2009 ACSM/CDC EXPERT MEETING REPORT
Background to the Meeting
There is now considerable evidence regarding the benefits of physical activity for older adults. However, in spite of a wealth of evidence about the benefits of physical activity, there has been little success in convincing older adults to adopt physically active lifestyles. Data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System indicate that less than a third of older individuals engage in regular physical activity, with the proportion meeting recommended guidelines progressively decreasing with advancing age.
In response to a perceived need for a strategic plan to promote physical activity among older adults, with funding support from the Robert Wood Johnson Foundation, the National Blueprint: Increasing Physical Activity Among Adults Age 50 and Older (NB) was developed by more than 50 national organizations. When the NB was released in 2001, representatives from 50 national organizations made a long-term commitment to collaborate in supporting and endorsing regular physical activity for Americans aged 50 and older. Led by a Steering Committee of representatives from the National Institute on Aging, the National Council on Aging, the Centers for Disease Control and Prevention, the American Geriatrics Society, the American College of Sports Medicine, and the Robert Wood Johnson Foundation, the NB was the first national coalition to focus exclusively on addressing the comprehensive issues involved in helping older Americans to become physically active.
The goals of the NB were to identify societal barriers to participation in physical activity and to recommend strategies to overcome identified barriers in the areas of research, home and community programs, medical systems, public policy, and marketing. The NB partners identified strategic priorities and produced Web sites, toolkits, publications, and other products and programs to promote physical activity. From local communities to the nation’s capital, the NB initiative attempted to influence public policy, the research community, the health care field, and the aging network by advocating for an active and healthy lifestyle for older adults. In this expert meeting, representatives from selected NB organizations came together to discuss how to maximize the impact of the newly developed Physical Activity Guidelines for Americans.
2008 Physical Activity Guidelines for Americans
In 2008, the Department of Health and Human Services (DHHS) published, for the first time, official U.S. government Physical Activity Guidelines for Americans (PAG). The DHHS Physical Activity Guidelines for Americans conclude that there is strong evidence that, compared to less active persons, more active men and women have lower rates of all-cause mortality, coronary heart disease, high blood pressure, stroke, type 2 diabetes, metabolic syndrome, colon cancer, breast cancer, and depression. The DHHS provided specific recommendations and advice for promoting physical activity among specific segments of the population, including older adults. However, relatively little is known about the degree to which the 2008 PAG have impacted the physical activity strategies and programs of the organizations, associations, and agencies within the Aging Network that deliver programs and services to older adults throughout America.
In order to address issues and challenges related to disseminating the PAG throughout the Aging Network, the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) convened a small group of experts in aging and/or physical activity for a two-day roundtable meeting in fall 2009.
2009 Expert Meeting Goals
The goals of the meeting were as follows:
- To discuss and identify ways to maximize the impact of the 2008 Physical Activity Guidelines for Americans (PAG) across the Aging Network.
- To identify a set of public domain materials (Web and print) that can be disseminated to organizations in the aging network.
- To propose a strategy to seek broader input and buy-in from aging network organizations.
Structure of the Meeting
Twenty individuals with expertise in areas related to aging and physical activity were invited to participate in a two-day workshop that was held at the ACSM national headquarters in Indianapolis, Indiana. Following a series of presentations about the 2008 Physical Activity Guidelines, participants were divided into breakout groups. The breakout groups developed recommendations regarding how best to maximize the impact of the 2008 Physical Activity Guidelines for Americans across the Aging Network.
Below we summarize the key recommendations of the expert panel.
Strategies for Increasing the Visibility and Impact of the PAG
There was a consensus among the expert group participants that the 2008 PAG were not yet widely disseminated throughout the Aging Network and there is a need to increase the visibility of the PAG both among older adults themselves as well as among groups and organizations serving older adults.
Increasing Awareness of the PAG among Individual Older Adults
The following strategies could be used to increase awareness among older adults.
- Organizations should be encouraged to conduct focus groups to identify physical activity messages that are consistent with the PAG and that resonate with older adults.
- In order to increase the reach and penetration of messages related to the PAG, targeted messages should be developed for key subgroups in the older adult population, including ethnic minorities; persons with disabilities, frail and home bound older adults, etc.
- Traditional (print, TV, radio) and new (Web, social networking, viral) media outlets should be used to deliver physical activity messages that are disseminated broadly and reinforced regularly.
- Future iterations of the PAG should include funding streams to support a public information campaign to educate members of the public about key aspects of the Guidelines.
- Organizations and groups should attempt to relay messages about physical activity to older adults by using existing health networks to share information and advice about physical activity. Messages about physical activity in general may be as or more effective than messages focusing exclusively on the PAG per se.
- Initiatives such as the American Medical Association/American College of Sports Medicine “Exercise is Medicine” campaign should be explored as a mechanism for changing attitudes towards physical activity as a legitimate and essential component of medicine.
- Innovative strategies will be needed to reach the most sedentary and frail older adults. For example, organizations should consider reaching out to frail and home-bound seniors through home visits from home care aides, meals on wheels, physical therapists, etc.
- Organizations and groups should attempt to come to a consensus on standard phrasing for the PAG and use it regularly. Currently a number of terms are used interchangeably (30 min a day, 150 a week, 2 and ½ hours per week), which can be confusing to readers.
Increasing Commitment to the PAG among Organizations in the Aging Network
The following steps are needed in order to increase organizational buy-in and commitment across the Aging Network.
- It is important to conduct an environmental scan to identify Aging Network organizations already actively engaged in disseminating information about PAG.
- Key Aging Network organizations not currently addressing physical activity should be identified. These organizations should be invited to become more involved by joining coalitions and partnerships advocating for healthy and active aging.
- The existing PAG toolkit should be modified for use with older adults. The toolkit should be made available electronically to organizations within the Aging Network.
- PAG Older Adults fact sheets that are in the public domain and which can be co-branded for use by Aging Network organizations should be developed and disseminated.
- It is important to increase visibility of existing resources including the Be Active Your Way guide and the NIA Everyday Guide to Exercise and Physical Activity.
- All Aging Network organizations with a mission to promote active aging should be encouraged to become active participants in the National Physical Activity Plan.
Key Policy Targets Related to Physical Activity for Older Adults:
The expert group recognized that progress in disseminating information about physical activity in general and the PAG in particular is not likely to occur without specific policy changes in areas related to prevention and health. The following policy targets were identified.
- Include physical activity and chronic disease prevention as an integral part of the national health reform process.
- Work with participating groups and organizations to ensure that older adults feature prominently in the National Physical Activity Plan.
- Expand funding for the evidence-based prevention initiatives of the Administration on Aging.
- Seek congressional reauthorization for the PAG every five years and secure funding for a public information campaign related to PAG.
- Charge an Agency for Healthcare Research and Quality (AHRQ) Task Force to review the strength of clinical evidence related to the benefits of PA for older adults.
Next Steps: Moving Forward in the Absence of Substantial New Resources
The Expert Panel recognized that it is essential to continue to build on the momentum generated by the publication of the first-ever DHHS Physical Activity Guidelines for Americans. However, the specific road forward selected will inevitably depend on the availability of resources. The following strategies were identified as valuable steps that would increase the visibility of the PAG among older Americans.
- Create an electronic clearinghouse for sharing PAG information. The clearinghouse should include information for older adults themselves as well as support for Aging Network organizations.
- Disseminate a series of PowerPoint slides targeting individual older adults and health professionals that can be easily downloaded and co-branded.
- Combine the resources of existing national organizations by jointly developing posters, videos, and images related to the PAG.
- Share research outcomes and program success stories among Aging Network organizations. These vignettes could be used in newsletters, Web sites, and other social media.
- Schedule regular meetings of representatives of key groups and organizations at annual conferences.
- Develop and disseminate public domain consensus statements and issue briefs that can be used as a call to action (print/electronic/video)
Existing PAG and Physical Activity Resources Available in the Public Domain
The expert panel recognized that a significant amount of excellent resources about the PAG and related topics are already available online. A partial list of online resources and materials is below.
DHHS PAG Web site materials
PAG Homepage: http://www.health.gov/PAGuidelines/
Be Active Your Way: http://www.health.gov/PAGuidelines/adultguide/default.aspx
PAG Toolkit: http://www.health.gov/PAGuidelines/toolkit.aspx
Exercise & Physical Activity: Your Everyday Guide from the National Institute on Aging: http://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/
NIH Senior Health: http://nihseniorhealth.gov/
Administration on Aging
Evidence-Based Prevention Program: http://www.aoa.gov/AoA_Programs/HPW/Evidence_Based/index.aspx
President’s Council on Physical Fitness and Sports
National Physical Activity Plan
National Plan Homepage: http://physicalactivityplan.org/
National Plan Mission and Vision: http://physicalactivityplan.org/theplan.htm
AARP Health and Fitness
AARP Fitness Resources: http://products.aarp.org/discounts/fitness/
Exercise is Medicine Homepage: http://www.exerciseismedicine.org/
Online Exercise Screening Tool
EASY Screening Tool: http://www.easyforyou.info/
National Council on Aging
Center for Healthy Aging Homepage: http://www.healthyagingprograms.org/
Evidence-Based Programs: http://www.healthyagingprograms.org/content.asp?sectionid=32
2009 Expert Meeting Participants
Beattie, Lynn Bonita—National Council on Aging
Chodzko-Zajko, Wojtek—University of Illinois
DeMano, Angela—Human Kinetics Publishers
Earle, Roger—Human Kinetics Publishers
Holding, Brian—Human Kinetics Publishers
Hurley-Zarus, Suzanne—Centers for Disease Control and Prevention
Kruger, Judy—Centers for Disease Control and Prevention
Loughrey, Kay—Department of Health and Human Services
Malavasi, Leticia—University of Illinois
Melstrand, Graham—American Council on Exercise
Milner, Colin—International Council on Active Aging
Najib, Salva—University of Illinois
Ory, Marcia—Texas A&M University
Rogers, Michael—Wichita State University
Schwingel, Andiara—University of Illinois
Senior, Jane—American College of Sports Medicine
Whitehead, Jim—American College of Sports Medicine
This article is from Active Aging Today, July/August 2010. Subscribe to Active Aging Today.