AN AGENDA FOR PHYSICAL ACTIVITY AND HEALTH:

                 PUBLIC POLICY PRIORITIES OF THE 
        NATIONAL COALITION FOR PROMOTING PHYSICAL ACTIVITY
                (Revised Draft - 7/3/96 - 8 pages)
                   ACTIVELY IMPROVING HEALTH  
                          AN OVERVIEW  
The links among physical activity, fitness, and health are well-established 
scientifically and medically.  Much scientific and medical evidence indicates 
that physical inactivity is a major risk factor for cardiovascular, metabolic, 
and other diseases.  Even moderate levels of regular physical activity confer 
significant health benefits.  However, large segments of the American population
remain inactive, with little or no physical activity in their daily lives.  Current 
trends are not promising. More than 60 percent of American adults do not receive 
the recommended amount of physical activity, and 25 percent of the adult population 
is not active at all. The year 2000 could begin an era of worsening health habits, 
with major health and financial consequences for families and the entire nation.  
Given that context, the National Coalition for Promoting Physical Activity (NCPPA) 
was created in May 1995.  Composed of over 100 member and participating organizations, 
the Coalition is working to sustain and extend U.S. leadership in the 21st century
in the understanding, communication, and promotion of physical activity and health.  
Its aim is to achieve constant increases in physical activity among all persons in the 
United States in order to improve and maintain health and quality of life.  To achieve 
that goal, the Coalition provides an organizational vehicle to enhance meaningful 
cooperation among associations and voluntary health organizations, foundations, 
government agencies, academia, and industry. 
The Coalition has several important areas of activity, including:
   (1) Communication and Education:  stimulating and staging effective health promotion
       and education activities, and updating the media frequently.
   (2) Research and Clinical Practice:  supporting efforts to improve the strength of 
       the scientific, behavioral, and clinical practice aspects of physical activity 
       and health. 
   (3) Liaison and Inter-organizational Outreach:  reaching out to relevant organizations
       and identifying means and opportunities for effective collaboration.
   (4) Advocacy and Political Education:  providing accurate information and education
       to the media, decision-makers, and opinion leaders at all levels of government and 
       community, while encouraging governmental and regulatory policies and practices that 
       will improve the understanding and support of physical activity and health, and that 
       will motivate and positively re-enforce people to engage in physical activity.
The National Coalition for Promoting Physical Activity believes that all adults and children 
should participate in regular moderate or vigorous physical activity.  All should have as a 
minimal goal the accumulation of at least thirty minutes of moderate physical activity on 
most and preferably all days of the week.  Those already meeting that guideline may well 
derive further health and fitness benefits by becoming more physically active or including 
more vigorous physical activity in a regular routine.  Furthermore, the National Coalition also 
believes that optimal progress across the nation cannot be made without a program that 
communicates, educates, and advocates favorable policies and practices at the federal, state, and 
local levels. 
The National Coalition also believes that the release of the first Surgeon General's Report on
Physical Activity and Health is an opportunity to focus the attention of the Nation and its 
leaders on the importance of physical activity and the need for change.
To accomplish its aims and to build on the release of the Surgeon General's Report, the 
National Coalition has identified five major priority areas for action, and will support 
policies, practices, and strategies at all levels that are consistent with the 
recommendations for each of these priority areas:
     1. Education 
     2. Research            
     3. Health Care and Health Insurance 
     4. Community and Employer
     5. Target Populations
         PROMOTING PUBLIC AND PROFESSIONAL UNDERSTANDING
                       EDUCATION PRIORITIES
Effective educational programs for all segments of the population are needed to reduce the
prevalence of physical inactivity among Americans, and the health and economic costs 
associated with sedentary lifestyles.  In addition to such well-known indicators as abnormal 
blood lipid and blood pressure levels, obesity, tobacco use, and alcohol abuse, physical 
inactivity has been identified as a key risk factor associated with several serious health 
problems.  A growing body of evidence demonstrates the relationship between physical inactivity, 
or lack of exercise, and cardiovascular diseases, hypertension, diabetes, obesity, some cancers, 
and depression. Conversely, recent studies show that regular physical activity plays a significant 
role in the prevention and management of these serious health problems.  Support is needed from 
legislators and policy makers at the federal, state, and local levels for education programs. 
The National Coalition recommends the following as goals at the federal, state, and local levels:
     1. All schools should deliver quality daily physical education and comprehensive health 
        education to all students, K-12.  Unfortunately, physical activity declines dramatically 
        with age during adolescence. In high school, enrollment in daily physical education classes 
        dropped from 42 percent in 1991 to 25 percent in 1995.   Effective school-based education 
        programs are essential for the development of positive attitudes and behaviors that will 
        carryover and foster active and healthy lifestyles throughout the adult years.  In addition, 
        schools should strive to maximize physical activity access and opportunity for students 
        (e.g., keeping facilities open after normal hours, and providing equipment and supervision 
        during those non-traditional times.
     2. All Americans should have an opportunity to learn and internalize what it means to be 
        physically educated.  These guidelines should include being one who learns skills necessary
        to perform a variety of physical activities, is physically fit, participates regularly in 
        physical activity, knows the implications of and the benefits from involvement in physical 
        activities, and values physical activity and its contributions to a healthful lifestyle.  
        All individuals should have an appreciation for the wide range of physical activity options 
        from which one can gain health benefits, including competitive or recreational sports, 
        participation in exercise programs at health and fitness clubs, use of at-home exercise 
        equipment, dancing, and incorporation of moderate physical activity into everyday routines 
        (e.g., walking the dog, taking the stairs).
     3. All individuals should understand the importance of combining regular physical activity 
        with a healthy diet that conforms to the 1995 Federal Dietary Guidelines for Americans. 
        In this regard, all persons should appreciate the integrated nature of a more healthy 
        lifestyle, so that the promotion of physical activity and the avoidance of tobacco, for 
        instance, can be found in and related to nutrition education and vice versa.  
     4. Appropriate education programs should be developed and targeted specifically to at-risk 
        populations among whom physical inactivity is particularly prevalent, including the 
        socio-economically disadvantaged, the less educated, persons with disabilities, older adults, 
        and youth between the ages of 13-19 whose levels of inactivity and body weight have increased 
        in recent years.
     5. Funding for quality school health promotion programs should be increased from both 
        traditional sources, such as apportioning state sales taxes, and from newer resources, such
        as earmarking revenue from state lottery programs.  Also partnerships should be established 
        with corporations in order to fund innovative health education programs, so that all can benefit 
        from a healthier working population in the next century.
     6. Advice on, assessment of, prescription for, and referral to resources on physical activity 
        should be provided by medical care professionals (e.g., physicians, nurses, exercise physiologists, 
        allied health personnel) to patients as they are seen in the clinical setting.  This advice and 
        referral may be presented to the patient as part of routine health maintenance examinations or be 
        considered as patients seek clinical assistance for predetermined medical reasons.
   BUILDING THE NATION'S CAPABILITY IN RESEARCH AND PREVENTION
                       RESEARCH PRIORITIES 
Investment in biomedical research ensures the good health and well-being of our nation, families, and children.  
Recent polls reflect this need and show that an overwhelming majority of Americans believe that more 
money should be spent on medical research to better diagnose, treat, and prevent diseases.  The public also is 
aware that biomedical research extends well beyond the basic treatment and control of diseases, but also to the 
prevention of diseases.  The National Coalition promotes basic and applied biomedical and outcomes research.    
While many people know that exercise is good for them, many do not know why nor do they understand how much or 
what kind of exercise is right for them.  Study after study has demonstrated a link between physical activity 
and the prevention of cardiovascular diseases, certain cancers, and diabetes.  Exercise also helps control weight, 
promotes mental health, and builds and maintains healthy bones. 
Evidence on what helps people incorporate physical activity into their lives is not clear.  Physical education 
classes in schools, worksite health promotion programs, and counseling by health care providers have been 
effective in promoting physical activity. More needs to be learned about what helps individuals change their 
physical activity habits and how changes in community environments, policies, and social norms might support that 
process.  The National Coalition supports the development and implementation of effective programs that promote physical 
activity.
The National Coalition for Promoting Physical Activity recommends the following:
     1. Growth in the National Institutes of Health (NIH)-supported biomedical research nationwide.  Ensure growing 
        support of the research process and capitalize on all opportunities for scientific breakthroughs.  This growth 
        should include:  (a) an increase in federal funding and research grant and training budgets to adequately support 
        research as it pertains to physical activity.  (b) significant real growth in federal funding for biomedical research 
        programs of the National Institutes of Health, in particular, the National Heart, Lung and Blood Institute; the 
        National Institute of Diabetes and Digestive and Kidney Diseases; the National Institute of Child Health and Human 
        Development; the National Institute of Neurological Disorders and Stroke; and the National Institute on Aging. 
        (c) increased federal funding for clinical, behavioral, and outcomes research under such agencies as the Agency for 
        Health Care Policy and Research (AHCPR).  The AHCPR plays an important role through the establishment of clinical practice 
        guidelines and conduct of outcomes research.  Practice guidelines and outcomes research help ensure that high quality 
        and cost-effective medical services are provided.
     2. Increased funding and promotion of such federal agencies as the Office of Disease Prevention and Health Promotion (ODPHP) 
        to promote and support physical activity among all Americans.  The ODPHP is the federal office responsible for prevention 
        policy activities of the Department of Health and Human Services.  The ODPHP promotes activities in the private sector, 
        services a national information center, and offers programs, research, and communications support for disease prevention and 
        health promotion.  The cornerstone of ODPHP's mission is the development, monitoring, and implementation of the Healthy 
        People 2000 program.
     3. Increased support for the Centers for Disease Control and Prevention along with other relevant federal agencies.  CDC is 
        developing a comprehensive physical activity program that will build on research, of the kind emerging from the National 
        Institutes of Health; will support state, school, and community interventions; and will expand communications to professionals 
        and the public.  Increases in funding are needed to support:
*    A coordinated national communications effort: In order to disseminate effective physical activity and nutrition messages.
*    Program development:  Earmarked support for states to establish physical activity capacity in health departments, develop local physical 
     activity programs, form coalitions and work closely with the managed care industry.
*    An increase for the Preventive Health and Human Services Block Grant: An important primary source of federal funding for states to support 
     prevention activities.
*    An increase for CDC's school health programs:  Support for states to implement model school health programs that address physical inactivity, 
     diet, and tobacco use, currently received by only 13 states.
*    Surveillance and epidemiology:  Support to develop, validate, and disseminate improved standardized methods for assessing physical activity 
     in target populations, including women, minorities, adolescents, and disadvantaged populations.
*    Interventions research:  Funding to develop and evaluate practical model interventions to promote physical activity in various settings, 
     such as work sites, churches, health care settings, and schools.
                  CHANGING POLICIES AND SYSTEMS
           HEALTH CARE AND HEALTH INSURANCE PRIORITIES
Rising health care costs place an extreme burden on federal, state, and local 
governments. Medical and scientific research demonstrates that appropriate 
interventions and modifications of lifestyles can reduce or eliminate large 
numbers of health risks.  An expansion in health promotion and preventive care 
represent tremendous opportunities for the United States.  No where is this
more dramatic than in the area of health benefits to be gained nationally by 
increasing, even moderately, the population's level of physical activity.  
Simply put:  a massive gain in improved health is possible if we can lower the 
number of sedentary, physically inactive people.  As HMOs and other managed 
care delivery options continue to grow, the National Coalition considers it 
an important priority that preventive care -- including counseling on physical 
activity -- is routinely and effectively provided to patients. In addition, a 
number of other important policy matters related to health care and health 
insurance would assist with this improvement in American's health.
Several matters pertinent to the U.S. Congress and state legislatures are 
important to physical activity.  For example, Congress has proposed changes in 
tax laws to encourage individual savings for health care expenses.  Depending 
on how such a proposal is written, individuals either could be encouraged or 
discouraged to seek preventive care, including counseling in regard to the 
risks of poor health habits, such as being physically inactive, or the benefits 
from changes in lifestyle. Furthermore, in debating insurance reform, some 
states have attempted to prohibit health insurance companies from offering 
incentives for health plan members to engage in fitness or physical activity 
programs.  Outlawing a financial incentive lessens the attractiveness of such a
program.  Also, health care providers and allied health professionals continue 
to play a vitally important role in providing information, instruction, and 
encouragement to patients and clients in regard to the importance of regular 
physical activity. 
The National Coalition for Promoting Physical Activity recommends the following 
at the federal, state, and local levels:
     1. States should allow and encourage insurance companies doing business 
        in their jurisdiction to allow incentives for insured members to 
        participate in fitness and physical activity programs and engage in 
        other healthy lifestyle habits, as many already are doing for 
        tobacco-free clients. Encouragement and flexibility should be provided 
        to the states by the federal government in order to achieve such 
        flexibility.
     2. Any federal initiatives relative to health care policy and reform should 
        include support for and encouragement of health promotion, preventive 
        care, and rewarding healthy habits, such as regular physical activity, 
        that have a demonstrated ability to avoid or postpone disease and 
        disability.
     3. Programs, training, and incentives should be identified and developed 
        for health care providers and allied health professionals to ensure 
        accurate and consistent information and counsel is provided to patients 
        and clients. This should result from a combination of federal funding 
        and private sector support for quality initiatives, as well as a careful 
        review and any necessary modification of the education and training of 
        health professionals. 
     4. In clinical practice, a lack of time and absence of a means for 
        reimbursement creates barriers for health care providers to give 
        adequate attention to counseling patients about physical activity and 
        nutrition. Such advice to patients has great potential to help 
        individuals stay healthy, and therefore should be considered of 
        sufficient value within the U.S. health care system to merit appropriate 
        reimbursement. In addition, a careful examination should be made of the
        diverse practice settings in the United States -- from HMOs to V.A. 
        hospitals -- to ensure that each environment provides an adequate focus 
        on health promotion and disease prevention measures.       
          BUILDING PARTNERSHIPS FOR HEALTH IMPROVEMENT
                COMMUNITY AND EMPLOYER PRIORITIES
Communities present a tremendous opportunity for health promotion and disease 
prevention. Relatively simple measures can have a major impact, such as building 
zone ordinances that encourage rather than discourage options to be physically 
active, the inclusion of bikeways and walkways in communities, security measures 
to provide safe, well-lighted areas for outdoor activities, and regulations that 
allow access to recreation and sports facilities and play fields.  In addition, 
business and industry must invest in the health of Americans to maintain a 
productive workforce and control health care costs.  To achieve this, corporations, 
schools, hospitals, and non-profit organizations must assist government by 
integrating physical activity into health policies and programs.  The National 
Coalition for Promoting Physical Activity will work with the private and public 
sectors to identify and support national, state, and local policies that promote 
physical activity.  To that end, the National Coalition recommends the following 
federal, state, and local policies: 
     1. Various incentives should be provided to participating employees as 
        part of worksite wellness programs and/or health benefits programs, 
        and financial incentives should be provided for employees who reduce 
        health risks by becoming physically active.
     2. Access to safe and affordable recreation facilities and opportunities 
        --  such as safe walking and bike trails and roadways -- should be 
        expanded.
     3. The regulatory and physical environment conducive to increased physical 
        activity should be improved.
     4. Employees should have opportunities to use facilities and other means 
        of engaging in physical activity.
     5. Community, media, and public leaders who themselves are physically 
        active should be encouraged to help educate and encourage the 
        population to engage in physical activity.
     6. Employers should become familiar with and consider instituting health 
        promotion programs in the business environment.  The numbers of employers 
        offering aspects of health promotion has increased, and opportunities 
        for further progress are abundant.  For example, employers -- and 
        particularly smaller employers --- should be encouraged to cooperate 
        with other organizations, in order to more effectively provide such 
        opportunities to their employees. 
     7. In each community, leading corporations should be identified and 
        partnerships created with affiliates and government agencies in order 
        to promote physical activity.
     8. Existing facilities should be upgraded, and open space developed in 
        order to achieve safe and affordable supervised recreation programs.
     9. Regulatory ordinances that promote physical activity and safety should 
        be identified and used, such as building codes, zoning, and urban design 
        (e.g., sidewalks, well-lighted stairs, and street lights.) 
            FOCUSING ON PHYSICAL ACTIVITY NEEDS OF ALL
                   TARGET POPULATION PRIORITIES
In regard to the general population, the public health benefits of increasing 
physical activity are enormously important, due to the prevalence of sedentary 
lifestyles and the impact of activity on disease risk.  Obviously, physical 
activity also is extremely important in regard to non-diseased and chronically 
diseased and disabled populations.  Such groups include older adults and persons
with disabilities, as well as those less educated and socio-economically 
disadvantaged. These groups also possess unique behavioral, physical and/or 
physiological characteristics and needs. Physical activity not only plays an 
important role in health maintenance within these populations, but can assist 
with the management of various diseases and conditions and allow daily living 
with a minimum amount of assistance. Therefore, the National Coalition stresses 
the importance of the following general priorities:
     1. Expand and extend health promotion and prevention programs -- including 
        counsel on physical activity -- to American populations with special 
        needs and circumstances. 
     2. Increase funding and support for research programs and public education 
        initiatives that are relevant to these populations.
     3. Encourage and assist the adoption of lifetime recreational and physical 
        activity habits that are appropriate and beneficial to the health of 
        such populations.

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Kai Sommer ist ein etablierter Fachmann in den Branchen Gesundheit, Fitness und Medizin. Er schreibt bereits - neben anderen Tätigkeiten in diesen Bereichen - seit über 7 Jahren für unseren Gesundheitsblog Ncppa.org und beweist dabei immer wieder seinen einmaligen Expertenstatus.

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