National Physical Activity Plan aims to get Americans moving

USA Today

One day, most kids may jump on their bikes and ride to school.

While they're there, they'll be playing active games in high-caliber physical education classes and doing lots of fun recreational activities before and after school.

Adults should be able to walk, bike or jog to work, the grocery store or a local park or community recreation center, where they will be able play golf or tennis or take exercise classes.

And doctors may talk to their patients about an important new "vital sign" — their physical activity level.

These are among the goals that could be achieved with comprehensive, wide-ranging strategies outlined in the new U.S. National Physical Activity Plan, which is being released today by an expert panel representing influential health organizations. Among groups involved are the Centers for Disease Control and Prevention, the American College of Sports Medicine, the American Heart Association and the American Cancer Society.

The purpose: to create an environment in which Americans can be physically active where they live, work and play, says Russell Pate, an exercise researcher at the Arnold School of Public Health at the University of South Carolina-Columbia. He chaired the panel.

Experts have been encouraging people to be physically active for years because it lowers the risk of heart disease, stroke, cancer, diabetes, osteoporosis and a long list of other health problems.

To get the health benefits of exercise, adults need at least 2½ hours of moderate-intensity activity a week, such as brisk walking, or 1¼ hours of a vigorous-intensity activity, such as jogging or swimming laps, or a combination, federal guidelines say.

But right now, only 31% of Americans do enough regular leisure-time physical activity; about 40% do no regular leisure-time physical activity, government statistics show.

Exercise tough to fit in

The national physical activity guidelines have not been sufficient to get people moving, Pate says. "Educating, cajoling and finger-wagging are not enough."

It's difficult to work physical activity into daily life, partly because of sprawling communities and long commutes, and many people don't have safe and attractive places to walk, he says.

Colleen Doyle, nutrition and physical activity director for the American Cancer Society and a member of the panel that created the plan, says, "We are at a crisis with our health in large part because we eat too much and we're not active enough."

Among ideas in the plan:

• Make sure roadway spending includes money for "complete streets," accommodating cars, bikes and pedestrians.

• Have doctors assess patients' physical activity levels at appointments and discuss ways they can meet the activity guidelines.

• Encourage early childhood education programs to have little ones as physically active as possible.

• Provide access to and opportunities for physical activity before and after school.

• Encourage school officials to find ways for children to walk and bike safely to school.

• Provide tax breaks for building owners or employers who provide amenities in workplaces that support active commuting, such as showers in buildings, secure bicycle parking, free bicycles or transit subsidies.

• Increase funding and resources for parks, recreation, fitness and sports programs and facilities in areas of high need.

Pate says such ideas would need to be implemented with cooperation from elementary school principals, county council members, state legislators, Congress and corporate human resource directors.

Price could be high

Not everyone agrees the plan will get folks moving.

"Most people are overweight not because there isn't a sidewalk in their neighborhood but because we like to eat and we don't like to exercise," says David Boaz, executive vice president of the Cato Institute, a libertarian think tank in Washington, D.C.

And the price of the changes could be high. "Everything costs something," Boaz says. "Every action has a cost, and when it's government-involved, whether it's federal or local, they are generally less efficient with money. This is the elite planning for how the masses should live."

Nancy Brown, chief executive officer for the American Heart Association and a member of the panel, says: "There's no question that anytime you want to make wholesale change on anything, there's a cost involved with it. But there is also a huge return on investment."

Some of the changes won't cost anything, Pate says. Others will require resources to be redirected, and still others will require new resources, but the payoff will come in saving lives and health care dollars, he says.

More Treatment Doesn't Always Mean Better Health

USA Today

President Obama boards Marine One at National Naval Medical Center in Bethesda, Md., Feb. 28 after his first physical exam as president. Doctors pronounced him in "excellent health."  By Susan Walsh, AP

 

 

President Obama's first medical checkup since he took office involved more than just a history, physical and blood tests. His Navy doctors also ordered CT scans, which are rapid-fire X-rays, of Obama's coronary arteries and colon. The CT or "virtual" colonoscopy allowed doctors to look for colon cancer without putting the president to sleep, so he wouldn't have to transfer power to his next in command.

Navy Capt. Jeffrey Kuhlman, who led the medical team, proclaimed Obama in "excellent health." But San Francisco cardiologist Rita Redberg, editor of the Archives of Internal Medicine, says she was "troubled" by the exam. That's because coronary CT scans, which detect calcium deposits in arteries, and virtual colonoscopies aren't recommended for men of Obama's age and medical history, she says. Both boost a person's lifetime risk of cancer.

"Mr. Obama appears to have been administered two cutting-edge, expensive diagnostic tests that exposed him to a radiation risk while likely providing no benefit to his care," Redberg wrote in an editorial. What's more, she says, his doctors' zeal reflects one of the flaws in the U.S. health system that Obama's administration is trying to fix.

"It's low-hanging fruit to rid our system of procedures and tests that we're spending a lot of money on that are actually making people worse," Redberg said in an interview. "Multiplied many times over," she says, cases such as Obama's burden society with "huge costs" and put patients in harm's way.

But doctors have long been rewarded for providing more care, though more isn't always better. Three recent studies show that a doctor's instincts are no match for hard science:

• ASTRAL, a study of about 800 patients with high blood pressure from clogged kidney arteries, found that propping arteries open with stents didn't lower blood pressure and raised patients' risk of side effects, including deaths.

• ACCORD, a $300 million study sponsored by the National Institutes of Health, found that patients with type 2 diabetes who take the billion-dollar Abbott drug called Tricor don't live any longer than patients who don't. Doctors have been prescribing Tricor since the mid-'70s; Abbott is now advertising a newer, more expensive, patent-protected version called Trilipix. A second arm of the study showed that pushing blood pressure below the usual floor in diabetic patients not only failed to help them but also raised their risk of premature death.

• NAVIGATOR, a 9,000-patient study sponsored by Novartis, found that the drug valsartan, sold as Diovan, kept 14% of diabetes-prone people who were given the drug from developing diabetes. But neither valsartan nor nateglinide, sold as Starlix, prevented the heart attacks, strokes or other cardiovascular events that make diabetes so devastating.

"The good news for patients is that you don't have to take a bunch of medications to try to improve your outcome," says Robert Califf, chancellor for clinical research at Duke University.

Doctors and patients often groan when a study yields negative results rather than new hope in an easy-to-swallow pill. Negative results often contradict conventional wisdom, the pet theories of academics and costly ad campaigns for billion-dollar drugs, argues Yale cardiologist Harlan Krumholz. But they reinforce a humbler message, he says, by showing that doctors can sometimes achieve more by doing less — and spending less — and by convincing patients that prevention always trumps medication.

Starting today, Redberg plans to make the case in her journal. Under a new heading, "Less is More," she'll feature studies showing widely used tests, drugs and procedures that don't pass muster.

She'll also make the point by example, as she did in her Obama editorial. Redberg says the CT cancer risk is important; coronary calcium scans cause nine extra cancers in every 100,000 men tested.

White House spokesman Reid Cherlin says Obama's doctors chose to follow "Staying Healthy at 50-plus" guidelines issued by the U.S. Preventive Services Task Force. "Yes, the patient is 48, but those guidelines seemed the most appropriate," Cherlin says.

Cherlin acknowledges that the guidelines say there's "insufficient evidence" to judge the benefits and harms of CT colonoscopy in patients younger than 50. He says the doctors decided to do a coronary CT scan because Obama's LDL, or bad cholesterol, rose. The options were discussed with the president, who gave consent, Cherlin says.

Redberg evaluated the White House response at USA TODAY's request. "The president and his physician can, of course, choose whatever care he would like," she says. "But I do think he would set a great example by getting evidence-based care and not giving the impression that he thinks more technology is automatically better."

And while the task force declined to make a recommendation on CT colonoscopy for patients such as Obama, she says, "it does recommend against the coronary (CT) scan. It would be better for him, as a young man, not to be exposed to unnecessary radiation."