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> MONTANA NUTRITION AND PHYSICAL ACTIVITY PROGRAM
Physical Activity
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Sedentary Lifestyles
For a variety of reasons, Americans today tend to be far more sedentary than in past eras. Modern technology has replaced many of the physically exerting jobs of the past, and in today’s market, most wage-earners are sitting at a desk for the majority of their work days. Communities are built to accommodate drivers, not walkers. And, outdoor recreational activities are more and more often replaced by indoor activities such as watching television and playing computer games.
In the past, many Montanan livelihoods were intimately tied to the land and one’s ability to work it through farming and ranching. Montana childhood experiences of yesteryear were filled with hours of natural, vigorous outdoor play, walking or biking to school, and participating in physical chores that were necessary for the family’s economic stability. Today, housing and commercial developments are replacing agricultural land. These economic and cultural changes have affected the way Montanans earn their livelihood as well as created more dependence on the automobile for transportation. We have "engineered" physical activity out of our lives, and the results are not healthful. Now, we must find new ways to build physical activity into the daily routines of children, adults and Montana families.
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Benefits of Physical Activity
Physical activity is a key factor in achieving and maintaining a healthy weight, and it offers many additional benefits. In fact, physical activity is one of 10 leading health indicators
listed in the Department of Health and Human Services US document Healthy People 2010: Understanding and Improving Health (Healthy People 2010). People who are physically active are less likely to die of coronary heart disease, the nation’s leading cause of death, and they are less likely to develop many chronic diseases such as high blood pressure, type 2 diabetes, osteoporosis, and certain cancers. In addition, physical activity reduces symptoms of anxiety and depression, promotes healthy bones and joints and reduces arthritis pain. Because the physical and mental health benefits of physical activity are well documented, and because the economic costs of inactivity and obesity are high, public insurance programs and employers who provide insurance benefits to employees have an economic interest in promoting physical activity. For school children, exercise is associated with improved academic outcomes and reduced anxiety, depression and disruptive behavior.
Opportunities
The state of Montana has many opportunities to increase the physical activity of all residents.
Outdoor Activities
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Montana is still a place where people can enjoy outdoor activities under the grandeur of the "Big Sky." People who live and work in Montana as well as those who visit the state are often drawn here because of the plethora of hiking, biking, skiing, rafting, and other outdoor activities that exist.
Walkable Communities
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Because our communities are relatively small and (in comparison to other states) undeveloped, we have the opportunity to promote more active community environments. Encouraging developments with a more traditional neighborhood design, such as streets connected in a more grid-like style with sidewalks/bike lanes and trees and close-to-home destinations make walking and biking an easier, safer, more convenient and more enjoyable choice.
- In 2005, the US Department of Transportation awarded $1 million to Montana to orchestrate "Safe Routes to School" programs for infrastructure projects and education/promotion campaigns to make it safer for children to walk and bike to school.
School Wellness
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The Montana School Board Association, the Montana Office of Public Instruction (OPI) and the Montana Board of Public Education are supportive of school wellness policies. Such policies will help pave the way for increased physical activity of staff, students, and (indirectly) their families.
- A number of advocacy organizations in Montana are willing to work with schools to determine how to raise the physical activity of students in a way that is affordable.
Worksite Wellness
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In recent years the DPHHS Cardiovascular Health Program has surveyed hundreds of large and small employers across Montana and has identified a strong interest among many employers in promoting physical activity and other healthy behaviors among employees. In 2005, the Missoula City-County Health Department surveyed 250 local employers with similar results. These employers are motivated by a variety of factors including a desire to reduce absenteeism, increase productivity, increase staff morale, and control rising health insurance costs.
- Some employers are already instituting innovative weight control and fitness programs. For example, the State of Montana offers the Why Weight program, a pilot weight loss project that reimburses eligible employees up to $300 for reducing their BMI (they must be willing to speak with the health coach). In 2005, the State also piloted a fitness program for hunters, which it plans to repeat in coming years. Similarly, the Joint Powers Trust, which provides group health benefit plans to thousands of city and county employees, is introducing a program to promote physical activity and other healthy behaviors in an effort to reduce insurance premiums. Information on the financial "return on investment" will be tracked, analyzed, and shared with other employers. At the same time, Blue Cross Blue Shield of Montana has designed and offers to their employer groups work site health promotion tools, resources, and training at no additional cost, all in an effort to assist these groups in managing their health risk. In addition, the Montana Council for Worklife Wellness is a statewide coalition of people working on promoting health in the workplace. These are just a few examples of ways that employers and even the insurance industry are working to promote physical activity and other healthy behaviors among Montana workers.
Recommendations for Physical Activity — Adults
Physical inactivity for people of all ages is a pressing public health issue. The extensive use of technology has virtually eliminated any need for physical activity in order to earn a living. And like people of all ages, adults spend much of their leisure time watching TV or in other sedentary pursuits. Consequently, as shown below, not enough people are meeting current recommendations and the proportion meeting recommendations declines with age.
The American College of Sports Medicine has collaborated with the American Heart Association to update the physical activity recommendations for adults ages 18 – 65 years. To promote good health, the new recommendations for adults are:
Aerobic Activity — Moderate intensity physical activity for a minimum of 30 minutes on 5 days each week OR vigorous-intensity aerobic activity for a minimum of 20 minutes on 3 days each week OR a combination of the two approaches. If preferred, three 10 minute bouts can be used to accumulate 30 minutes of activity. Activity of "moderate intensity" means a brisk walk or other activity which noticeably increases the heart rate; "vigorous activity" would include jogging or any other aerobic activity that causes rapid breathing and a substantial increase in heart rate. Note that this recommended level of physical activity is to be ADDED TO customary activities of daily living.
Muscle-Strengthening Activity — This type of activity is also known as weight training or resistance exercise and is recommended on a minimum of two non-consecutive days each week. A well-rounded program would insure that 8 – 10 exercises covering the major muscle groups are included each week. Use enough weight to permit the completion of 8 – 12 repetitions in good form before fatigue is reached. After weeks or months, progressively more weight should be added, but good form should be maintained at all time.
Greater Amounts of Activity — More activity than the minimum recommended above yields greater health dividends and can contribute to greater physical fitness and greater protection from chronic health conditions. For example, aerobic activity can be pursued more than the 5 day minimum recommended here, or more frequent vigorous activity is acceptable. Greater skeletal health is a benefit of extra weight-bearing activity and higher impact activity (such as stair-climbing, high-impact aerobics, jogging, etc.).
Prevention of Weight Gain — More activity, that is the same activity as recommended above, but of a longer duration may be needed to prevent unhealthy weight gain. Furthermore, the authors acknowledge that factors such as reductions in food intake may have to be considered to prevent weight gain. Most of the studies of weight gain prevention focus on prevention of re-gain after significant weight loss. Those studies suggest that 60 to 90 minutes of moderate intensity activity per day may be necessary for weight maintenance after such large weight losses. But for prevention of weight gain in the first place, more research is needed to make authoritative recommendations about what types and amounts of activity are needed and in what combination with caloric restriction.
Recommendations for Seniors or Younger Adults with Chronic Conditions
To promote good health, the recommendations are:
Start, and get help if you need it — This means that older adults may have physical conditions or functional impairments that require modification of the following recommendations. Aiming for goals that are lower (less demanding) than those outlined below may be entirely appropriate. If you have any doubts about how to safely implement these recommendations, consult with a medical professional who can tailor them to suit the individual correctly and safely.
Aerobic Activity Moderate intensity physical activity for 30 minutes on 5 days each week OR vigorous-intensity aerobic activity for 20 minutes on 3 days each week OR a combination of the two approaches. Note that this recommended level of physical activity is to be ADDED TO customary activities of daily living. For older adults who may fatigue easily, 10 minute bouts — with periods of rest in between — can be used to accumulate 30 minutes of activity. Activity of "moderate intensity" means a brisk walk or other activity which noticeably increases the heart rate. "Vigorous activity" would include jogging or any other aerobic activity that causes rapid breathing and a substantial increase in heart rate. In contrast to during vigorous activity, during exercise of “moderate intensity” it should be possible to carry on a conversation.
Muscle-Strengthening Activity This type of activity — which is extremely important for seniors — is also known as weight training or resistance exercise. It is recommended on two non-consecutive days each week. A well-rounded weight training program will consist of 8 – 10 exercises selected to cover major muscle groups in the upper and lower body. Use enough weight to permit the completion of 10 – 15 repetitions in good form before fatigue is reached. Seniors will likely need to aim for much more modest goals, especially to begin with, and they may never reach these recommended goals. This is OK. Remember that quality — that is good form — is more important than quantity. After weeks or months, progressively more weight can be added, but good form should be maintained at all time.
Balance As we age, the risk of falls increases. Specific exercises to improve balance are part of a well-rounded exercise plan for older adults but are of critical importance to those individuals known to be at risk for falling.
Flexibility It is no secret that we stiffen as we age. Exercises designed to maintain or increase flexibility should be performed for at least 10 minutes a day, two days a week. You may be more comfortable stretching those muscles and tendons after a 10 minute warm-up period.
Functional Health Physical activity makes the activities of daily living — walking, dressing, cleaning and caring for oneself, as well as gardening or chores around the house — easier to carry out.
Exceeding Recommendations If you feel you can exceed the minimum recommendations outlined above, feel free to go for it. This will yield further fitness dividends, build muscle and bone, and improve certain diseases or conditions. In addition to improved health and reduced disease risk, the most important benefits are increased mobility, productivity and independence.
Exercise Plan It is recommended that each individual have a physical activity plan. A well rounded plan will incorporate each of the elements discussed above and will specify how, when and where each activity will be performed. Re-evaluate plans periodically or as abilities improve or as health status changes.
Prevention of Weight Gain In older adults, more activity than that recommended above, or activity of a longer duration may be needed to prevent unhealthy weight gain. Diet may also need to be adjusted and other factors that affect body weight may need to be considered. Most of the studies of weight gain prevention focus on prevention of re-gain after significant weight loss. Those studies suggest that 60 to 90 minutes of moderate intensity activity per day may be necessary for weight maintenance after weight loss. But for prevention of weight gain in the first place, more research is needed to make authoritative recommendations, especially for older adults.
Recommendations for Children and Teens
A minimum of 60 minutes of moderate-to-vigorous physical activity every day of the week is recommended.
Moderate physical activity consists of activity that raises the pulse above the resting heart rate but does not make the person perspire or breathe heavily. Examples include brisk walking, gardening, dancing, and bicycling slowly.
Vigorous physical activity consists of activity that makes the person perspire and breathe heavily. Examples include jogging, playing basketball, and cross-country skiing.
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