Brief Interventions for Physical Activity

Introduction

Regular physical activity is associated with enhanced health and reduced risk of all-cause mortality. Beyond the effects on mortality, physical activity has many health benefits, including reduced risk of cardiovascular disease, ischemic stroke,non–insulin-dependent (type 2) diabetes, colon cancers, osteoporosis, depression, and fall-related injuries. Despite the benefits of regular physical activity, only 25% of adults in the United States report engaging in the recommended amounts of physical activity (i.e., 30 minutes of moderate-intensity activity on 5 or more days per week, or 20 minutes of vigorous-intensity activity on 3 or more days per week); 29% report no leisure-time regular physical activity; and only 27% of students (grades 9 through 12) engage in moderate-intensity physical activity (30 minutes, 5 or more days per week). According to Healthy People 2010, physical activity is ranked as a leading health indicator. The Physical Activity objectives for Healthy People 2020  has developed goals to improve health fitness and quality of life through daily physical activity.

Recommendations to increase physical activity have been made for individuals and clinical settings but not for community settings. Increased physical activity has been linked not only to behavioral and social correlates but also to physical and social environmental correlates. Therefore, the role of community-based interventions to promote physical activity has emerged as a critical piece of an overall strategy to increase physical activity behaviors among the people of the United States

Physical activity levels are positively affected by:

• Individual behavior around active living.

• Structural environments, such as the availability of sidewalks, bike lanes, trails, and parks.
• Legislative policies that improve access to facilities that support physical activity.

Strategies to Increase Physical Activity:

Informational Approaches to Increasing Physical Activity: by providing information necessary to motivate and enable people to change their behavior, as well as to maintain that change over time. The interventions use primarily educational approaches to present both general health information, including information about cardiovascular disease prevention and risk reduction, as well as specific information about physical activity and exercise. The focus is mainly on the cognitive skills thought to precede behavior. The provision of information is intended to change knowledge about the benefits of physical activity, increase awareness of opportunities within a community for increasing physical activity, explain methods for overcoming barriers and negative attitudes about physical activity, and increase participation in community-based activities.

Interventions reviewed here are:

(1) “point-of-decision” prompts are the signs placed by elevators and escalators to encourage the use of stairs for health benefits.

Signs paced by elevator

(2) community-wide education campaigns and mass media campaigns: intervention approaches are used to increasing physical activity. Campaign messages are directed to large and relatively undifferentiated audiences through diverse media, including television, radio, newspaper columns and inserts, direct mailings, billboards, advertisements in transit outlets, and trailers in movie theaters.

(3) classroom-based health education focused on information provision and skills related to decision making. Health education classes, taught in elementary, middle, or high schools, are designed to effect behavior change through personal and behavioral factors that provide students with the skills they need for rational decision making.

A systematic review and meta-analysis of the effect of mass media campaigns on physical activity in adults indicated that mass media campaigns may promote walking, but may not reduce sedentary behavior or lead to achieving sufficient physical activity. Further research is required to examine the effect of mass media campaigns on other measures and types of physical activity.

Behavioral and Social Approaches to Increasing Physical Activity: focus on teaching widely applicable behavioral management skills and structuring the social environment to provide support for people trying to initiate or maintain behavior change. Interventions often involve individual or group behavioral counseling and typically include the friends or family members that constitute an individual’s social environment.Interventions also involve making changes in the home, family, school, and work environments.

Skills focus on a)recognizing cues and opportunities for physical activity,b) ways to manage high-risk situations, and c) ways to maintain behavior and prevent relapse.

Interventions are:

(1) school-based physical education (PE): This can be done in a variety of ways, including:

• adding new or additional PE classes,
• lengthening existing PE classes, or
• increasing moderate to vigorous physical activity (MVPA) of students during PE class without necessarily lengthening class time. For examples include changing the activities taught (e.g., substituting soccer for softball) or modifying the rules of the game so that students are more active (e.g., having the entire team run the bases together if the batter makes a hit).

Research suggests there is strong evidence that school-based PE is effective in increasing levels of physical activity and improving physical fitness.

(2) college-based health education and PE: use didactic and behavioral education efforts to increase physical activity levels among college student. The aim is to set long-term behavioral patterns during the transition to adulthood. It includes supervised physical activity in the class. A study in Research quarterly and Exercise and sports concluded that students graduating from colleges with higher Physical Education Activity requirements demonstrated more positive exercise attitudes and behaviors

(3) classroom-based health education focused on reducing television viewing and video game playing,

(4) family-based social support interventions: The entire family may be helpful in determining how to best promote behavior change among all its members. Many disease risk factors (behavioral and physiologic) aggregate within families and family is a major source of influence for children in the modeling of health behaviors and is, therefore, an appropriate target for intervention. Moreover, a supportive social environment has been shown to increase maintenance of behavior change. Programs typically include joint or separate educational sessions on health, goal-setting, problem-solving, or family behavioral management and will often incorporate some physical activities. Interventions in this category targeted to children and their families are often implemented as part of a larger strategy that includes other school-based interventions, such as school-based PE or classroom-based health education. Obesity-related intervention programs can use parental involvement as one key to success in developing an environment that fosters healthy eating and physical activity among children and adolescents. Lindsay et al writes "Parents play a critical role at home preventing childhood obesity, with their role changing at different stages of their child's development. By better understanding, their own role in influencing their child's dietary practices, physical activity, sedentary behaviors, and ultimately weight status, parents can learn how to create a healthful nutrition environment in their home, provide opportunities for physical activity, discourage sedentary behaviors such as TV viewing, and serve as role models themselves".

(5) social support interventions in community settings: These interventions focus on changing physical activity behavior through building, strengthening, and maintaining social networks that provide supportive relationships for behavior change. This change can be achieved either by creating new social networks or working within pre-existing networks in a social setting outside the family, such as the workplace, The worksite wellness program also has potential to increase employees’ productivity, reduce absenteeism, and increase morale. For example, setting up a “buddy” system, making a “contract” with others to achieve specified levels of physical activity, or setting up walking or other groups to provide companionship and support while being physically active.

There is strong evidence that social support interventions in community settings are effective in increasing levels of physical activity, as measured by an increase in the percentage of people engaging in physical activity, energy expenditure, or other measures of physical activity.

(6) Individually-adapted health behavior change programs: are tailored to the individual’s readiness for change, specific interests, and preferences. These programs teach participants specific behavioral skills that enable them to incorporate moderate-intensity physical activity into daily routines. Behaviors may be planned (e.g., a daily scheduled walk) or unplanned (e.g., taking the stairs when the opportunity arises). All programs incorporated the following behavioral approaches: (1) setting goals for physical activity and self-monitoring of progress toward goals, (2) building social support for new behavioral patterns, (3) behavioral reinforcement through self-reward and positive self talk, (4) structured problem-solving geared to maintenance of the behavior change, and (5) prevention of relapse into sedentary behaviors. All of the interventions evaluated were delivered to people either in group settings or by mail, telephone, or directed media. Studies suggest a strong correlation between the use of such behavior change programs and the improvement in levels of physical activity,

https://youtu.be/ZJIi-8IWpSY

Environmental and Policy Approaches to Increasing Physical Activity: are designed to provide environmental opportunities, support, and cues to help people develop healthier behaviors.The goal is to increase physical activity through changing social networks, organizational norms and policies, the physical environment, resources and facilities, and laws.

Creating or modifying environments to make it easier for people to walk or bike is a strategy that not only helps increase physical activity, but can make our communities better places to live. Communities designed to support physical activity are often called active communities. The Guide to Community Preventive Services recommends strategies to increase physical activity that are related to walkability—community-scale urban design, street-scale urban design, and improving access to places for physical activity (including providing maps and descriptive information).

The creation of healthful physical and organizational environments includes:

• providing access to weight and aerobic fitness equipment in fitness centers or community centers

• proximity and density of places,such as parks and play grounds for physical activity within neighborhoods

• creating walking trails, safety lighting, and managing air pollution

All of the above mentioned factors affect physical activity levels, regardless of individual motivation and knowledge.

https://www.cdc.gov/physicalactivity/downloads/national-health-interview-survey-2015-508.pdf

The implementation of these strategies will require hard work and widespread policy change which would lead to longer-lasting lifestyle changes, that ultimately will prevent preventable disease, lower health care costs, and save lives. To accomplish the goal of achieving high rates of physical activity, physicians, physiotherapists physiologists, behavior medicine specialists, sociologists, recreation specialists, architects, city planners and engineers should work together in order to engage schools, worksites, religious institutions, and communities thus creating opportunities to promote physical activity.

Referencesy,

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