Summary1
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.
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 that prompted this consensus study.
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1 This Summary does not include references. Citations for the findings presented in the Summary appear in subsequent chapters of the report.
STUDY BACKGROUND AND APPROACH
This committee’s work is an extension of previous efforts to address concerns around the need for physical activity surveillance. In 2014, the Centers for Disease Control and Prevention (CDC) collaborated with the American College of Sports Medicine to review the state of physical activity–related surveillance and develop an overarching strategy to establish a national plan for such surveillance, with the goal to enhance coordination and collaboration among sectors. Five strategic priorities to guide future physical activity surveillance in the United States were identified (Fulton et al., 2016). As a result, in 2017, the Physical Activity and Health Innovation Collaborative (PA IC), an ad hoc activity affiliated with the Roundtable on Obesity Solutions of the National Academies of Sciences, Engineering, and Medicine, served as the convener for a meeting of experts brought together to identify specific actions that could improve physical activity surveillance in the United States and to suggest approaches for implementing those actions. Attendees identified 23 recommended actions to advance surveillance of physical activity in specific population subgroups and to enhance monitoring of institutional and community supports that influence physical activity behaviors. A discussion paper was developed that provided the recommended actions that resulted from the convening (Pate et al., 2018).
As a follow-up, based on a request from CDC related to the need for continuing progress toward improving physical activity surveillance, a seven-member ad hoc committee was convened to develop strategies to support the implementation of the recommendations to improve national physical activity surveillance that were identified in the discussion paper (Pate et al., 2018). See Box S-1 for the committee’s task. To fulfill its charge, on November 1–2, 2018, as a way of helping the committee gather information, the committee held a public meeting for approximately 30 individuals with expertise in the four areas to discuss strategies for implementing actions to improve physical activity surveillance. As prescribed in the task, information gathered during the meeting of experts was the primary source of input that informed the committee’s recommendations. It should be noted that the committee was not charged with conducting a formal search of the relevant scientific/professional literature, and such a search was not undertaken.
Several overarching principles informed the committee’s selection of strategies and supporting actions to implement those strategies: physical activity surveillance systems should be as equitable as possible and appropriately representative of the U.S. population and its institutions and communities; physical activity is a complex behavior and it is influenced by factors operating in a variety of settings; and given the complexity of physi-
cal activity behavior, a comprehensive surveillance system will be successful only if a diverse set of key partners participate in the design of the system and then act to implement enhancements.
Additionally, the committee employed guidance during the selection process to ensure that the strategies and actions selected should collect information in a manner that is legal, ethical, and properly attendant to personal, institutional, and community confidentiality; expand the availability of physical activity information at the state, tribal, and local levels, as well as at the national level; enhance physical activity surveillance in subpopulations other than children and in other settings, including the home, faith-based
organizations, and educational institutions; leverage new technologies to the extent possible; address surveillance of participation in all those types of physical activity; be feasible for implementation in the near term; and support research on the public health implications of physical activity.
RECOMMENDED STRATEGIES AND ACTIONS TO IMPROVE NATIONAL PHYSICAL ACTIVITY SURVEILLANCE
The committee presents 22 strategies for improving national physical activity surveillance: 6 for children, 6 for health care, 4 for workplaces, and 6 for community supports for physical activity. The committee also recommended specific actions to support implementation of each strategy. A total of 59 implementation actions were identified: 16 for children, 16 for health care, 12 for workplaces, and 15 for community supports for physical activity. The full list of strategies and supporting actions for implementation is provided below.
Children
Strategy 1: Develop and implement state- and national-level systems for monitoring physical activity policies and practices in early child care and early childhood education settings.
Strategy 2: Enhance existing surveillance systems for monitoring elementary through high school–based physical activity policies and programs.
Strategy 3: Develop a protocol that leverages ongoing administration of physical fitness tests, such as FitnessGram, for the purpose of monitoring fitness levels of children and youth.
Strategy 4: Expand objective monitoring of physical activity in children (ages 3 to 18 years) by incorporating validated wearable technologies into existing surveillance systems.
Strategy 5: Develop a system for monitoring community-level availability of organized sports and other physical activity programs for children.
Strategy 6: Identify features of the built environment that are most likely to influence physical activity in children, and embed an assessment of the perceived availability and use of these features into existing surveillance systems.
Health Care
Strategy 7: Develop surveillance systems to monitor the prevalence of physical activity assessment in adults through expanded integration of a standard physical activity vital sign (PAVS) in health care delivery.
Strategy 8: Develop surveillance systems to monitor the prevalence of physical activity assessment and promotion among children through integration of a standard pediatric physical activity vital sign (PedsPAVS) in health care delivery.
Strategy 9: Expand the use of data from wearable devices for monitoring physical activity in at-risk patients.
Strategy 10: Conduct surveillance of cardiorespiratory fitness and muscle strength testing among at-risk populations in health care settings.
Strategy 11: Ensure that national health care delivery surveys include questions about physical activity assessment and counseling in health care settings.
Strategy 12: Conduct surveillance of physical activity levels in the health care workforce and related training programs.
Workplaces
Strategy 13: Document existing surveillance efforts that capture physical activity, physical fitness, and sedentary behavior in the workplace and in employees’ commutes to and from work, and identify opportunities to expand these efforts.
Strategy 14: Convene public and private stakeholders to prioritize and implement consensus key measures2 to assess individual-level physical activity, physical fitness, and sedentary behavior surveillance in the workplace.
Strategy 15: Develop consistent measures for physical activity in workplace designs and operations, policies, programs, culture, and climate, and use these measures in comprehensive surveillance of physical activity and physical fitness in the workplace.
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2 Described in Whitsel et al., 2019.
Strategy 16: Obtain longitudinal support and funding for the Workplace Health in America survey.
Community Supports for Physical Activity
Strategy 17: Prioritize a set of constructs and corresponding survey items to assess perception of community supports for active transportation and active recreation, incorporate the constructs and survey items into national surveillance systems, and promote their use at the local level.
Strategy 18: Identify and compile GIS-based data sources and methods to facilitate national surveillance of community supports for physical activity.
Strategy 19: Explore opportunities for partnering with professional organizations to query their membership about physical activity–supportive policies in the communities where they work and to share policy tracking data for surveillance purposes.
Strategy 20: Develop and standardize methods for linking policies, self-reported surveillance systems, and environmental geospatial data to identify opportunities to support physical activity.
Strategy 21: Identify a brief set of prioritized constructs and methods that could be assessed using audits (observations) of streets, parks, and other relevant public spaces.
Strategy 22: Identify methods to assess physical activity events, programs, social environments, and promotion resources.
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