There are many reasons why individuals might not meet the Physical Activity Guidelines, but one major factor is the physical environment that surrounds them. When people don't have the option to make the healthy choice regarding their participation in physical activities, there is no possible way they can do it.

Over the past several decades, our society has engineered physical activity out of our lifestyles. For example, 13% of children five to fourteen years old usually walked or biked to school in 2009, compared with 48% of students in 1969. For a long time, neighborhoods were being built without regard for pedestrians, putting the needs of the driver first. Safe biking lanes, walking paths that connected places where people wanted to go, and a variety of safe outdoor play spaces were all but engineered out of most built environments. Schools were being put in a position where they had to eliminate physical education, whether for budget reasons or to meet academic goals. Offices were built without bike racks, employee changing areas, or easy to use staircases, further enhancing less physical activity instead of more.

Fortunately, things are starting to change. A healthier communities movement is building across the nation. The Y, along with other national organizations, is leading the way. Since 2004, with support from the Centers for Disease Control and Prevention and other corporate and foundation donors, the Y has engaged leaders in 200 communities in working together to implement strategies that provide opportunities for physical activity.

YMCAs engaged in our Healthier Communities Initiative (pioneering Healthier Communities, Statewide Pioneering Healthier Communities and ACHIEVE) are helping families by giving parents peace of mind when they let their kids walk to school. The initiative is focused on creating safer routes, making streets safe for all users whether they are on foot or on wheels. The organizations strive to keep a generation of kids healthier by working with schools to increase physical education and physical activity during the school day, and making recess periods more active. The initiative also encourages employers to build environments that support activity among their employees. These examples are just the beginning.

How healthy is your community? What are examples of your community's efforts to change the built environment so more people engage in physical activity to meet the PA guidelines? How are you helping people see that their own built environment supports or inhibits meeting these guidelines? What barriers are there, and how can you work with other leaders in your community to collaboratively remove those barriers?

In today's society, we're flooded with negative messages and images about what it means to age and to be an older person. We are constantly exposed to stereotypes that show older adults through a lens of decline and diminished value, emphasizing the "burdens" of growing old. In North America, we seldom hear about the value of older adults, or the rich, untapped potential of an aging population. We don't see enough portrayals of active older adults who are taking on new challenges, expanding their knowledge and skills base, or working tirelessly to help others. The result? Our views of aging are distorted.

The distorted view of aging is a major reason we have limited success engaging older adults in physical activity.

Just this month, for example, MSNBC reported on the disconnect between fashion magazines and aging readers. "An analysis of editorial and advertising images reveals that despite proportions of older readers ranging as high as 23%, fashion magazines portray women over 40 sparingly, if at all," writes Stephanie Pappas. "Even in magazines geared toward aging Baby Boomers, the images collectively present a thin, youthful, wrinkle-free ideal that's impossible to maintain later in life."

This ideal has an impact on body image in older women, according to Denise Lewis, a University of Georgia gerontologist and author of the research. "It leads to issues that have people denying age, so going to great lengths to continue to look like that ideal of a youthful person," she explains.  The question is: If aging is something to be negated, denied or even "treated" through plastic surgery, where do we draw the line?

If looking old is somehow unacceptable, what about being old? An ad campaign for Circle K convenience stores blatanly disrespects and dismisses old age. The creative minds behind the campaign have used a drawing of a person in three stages of aging to illustrate the sizes of "Geezerade" slushy drinks and their cost. The eldest stage, which corresponds to the largest and most expensive drink, is an aging caricature: a bald, toothless, wizened old man. "Youngsters" can post their photos on the campaign's website and see themselves turned into "Geezers" - all just for fun, of course.

The "Geezerade" campaign is one overt example of ageism in marketing. But marketers make choices every day that have an impact on how society views aging. The campaigns they create too often reflect and reinforce negative perceptions of aging in society because they show one slice of the aging experience, if they show it at all. Marketing targeted to older people largely misses the mark by failing to connect with the realities of their lives.

One such reality is the ability of older adults to be physically active. Simply shifting attitudes from I can't to I can can help shift society's perceptions of aging, helping more adults to become healthier. 

What can you or your organization do to change perceptions of aging?

By Dr. David Geier, AOSSM

One of the most common reasons patients give for not exercising is an injury or pain. People often use knee or shoulder pain or some other limitation as an excuse for not playing sports or being physically active. And while certainly musculoskeletal injuries can affect participation, rarely should these injuries keep people on the sidelines permanently.

Joint pain is unfortunately a fairly common affliction among the United States population. According to the Centers for Disease Control and Prevention, in 2006 approximately 30% of adults reported that they experienced some sort of joint pain in the previous 30 days. Musculoskeletal injuries are rarely completely incapacitating, however. While many weekend warriors cite old knee or shoulder injuries as reasons that they can't exercise now, with so many options available, even people with real injuries should be able to modify their routines and still get in a good workout.

For example, a female with early knee arthritis can still perform cardiovascular-enhancing exercise. She might not be able to run long distances six or seven days a week, but she might be able to run two days a week and swim or ride a bicycle the other days to decrease the repetitive impact on her knees. A male with rotator cuff impingement from overuse at work or in the yard might have to back off from tennis or baseball, which might aggravate his shoulder, but he could play soccer or another non-throwing sport. And for athletes who enjoy lifting weights, simply adjusting a few of the exercises might be enough to exercise in spite of a current injury.

For those who fear that they are making an injury worse, they should see a sports medicine physician. Most injuries do not need surgery, and often there are simple initial treatments, such as physical therapy, home exercises, taping, or anti-inflammatory medications. And while patients are often reluctant to go to the doctor for fear of being completely shut down from a sport or activity, sports medicine physicians usually try to encourage treatments and rehabilitation that get people back to sports and exercise as quickly as possible.

Finally, even if the activity is potentially detrimental to a joint, it might not always be that bad. Someone with near bone-on-bone knee arthritis is possibly making his knee worse running every day. Having said that, if he wants to keep running, the benefits of his overall health might outweigh the risks to his knee. Daily exercise can provide multiple medical benefits, including improved cardiovascular function, lower blood pressure, and weight loss, as well as improved sleep and mood. Even if he needs a knee replacement in the future, the medical upside to exercise is significant.

While aches and pains can be an obstacle to physical activity, they shouldn't be permanent barriers to all exercise. If you are worried about injuries or exercise modification discuss it with a doctor and know that being physically active is possible despite these pains.

What kind of activities can we promote to keep people moving no matter the aches and pains?