Perspectives in Disease Prevention and Health Promotion Progress Toward Achieving the 1990 National Objectives for Physical Fitness and Exercise

Eleven of the 1990 health objectives for the nation address physical fitness and exercise. These 11 objectives target specific reductions in risk, improvements in public and professional awareness, availability of services, and surveillance systems. A status review in 1985 indicated that two objectives had been achieved or were on track for achievement by 1990, and seven were judged as unlikely to be achieved; data were unavailable to assess progress toward two objectives (1). This article summarizes progress through June 1988. REDUCTION OF RISK By 1990, the proportion of children and adolescents ages 10 to 17 participating regularly in appropriate physical activities, particularly cardiorespiratory fitness programs which can be carried into adulthood, should be greater than 90%.

This objective is unlikely to be met. The 1984 National Children and Youth Fitness Study (NCYFS) (2) found that 66% of children ages 10-17 were participating at the level recommended by the 1990 objective. The recommended level is at least three or more times/week for at least 20 minutes/session in an activity that is likely to be done as an adult, that involves large-muscle groups in dynamic contractions, and that requires 60% or more of cardiorespiratory capacity.By 1990, the proportion of children and adolescents ages 10 to 17 participating in daily school physical education programs should be greater than 60%.

This objective is unlikely to be met. In 1984, the NCYFS found that 36% of children 10-17 years old in grades 5-12 had daily physical education classes. In 1974-1975, an estimated 33% had daily classes. Achieving this 1990 objective will require different strategies for different grades. In 1984, greater than 90% of children in grades 5-8 were enrolled in physical education classes, but fewer than half had daily physical education classes. In contrast, the proportion of children in grades 9-12 enrolled in physical education classes ranged from 81% in grade 9 to 52% in grade 12; more than half of those enrolled had daily physical education classes. Thus, to achieve this objective by 1990, physical education classes need to be more frequent for grades 5-8, and enrollment needs to be increased for grades 9-12.By 1990, the proportion of adults 18 to 65 participating regularly in vigorous physical exercise should be greater than 60%.  This objective is unlikely to be met. At the midcourse review in 1985, an estimated 10%-20% of adults were participating at the level recommended in the 1990 objective. Data from the 1984-1987 Behavioral Risk Factor Surveillance System (BRFSS) sur veys and the 1985 National Health Interview Survey (NHIS) have shown that only about 8% of adults are participating regularly at the level recommended in the 1990 objectives (3).By 1990, 50% of adults greater than or equal to 65 years should be engaging in appropriate physical activity, e.g., regular walking, swimming, or other aerobic activity.

This objective is unlikely to be met. In 1975, an estimated 35% of adults greater than or equal to 65 years of age took regular walks. In the 1985 NHIS, 46% of this population reported walking for exercise. However, only 8% walked or participated in other physical activities often enough or long enough to meet the definition of appropriate physical activity recommended in the 1990 objectives (3). PUBLIC/PROFESSIONAL AWARENESS By 1990, the proportion of adults who can accurately identify the variety and duration of exercise thought to promote most effectively cardiovascular fitness should be greater than 70%.

This objective is unlikely to be met. In the 1985 NHIS, when adults greater than 18 years of age were asked about the characteristics of exercise needed to strengthen the heart and lungs, 39% reported that exercise should be done 3-4 days/week; 23%, for 15-25 minutes/occasion; and 34%, so that the heart rate and breathing are "a lot faster but talking is possible." All three questions were correctly answered by 5%.By 1990, the proportion of primary-care physicians who include a careful exercise history as part of their initial examination of new patients should be greater than 50%.

On the basis of limited data, this objective may have been achieved. In 1981, 47% of primary-care physicians in Massachusetts and Maryland reported that they "routinely" ask patients about exercise behavior. SERVICES/PROTECTION By 1990, the proportion of employees of companies and institutions with over 500 employees offering employer-sponsored fitness programs should be greater than 25%.

This objective appears to have been met. In 1979, only 3% of such companies had formally organized fitness programs. By 1985, 32% of the worksites with 250-749 employees and 54% of the worksites with greater than or equal to 750 employees reported offering employer-sponsored fitness programs (4). SURVEILLANCE/EVALUATION SYSTEMS By 1990, a methodology for systematically assessing the physical fitness of children should be established, with at least 70% of children and adolescents ages 10 to 17 participating in such an assessment.  This objective has two targets: 1) the development of methods to assess the fitness of children and 2) widespread participation by children in the assessment. The first target has been achieved. At least three tests of youth physical fitness, including national norms, are available (5-7). However, reliable estimates of the number of children participating in such tests are not available.By 1990, data should be available with which to evaluate the short- and long-term health effects of participation in programs of appropriate physical activity.

Progress toward this objective is difficult to evaluate. Since this objective was formulated in 1978, knowledge has increased substantially regarding the effects of physical activity on cardiovascular disease, hypertension, osteoporosis, diabetes, colon cancer, weight management, and depression. However, many questions about the health effects of physical activity remain unanswered (Table 1).By 1990, data should be available to evaluate the effects of participation in programs of physical fitness on job performance and health-care costs.

Progress toward this objective is difficult to evaluate. Although several studies have been conducted to assess the effects of physical fitness on job performance and health-care costs, substantive concerns about study design constrain firm conclusions. Other problems include the lack of standard operational definitions for job performance and health-care costs and the lack of comparability between measures.By 1990, data should be available for regular monitoring of national trends and patterns of participation in physical activity, including participation in public recreation programs in community facilities.

The first part of this objective has been met. Surveys have been implemented or are planned to monitor national trends and patterns of participation in physical activity. These surveys include the 1985 health promotion supplement to the NHIS, the BRFSS, and the National Health and Nutrition Examination Survey III. No information is available about participation in public recreation programs in community facilities, and no surveys are planned. Reported by: The President's Council on Physical Fitness and Sports. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health, Public Health Service. Cardiovascular Health Br, Div of Chronic Disease Control and Community Intervention, Center for Chronic Disease Prevention and Health Promotion, CDC.

Editorial Note

Editorial Note: Documentation of the health benefits of regular physical activity has increased, and methods to systematically track and describe patterns of physical activity in the United States have improved greatly. Evidence indicates that regular physical activity reduces the incidence of and/or is otherwise beneficial to many medical conditions--including coronary heart disease, colon cancer, osteoporosis, hypertension, depression, diabetes mellitus, and obesity. Most data about the relationship between physical activity and colon cancer have appeared within the past decade (15) and suggest that regular physical activity may reduce the risk of colon cancer as much as 50%. Because general relationships between physical activity and specific medical conditions have been established, research efforts can now be focused on more specific questions (Table 1).  Although objectives for participation in regular physical activity will not be fully met, systems to regularly assess the level of participation have been implemented. In 1985, CDC's National Center for Health Statistics included questions about physical activity in the NHIS. The same questions will be used in the 1990 survey. In addition, CDC's Center for Chronic Disease Prevention and Health Promotion has used the BRFSS to assist state health departments in monitoring levels of participation in leisure-time physical activity.

In the past decade, evidence has suggested that the benefits of regular physical activity accrue at lower levels of intensity than those required to meet the standard set in the 1990 objectives (16,17). For example, although less than 10% of the adult population meet the definition for "appropriate physical activity" suggested in the 1990 objectives, another 34% are regularly active (i.e., at least three 20-minute sessions/week) but at levels of intensity that are lower than the objectives recommend. Members of this latter group also appear to be receiving some health benefits. The national health objectives for the year 2000 will address the benefits from moderate-intensity physical activity and encourage greater participation at both moderate and vigorous levels.

References

1.Public Health Service. The 1990 health objectives for the nation: a midcourse review. Washington, DC: US Department of Health and Human Services, Public Health Service, 1986.

2.Ross JG, Dotson CO, Gilbert GG, Katz SJ. What are kids doing in school physical education? J Physical Education, Recreation and Dance 1985;56:73-6.

3.Caspersen CJ, Christenson GM, Pollard RA. Status of the 1990 physical fitness and exercise objectives--evidence from NHIS 1985. Public Health Rep 1986;101:587-92.

4.Office of Disease Prevention and Health Promotion. National Survey of Worksite Health Promotion Activities: a summary. Washington, DC: US Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, 1987.

5.President's Council on Physical Fitness and Sports. 1985 National School Population Fitness Survey. Washington, DC: US Department of Health and Human Services, Public Health Service, Office of the Assistant Secretary for Health, 1986.

6.American Alliance for Health, Physical Education, Recreation and Dance. AAHPERD health related fitness test manual. Reston, Virginia: American Alliance for Health, Physical Education, Recreation and Dance, 1980.

7.Ross JG, Gilbert GG. The National Children and Youth Fitness Study: a summary of findings. J Physical Education, Recreation and Dance 1985;56:45-50.

8.Powell KE, Thompson PD, Caspersen CJ, Kendrick JS. Physical activity and the incidence of coronary heart disease. Annu Rev Public Health 1987;8:253-87.  9.Blair SN, Jacobs DR Jr, Powell KE. Relationships between exercise or physical activity and other health behaviors. Public Health Rep 1985;100:172-80. 10.Blair SN, Goodyear NN, Gibbons LW, Cooper KH. Physical fitness and incidence of hypertension in healthy normotensive men and women. JAMA 1984;252:487-90. 11.Cummings SR, Kelsey JL, Nevitt MC, O'Dowd KJ. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiol Rev 1985;7:178-208. 12.Taylor CB, Sallis JF, Needle R. The relation of physical activity and exercise to mental health. Public Health Rep 1985;100:195-202. 13.Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS. Physical activity and depressive symptoms: the NHANES I epidemiologic follow-up study. Am J Epidemiol 1988;128:1340-51. 14.Koplan JP, Siscovick DS, Goldbaum GM. The risks of exercise: a public health view of injuries and hazards. Public Health Rep 1985;100:189-95. 15.Kohl HW, LaPorte RE, Blair SN. Physical activity and cancer: an epidemiological perspective. Sports Med 1988;6:222-37. 16.Powell KE, Spain KG, Christenson GM, Mollenkamp MP. The status of the 1990 objectives for physical fitness and exercise. Public Health Rep 1986;101:15-21. 17.Leon AS, Connett J, Jacobs DR Jr, Rauramaa R. Leisure-time physical activity levels and risk of coronary heart disease and death. JAMA 1987;258:2388-95.

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