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Columns: Clinical Applications

Promoting Physical Activity during the COVID-19 Pandemic

King, Kristi M. Ph.D., CHES; Hartson, Kimberly Ph.D., R.N.; Della, Lindsay J. Ph.D.; Terson de Paleville, Daniela Ph.D.

Author Information
ACSM's Health & Fitness Journal: 11/12 2020 - Volume 24 - Issue 6 - p 43-47
doi: 10.1249/FIT.0000000000000616
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Strong scientific evidence exists for the promotion of physical activity (PA) to support physical, mental, emotional, and social health. Multisectoral groups continue to unite to keep Americans physically active during the unprecedented COVID-19 pandemic, as advised by the Centers for Disease Control and Prevention (CDC). Although the implementation of the recommendations varies by state, CDC guidelines include physical distancing, avoidance of large gatherings of people and crowded places, and travel limited to short distances (1). Many states implemented stay-at-home recommendations, suggesting individuals only leave home for essential business and exercise. Uncertainties about the duration of the virus, the development and dissemination of a vaccine, and the necessity for future physical distancing and stay-at-home recommendations make it imperative for health and fitness professionals to remain up-to-date with the ever-evolving scientific guidance for COVID-19 while continuing to promote and support PA.

The American College of Sports Medicine (ACSM) has excellent, up-to-date COVID-19 related information on its web site (https://www.acsm.org/learn-develop-professionally/covid-19-updates-resources) (2) and the Exercise is Medicine® web site (https://www.exerciseismedicine.org/support_page.php/covid-19-and-exercise1/) (3). In addition to ACSM, the American Public Health Association (APHA) is committed to “Improving the health of the public and achieving equity in health status” (4). On April 4, 2020, APHA’s PA subcommittee hosted a live webinar entitled “Community Interventions to Enhance Physical Activity in the Population” (5). A panel of experts in the field presented to more than 150 professionals from various professions. In order to disseminate the key points of this webinar, the authors obtained permission from the APHA-PA chairperson to summarize the PA and public health experts’ presentations for the ACSM’s Health & Fitness Journal® audience. Therefore, the purposes of this Clinical Applications column are to synopsize the five public health experts’ presentations and to discuss readily applicable strategies that health and fitness professionals may incorporate to promote PA during the COVID-19 pandemic (Table).

TABLE 1 - Quick Links to PA and Public Health Resources
Resource Web Site
1. Centers for Disease Control and Prevention (CDC)
 a. Coronavirus (COVID-19)
 b. Active People, Healthy Nation
1. https://www.cdc.gov/
 a. https://www.cdc.gov/coronavirus/2019-ncov/index.html
 b. https://www.cdc.gov/physicalactivity/activepeoplehealthynation/index.html
2. American College of Sports Medicine (ACSM)
 a. COVID-19 Updates and Resources
 b. Exercise is Medicine® COVID-19 and Exercise
2. https://www.acsm.org/
 a. https://www.acsm.org/learn-develop-professionally/covid-19-updates-resources
 b. https://www.exerciseismedicine.org/support_page.php/covid-19-and-exercise1/
3. American Public Health Association (APHA)
 a. Communicable Diseases, COVID-19
 b. Community Interventions to Enhance Physical Activity in the Population Webinar
3. https://www.apha.org/
 a. https://www.apha.org/topics-and-issues/communicable-disease/coronavirus
 b. https://www.apha.org/events-and-meetings/apha-calendar/webinar-events/2020/enhancing-physical-activity
4. 2018 Physical Activity Guidelines for Americans, 2nd edition 4. https://www.health.gov/PAGuidelines
5. National Complete Streets — COVID-19 5. https://smartgrowthamerica.org/program/national-complete-streets-coalition/covid-19-how-is-your-community-responding/
6. National Physical Activity Plan (NPAP)
 a. State Physical Activity Plans
 b. Walking to Increase Physical Activity
 c. U.S. Report Card on Physical Activity in Children and Youth
6. https://www.physicalactivityplan.org/index.html
 a. https://www.physicalactivityplan.org/StatePAPlans.html
 b. https://www.physicalactivityplan.org/projects/walking.html
 c. https://www.physicalactivityplan.org/projects/reportcard.html

THE EPIDEMIOLOGY OF PA IN THE UNITED STATES

To begin the webinar, Noël Barengo, M.D., Ph.D., M.P.H., discussed the importance of PA as a means to promote health and well-being from a historical perspective (6). For example, records from approximately 2500 BC suggest that PA was touted for good health (7). Greek physician Hippocrates of the fifth and fourth centuries BC detailed the importance of exercise for health and well-being (8). Moreover, during the 20th century, landmark research was conducted such as the famous epidemiological evidence studies in which fewer incidences of acute myocardial infarction occurred in individuals with active occupations than those with sedentary occupations (9,10) and increased PA was associated with reduced incidence of type 2 diabetes (11).

The 2018 Physical Activity Guidelines for Americans, 2nd edition, provides scientific, evidence-based recommendations for how PA can help promote health and reduce the risk of chronic disease (12). These recommendations include engaging in at least 150 minutes a week of moderate-intensity aerobic PA, 75 minutes a week of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity aerobic activity, as well as muscle-strengthening activities two or more days a week. Although the benefits outweigh the risks associated with adopting an active lifestyle, most Americans are not sufficiently active (13). During the APHA webinar, subsequent presenters focused on tools that could be used to encourage the maintenance and addition of PA during the COVID-19 pandemic.

BUILT ENVIRONMENT, PARKS, AND TRANSPORTATION AS TOOLS TO INCREASE PA IN THE POPULATION DURING COVID 19

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Carissa Smock, Ph.D., M.P.H., discussed how the built environment can facilitate (or hinder) PA in the community, with special consideration given to the fact that access to gyms, playgrounds, sports fields and courts, outdoor fitness equipment, and other exercise facilities may be restricted during the pandemic (14). Although it is unknown exactly how the pandemic has affected PA behavior, during the initial outbreak in the United States, there was an increase in the number of people using parks and in people staying within 2 miles of their home to exercise. Parks have played and continue to play a critical role as an ally to help Americans maintain adequate levels of PA. While visiting a park, people should follow posted signage and avoid crowded areas (15). Some paths now only allow for walking in one direction to decrease traffic. In addition, some changes in access to active transport, including closure of bike shares and restrictions on public transportation, may decrease opportunities for PA. On the other hand, closures in parking lots may favor PA.

STRATEGIES FOR HEALTH AND FITNESS PROFESSIONALS TO PROMOTE PA

It is imperative for health and fitness professionals to consider how the built environment and access to parks and transportation may affect PA in their communities and be creative in developing strategies to promote PA given the current restrictions. In addition to using scientifically grounded guidance from credible professional health and fitness organizations, health and fitness professionals should follow CDC recommendations, as well as federal, state, and local guidance.

MASS MEDIA CAMPAIGNS AND PUBLIC EVENTS TO IMPROVE PA

Lynn Herrmann, Ph.D., MPH, explained that mass media campaigns can be used to support and enhance the positive effects of PA programs through message-based interventions delivered via mediated channels, such as television, outdoor signage, radio, and social media (16). These interventions generally focus on increasing awareness, knowledge, and self-efficacy, or affecting beliefs and attitudes about performing PA. Mass media campaigns can encourage increased PA to augment other enacted policy, community-based structural changes, and/or individually focused health promotion efforts (17). Mass media campaigns can be a “one-size-fits-all” campaign targeting everyone, but more successful campaigns are tailored to meet the needs of a specific priority population or audience, which is usually defined by a set of demographic, lifestyle, and/or behavioral characteristics.

Therefore, a successful mass media campaign should include the following: 1) a well-defined priority audience; 2) a clear mental objective (e.g., changing attitudes about PA); 3) a clear behavioral objective (e.g., increase PA by 1 day per week); 4) a clear, consistent motivating call-to-action message (e.g., “reported moderate PA for 30 minutes most days of the week”); and 5) dissemination via a combination of different media channels (e.g., social media, Internet, print, and television) specific to the priority audience. Before targeted dissemination on various media channels, it is important to pilot the message with members of the priority audience (e.g., Do you remember a campaign about PA? What was the message?) to ensure its effectiveness in achieving the desired objectives. Once a strong message has been developed and tested, a broader implementation of the campaign can occur. Lastly, it is important to evaluate if the mass campaign is effective. An evaluation should check that the message reached the priority audience at the desired frequency and intensity and determine the extent to which the mental and behavioral objectives were achieved (18).

STRATEGIES FOR HEALTH AND FITNESS PROFESSIONALS TO PROMOTE PA

Health and fitness professionals developing a mass media campaign during the COVID-19 pandemic must include environmental considerations. For example, because fewer people may be traveling and more people are staying near their homes, traditional outdoor communication channels, such as transit signs and billboards, may need to be replaced with media channels, like social media, that can reach audiences at home and/or at work. In addition, the call to action should be modified given the restrictions placed on communities during the pandemic. For example, health and fitness professionals may need to communicate exercise routines that can be done at home without sophisticated workout equipment. Dr. Herrmann also recommended virtual contests that encourage the creation and sharing of user generated content to document PA among audience members and motivate others to get active at home in creative ways.

POLICY STRATEGY TO INCREASE POPULATION PA

Given that policy has the potential to encourage change among large groups of people, Jamie Chriqui, Ph.D., M.H.S., described various types of policy that can affect PA in communities, including formal laws and regulations at the federal, state, and local levels (19). She also addressed the impact of noncodified policies, agreements, and contracts set by the government, companies, professional membership organizations, and community-based organizations on PA (20). For example, school-based PA policies include standards for physical educators, curricula, recess, and classroom activity breaks. Strategies that can help facilitate PA during the pandemic include complete streets policies, zoning and land use policies, car and bike parking requirements, and policies allocating funds for the development of infrastructure that supports PA. Leider and colleagues (21) found that active living zoning reforms for sidewalks, bike lanes, and street connectivity were associated with increased leisure time PA reports among U.S. adults before the COVID-19 pandemic. In this new, more restricted environment, it is likely that such reforms have become even more important factors for enabling PA.

STRATEGIES FOR HEALTH AND FITNESS PROFESSIONALS TO PROMOTE PA

As health and fitness professionals, it is important to understand the policies that affect a community’s ability to be physically active and to advocate for policies that promote high-quality physical education in schools, walkable neighborhoods, active transportation, and safe places to be active. Special considerations need to be given to newer COVID-19 policies and recommendations because much of the new guidance affects communities’ ability to be active. Dr. Chriqui emphasized two opportunities for policy-related engagement during the COVID-19 era, including 1) joining the National Complete Streets Coalition (22), which promotes the design of streets that are safe for users of all ages and abilities, and 2) supporting the CDC’s Active People, Healthy Nation (23) campaign to help 27 million people become more physically active by 2027. In addition,

Health and fitness professionals can use their knowledge and expertise to encourage local community leaders to support policies for active communities (24) that allow people to safely be physically active within pandemic restrictions.

THE NATIONAL PHYSICAL ACTIVITY PLAN

At the end of the webinar, Russell Pate, Ph.D., tied all of the major topics together by explaining that multiple sectors of society have a role to play in improving PA across the United States (25). Dr. Pate reviewed the National Physical Activity Plan (NPAP) (26), a comprehensive set of strategies that include policies, practices, and initiatives aimed at increasing PA in all segments of the population. According to the NPAP, nine sectors of society — business and industry; community recreation, fitness, and parks; education; faith-based settings; health care; mass media; public health; sport; and transportation, land use, and community design — are encouraged to work together to support each other’s strategies of PA promotion (Figure). Strategies and tactics for promoting activity are described in each of these sectors. For example, a community recreation, fitness, and parks sector strategy focus on “[developing] new, and [enhancing] existing, community recreation, fitness, and park programs that provide and promote healthy PA opportunities for diverse users across the life span.”

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Figure 1:
National Physical Activity Plan’s Nine Sectors of Society that Contribute to Physical Activity.

The NPAP has resources available for health and fitness professionals, such as the U.S. Report Card on Physical Activity in Children and Youth (27), a detailed compilation and catalogue of state PA plans (28), and reports and recommendations for supporting walking and walkable communities (29). Health and fitness professionals may find these NPAP resources useful as they re-evaluate PA recommendations for their communities during the pandemic.

CONCLUSION

In an ever-changing world, the importance of helping people be physically active has remained critical to the health of individuals and our communities, particularly when faced with a viral pandemic that disproportionately affects those with preexisting and chronic health conditions. The expert panel from the APHA webinar reminded us that despite the constant changes occurring in how we conduct our lives, the built environment, mass media campaigns, and policy continue to be important considerations, perhaps even more now than before, for helping people be physically active. As we consider strategies to improve PA, it is imperative that we ensure that the promotion of PA reaches all people in all communities because being physically active is a human necessity for health.

Acknowledgment

The authors thank Dr. Noël Barengo, APHA-PA chairperson, for reviewing this Clinical Applications column.

References

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27. The National Physical Activity Plan Alliance. U.S. report card on physical activity in children and youth. [cited 2020 June 11]. Available from: https://www.physicalactivityplan.org/projects/reportcard.html.
28. The National Physical Activity Plan Alliance. State physical activity plans. [cited 2020 June 11]. Available from: https://www.physicalactivityplan.org/StatePAPlans.html.
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