How active are Georgians? : Georgia physical activity report / [S.K. Bricker ... [et al.]

How Active are Georgians?

Georgia
Ph y s i c a l Ac t i v i t y Report

Georgia Department of Human Resources 2001 Report on Physical Activity

TABLE OF
C o n t e n t s
CHAPTER 1: About Physical Activity.......................................................................................................................3 CHAPTER 2: How Active are Adult Georgians?........................................................................................................6 CHAPTER 3: Burden of Inactivity/Benefit of Activity.............................................................................................11 CHAPTER 4: New Strategies for Promoting Physical Activity.................................................................................14 CHAPTER 5: Examples & Resources for Promoting Physical Activity in Georgia...................................................19 APPENDIX
I. Physical activity-related objectives from Healthy People 2010 and current status of objectives in Georgia............26 II. Percent of adults (18+ years) by activity category and county, Georgia 1994, 1996, 1998, 1999 combined............28 III. Percent of adults (18+ years) by activity category and demographic groups, Georgia 1999...............................30 IV. Details about the Behavioral Risk Factor Surveillance System (BRFSS)...............................................................31 V. Details about estimating the burden of inactivity and the benefits of activity................................................33
GLOSSARY...................................................................................................................................35
ACKNOWLEDGEMENTS
American Heart Association, Southeast Affiliate....................................................Nettie Jackson, Advocacy Manager-Georgia American Heart Association,Communications Department, Southeast Affiliate...................John Smiles, Communications Director Georgia Department of Human Resources...................................................................Gary B. Redding, Acting Commissioner Division of Public Health...................................................................................Kathleen E. Toomey, M.D., M.P.H.,Director
Chronic Disease Prevention and Health Promotion Branch.........................James H. Brannon Jr., M.S., M.Ed., Director Health Promotion Section..............................................................................Pam Eidson, M.Ed., Director Cardiovascular Disease Prevention Initiative...............................Pam Wilson, Program Administrator
Epidemiology Branch.....................................................................................Paul A. Blake, M.D., M.P.H., Director Chronic Disease, Injury, and Environmental Epidemiology Section............Kenneth E. Powell, M.D., M.P.H., Director
Suggested Citation Bricker SK, Powell KE, Parashar U, Rowe AK, Troy KG, Seim KM, Eidson PL, Wilson PS, Pilgrim VC, Smith EM. Physical Activity Report, Georgia, 2001. Georgia Department of Human Resources, Division of Public Health and the American Heart Association, Southeast Affiliate, September, 2001. Publication Number: DPH01.81HW
1

HIGHLIGHTS
Regular physical activity reduces the risk of heart disease, high blood pressure, stroke, colon cancer, diabetes, falls and fractures.
The currently recommended amount of physical activity for good health is 30 minutes of moderate intensity physical activity on at least five, and preferably all days of the week. The recommended 30 minutes can be done in 10-minute segments.
Only one in four (24%) adult Georgians is regularly active.
One in four (27%) adult Georgians is sedentary (no non-occupational physical activity).
The proportion of adults who report being regularly active decreases with age, and increases with higher levels of education and income.
Walking is the most commonly reported activity.
Activity levels have declined over the past fifteen years.
Insufficient physical activity was responsible for: - 5,543 deaths - 29,844 hospitalizations - $477 million in hospital charges
Because some Georgians are physically active: - 6,107 deaths did not occur - 33,729 hospitalizations did not occur - $538 million in hospital charges were not incurred.
Methods to promote physical activity need to be expanded to include environmental and policy supports.
Environmental features and organizational policies designed to promote regular physical activity can occur in worksites, schools, healthcare settings and in other places.
A special thanks and acknowledgement to the:
South Carolina Department of Health and Environmental Control and the Prevention Research Center at the University of South Carolina School of Public Health for providing the report, "Good Health: It's Your Move Physical Activity in South Carolina" from which much of this report was adapted.
2

About Physical Activity

Within the past several years the health benefits of regular physical activity have been affirmed and summarized in reports from governmental and non-governmental organizations. The Surgeon General of

physical activity. Although the wording in the recommendations varies by organization, they all suggest that individuals accumulate at least 30 minutes of moderately intense physical activity on at least five, and preferably all, days of the week.

the United States1, the National Institutes of Health (NIH)2, the

Regular physical activity reduces the risk and negative impact of:

Centers for Disease Control and Prevention (CDC)3, the American

Heart disease High blood pressure

College of Sports

Stroke

Medicine3, and the

Colon Cancer

American Heart Association4 have concluded that regular physi-

Diabetes Falls and Fractures

cal activity is associated

Regular physical activity helps with:

with important health benefits and a higher quality of life in general.

Maintaining proper body weight Controlling osteoar thritis

These benefits include

Reducing symptoms of depression and anxiety

reduced rates of heart disease, high blood pressure,

Enhancing quality of life

diabetes, osteoporosis, colon cancer, anxiety, and decreases in the severity

minute walk after lunch.

T E N - M I N U T E
S E S S I O N S
The recommended 30 minutes of physical activity does not need to take place all at once. It may be more feasible to break up the 30 minutes into 3 ten-minute sessions throughout the day. Some examples of ten-minute sessions include parking your car farther rather than closer to your destination, getting off public transportation a few stops early, and taking a ten-

of depressive symptoms. Physical activity also helps people maintain healthy body weight, aids in the

EVERY INCREASE HELPS

management of osteoarthritis, reduces the risk of falls The benefits of physical activity vary depending on

and fractures, and enhances quality of life.

the frequency and duration of physical activity. The

In addition to confirming and delineating the health benefits of physical activity, these governmental and non-governmental reports contain three important messages. First, the regularity of activity is more important than the intensity. Second, activity need not be limited to special exercise sessions but can be woven into the fabric of routine activities. Third, inactive individuals improve their health by becom-

current recommendation of 30 minutes of moderateintensity physical activity at least five days a week is not a rigid threshold. For people who are already meeting this goal, adding more time or increasing the intensity of the activity will bring added benefit. For less active people, a little more physical activity improves their health and quality of life even if they do not fully achieve the recommended goal.

ing more physically active even if they do not reach the recommended levels.

PHYSICAL ACTIVITY, EXERCISE, AND PHYSICAL FITNESS

R E G U L A R I T Y
Regular physical activity at a moderate level, such as a brisk walk or raking the lawn, improves physical health. To achieve this benefit, regularity is more important than the intensity or strenuousness of the

In everyday speech, physical activity, exercise, and physical fitness are commonly used interchangeably. However, there are important differences in the meanings of these terms.5 Physical activity is any bodily movement produced by skeletal muscles that results in energy expenditure. The purpose of the

4

movement may be related to occupation, household chores, transportation, sports, hobbies, or any other pursuit. Exercise is the part of physical activity that is planned, structured, repetitive, and is usually done to improve or maintain fitness. Physical fitness is a set of attributes or skills that describes a person's ability to perform and sustain physical activity, such as cardiovascular endurance, flexibility, and strength. Physical fitness is dependent upon both heredity and behavior. Genetic endowment cannot be changed, but physical activity behaviors, on the other hand, can be changed.
HEALTHY PEOPLE 2010
Healthy People 2010 (HP 2010) is a document published by the US Department of Health and Human Services. The document contains goals and objectives to guide the efforts of health workers over the next decade. This report provides information about Georgia's status in accomplishing many of the Healthy People 2010 objectives related to physical activity and fitness. At this point, Georgia has collected and analyzed data pertaining to six of HP 2010's fifteen physical activity related objectives. Information will be presented on the proportions of adults engaging in no leisure time physical activity (objective 221), in regular physical activity (objective 22-2), and vigorous physical activity (objective 22-3). Information on the proportion of adults performing activities which enhance muscle strength (objective 22-4), the proportion of schools that require daily physical education (objective 22-8), and proportion of children who walk to school (objective 22-14b) will also be provided. (For a complete list of the physical activity related objectives, see Appendix I)
PURPOSE OF THIS REPORT
This report includes information about the physical activity patterns of Georgians, the costs of inactivity, and suggestions for future actions.

Chapter 2 describes current patterns of physical activity in Georgia, including the prevalence of regular physical activity, changes over time, differences between counties, and differences between groups of people based on their age, race, sex, and other characteristics. Chapter 3 estimates the cost in lives, hospitalizations, and hospital charges due to inactivity. In addition, it also estimates the savings in lives, hospitalizations, and hospital charges incurred by Georgians who are physically active. Chapter 4 suggests strategies to make it easier for people to be physically active. Chapter 5 describes projects and programs that have made progress in promoting and facilitating physical activity in Georgia, and that provide resourceful information and assistance.
References for this chapter
1U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
2NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. (1996) Physical Activity and Cardiovascular Health. JAMA 1 9 9 6 ; 2 7 6 : 2 4 1 - 2 4 6 .
3Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GS, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407.
4Blair SN, Powell KE, Bazzarre RL, Early JL, Epstein LH, Green LW, Harris SS, Haskell WL, King AC, Koplan JP, et al. Physical inactivity. Workshop V. AHA Prevention Conference III. Behavior change and compliance: keys to improving cardiovascular health. Circulation 1993;88:1402-1405.
5Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health related research. Public Health Reports 1985;100:126-131.

5

How Active are Adult Georgians?

AMONG ADULTS IN GEORGIA:
Nearly one in four (24%) is regularly active Just less than half (49%) are irregularly active Approximately one-fourth (27%) are inactive Those living in southwest Georgia are more likely
to be regularly active than those living elsewhere in the state Women and men are equally likely to be regularly active People 65 years of age and older are the least likely to be regularly active The proportion of adults who report that they are regularly active increases with increasing levels of education and income Walking is the most commonly reported activity Activity levels have declined over the past 15 years
STUDY DESIGN
The results presented in this report are based on data from the Georgia Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS collects information regarding health-related behaviors such as smoking, diet, and physical activity through a telephone survey of a representative sample of the state's civilian, noninstitutionalized adult population more than 17 years of age. Georgia has conducted the BRFSS every year since 19841. Telephone interviews are conducted
Tab le 2-1 Classification of activity lev els
REGULARLY ACTIVE
5 or more days a week for a total time of 150 minutes or more (see Healthy People 2010, recommendation 22-2)
o r 3 or more days a week of vigorous activity for
20 minutes or more each session (see Healthy People 2010, recommendation 22-3).
IRREGULARLY ACTIVE
Persons who report some moderate or vigorous activity, but are not regularly active.
I N AC T I V E
Persons who report no non-occupational physical activity in the past 30 days (see Healthy People 2010, recommendation 22-1).

throughout the year during both the daytime and evening hours. In 1999 a total of 2273 adults in Georgia were interviewed.
The BRFSS physical activity questions focus on nonoccupational activities such as sports, conditioning, and recreational pursuits (See Appendix IV for more information on the BRFSS). To describe physical activity patterns in Georgia, respondents were classified into three categories (Table 2-1): Regularly active adults include those who either a) were active 5 or more days per week and accumulated 150 minutes or more of moderate physical activity, or b) did 20 minutes or more of vigorous physical activity on 3 or more days per week. Irregularly active adults include those who performed some moderate or vigorous physical activity but do not meet the criteria reported above for regularly active persons. Inactive adults include those who reported no participation in non-occupational physical activity during the past 30 days.
Figur e 2-1 Classification of activity lev els

11% Group 1

Inactive 27%

7% Group 3

Regularly Active 24%

6% Group 2

Irregularly Active 49%

Group 1 (11%) = moderate intensity physical activity for 30 minutes per day at least 5 days per week (HP 2010,objective 22-2)
Group 2 (6%) = vigorous intensity physical activity for 20 minutes per session at least 3 days per week (HP 2010,objective 22-3)
Group 3 (7%) = satisfies criteria for both group 1 and group 2

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Figur e 2-2. Regularl y active adults by county, Georgia, 1994, 1996, 1998, 1999
Percent of Regularly Active Adults
<20% 20.0% - 24.9% 25.0% - 29.9% 30.0% or higher
Source:BRFSS

Table 2-2 Activities reported by Georgians, 1999

AC T I V I T Y

%

Wa l k i n g

3 8

Indoor conditioning activities

1 7

Recreational activities

1 7

J o g g i n g

1 0

Home maintenance activities

6

Team sports

6

Water or snow activities

2

Racquet sports

2

Figur e 2-3. Regularl y active adults by gender , Georgia, 1999
40

30 26 23
20
10

0 Men

Women

Source:BRFSS

Figur e 2-4. Regularl y active adults by race/ethnicity , Georgia, 1999

40

30 24 23
20
10

0 Non-Hispanic Whites
8

Non-Hispanic Blacks

Source: BRFSS

RESULTS
In 1999, 24% of adults in Georgia reported that they were regularly active, 49% reported that they were irregularly active, and 27% reported that they were inactive. Among those who were classified as regularly active, 18% were active 30 minutes a day for five or more days per week, while 13% were vigorously active for 20 or more minutes at a time. (Figure 2-1) [note: 7% of adults contribute to both categories of regular activity]. Georgians who live in the southwest region of the state were more likely to report being active than those living elsewhere (Figure 2-2). The percent of regularly active adults was similar for men and women (Figure 2-3), as well as for persons of different race (Figure 2-4). The proportion of adults who reported being regularly physically active decreased significantly with age (Figure 2-5). At the same time, the proportion of adults who reported regular physical activity increased with increasing levels of education and income. However, these observed increases can be partially explained by the decrease in the average ages of those people who make up the education and income categories. (Figures 2-6 and 2-7). Persons living in urban areas

did not report being regularly active significantly more often than those living in rural areas (Figure 2-8).
Walking was the most popular activity reported by Georgians (Table 2-2). Participation in walking and home maintenance activities increased with increasing age, whereas, participation in jogging and team sports decreased with increasing age (Figure 2-9).
Since 1984, the proportion of adults, in Georgia, who are regularly active has declined, while the proportion who are regularly inactive has increased (Figure 2-10).
References for this chapter
1Siegal PZ, Frazier EL, Mariolis P, Brackbill RM, Smith C. Behavioral risk factor surveillance, 1991: Monitoring progress towards the nation's year 2000 health objectives. CDC Surveillance Summaries. Morbidity and Mortality Weekly Report 1993; 42(No. SS-4):1-21.

Figur e 2-5. Regularl y active adults by age gr oup , Georgia, 1999
40

30

27

27

20

10

24

24

23

19

0

18-24 yrs

25-34 yrs

Source: BRFSS

35-44 yrs

45-54 yrs

55-64 yrs

65+ yrs

Figur e 2-6. Regularl y active adults by years of education, Georgia, 1999

40

31 30
25
22

20

18

10

8

0

<9th grade 9-11 grade

HS grad

Source: BRFSS

Some college

College grad

Figur e 2-7. Regularl y active adults by household income , Georgia, 1999

40

36

30

24 22

20

19

10

0

<$15,000

$15,000-34,999

$35,000-74,999

$75,000+

Source:BRFSS

9

Figur e 2-8. Regularl y active adults by urban/rural r esidence , Georgia, 1999
40

30

25

22

20

10

0 Urban
Source: BRFSS

Rural

Figur e 2-9. P ar ticipation in selected types of activities by age gr oup , Georgia, 1999

60

56

50

46

40 35
30 23
20

10
0 Walking

Source: BRFSS

10 14 5 1
Home Maintenance

18-24 yrs 45-64 yrs
21 11 6 0
Jogging

25-44 yrs 65+ yrs
11 8 2 0
Team Sports

Figur e 2-10. Ph ysical activity practices of adults, Georgia, 1984-1999

60

Inactiv e

50

Average increases in inactivity = 0.9% per year

40

Average increase in inactivity = .9% per year

30

20

10

Regularl y Activ e Average decrease in regular physical activity = 0.2% Average Decrease in regular activity =0.2% per year

0 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

Source:BRFSS

Burden of Inactivity Benefit of Activity

In 1999, in Georgia, lack of regular physical activity caused an estimated:
32% of all cases of heart disease 18% of all cases of high blood
pressure 32% of all cases of stroke 32% of all cases of colon cancer 18% of all cases of diabetes 32% of all cases of osteoporotic
falls with fractures
In 1999, combining the deaths, hospitalizations, and hospital charges for these six medical problems, insufficient physical activity was responsible for an estimated:
5,543 deaths 29,844 hospitalizations $477 million in hospital charges
On the other hand, 24% of Georgians were regularly active and another 49% were irregularly active. Had these persons not been active, this would have resulted in an additional:
6,107 deaths 33,729 hospitalizations $538 million in hospital charges

Physical activity reduces the risk of heart disease, high blood pressure, colon cancer, and non-insulin dependent diabetes mellitus. 1-3 In addition, evidence supporting the beneficial effects of physical activity on certain subtypes of stroke has accumulated in recent years.4,5,6,7 Finally, physical activity also reduces the risk of falls and fractures among the elderly, reduces problems with osteoarthritis and low back pain, and improves the overall quality of life. Methods are available to estimate the burden of physical inactivity and determine approximately how many people died or were hospitalized because of physically inactive and irregularly active lifestyles. Methods are also available to estimate the benefits related to physical activity and determine approximately how many additional people would have died or have been hospitalized if everyone were inactive. The burdens and benefits related to physical activity are represented for six conditions: heart disease, high blood pressure, stroke, colon cancer, non-insulin dependent

diabetes mellitus, and osteoporotic fractures from falls (see Appendix for description of methods used to arrive at these estimates).
The Burdens: Preventable deaths, hospitalizations, and hospital charges
Physically inactive and irregularly active lifestyles result in health and economic burdens that are potentially avoidable if everyone becomes regularly active. This burden resulting from physically inactive and irregularly active lifestyles can be estimated based upon the health risks for inactive lifestyles and the proportion of inactive and irregularly active people in Georgia. These estimates, called the Population Attributable Risk (PAR), provide a useful measure of the burden of lack of regular physical activity on the health of the population. PAR estimates suggest that if all Georgians were regularly active, there would be approximately 32% fewer people with coronary heart disease, 18% fewer people with high blood pressure,

Tab le 3-1. Estimated burdens of inactive and irr

egularl y active lif estyles, Georgia, 1999

Condition
Heart Disease High blood pressure Stroke Colon cancer Diabetes Osteoporotic falls & Fractures TOTAL

PAR
3 2 % 1 8 % 3 2 % 3 2 % 1 8 % 3 2 %

Deaths

Actual Avoidable

1 0 , 5 0 2

3 , 3 6 0

1 , 2 7 0

2 2 8

4 , 2 7 7

1 , 3 6 8

9 7 1

3 1 1

1 , 4 7 2

2 6 5

3 5

1 1

5 , 5 4 3

H o s p i t a l i z a t i o n s

Actual

Avoidable

4 6 , 5 6 6

1 4 , 9 0 1

7 , 6 9 3

1 , 3 8 4

2 3 , 5 1 3

7 , 5 2 4

2 , 3 5 0

7 5 2

1 2 , 6 2 4

2 , 2 7 2

9 , 4 1 2

3 , 0 1 1

2 9 , 8 4 4

Hospital Charges 1 (millions)

Actual Avoidable

$ 8 5 1

$ 2 7 2

$ 7 3

$ 1 3

$ 3 2 5

$ 1 0 4

$ 5 5

$ 1 8

$ 1 2 1

$ 2 2

$ 1 5 0

$ 4 8

$ 4 7 7

PAR = Population Attributable Risk:the percent reduction if all Georgians were regularly active 1 Rounded to the nearest $1 million

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32% fewer people with stroke, 32% fewer people with colon cancer, 18% fewer people with diabetes, and 32% fewer people with osteoporotic falls with fractures.
Based on the PAR for heart disease, hypertension, stroke, colon cancer, diabetes, and osteoporotic falls and fractures, the avoidable deaths, hospitalizations, and hospital charges attributable to inactive and irregularly active lifestyles in 1999 are presented in Table 3-1. If all Georgians became regularly active, there would be an estimated 5,543 fewer deaths, 29,844 fewer hospitalizations, and $477 million fewer hospital charges due to these conditions.

The Benefits: Prevented deaths, hospitalizations, and hospital charges
The additional deaths, hospitalizations, and hospital charges that theoretically would have happened if all Georgians were inactive but were prevented because some persons were either regularly or irregularly active are called the Population Events Prevented (PEP). The PEP is an estimated figure and, like the PAR, is not precise. Nevertheless, it is important to note that some Georgians are in better health because they are physically active, and that these health benefits lead to reductions

in deaths, hospitalizations, and hospital charges.
If all Georgians were inactive, then there would have been approximately 36% more people with coronary heart disease, 21% more people with high blood pressure, 36% more people with stroke, 36% more people with colon cancer, 21% more people with diabetes, and 36% more people with osteoporotic falls with fractures than the number actually observed. For the six conditions combined, an estimated additional 6,107 deaths, 33,729 hospitalizations, and $538 million in hospital charges did not occur (Table 3-2).

Table 3-2. Estimated benefits from regularly active and ir

regularly active lifestyles, Georgia, 1999

Condition
Heart Disease High blood pressure Stroke Colon cancer Diabetes Osteoporotic falls & Fractures TOTAL

PEP
3 6 % 2 1 % 3 6 % 3 6 % 2 1 % 3 6 %

Deaths

Actual Avoided

10,502 3,780

1 , 2 7 0

2 6 7

4,277 1,540

9 7 1

2 0 4

1 , 4 7 2

3 0 9

3 5

7

6 , 1 0 7

H o s p i t a l i z a t i o n s

Actual

Avoided

4 6 , 5 6 6

1 6 , 7 6 4

7 , 6 9 3

1 , 6 1 5

2 3 , 5 1 3

8 , 4 6 5

2 , 3 5 0

8 4 6

1 2 , 6 2 4

2 , 6 5 1

9 , 4 1 2

3 , 3 8 8

3 3 , 7 2 9

Hospital Charg es 1 (millions)

Actual Avoided

$ 8 5 1

$ 3 0 6

$ 7 3

$ 1 5

$ 3 2 5

$ 1 1 7

$ 5 5

$ 2 0

$ 1 2 1

$ 2 6

$ 1 5 0

$ 5 4

$ 5 3 8

PEP = Population Events Prevented:the percent increase if all Georgians were inactive 1 Rounded to the nearest $1 million

References for this chapter
1Blair, SN, Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports and Exerc 1999;31(11Suppl): S646-S662.
2Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS,

Patrick K, Pollock ML, Rippe JM, Sallis J, Wilmore JH. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1 9 9 5 ; 2 7 3 : 4 0 2 - 4 0 7 .
3U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of

Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
4Bronner LL, Kanter DS, Manson JE. Primary Prevention of Stroke. The New England Journal of Medicine 1995; 333(21): 1392-1400.
5Lee IM, Paffenbarger RS. Physical activity and stroke incidence: the Harvard Alumni

Health Study. Stroke 1998; 10: 2 0 4 9 - 2 0 5 4 .
6Sacco RL, Gan RL, BodenAlbala B, Lin IF, Kargman DE, Hauser WA, Shea S, Paik MC. Leisure-time physical activity and ischemic stroke risk: the Northern Manhattan Stroke Study. Stroke 1998; 29(2)380387.
7American Heart Association. 2001 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association; 2000.

13

New Strategies for Promoting Physical Activity

Most physical activity-related health promotion programs teach individuals about the benefits of physical activity and how to select, begin, and maintain participation in physical activity. The programs commonly include information about how to do specific activities, how to fit exercise into your schedule, how to find an exercise partner, and other tips on overcoming barriers that inhibit regular physical activity. The programs focus on individuals and things that individuals can do to help themselves become more active. Research has shown that individual-oriented health promotion programs have had some success in helping people become more physically active. In spite of this success, the proportion of people in the United States who are regularly active is lower than the proportion of adults who are irregularly active or inactive. In Georgia, the proportion of people who are regularly active has been declining while the proportion who are inactive has been increasing. It is apparent that individually focused educational efforts are, by themselves, not enough to help all irregularly active and inactive Georgians become more active.
ENVIRONMENT AND POLICY
One promising approach to increasing physical activity is to make it easier for people to be active. This includes changing the environment in which activity occurs and modifying or creating organizational policies that affect the environment and peoples' behavior. Focusing attention on the environment acknowledges that there are certain barriers that individuals cannot control. For example, individuals may want to walk more but they are unable to do so because there are no sidewalks, the traffic is dangerous, or the walking path is not well lit. Other people may want to bicycle to work, but have neither a safe place to store a bicycle at their worksite nor the facilities to shower and change clothing. Still other people may prefer to climb a flight of stairs rather than wait

for an elevator but the stairwells are unattractive, potentially unsafe, or difficult to find. Too often, the environment makes it difficult to participate in regular physical activity. Efforts to make the environment more supportive will aid the promotion of regular physical activity.
Methods used to promote regular physical activity need to be expanded to include environmental and policy supports. Behaviors regarding physical activity are influenced on multiple levels (Figure 4.1).1 Beyond the individual level, behavior can be influenced by interpersonal variables as well as factors associated with organizations, communities, and societies. To increase the effectiveness and impact of health promotion programs, the influence of each of these levels must be incorporated into the intervention strategy, regardless of where the intervention takes place. In the past, the individual and interpersonal levels were often the exclusive focus of health education programs. However, expanding an intervention's scope to include several levels increases the overall impact and effect on the inter vention.
Figure 4-1. Socio-Ecological Model
S o c i e t y Nation,State C o m mu n i t y County, Municipality, Neighborhood
O r g a n i z a t i o n a l Organizations,Social Institutions
I n t e r p e r s o n a l Family, Friends, Social Networks
I n d i v i d u a l Knowledge, Attitude, Skills

15

For example, schools should not only instruct students about the benefits of physical activity, but also make changes at the organizational level, such as maintaining optimal physical features including playgrounds, playing fields, tracks, and gymnasiums and ensuring that they are accessible after regular school hours. In addition, parents and concerned community members can become involved by collaborating with the school on physical activity efforts and by working with state and local school boards and legislators to mandate recess and daily physical education. Such efforts help develop positive attitudes toward physical activity and create an environment and social climate that support and foster physical activity.
The following are further examples of environmental features and organizational policies designed to promote regular physical activity. Examples are categorized by venue and include general community, worksites, health care settings, and schools.
GENERAL COMMUNITY
Environmental Features
Safe contiguous sidewalks (adequate lighting, pedestrian crossing signals, and curb ramps) in residential and business areas2,3
Road space for bicyclists in the form of marked bicycle lanes, wider outside lanes, and paved shoulders3
Downtown centers restricted to foot and/or bicycle travel2,4
Safe, attractive, accessible pools, tennis courts, and other sport facilities with convenient hours of operation5
Safe, attractive, accessible hiking, biking, and fitness trails5
Safe, attractive, accessible community centers, parks, and play areas5

Policies
Zoning regulations requiring new developments to include green space for recreational facilities2,6
Zoning regulations requiring new developments to include safe and attractive walking and biking pathways to be used for transportation2,6
Building ordinances requiring convenient and attractive stairways2
Use of highway funds to support alternative forms of transportation (walking, bicycling, mass transit)6
Incentives to malls to allow mall walking programs2,6 Incentives for converting abandoned railway beds to
walking, jogging, or bicycling pathways2,6 Incentives to individuals to encourage walking,
bicycling, or taking mass transit to work2 Support of local physical activity events through the
contribution of public space, as well as police and emergency medical services by cities/towns6 Incentives to real estate developers to build retail centers and housing developments that are pedestrian friendly, i.e. building store fronts next to sidewalks and parking lots behind stores, building housing developments close to restaurants, retail, and other entertainment venues2 Organization and coordination of community watch groups to increase safety2
WO R K S I T E
Environmental Features
On-site shower and changing rooms for employees who bicycle or walk to work or engage in other physical activity during the work day5
Safe and attractive walkways from distant parking lots2,6
Safe, accessible, and attractive staircases2,6 On-site exercise facilities or exercise classes5 Walking, jogging, bicycling paths connecting to
the worksite and bicycle parking areas3
Policies
Flex time or work breaks specifically for activity2,5,6,7 Incentives or subsidies for fitness memberships5,8 Incentives or subsidies for walking, bicycling, or
taking mass transit to work2 Incentives for adopting and maintaining a physically
active lifestyle8,9 Health insurance discounts to regularly active
employees2,8 Sponsorship of employee teams in local leagues
or events

Photo by:Mark Fenton

HEALTH CARE SETTING
Environmental Features
Provision of educational materials to patients and posting of signs that promote physical activity in exam and waiting rooms
Policies
Assessment and counseling of all patients about their physical activity practices should be identified as a minimum standard of care10
Reimbursement of health care providers for assess ment and counseling about physical activity2,6,10
Provision of periodic training updates on physical activity for health care providers2,11
Provision of continuing interventions with multiple components, such as supervised exercise, provision of equipment, and behavioral approaches10
Worksite wellness programs for staff
S C H O O L
Environmental Features
Walking, jogging, and bicycling paths to school grounds3
Safe spaces, facilities, and equipment for interscholastic and intramural sports12
Schools located within neighborhoods allowing students to walk or bicycle to school8

Photo by:Mark Fenton
Policies
Daily quality physical education2,5,8,13 Certification of Physical Education. and Health
Education instructors13,16 Lifetime physical activity skills included in daily
physical education2,4,5,7,13 Health benefits of physical activity included in
health education curricula2,6 Access to school physical activity spaces outside
of normal school hours5,8 Extracurricular competitive and non-competitive
physical activity opportunities for students of all skill levels, including disabled students2,13 Extended hours when school recreational facilities are open to students and the community7,14 Running tracks, ball fields, and other facilities open to the public during summers, evenings, and weekends2,6,15 Recruitment of parental involvement in school-based physical activity efforts13,16 Increase efforts to institutionalize programs shown to be effective, so that they are a routine part of school programs, policies, and resource allocations15 Incorporating physical activity and wellness message within other academic curriculum.
17

References for this chapter:
1McLeroy KR, Bibeau D, Steckler A, Glantz K. An ecological perspective on health promotion programs. Health Education Quarterly 1988; 15(4): 351-373.
2King AC, Jeffery RW, Fridinger F, Dusenbury L, Provence S, Hedlund SA, Spangler K. Environmental and policy approaches to cardiovascular disease prevention through physical activity: issues and opportunities. Health Education Quarterly 1995; 22(4): 499-511.
3Federal Highway Administration. 1994. The National Bicycling and Walking Study. Final Report. Washington D.C.: U.S. Department of Transportation.
4King AC. Community and public health approaches to the promotion of physical activity. Medicine and Science in Sports and Exercise 1994; 26(11):1404-1412.
5U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.
6King AC et al. Background paper on environmental and policy approaches to cardiovascular disease prevention through physical activity: issues and opportunities. Health Education Quarterly 1993; 22(4):499-511.
7Sallis J, Bauman A, Pratt M. Environmental and policy interventions to promote physical activity presented at CIAR conference on physical activity promotion: An ACSM specialty conference. American Journal of Preventive Medicine 1998; 15(4)379-397.
8U.S. Department of Health and Human Services. Healthy People 2010 (Conference Edition, in Two Volumes). Washington, DC: January 2000.
9Brownson RC, Smith CA, Pratt M, Mack NE, JacksonThompson J, Dean CG, Dabney S, Wilkerson JC. Preventing cardiovascular disease through community-based risk reduction: The Bootheel Heart Health Project. American Journal of Public Health 1996; 86(2):206-213.
10Simons-Morton DG, Calfas KJ, Oldenburg B, Burton NW. Effects of Interventions in Health Care Settings on Physical Activity or Cardiorespiratory Fitness. American Journal of Preventive Medicine 1998;15(4):413-430.
11Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, EttingerW, Heath GW, King AC, Kriska A, Leon AS, Marcus BH, Morris J, Paffenbarger RS, Patrick K, Ploolock ML, Rippe JM, Sallis, Wilmore JH. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. The Journal of the American Medical Association 1995; 273(5): 402-406.

12Centers for Disease Control and Prevention. Guidelines for school and community programs: Promoting lifelong physical activity. July 2000; US Department of Health and Human Services.
13Centers for Disease Control and Prevention. Guidelines for school and community programs to promote lifelong physical activity among young people. Morbidity and Mortality Weekly Report 1997; 46(RR-6): 1-36.
14Schmid TL, Pratt M, Howze E. Policy as intervention: Environmental and policy approaches to the prevention of cardiovascular disease. American Journal of Public Health 1995; 85(9):1207-1210.
15Stone EJ, McKenzie TL, Welk GJ, Booth ML. Effects of physical activity interventions in youth: Review and synthesis. Am J Prev Med 1998; 15(4):298-315.
16The Secretary of Health and Human Services and the Secretary of Education. Promoting Better Health for Young People through Physical Activity and Sports - Report to the President, Fall 2000.
17Powell KE, Kreuter MW, Stephens T, Marti B, Heinemann L. The dimensions of health promotion applied to physical activity (1993) Journal of Public Health Policy 1993; 12(4):492-509.

Examples & Resources for Promoting Physical Activity in Georgia

T he examples of community programs to facilitate physical activity in Georgia in the following list may provide ideas and encouragement to those seeking to implement programs. The following points should be kept in mind:
The list comprises programs and projects known to the Division of Public Health. It is not the result of a systematic search and many excellent programs assuredly are missing. If you know of a program that should be included in future listings please complete and submit the form at the back of this report.
The list provides examples; it is not intended to be an endorsement by the Division of Public Health. The programs listed have not been formally evaluated.

COMMUNITY

PROGRAM NAME AND

TARGET GROUP

CONTACT INFORMATION

Atlanta Bicycle Campaign (ABC) Dennis Hoffarth P.O. Box 5525 Atlanta, GA 31107 (404) 881-1112 e-mail: atlantabike@mindspring.com website: www.atlantabike.org

All Atlanta residents

Bike Athens Jason Henderson P.O. Box 344 Athens, GA 30603 website: www.BikeAthens.com

Residents of Athens and Clarke Counties

Balance and Strength Improvement Seniors Clinic (B.A.S.I.C.) Kathy Hayter Wellstar Health System Health Place & Mobile Health Services 65 S. Medical Drive Marietta, GA 30060 (770) 792-5431 email: kathy.hayter@wellstar.org

Cardiovascular Disease Prevention Initiative (CVD-PI) Pam Wilson CVD-PI Program Manager, Division of Public Health Georgia Department of Human Resources 2 Peachtree Street, 16th Floor Atlanta, GA 30303 (404) 657-6629 email: pswilson@dhr.state.ga.us

All Georgians, with particular emphasis given to racial and ethnic minorities whose rate of cardiovascular disease is greater than that of white Americans

PROGRAM GOAL
Provide a safe environment for bicyclists and to promote bicycle transportation
Decrease motor vehicle use by enabling bike transportation
Increase strength and balance in older persons at risk for falls
Increase opportunities for physical activity and healthy eating through policy and environmental changes

PROGRAM ACTIVITIES/DESCRIPTION A grass roots organization involved with the regional transportation planning process.
Bike racks placed on city buses and streets. Bike lanes added to downtown streets.
Visits include gentle, supervised activity such as marching, chair exercises, balance training, resistance exercises, arm movements, and stretching. Participants meet twice a week. Every sixth visit includes balance testing.
Partnerships formed with public and private organizations; create a statewide strategic plan; assesses infrastructure for supporting change; trains district public health staff and partners.

Cardiovascular Disease Prevention Project - Unity Park Anne Wheeler, Nutritionist Southeast Health Unit Annex 1115 Church Street Waycross, GA 31501 (912) 287-6521 email: aswheeler@gdph.state.ga.us

Residents in neighborhood surrounding Unity Park, Coffee County, GA.

Increase use of the park by families for walking, basketball, biking and playing.

Park improvement includes repairing sidewalks, joining disconnected sidewalks, adding mile-marker signs to walking trails, repairing playground equipment and the addition of crosswalks.

20

PROGRAM NAME AND CONTACT INFORMATION

TARGET GROUP

PROGRAM GOAL

PROGRAM ACTIVITIES/DESCRIPTION

Fit Kids Alice Smith Children's Healthcare of Atlanta 1584 Tullie Circle NE Atlanta, GA 30329 (404) 250-2348 email: alice.smith@choa.org

Overweight youth, ages 6-12 and families

Gateway Village Ben Mance 1500 Morrow Road Morrow, GA. 30260 (770) 961-4002 website: www.gatewayvillage.org

Citizens of Gateway Village

Georgia Coalition for Physical Activity and Nutrition (G-PAN) Michelle Lombardo, Chair 3838 Song River Road Duluth, GA 30097 email: wellness@abraxis.com

Georgians of all ages

Georgia Golden Olympics (Georgia Golden Games, Inc) Vicki Pilgrim Health Promotion Branch Division of Public Health Department of Human Resources 2 Peachtree Street, 16-462 Atlanta, GA 30303 (404) 657-6644 email: vcpilgrim@dhr.state.ga.us
Georgia Striders Vicki Pilgrim Division of Public Health Department of Human Resources Health Promotion Branch 2 Peachtree Street, 16-462 Atlanta, GA 30303 (404) 657-6644 email: vcpilgrim@dhr.state.ga.us

Adults 50 years and older Adults

Hamilton Walkers at Walnut

Adults

Square Mall

Hamilton Medical Center

1200 Memorial Drive

Dalton, GA 30720

(706) 272-2342

[Note:Similar programs exist across Georgia. Local information on Mall Walking Programs may be available through local malls or hospitals]

Kids on the Move Alice Smith Children's Healthcare of Atlanta 1699 Tullie Circle Atlanta, GA 30329 (404) 417-5672 email: alice.smith@choa.org

Youth, ages 8-12, metro Atlanta

Improve diet, increase physical activity and enhance self esteem

Health education and exercise program for children and parents. Eight-week class sessions held at Children's Healthcare of Atlanta, or occasionally at neighborhood health center facilities, Parks and Recreation Centers or YMCA's.

Promote non-motorized vehicle transportation

Connects a college campus, nature preserve, and a mixed-use development via bike trails and pedestrian friendly roadways

Promote physical activity and nutrition to prevent chronic disease

A coalition comprised of over 200 individual members and about 80 organizations. Activities include the Take Charge of Your Health Campaign.

Maintain and improve health and well being of adults. Create an interest in lifetime sports and physical activity

Multi-sport events held at various locations around the state. Competitions are offered in individual and team sports. Statewide event held annually.

Encourage walking clubs and individual walking programs

Support materials distributed including information about the benefits of walking, log books, and wall posters. Groups can be formed at churches, malls, senior centers, recreation departments, neighborhoods and other locations.

Facilitate walking

Mall walking program plus periodic health classes at the mall and monthly health screening and information.

Reduce risk factors for heart disease and stroke

Eight-week health education and fitness program offered after school at elementary schools and recreation centers.

21

PROGRAM NAME AND CONTACT INFORMATION

TARGET GROUP

Kingdom Kids Fitness Kenneth Law 6961 Wind Run Way Stone Mountain, GA 30087 (770) 465-1703 email: trainupachild226@aol.com
PATH Foundation Ed McBrayer P.O. Box 14327 Atlanta, GA 30324 e-mail: pathf@ix.netcom.com website: www.pathfoundation.org
Pedestrians Educating Drivers on Safety (PEDS) Sally Flocks 1447 Peachtree Street, Suite 801 Atlanta, GA 30309 (404) 873-5667 e-mail: info@peds.org website: www.peds.org
Senior Walking Club/Senior Line Dancing Club
Many programs exist in Georgia. Contact local Departments of Recreation or local senior centers.

Youth of all ages, Atlanta suburb Residents of Atlanta Residents of Atlanta
Seniors

Strategies for Metropolitan Atlanta's Regional Transportation and Air Quality (SMARTRAQ) Dr. Larry Frank College of Architecture Georgia Institute of Technology Atlanta, GA 30332 e-mail: larry.frank@arch.gatech.edu website: http://transaq.ce.gatech.edu/smartraq/

Atlanta Communities

The Silver Comet Trail Steve Henry Metro Atlanta District of Transportation 5025 New Peachtree Rd. NE Chamblee, GA 30341-3195 (770) 986-1001 email: stephen.henry@dot.state.ga.us

Georgians of all ages

Walk-A-Weigh

Adults

University of Georgia

Georgia Cooperative Extension Service

203 Hoke Smith Annex

Athens, GA 30602

(706) 542-0541

PROGRAM GOAL
Improve physical health and self-esteem

PROGRAM ACTIVITIES/DESCRIPTION
Activities include playing games and sports , teaching health education and Christian principles.

Provide Atlantans with safe place to bike, run, walk, and skate

Constructed 65 miles of greenway trails. Plans to build trails linking neighborhoods and business centers with the Metro Area Regional Transportation Authority (MARTA).

Make metropolitan Atlanta safe Grassroots advocacy group working and accessible for all pedestrians to change legislation and policies
regarding neighborhood design.

Provide venue and opportunities for seniors to be active

Senior Walking Clubs walk at various locations and meet periodically for social events where incentives and refreshments are offered. Senior Line Dancing Clubs practice and perform on a regular basis.

Studies relationship between community design and modes of transportation

Conducts research to guide decisions about transportation, land use and community design. Emphasizes public health aspects of transportation and community design.

Provide a 57 mile long trail for use by foot or bicycle

Georgia Department of Transportation used money from the Transportation Equity Act to develop trails along old railway.

Decrease mortality due to obesity and heart disease through physical activity and healthy eating

Long-term behavior modification program to help people lose weight. Classes are offered to communities following needs assessments. Classes are often held in collaboration with local hospitals or health departments.

22

PROGRAM NAME AND CONTACT INFORMATION

TARGET GROUP

Walking Trail, Taylor County Randy Frazier Taylor County Department of Parks and Recreation P.O. Box 278 Butler, GA 31006 (478) 862-9047
[Note: Trails such as this exist in many
GA counties. Local information on trails
such as these may be obtained from local
Departments of Parks and Recreation]

Residents of Butler and Taylor County

PROGRAM GOAL

PROGRAM ACTIVITIES/DESCRIPTION

Provide a safe setting for community members to be physically active

The walking trail/track was built with funds from a local 1% sales tax targeted towards various community projects. The trail is lighted so walkers can use it at night. A children's play area is located in the middle of the track.

SCHOOLS

PROGRAM NAME AND

TARGET GROUP

CONTACT INFORMATION

PROGRAM GOAL

PROGRAM ACTIVITIES/DESCRIPTION

National Walk Our Children to School Day Partnership for a Walkable America Harold Thompson 1121 Spring Lake Drive Itasca, IL 60143-3201 (800) 621-7615 ext. 2383 website: www.walktoschool.org
The Organ Wise Guys Michelle Lombardo, Chair 3838 Song River Road Duluth, GA 30097 email: ORGANWISE@aol.com website: www.organwiseguys.com

Children in elementary and middle schools
Youth, grades K-5

Improve safety and opportunities for walking

Parents and other volunteers walk with children to school. As a part of this annual event, parents and children assess the safety and walkability of their routes to school.

Help children create and maintain healthy lifestyles

Interactive health education focusing on nutrition and regular physical activity.

Take 10!TM The International Life Sciences Institute Brenda Moore 2295 Parklake Drive, Suite 450 Atlanta, GA 30345 (770) 934-1010 email: bmoore@ilsi.org

Youth, grades 4-6

Tri-County Chronic Disease Prevention Youth, grades 6-8 Initiative Candice Y. Brooks 811 Hemlock Street Macon, GA 31201 (478) 751-6037 email: cybrooks@gdph.state.ga.us

Incorporate physical activity into the school day

Academic instruction is supplemented with 10-minute segments of moderate to vigorous activity. Activities are cross-referenced to the Georgia core curriculum.

Increase students' knowledge Enhanced P.E. curriculum, which of the importance of regular includes alternative activities such as physical activity and nutrition aerobics and dance. in the prevention of future chronic illnesses and establish policies to support enhanced physical activity in school setting.
23

WORKSITE

PROGRAM NAME AND

TARGET GROUP

CONTACT INFORMATION

PROGRAM GOAL

PROGRAM ACTIVITIES/DESCRIPTION

Coastal Health District Employee Fitness Program Marsha Pierce 1609 Newcastle St. Brunswick, GA 31520 (912) 264-3907
Fulton County Employee Fitness Program Charsie Herndon Fulton County Government Center 141 Pryor St., 4th floor Atlanta, GA 30303 (404) 730-7080 email: fitness.thinner@mayo.co.fulton.ga.us
Onsite Health Fitness Program King and Prince Seafood Corporation Connie Howell, RN Occupational Health Nurse 7 King and Prince Blvd. Brunswick, GA 31521 (912) 265-5155 ext. 701
Take Charge Challenge Bruce Leonard 809 Mill Bend Drive Lawrenceville, GA 30044 (770) 978-3821 email: be10@gateway.net

Employees of Coastal Health District

Assist and motivate employees to improve their health and reduce risk factors for chronic disease

Employees of Fulton County Government

Promote health and fitness

Employees of King and Fish seafood processing plant

Reduce the risk factors for mental and physical health problems

Worksites, schools, faith

Increase physical activity

communities, other group settings and cause sustainable

behavior change

Incentives provided for milestone hours of physical activity; health risk assessments and health education materials from the American Heart Association provided.
Fitness training and counseling in the areas of aerobics, flexibility, muscular strength, endurance/stamina, weight loss, and nutrition.
Walking club; weight-loss program; nutrition education; stress management and health classes offered on regular basis.
10-week incentive based physical activity program where participants set a physical activity goal to be met by the completion of the program.

If you would like us to consider your physical activity promotion program in future Phsyical Activity Reports, please send the following information:
Cardiovascular Disease Prevention Initiative Division of Public Health Georgia Department of Human Resources 2 Peachtree Street, 16th Floor Atlanta, GA 30303
Name of Program: Sponsoring Organization (if any): Address: Phone number: e-mail: Target Group: Program Goal: Description:
24

The Guide to Community Preventive Services (Community Guide) provides recommendations regarding population-based interventions to promote health and to prevent disease, injury, disability, and premature death. Recommendations are based on systematic reviews of the scientific literature (see Am J Prev Med 2000;18 (1S):1826). The Community Guide is a federally sponsored initiative and is part of a family of federal initiatives including

Healthy People 2010 and the Guide to Clinical Preventive Services. More information about the Community Guide (including links to a variety of resources) is available at http://www.thecommunityguide.org. Recommendations about physical activity programs from the Community Guide are scheduled for release in September 2001. Preliminary recommendations from the Community Guide are these:

TYPE OF INTERVENTION TO PROMOTE PHYSICAL ACTIVITY S T RO N G LY REC O M M E N D E D Community-wide education
School-based physical education
Non-family social support
Individually-adapted health behavior change
Creation and/or enhanced access to places for physical activity R E CO M M E N D E D "Point-of-decision" prompts
INSUFFICIENT EVIDENCE* Classroom-based school health education focused on information provision Mass media (only) campaigns
Health education with TV/Video game turnoff component College-age physical education/health education
Family-based social support
Transportation policy and infrastructure changes to promote non-motorized transit Urban planning approaches-zoning and land use

INTERVENTION DEFINITION
Multi-component community-wide campaigns designed to increase knowledge, influence attitudes and beliefs, and change behavior related to physical activity.
Modified curricula and policies to increase the amount of time students are moderately or vigorously active while in PE class, without necessarily increasing the amount of class time.
Building, strengthening, and maintaining social networks outside of the family, e.g., workplace, to change physical activity behavior.
Teaching individuals to incorporate physical activity into their daily routines through goal setting and self-monitoring, building social support, behavioral reinforcement, structured problem solving, and relapse prevention.
Building places for physical activity, e.g., bicycle trails, walking trails, or fitness centers; reducing barriers to existing places e.g., reducing fees or providing time for employees to use facilities during the workday.
Placement of highly visible health messages where the viewer has an option between a more healthy and less healthy option e.g., signs placed at the base of elevators or escalators prompting people to take the stairs.
Providing children in the classroom setting with information about health risks and behavioral risk factors related to physical activity. Single component interventions that use mass media to increase knowledge, influence attitudes and beliefs, and change behavior related to physical activity.
A subset of classroom-based health education classes that specifically emphasize decreasing the amount of time children spend watching television and playing video games.
Physical and health education classes adapted to the needs and lifestyles of college students with the aim of setting long-term behavioral patterns during the transition to adulthood.
Using the family support structure, specifically children and their families, to reinforce patterns and norms that support greater levels of physical activity. Expected Summer 2001
Not yet defined
Not yet defined

* Insufficient evidence does not mean ineffective, it means more research is needed.

25

Appendix I

Physical Activity-Related Objectives from Healthy People 2010 and Cur rent Status of Objectives in Georgia

Healthy People 2010 Objectives

Status of Objectives in Georgia

22-1 Reduce the proportion of adults who engage in no leisure-time physical activity. Target: 20 percent
22-2 Increase the proportion of adults who engage regularly, preferably daily, in physical activity for at least 30 minutes per day. Target: 30 percent
22-3 Increase the proportion of adults who engage in vigorous physical activity that promotes the development and maintenance of cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion. Target: 30 percent
22-4 Increase the proportion of adults who perform physical activities that enhance and maintain muscular strength and endurance. Target: 30 percent
22-5 Increase the proportion of adults who perform physical activities that enhance and maintain flexibility. Target: 43 percent
22-6 Increase the proportion of adolescents who engage in moderate physical activity for at least 30 minutes on 5 or more of the previous 7 days. Target: 35 percent
22-7 Increase the proportion of adolescents who engage in vigorous physical activity that promotes cardiorespiratory fitness 3 or more days per week for 20 or more minutes per occasion. Target: 85 percent
22-8 Increase the proportion of the Nation's public and private schools that require daily physical education for all students. Target: 25% for middle and junior high schools
5% for high schools

27% of Georgia adults engage in no leisure-time physical activity
18% exercise regularly for 30 minutes per day more than 5 days a week
11% fulfill criteria for this objective only 7% fulfill criteria for this objective in addition to fulfilling criteria for 22-3 13% engage in activity in which they are vigorously active more than 20 minutes per day, 3 days a week or more 6% fulfill criteria for this objective only 7% fulfill criteria for this objective in addition to fulfilling criteria for 22-2
28% engage in strength enhancing activities for at least two days a week1
Data have not been collected in Georgia.
Data are statistically unreliable.2
Data are statistically unreliable.2
Physical Education (PE) is no longer mandatory by law for middle schools. The Sate Board of Education has, by rule, made PE and health mandatory for grades K-5 for 90 hours of instruction per year. Each school containing any grade 6-12 must make available instruction in health and physical education. One course, equivalent to 150 hours of instruction, in health and PE is still required for graduation from high school.

22-9 Increase the proportion of adolescents (grades 9-12) who participate in daily school physical education. Target: 50 percent

Data are statistically unreliable.2

22-10 Increase the proportion of adolescents who spend at least 50 percent of school physical education class time being physically active. Target: 50 percent

Data are statistically unreliable.2

22-11 Increase the proportion of adolescents who view television 2 or fewer hours on a school day. Target: 75 percent

Data have not been collected in Georgia.

22-12 (Developmental) Increase the proportion of the Nation's public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal school hours (that is, before and after the school day, on weekends, and during summer and other vacations).

Data have not been analyzed.

22-13 Increase the proportion of worksites offering employer-sponsored physical activity and fitness programs. Target: 75 percent

Data collection is in progress.

22-14 a. Increase the proportion of trips one mile or less. Target: 25 percent for adults aged 18 years and older b. Increase the proportion of trips to school one mile or less made by walking. Target: 50 percent for children and adolescents aged 5 to 15 years

a. Data have not been collected in Georgia.
b. 19% of Georgia children who live a mile or less from school, walk to school3

22-15 a. Increase the proportion of trips five miles or less made by bicycling. Target: 2 percent for adults aged 18 years and older b. Increase the proportion of trips to school two miles or less made by bicycling. Target: 5 percent for children adolescents aged 5 to 15 years

a. Data have not been collected in Georgia. b. Data have not been collected in Georgia.

1Taken from State added question in 1999 BRFSS 2Data on this information is collected with the Georgia Youth Risk Behavior Survey (YRBS). The YRBS, conducted every odd year, samples 53 high schools and 53 middle schools. However, Georgia has a low participation rate making the information statistically unreliable. 3Data source: Data were collected as part of the Georgia Asthma Survey, a telephone survey of Georgia households with children conducted in 1999. Respondents in households which had a child between the ages of 5 and 17 years old, were asked the following two questions related to walking to school: 1) How does {child name} get to school most days of the week? 2) About how many miles is it from where you live to the school {child name} attends? The sample is analyzed using the same weighting system as the Georgia BRFSS.

Appendix II
Percent of adults (18+ years) by activity category and county 1994, 1996, 1998, 1999 combined.

, Georgia

County
Georgia
Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantly Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur DeKalb Dodge Dooly Dougherty

Regularly Active
24 21 20 16 38 26 24 24 29 18 27 26 26 12 38 29 27 25 20 30 12 27 26 15 12 22 32 25 28 35 34 22 24 32 23 22 27 31 24 21 26 21 18 31 33 24 31 29

28

Irregularly Active
49 34 37 39 31 38 41 48 45 43 38 42 38 35 24 39 47 41 41 35 37 37 46 36 37 36 34 31 47 46 29 40 36 42 38 37 41 33 48 43 40 37 51 30 42 39 42 35

Inactive
27 45 43 45 31 36 35 28 27 39 36 32 36 53 38 33 26 33 38 35 51 36 28 49 51 43 34 44 25 19 37 38 40 26 39 41 32 35 29 35 34 42 31 40 25 37 27 36

County
Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gilmer Glascock Glynn Gordon Grady Green Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin McDuffie McIntosh

Regularly Active
29 34 33 25 28 23 34 15 24 22 23 30 26 16 29 22 20 29 31 20 26 21 30 24 28 28 11 28 25 22 33 22 20 25 27 26 26 18 25 28 30 25 24 24 26 10 27 23

Irregularly Active
44 32 29 42 42 50 47 42 46 33 50 41 48 39 35 31 42 31 39 48 37 46 29 49 39 42 57 42 43 38 46 40 36 40 43 39 38 36 35 30 35 36 39 29 35 45 41 29

Inactive
27 34 38 33 30 27 19 44 30 46 27 29 26 45 37 47 38 41 30 32 37 34 41 28 33 29 32 30 32 39 21 39 44 35 30 34 36 46 40 42 36 39 38 47 39 45 32 47

* Percent total for some counties may not add up to 100 due to rounding

County
Macon Madison Marion Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnum Quitman Rabun Randolph Richmond Rockdale Schley Screven Seminole Spalding Stephens

Regularly Active
24 31 31 15 33 25 22 20 19 17 33 17 35 32 32 25 17 15 18 27 25 28 32 22 32 28 25 24 25 29 19 24

Irregularly Active
39 43 33 42 29 31 42 45 35 38 33 48 46 43 40 43 55 34 43 41 42 42 32 33 33 39 45 36 41 30 40 37

Inactive
37 26 36 43 38 44 36 35 45 44 34 35 19 25 28 32 28 51 38 32 33 30 35 45 35 32 30 40 34 41 40 39

County
Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Truetlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Regularly Active
29 25 30 30 28 26 23 30 29 28 21 20 22 15 26 25 21 24 22 19 16 27 27 21 31 21 16 16 22 28 26 27

Irregularly Active
33 39 32 38 24 38 41 35 32 37 38 36 44 51 41 39 37 40 34 49 39 36 34 31 34 40 33 34 41 41 31 38

Inactive
38 36 38 32 48 36 36 35 39 35 40 43 34 34 33 35 42 36 45 33 45 37 38 48 35 39 51 50 37 30 42 35

Appendix III
Percent of adults (18 years) by activity category and demographic groups,

Georgia, 1999.

County
Age <25 25-44 45-54 55-64 65+
Gender Men Women
Race/Ethnicity Non-Hispanic Whites Non-Hispanic Blacks Other
Education < 8 years 9-11 years HS graduate Some college College graduate
Income <$15000 $15,000-$34,999 $35,000-$74,999 $75,000+
Marital Status Married Divorced/separated Widowed Never married
Employment Status Employed Unemployed Homemaker Student Retired
Place of Residence Urban Rural
By year 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999

Regularly Active
27 25 24 23 19
26 23
24 23 29
8 18 22 25 31
19 22 24 36
24 23 19 29
23 27 27 39 24
25 22
31 23 21 22 22 21 21 17 19 23 27 15 25 24

Irregularly Active
63 52 48 41 38
49 50
50 50 42
38 47 46 54 52
40 48 54 48
49 46 35 54
53 51 46 56 37
50 47
52 53 52 45 46 43 42 43 42 41 40 33 45 49

Inactive
10 22 28 36 43
25 28
26 27 30
55 35 32 22 16
40 30 22 15
27 31 46 17
23 21 26 5 39
24 31
17 24 27 33 32 37 37 40 40 36 33 42 51 30 27

30

* Percent total for some counties may not add up to 100 due to rounding

Appendix IV.
Details about the Behavioral Risk Factor Sur

veillance System (BRFSS)

The Georgia Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed to assess the physical activity patterns among adult Georgians. The BRFSS is a survey conducted annually by the Division of Public Health, Georgia Department of Human Resources. Each month, approximately 190 randomly selected adults 18 years of age and older in Georgia are interviewed by telephone using standardized methods and questionnaires. The BRFSS covers a wide range of health behaviors including seat belt use, high blood pressure, and physical activity, providing estimates of the prevalence of these risk factors for injury and disease. BRFSS data have been collected in Georgia since 1984.
In 1999 a total of 2273 adults in Georgia were included in the BRFSS. All estimates presented in this report are based on the 1999 survey except for the analysis of time trends, which uses data from 1984 through 1999 and the county specific estimates which use data from 1994, 1996, 1998 and 1999. The trend analysis is not age-adjusted to a standard population. Because the number of people of races other than white or black was too small to give a stable estimate, the analysis by race is limited to white and black.

County Specific estimates were obtained by including, if necessar y, responses from participants in adjacent counties. If a county had fewer than 200 respondents, in 1994, 1996, 1998 and 1999 combined, respondents in all bordering counties were included as if they were residents of the county of interest. If there were still fewer than 200 respondents after adding one concentric ring of counties, a second or third concentric ring was added. Only Georgia residents were used. Nine counties did not need a ring to reach the required sample size. Seventy-eight counties needed one ring, while 70 counties required two rings and two counties needed three rings. The county specific prevalence estimates are weighted according to state demographic information.
Information about the quality and quantity of a respondent's physical activity was obtained from a series of questions regarding exercise, recreational activity, or physical activities away from the job. The BRFSS questions about physical activity begin by asking, "During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking for exercise?" If they answer yes, information

is then obtained about the type, frequency, and duration of the activity. Respondents are then asked about a second activity in an identical manner. The actual questions regarding physical activity are listed on the next page.
Three levels of physical activity among Georgians were defined in this report based on the number of days per week the respondents reported performing the activity and the average number of minutes the respondent was active each time they performed the activity. For individuals who reported two activities, it was assumed that the two activities were performed on different days. Respondents were considered regularly active if a) they reported activity on 5 or more days per week and accumulated 150 minutes or more of moderate or vigorous physical activity per week, or b) they reported vigorous physical activity on 3 or more days per week with 20 minutes or more per session. Respondents were considered irregularly active if they reported doing some leisure-time physical activity but were not regularly active. Respondents were considered inactive if they reported no non-occupational activity during the past 30 days.

BRFSS activities by categor y

Walking

Walking

Indoor

Aerobics class, boxing, calisthenics, dancing, aerobics/ballet, health club exercise, home exercise, judo/karate, rope

Conditioning Activities skipping, stair climbing, weight lifting, bicycling machine exercise, rowing machine exercise

Recreational Activities

Backpacking, bicycling for pleasure, bowling, golf, hiking cross-country, horseback riding, hunting large game, deer, elk, mountain climbing, skating ice or roller, sledding, tobogganing, snow shoeing, snow skiing, table tennis, other

Home Maintenance Activities Jogging Team Sports Water Activities
Racquet Sports

Carpentry, gardening (spading, weeding, digging, filling), mowing lawn, painting/papering house, raking lawn, snow shoveling by hand, snow blowing
Jogging, running
Basketball, soccer, softball, touch football, volleyball
Boating (canoeing, rowing, sailing for pleasure) camping, canoeing/rowing in competition, fishing from riverbank or boat, scuba diving, snorkeling, stream fishing in waders, surfing, swimming laps, water skiing
Badminton, handball, paddle ball, racquetball, squash, tennis

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Behavioral Risk Factor Sur veillance System (BRFSS) Questions on Exercise , 1984-1999

The next few questions are about exercise, recreation or physical activities other than your regular job duties.

1. During the past month, did you participate in any physical activities or exercises such as running, calisthenics, golf, gardening, or walking exercise?
a. Yes b. No, Go to Q11
Don't know/Not sure, Go to Q11 Refused, Go to Q11

2. What type of physical activity did you spend the most time doing during the past month?
Activity (specify): ___________________ __ __
See coding list A Refused, Go to Q6

Ask Q3 only if answer to Q2 is running, jogging, walking, or swimming. All others, go to Q4.

3. How far did you usually walk/run/jog/swim?

(See coding list B if response is not in miles and tenths)

Miles and tenths

__ __.__

Don't know/Not sure 7 7 7

Refused

9 9 9

4. How many times per week or per month did you take part in this activity during the past month?
a. Times per week __ __ b. Times per month __ __
Don't know/Not sure Refused

5. And when you took part in this activity, for how many minutes or hours did you usually keep at it?

Hours and minutes Don't know/Not sure Refused

__:__ __

6. Was there another physical activity or exercise that you participated in during the last month?
a. Yes b. No, Go to Q11 Don't know/Not sure, Go to Q11 Refused, Go to Q11

7. What other type of physical activity gave you the next most exercise during the past month?
Activity (specify): ___________________ __ __ See coding list A Refused, Go to Q6

Ask Q8 only if answer to Q7 is running, jogging, walking, or swimming. All others, go to Q11.

8. How far did you usually walk/run/jog/swim?

(See coding list B if response is not in miles and tenths)

Miles and tenths

__ __.__

Don't know/Not sure 7 7 7

Refused

9 9 9

9. How many times per week or per month did you take part in this activity during the past month?
a. Times per week __ __ b. Times per month __ __
Don't know/Not sure Refused

10. And when you took part in this activity, for how many minutes or hours did you usually keep at it?

Hours and minutes Don't know/Not sure Refused

__:__ __

1

Appendix V
Details about estimating the burden of inactivity and the benefits of activity

Population Attributable Risk: Population attributable risk (PAR) is an estimate of the proportion of deaths or other measures of disease burden caused by a particular risk factor. The PAR represents the proportion of disease in a population that could be eliminated if the exposure were removed from the population. For example, the PAR of inactivity is the fraction of heart disease deaths that would not occur if everyone were regularly active. As a formula, it is expressed:
# of Heart Disease Deaths (actual) # of Heart Disease Deaths (if all regularly active) (1) PAR =
# of Heart Disease Deaths (actual)

Because the value for "# of Heart Disease Deaths (if all regularly active)" cannot be directly measured, PAR is usually calculated using another formula that requires the prevalence of the risk factor and the relative risk of those with the risk factor compared to those without the risk factor.

(2) PAR =

Pexp(i) * (RRi 1) 1+ [Pexp(i) * (RRi 1)]

x 100

be either higher or lower than the actual number. A second assumption of the PAR calculated with formula (2) is that the prevalences of the other risk factors would not change if the risk factor of interest disappeared. These assumptions and others make the PAR an imperfect estimate of the proportion of disease caused by a specific risk factor. Nevertheless, the PAR provides a useful approximation of the potential gains from reducing the prevalence of various risk factors, including inactivity.
Population event prevented: Population events prevented (PEP) is an estimate of the proportion of deaths or other measures of disease burden prevented by a protective exposure. The PEP represents the additional proportion of disease in a population that would occur if the protective exposure were removed from the population. For example, the PEP of activity is the additional fraction of heart disease deaths that would occur if everyone were inactive. The formulas for PEP corresponding to formula (1) and formula (2) are:

# of Heart Disease Deaths (if all inactive) # of

Heart Disease Deaths (actual)

(3) PEP =

# of Heart Disease Deaths (actual)

In this equation Pexp is the prevalence of the exposure, RR is the relative risk, and (i) is the level of exposure to the risk factor if there is more than one level of the risk factor. The categories of activity used in this report provide two levels of risk, one level for those who are inactive and one level for those who are irregularly active. It is important to note that even if everyone were regularly active, the diseases of interest, such as heart disease or diabetes, would not be completely eliminated from the population. The rate of disease would be determined by the prevalence of other causal factors.
Calculating the PAR using formula (2) (above) assumes that other risk factors, known or unknown, are unassociated with the risk factor of interest. This assumption often does not hold. When it does not, the calculated PAR will

(4) PEP =

(RRs - 1) - (Pexp(i) * (RRi 1)) x 100 1+ [Pexp(i) * (RR(i) 1)]

RRs is the relative risk of the sedentary group with respect to the regularly active, Pexp is the prevalence of exposure, RR is the relative risk and (i) is the level of exposure to the risk factor if there is more than one.
Conditions selected for PAR and PEP analysis: Physical activity is known to reduce the risk for heart disease, high blood pressure, colon cancer, non-insulin dependent diabetes mellitus, and helps maintain proper body weight. Physical activity has also been shown to help maintain normal muscle strength, joint structure, and joint function which also prevents and reduces the of risk falling, thereby not only reducing the risk of hip fracture but also

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enabling older adults to remain functionally independent for longer periods of time. Evidence of a beneficial effect of regular physical activity on the incidence of stroke recently has, in our opinion become sufficient.1,2,3 There is also agreement that regular physical activity reduces the symptoms of depression and anxiety, and improves overall quality of life.4 More research is needed for confirmation of the effects of physical activity on other conditions such as cholecystitis (gall bladder inflammation, usually from gallstones), other cancers, and also on suicide.
The physical activity related PAR and PEP estimates have been calculated for heart disease, hypertension, colon cancer, non-insulin dependent diabetes mellitus and stroke. It should be noted that stroke is a heterogeneous disorder with several different pathologies. The benefits on stroke brought about by physical activity presumably occur for the most prevalent subtype of stroke in the United States, atherothrombotic stroke. Atherothrombotic stroke only comprises approximately 61% of all stroke cases.5 Also calculated, were the PAR and PEP estimates for a sixth condition consisting of osteoporosis plus hospitalizations and hospital discharges for hip fractures among individuals 60 years of age or greater. These conditions were selected because there is consensus about the independent beneficial effect of regular physical activity on their incidence and because RR estimates for each are available in the literature. Other established benefits, such as improved quality of life, are currently impossible to quantify in easily understood terms. Although mental health benefits are among the most important benefits of regular physical activity, this report did attempt to quantify them.
Relative risks for the selected conditions: The summary RR is considered the risk of inactive persons (BRFSS definition) compared to regularly active persons (BRFSS definition). For five of the six selected conditions, estimates for the relative risk (RR) were obtained from a recent article on the costs of inactivity.6 The estimated relative risk for all stroke (without regard to subtype) was taken from a review of five recent prospective studies on the relationship of stroke and physical activity.7 The geometrical mean of each summary RR and 1 was assigned for irregularly active persons.

430-438; Diabetes, 250; Colon Cancer, 153; Osteoporosis, 733 for both mortality and hospital discharge data and, for persons 60 years of age or more, 820 (fracture of the neck of the femur) from hospital discharge survey only.
Deaths: The number of deaths in Georgia in 1999 due to each of the six conditions was obtained from Georgia Vital Statistics data. The following ICD-10 codes were used: Ischemic Heart Disease, I20-I25; Hypertension (High Blood Pressure), I10-I13; Stroke, I60-I69; Diabetes, E10-E14; Colon Cancer, C18; Osteoporosis, M80-M81.
References for this chapter:
1Bronner LL, Kanter DS, Manson JE. Primary prevention of stroke. The New England Journal of Medicine 1995; 333(21):1392-1400.
2Lee IM, Paffenbarger RS. Physical activity and stroke incidence: the Harvard Alumni Health Study. Stroke 1998; 10: 2049-2954.
3Sacco RL, Gan RL, Boden-Albala B, Lin IF, Kargman DE, Hauser WA, Shea S, Paik MC. Leisure-time phsyical activity and ischemic stroke risk: The Northern Manhattan Stroke Study. Stroke 1998; 29(2):380-387.
4U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.
5American Heart Association. 2001 Heart and Stroke Statistical Update. Dallas, Texas: American Heart Association, 2000.
6Colditz, GA. Economic costs of obesity and inactivity. Med Sci Sports Exerc 1999;31(11, Suppl):S663-S667.
7Wannamethee SG, Shaper AG. Physical activity and the prevention of stroke. Journal of Cardiovascular Risk. 1999; 6:213-216.

Hospitalizations and hospital charges: The number of deaths, hospitalizations, and hospital charges for each of the six conditions in Georgia in 1999 was obtained from Georgia Hospital Discharge Survey data. The following ICD-9 codes were used: Ischemic Heart Disease, 410-414; Hypertension (High Blood Pressure), 401-404; Stroke,

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Population attributable risk (PAR) of insufficient physical activity for heart disease , high blood pressur e, strok e, colon cancer , diabetes, and osteoporosis and falls with fractures

Activity Categor y

P exp

Hear t

High Blood

Disease

Pressur e

Inactive

. 2 7

Irregularly Active .49

Regularly Active .24

Total PAR

RR PAR 2.0 18% 1.4 14% 1.0 ---
3 2 %

RR PAR 1.5 10% 1.2 8% 1.0 ---
1 8 %

Strok e
RR PAR 2.0 18% 1.4 14% 1.0 ---
3 2 %

C o l o n C a n c e r
RR PAR 2.0 18% 1.4 14% 1.0 ---
3 2 %

D i a b e t e s

O s t e o p o ro s i s /F alls with F ractures

RR PAR 1.5 10% 1.2 8% 2.0 --1.0 18%

RR PAR

2.0 18%

1.4 14%

1 . 0

- - -

3 2 %

PAR= Population Attributable Risk, Pexp= prevalence of the exposure. RR= relative risk

Glossary

Age adjustment - The application of observed age-specific rates to a standard age distribution to eliminate differences in rate estimates due to differences in the populations' age distributions. The U.S. standard population 2000 is the standard distribution used in this report.
Atherothrombotic stroke - Damage or destruction of brain cells due to reduced blood supply because of atherosclerosis.
Behavioral Risk Factor Surveillance System (BRFSS) The Georgia BRFSS is an ongoing population-based public health surveillance system that collects information regarding health-risk behaviors through a telephone survey of a representative sample of the state's civilian, non-institutionalized adult population.
Confidence intervals - The computed interval with a given probability, e.g., 95%, that the true value of a variable such as a mean, proportion, or rate is contained within the interval.
Environment - Physical and sociocultural surroundings that influence behavior.

Flexibility - The ability to move a joint through the full range of motion without discomfort or pain.
Healthy People 2010 - A national health promotion and disease prevention initiative which aims to increase the quality and years of healthy life and to eliminate health disparities.
High blood pressure - Blood pressure is measured as systolic (pressure of the blood in the arteries when the heart beats) and diastolic (pressure between heartbeats). High blood pressure, or hypertension, is generally considered to be greater than or equal to 140 systolic and 90 diastolic (measured in millimeters of mercury).
Inactive - Persons who report no non-occupational physical activity in the past 30 days.
Irregularly active - Persons who report some moderate or vigorous activity, but are not regularly active.
Intervention - A focused set of activities designed to reduce a risk factor or increase a protective factor.

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Ischemic Heart Disease - Heart disease caused by narrowing or hardening of the arterial walls. Ischemic heart disease is simply referred to as heart disease in this report.
Muscular endurance - The ability of the muscle to perform repetitive contractions over a prolonged period of time.
Muscular strength - The amount of force that a muscle can exert.
Non-Insulin Dependent Diabetes Mellitus Type II (NIDDM) - The form of diabetes mellitus characterized by gradual onset, usually in obese persons over the age of 40. Diabetes mellitus is a chronic disorder of metabolism affecting the way the body uses digested food for growth and energy. NIDDM is simply referred to as diabetes in Tables 3-1 and 3-2 of this report.
Physical activity - Bodily movement that is produced by the contraction of skeletal muscle and that results in energy expenditure.
Physical fitness - A set of attributes involving performance-related and health-related components that relate to a person's ability to perform physical activity. Examples of performance-related components of fitness include agility, balance, coordination, power, and speed. Examples of health-related components of physical fitness include body composition, cardiorespiratory function, flexibility, and muscular strength.
Policies - Organizational statements or rules that are meant to influence behavior.
Population Attributable Risk (PAR) - An estimate of the proportion of deaths or other measures of disease burden caused by a particular risk factor. The PAR represents the reduction in incidence that would be achieved if exposure to a particular risk factor could be completely removed from a population.
Population Events Prevented (PEP) - An estimate of the proportion of deaths or other measures of disease burden prevented by a protective exposure. The PEP represents the additional proportion of disease in a population that would occur if the protective exposure were removed from the population.

Prevalence - An estimate of how many people in a defined population have a specific disease at a given point in time.
Regularly active - Persons who report being physically active for 5 or more days a week for total time of 150 minutes or more or persons who report 3 or more days a week of vigorous activity for 20 minutes or more each session.
Relative Risk (RR) - A measure of the association of a risk factor to disease. RR is the ratio of the risk of disease or death among the exposed to the risk among the unexposed.
Sedentary - A lifestyle characteristic of persons who are relatively inactive.
Statistical trend - The tendency to move in a consistent direction that is unlikely due to chance. Specifically, a quantitative assessment indicates a 95% or more probability that the trend is not due to chance.
Stroke - Stroke is a cardiovascular disease that occurs when the brain is damaged because a blood vessel bringing oxygen and nutrients to the brain ruptures or is clogged by an atheromatous plaque or some other particle.
Youth Risk Behavior Survey (YRBS) - The Georgia YRBS is an ongoing school-based surveillance system that monitors health-risk behaviors among youth and young adults. The YRBS is conducted nationally by CDC and at the state level by education agencies.
Vigorous physical activity - Rhythmic, repetitive physical activities that use large muscle groups at 70 percent or more of maximum heart rate for age. An exercise heart rate of 70 percent of maximum heart rate for age is about 60 percent of maximal cardiorespiratory capacity and is sufficient for cardiorespiratory conditioning. Maximum heart rate equals roughly 220 beats per minutes minus age. Examples of vigorous physical activities include jogging/running, lap swimming, cycling, aerobic dancing, skating, rowing, jumping rope, cross-country skiing, hiking/backpacking, racquet sports, and competitive group sports such as soccer and basketball.

Program - A set of complementary and reinforcing interventions.

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