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13. Physical Fitness and Exercise Although some say the United States is caught up in a fitness craze, with Americans taking to jogging tracks, swimming pools, and aerobics classes, 38 witnesses made clear that many physical fitness and exercise goals are yet to be met. According to testimony, only a small fraction of adult Americans are exercising at optimal levels as specified in the 1990 Objectives and by the American College of Sports Medicine. About half are quite sedentary, despite the fact that sedentary adults have double the risk of cardiovascular disease." (#021 J Youth also are failing to meet exercise goals, and their fitness is declining. (~121) Steven Blair of the Institute for Aerobics Research in Dallas notes that although much is known about the kind of exercise needed to achieve physical fitness, considerably less is known about the level of activity required to achieve positive health effects. (~021J Nevertheless, current knowledge prompted Blair and many other witnesses to propose new directions in the health objectives for the year 2000, including a greater emphasis on moderate levels of exercise. According to David Sobel of the Permanente Medical Group, the myth of "no pain, no gain" needs to be firmly debunked in the public mind. The image and standard of vigorous, sweat- soaked exercise has discouraged many sedentary indi-~-~duals from even trying to become more acti ~ The bulk of benefit may come from exp; Ding as little as 500 kilocalories a week in moderate physical activity. And such activity need not be an arduous bout of exercise, but can ye pleasurable, enjoyable activities: walking, gardening, bowling, dancing, golf, and so on. (#780,) Others called for more attention to musculoskeletal fitness, the contribution of exercise to controlling certain diseases, and the potential adverse effects of exercise. (~021) The fitness of our nation's youths, more precise- ly, the lack thereof~oncerned a number of witnesses. According to American College of Sports Medicine: Over one-half of our children do not get enough exercise to develop healthy hearts and lungs, and 118 Healthy People 2000: Citizens Chart the Course a significant number of our school age youth already have established risk factors for car- diovascular disease. A conservative estimate suggests that adolescent obesity is prevalent among 20 to 30 percent of our youth. In our opinion, the majority of this can be attributed to significant reductions in physical activity, both at school and at home, the adoption of sedentary lifestyles, and the promotion of poor nutritional habits. (~534) Among the recommended improvements to be addressed through Year 2000 Health Objectives are more and better-quality physical education programs in school and agreed-upon standards for fitness tests. Witnesses spoke with almost one voice about the need to stress health-related fitness-rather than motor fitness or power or sports-related fitness-for children. NEW EMPHASES NEEDED Much testimony about physical hltness and exercise includes proposals that would significantly alter the approach of the 1990 Objectives which, many wit- nesses believe, focused quite narrowly on attaining relatively high levels of cardiovascular fitness. A major shift called for by many witnesses is to deemphasize high-intensity exercise and focus instead on getting more people involved in moderate exercise. (~021; #187; #534) James Ross fears that the em- phasis on high-intensity exercise "has turned off a lot of people" who cannot or will not exercise long or hard enough. The past emphasis on intense exercise, according to Ross, probably has resulted in a lot of injuries to people who felt compelled to stick to exercise programs at all costs. From a public health perspective, encouraging more people to exercise at various levels of intensi~and in various ways suited to their own needs, interests, and abilities might be better. (#187) Taking a slightly different approach, Blair suggests that the 1990 objectives aimed at producing relatively high levels of physical fitness be retained but that new objectives be formulated to promote gains in moder- ate activity. A reasonable target for the year 2000 could be to reduce the percentage of extremely sedentary people to 2~25 percent. (#021)

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Witnesses also say that the emphasis on car- diovascular fitness in the 1990 Objectives short- changed other aspects of physical fitness. Several suggest adding objectives relating to the musculoskele- tal system. (#021; #248; #534J Blair notes that musculoskeletal fitness is especially important in older individuals to prevent disability and preserve function- al capacity for routine occupational, recreational, and daily tasks. (#021J Witnesses also note other effects of exercise that should be reflected in the Year 2000 Health Objec- tives. Ross refers to the impact of exercise on non- insulin~ependent diabetes, the control of depression and anxiety, weight control, and the cessation of addictive behaviors. (#187) David Stscovick of the University of Washington sounds a note of caution by pointing out that none of the 1990 Objectives addressed the responsibility to minimize the adverse effects of exercise, which can range from sore muscles to sudden death. Studies suggest that 15 percent of sudden cardiac deaths occur during moderate or vigorous exercise,2 and that this is not a random event: vigorous exercise can precipi- tate sudden cardiac death. Nevertheless, he adds, among men who engage in regular vigorous exercise, the transient risk during activity is outweighed by a decreased risk at other times, so that the overall risk to vigorous exercisers is still less than among seden- taIy men. (#200) Siscovick proposes that the Year 2000 Health Objectives place greater emphasis on the importance of reducing risks through pre-exercise evaluation and counseling, controlling extremes of temperature around exercise periods, and reducing cigarette smoking and alcohol use. He cites Kenneth Powell and Ralph Paffenbarger: "The potential overall beneficial impact of physical activity on health will be poorly served if activity patterns are recommended indiscriminately for all groups without regard for the subgroup's specific benefits and risks.n3 (it200) , ~ SPECIAL POPULATIONS A number of populations were identified as having special physical fitness needs and problems that require attention in the Year 2000 Health Objectives. The American College of Sports Medicine (ACSM) comments that the fitness boom has affected primarily highly educated, affluent suburbanites; blue collar and minority populations have not been affected much by pressures to exercise and maintain a healthful diet. In setting new objectives, ways must be found to influence these groups. (#534) Several witnesses propose objectives specifically targeted to older adults. According to the ACSM, because of major physiological changes in the nerves and muscle fibers, muscle mass in older individuals is decreased by approximately 50 percent compared to younger adults. James Breen of George Washington University proposes that by the year 2000, 50 percent of adults 65 years and older participate three or more times per week for sessions of 30 minutes or more in activities designed to promote or maintain flexibility, ambulatory skills, arm and hand strength, or other skills of daily living, and in physical activity at least as vigorous as a sustained slow walk. (#550) However, physical health after age 65 is related integrally to earlier lifestyle habits. Thus, the ACSM states, "our target for the year 2000 should be to stimulate all adults to maintain their strength by incorporating strength-type training activities into their daily lives. In addition, more research into the benefits of strength training on cardiovascular and skeletal muscle injuries needs to be performed." (#534) The need to pay special attention to those with developmental disorders, especially children, and to individuals who are physically, mentally, or emotional- ly disabled also was discussed. (#248; #313) REVISING GOALS FOR CHILDREN AND YOUTH America's children are not physically fit, according to many witnesses, who place much of the blame on the poor condition of physical education programs. Many recommendations for Year 2000 Health Objectives reflect the need to shift the focus of physical educa- tion classes from the quantity of time spent in class (the focus of the 1990 Objectives) to the quality of the program. The child of the 1980s is less fit and fatter than the child of the 1960s, according to Charles Kuntzleman of Fitness Finders. (~121j Today's child typically gets less than 15 minutes of vigorous exercise a day. Kuntzleman says that only 25 percent of a child's time in the physical education classroom involves motor activity, and only 1 to 3 minutes of that time is of sufficient intensity to train the heart and make the child fit, whereas a minimum of 20 minutes is necessary. In addition, students do not tend to develop skills that promote lifelong physical fitness. "It is time for schools to recognize that the Physical Fitness and Exercise 119

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traditional curriculums developed in the early part of this century do not have application today." (#121) Kuntzleman and others made specific recommenda- tions about improving the quality of physical educa- tion classes by the year 2000. (#021; #121; #171; #187; #534; #596) Many suggestions emphasize activities that build strength and muscular flexibility, and teach lifelong fitness values and skills. The American Alliance for Health, Physical Education, Recreation and Dance (AAHPERD) also says that physical education should be taught every day for 30 to 55 minutes, depending on the grade, and classes should be no larger than those of other academic programs. The AAHPERD says that by the year 2000, all physical education classes in seventh through twelfth grades, and 75 percent of classes for kinder- garten through sixth grades, should be taught by a certified physical educator. (#596) Blair emphasizes the importance of teaching health and fitness concepts and Reemphasizing motor performance, or sports skills instruction. He notes that most vigorous exercise among children takes place outside the physical education class and indi- cates that increasing enrollment in physical education classes is not a priority. t~o214 Others propose targets for increased participation but emphasize the importance of improving the quality of the courses. Kuntzleman, for instance, recognizes the "Feelin' Good" program, sponsored by the W.K Kellogg Foundation, as a model for improving aerobic and muscle fitness levels, flexibility, cardiovascular know- ledge, exercise participation, and other positive out- comes. He also criticizes the trend toward reducing physical education classes as money becomes tight. (#121) Several witnesses note that a serious impediment to improving youth fitness is the lack of agreed-upon standards and programs. For example, according to Russell Pate of the University of South Carolina: The greatest current deficiency in the field of youth fitness testing is the lack of widely accepted criterion-referenced standards for physical fitness in children and youth. The lack of such standards greatly retards our ability to interpret the results of physical fitness tests and limits our ability to communicate effectively to children, their parents, and the public the meaning of fitness test results. By the year 2000, there should be widely accepted criterion-referenced standards for physical fitness tests 120 Healthy People 2000: Citizens Chart the Course in children and youth, testifiers say. (#171; #187) The AAHPERD proposes that by the year 2000, more than 75 percent of schools should test all their students for physical fitness and recognize student progress. Only about 50 percent of students in the first to fourth grades currently attend schools that provide such testing.4 (#596) Numerous witnesses commented on the importance of using tests that assess activities that will lead to improved health, rather than just greater strength or athletic prowess. Brian Sharkey points out that the President's Council on Physical Fitness and Sports favors a fitness test that is not health related. The AAHPERD, on the other hand, promotes a health- related test. The inconsistency is confusing and should be resolved in favor of the health-related test, Sharkey says. (#363) Pate supports Sharkey's con- clusions and believes progress already is being made. Through the mid-1970s, the traditional motor performance tests that emphasized measurement of speed, power, and agility were dominant. However, over the past 10 years, virtually all newly developed tests have emphasized health fitness, including cardiorespiratory endurance, body fatness, flexibility, and muscular strength/ endurance. This approach to physical fitness testing seems to indicate that the physical educa- tion profession's operational definition of physi- cal fitness is becoming more health-oriented. (#171J Several witnesses said that objectives for the year 2000 should include goals for children as young as age five or six; the 1990 Objectives include only children ten and older. (#171; #248; #313) "The growth and development literature suggest that behavior patterns are established several years prior to age ten," according to Jeanette Winfree of the American Physical Therapy Association. (#313) The importance of physical fitness for children with developmental disabilities also was mentioned. (#248) IMPLEMENTATION Testifiers identified a number of specific sites with the potential to reach large numbers of adults. Loring Wood of the NYNEX Corporation and others en- dorse the value of worksite fitness programs. t#021; #sso; #736J However, Winfree urges more worksite programs that address flexibility and muscle strength

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and place special emphasis on the serious problem of back injuries. (~313) Witnesses representing the National Recreation and Park Association encourage increased public support for, and utilization of, recreation facilities in promoting health and wellness. Recreational and health professionals should work together to "jointly develop and pursue a plan and strategy to define practical goals, policies, and means to achieve improved health and recreation." (#538; #620) The need to do a better job of training certain professions about exercise and physical education was mentioned by several testifiers. Kuntzleman believes that an underlying cause of the lack of fitness in our youth relates to the need to upgrade the quality of physical education teachers. Our graduates seem to be so tuned in to sport skills development that they have neglected the basic vocabulary of the sport of fitness and acquisition of basic motor skills. We need a vocabulary of fitness, just as we have a basic vocabulary for teaching kids how to read, write, do math, etc. (~121) There also were calls for expanding the education of physicians about exercise physiology and the value of physical activity so that they can encourage their patients in health-related activities. (#021; #541) Physicians also should instruct patients in ways to minimize the risk of sudden cardiac death during vigorous exercise. (~200J Several witnesses cite the need for additional data to set or monitor progress in goals. Blair says current surveys are doing Reasonably well" in tracking REFERENCES physical activity, at least for adults; however, a better tracking system is needed for physical fitness. (#021) Breen identifies several goals relating to the need for increased knowledge about the relationship between exercise and health outcomes. (~550) Siscovick says that by the year 2000, a methodology for identifying all exercise-related sudden cardiac deaths and moni- toring age-, gender-, and race-specific incidence rates should be established. (#200) Breen says that by the year 2000, the incidence of injuries from the most popular adult exercises should be known. (#550J The ACSM calls for more research into the bene- fits of strength training in relation to cardiovascular and skeletal muscle injuries, noting that the greater elasticity of blood vessels in the young enables them to better compensate for cardiac overloads; it is not known whether strength training leads to greater elasticity in later years. (~534J Marilyn Gossman and Jane Walter, representing the American Physical Therapy Association, also say that more research on exercise and the musculoskeletal system is necessary. They call for additional risk-benefit data on fitness programs by the year 2000, with special emphasis on their effect on the musculoskeletal system. (~248) In addition to its specific proposals for improving physical education courses, the American Alliance for Health, Physical Education, Recreation and Dance requests action by the federal government. The AAHPERD proposes substantial federal funding for research aimed at improving physical education courses, as well as establishment of an Office of Physical Education in the Department of Education. The organization also calls for providing women equal opportunities to compete in school and college athletics and sports programs as a way of encouraging lifelong fitness. (~596J 1. Powell KE, Thompson PD, Caspersen CJ, et al.: Physical activity and the incidence of coronary heart disease. Annual Review of Public Health, vol. 8. Edited by L Breslow, JE Fielding, LB Lave. Palo Alto: Annual Reviews, 1987 2. Vuori I: The cardiovascular risks of physical activity. Acta Med Scand Suppl 711:205-214, 1984 3. Powell KE, Paffenbarger RS: Workshop on epidemiologic and public health aspects of physical activity and exercise: A summary. Pub Health Rep 100~2~:118-126, 1985 4. Ross JO, Pate RR: Summary of findings from the National Children and Youth Fitness Study II. J Phys Educ Rec & Dance, 50-96, November-December 1987 Physical Fitness and Exercise 121

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TESTIFIERS CITED IN CHAPTER 13 021 Blair, Steven; Institute for Aerobics Research (Dallas) 121 Kuntzleman, Charles; Fitness Finders (Spring Arbor, Michigan) 171 Pate, Russell; University of South Carolina 187 Ross, James; Maryland 200 Siscovick, David; University of Washington 248 Gossman, Marilyn and Walter, Jane; American Physical Therapy Association 313 Winfree9 Jeanette; Physical Therapy Services (Galveston, Texas) 363 Sharkey, Brian; University of Northern Colorado 534 Raven, Peter and Drinkwater, Barbara; American College of Sports Medicine 538 Curtis, Joseph; City of New Rochelle Department of Human Services (New York) 541 Sheehan, George; The Second Wind (Red Bank, New Jersey) 550 Breen, James; George Washington University (Washington, D.C.) 596 Perry, Jean; American Alliance for Health, Physical Education, Recreation and Dance 620 Twice, R. Dean; National Recreation and Park Association 736 Wood, Loring; NYNEX Corporation 780 Sobel, David; The Permanente Medical Group 122 Healthy People 2000: Citizens Chart the Course