This document discusses strategies for increasing physical activity levels through "push" approaches that make active choices the default option rather than relying on individual motivation. It provides evidence that brief activity breaks of 10 minutes can have benefits for health, costs, and productivity in workplace settings. Studies show implementing 10-minute physical activity breaks in various organizations and schools has resulted in increased activity levels and improvements in outcomes like blood pressure, weight, and absenteeism. The document argues for promoting physical activity through environmental and policy changes rather than solely relying on individual motivation.

1. Active by Default:
Getting Communities Moving
10 Minutes at a Time
Toni (Antronette K) Yancey, MD, MPH
Professor, Department of Health Services
Co-Director, UCLA KP Center for Health Equity

2. The Problem

3. Extremely Low US Physical
Activity Levels*
Mean moderate to vigorous intensity PA
levels: US adults = 6-10 min/day
PA Levels meeting federal recommendations:
<5% adults
<10% teens
<50% children
*when objectively measured—NHANES (Troiano et al., 2008)

4. Leisure Time Physical Activity Levels:
Little Change in >2 Decades

5. 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

6. A potential solution

7. “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

8. Why worksites?
The practical reasons…
• Proportion of time spent at work is high & expanding
– Large proportion of daily caloric intake consumed during
work hours
– Opportunities for physical activity outside of work hours
may be limited
• Humans evolutionarily programmed for sedentariness &
most won’t exercise on their own even if given instruction,
encouragement and time, e.g., data entry workers reported
stretching during only 25% of conventional breaks and 39%
of supplementary breaks (Galinsky et al., 2007)
• Especially true for ethnic minority/low income populations
who may work longer hours or multiple jobs, have longer
commutes, and be single parents

9. Cross-sectional Workplace Studies
Employee Health Care Cost Savings
from Physical Activity
Among 23,490 employees at large corporation:
• Moderately active and very active employees had
$250 less paid health care costs annually than
sedentary employees across all weight statuses
• Savings were $450 for moderately and very
active obese employees compared with their
sedentary obese counterparts

10. Why worksites?
On the philosophical side…
• Changes made at work may spill over to home & school
• Growing realization of need for interventions to change the
physical & socio-cultural environment—work is important
context for such influence
• Recognition of cultural assets available to build upon, e.g.,
centrality of dance and music in ethnic minority populations
• Physical activity interventions focused solely on ―leisure-
time‖ behaviors less successful among lower income
individuals and people of color, especially women, those
with highest rates of chronic disease &obesity
• Need more interventions that ―push‖ vs. ―pull‖ someone to
choose active alternatives (i.e. make the active choice the
default choice that must be opted out of vs. opted in to)

11. Benefits of activity breaks
• A simple 10% decrease in inactivity could decrease
healthcare spending by $150M/year
• Introducing 10-minute activity bouts in the
workplace can:
 Waist line, blood pressure, weight, and percent body fat
 Appetite (relative appetite suppressant)
 Urge to smoke
 Stress and anxiety
 Harmful effects of prolonged sitting
 Speed and accuracy of data-entry
 Engagement of inactive individuals
 Mood, self-efficacy; self-esteem
 Fruit and vegetable intake, water consumption
 Overall (total) physical activity (due to spill-over to non-work settings)
 Supportive work environment
 Energy levels
 Cognitive processing, especially executive function component (judgment, processing
efficiency)
11
 Bone density 11

12. Creating an Active School Day:
Making activity the default option
 Improving the quality of physical education (PE) and
ensuring adherence to mandates for PE duration
(200 min/10 d elementary/400 min/10 d secondary)
 Integrating 10-minute Instant Recess break at
scheduled time(s) of the day
 Improving equipment & supervision to increase PA
during recess
 Establishing auto-free zones, e.g., bus drop-off
point so that students & staff must walk 5-10 min.
 Redesigning classrooms to substitute stability balls
for chairs, rotations among small group activity
stations

13. What Is Instant Recess®?
• Incorporation of 10-minute activity breaks into daily
routine, e.g., on paid time or during non-PE classes
• Simple and easily replicable, low-impact, moderate
intensity movements set to music and scientifically
designed to produce a manageable level of exertion,
positive and reinforcing affective responses and
fitness improvements, and minimal injury risk for
sedentary or overweight workers
• Structured to maximize accessibility & effectiveness
while minimizing wasted time
• Implemented in over 1000 workplaces and thousands
of schools since 1999, materials purchased in 45
states and DC, as well as 10 foreign countries
• Evaluated in foundation- & federally-funded studies

14. Integrating 10-Minute Instant Recess®
Breaks into Organizational Routine
 Short bouts easier for sedentary individuals,
minimizing perspiration & hair/make-up disturbance
 Variable intensity, low-impact physical activity
accommodates higher proportion overweight, unfit
and/or disabled individuals
 Social support & desire for conformity drives
participation
 Activity breaks may be framed as fun, play, stress
release, entitlement to move vs. exercise=work,
drudgery, obligation to most people
 Needed to counter negative activity framing typical
in food policy debate

15. Activity Breaks Work!
The rapidly growing evidence base
• Documented individual and organizational receptivity
to integrating activity into routine ―conduct of
business‖
• Contribute to daily accumulation of activity
• Motivational “teachable moment” helping inactive
people link sedentariness to health status
• As little as 10 min./day improves BP, weight, waist
circumference, mood, attention span, cumulative
trauma, absenteeism, employee retention, bone
mineral density, academic performance, discipline
• “Spill-over” to increases in active leisure
• Favorable return on investment — LL Bean mfg. plant
gets 30 min. productivity for 15-min. investment (three
5-min. breaks per shift)

16. Studies

17. • 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

18. 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)

19. Pilot Study Baseline Data:
Worksite policies/practices
PA Promotion Policy/Practice Endorsed n %
Casual attire during working hrs 15 68%
Standing/stretching/fidgeting during meetings 12 55%
PA on paid work time during wkday* 7 32%
Exercise breaks during meetings or time(s) of wkday 6 28%
Policy (formal or informal) supporting employee PA 6 28%
Flex time to accommodate PA 4 18%
Walking club(s) 4 18%
*Correlated with higher % employees reporting group PA during wk (t(274)=2.47, p=0.01

20. 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)

21. 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

22. REACH Organizational Wellness
Assessment Outcomes

23. 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)

24. 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  winning Wave move
selected for San Diego Padres’
FriarFit IR DVD
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‖

25. Instant Recess® @ Winston-
Salem/Forsyth County, NC USD
Evaluation of IR in implementation of policy
change to require 30 minutes of daily PA in
elementary school day: 8-school pilot study
• Increase in % of children doing fitness skills (IR)
Intervention (+9%) vs. Control (0%), p < 0.05
• Increase in % of children who were ―on-task‖
Intervention (+6%) vs. Control (-5%), p < 0.05
Just piloted district-wide in all 16 middle
schools with 12,000 students daily

26. Mean Minutes of Light, Mod. &
Vig. PA in WSFCUSD Classes (SOFIT)

27. 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)

28. Other Activity
Break Intervention
Studies:
Cases & Trials

29. 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 year)
• 1 kg weight loss (0.4 kg/m2) + 1.6 cm ―waist‖ loss after 1 year

30. 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!

31. Replacements, Ltd.
Greensboro, NC
• Instituted 10-minute group stretch breaks on the clock
every morning & afternoon 5 yrs ago in 550-employee
distribution center
• Occupational RN identified two departments with large
numbers of musculoskeletal complaints. Provided
instruction sheet to Dept #1 for individual use at their
desks; in Dept#2, turned on music and employees did the
stretches as a group ―on the clock‖ scheduled into the
daily routine.
• Dept #2 saw greater impact on musculoskeletal
complaints due to higher participation rates
• Decreases in workers’ comp claims led to decrease in
premiums

32. Westinghouse Plant
College Station, Texas
• Study participants were employees who assembled
computer boards
• Performed set of 23 flexibility and strength exercises
designed to prevent lower-back & carpal tunnel injury
• 10 minutes each day on company time under
supervision.
• Daily participation rates 97-100%
• Significant improvements observed in wrist flexion,
wrist extension, lower-back flexibility, fatigue, and
mood, compared with a control group that did not
participate in these exercises

33. Danish Public Administration
Authority
• 616 office workers from 9 sites in dif. geographic areas
• 3-group design, all allotted 1 hr/wk during paid time:
A Three 20-min. neck & shoulder resistance training exercises
B Varied physical activity (PA)--organized walks, 8-min. aerobic &
resistance exercise CD, steppers at copiers, hallway punching bags
C Attention controls—group discussion of worksite wellness—no PA!
• Both PA conditions worked compared with controls:
✪Statistically significant systolic BP (-6 mm Hg), body fat
(-2.2%), shoulder & back pain
✪Statistically significant muscle strength, VO2max
(aerobic capacity)

34. University of Kansas PAAC
Cluster Randomized
Controlled Trial Outcomes
•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!

35. Dissemination

36. Network for a Healthy CA
CA Dept of Health Svcs./Public Health
Initial source of
support for LA Lift Off!
via USDA food stamp
nutrition education
funds in 2000
Funded development
of first Instant Recess®
break with Allen
Rossum & the Pro.
Athletes Council in
2007

37. WNBA LA Sparks’ SPARKing
Motion Accomplishments
• Sample moves:
*Thompson Tip-off
*Milton-Jones Jumper
*Parker Power Jam
• Launch event featured
first-ever in-game
exercise break in a
professional sports
contest and distribution
of 1000 CDs + photo
guide inserts

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

39. Organizational Profiles – In Brief
• 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 each mtg & reimburses members only for
healthy refreshments x 5 yrs
• Orange Co. Health Dept, 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 participation in gospel
aerobics classes
• WPFW Pacifica Radio Station, DC – broadcast 10-min IR
breaks daily x 6 mos; re-launching w/ Wobble Dance IR

40. SHIRE non-profit, Washington, DC
Washington Post
“Instant Recess…calling card for the National
Physical Activity Plan

41. Dr. Yancey goes to Washington!

42. Alliance for a Healthier Generation
• Healthy School Framework including 8 areas of focus
• Activity breaks most commonly selected PA intervention along with elementary
school recess: 75% of those inventoried (sample n=3504) of 12,000+
participating schools endorsed item “All students have the opportunity to
participate in physical activity breaks on a daily basis.”
• Success Stories:
“Get up and moving each & every morning before flag salute”
--John Glenn Elem., Pine Hill, NJ
“Students are running or power walking 2/5 mi before they play at recess and
principals, teachers & other staff routinely move with them…students more
energetic & attentive in PM classes, eating healthier foods & throwing less
away at lunch, and exhibiting fewer behavior problems during recess
--Jackson Elem., St. Paul, MN
“Use technology to get classes moving, uploading PA videos to school server
and streaming them 4x/day so teachers can use at their convenience
--Norris Elem., Firth, NE

44. HEALCitiesCampaign.org
CA League of Cities & CCPHA
22 cities have now
adopted policies
advocating activity
breaks in meetings
lasting an hour or longer
First 5 LA Commission informally
adopted & featured IR® break at Sep
2011 meeting, and now on Oct agenda
for formal policy change!

45. Amazon book ranking
Nov 21, 2010--318,000

Nov 23, 2010—21,000!

47. Sitting All Day: Worse For You
Than You Might Think
by PATTI NEIGHMOND
April 25, 2011 ... breaks? Toni Yancey's Instant Recess book
offers the following suggestions for people who feel chained
to their office desks:
http://www.npr.org/2011/04/25/135575490/sitting-all-day-
worse-for-you-than-you-might-think
Amazon book ranking
April 24,2011--523,000  April 25,2100--2300!

48. Adopts Instant Recess® in support of Let’s Move!
Plymouth UCC
(North
Houston, TX)
―Musical Pews‖
IR break

49. The Jesus Shuffle

50. Washington Post
September 6, 2011

51. IR on campus!
Arizona State U.
Only Exposure
(of which we’re aware)
Prompting Adoption is
via YouTube
IR at school!
CBS News, 9/22/11
Midlands, TX school district
adopts IR

52. KEEN “Recess Is Back!”
Began as marketing
campaign
Now viewed as part of
company ―DNA‖
2020 goals for instigating
Recess Revolution

57. Recess breaks:
The smoking ban of the
physical activity movement?

59. Instant Recess® materials are
available
• For purchase at:
www.toniyancey.com/instantrecess
• For free streaming at:
www.youtube.com/tonikyancey
www.youtube.com/gramercyNC
• For free download at:
www.gramercyresearch.com
• Materials are available in audio (CD) and video (DVD)
format

60. Selected References
• Barr-Anderson D et al. Structural integration of brief bouts of physical activity into
organizational routine: systematic review. AJPM 2011;40:76-93.
• Crawford P et al., Walking the talk. AJPH, 2004;94:1480-1485.
• Donnelly J et al. Physical Activity Across the Curriculum: RCT to diminish overwt &
prev. obesity in elem. school children. Prev Med 2009;49:336-41.
• Galinsky, T et al. Supplementary breaks and stretching exercises for data entry
operators: a follow-up field study. Am J Indus Med 2007;50, 519-27.
• Lara, A, Yancey, AK, Tapia-Conyer, R et al. Pausa para tu Salud: reduction of weight
and waistlines by integrating exercise breaks into workplace organizational routine.
Prev Chronic Dis 2008;5:A12.
• Pronk, SJ, Pronk, NP, Sisco, A et al. Impact of a daily 10-minute strength and
flexibility program in a manufacturing plant. Am J Health Promot 1995;9:175-8.
• Wang F, McDonald T, Champagne LJ, Edington DW. Relationship of BMI and physical
activity to health care costs among employees. J Occup Environ Med 2004;46:428-
436.
• Woods D. Implementation of 10-minute exercise breaks in LAUSD elementary
schools. UCLA School of Public Health. Filed May 25,2011.
• Yancey A. “Pushing Workplace Physical Activity. NHLBI Chronic Disease Prev. in the
Workplace Expert Convening. Washington, DC. May 21, 2009.
• Yancey T (AK). Getting our instant gratification society moving, one school at a
time. CAHPERD Journal 2011;73(1):34-39.
• Yancey T. Instant Recess: Building a Fit Nation 10 Minutes at a Time. Berkeley, CA:
University of California Press, 2010.

61. Senior Investigators: McCarthy, Bastani, Berrien, Cole,
Eisenberg, Fielding, Gonzalez, Guinyard, Kumanyika,
Maxwell, Perot, Sallis, Simon, Taylor
Junior Investigators: Whitt-Glover, Glenn, Keith, Alhassan
Post-docs: Bell-Lewis, Hasson
Students: Hopkins, AuYoung, Jackson, Leak, Woods
Administrators/Business Leaders: Wilson, Anderson,
Bernert, Eisenberg, Flores, Girard, Graham, Harding, Keith,
Kimbrough, Levine, Miles, Nevarez, Osby, Overton, Pittman,
Ross, Sanchez, Standish
Pro Athletes/Talent: Rossum/PAC, Winfield, Jones, Milton
Instant Recess® team

62. Facebook.com/InstantRecess @InstantRecess