.
.
MEDICAL CONDITIONS: OBESITY :
PHYSICAL EXERCISE AND FITNESS :
WALKING :
WALKABLE COMMUNITIES:
Step it Up!
The Surgeon Generals Call to Action
to Promote Walking and Walkable Communities
http://www.cdc.gov/physicalactivity/walking/
call-to-action/index.htm?s_cid=bb-dnpao-calltoaction-005
.
A shorter URL for the above link:
.
http://tinyurl.com/z3lhp8y
.
.
Physical activity is one of the most important things Americans can do to
improve their health.
.
Regular physical activity can reduce the burden of chronic diseases, such
as heart disease, diabetes, and some cancers, and can prevent early death.
.
Despite the known health benefits of being physically active, only
one-half of U.S. adults and about one-quarter of high school students meet
the minimum guidelines[PDF-8.35MB] for aerobic physical activity. Walking
is an easy way to start and maintain a physically active lifestyle, and
walkable communities make it easier for people of all ages and abilities
to be active.
.
The goal of Step it up! The Surgeon Generals Call to Action to Promote
Walking and Walkable Communities is to increase walking by working
together to increase access to safe and convenient places to walk and
wheelchair roll and to create a culture that supports walking for all
Americans.
.
Complete report[PDF-1.27MB]
http://tinyurl.com/nus4hzh
.
Executive summary
Partner booklet[PDF-2.62MB]
http://tinyurl.com/psr4thn
.
Consumer video
Infographic[PDF-1.44MB]
http://tinyurl.com/h783ewc
.
Slide Set[PDF - 1MB]
Find out more about the role each sector can play:
http://tinyurl.com/h6rz3g6
.
Colleges and Universities[PDF - 253 KB]
http://tinyurl.com/zzb6ymh
Employers[PDF - 562 KB]
http://tinyurl.com/hvyyo4f
.
Health Care[PDF - 553 KB]
http://tinyurl.com/hgjfmw4
.
Media[PDF - 481 KB]
http://tinyurl.com/gqnchn8
.
Nonprofit Organizations[PDF - 534 KB]
http://tinyurl.com/hw7d59a
.
Parks and Recreational Facilities[PDF - 366 KB]
http://tinyurl.com/jxzuj25
.
Public Health[PDF - 440 KB]
http://tinyurl.com/hmp98ok
.
Schools[PDF - 405 KB]
http://tinyurl.com/h2vl9uf
.
Transportation, Land Use,
and Community Design Planners [PDF - 611 KB]
http://tinyurl.com/jg9nso6
.
.
Step It Up! The Surgeon Generals Call to Action to Promote Walking and
Walkable Communities
Executive Summary
.
One out of every two U.S. adults is living with a chronic disease, such as
heart disease, cancer, or diabetes.1 These diseases contribute to
disability, premature death, and health care costs.2,3 Increasing peoples
physical activity levels will significantly reduce their risk of chronic
diseases and related risk factors.4,5 Because physical activity has
numerous other health benefitssuch as supporting positive mental health
and healthy agingit is one of the most important actions people can take
to improve their overall health.4,5
.
Step It Up! The Surgeon Generals Call to Action to Promote Walking and
Walkable Communities recognizes the importance of physical activity for
people of all ages and abilities. It calls on Americans to be more
physically active through walking and calls on the nation to better
support walking and walkability. Improving walkability means that
communities are created or enhanced to make it safe and easy to walk and
that pedestrian activity is encouraged for all people.6 The purpose of the
Call to Action is to increase walking across the United States by calling
for improved access to safe and convenient places to walk and wheelchair
roll and by creating a culture that supports these activities for people
of all ages and abilities.
.
The Call to Action includes five strategic goals to promote walking and
walkable communities in the United States: make walking a national
priority; design communities that make it safe and easy to walk for people
of all ages and abilities; promote programs and policies to support
walking where people live, learn, work, and play; provide information to
encourage walking and improve walkability; and fill surveillance,
research, and evaluation gaps related to walking and walkability. Action
by multiple sectors of society, as well as by families and individuals,
will be needed to achieve these goals.
.
Physical Activity: An Essential Ingredient for Health
.
Being physically active is one of the most important steps that people of
all ages and abilities can take to improve their health.5 Increasing
peoples physical activity level will significantly reduce their risk of
chronic disease and premature death and support positive mental health and
healthy aging.4,5
.
Chronic Disease in the United States
.
Chronic diseases are the leading causes of death in the United States and
major contributors to disability.3 In 2012, almost 50% of U.S. adults, or
117 million people, were living with a chronic disease, and of this group,
about 60 million were living with two or more chronic diseases.1 Chronic
diseases also ranked as four of the top five most costly medical
conditions.7
.
Benefits of Physical Activity
.
Physical activity can reduce illness from chronic diseases and premature
death.4,5 Regular physical activity helps prevent risk factors for disease
(such as high blood pressure and weight gain) and protects against
multiple chronic diseases (such as heart disease, stroke, some cancers,
type 2 diabetes, and depression).4,5 In children and adolescents, physical
activity can improve bone health, cardiorespiratory and muscular fitness,
and body composition.4,5
.
People living with chronic disease also benefit from being physically
active.4,8-20 For example, physical activity can lessen the severity of
their condition, as well as prevent disease progression and premature
death,4,12-16 help manage or reduce symptoms,8-11 and improve
mobility.13,16
.
Among adults, physical activity is associated with improved quality of
life,4,21,22 emotional well-being,4,23,24 and positive mental
health.4,23-25 Regular physical activity is also important for healthy
aging5 and may delay the onset of cognitive decline in older
adults.4,26-28
.
In children and adolescents, some evidence suggests that physical activity
can lower levels of anxiety and depression.4,29-31 When schools encourage
participation in physical activity as part of physical education, recess,
classroom lessons, or extracurricular activities, students can also
improve their academic performance.32,33
.
Physical Activity Guidelines for Americans
.
To obtain substantial health benefits, the 2008 Physical Activity
Guidelines for Americans recommends that adults get at least 150 minutes
of moderate-intensity aerobic physical activity or 75 minutes of
vigorous-intensity physical activity, or an equivalent combination, each
week and that children and adolescents be active for at least 60 minutes
every day.5 People who are inactive and those who do not yet meet the
guidelines are strongly encouraged to work toward this goal. Adults with
disabilities who are unable to meet the guidelines should avoid inactivity
and try to get regular physical activity according to their abilities.5
.
Physical Activity in the United States
.
Despite the health benefits, only one-half of U.S. adults reported levels
of physical activity consistent with the guideline for aerobic physical
activity in 2013.34 Adults who were male, younger, white, or Asian or who
had higher levels of education were more likely to have met the aerobic
physical activity guideline.34
.
Only 27% of high school students reported levels of physical activity that
met the guideline for 60 minutes of physical activity a day in 2013. 35
Male high school students and students in lower grade levels were more
likely to meet the guideline.34,35
.
Why Focus on Walking as a Public Health Strategy?
.
Strong evidence exists that physical activity has substantial health
benefits.4,5 People can get these benefits through brisk walking or by
adding brisk walking to other physical activities.5 Walking is an
excellent way for most Americans to increase their physical activity. It
is also a powerful public health strategy for several reasons.
.
Walking does not require special skills, facilities, or expensive
equipment and is an easy physical activity to begin and maintain as part
of a physically active lifestyle.36 Most people are able to walk, and many
people with disabilities are able to walk or move with assistive devices,
such as wheelchairs or walkers. Walking has a lower risk of injury than
vigorous-intensity activities.5,37 Walking also may be a good way to help
people who are inactive become physically active because walking can be
easily adapted to fit ones time, needs, and abilities.5,37
.
Walking is a common form of physical activity. In 2010, more than 60% of
adults reported walking 10 minutes or more in the past week for
transportation or leisure.38 Adults with more education, those who were
white or Asian, and those who were younger were more likely than their
counterparts to report any walking.38,39
.
People walk for many purposes, such as for transportation to get to
school, work, a store, or the library or for leisure to have fun,
socialize with friends or family, walk their dog, or improve their health.
Because walking is multipurpose, it provides many opportunities for people
to incorporate physical activity into their busy lives. In 2010, about
half of U.S. adults reported walking during their leisure time and less
than one-third reported walking for transportation.40
.
Communities can benefit when they implement strategies that make them more
walkable and when more people walk. Communities designed to be walkable
can improve safety not only for people who walk but for all community
members.41-43 Walkable communities and communities where more people walk
offer opportunities for personal interaction and social involvement.44
Communities designed to be walkable have the potential to reduce air
pollution and greenhouse gases because people may choose to walk or bike
rather than drive.45,46 Finally, walkable communities are attractive
places for businesses to locate, which may help local economies
thrive.47-49
.
Why Dont People Walk More?
.
Many more people could meet the 2008 Physical Activity Guidelines for
Americans5 by starting to walk or increasing the amount they walk.
Although walking is a popular form of physical activity and can be easily
done by most people, barriers to walking do exist.
.
People report lack of time as one challenge that prevents them from
walking or doing other kinds of physical activity.50,51 People may
struggle to meet the current guideline for regular aerobic physical
activity as they cope with competing demands of work, school, home, and
caring for themselves and others.
.
Safety concerns can be a barrier to walking. Several factors can influence
pedestrian risk, such as unsafe driver41,52,53 and pedestrian
behaviors41,52-55 and challenging physical environments.41,42,53 Perceived
traffic dangers may also be barriers to walking. In surveys of parents,
the most commonly reported barrier for walking to school was distance to
school, followed by traffic-related dangers.56,57 Fear of crime or
perceptions of an unsafe neighborhood may also be potential barriers to
walking.58-61
.
In addition, the ways in which communities are designed and built can
present barriers to walking. When everyday destinations are located too
far away from home, walking will not be a convenient option.62-65 Because
people are more likely to walk when they use public transportation,
62,66-73 the lack of an adequate public transit system may mean that
opportunities to walk are lost.
.
Disability, chronic conditions, and age can be barriers to walking. During
20092012, 11.6% of U.S. adults aged 1864 years reported a disability, and
adults with disabilities were more likely to be physically inactive than
adults without a disability.74 Chronic conditions and age can make it
difficult for people to walk. For example, people with arthritis may find
walking painful.75 Older adults and those who are frail may be reluctant
to walk because of concerns about falls and subsequent injury.
.
How to Increase Walking and Improve Walkability
.
Ultimately, individuals make the decision to walk. However, the decision
to walk can be made easier by programs and policies that provide
opportunities and encouragement for walking and by improvements to
community walkability. Improving walkability means that communities are
created or enhanced to make it safe and easy to walk and that pedestrian
activity is encouraged for people of all ages and abilities.6
.
Community and street design policies are recommended approaches for
increasing physical activity, including walking.76,77 Community design can
support physical activity, for example, by locating residences within
short walking distance of stores, worksites, public transportation,
essential services, and schools and by building and maintaining sidewalks
or paths between destinations that are well-connected, safe, and
attractive. 76,77 Street design can also support walking and enhance
pedestrian safety through measures that improve street lighting and
landscaping and reduce traffic speed.76,77 Transportation and travel
policies and practices that create or enhance pedestrian and bicycle
networks and expand or subsidize public transit systems can be another
approach to encourage walking for transportation.78,79
.
Several program and policy strategies are recommended to increase physical
activity, including walking. For example,
.
Creation of or Enhanced Access to Places for Walking with Informational
Outreach. Creating or enhancing access to places for physical activity,
combined with information to encourage use of these places, is a strategy
recommended to increase physical activity.80,81 Examples of places for
walking include public parks; health, fitness, and recreational
facilities; schools, colleges, and universities; malls; senior centers;
and worksites.
.
Social support interventions. Social support interventions increase
physical activity by providing supportive relationships for behavior
change.82 They include actions that provide friendship and support, such
as buddy systems, contracts with others to complete specified levels of
physical activity, or walking groups. 80,81
.
Individually-adapted health behavior change programs. These programs teach
behavioral skills that help participants incorporate physical activity
into their daily routines.80-82 Programs usually incorporate some form of
counseling from a health professional or trainer to help participants set
physical activity goals, monitor their progress toward these goals, seek
social support, and use self-reward to reinforce progress.82,83
.
Community-wide campaigns. A community-wide campaign is a concentrated
effort to promote physical activity that combines a variety of strategies
such as media coverage, risk factor screening and education, community
events, and policy or environmental changes.81,84
.
What Sectors Are Needed to Help Implement Community Approaches?
Many groups have a role to play to make the United States a nation with
safe, easy, and desirable places to walk as part of our daily lives.
.
Transportation, Land Use, and Community Design
.
Decisions and plans made by the transportation, land use, and community
design sector can affect whether communities and streets are designed to
support walking. This sector can change the design of communities and
streets through roadway design standards, zoning regulations, and building
codes76 and improve the pedestrian experience through landscaping, street
furniture, and building design.85 This sector is also integral in the
planning and implementation of public transit systems.
.
Parks and Recreational and Fitness Facilities
.
Public parks offer access to places to walk.86,87 Health and fitness
facilities offer group walking programs and access to places for walking,
including places to walk indoors. Better access to parks, playgrounds, and
recreational centers may encourage active transportation, such as walking
to the location.88 Health and fitness facilities should be designed,
built, and maintained to be accessible to the entire population, including
people with mobility limitations or chronic conditions.
.
Schools
.
Schools can provide opportunities for physical activity through physical
education, recess, after-school activity programs, and physical activity
breaks, 89,90 and walking can be incorporated into these opportunities.
Schools can encourage walking by promoting safe routes for students to
walk to and from school. Opening school facilities, such as gyms,
playgrounds, fields, and tracks, to the community during nonschool hours
is a promising strategy to increase access to physical activity and
recreational facilities91 and increase physical activity levels.92-94
.
Colleges and Universities
.
Walkable campus strategies help students, faculty, and staff members adopt
active living behaviors on campus.95 Colleges and universities can also
educate and train future professionals to recognize their role in
promoting walking and walkable communities. This training can be directed
to students in health disciplines, as well as to students in other
relevant fields, such as architecture, transportation, urban design, and
business.
.
Worksites
.
Worksites can offer access to on-site facilities or employer-subsidized,
off-site exercise facilities to encourage physical activity among
employees. 96,97 They can adopt policies that include brief activity
breaks, flexible schedules, and walking meetings as potential strategies
to increase participation in worksite physical activity.98-100 Incentives
and social support programs can also be used to encourage employees
interest and participation in physical activity programs.81,100
.
Volunteer and Nonprofit Organizations
.
Volunteer and nonprofit groups can provide access to facilities, programs,
and information to promote walking. For example, they can open their
facilities and walking programs to the wider community for free or at low
cost, or they can organize social support programs. These organizations
can also serve as messengers to share information about the benefits of
walking and walking programs and ways to improve walkability.
.
Health Care
.
Health care professionals can assess patients' physical activity levels
and educate patients across their lifespan about the importance of
physical activity. Counseling may be especially important for adults who
are at higher risk of chronic disease, such as those who are overweight or
obese and have additional risk factors for cardiovascular disease.101,102
Walking is an especially good activity for health care professionals to
promote because most of their patients can walk, and walking can be easily
modified to a persons abilities.
.
Media
.
The media can be effective in influencing attitudes and changing
behaviors, including health behaviors.103-106 Media campaigns can be part
of effective multicomponent interventions designed to increase physical
activity. However, evidence on the effectiveness of stand-alone mass media
campaigns to increase physical activity at the population level is
inconsistent.107
.
Public Health
.
Public health professionals can conduct research and evaluate programs to
determine what works to promote and sustain physical activity, including
walking. They can summarize findings about what community approaches work
to increase walking and walkability, and they can help other sectors
design and implement interventions. They can convene partners across
multiple sectors to learn from each other and to develop strategic action
plans that efficiently use each partners expertise and resources. Public
health professionals also collect data about walking and walkability to
measure and monitor changes over time.
.
Gaps in Surveillance, Research, and Evaluation
.
Existing research provides an evidence base about what works to increase
walking in the United States. However, additional surveillance, research,
and evaluation work is needed to maximize the success of community
approaches and address disparities in walking and walkability.
.
Surveillance
.
Walking among adults is assessed through self-report in several
surveillance systems38,108,109 but not in a consistent manner.
Surveillance systems that assess walking among children and adolescents
mainly collect data on walking for transportation.108,110,111 Improvements
to existing surveillance systems are needed to establish standard and
valid measures of walking that can be used across systems at national,
state, regional, and local levels.
.
No national surveillance system routinely and comprehensively monitors
local neighborhood features of a walkable community. Brief survey and
on-the-ground audit tools or technological approaches that capture the
most important aspects of walkability are needed to increase the
feasibility of routinely assessing key features of the environment as part
of core questions in surveillance systems.
.
Research
.
Existing research demonstrates that broadly defined or multicomponent
interventions increase physical activity,77,81,82 but it is rarely known
which set of individual elements are most effective, necessary, or
sufficient to achieve a positive effect while minimizing any negative
effects, such as injuries. Effective communication can also be an
important component of physical activity programs.81 However, researchers
are not sure which specific messages or combination of messages and other
intervention components, such as walking programs and access to places to
walk, are best for populations that vary in age, location, race/ethnicity,
and socioeconomic status.
.
Evaluation
.
Communities across the country are implementing a variety of interventions
that promote walking, but many of these interventions are not being
adequately evaluated. Evaluation planning should occur early in the
development process to identify key stakeholder questions and ensure that
adequate resources are allocated to the evaluation.112 Evaluation data
would be strengthened by the use of common metrics across studies to allow
comparison of the relative cost and effectiveness of various
interventions.
.
Economic Analysis
.
Additional research is needed to fully describe the economic benefits of
adequate levels of physical activity in the United States.113 Research and
evaluation studies should collect data to support economic
analysis.114,115 In addition, to fully capture the range of costs and
savings from changes in environmental design or program implementation,
economic analyses may need to consider other potentially quantifiable
savings that result from these types of interventions.116-118
.
The Call to Action
.
The Call to Action includes five goals, with related strategies to support
walking and walkability in the United States. These strategies will make
it easier and safer for people to walk and to use a wheelchair, ride a
bike, and be active in other ways. Support for these goals and strategies
is needed across many sectors of society, such as transportation, land
use, and community design; parks, recreation, and fitness; education;
business and industry; volunteer and nonprofit; health care; media; and
public health.119 Families and individuals will also need to be involved
to make the United States a walkable nation.
.
.
Goal 1. Make Walking a National Priority
Encourage people to promote walking and make their communities more
walkable.
.
Create a walking movement to make walking and walkability a national
priority.
.
Goal 2. Design Communities that Make It Safe and Easy to Walk for People
of All Ages and Abilities
Design and maintain streets and sidewalks so that walking is safe and
easy.
.
Design communities that support safe and easy places for people to walk.
.
Goal 3. Promote Programs and Policies to Support Walking Where People
Live, Learn, Work, and Play
.
Promote programs and policies that make it easy for students to walk
before, during, and after school.
.
Promote worksite programs and policies that support walking and
walkability.
.
Promote community programs and policies that make it safe and easy for
residents to walk.
.
Goal 4. Provide Information to Encourage Walking and Improve Walkability
Educate people about the benefits of safe walking and places to walk.
Develop effective and consistent messages and engage the media to promote
walking and walkability.
.
Educate relevant professionals on how to promote walking and walkability
through their profession.
.
Goal 5. Fill Surveillance, Research, and Evaluation Gaps Related to
Walking and Walkability
.
Improve the quality and consistency of surveillance data collected about
walking and walkability.
.
Address research gaps to promote walking and walkability.
Evaluate community interventions to promote walking and walkability.
.
Conclusion
.
Promoting walking offers a powerful public health strategy to increase
physical activity. With the Call to Action, the U.S. Surgeon General calls
on Americans to be physically active and for the nation to better support
walking and walkability for people of all ages and abilities. To improve
walking and walkability, communities need to be designed to make walking
safer and easier; programs and policies need to be available to support
and encourage walking; and individuals and families need to support each
other to become and stay active. Many partners are already involved, but
more engagement is needed to increase the reach, breadth, and impact of
these efforts. Walking is an easy and inexpensive way to improve the
health and well-being of all Americans. Now is the time to step it up and
make walking a national priority.
.
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