Author: Ginny Frederick

The webinar “Streets as Places: An LQC Approach to Making Streets Vibrant and Active” focused on the new concept of Lighter, Quicker, Cheaper (LQC) interventions to change the built environment to promote physical activity. These interventions are based on the idea of placemaking, or creating public spaces where people want to be. In the U.S., historically we have not done a great job of making these kinds of spaces. The idea behind placemaking is that people will often spend more time in a place that offers them things to do, comfortable places to sit or do other activities, and that provide a sense of community. These characteristics also help to improve the built environment for physical activity in such spaces. LQC interventions are currently being used across the country for their placemaking abilities.

As previously mentioned, LQC interventions are not necessarily permanent changes to an environment, but rather a temporary change that allows the community to see the potential in its public spaces. These interventions can be extremely simple in nature such as marking a bike lane with decorative cones, making parklets, reducing street crossing distances using paint, and creating hay bale roundabouts. In general, a public space lends itself to an LQC intervention if there are 10 things to do, such as: sit and relax, read a book, take a walk, window shop, ride a bike, etc. By implementing “light” changes such as adding benches or greenery, slowing vehicle speeds, and adding temporary crosswalks or bike lanes, people begin to see the street as a place to gather and spend time together, rather than just a road for automobiles. In the grand scheme of placemaking, these LQC experiments act as part of a greater feedback loop which allows for reactions from the community to improve upon the existing environment.

Cathy Costakis of Montana State University is an expert in working to improve physical activity and the built environment in rural communities. She explains that while many people think it is difficult to increase physical activity in rural areas, the small nature of the towns is ideal for promoting walking and bicycling. While there are some challenges such as reduced capacity, cultural norms of using automobiles, and reduced funding, the opportunities for change in these communities are large given the strong leadership and close-knit nature of such places. For the past 5 years, Montana’s Building Active Communities Initiative has provided training and a guided action institute for communities who want to learn more about improving the built environment to promote physical activity. In it’s most recent version, the Institute has focused on increasing community involvement and engagement through the use of LQC interventions. These interventions have taken off in many communities in the form of temporary crosswalks, pop-up bike lanes, parklets, and a bike to school day.

LQC interventions are an extremely effective way to begin improving the built environment to support physical activity. These experiments allow communities to re-imagine their streets as places for people, not just cars.

Dr. Katrina Piercy from the Department of Health and Human Services (HHS) recently delivered a webinar titled “Developing the Second Edition of the Physical Activity Guidelines for Americans.” The purpose of the webinar was to provide an explanation of the development of the upcoming federal physical activity recommendations.

Dr. Piercy began by describing the events leading up to the start of the Second Edition of the Physical Activity Guidelines for Americans. The first edition, released in 2008, was the first time the federal government put out physical activity guidelines. These recommendations focused on the amount of activity necessary for overall health benefits for people over age 6. The guidelines state that adults should aim to get the equivalent of 150 minutes of moderate-intensity aerobic activity per week and perform muscle-strengthening exercises for each major muscle group on two days per week. It is recommended that children accumulate 60 minutes per day of aerobic, muscle-, and bone-strengthening activity. Currently only 20% of adults and adolescents meet the respective aerobic and muscle-strengthening guidelines.

After discussing the current recommendations, Dr. Piercy continued with an explanation of events leading to the updated guidelines that will be released in 2018. Since the release of the previous recommendations, the field of research regarding physical activity and health has grown exponentially with many previous gaps having been identified and addressed. In addition, several key documents supporting physical activity have been released such as the Surgeon General’s Call to Action to Promote Walking and Walkable Communities and the updated National Physical Activity Plan.

On the heels of these developments, the official process of updating the guidelines began with the chartering of the Physical Activity Guidelines Advisory Committee. This group of subject matter experts was selected through a nomination process to provide guidance to the federal government. The committee has since participated in several public meetings to discuss the process of developing the new guidelines. Their charge is to revisit the 2008 Guidelines and determine what is consistent with current literature, what needs to be updated, and what areas still need to be addressed. The committee was then divided into subgroups to examine the following topics specifically:

• Aging
• Brain health
• Cancer
• Cardiometabolic health & weight management
• Exposure
• Individuals with chronic conditions
• Promotion of physical activity
• Sedentary behavior
• Youth

From there, an extensive literature review was conducted, and the committees continued to hold meetings to provide updates on their findings. The final product of this process will be the Advisory Committee Report which will provide independent evidence and recommendations based on the current evidence. This document will be used by federal staff at HHS to develop policy documents, or the actual guidelines. The final step in the process is having the new guidelines reflected in federal initiatives and resources such as funding announcements.

Overall this webinar provided great insight into what can be a very complicated process to try to understand.

The webinar “Activity Advocates: NCPPA” was hosted by the National Physical Activity Society in partnership with the National Coalition for Promoting Physical Activity (NCPPA) and is a bit different than many of their other webinars. While usually focusing on small policy changes to promote physical activity in our communities and worksites, this particular webinar was focused on federal policies that will impact physical activity at the national level.

The NCPPA is a group consisting of different associations, healthcare organizations, and private corporations that advocates for policies promoting physical activity. Currently, NCPPA is focusing on federal policies that are statutory and regulatory. To support such policies, members of NCPPA act as advocates in Washington. Representatives meet with members of Congress and other regulatory and federal partners, attend or lead legislative briefings about physical activity policy, and participate in lobbying efforts. The goal of the coalition is to keep members and partners informed of the work being done on physical activity policy at the federal level and advocate for key legislation regarding physical activity. In this way the coalition acts as a convener to help coordinate efforts across multiple groups.

The webinar focused on several key issues the NCPPA is currently engaged in. The first effort is related to physical education in schools. Recently, the Every Student Succeeds Act (ESSA) was passed, which replaced the former No Child Left Behind Act. Under ESSA, physical education is designated as part of a well-rounded curriculum. This is vastly different than previous legislation which focused on devoting more time to “core subjects” such as math and science, often at the expense of PE. This policy will also make PE available for funding through the Title I mechanism which is aimed at providing resources for schools with economically disadvantaged students. NCPPA’s second initiative is related to the CDC’s newest framework, Active People, Healthy Nation. This framework aims to unify the different aspects of work being done at CDC to promote physical activity (surveillance of physical activity levels, media campaigns to promote the benefits of activity, etc). As part of this initiative, NCPPA will be the leading body advocating for funding to reach the goal of saving lives and protecting health by helping 25 million Americans become more physically active.

The final major initiative being led by NCPPA is the Personal Health Investment Today (PHIT) Act. This policy would expand the IRS tax-related definition of “medical expenses” to include “qualified sports and fitness expenses.” This would mean that individuals could use pre-tax funds, such as those in a health savings account, to pay for gym memberships, youth sport fees, and other costs related to participating in physical activity. Personally, I was extremely excited to hear this and think it will be a great tool in promoting physical activity.

In summary, the NCPPA plays a vital role in advocating for federal policies that promote physical activity in all sectors of society. Their achievements to date indicate that the future for physical activity on Capitol Hill is bright!

“Workplace Wellness: Walk this Way” was hosted by experts from ChageLab Solutions, a group who works to develop innovative policies to achieve healthier communities. The webinar focused on ChangeLab’s newest resource Walk This Way which seeks to promote policies to increase physical activity in and around workplaces in hopes of helping more Americans meet the Physical Activity Guidelines. The guide is provided as a resource to wellness promoters who may be working with communities, or as a champion for their workplace.

The first few policies discussed are focused on increasing physical activity in the workplace itself. Benefits of physical activity in the workplace are numerous and include improved employee health, greater productivity, and decreased healthcare costs. One of the most interesting policies was giving paid time for physical activity. This type of policy encourages employees to be active during the workday by including it as part of their paid time. Employees don’t have to “clock out” or add extra time at the end of the day to make up for time spent exercising. While it is effective, this policy may be difficult to implement given the amount of buy-in needed from leadership. In addition to paid time for activity, another interesting policy was a workplace wellness tax credit. Under this policy, private employers who develop, adopt, and implement workplace wellness policies are provided monetary incentives. This strategy is often used to promote workplace wellness programs in small businesses, who are less likely to have such programs. Again, because these policies require buy-in at higher levels, such as local government, they may be somewhat difficult to implement.

The second part of the webinar focused on policies to increase physical activity around workplaces. For most people, commuting to work involves sitting in a single-occupant vehicle for 30 minutes to an hour each way. However, if we work to improve the infrastructure of communities around our homes and workplaces, more people would have the opportunity to include active transportation as part of their commute. The Walk This Way guide focuses on four different strategies to improve the infrastructure and systems related to active commuting. One policy, complete streets, involves re-thinking the design of our streets, which typically cater to automobiles, to include safe and accessible transportation options for pedestrians and cyclists. Using this strategy, streets are re-designed to include features such as bike lanes, parking lanes, sidewalks, and median islands, which make it easier and safer for people to walk and bike.

Overall, Walk This Way provides excellent recommendations for anyone looking to improve access and opportunities for physical activity. These days, many people spend a majority of their time at or around their workplace. Using strategies like those described in this resource will allow us help people incorporate physical activity into their workday, which may be more effective than trying to increase physical activity during leisure time. As resources like this continue to become available, physical activity promoters have even more tools at their disposal to help people lead more active lifestyles.

In her lecture ‘Using Activity Trackers in Research Studies’ Dr. Kelly Evenson discussed the brief history of tracking devices in physical activity studies and the potential of these devices to aid in public health surveillance of physical activity.

Personal activity trackers are a relatively new phenomenon, gaining much popularity with brands like Nike and Garmin offering commercial products for individuals to keep track of their health behaviors. There are currently over 400 activity trackers on the market and devices like Fitbit have been used to track physical activity in over 140 research studies worldwide. The advantages of using such devices in research studies include the fact that they are low-cost, passive, and low-burden ways to assess physical activity levels.

In order to be confident in the results gained from studies using activity trackers, we must first assess their reliability and validity. Dr. Evenson and her research team completed a systematic review on the topic to determine the reliability and validity of these devices in five specific measures: steps, distance, physical activity, energy expenditure, and sleep. The results of this work indicated that trackers are relatively accurate at capturing the number of steps taken, but less accurate at estimating energy expenditure and sleep. In addition, the authors indicate that more studies are needed in order to determine the validity of trackers to provide accurate information on distance and overall physical activity. Luckily, Dr. Evenson shared that since this review was undertaken, there have been a multitude of new studies using these devices so her group is beginning to plan another review of the literature to assess these topics and update their conclusions.

With the popularity of these devices and the increasing amount of research being conducted on their accuracy, it is only logical to wonder if activity trackers could have a role in public health surveillance of physical activity on a national level. Currently, physical activity at this level is assessed by survey and sometimes accelerometry in nationwide surveillance systems. Dr. Evenson and her colleagues performed a study to assess the agreement between Fitbit data and that from the Behavioral Risk Factor Surveillance System and unfortunately at this time, there was no correlation between the two.

In closing her discussion, Dr. Evenson mentioned a few pieces of advice for different audiences regarding use of activity trackers. For individuals, she recommends making sure to wear the device in the same position every day, enter and update personal characteristics (i.e. height, weight, and age), and make sure the device is set to receive updates so its algorithms remain accurate. For researchers, Dr. Evenson urged more studies focused on assessing reliability and validity of these instruments and making sure that they are tested for such in both free-living and lab-based conditions. Finally, she recommends that device manufacturers publicize information about updates to their software (apps), allow users to have access to data in smaller time intervals, and that they establish standards for rigor in what they measure.

In the seminar ‘Snacking among Children: Essential or Excessive?’ Dr. Jennifer Fisher shared her research on snacking among children and the factors that influence this behavior. She explained that snacking has been increasing among children since the 1970’s and is now accounting for a substantial portion of their daily energy intake. While the prevailing wisdom in this field is that snacking is healthy, even essential for children in order to meet energy demands of growth and development, Dr. Fisher’s research indicates the need for a better understanding of this behavior before we deem it such.   

Dr. Fisher’s research focuses on factors that interact to influence snacking; parenting, the child’s appetite, food and nutrient intakes, and obesity. While she discussed each factor briefly, her research on parenting was most fascinating. In this area, Dr. Fisher seeks to understand parental definitions, goals, and practices related to snacking. Her findings indicate that the definition of snacking is extremely variable and is dependent on factors such as time of day, type of food being offered, and context in which the food is given. Some of her research shows that parents think of ‘snacks’ and ‘meals’ as distinct with ‘snacks’ being foods that require less preparation, offer less nutritional value and balance. Conversely, parents perceived ‘meals’ as time for making memories and connecting with their child.

According to the research, parents also cite a variety of reasons for offering snacks to their children that range from providing nourishment to using snacks as a reward for good behavior or incentive to change bad behavior. One of Dr. Fisher’s more recent studies indicated that the nutritional value of the snack depended on the reason it was being offered. For example, when parents offered a snack for reasons other than providing nutrition for their child, such as to control bad behavior, that snack tended to contain more solid fats and added sugars than a snack that was given because the child was hungry.

Although most of Dr. Fisher’s research is cross-sectional, the relationships between factors related to snacking and the possible health implications are evident. Her findings demonstrate the need for reevaluation of public health guidelines that promote snacking for young children. Improved guidelines may do more to inform parents of the role snacks play in a child’s overall diet, appropriate purposes for offering snacks and how to choose snacks based on nutritional quality. Further, before we can recommend snacking as a public health practice for children, we need much more information on the various factors that impact this behavior.

Until the research on this subject advances, practitioners should do their best to continue educating parents on appropriate foods to offer children both during meals and as snacks. It is also important to promote strategies that help parents understand the role of snacks as part of their child’s overall diet and nutrient intake. Developing one-pagers or brochures on these topics might a way to provide this information to parents, patients and consumers in an easily accessible manner.