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 PW I N S T O N - S A L E M , N CE 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 MW 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 MW W W . G R A M E R C Y R E S E A R C H . C O MInstant Recess®: Building a FitNation 10 Minutes at a Time!
Age-adjusted Prevalence of Obesity and DiagnosedDiabetes Among U.S. Adults Aged 18 Years or OlderObesity (BMI ≥30 kg/m2)Diabetes1994199420002000No 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 athttp://www.cdc.gov/diabetes/statistics20102010
What has changed?1980 2004Overweight children (ages 6-11) 7.0% 18.8%Overweight adolescents (ages 12-19) 5.0% 17.1%thenthenthenthennownow nownow
Whitt-Glover MC, Taylor WC, Floyd MF, Yore MM, Yancey AK, and Matthews CE. Disparities in Physical Activity among USChildren and Adolescents: Prevalence, Correlates, and Intervention Implications. Journal of Public Health Policy 2009, 30(Supplement 1): S309 – S334.Physical Activity Prevalence in Children
Source: http://www.statehealthfacts.org/comparemaptable.jsp?ind=92&cat=2Percent of adults who participated inmoderate or vigorous PA, 2011
Percentage of adults who were highly active accordingto the 2008 Guidelines: NHIS 2009Sex8
What is sedentary? 1. Characterized by or requiring a sitting posture: asedentary occupation. 2. Accustomed to sit or rest a great deal or to takelittle exercise. 3. Chiefly Zoology . A. abiding in one place; not migratory. B. pertaining to animals that move about little or arepermanently attached to something, as a barnacle.www.dictionary.com
Sedentary Behavior Research Network We suggest that journals formally define sedentarybehaviour as any waking behaviourcharacterized by an energyexpenditure ≤1.5 METs while in a sitting orreclining posture. In contrast, we suggest thatauthors use the term “inactive” to describe thosewho are performing insufficient amounts of MVPA(i.e., not meeting specified physical activityguidelines).Sedentary Behaviour Research Network. 2012. Standardized use of the terms “sedentary”and “sedentary behaviours”. Appl Physiol Nutr Metab. 37: 540–542.
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 mayaccount for the energy imbalance (+100 Calories)causing the obesity epidemic Men who sit >23 hours a week of sedentary activity hada 64% greater risk of dying from heart disease thanthose who sit <11 hours a week, including many whoroutinely exercised Work days are associated with nearly 1 hour more sittingthan non-work days
Effects of Prolonged Sitting Increase in sedentary work, entertainment &transportation means 95% of Americans don’t getenough physical activity Sitting increases risk of death up to 40% & doublesthe 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
SITTING4 STEPSGETTING OUTOF A CHAIRSTANDINGSitting induces muscular inactivityHamilton, 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
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 yoursystem right there….” Daily activity is exercise “I work the third shift….I’m just always wipedout…” 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
Prevention vs. Treatment Most experts agree that diet is most critical for weightloss (treating obesity), but physical activity (PA) ismost critical for preventing weight gain (PAGAC,2008) Without increases in PA at a population level,impossible to decrease caloric intake sufficiently toachieve energy balance and get essentialmicronutrients (Hill et al., 2005) White hunger drives eating, there is no inherentbiological drive to be active in adulthood—thereforepush strategies necessary to achieve population-widePA increases (Yancey, 2009; 2010)
Population benefit estimates of risk factorchange: PA 3-minute bouts of PA 10 times per day lowers serumtriglycerides to same extent as 1 continuous 30-minutebout of PA (Miyashita et al., 2006) Sedentary behaviors (e.g., TV watching) as well as sub-optimal >moderate PA levels contributed to DM & obesityrisk over 6 yrs in women (Hu et al., 2003) Number of bouts as well as volume of PA correlated withyouth 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 companytime since 1982 Productivity measurements indicate 30 min.returned productivity for every 15 min. investedin exercise (5-min. breaks 3x/day) Reduced work-related injuries from 14/yr toessentially none within 1st 3 years Stretch breaks are viewed as a safety measuresimilar to wearing safety glasses Have now increased to a few minutes every hour!
PAAC Cluster Randomized ControlledTrial OutcomesDonnelly 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 inBMIWhen 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 individualmotivation--largely unsuccessful at population level--Improvements greater in individual inclined to be activeExamples: gym membership subsidies, stair prompt posters,lunchtime or after-work exercise classesPush strategies: Efforts to make the active choice thedefault option—the path of least resistance, requiringindividuals to “go out of their way” to make inactive choice--Promise of broader engagement, including those at greaterrisk for obesity—including ethnic minority groupsExamples: walking meetings, exercise breaks during non-discretionary time at work, nearby parking restricted todisabled, scheduling meetings at a distance from workspace
What is Instant Recess®? Instant Recess® is a 10-minute low-impact physical activitybreak 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 anindividual or organization. Can be used anytime, anywhere, by anybody
Basic Structure of an Instant Recess® Break IR Breaks are designed to maximize energyexpenditure Moves engage large muscle groups in the upper and lowerbody. IR Breaks are choreographed to be “do-able” for allages, 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, andpersonal 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 breakfrom the work day Provides a boost of energy during the “mid-afternoon slump” Also encourages changes to improvethe food environment at work With increased energy from taking daily recessbreaks, healthier snacks will taste better. Employs multiple levels of influence: “Deliberate Practice” Social Support and Group Dynamics Motivational “teachable” moment
10-min. Instant Recess® during staff / trainingmeetings longer than 1 hour 449 employees, mostly overweight, middle-agedwomen, ethnically diverse 90+% participation Demonstrated feasibility of engagement regardless ofweight or physical activity levels Found group breaks add social conformity factor thatpositively influenced participation “Teachable moment” - increased individual awarenessof poor physical conditioning and health status
Pausa para tu SaludMexican Ministry of Health, Mexico City 10-15 minute exercise breaks to musicbroadcast 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 WICStaff Wellness TrainingSignificant findings: Increased perceived workplace supportfor 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 WICparents promoting physical activity (64 vs. 35%, p<.05)& sensitivity in handling weight-related issues (92 vs.58%, p<0.01)
Pilot Study OutcomesBaseline 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 ControlBP (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 EvaluationOutcomes 36 health & human services agency worksites inLA and Orange Co, CA Significant increases in:1. Exercise break policies (meetings &scheduled time of workday)2. Nutrient-rich food procurement policies3. Policies requiring nutrient-richfoods/beverages in company meetingsMaxwell et al., Prev Chr Dis, 2011
South Bay Health Center Launched Instant Recess® Jan 2011 in callcenter, 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) incall 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 to12 (lab x 4 mos), 1 to 0 (in-pt x 2 mos)
Instant Recess®Champion Schools, PhoenixPre-tested at the Champion charter school in a low-incomePhoenix, AZ areaHosted “Think You Got Moves?” contestComments from teachers: “feasible to use daily because helps kids settle down afterlunch” “kids, girls especially, perform better in PE class because IRexercises 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) increasedin intervention (8.7%) and control (0.5%)schools, p > 0.05
Percent Time in On Task Behavior% time in on-task behavior increased in interventionschools (+6.4%) and decreased in control schools (-5.2%),p = 0.03
Mean Minutes of PA in SchoolClassrooms by Intervention Type0.02.04.06.08.010.012.014.0Spring baseline Spring followup Fall baseline Fall followupMeanMinutesIntervention Schools Crossover SchoolsControl Schools Instant Recess ClassroomsBar = SE
Minutes of Fitness Skills and MVPA in Classroomsby Level of Enthusiasm for Instant Recess-202468101214160 5 10 15 20MinutesofMVPAMinutes of Fitness SkillsNo Instant RecessMixed EnthusiasmMin FS Min MVPANo Instant Recess 0.64 0.61Mixed enthusiasm 4.79a 0.54Enjoyed Instant Recess 6.47b 2.57ba p = 0.0008 vs No Instant Recessb 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 interventioncontrol groups--main outcome = school day pedometerreadings (measured beginning & end of school day) Final model: Linear regression of post-treatment steps onboth intervention groups and baseline steps, clustered byschool, and student ID (R2 = 0.2292, F = 78.41 (p < .001)) Results: Adjusting for intervention group, mean stepssignificantly increased with IR intervention (+1910.3steps; p<.001)
Forsyth County, NCCommunity-Based Dissemination of Lift Off! Breaks Focused on feasibility of dissemination inschools and churches $500 mini-grants given to 10 organizations Develop innovative ways to incorporate the Lift Offconcept into regularly scheduled organizationalactivities Each funded site recruited 20 participants Organizations conducted activities for at least 6months and participated in pre- and post-programevaluation Physical activity data were collected usingaccelerometers and questionnaire. Demographicdata and process measures were also collected
Results020040060080010001200Walking Moderate Vigorous TotalPhysical Activity Changemeasured by IPAQ - ContinousActivityPre Mean (SE)Post Mean (SE)
HEALCitiesCampaign.orgCA League of Cities & CCPHA22 cities have nowadopted policiesadvocating PA breaks inmeetings lasting an houror longerFirst 5 LA Commission formally passed PAbreak integration policy 10/13/11!
Organizational Profiles & Case Studies City of Duarte, CA – 3-min. PA breaks every City Councilmeeting x 6 yrs Delta Sigma Theta Sorority, LA – turns up AC 15 min. pre-IRbreak & reimburses only for healthy refreshments x 5 yrs City/County of San Francisco Dept of Public Works, CAconducts stretch breaks with gen. svcs. employees every day Orange Co. Health Care Agency, CA – trained entire healthpromotion staff in implementing & dissem. IR breaks x 3 yrs St. John’s CME Church, NC – occasional IR breaks duringSunday service increased particip. in gospel aerobics classes WPFW Pacifica Radio Station, Washington DC – broadcast10- min. IR breaks daily 1:05 ET x 6 mos
San Diego Padres’PETCO Park onSunday home game“family” days
Common Factors of Instant Recess Success StoriesPhysical Layoutand Social ClimatePre-ExistingWellnessInfrastructureDedicated group ofIR “Sparkplugs”Persistence inTroubleshootingEffortsLeadershipSupport and ActiveParticipationInnovation andCreativityHopkins et al (2012). Implementing organizational physical activity and healthy eating strategies on paid time. HealthEducation Research. Available at http://her.oxfordjournals.org
ENABLE CHANGEPartnered with Dr. Yanceyto create the InstantRecess ToolkitBuild the case for recess:•Health & productivityevidence•Return on investmentfigures for implementingrecess•Case studiesProvide tools forimplementation:•Step-by-step guide•Engagement ideas•Tracking charts•Motivational materials http://corptoolkit.keenfootwear.com
IGNITE A REVOLUTION• 13,712 individual pledgesto take recess• 215 media mentions onthe Toolkit• Public Health Instituteacknowledgement• Association of Cliniciansfor the Underserved(ACU) distribution viawebsite• Kaiser Permanenteactivation of InstantRecess ®
Instant Recess:Book chapter headingsINTRODUCTIONCHAPTER ONE The High Price of a Sedentary America & Challenge ofGetting Us MovingCHAPTER TWO The Benefits of Widespread Physical Activity &Opportunities to Move the NeedleCHAPTER THREE The Evolution of an IdeaCHAPTER FOUR The Marketing and Social Marketing of Physical Activityand FitnessCHAPTER FIVE The Case for the Recess ModelCHAPTER SIX Instant Recess—What’s Good for the Waistline Is Good for theBottom Line!CHAPTER SEVEN A Glimpse of the Future—How Instant Recess sparked aphysical 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 oftengreater 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 andboost 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 workclothes
Public Health Successes of the late20th CenturyTobacco controlDrinking & drivingSeatbelts & child safety seatsBreastfeeding initiationOrganization change = catalyst or sweet spot!
Recess breaks:The smoking ban of thephysical activity movement?
“You must be the changeyou wish to see in theworld.”-- Mahatma Gandhi“Never doubt that a small group ofthoughtful, committed citizens canchange the world. Indeed it’s the onlything that ever has!”--Margaret MeadTogether 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 GROWINGRAPIDLY!…and more!
Facebook.com/InstantRecess @InstantRecessInstant 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