By Dr. James Sallis

Does anyone ever ask you why you work in the physical activity or physical education field? If so, or if you wonder whether this hard work is worth it, consider these facts:

• Physical inactivity accounts for almost 200,000 U.S. deaths annually (Danaei et al., 2009). It is ranked fourth behind smoking (450,000 deaths), high blood pressure (300,000), and overweight/obesity (200,000 deaths). Of course, physical activity helps people quit smoking, control high blood pressure, and prevent obesity.

• The World Health Organization (2004) estimates 2 million deaths per year from physical inactivity internationally, making it the 7th leading cause of death.

• The 1996 Surgeon General’s Report, Physical Activity and Health, identified physical inactivity as a risk factor for early death, cardiovascular diseases, several cancers, Type 2 diabetes, mental health problems, reduced quality of life, osteoporosis, and several other diseases (U.S. Department of Health and Human Services, 1996).

• The Centers for Disease Control and Prevention estimates at least $76 billion in health care costs annually from physical inactivity (Pratt et al., 2000).

• Based on recent data from objective monitoring using accelerometers, fewer than 50% of elementary children, 10% of adolescents, and 5% of adults are meeting current physical activity guidelines (Troiano et al., 2007). Thus, the vast majority of the American population is at risk of early death, multiple diseases, reduced quality of life, and higher health care costs due to physical inactivity.

• The Surgeon General’s 2001 Call to Action on obesity (U.S. Department of Health and Human Services, 20001) and the Institute of Medicine’s 2005 report on Preventing Childhood Obesity (Koplan et al., 2004) identified increased physical activity as essential for reversing the obesity epidemic.

• The Department of Health and Human Services released the first official government physical activity guidelines in 2008 (Physical Activity Guidelines Advisory Committee, 2008).

• In the 13 years since the 1996 Surgeon General’s Report, about 2.6 million Americans have died because of insufficient progress in increasing physical activity (13 years X 200,000 deaths per year).

Are you now more convinced than ever that promoting physical activity is a very high priority? Don’t you think everyone should place a high value on physical activity? So do I, but unfortunately, not everyone values physical activity. This includes many of the groups responsible for improving health in the United States.

I want to call your attention to the October 2009 issue of Preventive Medicine. It contains a series of short commentaries that explain why more emphasis needs to be placed on promoting physical activity and what changes are needed to be successful. This issue grew out of a startling revelation. The National Institutes of Health published a list of 214 research topics for which it tracks funding. The list included every disease you ever heard of, enzymes you have not heard of, and a wide range of health behaviors, including diet, smoking, alcohol abuse, and violence. Everything important to health—except physical activity. It later became clear that NIH tracks 360 research topics, and physical activity was not on that list either—despite the fact that NIH has spent hundreds of millions of dollars over several decades on physical activity research.

Of course, this news was upsetting to physical activity professionals. How could the world’s leading health research organization not care enough to track spending on one of the leading health issues? The editor of Preventive Medicine decided the NIH situation was a symptom of a larger problem of physical activity being undervalued in every part of the health field. As just one example, every state, city, and county health department has many nutritionists, but most state health departments only have one physical activity specialist, and that person may be a nutritionist working on physical activity part-time. The journal is freely available online, and the short commentaries are easy to read:

http://www.elsevier.com/wps/find/journaldescription.cws_home/622934/description
http://www.activelivingresearch.org/resourcesearch/journalspecialissues

As Toni Yancey and I ask in our introductory editorial, will physical activity be Rodney Dangerfield who never gets any respect, or Cinderella who is just waiting in the shadows until she gets her chance to become belle of the ball? The answer depends on us. One of the reasons physical activity is undervalued is that physical activity professionals and enthusiasts are too nice—and too quiet. We do not advocate well enough for what we believe in.

I hereby challenge you to take action to advocate for increased attention, resources, and funding for physical activity or physical education. Raise your voice for something that will make a difference. Here are some of my suggestions for improvements to demand and argue for, but I know you can identify many more needs.

• A PE Coordinator in your school district or County Department of Education to promote improvements in PE.

• In secondary schools, more resources for PE and intramurals that benefit many, rather than for interscholastic sports that benefit a few.

• Open school grounds for community use during non-school hours.

• Hire a qualified physical activity specialist in your local health department who can promote physical activity, including supporting improved school PE.

• Write to local government leaders about where new parks or park renovations are needed.

• Testify at local planning commission meetings to educate them about the necessity to design new developments and transportation projects that support physical activity for transportation and recreation.

• Help write a Safe Routes to School grant proposal for your school.

• Make sure all neighborhoods in your area have sidewalks.

• Advocate for more and safer facilities for bicycling, like bike paths separated from traffic.

• Join the new Physical Activity Special Interest Group of the American Public Health Association.

Surely you can find a physical activity cause to adopt. Get educated about it. Be bold and speak up to the people who make decisions. We know the deadly consequences of inactivity, so we all have a responsibility to work for a more active America. Keep us informed about what you do. Email SPARK your good ideas for advocacy, success stories, and frustrations.

I’m including references in this entry.

1. American Public Health Association, 2008. Policy Statement 20079. Building a Public Health Infrastructure for Physical Activity Promotion. http://www.apha.org/advocacy/policy/policysearch/default.htm?id=1358
2. Danaei, G., Ding, E.L., Mozaffarian, D., Taylor, B., Rehm, J., Murray, C.J.L., Ezzati, M., 2009. The preventable causes of death in the United States: Comparative risk assessment of dietary, lifestyle, and metabolic risk factors. PLoS Med 6(4), e1000058.
3. Koplan, J.P., Liverman, C.T., Kraak, V.I., eds, 2005. Preventing Childhood Obesity: Health in the Balance. Washington, DC: National Academies Press.
4. Physical Activity Guidelines Advisory Committee, 2008. Physical Activity Guidelines Advisory Committee Report, 2008. Washington, DC, U.S. Department of Health and Human Services.
5. Pratt, M., Macera, C.A., Wang, G., 2000. Higher direct medical costs associated with physical inactivity. Physician Sports Med, 28, 63-70.
   Troiano, R.P., Berrigan, D., Dodd, K.W., Masse, L.C., Tilert, T., McDowell, M., 2007. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc 40, 181-188.
   U.S. Department of Health and Human Services, 1996. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.
6. U.S. Department of Health and Human Services, 2000. Healthy People 2010. Conference ed. Washington, DC: U.S. Department of Health and Human Services.
7. U.S. Department of Health and Human Services, 2001. The Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.
8. World Health Organization, 2004. Global Strategy On Diet, Physical Activity And Health. Geneva: WHO. www.who.int/gb/ebwha/pdf_files/WHA57/A57_R17-en.pdf
9. Yancey, A.K., guest editor. Theme issue: Forum on Physical Activity Research and Funding. Prev Med. October 2009, volume 49, issue 4.

Jim Sallis
www.drjamessallis.sdsu.edu