Laurie Whitsel, PhD, Vice President of Policy Research and Translation, American Heart Association
With publication of the second edition of the Physical Activity Guidelines for Americans in 2018, we have more evidence than ever to support physical activity’s far-reaching benefits for physical, mental, emotional, and social health and wellbeing. Given the compelling data on physical activity’s impressive contributions to health, it’s even more critical that public health efforts support our population in moving more and sitting less.
Most people in the United States have more moving to do: only about half of adults and about one-quarter of high school students meet the Guideline’s recommendations for aerobic physical activity. Surveillance of physical activity is a core public health responsibility because it’s how we measure and analyze the public’s engagement in physical activity (and inactivity). Surveillance activities are guided by standard protocols and track implementation and evaluation of interventions, programs, and policies that aim to increase physical activity. They provide the “before and after” data that we use to determine the impact of our efforts.
Measuring physical activity is more complex than one might think – it varies by type, intensity, duration, frequency, setting, motives, and environmental and social influences. It’s important to measure physical activity behaviors, such as walking, as well as the environments that support physical activity, such as a neighborhood’s walkability; but currently, there are insufficient surveillance tools. To fill that gap, the National Academies of Sciences, Engineering, and Medicine (NASEM) convened an expert committee to develop strategies that support the implementation of recommended actions to improve national physical activity surveillance.
Four focus areas for physical activity surveillance
The committee carefully considered health equity, use of new technologies, legal and ethical issues, and research needs as it developed its recommendations. The recommendations are focused in four priority areas: children, healthcare, workplaces, and community. An overview of the recommended strategies for implementation of effective physical activity surveillance in these four areas follows:
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.
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 healthcare 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 healthcare 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 healthcare settings.
Strategy 11: Ensure that national healthcare delivery surveys include questions about physical activity assessment and counseling in healthcare settings.
Strategy 12: Conduct surveillance of physical activity levels in the healthcare workforce and related training programs.
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 measures 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.
Strategy 16: Obtain longitudinal support and funding for the Workplace Health in America Survey.
Strategy 17: Prioritize a set of constructs and corresponding survey items to assess perception of com-munity 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.
Time to rally the troops
Across the four areas outlined above, each strategy is supported by one or more action steps with key stakeholders that could help implement these actions. The American Heart Association is among the many actors named in the report. We’re honored to play a role, and we invite additional stakeholders – whether called out in the report or not – to rally with us to fill the critical public health need for physical activity surveillance.
Dr. Whitsel served as a member of the NASEM Committee on Strategies for Implementing Physical Activity Surveillance.