UN Side Event Report - American College of Sports Medicine

Visitwww.acsm.org/unsideeventforfulcitation.

“After the UN Summit,we have a continuing role to work togetherin mobilizing multi-sector and multi-stakeholder actionaround physical activity and sports to optimize individualand population health and well-being.”

September 18, 2011Dear Colleagues:The American College of Sports Medicine (ACSM), in association withour cooperating Wellness Week Partners (the Pan American HealthOrganization and the World Economic Forum), the President’s Councilon Fitness, Sports & Nutrition, and the CDC/WHO Collaborating Centerfor Physical Activity and Health, welcomes distinguished ministersand their representatives, accomplished athletes, colleagues, andfriends to this historic Side Event on Physical Activity and NCDs.We hope this strategic convening of members of the healthcommunity and social, academic, and private sector interests willmobilize commitment to developing actionable strategies andinvestments that utilize the power of physical activity and sports tomake a difference in people’s lives and in the global health agenda.As this is only the second time in history that the UN has cometogether to hold a High-level Meeting on Health, ACSM applauds theUN High-level Meeting on NCDs for acknowledging the importanceof acting on this epidemic of chronic disease and working to achievea culture of health for all. ACSM is honored to be able to participatein the upcoming United Nations High-level Meeting on NoncommunicableDisease Prevention and Control, as part of a selectedcadre of global health organizations. We are extremely pleased thatthis gathering will focus on physical inactivity as a principal risk factordriving the prevalence of NCDs.As an organization of more than 50,000 sports scientists, academics,public health officials, physicians, and other allied health and fitnessprofessionals, we are profoundly committed to developing thelinkages between physical activity and non-communicable diseasesin multi-sector and multi-disciplinary partnerships with civil societyorganizations, NGOs, government agencies, and the private sector.In response to the UN’s call for countries to adopt a concise set ofaction-oriented outcomes that will shape the international agendafor generations to come, today, ACSM announces fi v e major globalinitiatives that we hope will help move government and society froma disease-centered culture to a culture of wellness and prevention,where physical activity can be a critical instrument of action in theglobal prevention plan for getting us healthy.ACSM Physical Activity Global Agenda:1. Creating a call to action for a Global Physical Activity andSports Coalition on NCDs, Health and Development, toadvance a multi-sector and multi-stakeholder agenda forpolicies, programs and partnerships to increase opportunities forphysical activity, especially in low-and-middle income countries.2. Formation of a Global Physical Activity Innovation Networkto harness public/private sector partnerships and capabilitiesto advance research, international development objectives, andhealth promotion campaigns that can create linkages betweenphysical activity and sports in reducing health disparities amongchildren, women, the underserved, and at-risk populations.3. Development of Physical Activity 360, a global onlinecollaborative platform, where distinct communities cancome together to share information and drive insights,visibility, and action on physical activity “best investments.”4. Establishment of seven Exercise is Medicine® RegionalCenters dedicated to bringing together leaders in sportsscience, medicine, and health care at regional and country levelsto network and cooperate on capacity-building projects foradvocacy, research, education, and training.5. Providing complimentary global ACSM e-membershipsand access to research and practice to scientists, healthcareproviders, public health professionals, and others inlow-and middle-income countries to support advancesin promoting active and healthy lives and in combattingNCDs.We look forward to joining efforts with those speaking at andattending the Side Event on Physical Activity and NCDs to developactionable steps to create a “culture of health for all” throughpartnership investments in physical activity.Sincerely,Jim WhiteheadExecutive Vice President/CEOAmerican College of Sports Medicine401 W. Michigan Street, Indianapolis, IN 46202Telephone 317.637.9200, ext. 100 | Telefax 317.634.7817E-mail jwhitehead@acsm.org | Cell 317.281.7608

On behalf of the Pan American Health Organization(PAHO), we are happy and excited to partner in theSide Event on Physical Activity and NCDs with theAmerican College of Sports Medicine, the CDC/WHOCollaborating Center for Physical Activity and Healthand the President’s Council on Fitness, Sports &Nutrition. The initiative for the UN High-level Meetingbegan in the Caribbean when Commonwealth Headsmet at the CARICOM Summit of the Americas inSeptember 2007, to urge collaborative action againstnon-communicable diseases (NCDs). The CARICOMcountries were at the forefront of giving voice to thechronic disease challenges faced by millions of peopleliving in low- and middle-income countries aroundthe world. As a result of their advocacy, we stand heretoday helping organize not only the UN Summit onNCDs, but also the Side Event on Physical Activity andNCDs.The UN High-level Meeting on NCDs is a game changerwith physical activity forming an important pillar inthe prevention and treatment of chronic diseases.Decades ago, the longitudinal studies of Paffenbargershowed that people who are fit or physically activeare three to five times less likely to have a heart attackeven if they suffer from hypertension, diabetes, andobesity. That’s a message of hope.The Side Event on Physical Activity and NCDs is alsoa key event of Wellness Week, co-organized by PAHOand the World Economic Forum. Wellness Week isan effort to develop a social movement on healthysettings for healthy living.As we call attention to the role and value of physicalactivity at this pre-conference to the UN High-levelMeeting on NCDs, we are also delighted to acknowledgethe participation and presence of ministers of health atthis inaugural Side Event on Physical Activity and NCDs.What an impressive gathering of ministers of healthand their representatives from Aruba, Brazil, Colombia,Mexico, Nova Scotia, Peru, Uruguay, and the UnitedStates. Their commitment to physical activity andsports as a strategic tool in building a “culture of healthfor all” across the “whole of government” and “whole ofsociety” is empowering efforts to reduce poverty andhealth disparities among at-risk populations, while atthe same time fostering development and education,and enabling environments that empower people tocontrol their health determinants.Physical activity is a natural activity system that helpsto reduce stress, increases biologic reserves, improvescognitive development, and reduces the risk of NCDs.PAHO is committed to working across borders andacross sectors in the fight to stop the epidemic of noncommunicablediseases to ensure individuals, families,and communities enjoy the cultural, behavioral, healthand socioeconomic benefits that physical activity canbring to life. As the Side Event conference taglinestates: Now is the time to “seize the opportunity andbuild for tomorrow.”Carlos Santos-Burgoa, MD, MPH, PhDSenior Advisor on Violence, Injuryand Human SecurityPan American Health OrganizationC. James Hospedales, MD, MPHCoordinator, Chronic Disease Preventionand ControlPan American Health Organization

September 18, 2011The President’s Council on Fitness, Sports & Nutrition is proud to co-partner in the Side Event on Physical Activity and NCDs, incooperation with the American College of Sports Medicine, the Pan American Health Organization, and the CDC/WHO CollaboratingCenter for Physical Activity and Health. We would like to express our thanks to the American College of Sports Medicine for conveningthis prestigious gathering of ministers of health, world-champion athletes, and business, education, civil society organizations, andNGOs to discuss the importance of physical activity and sports in preventing and treating chronic disease in front of the historic UNHigh-level Meeting on Non-Communicable Disease.The realization of this Side Event on Physical Activity and NCDs provides an exceptional opportunity to take stock of the role of physicalactivity and sports in creating healthier futures as we confront the tremendous challenge that the burden of NCDs represents for publichealth.The mission of the President’s Council on Fitness, Sports & Nutrition is to serve as a catalyst to promote healthy lifestyles that engageAmericans across their lifespan. Working with the Office of the Secretary of Health and Human Services and our First Lady MichelleObama’s “Let’s Move” program, we are committed to help reverse the obesity crisis in America.In September 2010, we created the Million PALA Challenge to motivate one million Americans to get active and earn the PresidentialActive Lifestyle Award (PALA) in a year. Since the start of the challenge, more than 1.7 million Americans have gotten active and earnedtheir PALA, far exceeding the initiative’s goal. The program rewards youths who are active for 60 minutes a day and adults 30 minutesa day, five days a week for six out of eight weeks. After completing the program, participants receive a free, downloadable certificatesigned by PCFSN co-chairs, New Orleans Saints quarterback Drew Brees and three-time US Olympic gymnast Dominique Dawes.On September 24, fifty thousand children and families will join First Lady Michelle Obama, together with world-class athletes andNickelodeon stars for the biggest Worldwide Day of Play ever!Sport for all and movement for a lifetime! That’s the theme we are promoting here today with stakeholders from different sectors andinspirational athletes working together on behalf of public health and the sports community, in the pursuit of shared values and theshared goal of “health for all.”Sincerely,Shellie Pfohl, Executive Director

Dear Colleagues,The CDC/WHO Collaborating Center for Physical Activity and Health was proud to partner withACSM, PAHO, WEF and the President’s Council on Fitness, Sports and Nutrition in organizingthe Side Event on Physical Activity in conjunction with the UN High Level Meeting on NCDsheld in New York City, Sunday, September 18, 2011. We are particularly grateful to Jim Whitehead,Executive Vice President of ACSM, and his team for leading and underwriting the efforts whichbrought this event to fruition. We look forward to witnessing increased action of countries to promotephysical activity, which we anticipate will follow these historic meetings, as an essential componentof plans for the prevention and treatment of NCDs.Sincerely,Becky Lankenau, MS, MPH, Dr. PHDirectorCDC/WHO Collaborating Center for Physical Activity and HealthCenters For Disease Control and PreventionNCCDPHP/ DNPAO/ PAHB4770 Buford Hwy. NE, K-46Atlanta, GA 30341-3717 USA

AcknowledgementsThe Side Event on Physical Activity was convened and financially supported by the AmericanCollege of Sports Medicine (ACSM), led by Jim Whitehead, CEO and Executive Vice President. ACSMis grateful to its co-partners, the Pan American Health Organization, the CDC/WHO CollaboratingCenter for Physical Activity and Health, and the President’s Council on Fitness, Sports & Nutrition,for their active and valued participation and guidance throughout the process. In particular, wewish to acknowledge the contributions of Dr. C. James Hospedales and Dr. Carlos Santos-Burgoa(PAHO), Dr. Becky Lankenau (CDC/WHO Collaborating Center for Physical Activity and Health), Ms.Shellie Pfohl, (President’s Council on Fitness, Sports & Nutrition), and Ms. Caitlin Morris (Nike), whoseinvaluable assistance made the Side Event on Physical Activity and NCDs an historic opportunity.Special thanks are extended to Maria Stefan, ACSM Senior Advisor, Global Partnerships, and Presidentof the ChaseameriCa Group, for her substantial involvement in planning and implementing the SideEvent on Physical Activity and NCDs and the writing of this summary report. The Side Event onPhysical Activity and NCDs also benefitted greatly from the contributions of ACSM senior staff: TimCalvert, Dan Henkel, Jeanne M. Hennings, Stephanie Garwood, and Jerod Keller.On behalf of all the co-partners, we are grateful to all of the speakers for their insights, contributions,and partnership. Finally, thank you to all conference attendees and colleagues from civil societyorganizations, NGOs, government agencies, academia, the media, and private sector, who madethe conference so successful.

Centers for DiseaseControl and PreventionWHO Collaborating Centerfor Physical Activity and HealthSide Event On Physical Activity And NCDsSeizing the Opportunity, Building for TomorrowSunday, September 18, 2011 | 11:00am – 4:00 pmMillennium U.N. Plaza Hotel, NYC – Diplomat Ballroom, 2nd FloorOne United Nations Plaza, 44th Street between First and Second AvenueORGANIZING PARTNERSJim Whitehead, MACEO and Executive Vice PresidentAmerican College of Sports MedicineJanet Walberg Rankin, PhDProfessor, Virginia TechPresident-elect, American Collegeof Sports MedicineCarlos Santos-Burgoa, MD, MPH, PhDSenior Advisor on Violence, Injuryand Human SecurityPan American Health OrganizationC. James Hospedales, MD, MPHCoordinator, Chronic DiseasePrevention and ControlPan American Health OrganizationBecky Lankenau, DrPH, MS, MPHDirector, CDC/WHO CollaboratingCenter for Physical Activity and HealthShellie Pfohl, MSExecutive Director, President’s Councilon Fitness, Sports & NutritionMaria StefanSenior Advisor, Global PartnershipsAmerican College of Sports MedicineExecutive SummaryThis report provides an overview of the Side Event on Physical Activity and NCDs,which took place September 18, 2011, in front of the UN High-level Meeting onNon-Communicable Diseases, in New York City. The Side Event was organizedby the American College of Sports Medicine, in partnership with Wellness Weekorganizers (the Pan American Health Organization and the World EconomicForum), the CDC/WHO Collaborating Center for Physical Activity and Health,and the President’s Council on Fitness, Sports & Nutrition. United by a sharedconviction about the role of physical activity and sports in contributing to healthypeople and heath-enabling environments, the Side Event drew the U.S. SurgeonGeneral, national ministers of health, Olympic athletes, delegates to the U.N.High-Level Meeting, and leaders from nonprofit organizations, philanthropies,governments and business.The Side Event provided advocates with an historic opportunity to make a compellingcase about the multi-sector and multi-stakeholder value of physical activity,in front of the UN High Level Meeting on NCDs, a generational opportunity tocall out the scope and reach of physical activity within the broader NCD platform.The hundreds who attended the Side Event, acclaimed its value in bringingtogether diverse sectors and stakeholders to share views and experiences aboutphysical activity as an effective and affordable healthcare investment. Theynoted its cross-cutting power to reach at-risk populations, increase school andworkplace performance, and enhance social integration and developmentefforts.8 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

More than 80% of deaths from NCDs occur in low- and middle-income countries. Between 2006 and 2015, deathsdue to NCDs are expected to increase by 17%. Physical activity improves quality of life and reduces the risk of dyingprematurely.On May 13, 2010, the UN General Assembly voted unanimously for Resolution 64/265 to hold a UN High-levelMeeting on NCDs, September 19-20, 2011. The HLM, spearheaded by the World Health Organization, identifiedfour priority NCDs—diabetes, cancer, and chronic respiratory and cardiovascular diseases—and their common riskfactors—tobacco use, alcohol abuse, unhealthy diet, and physical inactivity—as responsible for 60% of all deaths inthe world. These will account for two-thirds of all deaths globally in low- and middle-income countries in the next25 years.The UN General Assembly’s decision to convene a High-level Meeting created a timely opportunity to elevate chronicdiseases onto the global stage and to clearly link physical inactivity to the prevention and treatment of NCDs.The Side Event Focused On The Pillars Of:1. Leadership: Ministerial Dialogue on Physical Activityand the “Americas.” Opening dais of ministers of healthand/or their representatives from Aruba, Brazil, Colombia,Peru, and the United States, discussed the “state of physicalactivity” in national policy and planning processes.2. Awareness-Raising: Sports, Culture and Society.A panel composed of world-champion and Olympic athletesdocumented the power of sports and fitness in improving theirindividual lives and in mobilizing mass populations to betterhealth.3. Collaboration: Physical Activity as a Best Buy inAdvancing Towards a Healthier World. Senior officialsfrom business, public health, academia, development, andpatient interests came together to showcase the possibilitiesof physical activity and sports in achieving thematicmulti-sectorial goals.4. Innovation and Adaptability: Getting the ROI onPhysical Activity. A showcase of programs that scaledphysical activity through the schools, worksite, grassrootssports, and primary care platforms.5. Taking Action: Questions were posed to attendees forfuture follow-up, including:a. International Level Action: What do we need to do toinform the setting of targets and to prepare for 2012?b. National Level Action: What needs to be done to getphysical activity/NCD priorities into national health anddevelopment plans?c. Evidence Base: What critical areas of research—especially implementation research—do we need inorder to position physical activity and NCDs for futureintegration into development goals?d. Missing in Action: Are there issues that were poorlyserved in the Political Declaration?e. Working with Different Sectors: What are the specificissues we need to attend to in developing partnerships,including with the private sector?SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 9

Major Learning OpportunitiesWe may be better served by “changing the tenor of the physical activity conversation,” as health is often not the primary motivator forphysical activity programming. Poverty reduction, social integration, workplace performance, health environments, building capacity, andaccessibility could be the platforms on which to build engagement and health-enabling environments. We need to map a multi-sector,multi-stakeholder approach that has us collaborating at a level where we can see coordinated action and leveraging of resources that canlead to large-scale behavior change.Contextual Themes• Physical activity is an effective disease-prevention tool andequally effective health and wellness tool.• Physical activity should be a vital sign in the screening,diagnosis, prevention, and treatment of chronic disease.• Physical activity and sports have greater influence and powerthan any other social movement to achieve a health multipliereffect.• Physical activity and sports are powerful engines for healthmobilization and communication, health promotion andhealth maintenance, social integration, equity and genderequality, environmental improvement, human performanceand productivity, education and advocacy, capacity building,and peace and development.• Physical Activity is a critical component in creating a cultureof health for all across the whole of government and wholeof society.• The framework for effective multi-sector coordinationinvolves: mutuality of interest, mutuality of purpose, and theclear allocation of resources. Physical activity interests needto build a consultative process to identify where we can seecoordinated action leading to large-scale behavior changethat leads to increased levels of physical activity.• Physical activity and sports reduce health disparities inwomen, children, the disabled, and populations at greatestrisk.• Not every stakeholder speaks the same language whendiscussing the benefits of physical activity and sport. Somesee sport as a game, or the top of the pyramid, where it’s allabout competitive performance and where professionalsplay; not seeing its power socially and culturally to mobilize,inspire, or be utilized as a poverty-reduction strategy, asa peace promotion tool, or as an opportunity to breakdown stereotypes. We also need to develop a language ofco-benefits between physical activity and best buys.• The ROI on physical activity is Health Igniting Performance—physically, socially, mentally, emotionally, and financially.• Physical activity and sports investments in adolescents are amajor best buy in advancing towards a healthier world.• Having good physical education programs in schools frompreschool to high school are the door openers to exerciseand physical activity along the life course. They are behaviorchange mechanisms that can mean the difference betweenunsustainable health care costs and healthier lives with fewerNCDs.• There is a need to organize the evidence base globally, anddefine the physical activity interventions across sectorsthat are most urgent, scalable, effective, culturally relevant,politically viable, and resource accessible. Our physical activity“best buys” need to tie into the larger political environmentso that its impact is population-based and part of the currentglobal policy agenda.• We need to develop targets and indicators for physicalactivity for adolescents and adults that can be presented tothe World Health Organization in 2012, making the case thatinvesting in sports, fitness, and physical activity is investing inthe future. The road to victory in reducing ever rising healthcare costs due to the pandemic of NCDs is implicit in theaccess to, affordability of, and effectiveness of physical activityopportunities at home, at school, in the community, and atthe worksite.• The role of the patient and consumer is important inempowering people to take self-help action to prevent andtreat chronic disease conditions.10 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

The growing political dynamic ofinterest in sports and physical activityby the UN community is evident Inthe following milestones:1999: UN Secretary General Kofi Annan at the World EconomicForum in Davos calls on the sporting world, along with the political,economic, scientific, and religious spheres, to make a greater effort toattain a more just and peaceful world.2000: The WHO Global NCD Action Plan is endorsed by the WorldHealth Assembly and focuses on: 1) mapping the NCD epidemic anddeterminants; 2) reducing the level of exposure of individuals andcommunities to the common risk factors; and 3) strengthening healthcare for people with NCDs.2001: Secretary General Annan names a Special Advisor on Sport forDevelopment and Peace.2002: UN InterAgency Task Force on Sport for Development andPeace is set up to examine the role that sport and physical activity canplay in achieving the Millennium Development Goals.2003: WHO Report on Health and Development through PhysicalActivity and Sport; Magglingen Declaration confirms sport as a “humanright.”2004: The World Health Assembly endorses the WHO Global Strategyon Diet, Physical Activity and Health.2005: UN General Assembly declares 2005 as the International Year ofSport and Physical Education.2007: Heads of Government of the Caribbean Community, meetingat a special CARICOM Summit on NCDs issue an NCD Declaration.2008: The World Health Assembly endorses the action plan for theglobal strategy for the prevention and control of NCDs, which providesa road map for member states, the Secretariat, and internationalpartners.2009: The ECOSOC/UNESCWA/UNDESA/WHO Western Asia MinisterialMeeting adopts the Doha Declaration on NCDs and Injuries.2009: Commonwealth Heads of State issue statement onCommonwealth action to combat NCDs.2010: UN General Assembly unanimously adopts resolution 62/265on the prevention and control of NCDs, co-sponsored by 78 memberstates and the Group of African States.2011: WHO Regional Consultations on NCDs; First Global MinisterialConference on Healthy Lifestyles and NCDs in Moscow; SpecialConsultation with NGOs and Civil Society, the private sector, andacademia; UN’s HLM on NCDs.Dr. C. James Hospedales, Coordinator, Chronic DiseasePrevention & Control, PAHO.Dr. Carlos Santos-Burgoa, Senior Advisor on Violence, Injuryand Human Security (PAHO) addressing the importance ofthe UN High-level Meeting on NCDs and the Side Event onPhysical Activity.Ministers of Health and their representatives:Dr. Fernando Ramirez Campos, Chief of NCDs, Ministry ofHealth, Colombia; Dr. Deborah Carvalho Malta, NationalCoordinator of Surveillance in NCDs, Injury Prevention andHealth Promotion, Ministry of Health, Brazil; U.S. SurgeonGeneral, Dr. Regina Benjamin; Dr. Alberto Tejada Noriega,Minister of Health, Peru; Dr. C. James Hospedales, PAHO;Dr. Richard Visser, Minister of Sports and Health, Aruba(speaking).SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 11

Seizing the Opportunity and Promise of Physical Activityin NCD Prevention and TreatmentThe UN Political Declaration sets a base for action in the need to settargets and create mechanisms within government for multi-sectorplanning and interaction. Additionally, the Political Declarationidentifies a multi-sector role for the following tasks:a. Strengthening health care systemsb. Reducing risk factorsc. Promoting and creating healthy environmentsd. Engaging non-health and other key stakeholders in buildingcollaborative partnershipse. Advancing the quality of research and developmentThe Side Event on Physical Activity reinforced these actions and citedthe need for:1. A collaborative and coordinating mechanism for driving globalphysical activity and sports actions and intersections2. Development of transformative partnerships to support largescalable actions3. Consensus on best practices and metrics to support theevidence baseThe Side Event on Physical Activity and NCDs reinforced thatnon-communicable disease prevention is a priority across the world;and that physical activity and sports are practical starting points foraddressing non-communicable diseases. While it is not the onlystarting point, it is affordable, effective, engaging, and positive. Itis something that has political viability. Physical activity and sportsembody frameworks that foster active, healthy lifestyles and createproven, positive impacts on overall individual health—physically,mentally, and socially—as well as being an important tool that cutsacross borders and global cultures in fostering peace, education, anddevelopment.Globally, more than a billion adults and children are overweight or obese. For the first time in the historyof the world, this is equal to the number of children and adults who suffer from nutritional deficienciesand malnutrition. Some 43 million preschool children worldwide are obese or overweight. Theconsequences of chronic diseases are no longer simply issues for Western countries; they are also issuesfor the developing world. They are health issues with staggering socioeconomic and political impact.By 2020, more than 700 million people around the world will be over age 65. How can we ensure thatolder people can remain independent as they age and that health care costs will not overwhelm theneed to care for us as we age? Without concerted action, deaths from chronic disease will increase to41 million by 2015, and almost half of those deaths will be of people under 70.Physical inactivity is the fourth leading risk factor for all global deaths. Yet, regular physical activity canhelp stop the world’s biggest killers, improve quality of life, and reduce the risk of dying prematurely by:• Reducing the risk of heart disease by 40%• Lowering the risk of stroke by 27%• Reducing the incidence of diabetes by almost 60%• Reducing mortality and the risk of recurrent breast cancer by almost 50%• Lowering the risk of colon cancer by more than 60%• Reducing the risk of developing Alzheimer’s disease by nearly 40%Source: EIM Fact Sheet, 201212 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Policy Themes:Left to right: Dr. Alberto Tejada, Minister of Health, Peru; Dr. Richard Visser, Ministerof Sports and Health Aruba; U.S. Surgeon General, Dr. Regina Benjamin; Dr. DeborahCarvalho Malta, National Coordinator of Surveillance in NCDs, Injury Prevention andHealth Promotion, Ministry of Health, Brazil; Jim Whitehead, CEO, ACSM.Ministerial Dialogue on PhysicalActivity, NCDs, and the “Americas”Moderator: Dr. C. James Hospedales, Coordinator, Chronic DiseasePrevention and Control, PAHOThis session focused on the linkage between physical activity andhealth as a wellness and prevention tool in reducing the NCDdisease burden in their representative countries in the Americasregion. The ministerial dialogue began with each minister makinga statement about the role of health, fitness, and risk factorscontributing to non-communicable diseases in his or her country.Focus was centered on the meaning of physical activity and sportwithin each nation and what the ministers are doing to promotehealthy populations.1. Governments are committing to specificaction plans on NCDs through their ministriesof health; and are working in coordinationwith ministries of sports, education,transportation, environment, and foreignministries, to integrate health for all acrossthe whole of government.2. There is a movement to integrate preventioninto every health care interaction.3. Physical activity is an important healthcomponent in promoting healthier lifestyles.4. Physical activity should be a standard partof early diagnosis and referral counseling inprevention and treatment of NCDs, especiallyfor the young.5. High priorities are being given to at-riskpopulations that are not traditionally activeand empowering them to “get active”through social equity, active transport, andurban design programs.6. Young people who build sports and fitnessinto their lives will most likely become activeadults at lower risk for chronic disease.7. Multi-sector partnerships between federalgovernment and municipalities can resultin policy actions and funding resourcesthat enhance the scope, reach, access, andcapacity of physical activity opportunities,from public health to the built environmentto active transport interventions.8. Advocacy to change behavior must targetnot only individuals, but also policymakers,who can serve as role models.9. Physical activity and sports complementeach other and promote citizenship andsocial values that enhance social cohesion,environmental values, health, and generalwell-being.10. Governments have the responsibility toprovide the appropriate environmentand structures for physical activity toaccommodate both sporting games and anarena for non-sporting individuals to exercisein whatever form they choose.SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 13

Dr. Deborah Carvalho Malta,National Coordinator of Surveillance inNon-Communicable Diseases and Injury Preventionand Health Promotion, of the Health SurveillanceSecretariat at the Ministry of Health, BrazilDr. Malta stated her office has measured the risk and preventivefactors for non-communicable diseases in 27 state capitals in Brazilto support health promotion and disease prevention. She noted:Left to right: Dr. Becky Lankenau, Director, CDC/WHO Collaborating Centerfor Physical Activity and Health; Dr. Deborah Carvalho Malta, NationalCoordinator of Surveillance in NCDs, Injury Prevention and HealthPromotion, Ministry of Health, Brazil; and Dr. Janet Walberg Rankin,ACSM President-elect.U.S. Surgeon General, Dr. Regina Benjamin, MD, MBA:Dr. Benjamin noted that prevention is the foundation of her work.She referred to four major actions her office has undertaken to stemthe tide of the chronic disease through physical activity interventions:. The 2010 release of the Surgeon General’s Vision for aHealthy and Fit Nation. First Lady Michelle Obama’s “Let’s Move!” campaign to solveobesity in a generation. Release of the first-ever National Prevention Strategycommitted to moving the nation from a focus on sicknessand disease to one based on wellness and preventionthrough the design, development, and action of a “healthfor all” policies approach across the whole of government.Dr. Benjamin co-chairs the National Prevention, HealthPromotion and Public Health Council, comprising 17Cabinet members who are heads of federal agencies in theUnited States. Co-chair of Exercise Is Medicine® (EIM), dedicated to makingphysical activity and exercise a vital sign that should bepart of every health care interaction. EIM—now a globalinitiative—calls for counseling and referrals to harness thepreventative power of healthy lifestyles• 72% of deaths in Brazil are from NCDs, with 31% from CVD,38% from respiratory disease, and 2% from diabetes.• Brazil has a National Policy for Health Promotion that hasprioritized healthy diet, physical activity, and alcohol andtobacco prevention as key components of Brazil’s healthpolicy. The Action Plan to Tackle NCD is committed to reducingthe premature death rate from NCDs by 2% a year.• Since 2005, $100 million has been invested by Brazil in 1,000municipalities for physical activity projects.• The U.S. Centers for Disease Control and Prevention andthe Brazilian Ministry of Health have created, in partnership,a Guide for Useful Interventions for Activity in Brazil andLatin America, known as the GUIA Project. The GUIA projectaddresses physical inactivity and obesity by identifying,testing, and disseminating potentially effective interventionsthat promote physical activity, such, as the “Academia daCidade” in Recife and “CuritibaAtiva” in Curitiba. Evaluation ofthese programs demonstrate their effectiveness in increasingthe level of physical activity in these cities.• The Brazilian Ministry of Health created the “Academia daSaúde” (Health Academy) in 2010, a city health and physicalactivity program that has become a federal/municipalpartnership, dedicated to creating 4,000 units across Brazilby 2015 linked to primary care, with the aim of reducingstructural obstacles for access to physical activity and healthfor low-income populations.• Plans are underway to integrate the physical activity themeinto the World Cup in 2014 and the Olympic Games in 2016.Since 1980, obesity rates in the United States have doubledin adults and more than tripled in children. A study from theUniversity of North Carolina School of Medicine showed thatobese children as young as three years old manifest signs of aninflammatory response linked to heart disease later in life. Dr.Benjamin also shared the concept of the “walking school bus,”an easy way to improve the activity levels of children by simplywalking and biking from home to school with an adult.14 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Dr. Fernando Ramirez Campos,Chief of Non-Communicable Diseases,Ministry of Health, ColombiaDr. Ramirez noted that in agreement with the Colombia NationalOrganization for Sports, the Colombian Ministry of Health iscommitted to investing a percentage of its budget in promotingphysical activity around the country. Its physical activity plan hasthree critical components:• Increasing physical activity screening, counseling, and referralin the primary care arena, especially in CVD diagnosis andprevention• Bringing physical activity health promotion activities to at-riskpopulations through a coordinated inter-sectorial approach ofthe Ministries of Health, Education, Sport, and Environment• Making major investments in Ciclovías and Recreovías, so asto create environments that influence populations to “getengaged” www.youtube.com/watch?v=ELa5CHsUepoDr. Carlos Alberto Tejada Noriega,Minister of Health, PeruAs a former soccer referee for the professional PeruvianLeague and Mayor of Lima, Minister Tejada has always valuedsports and physical activity as relevant to actions aimed atreducing chronic diseases.• His focus is looking at the health determinants of aging,poverty, and urbanization in designing health programs totackle the epidemic of NCDs; and public policies centered onthe development of healthy cities.• He believes in the value of physical activity as an expedient wayto reach populations as it encompasses both prevention andmovement characteristics.• He is committed to public health officials being role modelsand encourages government officials to participate inorganized physical activity events.• He is a strong proponent of building policies that are part ofeveryday life, such as empowering population masses to getactive through organized ciclovía programs and to have thosein sports actively involved in mass activity programs.• He believes that the NCDs issue has to be taken from the sideof health, and not from the side of disease. He is a proponent ofworking with private enterprises to carry the message forwardand develop it at all levels.Dr. Richard Visser, Minister of Health and Sports, ArubaDr. Visser reported that his country looks at fitness as a pyramid,with individual sport at the bottom of the pyramid, organized andschool sports in the middle, and elite athletes at the top. The massof the pyramid moves upward, feeding from the base. As a result,Aruba focuses on securing a strong foundation, with an emphasison overall health and everyday activities, like walking, with sportsactivities organically growing from the base.Source: World Health Organization, 2008As a Minister of Health and Sports, he discussed the importance of:• Integrating public health and education in National SportsCouncil activities and promoting “sports for all” concepts• Developing linear parks, recreovías, and BoBario projects thatcreate neighborhood access to physical activity• The importance of sport as a positive influence in preventingaddictive behaviors and social problems, such as teen pregnancy.• The new guide or “plate” for healthy living…an animatedsailboat that involves nutrition and physical activity learningapplications, aimed at educating children in schools, on theircomputers, and on their phones as a mobile appHe added that Aruba’s responses to the NCDs are embedded in thehealth care system with specific emphasis in primary health care andpublic health policies and programs. As a fast growing, aging partof the population will face heart failure, diabetes, depression, andweight issues at the same time, the Ministry is not in favor of a morevertical approach for all separate diseases, but rather an integratedtreatment, using a cost containment approach in health carepolicies and systems of prevention, treatment, and long term care.The Minister highlighted the Aruba Call to Action on Obesity andmajor planks:• To commit to the fight against childhood obesity and topromote healthy weight by sharing strategies and actions withand between governments, institutions, and communities• To facilitate accumulation and exchange of knowledge oneffective strategies and settings• To increase awareness that obesity has significant impact onlabor productivity• To incorporate obesity data into chronic disease surveillancesystems• To incorporate a life-course approach to health through mothersand children and enhancing primary health care• To modify obesogenic environments to facilitate movementand energy balance• To develop self-care platforms such as eMedicineSIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 15

“Sports transcends people’s differences.Skating helped me find focus and turn a difficult life situationinto a positive experience. It improved my outlook on myself,and it gave me a platform to give back.”~Sarah HughesSports, Culture, and Society:Realizing the Power of Sports as aMobilization and Development ToolModerator, Shellie Pfohl, Executive Director, President’s Council onFitness, Sports & NutritionFour world-champion athletes discussed the meaning, purpose,and value of sport in their lives. Each reiterated that “sport forall” is central to understanding sport. Too many times, languagegets in the way of understanding. Sport is more than games,professional and Olympic competition. It is all forms of physicalactivity that contribute to physical fitness, mental well-beingand social interaction. These include play; recreation; organized,casual, or competitive sport; and indigenous sports or games.“Sport for all” aims to maximize access, and emphasis is placed onparticipation and inclusion of all groups in society, regardless ofgender, age, ability, or race.Sport, Health and Development ThemesParticipation in sport has significant physical benefits,contributing to people’s ability to lead long and healthy lives,improving well-being and reducing chronic diseases.• Sport provides psychosocial benefits, such as fosteringsocial integration and teaching coping mechanisms andreducing depression and anxiety.• Sport builds human capabilities by increasing cognitivedevelopment and contributing to education and businessperformance, and raising respect for the environment.• Sport is a key component of social life, directly engagingcommunities, improving relationships and understanding.• People living with disabilities constitute at least 10% of theglobal population. Participation in physical activity, sport,and play can be especially valuable in empowering childrenwith disabilities and teaching them key life skills. It can helpbuild more inclusive societies by raising awareness aboutthe contributions children with disabilities can make in theircommunities.• Sports provide a safe environment to play…to learn…todiscuss sensitive issues.• As a cross-cutting program strategy, Sport asDevelopment serves as a powerful vehicle to address NGOpriorities in childhood development, education, and genderequality.• High-performance athletes and events wield celebrityappeal where popularity can be a powerful medium forbridging divides and delivering health education, and issuemessaging that transcends cultural and political borders.16 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Left to right: Gary Hall, Jr., Multi-Olympic swimming medalist; Dr. Janet Walberg Rankin, ACSM President-elect; Wendy Hilliard, World-championrhythmic gymnast; Sarah Hughes, 2002 Olympic ice skating gold medalist; Shellie Pfohl, President’s Council on Fitness, Sports & Nutrition ExecutiveDirector; Jim Whitehead, ACSM CEO; Chris Waddell, multi-Paralympic skiing medalist (sitting).Gary Hall, Jr., 10 Olympic medals in swimming, Type 1 diabetes,President Hallway Diabetes Consulting, Diabetes and PhysicalActivity Advocate, National Youth Sports Health & Safety InstituteLeadership Board, Sanford Children’s International Board, JuvenileDiabetes Research Foundation Government Relations Committee.Message: “If there was a drug today that had the health benefits andefficacy of exercise, every doctor in the world would prescribe it!”A champion motivating middle school children about eradicatingobesity through sharing and showing the importance of staying fit forlife using the Olympic ideals of his World Fit after-school program.Chris Waddell, Founder, One Revolution Foundation; mostdecorated (12 medals over 4 Games) male skier in Paralympic historyand first paraplegic to summit Mt. Kilimanjaro unassisted. Inductedinto both Paralympic Hall of Fame and U.S. Ski and Snowboard Hallof Fame.Message: “It’s not what happens to you, it’s what you do with whathappens to you. The world record for a wheelchair marathon is 1:18:27.That’s about 45 minutes faster than the fastest runner ever.”A champion shifting the paradigm of how we look at “disabled”people, saying, “unlike able-bodied individuals,” he “doesn’t have theluxury of getting out of shape.”Wendy Hilliard, New York Director, GoGirlGo!, Women’s SportsFoundation; Record-setting, nine-time U.S. National RhythmicGymnastics team member, U.S. Gymnastics Hall of Fame member.First African-American and first gymnast president of the Women’sSports Foundation (WSF). President of Wendy Hilliard Foundationthat provides gymnastics for over 5,000 inner-city youth.Message: “I started my gymnastics career in the recreation department.I started my Foundation to continue that grassroots tradition so physicalactivity and sport is accessible to those who can’t pay to play; and to helpchildren become champions, whether in gymnastics or in life.”A champion using sport as a vehicle for breaking down barriers,mentoring, and promoting gender equity and access.Sarah Hughes, 2002 Gold Olympic figure skater, four-time U.S.Championship medalist, 2002 USOC SportsWoman of the Year,and Women’s Sports Foundation Sportswoman of the Year. Fourthyoungest Olympic figure-skating champion and only seventh Americanwoman to capture the gold-medal title.Message: “Sports transcends people’s differences. Skating helped mefind focus and turn a difficult life situation into a positive experience. Itimproved my outlook on myself, and it gave me a platform to give back.”A champion using sport as both a personal and social developmenttool, helping those disadvantaged develop self-belief, new lifeexperiences, and life skills.SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 17

Best Buys In Physical Activity:Advancing Towards a Healthier WorldModerator, Jim Whitehead, CEO, American College of Sports MedicineReversing physical inactivity and sedentary lifestyles is a societaland individual necessity. The efforts to engineer physical activityout of our lives go unchecked by an appreciation of just howfundamental physical activity is to our physical, social, cultural,political, and economic well-being. As noted in the WHO Strategyon Diet, Physical Activity and Health, and re-captured in the TorontoCharter for Physical Activity and its follow-up document, NoncommunicableDisease Prevention - Investments That Work forPhysical Activity, and the Ad Hoc Task Force on a Global PhysicalActivity Trust, there are seven “best buys,” which if applied at sufficientscale, could make a significant contribution to reducing the burdenof non-communicable diseases and promote population health (seewww.globalpa.org.uk).The conundrum is that data on multi-sector investments inphysical activity and knowledge about stakeholder interests islacking in many areas on a population health level. To create policyand program initiatives that are scalable, effective, culturally salient,politically viable, and financially affordable by countries, physicalactivity interests need to develop a consultative process that bringstogether government, civil society, academic, NGO, and private“BEST BUY” INVESTMENT THEMES:1. A ‘whole of school’ approach to physical activity,prioritizing regular, highly active, physical educationclasses, and providing suitable physical environmentsand resources to support structured and unstructuredphysical activity throughout the day.2. Transport policies and systems that prioritize walking,cycling, and public transport.3. Urban design regulations and infrastructure thatprovide for equitable and safe access for recreationalphysical activity, and recreational and transportrelatedwalking and cycling across the life course.4. Physical activity and NCD prevention integrated intoprimary health care systems.5. Public education, including mass media, to raiseawareness and change social norms on physicalactivity.6. ‘Whole of community’ approaches involving multiplesettings and sectors where people live, work, andrecreate, that integrate community engagement andresources.7. Sports systems and programs that promote “sport forall” and encourage participation across the life span.sector stakeholders in areas of specific competence and interest,to identify translatable “best buys” across borders and populationsand bridge evidence gaps in:• Research and surveillance data• Demographics to be affected• Most pressing challenges and needed interventions• Expected return on investment• Resources required to create impact• Metrics for evaluating outcomesThe information below excerpts the remarks of knowledgeablemembers of the global physical activity community as they lookat physical activity investments across sectors and highlightinterventions that have global application in preventingand treating NCDs. The evidence suggests that coordinatedinvestment in these areas could improve public health generally,while also reducing health inequalities.Exercise Is Medicine: The Rx for Strengtheningthe Health Care Delivery SystemDr. John Duperly, PhD, Associate Professor, Universidad de los Andes andChair, Exercise Is Medicine, Latin American Regional CenterBecause developing countries have relatively limited resourcesto devote to health care for people with chronic diseases,prevention is the most cost-effective and sustainable wayto address this health challenge. Physical inactivity is thegreatest contributor to mortality and morbidity from all causes.Globally more than 60% of adults and two-thirds of children arenot physically active. Exercise Is Medicine is a global initiative andcall to action to develop exercise as a standardized vital sign inpatient screening, diagnosis, and referral counseling, especiallyat the primary care level. EIM is country-led, inclusive, andcoordinated across disease and health care silos, with the missionof encouraging health care systems providers, physicians, exercisescientists, public health, and allied health and fitness professionalsto make physical activity a key component in NCD research,prevention, and treatment strategies. It works off a chroniccare model of providing clinical information support, decisionsupport, health care delivery support, self-managementsupport, and community support.EIM has established a “glolocal” structure of six EIM Regional Centersaround the world, composed of 22 national working task forcesof experts, who will serve as an advisory mechanism to nationalgovernments and health care providers.*The Ad Hoc Task Force for a Global Physical Activity Trust.18 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Health Igniting Performance: OptimizingHealth and Wellness in the WorksiteDr. Jack Groppel, PhD, FACSM, FACN. Co-founder Human PerformanceInstitute, and Vice President of Applied Science & Performance Trainingfor Wellness & Prevention, Inc., a Johnson & Johnson companyPhysical activity should be viewed as a driver of performance andhealth in business and the workplace, stated Dr. Jack Groppel.He noted that the body is business-relevant in optimizingemployee productivity and wellness and organizational health andfitness. “Health Igniting Performance” is a transformational way ofchanging the current worksite health paradigm from a stand-aloneHR-driven management program to a performance value-creatingcorporate mission. By integrating and embedding concepts ofhuman performance and health into corporate missions, health carebecomes valued for the upstream value it produces for employees,their dependents, stakeholders, and for the organization, financially,socially, environmentally, physically, and mentally.According to Dr. Groppel, the missing link is for CEOs to understandnot only the importance of a physically active workforce, buttheir role as influencers and role models. Physical activity in theworkplace should not be a campaign, it should be a policy.Back row, left to right: Dr. John Duperly, Associate Professor, Universidad deLos Andes and Chair, EIM Latin America Regional Center; Dr. Trevor Hassell,Special Envoy on NCDs, Barbados, and Chair, Healthy Caribbean Coalition;Dr. Mike Pratt, Senior Advisor for Global Health, Centers for Disease Preventionand Control, Dr. Jack Groppel, Co-founder Human Performance Institute, andVice President of Applied Science & Performance Training for Wellness &Prevention, Inc., a Johnson & Johnson company. Front row, left to right:Priscilla Farrell, Silver Sneakers consumer; Dr. Felipe Lobelo, Senior ServiceFellow, Centers for Disease Control and Prevention, Global Health PromotionOffice; and Dr. Montserrat Meiro-Lorenzo, Senior Public Health specialist,The World Bank.Subnational Government Partnerships: Mobilizing for Large-scale Community EngagementDr. Montserrat Meiro-Lorenzo, MD, Senior Public Health Specialist, The World BankNever before in human history have so many children survivedchildhood; and never have so many malnourished children, gotto adulthood. Never have so many calories been available percapita to so many; and unfortunately so many of those caloriesbeing empty calories. And never have so many made such aneffort to make sure that we don’t move at all.We’re in a situation in which for the first time in history, physicalactivity that used to be part of a normal life, has become reallya luxury for many of us. We have best buys in terms of what todo. We need to think now about the best buy and how to do it,from both the political economy and public policy perspective.As action on the global NCD problem is a complex problem,requiring complex adaptive responses and solutions, cities andsubnational government leadership is important in affectinglarge-scale population health engagement and behaviorchange.Dr. Meiro-Lorenzo noted that while some NCD preventionprograms are led by the health sector, others are initiated bya range of stakeholders that have core competencies in areassuch as social equity and the built environment, which mighthold greater value and impact for physical activity interests. Sheproposed that a fundamental paradigm change is needed inpublic health, using the ciclovía program as an example. Ciclovíasdidn’t necessarily start as a public health program; it started as arecreational program, as a program to glue society and help curesocial ills. She suggested physical activity interests would benefitfrom engaging local governments in “health development”through a process of partnership-based planning, capacitybuilding, and innovative projects, as there is a need to addressissues that go beyond traditional health care, and encompassopportunity for creating intersectoral action on creating morehealth-friendly environments and fitness building capacity.SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 19

Ciclovías: Physical Activity and Active TransportDr. Felipe Lobelo, Senior Service Fellow, MD, PhD, Centers for DiseaseControl and Prevention, Global Health Promotion OfficeCiclovía is an intersectoral alliance where you have the mayor’soffice, the sports and recreation department, the policedepartment, the health department, private sector, and NGOscoming together to promote physical activity. The concept ofciclovías began in Bogota, Colombia, in the 1980s. A ciclovíaconsists of the temporary or permanent closure of a major street(or streets) to motorized vehicles so that people are free to usethe roadway without concern for their safety. They are held everySunday and on holidays from seven in the morning until three inthe afternoon, allowing residents to enjoy the public space in ahealthy and safe manner with the closing of over 110 kilometers ofroads for biking and pedestrian activities. Every weekend over twomillion Santa Fereños (citizens of Bogotá) participate in the ciclovíaenjoying outdoor activities. Complementing the ciclovía, is therecreovía, free exercise classes that citizens can participate in.Dr. Lobelo noted Ciclovías are inexpensive preventive healthprograms. They encourage exercise, increase social integration, andproduce large-scale public health, social capital, and economicdevelopment returns. Ciclovías facilitate a change in the urbanlandscape that increases the population’s weekly physical activity,decreases auto emissions, and promotes both “healthy people” andenvironmentally friendly “healthy cities” at a cost of generally $10 peruser in Latin America. Early research shows that the cost–benefit ratiofor health benefits from physical activity ranges between 1.2 and4.2 indicating, that in general, ciclovía programs are cost beneficial.Ciclovías are happening in 97 cities and in 15 countries around theworld.Academie da Cidade and the GUIA Project:Physical Activity and the Built EnvironmentDr. Mike Pratt, MD, MPH, Senior Advisor for Global Health,Centers for Disease Prevention and ControlThe GUIA project is an example of how practical applied public healthresearch has actually influenced policy in the process of makingthe world a better place. Dr. Pratt described the GUIA Project as across-national collaborative relationship between the CDC, theMinistry of Health in Brazil, and researchers, practitioners, andinstitutions bilaterally to establish a guide for assessing and evaluatinguseful physical activity interventions in Latin America, similar to theU.S. Community Guide. Since its beginning in 2005, the project hascompleted a systematic review of the literature (published in threedifferent languages in the American Journal of Preventive Medicine)and evaluated two physical activity interventions in communitysettings in Brazil. While the project engaged the Ministry of Healthin Brazil in a leadership and technical role, it also worked very closelywith municipalities and the states in Brazil with some initial fundingand support from the World Bank, collaboration from the WorldHealth Organization and the Pan American Health Organization,and funded by CDC through the Prevention Research Network. Theprogram was first implemented in 2002 by the Health Secretary ofRecife. The program currently has approximately 30,000 participantsin its 19 “polos” (settings where the intervention occurs, commonlypublic parks), and has resulted in the doubling of the population’sphysical activity levels from when first started.Academia da Cidade is a federal/municipal partnershipoutgrowth of the Recife community-based physical activityprogram, that will put 4,000 city gyms throughout Brazil at aninvestment of more than $2.5 billion over 10 years. The communityintervention takes place daily from 5:30 to 8:30 a.m. and from 5:00 to8:00 p.m. and it includes aerobic and dance classes, and organizedjogging groups, as well as exercise and diet orientation sessionsfor healthy people and also persons with hypertension, obesity,diabetes, and heart disease. Academie da Cidade is a showcasefor demonstrating the multiplier effect of partnership: creates“safe places” for community engagement, increases populationphysical activity levels, and delivers health services at the same time.Dr. Pratt noted the program in Brazil has worked so well that it is beingreplicated in San Diego by the Prevention Research Center there tosee how well it will work in Latino communities in the United States.We’re seeing the model more broadly adapted to work with Mexicoon a similar collaboration to see if the U.S. and Mexico can worktogether on obesity prevention using the same kind of governmentto-governmentand university-to-university collaboration.Lessons learned: 1) Non-communicable disease prevention is apriority across the Americas; 2) Physical activity is a practical startingpoint for addressing NCDs as community interventions for physicalactivity are scalable, cost efficient, and effective; and 3) physicalactivity investments are translatable across borders, as we see in the“Americas” region.20 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Healthy Caribbean Coalition:Creating Civil Society Advocacy AlliancesDr. Trevor Hassell, Chair, Healthy Caribbean Coalition;Special Envoy on NCDs, BarbadosThe issue of physical activity as a contributing risk factor to NCDsis a very important one for the Caribbean, said Dr. Hassell, becauseit is the region of the Americas that is worst affected by NCDs.For example, more than 60% of all deaths in the region are fromNCDs. Ten percent of the people in the region are diabetic, 25%are hypertensive, and 25% are obese. So the need to increasephysical activity in the Caribbean has been well recognized asdemonstrated by several major policy statements by heads ofgovernment in the Caribbean and by civil society in the Caribbean.The coming together of intersectoral civil society alliances toachieve a common good is the new politics of health advocacy,shared Dr. Hassell. The Healthy Caribbean Coalition representsthat effort in the fight against NCDs in the CARICOM countries.Not only does it outreach to business, community, academia,public health, and policy-making officials in the Caribbean, but itestablishes partnerships and relationships between health NGOsthroughout CARICOM and Commonwealth countries. Throughits “Get the Message” advocacy and educational campaign usingmobile phones, and new and traditional media, some 500,000messages of support were received indicating to heads of statethe importance of the UN’s HLM on NCDs before the vote on theUN Political Declaration. The Healthy Caribbean Coalition hasstrongly advocated a policy strategy of rewards and incentives toget people active, including:• Making materials and aids used in exercise and physicalactivity more affordable for personal use…VAT exemption• Enacting policies to facilitate development of smallcommunity gyms• Creating tax incentives for property developers to createsafe recreational spaces in communities• Increasing physical activity in schools• Enacting legislation and policies to make the city and thecountry more conducive to walking and riding• Focusing attention throughout the region on NCDs withCaribbean Wellness Day activitiesAgita Sao Paulo (Agita Mundo):Physical Activity Mass Communication/Social Mobilization Agita MundoProvided on behalf of Dr. Victor Matsudo, Founder, Agita MundoThe Agita Sao Paulo (Agita Mundo) program in Brazil provides anexample of a successful mass communications/physical activityinitiative built around a wide range of intrapersonal, social, andenvironmental factors that affect physical activity levels. By takinginto account each of these factors, Agita Sao Paulo successfullydelivered a clear, simple message on the health and social benefitsof 30 minutes of moderate physical activity every day, resulting indecreasing the number of sedentary Sao Paulo inhabitants from14.9% of the population in 1999 to 11.2% in 2004; and 9.6% in 2002to 2.7% in 2008. The proportion of individuals with less than 150minutes of activity per week decreased from 43.7% to 11.6%, andphysical activity levels increased by 20%. Strategic partnershipswere critical to the success with over 350 organizations fromall sectors engaged in coordinated and integrated action.Cost-effectiveness studies undertaken by the CDC resulted in publiccost savings of $310 million. An Agita Mundo Network has beenestablished linking over 200 institutions from 58 countries to buildcapacity, support research and evaluation, and undertake socialmobilization. It costs the state less than $.01 per state inhabitantper year.SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 21

Silver Sneakers: Physical Fitness HealthCare Delivery to SeniorsPriscilla Farrell, patient/consumer, on behalf of Healthways“Silver Sneakers” programSpeaking: Trevor Shilton, Director of Cardiovascular Health, NationalHeart Foundation, Australia, and Global Vice President for Advocacyfor the IUHPE and Deputy Chair of Global Advocacy for PhysicalActivity.“Unplug and Play”Trevor Shilton, Director of Cardiovascular Health, NationalHeart Foundation, Australia, and Global Vice President forAdvocacy for the IUHPE and Deputy Chair of Global Advocacyfor Physical Activity“Unplug and Play,” is a West Australian social marketing campaigntargeted to getting children away from computers and goingoutside to play, with a website listing 100 ways to “unplug andplay.” The media campaign is one component of a long-term,modestly funded health promotion campaign that is a mix ofradio, print, brochure, and posters, complete with a letter from theDirector General of Education sent to all parents of 6-12 year oldsin Western Australia. The program has a mechanism for parentsto monitor their children’s media use as well as a family pledgecomponent. Trevor Shilton reported the program shows goodcut-through beyond awareness to acceptance, intention, andmodest self-reported behavior change. It achieved 65% mediaawareness in 2011, up from 50% in 2008. About 70-80% ofparents report having conversations with their child about thecampaign messages, and 40% report having the intention tomonitor children’s media watching and encourage outside play.Evidence suggests that media campaigns alone are unlikely tochange behavior, stated Trevor; that they are more effectivewhen combined with behavioral, social, and environmentalcomponents as part of a comprehensive community-widestrategy.Ms. Farrell represented the patient/consumer “proof ofconcept” that physical activity can change people’s healthand their life. She outlined an array of chronic diseases—lung disease, Crohn’s, Type II diabetes—that affected herability to move and maintain an active lifestyle from 2003to 2008. Following a call from her insurance company, shelearned that through the Medicare Advantage program,her insurance provider offered a Healthways “SilverSneakers” gym membership benefit. Silver Sneakers is afun, energizing program that helps older adults take greatercontrol of their health by encouraging physical activity andoffering social events through a fitness center membershipthat allows them to access conditioning classes, exerciseequipment, customized classes designed exclusively forolder adults who want to improve their strength, flexibility,balance, and endurance, health education seminars, andonline support to help lose weight and reduce stress. Shelost 115 pounds, diabetes is in check, cholesterol holdingsteady at 140, and no more portable oxygen tank. The sideevent was an international discussion on what Ms. Farrellfelt Healthways does best and is one of those programsalready in place that can make a difference in preventingNCDs and bringing symptoms under control. She is anexample of its success; reinforcing that “exercise is the bestmedicine.”22 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Opportunities And Barriers To Increasing Physical Activity And Improving HealthModerator, Dr. Janet Walberg Rankin, Professor, Virginia Tech University, President-elect, ACSMGETTING THE ROI ON PHYSICAL ACTIVITYCaitlin Morris, Director of Strategic Initiatives, NikeCaitlin Morris, Director of Strategic Initiatives for Nike, agreedthat to get to the level of scale we need in physical activity, weneed a multi-sector, multi-stakeholder approach. However, shereinforced, we first need to identify each of our organization’score capacities and where the needle movers are in creatingbehavior change, leverage, and impact in different sectors. Aspart of the way forward, she stated that we need to separateout immediate issues from three-to-five year policy shifts andidentify where the system blocks are. After review and analysis,we then need to determine where we can collaborate at a levelwhere we can see coordinated action. Morris suggested that theWorld Bank recommendation to operate at the city level mayactually be the level to create systemic change.In concluding her remarks, she posited that to effect any kindof ROI, we need to develop national or global platforms aroundmetrics. For example, we believe ‘whole of school’ is a best buybecause we believe it increases academic performance. But ifwe don’t have the correlating data between physical activityand academic performance to prove it, then we can’t make the“business” case.Innovation In The Workplace: Scaling Physical Activity in the WorksiteDr. Eva Jane-Llopis, Director, Chronic Disease and Wellness Program, World Economic ForumWorkplaces are front-runners in promoting health. With globalproductivity and health of workforces worldwide under threatfrom NCDs, it is important to note that workplace wellnessschemes that address lifestyle changes and promote health canprevent up to 40% of NCDs, shared Dr. Jane-Llopis. She remarkedthat approximately one-third of the workforce suffers frompreventable diseases in a given year. Physical inactivity, manytimes referred to as the Cinderella factor of NCDs, is maybesomething that we need to rethink, she noted, as what we’reseeing is that physical inactivity or activity is not so much a riskfactor as a well-being factor. It’s the only one that when youdo something, like exercise, you actually are achieving gains foryourself—health gains, mental health gains, social gains, andsocial connectedness. We need to start thinking about how tocreate the system level change in culture and practice, to reversethe sedentary lifestyles that we have today. Being able to establishbaseline global metrics so companies can compare themselvesis essential; as is cross-fertilizing between the private and publicsectors and leveraging academia to create the system-levelchange in culture and practice, concluded Dr. Llopis.Physical Activity Innovation OpportunityIn the physical activity arena, there are no metrics defininghow companies play in the “physical activity” space. Part of theissue is that physical inactivity is not looked upon as so muchof a risk factor, as it is looked upon as a well-being factor. It isonly when you are doing something that you actually achievegains. Accordingly, only 30% of worksites with more than 5,000workers surveyed by the WEF have some type of physical activityincentives in place, compared to 50% or more of workplaceshaving tobacco and alcohol programs in place. In addition tothe private sector, government also has a very important rolein scaling up workplace health and wellness programs andincentivizing public employees to change behavior to lower riskfactors.The opportunity exists to make physical activity a prioritywith companies interested and engaged in wellness, and tocreate the metrics to integrate it into core business systemspromoting organizational performance and employeewell-being.Program InnovationInnovations occur at the private sector and government levels.For example, public employees’ subsidies for the car park areshifted to cash for those who commute by bicycle to work,and two companies quite nearby each other swap parking, soemployee in company A parks in company B and then walks tohis workplace.Humana’s social, mobile, and virtual weight loss club foremployees with a BMI over 28 has more than 1,000 members,with roughly 80% using the Biggest Loser Club website regularlyto track their progress.BCG and Healthways newly designed Wellness App for WorldEconomic Forum members allow companies to simulate thepotential impact of their workplace wellness initiatives. Basedon a company’s demographic profile and related potential riskfactors, the Wellness App estimates the costs of current ill health,then offers a choice of possible interventions and calculates thesavings to be gained by the intervention program chosen.SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 23

Innovative Opportunities for Shaping the Futureof Physical Activity in SchoolJayne Greenberg, District Director of Education and Health Literacy for Miami-Dade County Public SchoolsPhysical education as has been practiced over theyears is viewed as boring, not fun and not importantby many. As an educator in Miami-Dade publicschools, Dr. Greenberg said the challenge is having347,000 students, with 16,000 being student athletesand approximately 330,000 not involved in any sport.Bringing quality physical education into the schoolsystem, she noted, meant refocusing the missionstatement to an emphasis on reducing preventablehealth disparities and increasing fitness levels of morethan 300,000 students, of which 60% are Hispanic and27% are African-American. Dr. Greenberg reportedthis was accomplished by collecting data, performinghealth assessments, and mandating fitness testing. Theresults of these efforts produced a school health index,wellness policies, and a Youth Risk Behavior Surveyagainst which programs are measured.The Miami-Dade public school district is the fourthlargest school system in the U.S., where students arefrom 90 different countries and speak 125 languages.In 2010, over 1,250 students with disabilities receiveda President’s Active Lifestyle Award. Overweightstudents lose an average of 8 pounds per semester, andunderweight students gained an average of 2 poundsper semester. Cost of the program to the school district:ZERO! It is funded through grants and corporatesponsorships. The biggest issue for the program isturning students away because there are not enough teachers.Below is a power point presentation by Dr. Greenbergthat captures the visionary PE program of Miami-Dade.http://www.authorstream.com/Presentation/NASBE-79906-Greenberg-Miami-Dade-County-Public-SchoolsMiami-Florida-PHYSICAL-EDUCATION-Entertainment-ppt-powerpoint/Physical Activity Innovation OpportunityTaking the playbook on the road and doing “dog and pony”shows for motivated PE Health Literacy District Directorsthat promotes physical activity and health literacy at theschool level through wellness policies, a school healthindex, and Youth Risk Behavioral surveys.Program InnovationThe program mandates fitness testing, youth risk behaviorassessments, and lots of technology to monitor, measure,assess, inspire, and motivate. Just on the technology side,through the use of iPod, iTouch, and video podcasting,students learn their academics while exercising onsophisticated treadmills. Program offerings extend fromsailing and snorkeling, to yoga and Pilates, to dance andspinning classes, to Project Adventure on the Beach andI Can Do It, You Can Do It, for autistic children and thosewith disabilities, who participate in 30 minutes of physicalactivity five days a week. A unique way to integrate the“built environment” into physical activity programming.Dr. Eva Jane-Llopis, Director,Chronic Disease and WellnessProgram, World EconomicForum.24 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

Exercise is MedicineAdrian Hutber, VP, Exercise Is Medicine Global InitiativeLeft to right: Dr. Adrian Hutber, VP, Exercise is Medicine; Dr. JayneGreenberg, District Director of Education and Health Literacy, Miami-Dade Public School, Judy McPherson, Founder and Executive Director,PLAY SOCCER Nonprofit International; Caitlin Morris, Director of StrategicInitiatives, Nike; Dr. Janet Walberg Rankin, ACSM.Innovation in Grassroots SportsJudy McPherson, Founder and Executive Director,PLAY SOCCER Nonprofit InternationalPLAY SOCCER is a grassroots healthy lifestyles program usingsoccer as the instrument of action, in teaching healthy life skillsto the most at-risk youngsters in Africa. Instead of a top-downcompetitive program, PLAY SOCCER provides a ball for childrento use in games that teach health skills, nutrition, hygiene, andsocial values in a 48-week curriculum. Judy McPherson sharedthat the program is designed as Activity Based Education. Localyouth from their communities are trained as instructors to buildcapacity, so the program is replicable, transferable, and sustainable.Physical Activity Innovation OpportunityTo scale the program with the Ministry of Education and Sportto bring it into village schools to foster social inclusion, healthychoices, and physical activity.Program InnovationThe Global Peace Games for Children and Youth, aged 5-15, areorganized by nonprofits and communities around the world. Thegames are linked by common themes and encourage children andyouth to share and celebrate the values and skills they learn onthe playing field, and to find peaceful solutions in their daily livesand communities. The games take place in the fall of each yearat locally scheduled dates around the time of the United NationsInternational Day of Peace (September 21).Dr. Hutber stated that while we know that the benefits ofphysical activity can’t be denied, they tend to get ignored inhealth care. The evidence is overwhelming on the cost andhealth burden of inactivity. Exercise Is Medicine is a global “call toaction” to all healthcare providers to prescribe physical activity asa means to prevent and treat NCDs. Physicians and primary careprofessionals are asked to assess and review a patient’s physicalactivity level during the medical visit; provide a physical activityprescription that fits the patient’s health condition; and refer thepatient to an allied health or fitness counselor to monitor andassess behavior change.The Exercise Is Medicine global initiative is an intersectoral allianceof medical associaions, allied health and fitness professionalgroups, sports medicine societies, healthcare associations,universities and policy-makers dedicated to driving physicalactivity investments and iterventions into the continuum of care.Physical Activity InnovationPhysicians prescribing physical activity and referring patients forcounseling as an NCD clinical prevention and treatment approach.Program Innovation:• Influencing medical school curricula and health carecontinuing education to include information aboutphysical activity as part of disease prevention and wellnessmanagement• Developing a health care provider/fitness referral system andcertified database• Providing education, training and communication toolsfor healthcare providers and fitness professionals to makephysical activity and exercise a standard part of diseaseprevention and treatment• Developing a Health Care Effectiveness and Data InformationSet (HEDIS) measure for physical activity that includes fieldsfor tracking patients’ physical activity in electronic records• Establishing a payment reimbursement system for physicalinactivity diagnosis• Bringing all health care interests together through theNational Task Forces and Regional Center umbrella to begindeveloping a dialogue and a road map for actionSIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 25

CONCLUSIONScientific evidence over the last 20 years has shown that asedentary lifestyle is not compatible with health. Leadingsports scientists report that physical inactivity is the mostneglected global health issue of the 21st century!In the last two decades, the risk factor of physical inactivityhas become increasingly prevalent not only in developedcountries, but in developing countries, because of a toxiccombination of population shifts from rural to urban areas,increased availability of inexpensive, energy-dense food,growing use of technology for entertainment, globalization,and aging demographics. More than half the people in theworld live in urban environments where investments in greenspace, recreational facilities, and active transport systems arenot a priority.The World Health Organization Global Strategy on Diet, Healthand Physical Activity and the WHO Global Strategy for thePrevention and Control of NCDs have shined an importantlight on global physical inactivity, estimating that insufficientphysical activity leads to a 20 to 30 percent increased risk fromchronic disease.Participants at the Side Event agreed on the critical importanceof optimizing population health and well-being throughmulti-sector and multi-stakeholder physical activity approachesthat focus on:• Supporting evidence-based surveillance and researchon physical activity to effect individual and large-scalepopulation behavior change, prioritizing those most atrisk• Incorporating physical activity policies and preventionstrategies across the “whole of government”• Supporting capacity building in the physical activityeducation and training of the healthcare workforce• Encouraging community design and development thatpromotes active living• Facilitating access to safe, accessible and affordable placesfor physical activity• Promoting and strengthening school policies andprograms that increase physical activity• Supporting workplace policies and programs that increasephysical activity• Increasing access to sports opportunities and utilizingsports as a development tool with at-risk communities toreduce health disparities, increase social integration, andspread health promotion practices• Strengthening the healthcare system and NCD preventionand treatment by assessing patient physical activity levelsand providing education, counseling and referral servicesas part of the clinical care continuum• Working with civil society organizations, NGOS, the privatesector, and government in creative partnerships to buildglobal capacity for NCD prevention and treatment inlow-and-middle-income countries• Fostering information sharing and collaboration amonginternational, regional, and national PA promotionnetworks and multi-sector/multi-stakeholder interestsThe Organizing Partners of the Side Event on PhysicalActivity and NCDs stand ready to work with all attendeesand interested stakeholders to build out the nextstage of collaborative action to “seize the opportunityand promise of physical activity” in moving the worldtowards better health across the “whole of society” and“whole of government,” with the first step being a callto action for a Regional Summit on Physical Activity inthe Americas!26 | SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs

“Health is a state of complete physical,mental and social well-being and not merelythe absence of disease or infirmity.The enjoyment of the highest attainablestandard of health is one of thefundamental rights of every human beingwithout distinction of race, religion,political belief, economic or social condition.”~ Constitution of the World Health Organization (WHO), 1946SIDE EVENT ON PHYSICAL ACTIVITY AND NCDs | 27

American College of Sports Medicine401 W. Michigan Street, Indianapolis, IN 46202Telephone: 317.637.9200Website address: www.acsm.orgEmail address: UNPhysicalActivitySideEvent@acsm.org