Strategies That Work for Increasing Physical Activity

Community Strategies

The strategies listed in this section can help communities create social and physical environments that promote physical activity. Most of these strategies are recommended by the Community Preventive Services Task Force on the basis of systematic reviews of their effectiveness in increasing physical activity.²² The Community Preventive Services Task Force is an independent, nonfederal, unpaid panel of public health and prevention experts that provides evidence-based findings and recommendations about community preventive services, programs, and policies to improve health.

Individually Adapted Health Behavior Change Programs

Individually adapted health behavior change programs are tailored to each participant.²³ They aim to increase physical activity by teaching participants skills to help them add physical activity to their daily routines. These skills can include—

• Goal-setting and self-monitoring of progress toward those goals.
• Building social support for new behaviors.
• Behavioral reinforcement through self-reward and positive self-talk.
• Structured problem-solving to maintain the behavior change.
• Prevention of relapse into sedentary behavior.

Social Support Interventions in Community Settings

Social support interventions in community settings involve building, strengthening, and maintaining social networks in order to provide supportive relationships for behavior change.²⁴ Examples for physical activity could include walking clubs, buddy systems, or contracts with others to complete certain levels of physical activity.

Enhanced School-Based Physical Education

Enhanced school-based physical education (PE) involves changes that increase the amount of time that students in kindergarten through 12^th grade engage in moderate- or vigorous-intensity physical activity during PE classes.²⁷ Examples of these strategies include²⁵—

• Instructional strategies and lessons that increase physical activity, such as modifying the rules of games or substituting more active games for less active ones.
• Physical education lesson plans that incorporate fitness and circuit training activities.

Community-Wide Campaigns

Community-wide campaigns are highly visible, broad-based, multicomponent strategies that involve many sectors of the community in order increase physical activity, including social support, risk factor screening, and health education.²⁶

Community-Scale Urban Design and Land Use Policies

Community-scale urban design and land use policies include design elements designed to address the proximity of residential areas to stores, jobs, schools, and recreation areas; the connectivity of streets and sidewalks; and the aesthetic and safety aspects of the physical environment. Urban design and land use policies include zoning regulations, building codes, other government policies, and builders’ practices to promote physical activity.²⁷

Creation of or Enhanced Access to Places for Physical Activity

Worksites, coalitions, agencies, and communities can help create or enhance access to places for physical activity as part of their efforts to change the local environment to create opportunities for physical activity. Such changes include creating walking trails, building exercise facilities, or providing access to existing nearby facilities.²⁸

Street-Scale Urban Design and Land Use Policies

Street-scale urban design and land use policies support the efforts of urban planners, architects, engineers, developers, and public health professionals to change the physical environment of small geographic areas, generally limited to a few blocks, in ways that promote physical activity. For example, infrastructure projects can include design components that improve street lighting, increase safety of street crossing, use traffic-calming approaches (such as speed humps and traffic circles), or enhance street landscaping. Policy instruments can include building codes, roadway design standards, and environmental changes that promote physical activity.²⁹

Point-of-Decision Prompts to Encourage Use of Stairs

Point-of-decision prompts are motivational signs placed in or near stairwells or at the base of elevators and escalators to encourage people to use stairs more often. These signs inform people about the health or weight loss benefits of taking the stairs. They also remind people who are already predisposed to becoming more active (for health or other reasons) about an opportunity to do so.³⁰

Transportation and Travel Policies and Practices

Transportation and travel policies and practices that create or enhance pedestrian and bicycle networks and expand or subsidize public transit systems can be another approach to encourage walking and biking for transportation. Although the Community Preventive Services Task Force found insufficient evidence for these practices in 2004,³¹ more recent reviews conducted by the National Institute for Health and Care Excellence³² and the National Academies of Sciences, Engineering, and Medicine’s Transportation Research Board³³ found evidence that a variety of transportation policies offer effective ways to promote both leisure-time and transportation-related physical activity. Creating walkable communities around transit hubs can further encourage walking.^34,35

Clinical Strategies

Professional organizations and recommendations from the U.S. Preventive Services Task Force (USPSTF) indicate that health care professionals have a role to play in counseling their patients about physical activity. Professional organizations encourage counseling as part of routine care for patients.^37,38 Health care professionals can use the USPTF recommendations below to aid in patient counseling. USPSTF recommends physical activity as part of intensive behavioral counseling for adults who have cardiovascular risk factors and are overweight or have obesity and for children aged 6 or older with obesity.

USPSTF Recommendations Related to Physical Activity

USPSTF is an independent, volunteer panel of national experts who make evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications. Each recommendation receives a letter grade (A, B, C, or D) or an “I” statement that indicates insufficient evidence. This section summarizes the recommendations relevant to physical activity³⁹—

Healthful Diet and Physical Activity for Cardiovascular Disease Prevention in Adults with Cardiovascular Risk Factors: Behavioral Counseling
The USPSTF recommends offering or referring adults who are overweight or obese and have additional cardiovascular disease (CVD) risk factors to intensive behavioral counseling interventions to promote a healthful diet and physical activity for CVD prevention. Grade: B

Obesity in Adults: Screening and Management
The USPSTF recommends screening all adults for obesity. Clinicians should offer or refer patients with a body mass index (BMI) of 30 kg/m2 or higher to intensive, multicomponent behavioral interventions. Grade: B

Obesity in Children and Adolescents: Screening
The USPSTF recommends that clinicians screen children aged 6 years and older for obesity and offer them or refer them to comprehensive, intensive behavioral intervention to promote improvement in weight status. Grade: B

Resources for Physical Activity Counseling

The following resources provide additional information about recommendations for physical activity counseling—

• American Academy of Pediatrics: Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents
• American College of Sports Medicine: Exercise is Medicine
• CDC: Increasing Physical Activity Among Adults with Disabilities