M E L I C I A C . W H I T T - G L O V E R , P H . D .

G R A M E R C Y R E S E A R C H G R O U P

W I N S T O N - S A L E M , N C

E M A I L : M W H I T T G L O V E R @ G R A M E R C Y R E S E A R C H . C O M

W E B S I T E S : W W W . I N S T A N T R E C E S S . C O M

W W W . G R A M E R C Y R E S E A R C H . C O M

Instant Recess®: Building a Fit Nation 10 Minutes at a Time!

Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among U.S. Adults Aged 18 Years or Older

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% 26.0%

No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

2010

2010

What has changed?

1980 2004

Overweight children (ages 6-11) 7.0% 18.8%

Overweight adolescents (ages 12-19) 5.0% 17.1%

then

then

then

then

now

now now

now

Whitt-Glover MC, Taylor WC, Floyd MF, Yore MM, Yancey AK, and Matthews CE. Disparities in Physical Activity among US Children and Adolescents: Prevalence, Correlates, and Intervention Implications. Journal of Public Health Policy 2009, 30 (Supplement 1): S309 – S334.

Physical Activity Prevalence in Children

Physical Activity Prevalence in Adolescents

Physical Activity Prevalence in Adolescents

Source: http://www.statehealthfacts.org/comparemaptable.jsp?ind=92&cat=2

Percent of adults who participated in moderate or vigorous PA, 2011

Percentage of adults who were highly active according to the 2008 Guidelines: NHIS 2009

Sex

8

What is sedentary?

1. Characterized by or requiring a sitting posture: a sedentary occupation.

2. Accustomed to sit or rest a great deal or to take little exercise.

3. Chiefly Zoology .

A. abiding in one place; not migratory.

B. pertaining to animals that move about little or are permanently attached to something, as a barnacle.

www.dictionary.com

Sedentary Behavior Research Network

We suggest that journals formally define sedentary behaviour as any waking behaviour characterized by an energy expenditure ≤1.5 METs while in a sitting or reclining posture. In contrast, we suggest that authors use the term “inactive” to describe those who are performing insufficient amounts of MVPA (i.e., not meeting specified physical activity guidelines).

Sedentary Behaviour Research Network. 2012. Standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 37: 540–542.

THIS is…..

What is

contributing to

sedentariness?

Recess!

Quality family time….

SITTING IS HAZARDOUS TO OUR HEALTH

Each 2-hr increment in sitting associated with 7% increase in Type 2 diabetes & 5% increase in obesity

Increasingly sedentary work over the past 50 yrs may account for the energy imbalance (+100 Calories) causing the obesity epidemic

Men who sit >23 hours a week of sedentary activity had a 64% greater risk of dying from heart disease than those who sit <11 hours a week, including many who routinely exercised

Work days are associated with nearly 1 hour more sitting than non-work days

Effects of Prolonged Sitting

Increase in sedentary work, entertainment &

transportation means 95% of Americans don’t get

enough physical activity

Sitting increases risk of death up to 40% & doubles

the risk of cardiovascular disease:

Shuts off electrical activity in leg muscles

Drops rates of calorie burning to 1/minute

Drops fat-burning enzymes by 90%

Drops good cholesterol & insulin effectiveness

SITTING

4 STEPS GETTING OUT OF A CHAIR

STANDING

Sitting induces muscular inactivity

Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity,

metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56, 2655-2667

Social activities promote sedentariness

Sociocultural

Sedentary attitudes

Enjoyment of sedentary behaviors

Even more emphasis on family time

Peer influence

Cultural attitudes/Importance of rest

Airhihenbuwa et al., AJHP, 1995

Rest more important than/necessary for exercise

“You will be too pooped to pop—that’s ruining your system right there….”

Daily activity is exercise

“I work the third shift….I’m just always wiped out…”

No fear of death like other cultures

“Whites have the best bodies in the morgue”

Compensatory effect of exercise?

Sociocultural

Sedentary attitudes

Enjoyment of sedentary behaviors

Even more emphasis on family time

Peer influence

Cultural attitudes/Importance of rest

Pre-existing health conditions

Chronic disease prevalence

Gender roles/differences

Preferred/expected activities

Safety

Can you be active and sedentary?

YES!!!

Leisure Time Physical Activity Levels:

Little Change in >2 Decades

The evolution of (wo)man

Hunter-gatherers 5000 cal

Agriculture 6000 cal

Laborers 3000 cal

Office workers 1800 cal

1 million yrs ago

10,000 yrs ago

1915

2000

AVERAGE ENERGY EXPENDITURE ESTIMATES

Mouse potatoes 1500 cal? 2010

A solution

Prevention vs. Treatment

Most experts agree that diet is most critical for weight loss (treating obesity), but physical activity (PA) is most critical for preventing weight gain (PAGAC, 2008)

Without increases in PA at a population level, impossible to decrease caloric intake sufficiently to achieve energy balance and get essential micronutrients (Hill et al., 2005)

White hunger drives eating, there is no inherent biological drive to be active in adulthood—therefore push strategies necessary to achieve population-wide PA increases (Yancey, 2009; 2010)

Population benefit estimates of risk factor

change: PA

3-minute bouts of PA 10 times per day lowers serum triglycerides to same extent as 1 continuous 30-minute bout of PA (Miyashita et al., 2006)

Sedentary behaviors (e.g., TV watching) as well as sub-optimal >moderate PA levels contributed to DM & obesity risk over 6 yrs in women (Hu et al., 2003)

Number of bouts as well as volume of PA correlated with youth overweight (Mark & Janssen, 2009)

“Bouts” more efficient at weight and waist control than “non-bout” PA in adults (Strath et al., 2008)

Manufacturing Facility

Has provided brief stretch breaks on company

time since 1982

Productivity measurements indicate 30 min.

returned productivity for every 15 min. invested

in exercise (5-min. breaks 3x/day)

Reduced work-related injuries from 14/yr to

essentially none within 1st 3 years

Stretch breaks are viewed as a safety measure

similar to wearing safety glasses

Have now increased to a few minutes every hour!

PAAC Cluster Randomized Controlled

Trial Outcomes Donnelly et al., Prev Med 2009

•Main effects on:

(1) accelerometry-monitored daily PA, in-school,

and outside school—both weekend, weekday

(2) improved academic achievement for reading,

math, spelling & compos. scores

•Disaggregated by exposure:

(1) 9 of 14 intervention schools averaged 75+ min.

active lessons/wk

(2) these schools showed signif. less increase in

BMI When teacher were active with students, student PA levels were significantly higher!

“Push” vs. “Pull”

Pull strategies: Majority of physical activity promotion efforts,

including traditional worksite prog. rely on individual motivation--largely unsuccessful at population level

--Improvements greater in individual inclined to be active

Examples: gym membership subsidies, stair prompt posters, lunchtime or after-work exercise classes

Push strategies: Efforts to make the active choice the default option—the path of least resistance, requiring individuals to “go out of their way” to make inactive choice

--Promise of broader engagement, including those at greater risk for obesity—including ethnic minority groups

Examples: walking meetings, exercise breaks during non-discretionary time at work, nearby parking restricted to disabled, scheduling meetings at a distance from workspace

What Is Instant Recess®?

What is Instant Recess®?

Instant Recess® is a 10-minute low-impact physical activity break that consists of: 7 – 8 aerobic-based callisthenic, dance, or sports related movements Upbeat, rhythmic music set at a moderate pace.

Tailored to represent cultural values and assets, popular sports,

and setting-specific elements e.g. California Endowment “Here and Now” IR

A “low-maintenance” physical activity strategy:

Low-cost (both money and time) No change of clothes necessary Can be modified to meet specific needs of an individual or organization. Can be used anytime, anywhere, by anybody

Basic Structure of an Instant Recess® Break

IR Breaks are designed to maximize energy expenditure Moves engage large muscle groups in the upper and lower

body.

IR Breaks are choreographed to be “do-able” for all ages, body types, and levels of coordination Each move is easy to learn, so that everyone can participate. Modifications available to tailor each move to your level, and

personal flair is highly encouraged!

IR breaks are designed to minimize risk of injury Your neck, back, and knees are protected to avoid injury

How Does Instant Recess® Work?

Creates opportunity on “paid time” Gives employees a brief mental and physical break

from the work day Provides a boost of energy during the “mid-

afternoon slump”

Also encourages changes to improve

the food environment at work With increased energy from taking daily recess

breaks, healthier snacks will taste better.

Employs multiple levels of influence: “Deliberate Practice” Social Support and Group Dynamics Motivational “teachable” moment

Studies

10-min. Instant Recess® during staff / training meetings longer than 1 hour

449 employees, mostly overweight, middle-aged women, ethnically diverse

90+% participation

Demonstrated feasibility of engagement regardless of weight or physical activity levels

Found group breaks add social conformity factor that positively influenced participation

“Teachable moment” - increased individual awareness of poor physical conditioning and health status

Pausa para tu Salud Mexican Ministry of Health, Mexico City

10-15 minute exercise breaks to music

broadcast thru intercom system

Mandatory

Secondary analysis of data,

n=335, collected annually on all employees

Not study volunteers—75% retention at 1 yr

1 kg weight loss (0.4 kg/m2) + 1.6 cm

“waist” loss after 1 year

California Fit WIC

Staff Wellness Training

Significant findings:

Increased perceived workplace support

for staff PA (96 vs. 58%, p=0.002)

and healthy food choices

(85 vs. 28%, p=0.001)

Change in types of foods served during meetings (72 vs. 24%, p=0.002) & PA priority in workplace (96 vs. 71%, p<0.02)

Increased self-reported counseling behaviors with WIC parents promoting physical activity (64 vs. 35%, p<.05) & sensitivity in handling weight-related issues (92 vs. 58%, p<0.01)

Pilot Study Outcomes Baseline sample:

N =391 across 25 sites, health and human services gov’t & non-profit wk units

Predominantly female (89.77%) & African American or Latino (78.24%)

Mean age = 43.5 yrs

Mean BMI = 30.0 kg/m2

Mean WC = 90.5 cm (35.6 in)

6-Month follow-up sample (Cohort 3 only):

N = 130 individual participants (90% reten.)

8 work units: 6 Intervention, 2 Control

Preliminary findings:

Intervention Control

BP (mm Hg) 1.3 1.2 (effect size = -2.5)

BMI (kg/m2) 0.01 0.4 (effect size = -0.4)

REACH Dissemination Mid-Point Evaluation

Outcomes

36 health & human services agency worksites in

LA and Orange Co, CA

Significant increases in:

1. Exercise break policies (meetings &

scheduled time of workday)

2. Nutrient-rich food procurement policies

3. Policies requiring nutrient-rich

foods/beverages in company meetings

Maxwell et al., Prev Chr Dis, 2011

South Bay Health Center

Launched Instant Recess® Jan 2011 in call center, Apr in lab/path, Jun in in-pt unit 3000

Compared to 2010 data from same period, reduced sick days by 1.8 days/FTE (7.5 – 5.7) in call center, 1.9 days in an in-pt unit (6.2-4.3)

Injury rates--“accepted workers’ comp claims”--decreased from 3 to 0 (call center x 8 mos), 18 to 12 (lab x 4 mos), 1 to 0 (in-pt x 2 mos)

Instant Recess®

Champion Schools, Phoenix

Pre-tested at the Champion charter school in a low-income

Phoenix, AZ area

Hosted “Think You Got Moves?” contest

Comments from teachers:

“feasible to use daily because helps kids settle down after

lunch”

“kids, girls especially, perform better in PE class because IR

exercises build their confidence”

“kids are taking ownership and bringing their own music”

Percent of Time Spent in Fitness Skills

% time in fitness skills (Instant Recess) increased in intervention (8.7%) and control (0.5%) schools, p > 0.05

Percent Time in On Task Behavior

% time in on-task behavior increased in intervention schools (+6.4%) and decreased in control schools (-5.2%), p = 0.03

Mean Minutes of PA in School Classrooms by Intervention Type

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Spring baseline Spring followup Fall baseline Fall followup

Me

an M

inu

tes

Intervention Schools Crossover Schools

Control Schools Instant Recess Classrooms

Bar = SE

Minutes of Fitness Skills and MVPA in Classrooms by Level of Enthusiasm for Instant Recess

-2

0

2

4

6

8

10

12

14

16

0 5 10 15 20

Min

ute

s o

f M

VPA

Minutes of Fitness Skills

No Instant Recess

Mixed Enthusiasm

Min FS Min MVPA No Instant Recess 0.64 0.61 Mixed enthusiasm 4.79a 0.54 Enjoyed Instant Recess 6.47b 2.57b

a p = 0.0008 vs No Instant Recess b p < 0.0001 vs No Instant Recess

Instant Recess® @ LAUSD Active Living Research dissertation grant

6 schools, n=647 students with baseline + follow-up data, 68 participating teachers/classrooms

Cluster RCT with early intervention-delayed intervention control groups--main outcome = school day pedometer readings (measured beginning & end of school day)

Final model: Linear regression of post-treatment steps on both intervention groups and baseline steps, clustered by school, and student ID (R2 = 0.2292, F = 78.41 (p < .001))

Results: Adjusting for intervention group, mean steps significantly increased with IR intervention (+1910.3 steps; p<.001)

Forsyth County, NC Community-Based Dissemination of Lift Off! Breaks

Focused on feasibility of dissemination in schools and churches

$500 mini-grants given to 10 organizations Develop innovative ways to incorporate the Lift Off

concept into regularly scheduled organizational activities

Each funded site recruited 20 participants Organizations conducted activities for at least 6

months and participated in pre- and post-program evaluation

Physical activity data were collected using accelerometers and questionnaire. Demographic data and process measures were also collected

Results

0

200

400

600

800

1000

1200

Walking Moderate Vigorous Total

Physical Activity Change

measured by IPAQ - Continous

Activity

Pre Mean (SE)

Post Mean (SE)

Dissemination

HEALCitiesCampaign.org CA League of Cities & CCPHA

22 cities have now adopted policies advocating PA breaks in meetings lasting an hour or longer

First 5 LA Commission formally passed PA break integration policy 10/13/11!

Organizational Profiles & Case Studies

City of Duarte, CA – 3-min. PA breaks every City Council

meeting x 6 yrs

Delta Sigma Theta Sorority, LA – turns up AC 15 min. pre-IR

break & reimburses only for healthy refreshments x 5 yrs

City/County of San Francisco Dept of Public Works, CA

conducts stretch breaks with gen. svcs. employees every day

Orange Co. Health Care Agency, CA – trained entire health

promotion staff in implementing & dissem. IR breaks x 3 yrs

St. John’s CME Church, NC – occasional IR breaks during

Sunday service increased particip. in gospel aerobics classes

WPFW Pacifica Radio Station, Washington DC – broadcast

10- min. IR breaks daily 1:05 ET x 6 mos

San Diego Padres’ PETCO Park on Sunday home game “family” days

Related Changes

Adopts Instant Recess® in support of Let’s Move!

Plymouth UCC

(North

Houston, TX)

“Musical Pews”

IR break

The Jesus Shuffle

Common Factors of Instant Recess Success Stories

Physical Layout and Social Climate

Pre-Existing Wellness

Infrastructure

Dedicated group of IR “Sparkplugs”

Persistence in Troubleshooting

Efforts

Leadership Support and Active

Participation

Innovation and Creativity

Hopkins et al (2012). Implementing organizational physical activity and healthy eating strategies on paid time. Health Education Research. Available at http://her.oxfordjournals.org

ENABLE CHANGE

Partnered with Dr. Yancey

to create the Instant

Recess Toolkit

Build the case for recess:

•Health & productivity

evidence

•Return on investment

figures for implementing

recess

•Case studies

Provide tools for

implementation:

•Step-by-step guide

•Engagement ideas

•Tracking charts

•Motivational materials

http://corptoolkit.keenfootwear.com

RECESS COST BENEFIT CALCULATOR

IGNITE A REVOLUTION

• 13,712 individual pledges

to take recess

• 215 media mentions on

the Toolkit

• Public Health Institute

acknowledgement

• Association of Clinicians

for the Underserved

(ACU) distribution via

website

• Kaiser Permanente

activation of Instant

Recess ®

UC Press, released November 2010

Instant Recess:

Book chapter headings

INTRODUCTION

CHAPTER ONE The High Price of a Sedentary America & Challenge of Getting Us Moving

CHAPTER TWO The Benefits of Widespread Physical Activity & Opportunities to Move the Needle

CHAPTER THREE The Evolution of an Idea

CHAPTER FOUR The Marketing and Social Marketing of Physical Activity and Fitness

CHAPTER FIVE The Case for the Recess Model

CHAPTER SIX Instant Recess—What’s Good for the Waistline Is Good for the Bottom Line!

CHAPTER SEVEN A Glimpse of the Future—How Instant Recess sparked a physical activity movement

Why Does Instant Recess® Work?

Minimal Cost For companies, minimal cost of time and money For employees, ability to use paid time to “recharge” The return on investment in terms of employee productivity is often

greater than the time invested

Made for Groups Group setting provides social support to engage in healthy behaviors Group setting also provides time to improve employee relationships and

boost morale

Reduces Barriers to Activity Initiated as a “default” activity rather than a “voluntary” option. Adjustable for all shapes, sizes, abilities, and fitness levels Minimizes perspiration, so prevents messing up hairstyles or work

clothes

Public Health Successes of the late 20th Century

Tobacco control

Drinking & driving

Seatbelts & child safety seats

Breastfeeding initiation

Organization change = catalyst or sweet spot!

Recess breaks:

The smoking ban of the

physical activity movement?

“You must be the change you wish to see in the

world.” -- Mahatma Gandhi

“Never doubt that a small group of thoughtful, committed citizens can

change the world. Indeed it’s the only thing that ever has!” --Margaret Mead

Together we can make a difference!

Take Home Points

Continue to promote exercise/physical activity

Adults

150 min/wk of moderate or 75 minutes/wk vigorous

Muscle strengthening > 2 d/wk

Children

Aerobic activity > 60 min/d

Muscle strengthening > 3 d/wk

Bone strengthening > 3 d/wk

Move toward reducing sedentary time for all

Incorporate physical activity into daily routines

THE INSTANT RECESS® LIBRARY IS GROWING RAPIDLY!

…and more!

Facebook.com/InstantRecess @InstantRecess

Instant Recess Materials are available:

For purchase at: http://www.journeyworks.com/Instant-

Recess/products/255/

For viewing online at: www.youtube.com/gramercync

*Materials are available in audio (CD) and video (DVD) format