We who teach know that real education involves putting ideas into action. A science lesson hits home when textbook reactions are tested in the lab. Rote rules of grammar become the sinews of real writing. Similarly, we who advocate physical activity for health can do real and lasting good when we go beyond preaching healthy lifestyles to helping them become reality.

Examples abound, from teachers scheduling classroom physical activity breaks to neighbors pitching in to create pocket parks where they are most needed. More employers are starting workplace wellness programs and toting up gains in productivity, morale and cost savings. Friends are exercising together for support and motivation.

Such efforts are happening community-wide, as well. The ACSM American Fitness Index, valued as an assessment tool that gauges the health status of the 50 largest metropolitan areas in the United States, now is helping communities bring about changes that will make a substantive difference in their residents' health and wellness.

The AFI Technical Assistance Program (TAP) builds upon the annual AFI data report. Working with selected communities (originally, Indianapolis and Oklahoma City, then expanding to ten through 2013), TAP seeks to identify actionable areas with the best evidence for improving health and fitness at the community level. The goal is not to recreate the wheel, but rather to coordinate and streamline efforts already underway. Steps include:

• Interviews with community advocates and experts
• Working with a community team to create a five-year strategic plan
• Public evaluation and comment
• Implementation and evaluation, with help from ACSM experts

Quite a process, isn't it? TAP is designed to get results and, importantly, is evidence-based and accountable. A grant from the WellPoint Foundation helps make it possible.

While every community may benefit from a comprehensive approach to planning and implementation like the AFI Technical Assistance Program, there is incalculable, cumulative benefit in the thousands of programs and projects that Americans are putting into place to foster more physically active communities.

Let's learn from the TAP and other programs, keeping our eyes open for the efforts of any size that can add up to real change. The National Physical Activity Plan and the ACSM American Fitness Index offer the big picture; it's up to us to make it real at a level that affects everyone in the US.

What efforts are underway in your community to improve opportunities for health and wellness?

What's being done to address gaps identified in the American Fitness Index?

The best summary I’ve heard of our nation’s anti-obesity efforts to date goes something like this: “We’ve tried a thousand ideas and they all work a little.”

The point was that it’s very difficult to design a program for behavior change that works across several demographics.  We all have different motivations, priorities, and challenges that aren’t easily captured by one program.  There is at least one incentive, however, that appears to be a powerful force of change for a broad cross-section of the American public: cash.

What happens when people are financially incentivized to be physically active?

A study by Blue Cross and Blue Shield of Minnesota documented the results of a program that provided enrollees with a potential health club membership discount of $20/month based on attendance.  The study found that a) the discount encouraged use of health clubs (43% of BCBS employees surveyed said they joined a health club because of the discount); and b) those who regularly attended a gym appeared to have better health (17.8% lower claim costs than non-participants).

A similar Medica study explored the results of a program that offered a $20/month discount on a gym membership for enrollees who visited a gym at least eight times each month.  The study found that a) the membership discount encouraged people to exercise regularly (43% of enrollees qualified for the discount); and b) after two years, people who began a regular program of exercise and met the threshold of eight times/month had significantly lower costs for prescriptions, doctor appointments, and care at clinics and hospitals (medical costs for enrollees were 33.6% lower than a control group).    

These two studies strongly support the use of financial incentives to increase physical activity.  Moreover, they offer a compelling argument for the adoption of fitness programs as a method for reducing organizational health care costs.  Not surprisingly, a review of the published studies relating to health promotion programs found that fitness programs lead to reduced health care costs.

It’s also important to note that physical inactivity also carries a hidden cost related to reduced productivity.  Researchers in Michigan found that physical inactivity resulted in the loss of 20 days per worker, costing $8.6 billion annually.

Fortunately, it seems as though the c-suites are catching on to the importance of physical activity.  A benefits survey conducted by the Society for Human Resource Management in 2008 revealed that 36% of the surveyed organizations offer either a fitness center subsidy or reimbursement, while 21% of the organizations provided onsite fitness facilities.  Some of the respondents (6%) even offered a fitness equipment subsidy or reimbursement.

What are some other proposals or current policies that would financially incentivize physical activity?

Photo credit: D Sharon Pruitt

Policy...isn't that something that only the “wonks” of the world think about? You know the type...they run around quoting combos of letters and numbers like HB123 or SB567...or preaching that ABC policy will mean XYZ to the local community.  The reality is that, according to Wikipedia, “shaping public policy is a complex and multifaceted process that involves the interplay of numerous individuals and interest groups competing and collaborating to influence policymakers to act in a particular way.”

Many individuals never give much thought to how ideas become laws or policies nor do they think that they can help affect change in areas that they are passionate about. The truth of the matter is that while the “wonks” are an integral part of turning ideas into policy, in most cases, it really does take a whole cast of characters to affect change including both organized groups and individual citizens.

The nations' first Physical Activity Plan that was introduced in May has been described as “policy based” but what does that really mean? Under the leadership of the, National Coalition for Promoting Physical Activity a broad array of groups have formed an NPAP implementation team to work on converting the strategies and tactics included in the NPAP into local, state and federal policies that help Americans to meet the Physical Activity Guidelines for Americans.

Let's look at an example....take Safe Routes to School. According to the Safe Routes to School National Partnership, SRTS programs work to insure that communities put policies into place that make it safe for children to walk or bicycle to school thus increasing the amount of physical activity in their day. The NPAP consists of eight different sectors including Education and Transportation/Active Living. Under the tactics listed for one of the education strategies is: “Support SRTS efforts to increase active transportation to and from school and support accommodations for children with disabilities.” Under the Transportation and Active Living Sector there are tactics related to SRTS such as, “support annual reporting by all schools of their transportation mode split” and “expand safe routes” initiatives at national, state, county and local levels to enable safe walking and biking routes to a variety of destinations especially to schools.”

My personal hope is that the concept of “Safe Routes” can be expanded to include community places such as parks, Y's, libraries, retail areas, etc. Imagine being able to have your children or yourselves be able to safely ride their bike or walk to the library....the benefits are endless to such a concept reaching beyond the obvious of increasing physical activity to include such things as reducing the amount of emissions in the air.

Would you like to see “Safe Routes” expanded to include other community places? What do you see the as the benefits and the challenges of this type of expansion?