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Zimmet PZ. Kelly West Lecture 199 1 challenges in diabe- tes epidemiology- from West to the rest. Diabetes Cat-e 1992;15:232-252. 172 CHAPTER 5 PATTERNS AND TRENDS IN PHYSICAL ACTWIN Contents Introduction .......................................................... Physical Activity among Adults in the United States ........................... Recent Patterns of Leisure-Time Physical Activity .......................... Physical Inactivity during Leisure Time ............................... Regular, Sustained Physical Activity during Leisure Time ................. Regular, Vigorous Physical Activity during Leisure Time .................. Participation in Specific Physical Activities ............................. Leisure-Time Physical Activity among Adults with Disabilities ................ Trends in Leisure-Time Physical Activity ................................. Physical Activity among Adolescents and Young Adults in the United States Physical Inactivity ............................................ Vigorous Physical Activity ..................................... Other Physical Activity ........................................ Physical Education in High School ............................... Sports Team Participation ...................................... . 175 177 177 . 177 177 181 . 184 . 186 186 186 188 189 192 198 200 Conclusions ............................................................... 200 ResearchNeeds .......................................................... 201 Appendix A: Sources of National Survey Data . . . . . . . . 201 Appendix B: Measures of Physical Activity in Population Surveys . . . . . _ . . . . _ . 203 References ._...._....,.....__......._.........................,,........... 206 CHAPTER 5 PATTERNS AND TRENDS Introduction T his chapter documents patterns and trends of reported leisure-time physical activity of adults and adolescents in the United States and compares the findings to the goals set by Healthy People 2000 (U.S. Department of Health and Human Services (USDHHS] 1990; see Chapter 2, Appendix A, for the 1995 revised Healthy People 2000 objectives for physical activity and fitness). The information pre- sented here is based on cross-sectional data from national- and state-based surveillance systems, spon- sored by the Centers for Disease Control and Preven- tion (CDC), that track health behaviors including leisure-time physical activity. Although self-reported survey information about physical activity is likely to contain errors of overreporting, there is no other feasible way to estimate physical activity patterns of a population. Moreover, there is no widely accepted "gold standard" methodology for measuring physi- cal activity (see Chapter 2). Occupational and most domestic physical activi- ties are not presented because such information is not available. Most national goals address leisure- time rather than occupational physical activity be- cause people have more personal control over how they spend their leisure time and because most people do not have jobs that require regular physical exertion. Nonetheless, measuring only leisure- time physical activity leads to an underestimate of total physical activity, especially for those people with physically demanding jobs. Five surveys provided data oh physical activity for this review: 1) the National Health Interview Survey (NHIS), which included questions on physi- cal activity among adults in 1985, 1990, and 1991; 2) the Behavioral Risk Factor Surveillance System (BRFSS), a state-based survey of adults that was conducted monthly by state health departments, in IN PHYSICAL ACTIVITY collaboration with the CDC, and included questions on physical activity from 1986 through 1992 and in 1994; 3) the Third National Health and Nutrition Examination Survey (NHANES 111) of U.S. adults from 1988 through 1994 (data from Phase 1, 1988- 199 1, were available for presentation in this report); 4) the 1992 household-based NHIS Youth Risk Be- havior Survey (NHIS-YRBS) of 12- through 21-year- olds; and 5) the national school-based Youth Risk Behavior Survey (YRBS), which was conducted in 1991, 1993, and 1995 among students in grades 9- 12. The methodologies of these surveys are summa- rized in Table 5-1 and are described in detail in Appendices A and B of this chapter. When adult data from the NHIS, BRFSS, and NHANES III are presented for comparison, they are shown from the most nearly contemporaneous sur- vey years. Otherwise, the most recent data are pre- sented. For determining trends, BRFSS data are restricted to those states that collected physical ac- tivity information each year. Responses to questions included in the surveys were compiled (see Appendix B) into categories approximately corresponding to the Healthy People 2000 physical activity objectives. These objectives are based on the health-related physical activity dimensions of caloric expenditure, aerobic intensity, flexibility, and muscle strength (Caspersen 1994). Thus the "regular, sustained physical activity" cat- egory used here pertains to total caloric expenditure and includes a summation of activities of any inten- sity, whereas the "regular, vigorous" category per- tains to aerobic intensity and therefore includes only activities of vigorous intensity. Because some ac- tivities (e.g., vigorous activity of 30 minutes dura- tion) fall into bothof these categories, the categories are not mutually exclusive. Adding together the proportion of people in each category thus yields an