Cindy Karra br>
Dr. Koop Issues Action Plan to Implement the Surgeon Generals
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 Generals Report on Physical
Activity and Health into practice for all Americans.
"Were 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. Koops 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Shape Up America!, what is keeping Americans from taking action is an outdated belief that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 isnt convincing Americans about the benefits
of exercise. Its 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 Generals report.
Specifically, the plan calls for:
- 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.
- Mobilizing the nations 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 nations 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
- 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.
- 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.
- 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.
- 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 childrens lives.
- 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.
- 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.
- 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.
- 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 Generals
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
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 thats 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, its just what the doctor ordered.