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This symposium addressed the importance of selective partnering between public health and other sectors in order to enhance physical activity promotion. The speakers reviewed the potential benets of partnering, common partnering concerns and their remedies, and important tasks for developing successful partnerships. Key leadership practices and a framework for convening conversations with potential partners were presented. Motivations for industry, trade associations, and other partners to engage with public health to promote physical activity were discussed, and the importance of using stakeholder relationship management to engage partners was emphasized.
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S356
Journal of Physical Activity and Health, 2010, 7(Suppl 3), S356-S368
© 2010 Human Kinetics, Inc.
TRACK 4: COMMUNITY & PUBLIC HEALTH PROMOTION STRATEGIES
Powerful Partnering:
Courting New Realms
to Boost Global Physical
Activity Promotion
Becky H. Lankenau, Dianne Culhane,
and Maria Stefan
Lankenau is Director of the CDC/WHO Collaborating
Center for Physical Activity and Health, Centers for
Disease Control and Prevention, Atlanta, GA. Culhane
is the retired Global Director of Public Affairs and Com-
munications, The Coca Cola Company, and consultant
and coach for Comunica, Inc., Kiawah Island, SC. Stefan
is Managing Director of The ChaseAmerica Group,
Philadelphia, PA.
This symposium addressed the importance of
selective partnering between public health and
other sectors in order to enhance physical activ-
ity promotion. The speakers reviewed the poten-
tial benets of partnering, common partnering
concerns and their remedies, and important
tasks for developing successful partnerships.
Key leadership practices and a framework for
convening conversations with potential part-
ners were presented. Motivations for industry,
trade associations, and other partners to engage
with public health to promote physical activity
were discussed, and the importance of using
stakeholder relationship management to engage
partners was emphasized.
Keywords: leadership, stakeholder relationship,
public health
In an era of modest scal and human resources, creative
partnering has become an increasingly important avenue
to pursue both domestic and international physical activ-
ity (PA) promotion agendas. In an effort to hear from
leadership outside the public health sector on how to
build powerful new partnerships to enhance global PA
promotion, a symposium entitled “Powerful Partnering:
Courting New Realms to Boost Global Physical Activity
Promotion” was held at the 3rd International Congress on
Physical Activity and Public Health in Toronto, Canada,
May 2010.
This symposium was organized with 3 primary learn-
ing objectives: 1) to understand the respective potential
roles of partners outside public health in promoting PA
around the world; 2) to appreciate the respective motiva-
tions for industry, trade associations, and other potential
partners to engage with public health to promote PA; and
3) to learn effective approaches to collaborating with part-
ners outside public health. Dr. Becky Lankenau from the
Centers for Disease Control and Prevention presented an
overview of the potential benets of partnering, common
concerns raised by these relationships, and their remedies;
and the important tasks inherent in partnering. Ms. Dianne
Culhane, former Global Director for Public Affairs and
Communications at the Coca Cola Company and now a
Consultant and Coach with Comunica, Inc., presented
“Creative Communication Tools and Leadership Practices
to Promote Physical Activity Partnerships.” Ms. Maria
Stefan, Managing Director of The ChaseAmerica Group,
presented “Engaging the Best to Do the Most: Industry,
Trade Associations and Other Potential Allies.
Dr. Lankenau began by listing a number of potential
benets of partnering: 1) enhanced potential commitment
and policy support to PA promotion, 2) increased societal
acceptance and perception of added value of PA promo-
tion, 3) expanded dissemination reach for PA messages,
4) marketing expertise to formulate creative PA commu-
nication approaches, 5) scientic consensus on important
issues such as PA guidelines, 6) manpower resources for
training activities and technical assistance on domestic
and international projects, 7) expanded entry points to
effective PA promotion, 8) concentrated focus on various
determinants of and barriers to PA, 9) proactive dialogue
to anticipate changing contexts in which to promote PA
most effectively, 10) discovery of new technologies to
enhance PA training and promotion, and 11) funds for
conference support, research and program implementa-
tion. When partnering concerns such as exclusivity are
raised, these concerns can be remedied by establishing a
written agreement, creating a “round table “ of multiple
groups from the same sector or working with trade orga-
nizations, limiting corporate attribution and minimizing
visibility of potentially contentious products. Dr. Lanke-
nau concluded by emphasizing that to be successful in
partnering it is important to: maintain timely, positive,
constructive, ongoing dialogue; study the language,
culture and incentives of potential partners; proactively
study shifts in the priorities of potential partners; develop
attractive “marketing” materials for prospective partners;
and keep an open mind and a sense of humor.
Ms. Culhane focused on creative leadership practices
and a framework for convening conversations that can
Community & Public Health Promotion Strategies S357
foster innovation and new partnerships for promoting
physical activity. The key leadership practices include
• Curiosity: pursue genuine interest in others and other
perspectives, world views
• Creative orientation and current reality: focus on the
vision you want to achieve and develop an accurate
understanding of what currently and really exists
• Value my voice and our collective voice: speak your
truth, at the same time you value and tap the wisdom
of others
• Balance inquiry and advocacy: contribute powerful
questioning and learning toward exploration, at the
same time you communicate your perspective in a
way that can be heard
Use divergent and convergent thinking: invite differ-
ent viewpoints and disruption to invent new possibili-
ties as well as build powerful decisions, resolution
and commitment
• Serve as learner and expert: seek new capability and
freely share your experience and knowledge.
With the key leadership practices as a foundation,
the steps to convening productive conversations include
• Engage: clarify intention, examine current reality,
identify shared purpose and plan for inquiry
• Inquire: explore stories and experience, consider
interests, investigate multiple perspectives
Invent: identify options, disrupt old thinking,
co-create
• Commit: outline action, build agreement, capture
learning.
Maria Stefan indicated that why and how public
health agencies should work with companies, trade
associations and other potential allies from the business
sector to promote PA can be summarized in economic
terms, strategic branding motivations, corporate respon-
sibility, advocacy, market research and communications.
As more and more companies submerge their corporate
egos to focus more intensely on stakeholders, there
is an increased opportunity for public health and the
business sector to cooperate on activities that have
performance-based outcomes. The respective motiva-
tions for industry, trade associations and other partners
to engage with public health to promote PA are both acts
of self-interest and philanthropy. Expanding engagement
between the public and private sector can lead to new
learning and knowledge transfer, expertise and resource
sharing, access to specic populations, implementation
and promotion of work, school, family and community
activities, direct nancial support and constituency sup-
port of political advocacy initiatives.
Ms. Stefan emphasized that the PA approach to
engaging partners has to be rooted in a stakeholder rela-
tionship management system. Determining who wants
or needs to be involved, how their interests are affected,
when and how that involvement can be achieved and
whose participation and support are crucial to creating
this stakeholder management model, provides the basis
for developing collaborations.
Conclusion. This symposium addressed important
issues regarding partnering between public health and
other sectors in order to enhance PA promotion, and
provided practical guidance for developing successful
partnerships. The following are key points from the
symposium:
1. The benets to be gained by selective partnering
are substantial. However, successful partnering
requires time and commitment and, therefore, has
staff resource implications
2. Creative leadership practices, and a framework for
convening conversations, can foster innovation and
new opportunities for promoting PA
3. Successful engagement with partners requires a
stakeholder relationship model as the basis for
developing collaborations.
Acknowledgments
The authors gratefully acknowledge the assistance of Ms.
Madalena Soares in the preparation of this manuscript. The
views in this commentary are those of the authors and do not
necessarily represent the ofcial position of The Centers for
Disease Control and Prevention (CDC).
Health Promoting Schools:
The What, The Why
and, Yes! It Works!
Doug Gleddie, Antony Card,
Farida Gabbani, Louise Humbert, and
Mark Jones
Gleddie is with Ever Active Schools, Grant MacEwan
University, Edmonton, Alberta, Canada. Card is with
Memorial University, St. John’s, Newfoundland, Canada.
Gabbani is with the government of Nova Scotia. Hum-
bert is with the University of Saskatchewan, Saskatoon,
Saskatchewan, Canada. Jones is with the government of
Newfoundland.
This panel presentation sought to examine
the nature of the Health Promoting Schools
approach (HPS) and the role it plays in physi-
cal activity and health promotion. Each panelist
covered a related aspect of HPS including: a
S358 Symposia Summaries
general overview of the approach with a sum-
mary of relevant frameworks; an examination
of policy and government support for HPS; the
role of physical education; and assessment of
the impact of HPS.
Keywords: physical education, comprehensive
school health, policy, implementation, assess-
ment
The Health Promoting Schools approach (HPS) has
gained considerable momentum since the inception of
guidelines developed by the World Health Organization
in 1995.1 A recent meta-analysis of HPS2 concluded that
although evidence supports the efcacy of the approach,
not all HPS programs are effective. HPS interventions
that included physical activity were found to be among
the most effective along with healthy eating and mental
wellbeing. Given this prevalence, a panel presentation,
entitled “Health promoting schools: the what, the why
and yes it works,was held at the Third International
Congress for Physical Activity and Public Health in
Toronto, May 2010.
Physical and Health Education Canada has adopted
the 4 E’s (Education, Environment, Everyone, Evidence)
as a framework for effective implementation and assess-
ment of HPS. In this framework everyone (home, school
and community) is responsible for raising healthy chil-
dren: physically, emotionally and socially. Dr. Antony
Card from Memorial University (Newfoundland) pre-
sented an overview of the HPS approach, its development
and the 4 E’s. Ms. Farida Gabbani from the Department
of Health Promotion and Protection (Nova Scotia) pre-
sented the role of policy and government support. Dr.
Louise Humbert from the University of Saskatchewan
(Saskatchewan) presented the role of physical education
curricula in HPS. Mr. Doug Gleddie from Ever Active
Schools (Alberta) presented an examination of a district
level implementation and assessment of HPS.
Dr. Card presented a short history of HPS includ-
ing frameworks from Physical and Health Education
Canada (PHE Canada), the Joint Consortium for School
Health and the World Health Organization. Although the
frameworks are structured and worded differently, each
includes the same basic elements of HPS as illustrated
in the 4 E’s from PHE Canada.3 Education involves sup-
porting a culture of learning for all school community
members. Everyone means to collaborate in a meaningful
way with the people involved in the everyday life of the
school. Environment includes fostering safe social and
physical environments in the school, home and com-
munity and, implementing policies that enable healthy
active lifestyles. Evidence contains the concepts of col-
laboratively identifying goals, planning for action and
gathering information to indicate effectiveness. Dr. Card
concluded with an examination of the many applicable
theoretical frameworks for HPS and further reiterated
the concept that through HPS, health and learning are
interdependent.
As policy is identied in all the major HPS frame-
works, Ms. Gabbani highlighted the role of government in
supporting HPS through policy development. A number
of denitions and frameworks were presented to illus-
trate this link. In Canada, a federal/provincial/territorial
strategy includes a 4-point action plan to: approve a joint
policy statement; enhance collaboration; focus on after
school time (critical hours) and; coordinate social market-
ing. Ms. Gabbani shared a number of examples of both a
lack of policy in practice as well as strong policy-practice
links such as model school wellness policies. Although
attractive due to the potential for large reach and dispar-
ity reduction, policy development can be inuenced by
such factors as funding, political ideology and crises.
Policy development and implementation may be aided
by factors like communication and coordination from all
stakeholders; training; adequate resource support; and
learning lessons from policies like tobacco, seatbelts and
recycling. Ms. Gabbani further stated that policy is criti-
cal in the struggle to reduce inactivity and make physical
activity a part of everyday life.
Dr. Humbert rmly embedded physical education
(PE) as a critical element of the HPS model. Across
Canada, PE curricula are available to all students regard-
less of their socio-economic status, setting or background.
Essentially, the goal of PE is for students to gain the
knowledge, skills, and attitudes to lead an active, healthy
lifestyle. The emerging concept of physical literacy rec-
ognizes the important role of physical activity and educa-
tion to the growth and development of the whole person.
Dr. Humbert pointed out that while physical activity can
be dened as energy expenditure, PE is intended to build
student’s skills, knowledge, and attitudes. There are many
challenges to PE including curricular priorities, teacher
training, time, resources and facilities. Unfortunately,
PE has been in a state of decline in Canada. Given the
current inactive and unhealthy state of our society this
decline is ironic, tragic and senseless. Now more than
ever, we have evidence that PE plays a vital role and
policymakers should stop trying to justify cuts to PE; stop
arguing over whether PE is essential and; aggressively
make room for PE.4
Mr. Gleddie’s presentation focused on assessing
the impact of HPS. A short review of literature revealed
some strengths and gaps in what we know to be effec-
tive—especially in the area of local implementation.
Although there are multiple examples of HPS program-
ming across Canada, the focus of the presentation was on
the Battle River Project (BRP), a study on school district
level implementation of HPS.5 The BRP was designed to
examine how the school environment and health / educa-
tion outcomes of children and youth can be positively
improved when a HPS model, the Ever Active Schools
Program (EAS), is implemented with school district
support. A case study of the BRP revealed a number
of themes including: participation, coordination, and
integration (district implementation); and perceptions/
misconceptions, bottom up/top down, exible rigid-
ity, and the way we do business (health school policy
development). One example of success can be found in
Community & Public Health Promotion Strategies S359
the “Pyramid of Success” (Figure 1). Prior to the BRP,
health was not included in this critical graphic that denes
priorities and focus areas for all schools in the district.
Mr. Gleddie concluded with 3 key lessons from the BRP:
the value of building relationships; the importance of
effective communication and; the need to integrate health
into the school district culture.
More Collaboration—More
Power in Combating
Ill Health
Ilkka Vuori, Steven N. Blair, Fiona C. Bull,
and Peter T. Katzmarzyk
Vuo ri is wi th the Fi nn is h B one a nd Join t Ass oci at io n, He l-
sinki, Finland. Blair is with the Depts of Exercise Science
and Epidemiology/Biostatistics, Arnold School of Public
Health, University of South Carolina, Columbia, SC. Bull
is with the School of Population Health, University of
Western Australia, and Loughborough University, United
Kingdom. Katzmarzyk is with the Pennington Biomedical
Research Center, Baton Rouge, LA.
This symposium highlighted the position of
physical activity as one of the most important
factors causally related to common non-com-
municable diseases (NCDs), and discussed the
need for including physical activity in compre-
hensive prevention strategies and policies to
combat the major NCDs. Lifestyle factors such
as smoking, physical inactivity, and obesity
are all major risk factors for ischemic heart
disease, cerebrovascular disease, and several
cancers, and physical inactivity globally ranks
as the fourth leading risk factor for mortality.
Despite the solid evidence that physical activity
is related to several NCDs, stronger advocacy
actions are required because physical activity is
not viewed as a national priority in most coun-
tries. Much progress has been made on physical
activity surveillance as well as the development
of national policies, action plans and physical
activity guidelines. However, in most countries
there is a need for more workforce develop-
ment across all sectors and robust evaluation of
actions to build the evidence base on program
effectiveness.
Keywords: chronic disease, risk factors, physical
activity, tness
The aim of this symposium was to highlight the position
of physical activity as one of the most important factors
causally related to the most common non-communicable
chronic diseases (NCDs), and to discuss the need for and
progress of including physical activity in comprehensive
prevention strategies and policies to combat the major
NCDs.
The most recent data from the World Health Organi-
zation (WHO) indicate that physical inactivity globally
ranks as the fourth leading risk factor accounting for 3.2
million deaths annually and 5.8% of all deaths.1 In addi-
tion to global gures, Dr. Steven Blair presented data
from 41,000 men and 13,000 women in the Aerobics
Figure 1 – Battle River School Division Pyramid of Success.
The panel shared a variety of perspectives on the
HPS approach and highlighted a number of critical
components. While all panelists recognized the efcacy
of the HPS approach, there was an acknowledgement of
the need for continued research, development and critical
implementation of the approach.
Acknowledgments
Special thanks to Sharon May of PHE Canada for organizing
the panel. This panel presentation was made possible by funding
from Physical and Health Education Canada.
References
1. WHO. Regional guidelines: Development of health pro-
moting schools: a framework for action (Health Promoting
Schools, Series 5). Manila: WHO Regional Ofce for the
Western Pacic; 1996.
2. Stewart-Brown, S. What is the evidence on school health
promotion in improving health or preventing disease and,
specically, what is the effectiveness of the health promot-
ing schools approach? Health Evidence Network Report.
Copenhagen: WHO Regional Ofce for Europe; 2006.
3. Ever Active Schools. Framework and action plan.
Retrieved January 19, 2010, from: http://everactive.org/
framework-action-plan
4. Trost, SG, van der Mars, H. Why we should not cut PE.
Health and Learning. 2009;67:60-65.
5. Gleddie DL, Melnychuk, NE. An introduction to the
Battle River Project: District implementation of a health
promoting schools approach. Physical and Hlth Ed J.
2010;75:24-29.
S360 Symposia Summaries
Center Longitudinal Study indicating that in this U.S.
cohort the attributable fraction of poor cardiorespiratory
tness for all-cause mortality, adjusted for all of the other
risk factors, was 15.9% among men and 17.1% among
women.2 T he co rr es po nd in g p op ul at io n a tt ri but ab le fr ac -
tions among men were 14.7% for hypertension, 7.9% for
smoking, 3.8% for high cholesterol, 3.7% for diabetes,
and 2.6% for obesity, and among women 9.1% for smok-
ing, 6.9% for hypertension, 3.1% for obesity, 2.6% for
diabetes, and 1.6% for high cholesterol. This example and
data from other studies support the observations made by
Jeremy N. Morris in 1994 that “physical activity is the
best buy for public health,” and that of Blair from 2009,
“Physical inactivity: the biggest public health problem of
the 21st century.” The evidence shows convincingly that
physical activity should be given much more attention
than currently in developing, implementing, and funding
strategies and policies to combat ill health in all parts of
the world.
The urgent need to increase physical activity was
presented by Dr. Fiona Bull who outlined the broad
principles and key components of successful population-
based approaches to promoting increased participation
in physical activity. Substantial progress has been made
on developing strategies, tools and means to increase PA
based on sound theoretical basis. Good examples of this
work are now in the published literature sharing evalua-
tion of policy implementation and between country policy
comparisons. Several global (eg, GAPA, Agita Mundo),
regional (eg, HEPA Europe, RAFA-PANA in the Ameri-
cas, and APPAN in Western Pacic and South-East Asia),
and national networks are at work developing the work-
force, sharing experiences and resources, and supporting
more effective methods for advocacy and promotion of
PA. Although much progress has been made, much more
remains to be done. Dr Bull’s nal call was for stronger
advocacy actions because physical activity is not viewed
as a national priority, despite the solid evidence. Good
guidance for this work is available in the Toronto Charter
for Physical Activity.3
Dr. Peter Katzmarzyk emphasized the need to tackle
several risk factors in a coordinated fashion in combating
NCD´s, because many of them share the same underly-
ing risk factors. Thus, lifestyle factors such as smoking,
physical inactivity, and obesity are all major risk factors
for ischemic heart disease, cerebrovascular disease, and
several cancers. Further, physical inactivity and obesity
are major contributors to the growing epidemic of type 2
diabetes, and excessive use of alcohol increases the risk
of several common diseases and injuries. One example
of the increased awareness of the importance of several
behaviors inuencing a group of diseases is the develop-
ment of a new concept, “ideal cardiovascular health,” by
the American Heart Association.5 “Ideal cardiovascular
health” is dened by the presence of 4 ideal health behav-
iors (non-smoking, body mass index <25 kg/m2, physical
activity at goal levels, and pursuit of a diet consistent with
current recommendations) and 3 health factors (untreated
total cholesterol <200 mg/dL, untreated blood pressure
<120/80 mm HG, and fasting blood sugar <100 mg/dL).
Thus, the behavioral factors are now placed above the
traditional biological risk factors.
In order to be successful in inuencing these and
other unhealthy behaviors, new and expanded strategies
and policies are needed to inuence the social, psycho-
logical, and economical determinants of the various
behaviors at population, individual, and environmental
levels. Development, implementation, and funding of
such strategies and policies calls for much more extensive
collaboration and networking of much greater number of
institutions, organizations, and individuals than exists
today. Promising signs of this kind of development can
be seen in the functions of various networks and pro-
grams. As an example, the American Cancer Society,
American Diabetes Association, and American Heart
Association issued a joint Scientic Statement in 2004
which targeted the prevention of cancer, cardiovascular
disease and diabetes.4
In his concluding remarks, Dr. Vuori pointed out to
the need to apply the principles and strategies of both
health promotion and social marketing in the efforts
to increase physical activity. The principles of health
promotion can be directly applied to physical activity
promotion: building public policy that includes physical
activity on the agenda of policy makers in all sectors and
at all levels; creating environments supportive of physical
activity; strengthening community actions in favour of
physical activity; developing personal skills enhancing
adoption of physical activity as a part of life; and reori-
enting of services that support people to become and be
physically active. Also the strategies of social marketing
apply well to physical activity promotion. One key issue
is to create a win-win situation with the partners. Until
now physical activity has been advocated and promoted
mainly from outside, by persons involved in physical
activity professionally or otherwise, to be included into
the functions of other organizations or sectors, such as
health, transport, education, urban planning and environ-
ment. Too often the selling arguments have focused too
much on the interests of ourselves and not to those more
relevant to the other parties. These weaknesses can be
decreased by nding the needs, goals, and motives of
the partners, and by building a win-win strategy on this
basis. A second way to decrease the outside-approach
is to create knowledge, expertise, partners, and allies
as individuals, groups, and organizations, within the
partners so that they can advance their goals through
physical activity.
References
1. Wor ld He al th Or ga ni za ti on . Global health risks: mortality
and burden of disease attributable to selected major risks.
Geneva: World Health Organization; 2009.
2. Blair SN. Physical inactivity: the biggest public health
problem of the 21st century. Br J Sports Med. 20 09; 43: 1-2 .
3. The Toronto Charter for Physical Activity. A Call to
Action. http://www.globalpa.org.uk
Community & Public Health Promotion Strategies S361
4. Eyre H, Kahn R, Robertson RM, et al. Preventing cancer,
cardiovascular disease, and diabetes: a common agenda
for the American Cancer Society, the American Diabetes
Association, and the American Heart Association. Stroke.
2004;35:1999-2010.
5. Lloyd-Jones DM, Hong Y, Labarthe D, et al. Dening and
setting national goals for cardiovascular health promotion
and disease reduction. The American Heart Association’s
strategic impact goal through 2020 and beyond. Circula-
tion. 2010;121:586-613.
Lessons Learned
from Around the World:
ACSM’s Global Promotion
of Innovation in Physical
Activity and Health
Thomas M. Best, Russell Pate,
Adrian Hutber, James Pivarnik,
Melinda Millard-Stafford
The authors are with the American College of Sports
Medicine.
This symposium addressed the state of innova-
tion in physical activity and health through 3
U.S. initiatives, each of which has beneted
from the experience and involvement of orga-
nizations and individuals around the world. The
U.S. National Physical Activity Plan, Exercise
is MedicineTM, and Exercise is Medicine™ on
Campus, were described in detail. Information
on the origins, innovative programming and
global inuence on each program was discussed.
The importance of a call to action for a more sys-
tematic approach to unite health, globalization,
and innovation was underscored throughout the
symposium.
Keywords: physical activity, innovation, global,
Exercise Is Medicine, ACSM American Fitness
Index
Innovation, the translation of the new and effective into
widespread use, is critical to all 21st century endeavors.
This is especially so for physical activity and public
health, which became clear in 2002 when the World
Health Assembly called for a global approach to reduce
deaths and disease worldwide by improving diet and pro-
moting physical activity. This global approach required
new systems of discovery, broader collaborations, and
worldwide diffusion of new knowledge, effective practice
and policy. The Assembly’s 2004 endorsement of the
World Health Organization’s Global Strategy on Diet,
Physical Activity and Health launched a new era of
innovation in physical activity and health.1
The symposium began with Dr. Thomas Best of the
Ohio State University presenting an overview on the
global prevalence of physical inactivity and low tness
levels, and their roles as determinants of mortality and
morbidity. Three U.S. initiatives with features that were
informed by previous efforts from around the world
were highlighted: the U.S. National Physical Activity
Plan, presented by Dr. Russell Pate of the University
of South Carolina; Exercise is MedicineTM (EIM) as a
Global Initiative, presented by Dr. Adrian Hutber of the
American College of Sports Medicine (ACSM), and
The Healthy and Active University through the EIM on
CampusTM initiative, presented by Dr. James Pivarnik
of Michigan State University. In addition, Dr. Melinda
Millard-Stafford of the Georgia Institute of Technology
outlined approaches to the worldwide expansion of inno-
vation in physical activity and health. Dr. Pate presented
on the U.S. National Physical Activity Plan (the Plan),
addressing its origins in the call of the World Health
Organization for member countries to develop plans of
action in physical activity. The need for a U.S. Physical
Activity Plan was formally indentied in 2006 at a multi-
organizational roundtable convened by the ACSM.2 Dr.
Pate summarized the process by which teams developed
strategies and tactics for 8 societal sectors, and reviewed
252 national physical activity plans from 56 countries to
identify effective approaches and lessons learned.
Dr. Pate noted that a 2009 planning conference
brought together more than 200 experts, providing an
invaluable international perspective. The Plan, compris-
ing 52 strategies and 215 tactics, was launched in May
2010. World experience also underscored the need for
effective evaluation, large-scale collaboration, and novel
approaches at local, state and national levels.
Dr. Hutber discussed EIM, an initiative launched by
the ACSM and the American Medical Association in 2007
(www.exerciseismedicine.org). EIM seeks to mobilize
health care providers to act on the importance of physical
activity to public and patient health. The initiative asks
health care providers to prescribe exercise to patients/
clients or to refer them to qualied health professionals
for further counseling. Dr. Hutber noted that success
depends on the health care providers’ ability to quickly,
capably and comfortably address physical activity as a
“vital sign” and to refer patients to appropriate resources,
as well as on patients’ expectations that providers address
physical activity for health promotion and disease preven-
tion. Dr. Hutber announced that while EIM is already a
global effort with agreements to promote the program in
Latin America, Europe, Asia, Africa, and Australia, June
2010 marks the ofcial launch of EIM as a global initia-
tive. He underscored that EIM is customized to reect the
realities of lifestyle-based health promotion and disease
prevention and to respect national and cultural traits.
Dr. Pivarnik addressed the EIM on Campus initiative,
involving universities and colleges worldwide. EIM on
Campus promotes lifelong physical activity and healthy
S362 Symposia Summaries
lifestyles among students, faculty, administrators, and
staff, as well as the institution’s surrounding community.
He reviewed how EIM on Campus was inspired and
informed by international innovative experiences. Dr.
Pivarnik mentioned the Health Promoting University
program of the World Health Organization, the Healthy
Universities movement in England and the Asian Healthy
Universities Initiative. As examples of EIM on Campus
efforts in the U.S., he cited programs at Chatham Uni-
versity in Pittsburgh, PA, Mississippi State University
in Starkville, MS, and Lakeland College in Sheboygan,
WI. Dr. Pivarnik indicated that EIM on Campus will seek
international collaboration and will focus on innovative
strategies such as a University Wellness Recognition
Program to encourage large-scale adoption of health-
promotion efforts on campuses.
Dr. Millard-Stafford reviewed the strategies of inno-
vation and diffusion of ACSM’s initiatives and its many
collaborators around the world. She overviewed ACSM’s
new sub-specialty associations, such as the International
Association for Worksite Health Promotion, and ACSM’s
global partnerships, such as with the Physical Activity
Network of the Americas, Agita Mundo, and the Physi-
cal Fitness Research Laboratory of Sao Caetano do Sul
(CELAFISCS). Dr. Millard-Stafford highlighted the
ACSM American Fitness Index™ (AFI), which mea-
sures, ranks and publicizes the health and tness status
of major-population U.S. communities (www.american-
tnessindex.org). AFI encourages and provides resources
to those communities to make improvements. She noted
that the initiative’s infrastructure and methodology are
being considered by Mexico and other countries.
Conclusion and Knowledge Translation. This sym-
posium addressed the interplay of physical activity and
health, globalization and innovation. It constituted a
call to action for a more systematic approach to unite
these factors. Key points from the symposium included
1. Shared global collaboration is vital to needed
progress in physical activity and health. ACSM and
other similar organizations are dedicated to such
international partnerships
2. Innovative programs for physical activity
promotion can be implemented on a global scale,
but consideration must be given to the unique
characteristics of each region or community
3. Global integration of physical activity into the
discussion of prevention and treatment of disease
depends upon the engagement of all sectors: health
care providers, tness professionals, government,
academia, research science, and the public.
Acknowledgments
The symposium was organized and sponsored by the American
College of Sports Medicine (www.acsm.org), which is a non-
prot membership association of more than 45,000 members
and certied professionals in over 60 countries that has focused
on the scientic, medical, and public health aspects of physical
activitysince its founding in 1954.
References
1. World Health Organization. Global Strategy on Diet,
Physical Activity and Health. World Health Organization.
http://www.who.int/dietphysicalactivity/strategy/eb11344/
strategy_english_web.pdf. Published May, 2004. Accessed
June, 2010.
2. American College of Sports Medicine. Charting and
changing the policy landscape: promoting physical activity
& reversing physical inactivity through policy solutions. A
policy roundtable of national leaders dedicated to improv-
ing the public’s health. 2006.
Latest Findings
on Built Environments
and Physical Activity
in Diverse Countries: IPEN
James F. Sallis, Jacqueline Kerr,
John C. Spence, Chris Gidlow,
and Shigeru Inoue
Sallis is with San Diego State University, San Diego,
CA. Kerr is with the University of California, San Diego.
Spence is with the University of Alberta, Edmonton,
Alberta, Canada. Gidlow is with Staffordshire University,
Stoke-on-Trent, England. Inoue is with Tokyo Medical
University, Tokyo, Japan.
Evidence of environmental correlates of physi-
cal activity from many countries is needed to
guide international environmental change
efforts, but international evidence is limited. The
International Physical Activity and Environment
Network (IPEN) was developed to support and
coordinate studies in numerous countries. The
symposium highlighted new studies from inves-
tigators in the IPEN network. About 12 countries
are participating in a coordinated study that fea-
tures common designs and measures. Associa-
tions between built environments and walking
found previously in a few countries were shown
to generalize to 4 Japanese cities and a Canadian
city with extremely cold weather. A UK study
showed that IPEN-related studies can produce
additional benets of helping to explain why
some areas have high rates of chronic disease,
and this information can help target preven-
tive services. Growing international evidence
can guide policy changes within countries and
internationally to create built environments that
are more supportive of physical activity.
Community & Public Health Promotion Strategies S363
Keywords: exercise, ecological models, inter-
national, walkability
Physical inactivity is the fourth leading cause of death
worldwide,1 and global strategies to increase physical
activity identify built environment changes as critical
components.2 Evidence of environmental correlates
of physical activity from many countries is needed to
guide international environmental change efforts, and
though the international evidence is limited, it indicates
strong environment—physical activity associations.3
The International Physical Activity and Environment
Network (IPEN) was developed to support and coordinate
studies in numerous countries. The purpose of the sym-
posium was to highlight new results from investigators
in the IPEN network. Dr. Jacqueline Kerr (University of
California, San Diego, USA) began with an overview of
IPEN. Dr. John C. Spence (University of Alberta, Canada)
reported on a study in Canada, Dr. Shigeru Inoue (Tokyo
Medical University, Japan) reported on a study in 4 cities
in Japan, and Dr. Chris Gidlow (Staffordshire University,
England) presented a study conducted in England.
Dr. Kerr reported that IPEN began in 2004 to
encourage and support international studies of built
environments and physical activity. Studies conducted in
single countries are likely to have limited environmental
variation, thus underestimating associations with physi-
cal activity. Using common designs and measures will
allow pooling of results across countries and provide
more accurate estimates of effect sizes that can be used
to guide policy changes. IPEN has supported investiga-
tors to obtain local grants based on common methods,
and more than 12 countries are participating in the
coordinated study. A grant from the National Cancer
Institute in the US is supplementing individual country
grants and supporting the compilation and analysis of the
combined data. The IPEN website is available at www.
ipenproject.org.
Dr. Spence reported on a survey of 1205 adult
residents of Edmonton, Canada. Results revealed that
respondents living in highly walkable neighborhoods
were more likely to report walking 4 or more days per
week than those living in low walkable neighborhoods
(adjusted OR = 1.35, 95% CI 1.05–1.73). Therefore, the
walkability of neighborhoods was associated with the
frequency of walking among people living in a northern
Canadian city.
Dr. Gidlow presented data from the UK demon-
strating how IPEN-related research has been used to
link physical activity to health outcomes of people in
specic geographic locations. National data-sets showed
association of physical activity with early (<75 years)
cardiovascular disease mortality and prevalence of Type
II diabetes. At the small area level, physical activity was
associated with hospital episodes for the treatment of
cardiovascular disease and endocrine disorders. Future
analyses will incorporate the role of the built environ-
ment, assessed with more detail than most previous
studies. This research is being used locally to support
policy and environmental change to enhance the role of
physical activity in primary prevention.
Dr. Inoue reported on one of the rst studies of
built environments and physical activity in Asia. A
population-based study of 1481 adults was conducted
in 4 cities in Japan that varied widely in built environ-
ment characteristics. Total walking time was associated
with residential density, walking/cycling facilities, and
neighborhood aesthetics. Walking for daily errands was
consistently associated with residential density, land use
mix-diversity, and land use mix-access, while walking
for leisure was consistently associated with aesthetics.
Expected associations between environment and daily
step counts were not observed. Associations between
neighborhood environment and walking were generally
consistent with studies in Western countries. This is
important evidence of generalizability, because both the
built environment and culture are distinct in Japan from
the countries where previous studies were conducted.
Conclusions. Research on built environments and
physical activity is rapidly progressing around the
world. The studies reported in the present symposium
were complemented by another symposium at ICPAPH
chaired by Dr. Neville Owen that featured IPEN-related
ndings from 4 additional countries.4 The presenta-
tions in the present symposium support the following
conclusions:
1. It is feasible to conduct international studies of
environments and physical activity using common
methods, even when adapting measures for local
conditions. The country-specic data can inform
local policies, and IPEN is supporting investigators
to communicate results to policy makers
2. The Canadian findings of strong associations
between neighborhood walkability and walking
generally replicated results other cities. The study
indicated that walkability applies to a city with
extreme weather
3. Studying physical activity in specific types of
built environments can have additional benets of
helping to explain why disease rates are high in some
areas. Such data can lead to improved targeting of
preventive services and health care delivery
4. Patterns of association between built environment
attributes and physical activity in multiple domains
documented in Western countries appear to generalize
to Japan, despite differences in culture and built
environments.
Acknowledgments
The following individuals contributed to the presented papers:
Nicole Bracy, Terry Conway, Kelli Cain, Carrie Geremia, and
Marc Adams (San Diego State University); Nicoleta Cutsumisu,
Ronald Plotnikoff, Christopher Blanchard (University of
Alberta); Rachel Davey, Tom Cochrane, Graham Smith
S364 Symposia Summaries
(Staffordshire University); Yumiko Ohya, Yuko Odagiri,
Tomoko Takamiya, Kaori Ishii, Makiko Kitabayashi, Kenichi
Suijo, Teruichi Shimomitsu (Tokyo Medical University).
Sallis received funding from the National Institutes of Health
(NIH) Grant R01 CA127296. Kerr received funding from
the NIH Grant R01 CA127296. Spence received funding
from the Social Sciences and Humanities Research Council
(SSHRC), 410-2005-2348. Gidlow received funding from the
Medical Research Council NPRI Project grant G0501287.
Inoue received funding from a Grant-in-aid from the Ministry
of Health, Labour, and Welfare of Japan (Comprehensive
Research on Prevention of Cardiovascular Diseases and Other
Lifestyle Related Diseases: H19-Junkankitou-Ippan-008 and
H20-Junkankitou-Ippan-001) and a Grant-in-aid for scientic
research (C): 17590556 from the Japan Ministry of Education,
Culture, Sports, Science, and Technology.
References
1. Wor ld He al th Or ga niz at io n. Global health risks: mortality
and burden of disease attributable to selected major risks.
Geneva, Switzerland; Author: 2009.
2. Wor ld He al th Org an iz at io n. A guide for population-based
approaches to increasing levels of physical activity: imple-
mentation of the WHO global strategy on diet, physical
activity and health. Geneva, Switzerland; Author: 2007.
3. Sallis JF, Bowles HR, Bauman A, Ainsworth BE, Bull
FC, et al. Neighborhood environments and physical
activity among adults in 11 countries. Am J Prev Med.
2009;36:484-490.
4. Owen N, Mitas J, Sarmiento OL, et al. Identifying the
built-environment determinants of physical activity and
sedentary behaviour: emerging international evidence. J
Phys Act Health. 2010;7(Supp. 3):S364–S366.
Identifying the Built
Environment Determinants
of Physical Activity
and Sedentary Behavior:
Emerging International
Evidence
Neville Owen, Josef Mitáš,
Olga Lucia Sarmiento, Rodrigo Reis,
Takemi Sugiyama
Owen and Sugiyama are with the University of
Queensland, Brisbane, Australia. Mitáš is with Palacky
University, Olomouc, Czech Republic. Sarmiento is with
the Universidad de los Andes, Bogota, Colombia. Reis
is with Pontiff Catholic University of Parana, Curitiba,
Brazil.
This Symposium brought together European,
South American and Australian researchers con-
ducting studies in collaboration with IPEN (the
International Physical Activity and the Environ-
ment Network project). IPEN is supported by
a grant from the US National Cancer Institute,
and is gathering internationally-comparable
data on objectively-assessed and perceived
environmental attributes, self-reported and
objectively measured physical activity and
sedentary behavior, and a range of relevant
personal, social, and community attributes,
using a common protocol. Pooled analyses
of the data from participating IPEN countries
will allow examination of the impact of a wide
range of environmental conditions on physical
activity and obesity. Symposium presentations
highlighted opportunities provided by studies in
countries with widely-varying social, economic,
and environmental conditions to which their
populations are exposed, which may impact on
physical activity and obesity in different ways.
An approach to identifying the potential role
of built environment attributes in inuencing
sedentary behavior (too much sitting as dis-
tinct from too little physical activity) was also
presented. Potential implications of these new
approaches and data sources for environmental-
change and public health policy development
initiatives to promote more-active lifestyles at
national and international levels were discussed.
Keywords: walking, bicycling, sitting, land use,
automobile congestion
Objectively-Assessed Environmental Facto rs, Meth-
odological Approaches, and New Findings on Envi-
ronmental Correlates of Physical Activity in Regional
Towns in the Czech Republic. Few studies have been
published describing features of the socio-economic
and built environment related to physical activity levels
for residents of the Czech Republic.1 These analyses
are necessary to inform national health policies and to
support building more physical activity-friendly envi-
ronments. This is not common in the Czech Republic,
although the government supports research and has the
results showing trends across the nation. As the central
European countries develop, they copy the negative trends
in lifestyle from more developed countries: nevertheless,
there is apparent development in strategies to support
physical activity (cycling paths, new facilities etc.).
Evidence on relationships between built environment
and physical activity is new, and there is a great potential
for this research, due to excellent data on environmental
characteristics. In the Czech Republic, physical activity
appears to be higher in smaller towns, which tend to
have safer neighborhoods and access to forest trails, in
comparison to larger cities where walking distances to
many destinations may be longer due to the size of the
city. The IPEN project provides great possibilities for
investigators with different sources for comparisons of
environmental determinants of physical activity. Mitáš
introduced the variety of sources available in the Czech
Community & Public Health Promotion Strategies S365
Republic for GIS analyses and also described details of
the IPEN study currently being conducted.
New Evidence on the Built Environment Correlates of
Physical Activity Behaviors in Urban Areas of Colom-
bia. Bogotá, the capital of Colombia and home to
some 7 million inhabitants, is recognized for advanc-
ing sustainable transport, increasing the green area per
inhabitant and the Ciclovia program in which 121 km of
the main avenues of the city are closed to motor vehicles
on Sundays and holidays from 6 a.m. to 2 p.m. and
opened solely for pedestrians and cyclists. This presen-
tation showed the results of multi-level cross-sectional
studies2,3 whose objectives were to assess associations
between objective built environment characteristics and
walking behaviors among adults aged 18–64 years and
those older than 65 years. Among the younger adults
walking for transport was positively associated with
street density, connectivity and the presence of bus rapid
transit (TransMilenio) stations in the neighborhood, but
was negatively associated with a slope 4% and the pres-
ence of feeder stations. Among the older adults, walking
was positively associated with density of parks, safety
perception and with availability of the Ciclovia corridor,
but was negatively associated with a slope 5% and the
connectivity index. In Bogotá, a rapidly urbanizing city
in Latin America, built environment characteristics of the
neighborhood were associated with walking behaviors.
The associations differed according to age groups; how-
ever, mixed land use, which has been found to be associ-
ated with walking in developed countries, did not emerge
as signicant. The IPEN project will provide a unique
opportunity to assess longitudinally and with acceler-
ometers a subsample of 500 adult residents of Bogota.
Findings will guide future efforts to promote physical
activity in rapidly urbanizing developing countries.
Characterizing Relevant Environmental and Social Fac-
tors, and Their Associations With Physical Activity in
Curitiba, Brazil. Latin America as other regions in the
world is facing many problems typically present in urban
agglomerations such as trafc congestion, loss of public
space and adverse environmental impacts. Despite this
common scenario the evidence on the impact of the built
environment on physical activity in this region is limited.
For this reason the need for increasing the evidence on
this association is primordial. Curitiba is a State Capital
in southern Brazil and in the last decade it has been
internationally recognized for its efforts to deal such
problems by increasing green spaces and preservation
areas and also providing an innovative public transport
system. These characteristics, along with the provision
of parks and recreational areas, have been linked with
positive perceptions on physical activity attributes and
higher levels of activities. More recently the use of
secondary information on the city’s built environment
attributes has been successfully linked to recommended
physical activity levels (150 min/week) in the commu-
nity, and social norms and socio-economic conditions
were strong moderators of the relationships.4 This sug-
gests the need for both perceived and objective measures
to explore associations between physical activity and the
built environment. Although use of measures of walkabil-
ity seems to be feasible, its relationship with the social
aspects of community needs to be better explored. The
IPEN project will provide a unique opportunity to explore
these issues in the Latin American context.
Identifying Built-Environment Attributes Associated
With Sedentary Behavior. Sugiyama addressed the
conceptual and methodological issues in identifying
built environmental attributes associated with sedentary
behavior. There is a substantial body of research on envi-
ronmental attributes conducive to active lifestyles, and
sitting is behavior relevant to active lifestyles. Recent
research has shown that prolonged sitting to be a health
risk, independent of physical activity. Thus, in order to
have a greater impact on population health through envi-
ronmental modications, there is a need to also examine
potential links between the environment and sedentary
behavior. Recent Australian evidence suggests that, at
least for women, residents of low-walkable communi-
ties spend more time watching television.5 The case for
time spent sitting in cars was presented, as this is highly
prevalent behavior with known health consequences.
Abundant data are potentially available for this purpose,
in the form of household travel surveys.
Conclusions. Overall, this Symposium explored con-
ceptual, methodological, and cultural considerations
to be addressed when conducting built environment-
physical activity studies in different countries; unique
and common environmental attributes; how research can
take into account variations in cultural, social and eco-
nomic conditions; understanding the different research
focuses and different levels of research support needed in
different countries; and, potential implications of these
new ndings for environmental-change and public health
policy development initiatives to promote more-active
lifestyles at national and international levels.
Acknowledgments
IPEN: International Study of Built Environment, Physical
Activity, and Obesity. NIH Grant R01 CA127296. Owen and
Sugiyama: NHMRC Program Grant (#301200) and Queensland
Health Core Research Infrastructure. Mitas: Physical activity
and inactivity of the inhabitants of the Czech Republic in the
context of behavioral changes; # PR: 6198959221 from the
Ministry of Education, Youth, and Sports of the Czech Republic.
References
1. Frömel K, Mitáš J, Kerr J. The associations between
active lifestyle, the size of a community and SES of the
adult population in the Czech Republic. Health & Place.
2009;15:447-454
2. Parra D, Goméz LF, Pratt M, Samiento OL, Triche E,
Mosquera J. Policy and built environment changes in
Bogotá and their importance in health promotion. Indoor
Built Environ. 2007;16:344–348.
3. Gómez LF, Sarmiento OL, Parra DC, Schmid T, Pratt
M, Jacoby E, Neiman A, Cervero R, Mosquera J, Rutt,
C., Ardila M, Pinzón JD. Characteristics of the built
S366 Symposia Summaries
environment associated with leisure-time physical activity
among adults in Bogotá, Colombia: a Multilevel Study. J
Phys Act Health. 2010;7:S181-S195.
4. Reis RS, Hallal PRC, Parra D, et al. Promoting physical
activity through community-wide policies and plan-
ning: Findings from Curitiba, Brazil. J Phys Act Health.
2010;7:137-145.
5. Sugiyama T, Salmon J, Dunstan DW, Bauman AE, Owen
N. Neighborhood walkability and TV viewing time among
Australian adults. Am J Prev Med. 2007;33:444-449.
Sparking Change to Tackle
Childhood Obesity: Local
Advocacy in Action
in Ontario’s Communities
Sharon Brodovsky, Andrea Endicott, Larry
Ketcheson, Barbara Thompson,
and Vonnie Barron
Brodovsky is Senior Manager, Spark Together for Healthy
Kids, Heart and Stroke Foundation of Ontario, Canada.
Endicott is Community Mission Specialist, Heart and
Stroke Foundation of Ontario, Canada. Ketcheson is
Chief Executive Ofcer, Parks and Recreation Ontario,
Canada. Thompson is Founder and Lead of the Faith
Health Initiative. Barron is a Specialist with Spark
Together for Healthy Kids, Heart and Stroke Foundation
of Ontario, Canada.
This symposium proled Spark Together for
Healthy Kids™, the Heart and Stroke Founda-
tion of Ontario’s advocacy based initiative to
address childhood obesity. It highlighted the
role and contribution of advocacy to create
sustainable physical activity opportunities for
children and improve the health of future gen-
erations. Specically, the symposium provided
an overview of Spark Together for Healthy Kids;
advocacy practices for healthy school policy
development; effective partnership success
between Parks and Recreation Ontario and the
Heart and Stroke Foundation; and an example of
a Spark Advocacy Grant success story in Faith
communities.
Keywords: obesity, children, health promotion,
advocacy, policy
The health of children in Ontario, Canada is in a precari-
ous position. Twenty-eight percent of Ontario children
are now overweight or obese, a number greater than the
national average. In Canada over the past 25 years, the
rate of childhood obesity has tripled and 26% of Canadian
children are either overweight or obese.1 Already, 2 out
of 3 youth between the ages of 12 and 19 years have at
least 1 risk factor for cardiovascular disease and 1 in 4
have 2 risk factors.2 Th e i ss ue of chi ld re n’s he al th is c om -
pounded by the many barriers that prevent children from
being active and eating healthy foods. Spark Together for
Healthy Kids™ (Spark) is the Heart and Stroke Founda-
tion of Ontario’s response to the growing epidemic of
childhood obesity. It is an Ontario-wide initiative focused
on working together to inspire individuals, families, com-
munities, businesses, and government to spark collective
change to help children become more physically active
and eat healthier foods.
The symposium was organized with the goal of
providing a summary of the role and contribution of advo-
cacy to create sustainable physical activity opportunities
for children and improve the health of future generations.
Spark Together for Healthy Kids was established by
the Foundation in 2006, and following a public launch in
2009, quickly gained momentum by garnering partners,
funding grassroots advocacy projects, and assessing
community priorities for future advocacy work. The
symposium outlined the need for partnerships, the work
required to make them successful, as well as advocacy
practices for healthy school policy development. It
emphasized the importance of making a difference at
the community level in order to create the sustainable,
impactful change required to make progress in the ght
against childhood obesity. The session included examples
of successful partnerships and success stories from the
Foundation’s Spark Advocacy Grants, a unique grants
competition which provides nancial support to groups
to implement advocacy initiatives to increase physical
activity and/or access to healthy eating opportunities for
children across Ontario.
The 4 main topics were an overview of Spark
Together for Healthy Kids by Sharon Brodovsky (Heart
and Stroke Foundation of Ontario); advocacy practices
for healthy school policy development by Andrea Endi-
cott (Heart and Stroke Foundation of Ontario); effective
partnership success between Parks and Recreation
Ontario and the Heart and Stroke Foundation by Larry
Ketcheson (Parks and Recreation Ontario) and Sharon
Brodovsky; and an example of a Spark Advocacy Grant
success story by Barbara Thompson of the Faith Health
Initiative (Toronto, Ontario).
Spark is the Heart and Stroke Foundation of Ontar-
io’s strategy calling for public policies that encourage and
enable children to be physically active and have access
to healthy foods, recognizing that every sector of society
needs to play a part in creating sustainable solutions. The
mission of Spark is to create social change that has a sus-
tainable impact on the health and well-being of children.
To date, Spark has awarded more than 100 Spark
Advocacy Grants totaling more than $1 million, acquired
more than 22,000 signatures of public support, including
12,000 fans on Facebook. The combined effort of Spark
and its 170 national, provincial, and regional partners
have revealed that Ontarians believe childhood obesity
is a serious societal issue which is largely shaped by the
Community & Public Health Promotion Strategies S367
environment. In order to see change, public policy should
focus on accessibility of healthy food and affordable
recreation for children and youth.
A location with enormous potential for meaningful
change is schools. Referencing 5 Spark Advocacy Grant
school-based projects, Andrea Endicott highlighted
some of the key themes for successful advocating within
school settings. These included: identify correct timing
and uniqueness of your community; engage stakeholders
and students throughout the process; respect teachers and
administrators and align with their current responsibili-
ties; provide evidence-based research to promote simple
and clear “asks” and messages, and know that throughout
the process, it is vital to maintain sustainable partnerships,
involve the community and share success.
Larry Ketcheson and Sharon Brodovsky jointly pre-
sented on the partnership between Parks and Recreation
Ontario (PRO) and the Heart and Stroke Foundation of
Ontario. Partnerships are a critical element of the Spark
strategy, and PRO is one of its earliest partners. Results of
the partnership have included more comprehensive con-
tent in background research and policy issues, integration
and expansion of networks leading to increased message
distribution, and enhanced credibility. The combined
effort contributed to the establishment of a framework for
affordable and accessible recreation policy for Ontario.
The work of the Spark Advocacy Grants demon-
strates that real change is happening. One such story
was presented by Barbara Thompson of the Faith Health
Initiative (FHI). The Faith Communities and Health:
Mobilizing Healthy, Active Sunday Schools project
reached out to an initial 8 churches in Toronto to advocate
for increased physical activity for children. The project
made contact with church pastors and garnered their sup-
port in bringing physical activity to faith congregations.
After 3 years of working together and strengthening
partnerships, over 50 churches are now engaged with
the Faith Health Initiative. While each church is at a
different stage of development, all have embraced the
responsibility to include increased physical activity in
their mandates.
In conclusion, some important themes can be drawn
from this symposium. First, advocacy is a powerful tool
with a critical role in creating sustainable physical activ-
ity and healthy eating opportunities for children. Second,
partnerships are an essential aspect of successful advo-
cacy. Third, healthy school policy has the potential to be
one of the main avenues for improved childhood health
and nally, when advocating on any issue it is essential
to engage both the policy makers and those affected by
the policy.
References
1. Tremblay M, Shields M, Laviolette M, Craig CL, Janssen I,
Gorber SC. Fitness of Canadian children and youth: results
of the 2007-2009 Canadian health measure survey. Health
Reports (Statistics Canada 82-003). 2010;21:1-14.
2. Public Health Agency of Canada. Tracking Heart Disease
and Stroke in Canada 2009. Av a i l a b le a t : w w w. p h a c - a s pc .
gc.ca
... [17][18][19] Most studies of built environments have been conducted in the USA, Australia and Western Europe, with recent studies extending findings to Japan, 20 Colombia, 21 and Brazil. [22][23][24] Though the results have been mostly consistent, common methods were not employed, self-report measures of physical activity and environmental attributes dominated, and the limited variability in environmental exposures and physical activity within countries may have underestimated the strength of association. The 11-country International Prevalence Study that included common methods and a wide range of environments 25 found stronger associations with physical activity, compared with single-country studies that have limited variability. ...
... For example, perceptions of safety are reported in the context of expected norms. Because of the specificity of associations between environmental attributes and domains of physical activity and the emerging sedentary-behavior domain, 22 it is important to apply more detailed self-report measures of physical activity in multiple domains in international studies. By 2004, the use of a common protocol, with state-of-thescience measures and methods to maximize variability in environments was shown to be feasible in the USA, 29 Australia, 30 and Belgium. ...
... Studies from several other countries have been published, demonstrating the international relevance of built environments to physical activity but revealing somewhat-discrepant results that can only be resolved through international studies with comparable methods. 22,24,37 Establishing an International Network. Before proposing an international study, we first developed an international network to assess interest and build capacity for conducting a comparable study across countries. ...
Article
Background: National and international strategies to increase physical activity emphasize environmental and policy changes that can have widespread and long-lasting impact. Evidence from multiple countries using comparable methods is required to strengthen the evidence base for such initiatives. Because some environment and policy changes could have generalizable effects and others may depend on each country's context, only international studies using comparable methods can identify the relevant differences. Methods: Currently 12 countries are participating in the International Physical Activity and the Environment Network (IPEN) study. The IPEN Adult study design involves recruiting adult participants from neighborhoods with wide variations in environmental walkability attributes and socioeconomic status (SES). Results: Eleven of twelve countries are providing accelerometer data and 11 are providing GIS data. Current projections indicate that 14,119 participants will provide survey data on built environments and physical activity and 7145 are likely to provide objective data on both the independent and dependent variables. Though studies are highly comparable, some adaptations are required based on the local context&period; CONCLUSIONS&colon; This study was designed to inform evidence-based international and country-specific physical activity policies and interventions to help prevent obesity and other chronic diseases that are high in developed countries and growing rapidly in developing countries.
... zmiňování limity náhodného výběru ve výzkumu zastavěného prostředí bylo kontrolovatelné. Praktické převedení výsledku na poli tickou vůli zemí je další důležitý krok, kterým by se celý systém podpory aktivního a zdravého životního stylu v optimálních podmínkách nutně měl ubírat (Owen, Mitáš, Sarmiento, Reis, & Sugiyama, 2010). Další státy, které nebyly v době podání grantu schopné plnit všechny cíle, postupně vstupují do obdobných výzkumů a za pojují se do získávání dalších informací o environmentálním vlivu na PA a životní styl v různých kulturněsociálních a ekonomických podmínkách. ...
Book
Full-text available
The main domain of this publication is the linking of international research approaches with national specifics in the assessment of physical activity of the population living in different neighborhood environments. Long-term monitoring of key indicators and trends in lifestyle is one of the ways to anchor the issue in health prevention. The need for a multidisciplinary approach declares the need to specify the sub-layers of ecological model of health behavior. The publication highlights the complexity of the work on research surveys between 2005 and 2012. It should serve to professionals and the general public to get an overview of the basic correlates of physical activity in the adult population of the Czech Republic. Its mission is to preview the question of the future role of physical activity in the society within the context of politics and neighborhood environments.
... Studies in Bogota, Colombia, where a similar transit system exists (referred to as "feeder buses") have reported inverse relationships between walking for transport and feeder buses. 48 A potential strategy for physical activity promotion in Cuernavaca could be to designate and enforce the use of formal bus stops with enough distance between each other. ...
Article
Environmental factors have been associated with specific physical activity domains, including leisure-time and transport physical activity, in some high income countries. Few studies have examined the environmental correlates for domain-specific physical activity in low-and middle-income countries, and results are inconsistent. We aimed to estimate the associations between perceived environment and self-reported leisure-time walking, moderate-to-vigorous leisure-time physical activity and transport physical activity among adults living in Cuernavaca, Mexico. A population-based study of adults 20 to 64 years old was conducted in Cuernavaca, Mexico in 2011 (n = 677). Leisure and transport physical activity was measured using the International Physical Activity Questionnaire – Long Form. Perceptions of neighborhood environment were obtained by questionnaire. Hurdle regression models estimated the association between environmental perceptions and participation and time spent in each physical activity domain. High perceived aesthetics were positively correlated with participation and time spent in leisure-time walking and moderate-to-vigorous physical activity. SES differences existed for aesthetics in relation to participation in leisure-time walking. Participation in transport physical activity was positively associated with easy access to large parks, while closer distance to large parks was a negative correlate for participation and time-spent in this physical activity domain. Results suggest that perceived environmental characteristics related with physical activity are domain specific. High perceived aesthetics were an important correlate for leisure-time activities among Mexican adults, suggesting that policy strategies aimed at improving this environmental perception may be warranted. Patterns of associations between environmental correlates and transport physical activity differed from those reported in commonly studied high income countries.
... Most studies of physical activity and built environments have been conducted in the USA, Australia and Western Europe, with recent studies extending findings to Japan [1], Colombia [2], China [3], Brazil [4], and elsewhere [5,6]. Though there have been important consistencies in the results [7], it is not possible to interpret different patterns of association by country because common methods were not employed. ...
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b>Background : The IPEN (International Physical Activity and Environment Network) Adult project seeks to conduct pooled analyses of associations of perceived neighborhood environment, as measured by the neighborhood Environment Walkability Scale (NEWS) and its abbreviated version (NEWS-A), with physical activity using data from 12 countries. As IPEN countries used adapted versions of the NEWS/NEWS-A, this paper aimed to develop scoring protocols that maximize cross-country comparability in responses. This information is also highly relevant to non-IPEN studies employing the NEWS/NEWS-A, which is one of the most popular measures of perceived environment globally. Methods : The following countries participated in the IPEN Adult study: Australia, Belgium, Brazil, Colombia, Czech Republic, Denmark, Hong Kong, Mexico, New Zealand, Spain, the United Kingdom, and the United States. Participants (N = 14,305) were recruited from neighborhoods varying in walkability and socio-economic status. Countries collected data on the perceived environment using a self- or interviewer-administered version of the NEWS/NEWS-A. Confirmatory Factor Analysis (CFA) was used to derive comparable country-specific measurement models of the NEWS/NEWS-A. The level of correspondence between standard and alternative versions of the NEWS/NEWS-A factor-analyzable subscales was determined by estimating the correlations and mean standardized difference (Cohen’s d) between them using data from countries that had included items from both standard and alternative versions of the subscales. Results : Final country-specific measurement models of the NEWS/NEWS-A provided acceptable levels of fit to the data and shared the same factorial structure with six latent factors and two single items. The correspondence between the standard and alternative versions of subscales of Land use mix – access, Infrastructure and safety for walking/cycling, and Aesthetics was high. The Brazilian version of the Traffic safety subscale was highly, while the Australian and Belgian versions were marginally, comparable to the standard version. Single-item versions of the Street connectivity subscale used in Australia and Belgium showed marginally acceptable correspondence to the standard version. Conclusions : We have proposed country-specific modifications to the original scoring protocol of the NEWS/NEWS-A that enhance inter-country comparability. These modifications have yielded sufficiently equivalent measurement models of the NEWS/NEWS-A. Some inter-country discrepancies remain. These need to be considered when interpreting findings from different countries.
... Studies in Bogota, Colombia, where a similar transit system exists (referred to as "feeder buses") have reported inverse relationships between walking for transport and feeder buses. 48 A potential strategy for physical activity promotion in Cuernavaca could be to designate and enforce the use of formal bus stops with enough distance between each other. ...
Article
Introduction: There is compelling evidence linking physical activity with environmental characteristics in high-income countries, but evidence among low- and middle-income countries is scarce and results are inconsistent. This study assessed associations between perceived measures of the built environment and objectively measured physical activity among Mexican adults. Methods: A population-based study of adults aged 20-65 years was conducted in Cuernavaca, Mexico, in 2011 (N¼629). Participants wore an accelerometer for 7 days. Perceived environment data were obtained by questionnaire. In 2014, multiple regression models estimated the association between perceived environmental variables and total moderate to vigorous physical activity (MVPA); MVPA within 10-minute bouts was analyzed using a two-part model. Results: Easy access to neighborhood parks and close proximity to metropolitan parks were positively associated with total MVPA. Proximity to metropolitan parks was also positively related to any MVPA within bouts among women. High perceived aesthetics among those of low SES and high perceived safety from crime among men were positively associated with total MVPA and MVPA within bouts. Having few cul-de-sacs within the neighborhood and proximity to transit stops were inversely related to total MVPA. Conclusions: Access to parks, aesthetics, and safety from crime are important correlates of physical activity among Mexican adults. Yet, this study finds no association for other environmental features usually thought to be important for increasing activity levels. These findings highlight the importance of conducting more studies in low- and middle-income countries that examine the relationship between physical activity and the built environment.
... Most studies of physical activity and built environments have been conducted in the USA, Australia and Western Europe, with recent studies extending findings to Japan [1], Colombia [2], China [3], Brazil [4], and elsewhere [5,6]. Though there have been important consistencies in the results [7], it is not possible to interpret different patterns of association by country because common methods were not employed. ...
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Background The IPEN (International Physical Activity and Environment Network) Adult project seeks to conduct pooled analyses of associations of perceived neighborhood environment, as measured by the Neighborhood Environment Walkability Scale (NEWS) and its abbreviated version (NEWS-A), with physical activity using data from 12 countries. As IPEN countries used adapted versions of the NEWS/NEWS-A, this paper aimed to develop scoring protocols that maximize cross-country comparability in responses. This information is also highly relevant to non-IPEN studies employing the NEWS/NEWS-A, which is one of the most popular measures of perceived environment globally. Methods The following countries participated in the IPEN Adult study: Australia, Belgium, Brazil, Colombia, Czech Republic, Denmark, Hong Kong, Mexico, New Zealand, Spain, the United Kingdom, and the United States. Participants (N = 14,305) were recruited from neighborhoods varying in walkability and socio-economic status. Countries collected data on the perceived environment using a self- or interviewer-administered version of the NEWS/NEWS-A. Confirmatory Factor Analysis (CFA) was used to derive comparable country-specific measurement models of the NEWS/NEWS-A. The level of correspondence between standard and alternative versions of the NEWS/NEWS-A factor-analyzable subscales was determined by estimating the correlations and mean standardized difference (Cohen’s d) between them using data from countries that had included items from both standard and alternative versions of the subscales. Results Final country-specific measurement models of the NEWS/NEWS-A provided acceptable levels of fit to the data and shared the same factorial structure with six latent factors and two single items. The correspondence between the standard and alternative versions of subscales of Land use mix – access, Infrastructure and safety for walking/cycling, and Aesthetics was high. The Brazilian version of the Traffic safety subscale was highly, while the Australian and Belgian versions were marginally, comparable to the standard version. Single-item versions of the Street connectivity subscale used in Australia and Belgium showed marginally acceptable correspondence to the standard version. Conclusions We have proposed country-specific modifications to the original scoring protocol of the NEWS/NEWS-A that enhance inter-country comparability. These modifications have yielded sufficiently equivalent measurement models of the NEWS/NEWS-A. Some inter-country discrepancies remain. These need to be considered when interpreting findings from different countries.
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To investigate associations between neighbourhood greenspace and weight status, and to explore the contribution of physical activity to these associations. Cross-sectional observational study over two time-periods. Participants were adults (aged 18 years+) in from a nationally representative sample of the English population for the time periods 2000-2003 (n=42,177) and 2004-2007 (n=36,959). Weight status was defined as body mass index (BMI) category according to WHO classification. Neighbourhood greenspace was measured using the Generalised Land use Database for England that defines greenspace as parks, open spaces and agricultural land, excluding domestic gardens. Multinomial logistic regression models were used to estimate associations between neighbourhood greenspace and BMI and, in eligible sub-samples, to investigate the contribution of total physical activity to these. All models were adjusted for age, sex, social class, economic activity, neighbourhood income deprivation and urban/rural status. In 2000-2003 there was a counterintuitive association between greenspace and BMI. Residence in the greenest areas was significantly associated with increases in overweight (12%) and obesity (23%). In 2004-2007, there was a small protective effect of greenspace for those living in the greenest areas, but this was not statistically significant. Markers of total physical activity did not attenuate associations. Tests for interactions with urban/rural status confirmed that significant associations between neighbourhood greenspace and obesity were only present in urban areas in 2000-2003. Better evidence for the utility of greenspace in the prevention of weight gain is required before greenspace interventions are developed.
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Community programs have been suggested to be an important and promising strategy for physical activity (PA) promotion. Limited evidence is available regarding knowledge of and participation in these programs in Latin America. To describe participation in and knowledge of community PA programs and to explore associations with leisure-time PA in the city of Curitiba, Brazil. A cross sectional telephone survey was conducted among adults in Curitiba, Brazil (n = 2097). The International Physical Activity Questionnaire was used to determine levels of PA, and specific questions were used to evaluate the extent to which respondents knew about or participated in the programs conducted by the municipality. Logistic regression was used to assess the meeting of PA recommendations in leisure time based on program knowledge and participation. Knowledge of PA programs was high (91.6%) and 5.6% of population participated in the programs. After adjusting for individual characteristics, exposure to Curitiba's PA community programs was associated with leisure-time PA (POR = 2.9, 95% CI = 2.9-3.0) and walking for leisure (POR = 2.4; 95% CI = 2.3-2.4). The associations were stronger among men than among women. Knowledge and participation in Curitiba's community PA programs were associated with meeting recommended levels of PA in leisure time.
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The fitness of Canadian children and youth has not been measured in more than two decades, a period during which childhood obesity and sedentary behaviours have increased. This paper provides up-to-date estimates of the fitness of Canadians aged 6 to 19 years. Data are from the 2007-2009 Canadian Health Measures Survey (CHMS), the most comprehensive direct health measures survey ever conducted on a nationally representative sample of Canadians. Descriptive statistics for indicators of body composition, aerobic fitness and musculoskeletal fitness are provided by sex and age group, and comparisons are made with the 1981 Canada Fitness Survey (CFS). Fitness levels of children and youth have declined significantly and meaningfully since 1981, regardless of age or sex. Significant sex differences exist for most fitness measures. Fitness levels change substantially between ages 6 and 19 years. Youth aged 15 to 19 years generally have better aerobic fitness and body composition indicators than 20- to 39-year-olds. This decline in fitness may result in accelerated chronic disease development, higher health care costs, and loss of future productivity.
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There is an increasing interest in establishing the influence of urban environments on health. The importance of changes to environmental policy in order to promote physical activity has been emphasized during recent years. Bogotá, the capital of Columbia, is recognized as a Latin American leader in its creation of a more activity friendly environment. The city has undergone a number of urban and social changes which have resulted in a positive effect on the recovery of public spaces, access to recreational facilities, and promotion of non-motorized and public transportation options. These changes may have enhanced perceptions of quality of life and facilitated increased physical activity. The experience of Bogotá could be used as a potential example for leaders of other cities to encourage similar programs.
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Even though there is increasing evidence that the built environment (BE) has an influence on leisure-time physical activity (LTPA), little is known about this relationship in developing countries. The objective of this study was to assess the associations between objective built environment characteristics and LTPA. A cross-sectional multilevel study was conducted in 27 neighborhoods in which 1315 adults aged 18-65 years were surveyed. An adapted version of the IPAQ (long version) was used to assess LTPA. Objective BE characteristics were obtained using Geographic Information Systems. Associations were assessed using multilevel polytomous logistic regression. Compared with inactive people, those who resided in neighborhoods with the highest tertile dedicated to parks (7.4% to 25.2%) were more likely to be regularly active (POR = 2.05, 95% CI = 1.13-3.72; P = 0.021). Those who resided in neighborhoods with presence of TransMilenio stations (mass public transportation system) were more likely to be irregularly active (POR = 1.27, 95% CI = 1.07-1.50, P = 0.009) as compared with inactive people. These findings showed that park density and availability of TransMilenio stations at neighborhood level are positively associated with LTPA. Public health efforts to address physical inactivity should consider the potential influences of urban planning and mass public transportation systems on health.
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Understanding environmental correlates of physical activity can inform policy changes. Surveys were conducted in 11 countries using the same self-report environmental variables and the International Physical Activity Questionnaire, allowing analyses with pooled data. The participating countries were Belgium, Brazil, Canada, Colombia, China (Hong Kong), Japan, Lithuania, New Zealand, Norway, Sweden, and the U.S., with a combined sample of 11,541 adults living in cities. Samples were reasonably representative, and seasons of data collection were comparable. Participants indicated whether seven environmental attributes were present in their neighborhood. Outcomes were measures of whether health-related guidelines for physical activity were met. Data were collected in 2002-2003 and analyzed in 2007. Logistic regression analyses evaluated associations of physical activity with environmental attributes, adjusted for age, gender, and clustering within country. Five of seven environmental variables were significantly related to meeting physical activity guidelines, ranging from access to low-cost recreation facilities (OR=1.16) to sidewalks on most streets (OR=1.47). A graded association was observed, with the most activity-supportive neighborhoods having 100% higher rates of sufficient physical activity compared to those with no supportive attributes. Results suggest neighborhoods built to support physical activity have a strong potential to contribute to increased physical activity. Designing neighborhoods to support physical activity can now be defined as an international public health issue.
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