List the the six steps to the CDCs Physical Activity Evaluation Framework? At what phase of the PA program should evaluation

SECOND EDITION FOUNDATIONS OF PHYSICAL

ACTIVITY AND PUBLIC HEALTH

Harold W. (Bill) Kohl, III, PhD University of Texas

Health Science Center at Houston University of Texas at Austin

Tinker D. Murray, PhD Texas State University

Deborah Salvo, PhD Washington University in St. Louis

Library of Congress Cataloging-in-Publication Data Names: Kohl, Harold W., III., 1960- author. | Murray, Tinker Dan,

1951-author. | Salvo, Deborah, 1983- author. Title: Foundations of physical activity and public health / Harold W.

Kohl, III, PhD, University of Texas at Austin, Tinker D. Murray, PhD., Texas State University, Deborah Salvo, PhD, Washington University in St. Louis.

Description: Second edition. | Champaign, IL : Human Kinetics, [2020] | Includes bibliographical references and index.

Identifiers: LCCN 2019027467 (print) | LCCN 2019027468 (ebook) | ISBN 9781492589976 | ISBN 9781492592822 (epub)

Subjects: LCSH: Exercise. | Public health. | Health promotion– methods.

Classification: LCC GV481 .K548 2020 (print) | LCC GV481 (ebook) | DDC 613.7/1–dc23

LC record available at https://lccn.loc.gov/2019027467 LC ebook record available at https://lccn.loc.gov/2019027468

ISBN: 978-1-4925-8997-6 (print)

Copyright © 2020 by Harold W. Kohl, III, Tinker D. Murray, and Deborah Salvo

Copyright © 2012 by Harold W. Kohl, III, and Tinker D. Murray

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CONTENTS

PREFACE ACCESSING THE WEB RESOURCE ACKNOWLEDGMENTS

PART I    INTRODUCTION TO PHYSICAL ACTIVITY AND PUBLIC HEALTH

1         FUNDAMENTALS OF PUBLIC HEALTH

Defining Moments in Public Health

Areas of Specialization in Public Health

Core Functions of Public Health

Public Health Law

2         FUNDAMENTALS OF KINESIOLOGY Kinesiology Subdisciplines and Exercise Training

Principles of Exercise Training, Prescription, and Planning

Applying Physical Activity and Exercise Training Principles

Health and Fitness Benefits of Physical Activity and Exercise

3         INTEGRATING PUBLIC HEALTH AND PHYSICAL ACTIVITY

History of Physical Activity and Public Health

Role of Physical Activity in Chronic Disease Development

From Science to Practice and Back

Promoting Physical Activity for Health

Practitioners of Physical Activity in Public Health

4         MEASURING PHYSICAL ACTIVITY Evidence-Based Recommended Levels of Physical

Activity for Health

Laboratory Measures of Energy Expenditure

Electronic Devices to Measure Physical Activity

Direct Observation Techniques

Self-Report Instruments

Surveillance in Populations

Combining Measurement Approaches

PART II   HEALTH EFFECTS OF EXERCISE AND PHYSICAL ACTIVITY

5         CARDIORESPIRATORY AND METABOLIC HEALTH

Prevalence of Cardiovascular Disease

Risk Factors for Cardiovascular Disease

Kinesiology and Cardiorespiratory Health

Cardiorespiratory Fitness Assessments

General Recommendations for Cardiorespiratory Health

Prevalence and Economic Costs of Metabolic Disease

Metabolic Disease Risk Factors

Kinesiology and Metabolic Health

Common Tests of Metabolic Function

General Recommendations for Metabolic Health

6         OVERWEIGHT AND OBESITY Caloric Balance

Prevalence of Obesity and Overweight and Associated Health Consequences

Obesity and Overweight Risk Factors

Obesity and Overweight Challenges

Kinesiology and Body Weight

Common Assessments of Obesity and Overweight

Physical Activity Guidelines for a Healthy Weight

7         MUSCULOSKELETAL AND FUNCTIONAL HEALTH

Prevalence of Musculoskeletal Disorders and Related Health Challenges

Risk Factors Associated With Musculoskeletal Disorders and Associated Health Challenges

Kinesiology and Musculoskeletal Health

Common Tests of Musculoskeletal Fitness or Function

Physical Activity and Musculoskeletal Health

Functional Health

Risk Factors for Poor Functional Health

Common Tests of Functional Health

Fitness Recommendations for Functional Health

8         CANCERS Prevalence of Cancers

Cancer Risk Factors

Kinesiology and Cancers

Physical Activity Among Cancer Survivors

Physical Activity Guidelines for Cancer Prevention

9         BRAIN HEALTH Prevalence and Economic Costs of Brain Health

Disorders

Common Brain Health Conditions

Risk Factors Associated With Brain Health Disorders

Physical Activity and Brain Health

Physical Activity and Brain Cognitive Function

Physical Activity Guidelines for Brain Health

10      HEALTH RISKS OF EXERCISE AND PHYSICAL ACTIVITY

Musculoskeletal Injuries

Kinesiology and Musculoskeletal Injuries

Sudden Adverse Cardiac Events

PART III STRATEGIES FOR EFFECTIVE PHYSICAL ACTIVITY PROMOTION

11      INFORMATIONAL APPROACHES FOR PROMOTING PHYSICAL ACTIVITY

Understanding the Community Guide

Rationale for Informational Approaches

12      SCHOOL-BASED APPROACHES TO PROMOTING PHYSICAL ACTIVITY

Rationale for School-Based Physical Activity Programs

Kinesiology and Physical Activity Outcomes for Youth

School-Based Physical Activity and Physical Fitness Assessments of Youth

Physical Activity in Children and Adolescents

International and National Trends in Youth Physical Activity Levels

School-Based Physical Education

Developmental Considerations for Physical Activity in Youth

13      BEHAVIORAL AND SOCIAL APPROACHES TO UNDERSTANDING AND PROMOTING PHYSICAL ACTIVITY

Behavioral Theories and Theoretical Models of Behavior Change

Social Support for Health Behavior Change

Individually Adapted Health Behavior Change Programs

Socioecological Model of Behavior

Social Support Interventions in Community Settings

14      ENVIRONMENTAL AND POLICY APPROACHES TO PROMOTING PHYSICAL ACTIVITY

Access

Urban Design

Measuring the Built Environment

Physical Activity Policy

Land Use Policy

Co-Benefits of Activity-Promoting Environments and Policies

15      PROGRAM AND POLICY EVALUATION FOR PHYSICAL ACTIVITY AND PUBLIC HEALTH

Ways to Measure Program and Policy Effectiveness

Logic Models for Physical Activity Promotion and Policies

Evaluation Designs

Data Collection and Analysis

Disseminating Results

16      PARTNERSHIP DEVELOPMENT AND ADVOCACY

Key Factors in Building Partnerships

Strategies for Physical Activity Advocacy

GLOSSARY INDEX ABOUT THE AUTHORS

PREFACE

Welcome to Foundations of Physical Activity and Public Health, Second Edition. This text is a collection of the concepts that define the emerging field of physical activity and public health. Much like the more established fields (i.e., the effects of nutrition and smoking on public health), physical activity and public health has its roots in the grafting of two other fields. In this case, public health scientists and exercise scientists have come together to create an opportunity to improve health through research and promotion of physical activity. Methods and evidence from the public health sciences (epidemiology, health promotion, behavioral science, and environmental health) and kinesiology (exercise physiology, the movement sciences, and sport and exercise psychology), combined with a crucial eye on health policy, constitute our field. Although nothing can be substituted for experience, this text offers the background and introduction to the tools needed for the planning, implementation, and evaluation of physical activity promotion programs. This is the first textbook of its kind designed for a semester-long course in the field.

Few singular health behaviors can have as broad an impact on the health of individuals and populations as physical activity. The scientific base is growing and solidifying regarding the effects of physical activity on all-cause morbidity and mortality due to multiple noncommunicable diseases such as heart disease, some cancers, diabetes, and osteoporosis.

It is a very exciting time of growth in physical activity and public health. The seminal scientific works of Dr. Jeremy N. Morris and Dr.

Ralph S. Paffenbarger Jr. helped set the stage for what is now a worldwide focus on advancing the science, as well as reducing physical inactivity and promoting the benefits of regular physical activity for the prevention and treatment of chronic diseases and other health challenges. As the science and practice advance, physical activity is receiving increased attention from policy and organizational decision makers worldwide, including governmental ministers of health. Professional societies have been created to focus on advancing the research and practice of the field, the scientific literature has expanded dramatically on multiple fronts, and physical activity and inactivity are becoming parts of health policy decisions at all levels. An outstanding example is the Toronto Charter for Physical Activity: A Global Call to Action. This advocacy tool drives policies worldwide that are supportive of the role of physical activity in promoting health.

HOW THIS BOOK IS ORGANIZED Foundations of Physical Activity and Public Health is organized into three parts and 16 chapters.

PART I: INTRODUCTION TO PHYSICAL ACTIVITY AND PUBLIC HEALTH Part I introduces concepts of public health, kinesiology, and measurement. The chapters in this part highlight fundamentals of each and how they have come together.

Chapter 1 introduces the fundamentals of public health and provides information about the various subdisciplines of public health and how public health differs from medicine. Finally, there is a discussion about how public health policy is often linked to the legal and regulatory system, as well as discussion of an emerging specialization in public health.

The fundamentals of kinesiology are discussed in chapter 2. In the past, exercise was studied and often promoted as a means of enhancing maximal performance rather than promoting basic health

benefits for all. The components of exercise training are presented as well as the methods for applying them to target populations. The general health, fitness, and performance effects of physical activity and exercise are discussed. A final section presents ways to integrate traditional exercise prescription into physical activity and exercise programs.

Chapter 3 focuses on the emergence of the subdiscipline of physical activity and public health. Examples of the interdisciplinary interest in the field of physical activity and public health are reviewed and the knowledge, skills, and aptitudes for careers in physical activity and public health are provided.

In chapter 4, the importance of measuring physical activity is introduced, and the strengths and weaknesses of various laboratory and field methods are discussed. Overviews of the following techniques are included: indirect calorimetry, doubly labeled water, wearable devices, direct observation, and self-report instruments. Observational techniques such as physical activity surveillance and sources of data-based comparison are also discussed.

PART II: HEALTH EFFECTS OF EXERCISE AND PHYSICAL ACTIVITY The scientific base of the health effects of physical activity and inactivity is remarkable in its size and complexity. It continues to grow each year, and the overwhelming evidence for the health benefits and risks of physical activity provides much of the rationale for action.

Cardiovascular and metabolic diseases and their association to physical activity are presented in chapter 5. The chapter starts with a discussion of the prevalence and economic costs of cardiovascular and metabolic diseases. Specific physiological, biomechanical, and behavioral adaptations to physical activity and exercise are also identified. Common testing methodologies for predicting and diagnosing metabolic disease are provided. The evidence for the effect of physical activity on cardiorespiratory and metabolic disease is discussed.

Chapter 6 contains common definitions for overweight and obesity and a discussion about the prevalence (U.S. and worldwide) and the economic costs of these conditions. A discussion of caloric balance is included, and the contributions that physical activity and exercise have on balance-related issues are highlighted. The various risk factors associated with overweight and obesity are discussed, and specific physiological, biomechanical, and behavioral adaptations to physical activity and exercise are identified. Methods for assessing body composition are provided. The effects of physical activity on weight loss, weight maintenance, and weight regain are discussed along with the physical activity guidelines for achieving caloric balance and a healthy weight.

Chapter 7 focuses on musculoskeletal disorders and functional health. The risk factors, prevalence, and economic costs of musculoskeletal disorders and disability are discussed. Specific physiological, biomechanical, and behavioral adaptations to physical activity and exercise are provided. Common testing methodologies for muscle function and functional health are included. The evidence for the effect of physical activity on musculoskeletal disorders and disabilities in functional health is discussed.

In chapter 8, cancers related to physical inactivity are discussed and the prevalence of each is highlighted. The mechanism by which physical activity might reduce the risk of some cancers is included along with a discussion of common risks for cancer. Specific physiological, biomechanical, and behavioral adaptations to physical activity and exercise are identified. Included is a discussion of scientific evidence supporting the benefits of physical activity for cancer survivors, as well as evidence for the role of physical activity in the prevention of cancer.

Chapter 9 examines the effects of physical activity on brain health. The prevalence, economic costs, and risk factors of brain health disorders are discussed. A framework for studying brain health problems and their response to physical activity interventions is provided along with a discussion about the effects of physical activity

on brain function, which includes reaction time, learning tasks, cognitive function, and academic achievement. The recommendations for physical activity complete the chapter.

In chapter 10, adverse events associated with physical activity are discussed. Participation in regular physical activity and exercise may increase the risk of musculoskeletal injuries and sudden cardiac death in some cases. This chapter contains a discussion about defining adverse events, the prevalence of problems, the risks associated with injury, and the adaptive processes that may help prevent injury.

PART III: STRATEGIES FOR EFFECTIVE PHYSICAL ACTIVITY PROMOTION The chapters in part III introduce evidence-based strategies for increasing physical activity in individuals and populations. Public health is characterized by translating science into action to advance the health of the population. The strategies presented in part III have been scientifically demonstrated to increase physical activity and can be used for action in a variety of settings.

Methods for promoting physical activity are discussed in chapter 11, which opens with a discussion about the importance of using the Guide to Community Preventive Services as a resource for identifying physical activity intervention programs that work. A discussion about the impact of community-wide campaigns on increasing physical activity is included along with an overview of mass media campaigns.

In chapter 12, the rationale for school-based physical activity interventions is presented. The scientific benefits of physical activity in youth are reviewed, and commonly used physical fitness tests for school settings are discussed. A section that highlights current U.S. strategies and policies for promoting physical activity via school- based programs is included. The remainder of the chapter focuses on examples of evidence-based school physical activity programs.

In chapter 13, the focus is on evidence-based strategies for behavioral and social approaches to physical activity promotion. This chapter includes a discussion of current behavioral theories and theoretical models that are used to explain physical activity behavior in individuals. Social support strategies for physical activity promotion in communities are defined and highlighted, and examples of both types of approaches are provided.

In chapter 14, environmental and policy influences on physical activity are reviewed, as are strategies for change. The ways in which aspects of the physical and built environment can encourage or inhibit physical activity are reviewed. The role of urban design for physically active populations and evidence-based strategies for change are discussed.

In chapter 15, evaluation of physical activity programs is introduced. This chapter begins with a discussion of the six-step Physical Activity Evaluation Framework developed by the Centers for Disease Control and Prevention (CDC). The concepts of formative evaluation, process evaluation, outcome evaluation, and cost- effectiveness evaluation are covered. Logic models are presented. This chapter also contains discussions about evaluation designs, data collection and analysis, and publishing and communicating results.

Chapter 16 is the final chapter in the text; it focuses on building effective partnerships for physical activity programs. Examples of effective partnering include the U.S. National Physical Activity Plan, the World Health Organization Global Action Plan for Physical Activity, and the international Toronto Charter for Physical Activity. Strategies for physical activity advocacy are included, and models for advocacy and effective leadership conclude the chapter.

SPECIAL FEATURES The content organization of Foundations of Physical Activity and Public Health, Second Edition, is based on contemporary teaching

principles to maximize learning opportunities for students. Following are the features in each chapter:

Objectives: summaries of take-away messages you should learn by reading and studying the material Opening Questions: questions to help you think about how you can use information in the text Sidebars: examples of topics covered in the text, which will help you translate theory into practice Case Studies: real-life examples of selected concepts covered in the chapter Leader Profiles: mini-biographies of world leaders in physical activity and public health, all updated for the second edition; each leader addresses four key questions about his or her work in the field What You Need to Know: a bulleted review of the chapter to help you study the information provided Bibliography: additional published resources for further study

NOTE TO STUDENTS As the field of physical activity and public health expands, an increasing number of job opportunities will be available for those who achieve the core competencies as endorsed by the National Physical Activity Society, established in 2006 as the National Society of Physical Activity Practitioners in Public Health. Coursework that covers concepts of physical activity and public health will help future graduates in diverse employment settings such as public health and health care, business and industry, the nonprofit sector, education, mass media, urban planning and architecture, and parks and recreation. University students in majors and minors such as kinesiology, athletic training, physical therapy, medicine, nursing, and nutrition, as well as trainers in public services (fire, police, and military), rehabilitation specialists, and wellness instructors will find a natural connection between their professional duties and the need

for promotion of physical activity and public health to colleagues and communities. Core competency areas covered by the text are listed at the end of each chapter in the “Chapter Wrap-Up” section.

Additionally, a new web resource provides a variety of interactive activities, includeing e-Media links, flash card activities, and study questions to help you learn and understand the information presented in the text.

NOTE TO INSTRUCTORS This text is targeted for students in exercise science or public health programs who are enrolled in elective courses that expand their understanding beyond what is taught in traditional core courses. The 2018 Physical Activity Guidelines for Americans, the accompanying Physical Activity Guidelines Advisory Committee Report, and the CDC’s Guide to Community Preventive Services are valuable resources that provide much of the framework for the development of this text. You can find links to these in the web resource.

The following free ancillaries are also available to instructors who adopt this textbook:

The instructor guide includes syllabus suggestions, teaching tips, and sample class assignments. The test package has over 300 questions, including multiple- choice, true-false, short answer, and fill-in-the-blank questions. The test package can be downloaded in multiple formats, depending on your teaching needs, and can also be modified to include test questions that you create. The image bank includes figures and tables from the text. You can use these items to create your own PowerPoint presentations, handouts, or other class materials. A new presentation package offers PowerPoint slides for each chapter, outlining key points and including important figures from the text.

The web resource offers key term activities, e-Media links, and downloadable study questions for each chapter.

These resources can be accessed at www.HumanKinetics.com/FoundationsOfPhysicalActivityAndPublicH ealth. The authors, who have taught courses in physical activity and public health, have helped develop all of the ancillary materials.

We trust that Foundations of Physical Activity and Public Health, Second Edition, will allow you to develop courses that inspire students to pursue careers in physical activity and public health.

ACCESSING THE WEB RESOURCE

Throughout Foundations of Physical Activity and Public Health, Second Edition, you will notice references to a web resource. This online content is available to you for free upon purchase of a new print book or an ebook. All you need to do is register with the Human Kinetics website to access the online content. The following steps explain how to register.

The web resource offers learning activities that focus on key term comprehension, e–Media links, and downloadable study questions. We are certain you will enjoy this unique online learning experience.

FOLLOW THESE STEPS TO ACCESS THE WEB RESOURCE: 1. Visit

www.HumanKinetics.com/FoundationsOfPhysicalActivityAndPu blicHealth.

2. Click the second edition link next to the corresponding second edition book cover.

3. Click the Sign In link on the left or top of the page. If you do not have an account with Human Kinetics, you will be prompted to create one.

4. After you register, if the online product does not appear in the Ancillary Items box on the left of the page, click the Enter Pass Code option in that box. Enter the following pass code exactly

as it is printed here, including capitalization and all hyphens: KOHL-77ZK9-WR.

5. Click the Submit button to unlock your online product. 6. After you have entered your pass code the first time, you will

never have to enter it again to access this online product. Once unlocked, a link to your product will permanently appear in the menu on the left. All you need to do to access your online content on subsequent visits is sign in to www.HumanKinetics.com/FoundationsOfPhysicalActivityA ndPublicHealth and follow the link!

Click the Need Help? button on the book’s website if you need assistance along the way.

ACKNOWLEDGMENTS

I am grateful for the past, the present, and the future. Mentors in my past, especially Steven N. Blair believed in me and showed me the path. Colleagues in the present keep me stimulated and motivated. My students in the future will be leaders in physical activity and public health. This second edition would not have been possible without all of you. —HWK

Thanks to the leadership and staff at Human Kinetics for allowing us to complete this second edition. Thanks to Dr. Kohl for making this new edition a reality and to Dr. Salvo for joining our author team. Finally, thanks to my wife Mary for her love and support of all my writing efforts. —TDM

There are many people that have helped me become the scholar I am today. I thank each and every one of you for helping shape my career in public health. I would like to especially express my gratitude to Juan Rivera and Michael Pratt for your continuous guidance, support, and generosity.

I would also like to acknowledge that my professional achievements would not have been possible without the unconditional love and support of my family. I dedicate this book to my parents, Alfredo and Regina Salvo, for your patience and dedication. To Freddie, my accomplice and lifelong friend. To my husband, Umberto, thank you for always helping me see the glass

half full, and for being my partner and best friend. Arturo — también esto es para ti.

Last but certainly not least, I would like to express my immense gratitude to Bill and Tinker for inviting me to contribute to this work. Bill, thank you for believing in me and for your incredible support of my professional and personal growth. I am forever grateful for your mentorship and friendship. —DS

PART I Introduction to Physical Activity and Public Health

CHAPTER 1 Fundamentals of Public Health

OBJECTIVES After completing this chapter, you should be able to discuss the following:

»  The definition and history of public health »  The five main pillars of public health and how public health

has become specialized »  The five main principles that guide health promotion and

health education efforts in public health »  The 10 essential functions that support the core services

of public health

»  Why public health policy is often linked to legal and regulatory systems

»  The emerging physical activity specialization in public health

OPENING QUESTIONS What comes to mind when you read the words public health?

»  Screening children for nutritional deficiencies? »  Immunization programs to prevent an outbreak of influenza? »  Disaster responses to prevent disease transmission during and

after a hurricane or earthquake?

»  Prenatal education for expectant mothers?

»  Promotion of physical activity to lower the burden of chronic, noncommunicable diseases such as heart disease and diabetes mellitus?

If you answered yes to any of these questions, you are correct. Public health is all this and more.

Public health is a field that encompasses many disciplines in an effort to promote and protect health and prevent disease and disability in defined populations and communities. Although medicine and medical training are integral to public health, partic

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