National Guidelines for Diet and Physical Activity: International Implications

Richard P. Troiano, Ph.D.

Second Forum on NCD Prevention and Healthy Lifestyles Promotion

«For Healthy Life»

Presentation Overview1. Background of diet and physical activity

guidelines in US

2. Guidelines development process

3. International application and harmonization

4. Benefits of national guidelines

Dietary Guidelines for Americans• First released in 1980

– Required by legislation to be reviewed and updated every 5 years

– Review and recommendations by group of scientific experts

• Joint effort of the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Agriculture (USDA)

• Provide the basis for federal food and nutrition policy and education initiatives

Physical Activity Guidelines• Not required by legislation

• Recommendations by professional groups since 1970s– American Heart Association, American College of

Sports Medicine– Focused on exercise for fitness and risks of exercise

• Focus shifted to a public health model in 1990s

1996

2008 PHYSICAL ACTIVITY GUIDELINES FOR AMERICANS

Objective• Comprehensive, evidence-based physical activity

guidelines– Cardiorespiratory– Strength– Balance

• Harmonize various recommendations• Address subpopulations

– Older adults, persons with disabilities

PA Guidelines Development Process

PA Guidelines Advisory Committee

PA Guidelines Writing Group

Communications Workgroup

Processes Products

Launch “Team” (Public/Private)

650+ Page Reportsummarizing the science

2008 Physical Activity Guidelines For Americans

Dissemination plan,materials for public,

materials for partners,logo & key messages

Systematic Evidence Review Searchable Data Base(now public access)

4 Key Adult Guidelines

• Avoid inactivity• Substantial health benefits from medium amounts

of aerobic activity• More health benefits from high amounts of aerobic

activity• Muscle-strengthening activities provide additional

health benefits

www.who.int/dietphysicalactivity2010

International Harmonization

National Guidelines Informed by US Report

• Austria

• UK

• Ireland

• Canada

UKK Institute - Finland

IMPACT OF HAVING GUIDELINES

Meeting Physical Activity Recommendations

1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 20000

5

10

15

20

25

30

35

40

45

50

Men

Women

Year

Prop

ortio

n of

the

Popu

latio

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)

Data from Behavioral Risk Factor Surveillance System

Krebs-Smith, Reedy, Bosire 2010, Am J Epid

Healthfulness of the US Food Supply

Toward a Comprehensive,Public Health Approach

• Individual– Personal goal setting

• Interpersonal– Social support, encouragement

• Organizational– Worksite health promotion

• Community– Access to parks and recreational facilities

• Public policy– Policies that promote active transportation

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“Healthy choice should be the easy choice.”

From Guidelines to Action

Multi-Sector Approach• The National Physical Activity Plan includes

recommendations that are organized in eight societal sectors:

– Business and Industry– Education– Health Care– Mass Media– Parks, Recreation, Fitness and Sports– Public Health– Transportation, Land Use, and Community Design– Volunteer and Non-Profit

www.globalpa.org.uk

HEPA Europe – European network for the promotion of health-enhancing physical activity

• Brings together different institutions and organizations from all over Europe

• Collaborates closely with WHO/Europe

• Facilitates multi-sectoral approaches

• Advocacy and exchange of information

• Promotes and disseminates innovative HEPA strategies, programmes, approaches and good practice

• Promotes and engages in research

www.euro.who.int/hepa

Midcourse Report

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Role of Physical Activity Guidelines

• Justify expenditure of public funds for promotion and programming– Science to establish legitimacy among other public

health interventions• Define benefits to be expected by various

population groups and the necessary dose of activity

• Unified message and behavior targets– Consistent metrics for short- & long-term evaluation

• Support economic arguments in terms of health care cost savings as well as moral justification based on equity and human rights

Key Messages

• Provision of information alone, even scientifically-based physical activity guidelines, is not sufficient to bring about behavior change.

• Physical activity guidelines are necessary, but not sufficient, to increase levels of health-enhancing physical activity.

• Action at multiple levels is needed to support health-enhancing physical activity.

Thank you

Questions?