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Dr. Koop Issues Action Plan to Implement the Surgeon General’s Report on Physical Activity and Health

Washington, DC; July 11, 1996 -- With mounting evidence that physical activity reduces the risk of premature death from obesity and other diseases, Dr. C. Everett Koop, the former U.S. Surgeon General, today issued a 10-step "action plan" for the nation that is intended to put the findings of the new Surgeon General’s Report on Physical Activity and Health into practice for all Americans.

"We’re at a crossroads when it comes to promoting physical activity in this country," said Dr. Koop. "Americans may talk about wanting to be more active, but they are not putting that concern into action."

According to new survey research conducted for Dr. Koop’s anti-obesity campaign, Shape Up America!, what is keeping Americans from taking action is an outdated belief that physical activity has to be rigorous and requires a significant time commitment to be effective. At the same time, research commissioned by Shape Up America! finds that Americans are thwarted from becoming more active because of cost issues and lack of access to facilities on the job, at school, and in the community.

"Today, the biggest challenge isn’t convincing Americans about the benefits of exercise. It’s eliminating the barriers that are keeping people from incorporating more activity into their everyday lives. With what we now know about the health benefits of exercise, policy makers must view eliminating the obstacles to physical activity as a national imperative," Dr. Koop said.

Accordingly, Shape Up America!, in consultation with leading authorities in physical activity and public health, has issued an action plan identifying specific steps that can be taken by school boards, community leaders, health care providers, and the business community to implement the major conclusions of the Surgeon General’s report. Specifically, the plan calls for:

  1. Making physical activity accessible in the workplace -- Just as American industry has been instrumental in providing incentives for American workers to stop smoking, the business community should be on the front lines in encouraging employees to be more physically active. Specific actions that employers should take are offering an onsite fitness facility for employees, installing showers, paying for memberships in gyms or health clubs, promoting walking clubs and worker recreational activities, and providing information about physical activity on a regular basis.
  2. Mobilizing the nation’s physicians to promote physical activity -- Although most primary care providers report counseling their patients on behavioral changes, such as quitting smoking, few systematic attempts have been made to improve the physical activity counseling skills of physicians. To change this situation and truly enlist the nation’s physicians in becoming educators will require the commitment of professional societies and medical schools in raising the issue in journals and conducting medical education seminars. At the same time, physicians should be encouraged to counsel at-risk individuals about physical activity regimens with potential for being reimbursed for this prevention counseling. This can be an especially useful intervention for those patients whose diseases are especially linked to inactivity: heart disease, diabetes, and colon cancer.
  3. Providing incentives for physical activity efforts -- An important way to motivate Americans to become more physically active is to provide economic payoffs, like lower health insurance premiums or other incentives. Accordingly, insurers should be encouraged to support the actions of adults who attend health clubs and physical activity programs through reduced premiums. Similarly, the insurance industry, which invests heavily in health promotion programs, should become a major player in educating Americans about the importance of physical activity and providing solutions-oriented information on how to increase activity at home and at work.
  4. Improving the safety of parks, sidewalks and recreational areas -- A recent Shape Up America! survey identified concern about the safety of neighborhoods as a major barrier that is keeping many Americans, and especially lower-income populations, from becoming more physically active. This means a recognition on the part of local government leaders that neighborhood safety must become a priority concern.
  5. Expanding community programs that promote physical activity -- Especially at the community level, Americans must invest in those programs that encourage people of all ages -- from children to senior citizens -- to be more active. This can include afterschool and weekend programs, urban gardening, and increased funding for parks, bike paths, and recreational programs.
  6. Making physical education mandatory in schools -- According to the Centers for Disease Control and Prevention (CDC), enrollment and daily attendance in school physical education classes has been dropping rapidly: in 1995, 60 percent of the U.S. high school students were enrolled in physical education, but only 25 percent attended classes daily. To reverse this trend requires going "back to the basics," with a renewed sense of urgency on the part of parents and school boards to make physical activity an integral part of their children’s lives.
  7. Rethinking school PE and activity programs -- Instead of stressing sports skills, competitive athletics, and elite fitness awards, educators should develop programs that will help children establish exercise behavior patterns that will be maintained into adulthood. Programs should be fun, encourage activity that is intrinsically motivating, and instill confidence by recognizing effort. Further, educators need to redesign the PE curriculum so that children spend more time during class being physically active instead of sitting through lectures and other sedentary activities.
  8. Advocating the passage of legislation to protect schools from litigation -- This "hold harmless" provision should be applied to physical education teachers who conduct classes and/or recreational programs, eliminating the deterrent of potential law suits which has kept many school boards from offering more PE programs.
  9. Providing child care services in community recreation facilities -- A recent survey by Shape Up America! found that regardless of income, child care responsibilities keep parents from getting more physical activity: one in three respondents to the survey said they did not have anyone in the household to watch their children which prevented them from being more active. To remove this barrier, a key strategy would be for community organizations to provide free child care services for parents attending recreational facilities and community-based fitness programs. While there are obviously some costs involved, the result in terms of a healthier community far exceed the dollars spent.
  10. Elevating walking as a national priority -- To reverse the tide towards a sedentary lifestyle, public health leaders are promoting walking as an easy way to increase activity levels, recognizing that high-intensity activity and greater perceived exertion during exercise are major barriers that are preventing people from adhering to physical activity programs. This new emphasis on walking is based on the recognition that this activity is perceived by Americans as being simple, convenient, low cost, sociable, and not leading to physical injury. Further, walking provides the same benefits as more high-intensity activity such as sustained caloric expenditure, weight bearing effects, and the use of the large muscle groups.

Towards this end, Shape Up America! is using the timing of the Surgeon General’s report to announce a national walking campaign that will be implemented in communities all across the country. In cooperation with Take Off Pounds Sensibly (TOPS), an international nonprofit support group with 300,000 members worldwide, Shape Up America! will be promoting local walking clubs through TOPS’ 12,000 local chapters and through other community-based organizations.

To launch the national walking campaign, TOPS and Shape Up America! will host a Washington kickoff event involving Administration and Congressional leaders in a walk around Washington, DC. Scheduled for July 12 during the TOPS annual convention, the walk will involve as many as 3,000 TOPS members from every state and all provinces of Canada. The walking campaign then will be rolled out nationally in the spring of 1997.

According to Barbara J. Moore, Ph.D., President of Shape Up America! "A regular program of walking is an important investment in better health that everyone can afford. Even if that’s all a person can do, regular brisk walking increases energy expenditure, improves muscle tone, reduces levels of body fat, and reduces the risk of several major health conditions. Simply put, it’s just what the doctor ordered.