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OCR for page 118
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)
OCR for page 119
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
OCR for page 120
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
OCR for page 121
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
OCR for page 122
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
Representative terms from entire chapter:
physical fitness
