity-specific tools, such as balls, bats, sticks, and shoes.
For the most benefit, protective equipment and gear should be:
  • The right equipment for the activity
  • Appropriately fitted
  • Appropriately maintained
  • Used consistently and correctly.

Learning Activity 5.2: Watch this video titled Tragedy of Post-Concussion Syndrome.
  • How common are undiagnosed concussions?
  • Why is this important?

Be Active in Safe Environments

People can reduce their injury risks by paying attention to the places they choose to be active. To help themselves stay safe, people can look for:
  • Physical separation from motor vehicles, such as sidewalks, walking paths, or bike lanes;
  • Neighborhoods with traffic-calming measures that slow down traffic;
  • Places to be active that are well-lighted, where other people are present, and that are well-maintained (no litter, broken windows);
  • Shock-absorbing surfaces on playgrounds;
  • Well-maintained playing fields and courts without holes or obstacles;
  • Breakaway bases at baseball and softball fields; and
  • Padded and anchored goals and goal posts at soccer and football fields.

Follow Rules and Policies That Promote Safety

Rules, policies, legislation, and laws are potentially the most effective and wide-reaching way to reduce activity-related injuries. To get the benefit, individuals should look for and follow these rules, policies, and laws. For example, policies that promote the use of bicycle helmets reduce the risk of head injury among cyclists. Rules against diving into shallow water at swimming pools prevent head and neck injuries.

Make Sensible Choices about How, When, and Where To Be Active

A person’s choices can obviously influence the risk of adverse events. By making sensible choices, injuries and adverse events can be prevented. Consider weather conditions, such as extremes of heat and cold. For example, during very hot and humid weather, people lessen the chances of dehydration and heat stress by:
  • Exercising in the cool of early morning as opposed to mid-day heat;
  • Switching to indoor activities (playing basketball in the gym rather than on the playground);
  • Changing the type of activity (swimming rather than playing soccer);
  • Lowering the intensity of activity (walking rather than running); and
  • Paying close attention to rest, shade, drinking enough fluids, and other ways to minimize effects of heat.
Inactive people who gradually progress over time to relatively moderate-intensity activity have no known risk of sudden cardiac events, and very low risk of bone, muscle, or joint injuries.
Exposure to air pollution is associated with several adverse health outcomes, including asthma attacks and abnormal heart rhythms. People who can modify the location or time of exercise may wish to reduce these risks by exercising away from heavy traffic and industrial sites, especially during rush hour or times when pollution is known to be high. However, current evidence indicates that the benefits of being active, even in polluted air, outweigh the risk of being inactive.


Quick Review: What are some ways that you can reduce the risk of injury when engaging in physical activity?

Advice from Health-Care Providers

The protective value of a medical consultation for persons with or without chronic diseases who are interested in increasing their physical activity level is not established. People without diagnosed chronic conditions (such as diabetes, heart disease, or osteoarthritis) and who do not have symptoms (such as chest pain or pressure, dizziness, or joint pain) do not need to consult a health-care provider about physical activity.
Inactive people who gradually progress over time to relatively moderate-intensity activity have no known risk of sudden cardiac events, and very low risk of bone, muscle, or joint injuries. A person who is habitually active with moderate-intensity activity can gradually increase to vigorous intensity without needing to consult a health-care provider. People who develop new symptoms when increasing their levels of activity should consult a health-care provider.
Health-care providers can provide useful personalized advice on how to reduce risk of injuries. For people who wish to seek the advice of a health-care provider, it is particularly appropriate to do so when contemplating vigorous-intensity activity, because the risks of this activity are higher than the risks of moderate-intensity activity.
The choice of appropriate types and amounts of physical activity can be affected by chronic conditions. People with symptoms or known chronic conditions should be under the regular care of a health-care provider. In consultation with their provider, they can develop a physical activity plan that is appropriate for them. People with chronic conditions typically find that moderate-intensity activity is safe and beneficial. However, they may need to take special precautions. For example, people with diabetes need to pay special attention to blood sugar control and proper footwear during activity.

Gradually Increasing Physical Activity over Time: Real-Life Examples

Here are two examples that show how people at different ages, levels of fitness, and levels of experience can safely become more active over time.


Bill: A Man Who Has Been Inactive for Many Years
Bill wants to work his way up to the equivalent of 180 to 210 minutes (3 hours to 3 hours and 30 minutes) of walking a week. On weekdays he has time for up to 45 minutes of walking, and he plans to do something physically active each weekend. He decides to start with walking because it is moderate intensity and has a low risk of injury.
The first week, Bill starts at a low level. He walks 10 minutes a day 3 days a week. Sometimes he divides the 10 minutes a day into two sessions. He prefers to alternate rest days and active days. (Total = 30 minutes a week.)
Between weeks 3 and 8, Bill increases duration by adding 5 minutes a day and continues walking on 3 non-consecutive days each week. The weekly increase is 15 minutes. (Week 3 total = 45 minutes. Week 8 total = 120 minutes or 2 hours.)
In week 9, Bill adds another day of moderate intensity activity on the weekend, and starts doing a variety of activities, including biking, hiking, and an aerobics class. Gradually increasing the minutes of activity, by week 12 he is doing 60 minutes or more of moderate-intensity activity on the weekend. Reaching his goal: Over 3 months, Bill has increased to a total of 180 moderate-intensity minutes a week.
Kim: An Active Woman
Kim currently does 150 minutes (2 hours and 30 minutes) a week of moderate-intensity activity. She wants to work up to at least the equivalent of 300 minutes (5 hours) of moderate-intensity activity a week. She also wants to shift some of that moderate intensity activity to vigorous-intensity activity. Her current 150 minutes a week includes:
  • Thirty minutes of mowing the grass 1 day a week;
  • Thirty minutes of brisk walking 4 days a week; and
  • Fifteen minutes of muscle-strengthening exercises 2 days a week.
  • Increasing frequency and duration:
Over a month, Kim adds walking on another weekday, and she gradually adds 15 minutes of moderate-intensity activity on each of the 5 walking days each week. This provides an additional 105 minutes (1 hour and 45 minutes) of moderate–intensity activity.
Increasing intensity:
Over the next month, Kim decides to replace some walking with jogging. Instead of walking 45 minutes, she walks for 30 minutes and jogs for 15 minutes on each weekday, providing the equivalent of 300 minutes a week of moderate-intensity physical activity from her walking and jogging.
Reaching her goal:
After these increases, Kim is doing a total of 180 minutes of moderate-intensity activity each week (walking and mowing) and also doing 75 minutes (1 hour and 15 minutes) of vigorous–intensity jogging. One minute of vigorous-intensity activity is about the same as 2 minutes of moderate intensity activity, so she is now doing the equivalent of 330 moderate-intensity minutes (5 hours and 30 minutes) a week. She has more than met her goal.
  • Which physical activity plan would work best for you to increase your physical activity over time: Bill’s or Kim’s? Why?

Lesson 6: Pregnancy and Disabilities

Keeping Active during Pregnancy and with Disabilities

Source: The Physical Activity Guidelines for Americans, Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services. http://www.health.gov/paguidelines/guidelines/

All Americans should be physically active to improve overall health and fitness and to prevent many adverse health outcomes. However, some people have conditions that raise special issues about recommended types and amounts of physical activity. This Module provides guidance on physical activity for healthy women who are pregnant and for people with disabilities.

Physical Activity for Women during Pregnancy and the Postpartum Period

Women who are pregnant and those who’ve recently had a baby should be under the regular care of a health-care provider. Moderate-intensity physical activity is generally safe for women with uncomplicated pregnancies, but women should talk with their provider about how to adjust the amounts and types of activity while they are pregnant and right after the baby’s birth.
During pregnancy, women should avoid:
  • Doing activities with high risk of falling or abdominal trauma, including contact or collision sports, such as horseback riding, soccer, basketball, and downhill skiing.
  • Physical activity during pregnancy benefits a woman’s overall health. For example, moderate-intensity physical activity by healthy women during pregnancy maintains or increases cardiorespiratory fitness.
Strong scientific evidence shows that the risks of moderate-intensity activity done by healthy women during pregnancy are very low, and do not increase risk of low birth weight, preterm delivery, or early pregnancy loss. Some evidence suggests that physical activity reduces the risk of pregnancy complications, such as preeclampsia and gestational diabetes, and reduces the length of labor, but this evidence is not conclusive.
During a normal postpartum period, regular physical activity continues to benefit a woman’s overall health. Studies show that moderate-intensity physical activity during the period following the birth of a child increases a woman’s cardiorespiratory fitness and improves her mood. Such activity does not appear to have adverse effects on breast milk volume, breast milk composition, or infant growth.
Physical activity also helps women achieve and maintain a healthy weight during the postpartum period, and when combined with caloric restriction, helps promote weight loss.
Key Guidelines for Women during Pregnancy and the Postpartum Period
Women who are pregnant should be under the care of a health-care provider with whom they can discuss how to adjust amounts of physical activity during pregnancy and the postpartum period. Unless a woman has medical reasons to avoid physical activity during pregnancy, she can begin or continue moderate-intensity aerobic physical activity during her pregnancy and after the baby is born.
When beginning physical activity during pregnancy, women should increase the amount gradually over time. The effects of vigorous-intensity aerobic activity during pregnancy have not been studied carefully, so there is no basis for recommending that women should begin vigorous-intensity activity during pregnancy.
Women who habitually do vigorous-intensity activity or high amounts of activity or strength training should continue to be physically active during pregnancy and after giving birth. They generally do not need to drastically reduce their activity levels, provided that they remain healthy and discuss with their health-care provider how to adjust activity levels during this time.
During pregnancy, women should avoid doing exercises involving lying on their back after the first trimester of pregnancy. They should also avoid doing activities that increase the risk of falling or abdominal trauma, including contact or collision sports, such as horseback riding, downhill skiing, soccer, and basketball.

Physical Activity for People with Disabilities

The benefits of physical activity for people with disabilities have been studied in diverse groups. These groups include stroke victims, people with spinal cord injury, multiple sclerosis, Parkinson’s disease, muscular dystrophy, cerebral palsy, traumatic brain injury, limb amputations, mental illness, intellectual disability, and dementia.
Overall, the evidence shows that regular physical activity provides important health benefits for people with disabilities. The benefits include improved cardiovascular and muscle fitness, improved mental health, and better ability to do tasks of daily life. Sufficient evidence now exists to recommend that adults with disabilities should get regular physical activity.
People with disabilities are encouraged to get advice from professionals with experience in physical activity and disability because matching activity to abilities can require modifying physical activity in many different ways. Some people with disabilities also need help with their exercise program. For example, some people may need supervision when performing muscle-strengthening activities, such as lifting weights.


Lesson 7: Community Efforts to Increase Physical Activity

Community Efforts to Increasing Physical Activity Levels of Americans

Source: The Physical Activity Guidelines for Americans Office of Disease Prevention & Health Promotion, U.S. Department of Health and Human Services.http://www.health.gov/paguidelines/guidelines/

The low level of physical activity among Americans is a major contributor to the burden of chronic disease. This burden is costly in terms of quality of life and economic resources needed to provide medical care. Like life in other modern societies around the world, life in the United States requires very little daily physical activity. The amount of physical activity we do is largely a matter of personal choice and the environmental conditions under which we live. So far, little progress has been made in meeting our national health objectives for physical activity.
Based on a careful review of the science, the Physical Activity Guidelines provides essential guidance to help Americans achieve the health benefits of regular physical activity. However, providing guidance by itself is not enough to produce change. Action is necessary. Regular physical activity needs to be made the easy choice for Americans.
To accomplish this goal, public health research suggests the use of a “socio-ecologic” approach. This comprehensive approach involves action at all levels of society: individual, interpersonal, organizational, community, and public policy.

What Can Communities and Government Do to Help People Be Active?

Actions by communities and government can influence whether regular physical activity is an easy choice. Communities can provide many opportunities for physical activity, such as walking trails, bicycle lanes on roads, sidewalks, and sports fields. Organizations in the community have a role to play as well. Schools, places of worship, worksites, and community centers can provide opportunities and encouragement for physical activity.

Involve Many Sectors in Promoting Physical Activity

Interventions to improve access should also include outreach that increases awareness of the opportunity to be active.
Policies and programs that support street-scale design principles and practices that promote physical activity. For example, these types of policies and programs use crosswalks, sidewalks, traffic calming, and other safety measures to make it easier and safer for people to choose active transportation.
Policies and programs that support community-scale design principles and practices that promote physical activity. Community-scale design includes zoning that facilitates bicycling and walking by allowing schools, housing, and businesses to be built near one another.
The following list identifies relevant sectors and illustrates roles they play in promoting physical activity. The division of functions in the community into the following sectors does not use mutually exclusive categories. These sectors were chosen simply to illustrate how parts of the community have a role to play in promoting physical activity. Some communities may use different names and divisions of functions.
Parks and recreation. This sector plays a lead role in providing access to places for active recreation, such as playgrounds, hiking and biking trails, basketball courts, sports fields, and swimming pools.
Concern about crime can deter people from outdoors recreation. Law enforcement can promote a safe environment that facilitates outdoor activity.
Urban planning. The Guide to Community Preventive Services recommends both street-scale and community-scale design principles to promote physical activity. Urban planners have a lead role in implementing design principles to promote physical activity.
Transportation. The transportation sector has a lead role in designing and implementing options that provide areas for safe walking and bicycling. Mass transit systems also promote walking, as people typically walk to and from transit stops. Programs that support safe walking and bicycling to school help children be more physically active.
Education. The education sector takes a lead role in providing physical education, after-school sports, and public access to school facilities during after-school hours.
Architecture. Architects and builders can design and construct buildings with active options, such as access to stairs. Campuses should allow pedestrians pleasant and efficient methods of walking within and between buildings.
Employers and private organizations. Employers can encourage workers to be physically active, facilitate active transportation by supplying showers and secure bicycle storage, and provide other incentives to be active. Private and faith-based organizations can support community physical activity initiatives financially or by providing space for programs. Health and fitness facilities and community programs can provide access to exercise programs and equipment for a broad range of people, including older adults and people with disabilities. Local sports organizations can organize road races and events for the public. Senior centers can provide exercise programs for older adults.
Health care. Health-care providers can assess, counsel, and advise patients on physical activity and how to do it safely. Health-care providers can model healthy behaviors by being physically active themselves.
Public health. Public health departments can monitor community progress in providing places and opportunities to be physically active and can track changes in the proportion of the population meeting the Physical Activity Guidelines for Americans. They can also take the lead in setting objectives and coordinating activities among sectors. Public health departments and organizations can disseminate appropriate messages and information to the public about physical activity.


Learning Activity 7.1: Find out steps you can take to encourage your employees to take the stairs and increase their physical activity while at work at StairWELL.
Use this Walkability audit tool to determine how safe and attractive the walking environment is at your work site - Walkability

Optional Learning Activity:

Implement a Fitness Promotion program at your Workplace (e.g., develop signs to post by elevators encouraging people to take the stairs, get permission to post the signs, observe to see if anyone reads the signs and actually uses the stairs; start a noontime walking club, develop a walking route that is timed and measured for distance, recruit club members; launch a campaign to get people to park in the far end of the parking lot).


Contemporary Health Issues

Open Courseware

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