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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2019. Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States. Washington, DC: The National Academies Press. doi: 10.17226/25444.
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Below is the uncorrected machine-read text of this chapter, intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text of each book. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States Committee on Strategies for Implementing Physical Activity Surveillance Food and Nutrition Board Health and Medicine Division A Consensus Study Report of PREPUBLICATION COPY—Uncorrected Proofs

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001 This activity was supported by a contract between the National Academy of Sci- ences and the Department of Health and Human Services (Division of Nutrition, Physical Activity and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention [#200-2011-38807/ 75D30118F00068]). Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organiza- tion or agency that provided support for the project. International Standard Book Number-13:  978-0-309-XXXXX-X International Standard Book Number-10:  0-309-XXXXX-X Digital Object Identifier:  https://doi.org/10.17226/25444 Additional copies of this publication are available from the National Academies ­ Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu. Copyright 2019 by the National Academy of Sciences. All rights reserved. Printed in the United States of America Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2019. Implementing strategies to enhance public health surveillance of physical activity in the United States. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/25444. PREPUBLICATION COPY—Uncorrected Proofs

The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental ­nstitution i to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president. The National Academy of Engineering was established in 1964 under the ­ harter c of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary c ­ ontributions to engineering. Dr. C. D. Mote, Jr., is president. The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president. The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine. Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org. PREPUBLICATION COPY—Uncorrected Proofs

Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typi- cally include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task. Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies. For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo. PREPUBLICATION COPY—Uncorrected Proofs

COMMITTEE ON STRATEGIES FOR IMPLEMENTING PHYSICAL ACTIVITY SURVEILLANCE RUSSELL R. PATE (Chair), Professor of Exercise Science, Arnold School of Public Health, University of South Carolina GENEVIEVE FRIDLUND DUNTON, Associate Professor, Director, USC Real-Time Eating Activity and Children’s Health (REACH) Lab, Departments of Preventive Medicine and Psychology, University of Southern California ELIZABETH A. JOY, Medical Director, Community Health, Health Promotion and Wellness, and Nutrition Services, Intermountain Healthcare KESHIA M. POLLACK PORTER, Professor, Health Policy and Management, Bloomberg School of Public Health, John Hopkins University DANIEL A. RODRIGUEZ, Chancellor’s Professor, City and Regional Planning, University of California, Berkeley JAMES F. SALLIS, Distinguished Professor Emeritus, Department of Family Medicine and Public Health, University of California, San Diego LAURIE P. WHITSEL, Vice President, Policy Research and Translation, American Heart Association Study Staff HEATHER DEL VALLE COOK, Study Director MEREDITH YOUNG, Research Assistant ANN L. YAKTINE, Director, Food and Nutrition Board Consultants EMILY CALLAHAN, EAC Consulting MATHEMATICA POLICY RESEARCH v PREPUBLICATION COPY—Uncorrected Proofs

PREPUBLICATION COPY—Uncorrected Proofs

Reviewers This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manu- script remain confidential to protect the integrity of the deliberative process. We thank the following individuals for their review of this report: E. OSCAR ALLEYNE, National Association of County & City Health Officials TREVER BALL, Intermountain Healthcare DAHEIA J. BARR-ANDERSON, University of Minnesota DAVID BUCHNER, University of Illinois at Urbana-Champaign AARON HIPP, North Carolina State University RON GOETZEL, IBM Watson Health HAROLD W. (BILL) KOHL III, The University of Texas at Austin LAURA LINNAN, University of North Carolina at Chapel Hill SAGAR SHAH, American Planning Association KATHERINE TUCKER, University of Massachusetts Lowell GREGORY WELK, Iowa State University JEANETTE Y. ZIEGENFUSS, HealthPartners Institute vii PREPUBLICATION COPY—Uncorrected Proofs

viii REVIEWERS Although the reviewers listed above provided many constructive com- ments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by DIANE F. BIRT, Iowa State University, and MAXINE HAYES, Washington State Department of Health. They were responsible for making certain that an independent examination of this report was carried out in accordance with the stan- dards of the National Academies and that all review comments were care- fully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies. PREPUBLICATION COPY—Uncorrected Proofs

Preface Physical activity has long been recognized as a key component of a healthy lifestyle, and promotion of physical activity has been a longstand- ing priority in some societal sectors including education, health care, and recreation/parks. However, it is only in recent decades that physical ­ ctivity a has become a focus of the public health sector. Because physical activ- ity is a relatively new element in public health, important components of a comprehensive public health strategy for promoting physical activity are still being developed. Surveillance, the systematic, ongoing collection and analysis of health-related data, is a core public health function. The existing public health system in the United States includes some important physi- cal activity surveillance resources. But, many gaps remain to be filled. This ­ report provides a comprehensive set of recommended actions that, when taken, will contribute importantly to filling those gaps and establishing a robust physical activity surveillance system in the United States. This report builds on the products of two previous projects. In 2014, the Centers for Disease Control and Prevention and the American College of Sports Medicine convened an expert panel that identified priority areas for enhancing physical activity surveillance. This was followed by the work of a group of experts, convened in 2017 by the Physical Activity Innovation Collaborative, an entity affiliated with the Roundtable on Obesity Solu- tions of the National Academies of Sciences, Engineering, and Medicine. That group identified key strategies for enhancing physical activity surveil- lance. The work of the Committee that produced the current report was informed by the products of the two previous projects. This Consensus ix PREPUBLICATION COPY—Uncorrected Proofs

x PREFACE Study Report extends the recommendations of those projects by identifying specific actions that should be taken to implement strategies for enhance- ment of physical activity surveillance. The committee has many people to thank for their support in devel- oping the strategies and recommended actions presented in this report. In particular, the committee expresses its gratitude to the experts who were convened to advise the committee on specific actions to enhance physical activity surveillance. That group’s thoughtful, thorough, and detailed input was critical to the successful production of this report. In addition, the committee wishes to acknowledge the many public health practitioners and researchers whose work has established the foundation of evidence upon which the content of this report is based. The committee also thanks Emily Callahan for copyediting, and the team from Mathematica Policy Research, Kelley Borradaile, Daniel ­ inkelstein, and Andrew Hurwitz, for their contributions to the com­ ittee’s F ­ m work. Finally, the committee could not have done its work without the outstanding guidance and support of Heather Del Valle Cook, Senior Pro- gram Officer, and Meredith Young, Research Assistant, with the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine. We are deeply appreciative of the skill, energy, and warmth with which they supported the committee’s efforts. Lastly, we thank Ann Yaktine, Director of the Food and Nutrition Board, for her wisdom and support. Russell R. Pate, Chair Committee on Strategies for Implementing Physical Activity Surveillance PREPUBLICATION COPY—Uncorrected Proofs

Contents SUMMARY 1 1 INTRODUCTION 17 Study Background and Context, 19 Study Purpose and Approach, 20 Organization of This Report, 25 References, 26 2 CHILDREN 27 Introduction, 27 Strategies and Actions for Implementation of Physical Activity Surveillance in Children, 28 Conclusion, 40 References, 40 3 HEALTH CARE 45 Introduction, 45 Strategies and Actions for Implementation of Physical Activity Surveillance in Health Care, 46 Conclusion, 59 References, 59 xi PREPUBLICATION COPY—Uncorrected Proofs

xii CONTENTS 4 WORKPLACES 63 Introduction, 63 Strategies and Actions for Implementation of Physical Activity Surveillance in Workplaces, 65 Conclusion, 71 References, 71 5 COMMUNITY SUPPORTS FOR PHYSICAL ACTIVITY 73 Introduction, 73 Strategies and Actions for Implementation of Surveillance of Community Supports for Physical Activity, 78 Conclusion, 94 References, 95 APPENDIXES A ACRONYMS AND ABBREVIATIONS 99 B APRIL 2017 CONVENING AGENDA, PARTICIPANT LIST, AND DISCUSSION PAPER 101 C NOVEMBER 2018 OPEN SESSION AGENDA AND PARTICIPANT LIST 121 D TABLE OF SURVEILLANCE SYSTEMS 127 E CONSULTANT REPORTS 133 F COMMITTEE MEMBER BIOSKETCHES 181 PREPUBLICATION COPY—Uncorrected Proofs

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Physical activity has far-reaching benefits for physical, mental, emotional, and social health and well-being for all segments of the population. Despite these documented health benefits and previous efforts to promote physical activity in the U.S. population, most Americans do not meet current public health guidelines for physical activity.

Surveillance in public health is the ongoing systematic collection, analysis, and interpretation of outcome-specific data, which can then be used for planning, implementation and evaluation of public health practice. Surveillance of physical activity is a core public health function that is necessary for monitoring population engagement in physical activity, including participation in physical activity initiatives. Surveillance activities are guided by standard protocols and are used to establish baseline data and to track implementation and evaluation of interventions, programs, and policies that aim to increase physical activity. However, physical activity is challenging to assess because it is a complex and multidimensional behavior that varies by type, intensity, setting, motives, and environmental and social influences. The lack of surveillance systems to assess both physical activity behaviors (including walking) and physical activity environments (such as the walkability of communities) is a critical gap.

Implementing Strategies to Enhance Public Health Surveillance of Physical Activity in the United States develops strategies that support the implementation of recommended actions to improve national physical activity surveillance. This report also examines and builds upon existing recommended actions.

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