Pediatric Exercise Science, 1994, 6, 302-31 4 O 1994 Human Kinetics Publishers, Inc. Physical Activity Guidelines for Adolescents: Consensus Statement James F. Sallis and Kevin Patrick The International Consensus Conference on Physical Activity Guidelines for Adolescents convened to review the effects of physical activity on the health of adolescents, to establish age-appropriate physical activity guidelines, and to consider how these guidelines might be implemented in primary health care settings. Thirty-four invited experts and representatives of scientific, medical, and governmental organizations established two main guidelines. First, all adolescents should be physically active daily or nearly every day as part of their lifestyles. Second, adolescents should engage in three or more sessions per week of activities that last 20 min or more and that require moderate to vigorous levels of exertion. Available data suggest that the vast majority of U.S. adolescents meet the first guideline, but only about two thirds of boys and one half of girls meet the second guideline. Physical activity has important effects on the health of adolescents, and the promotion of regular physical activity should be a priority for physicians and other health professionals. The numerous health benefits of physical activity in adults have been extensively documented (1). The weight of scientific evidence has led to the development of specific exercise guidelines for the general population of adults (2), the recognition of physical inactivity as a major risk factor for cardiovascular diseases (3), and national health objectives to promote regular physical activity and decrease inactivity (4). Physical activity has the potential to confer health benefits on children and adolescents as well. Several national medical and professional organizations have issued opinion statements, resolutions, or guidelines for youth physical activity (5,6,7, 8). The U.S. national health promotion and disease prevention objectives (4) include goals for increasing physical activity of children and adolescents, and the American Medical Association's Guidelines for Adolescent Preventive Services (8) recommend physician counseling to promote regular physical activity in adolescents. However, the existing opinion statements and guidelines are based primarily on studies of adults, and some scientists and practitioners may not James F. Sallis is with the Department of Psychology at San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA 92120. Kevin Patrick is with the General Preventive Medicine Residency at the University of Califomia-San Diego State University, Student Health Services, San Diego State University, San Diego, CA 92182, and with the Office of Disease Prevention and Health Promotion, U.S. Public Health Service.
Transcript
Pediatric Exercise Science, 1994, 6, 302-31 4 O 1994 Human Kinetics Publishers, Inc.
Physical Activity Guidelines for Adolescents: Consensus Statement
James F. Sallis and Kevin Patrick
The International Consensus Conference on Physical Activity Guidelines for Adolescents convened to review the effects of physical activity on the health of adolescents, to establish age-appropriate physical activity guidelines, and to consider how these guidelines might be implemented in primary health care settings. Thirty-four invited experts and representatives of scientific, medical, and governmental organizations established two main guidelines. First, all adolescents should be physically active daily or nearly every day as part of their lifestyles. Second, adolescents should engage in three or more sessions per week of activities that last 20 min or more and that require moderate to vigorous levels of exertion. Available data suggest that the vast majority of U.S. adolescents meet the first guideline, but only about two thirds of boys and one half of girls meet the second guideline. Physical activity has important effects on the health of adolescents, and the promotion of regular physical activity should be a priority for physicians and other health professionals.
The numerous health benefits of physical activity in adults have been extensively documented (1). The weight of scientific evidence has led to the development of specific exercise guidelines for the general population of adults (2), the recognition of physical inactivity as a major risk factor for cardiovascular diseases (3), and national health objectives to promote regular physical activity and decrease inactivity (4).
Physical activity has the potential to confer health benefits on children and adolescents as well. Several national medical and professional organizations have issued opinion statements, resolutions, or guidelines for youth physical activity (5 ,6 ,7 , 8). The U.S. national health promotion and disease prevention objectives (4) include goals for increasing physical activity of children and adolescents, and the American Medical Association's Guidelines for Adolescent Preventive Services ( 8 ) recommend physician counseling to promote regular physical activity in adolescents. However, the existing opinion statements and guidelines are based primarily on studies of adults, and some scientists and practitioners may not
James F. Sallis is with the Department of Psychology at San Diego State University, 6363 Alvarado Court, Suite 103, San Diego, CA 92120. Kevin Patrick is with the General Preventive Medicine Residency at the University of Califomia-San Diego State University, Student Health Services, San Diego State University, San Diego, CA 92182, and with the Office of Disease Prevention and Health Promotion, U.S. Public Health Service.
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consider these to be adequate justification for widespread interventions with youth. In the interest of encouraging appropriate interventions, a consensus confer- ence was convened (a) to develop physical activity guidelines for adolescents that are based on age-specific data on the effects of physical activity and (b) to provide suggestions for implementing the guidelines in primary medical care settings.
The Consensus Process
In 1992 an advisory committee, composed of leading scientists and representatives of primary care medical societies and appropriate government agencies, was assembled to direct the development of a consensus on physical activity guidelines for adolescents. The adolescent age group was defined as ages 11 through 21 years. Adolescence was selected as the focus of the guidelines so the results could contribute to the American Medical Association's Guidelines for Adolescent Preventive Services (8) project. Specific physical activity guidelines for the general population and for high-risk subgroups of adolescents were developed, based largely on seven commissioned review papers. Two additional papers addressed the descriptive epidemiology of physical activity in adolescents and how these guidelines might be implemented in primary care settings.
Two respected scholars were invited to coauthor each of the nine back- ground papers. Drafts were critically examined by external reviewers plus a member of the steering committee. Second drafts were circulated to all participants prior to the consensus workshop. A draft consensus statement was revised at the workshop.
On June 1 1 and 12,1993, the authors and representatives of the participating organizations (listed in the Appendix) convened in San Diego, California. One working group had primary responsibility for the implementation guidelines. This final statement represents the consensus of the entire group.
Definitions
Physical activity, exercise, and physical fitness are words that are sometimes used interchangeably, but they are distinct concepts. Caspersen, Powell, and Christenson (9) provided the most widely accepted definitions. Physical activity is a broad term that describes "any bodily movement produced by skeletal muscles that results in energy expenditure" (9, p. 126). Exercise is a subset of physical activity that is "planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness" (9, p. 126). Physicalfitness is "a set of attributes that people have or achieve that relates to the ability to perform physical activity" (9, p. 128). Some fitness components are related to sports performance, and others are considered health- related fitness components. Health-related physical fitness components are cardio- respiratory endurance, muscular endurance, muscular strength, body composition, and flexibility. These fitness components also contribute to sports performance and capacity for occupational tasks.
The primary focus of this paper is physical activity, which is a complex set of behaviors. Physical activity varies along four basic dimensions (2), often
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referred to by the FITT mnemonic. "Frequency" is typically expressed as number of sessions per day or week. "Intensity" refers to the rate of energy expenditure, corrected for body mass, and is often indicated by kilocalories expended per minute or by multiples of resting metabolic rate (METs), although it can also be reflected by percent of maximum heart rate or percent of maximal oxygen uptake. "Time" spent in activity may refer to a single instance of physical activity or a cumulative time measure over a day or a week. "Type" of activity is a qualitative descriptor. Aerobic activities, such as distance running and swimming, involve rhythmic, dynamic movement of large muscle groups. Strength training activities, such as weight lifting, are also called resistance exercises.
Health Effects of Physical Activity in Adolescence
Physical activity affects many systems of the body and provides numerous health benefits for adults (1, 10). Because physical activity confers significant protection from chronic diseases such as cardiovascular diseases and non-insulin-dependent diabetes mellitus and because it appears to reduce the risk of osteoporosis and some cancers, there is substantial interest in beginning the prevention of these adult diseases during the first two decades of life through regular physical activity. In addition to these disease-prevention benefits, physical activity contributes to quality of life, psychological health, and the ability to meet physical workdemands and engage in leisure activities. Regular physical activity improves functional status and limits disability during the middle and later years. However, there is controversy regarding the effects of physical activity in youth on chronic disease in adulthood because long-term studies are lacking.
The health effects of physical activity during adolescence have been studied less frequently. However, adiposity, psychological functioning, immune status, and risk of musculoskeletal injury are significant health concerns in adolescence that may be influenced by physical activity. This section summarizes reviews of the literature on associations between physical activity and health indicators in adolescents, and the consensus guidelines are based upon these reviews.
Though the amount or dose of physical activity required to produce health benefits varies according to the outcome, it is not practical to have several guidelines for the general population of adolescents. Thus, the consensus group developed two general physical activity guidelines that are believed to improve several health outcomes for all adolescents while minimizing known risks. Needs of selected high-risk groups were also considered.
Not all health outcomes of interest have been adequately studied in adoles- cents. Seven topics were selected for review because they encompass major causes of morbidity or mortality in adolescence or adulthood, and a literature exists on their relation to physical activity in adolescents. Few studies assessed the effects of different amounts of physical activity, so the dose-response relation- ships are not known. In many cases recommendations are largely based on studies demonstrating that a specified amount of physical activity had a significant effect on an outcome. The evidence supported the stated recommendations, but it is possible that less physical activity would also be effective in some cases.
Aerobic fitness is strongly related to total mortality in adults, and it may tivity (1 1). This relationship has been
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extensively studied, and the following recommendation is supported for the general population of adolescent boys and girls. Adolescents should be involved in regular (preferably daily) physical activity. Additional aerobic fitness benefits may be achieved with moderate to vigorous physical activity, that is, a minimum of 3 days per week for a minimum of 30 min per session at an intensity of 75% of heart rate reserve: resting heart rate + .75(maximum heart rate - resting heart rate).
Bone mass develops rapidly during adolescence, and physical activity in adolescence may have an important role in reducing risk of osteoporosis in later life by enhancing peak bone mass (12). Active adolescents have better skeletal health than their less active peers at most of the bone sites tested. Data support a specific physical activity recommendation regarding only the type of activity. Individual bones must be stressed to increase bone mass; therefore, diverse weight-bearing activities are recommended on a frequent basis, preferably daily. Vigorous aerobic or anaerobic activities of a weight-bearing nature, as well as resistance training, seem to be effective in promoting good skeletal health. Long periods of immobilization should be avoided, even during illness, to prevent loss of bone. Prolonged, intense physical activity that impairs menstmal function in females is also detrimental to the skeleton. Inadequate calcium intake, smoking, and eating disorders may impair skeletal health.
Although several studies indicate that physical activity is associated with small reductions in percent body fat and small increases in fat-free mass in the general adolescent population, the data are not sufficient to develop a specific recommendation on the amount of physical activity needed for obesity control (13). Physical activity recommendations for obesity prevention should include consideration of dietary intake and genetic predisposition. The trend of increasing levels of adiposity among adolescents suggests that more physical activity is needed in the general population. In the treatment or prevention of obesity in adolescents, it is likely that the intensity of individual bouts of activity is less important than total calories expended.
In the general population of normotensive adolescents, no association is found between physical activity and blood pressure, or when found, the significant relationships are explained by differences in body size or adiposity (14). There- fore, no specific physical activity recommendation is made for normotensives. For high-risk adolescents, defined as those with blood pressures at or above the 90th percentile for age and sex, regular physical activity is effective in reducing blood pressure. Elevated blood pressures in adolescence can be decreased with 3 days per week of aerobic activity, performed for 30 min each occasion at an intensity of 60% of maximum heart rate (estimated maximum heart rate = 220 minus age). At least 3 months of training are required for an effect in adolescents with elevated blood pressure. Resistance training is not recommended for initial treatment, but can be effective for maintenance of blood pressure reductions.
In the general population, the data are mixed on the effect of physical activity on various lipids and lipoproteins (15). Experimental studies in adoles- cents do not support a relationship, but many observational studies demonstrate associations with HDL cholesterol. Based in large part on adult data, four 30-min sessions of large muscle group exercise per week, at an intensity equivalent to 80% of maximum heart rate may be an appropriate prescription. A minimum training period of 6 months may be necessary before beneficial effects can be
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expected. Three types of high-risk adolescents were identified; the obese, dia- betics, and those with family histories of heart disease or hypercholesterolemia. For the obese and those with family histories, there is some evidence that physical activity is effective in increasing HDL cholesterol.
Studies have examined associations of physical activity with a wide variety of psychosocial variables in adolescence, most commonly depression, anxiety/ stress, and self-esteemlself-concept (16). Most studies are on general population samples, and the majority of studies of each outcome find significant effects. To improve psychological health, the general population of adolescent boys and girls should engage in aerobic activities three times per week, for 20 min per occasion, at an intensity of 70% of maximum heart rate. Significant beneficial effects are obtained after 10 to 15 weeks of training. No recommendations could be developed based on studies of adolescents with clinical psychological disorders.
Injuries are the leading cause of death in adolescence, but physical activity and sports account for only about 5% of mortal injuries (17). Musculoskeletal injuries during the growing years of adolescence are of particular concern because of the vulnerability of the growth plates in the long bones. Although rare, injuries induced by forceful collisions during sports or by overuse during recreational physical activity have the potential to produce permanent damage to growing bones and to increase the risk of musculoskeletal problems in years later. The studies in this area typically report the types of injuries in adolescents and do not document rates of injuries or risk factors. No data are available on the risks of recreational activities, but injury rates for specific high school and college team sports indicate that football and wrestling are among the riskiest sports. Interpretation of these data is complicated by the different definitions of injury and varying levels of severity. No physical activity guidelines could be developed based on existing data on adolescents.
Physical Activity Guidelines for Adolescents
This systematic examination of the adolescent literature on physical activity and various health outcomes, in the context of the extensive adult literature, provides the background for the most informed guidelines that can be developed at the present time. There are a number of general considerations that form the back- ground for the recommendations.
There are two health-related rationales for adolescent physical activity. One is to promote physical and psychological health and well-being during adolescence. The second is to promote physical activity to enhance future health by increasing the probability of remaining active as an adult. It is believed that adolescents who develop a habit of participating in activities that can be carried over into adulthood will be more likely to remain active. These are typically thought of as activities that can be done by oneself or with one other person.
There are multiple health benefits of physical activity, and many expected positive outcomes have not yet been studied in adolescents. While physical activity entails some risk of injury, there was strong consensus that the benefits far outweigh the risks. Participating in a variety of activities that work different
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parts of the body provides more health benefits, improves more fitness compo- nents, and teaches more activity skills that may allow the adolescent to be active in a variety of settings.
Adolescents involved in a decision-making process that allows them to select enjoyable and preferred activities are believed to be more likely to continue activity than are adolescents who participate in activities they perceive as physi- cally or psychologically aversive. For those who are starting at a lower level of activity than recommended, gradual increases in physical activity over time are suggested.
Most adolescents can benefit from increasing their participation in physical activity. Many adolescents may want to exceed the guidelines because of an interest in athletics, recreational pursuits, or work demands. A small percentage of adolescents may engage in excessive amounts of physical activity that are associated with injuries, eating disorders or menstrual dysfunction. The following guidelines provide an amount of physical activity that is adequate for health maintenance for the general population of adolescents. The optimal amount of physical activity for health is not known.
General Population Recommendations Guideline 1
All adolescents should be physically active daily, or nearly every day, as part of play, games, sports, work, transportation, recreation, physical education, or planned exercise, in the context of family, school, and community activities.
Adolescents should do a variety of physical activities as part of their daily lifestyles. These activities should be enjoyable, involve a variety of muscle groups, and include some weight bearing activities. The intensity or duration of the activity is probably less important than the fact that energy is expended and a habit of daily activity is established. Adolescents are encouraged to incorporate physical activity into their lifestyles by doing such things as walking up stairs, walking or riding a bicycle for errands, having conversations while walking with friends, parking at the far end of parking lots, and doing household chores.
Rationale. Daily weight-bearing activities, of even brief duration, during adolescence are critical for enhancing bone development that affects skeletal health throughout life. Substantial daily energy expenditure is expected to reduce risk of obesity and may have other positive health effects that have not been documented.
Though it is desirable to have a quantitative recommendation for daily physical activity, the available data do not support such a specific recommenda- tion. Objective 1.3 from Healthy People 2000 (4) is similar to the present recom- mendation, and provides a quantitative benchmark that can be used until more data are available. The objective is to "increase to at least 30 percent the proportion of people aged 6 and older who engage regularly, preferably daily, in light to moderate physical activity, for at least 30 minutes per day" (4, p. 97). Recently issued guidelines from the Centers for Disease Control and Prevention and the American College of Sports Medicine (18) also state that adults should accumulate at least 30 min of moderate physical activity on most, preferably all, days of the week. Thus, it is reasonable to recommend this as a minimal amount of physical activity for adolescents.
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Consensus Statement - 309
Recent information from the Youth Risk Behavioral Survey (19) shows that about two thirds of adolescent males and one half of adolescent females participate in moderate to vigorous activity at least three times per week.
By the end of high school, only about half of adolescents are enrolled in school physical education classes, and available data indicate that, in general, physical education does not provide adequate amounts of physical activity to meet the second guideline. Adolescents obtain most of their physical activity outside of school, but participation in sports declines during adolescence. These data suggest that substantial numbers of adolescents, and the majority of girls, are not sufficiently active. The sex differences in physical activity suggest that effective interventions are especially needed for girls. During adolescence, time spent by both girls and boys in physical activity declines, and the decline continues into adulthood. Because of this downward trend, even those adolescents currently meeting the physical activity guidelines are at risk for becoming sedentary adults.
Implementing the Guidelines in Primary Health Care
Physicians should both promote physical activity in clinical settings and act as advocates for environments and programs that are supportive of physical activity (20). Interventions in multiple settings, targeting a variety of mediating factors, are needed to produce meaningful changes in adolescent physical activity. Be- cause there is limited research on physical activity interventions for adolescents, definitive recommendations cannot be made. Nonetheless the following represent consensus guidelines.
Promoting Physical Activity in Primary Care
1. All health care providers should regularly assess and counsel their adoles- cent patients about physical activity.
2. Physical activity assessment should enable health care providers to (a) categorize their patients as either already engaging in appropriate activity or in need of increased physical activity, (b) determine if a patient is at increased risk for health outcomes that can be beneficially affected by physical activity, and (c) identify barriers to either continued or increased physical activity the adolescent might experience.
3. Physical activity counseling should (a) be based upon the findings of the assessment, including individual needs and interests; (b) be based upon the guidelines stated earlier in this paper; (c) result in a specific activity plan that is discussed and agreed upon prior to the end of the visit; and (d) involve, as appropriate, peers, family, school, and other public and private community resources.
Rationale. Promoting physical activity among adolescents should be con- sidered a part of routine preventive health care. Assessment and counseling for physical activity also should be included in a comprehensive preventive services package for adolescents. Physicians and other health care professionals should assess and counsel adolescents regarding physical activity during preventive services and as opportunities arise during acute care and other health care visits.
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Preparticipation athletic examinations, camp physicals, and other required physi- cal exams are opportunities for physicians to assess and counsel about physical activity.
Many adolescents meet the physical activity guidelines and only need encouragement to remain active. Others need counseling to increase their current physical activity level. Those with elevated risk factors for chronic illnesses may need more specific activity recommendations. Persons with illness or disability may need special assistance in meeting these recommendations. Adolescent girls and young women are at high risk for inactive lifestyles, so sex-specific interven- tions may need to be developed. The circumstances of adolescents from diverse sociocultural and economic backgrounds need to be considered. Finally, particular attention should be paid to developing physical activity recommendations that accommodate seasonal and climatic variability.
Because health care professionals are highly credible sources of health information and have multiple contacts with adolescents, the potential for effective intervention is great through (a) brief assessment and counseling by the physician or other professionals in the office, (b) counseling parents and other family members to support the adolescent's physical activity, (c) having appropriate educational materials on hand to give to adolescents, and (d) referring adolescents to community organizations that can assist them in their physical activity.
Research on behavior change indicates that some methods are more effec- tive than others. Merely providing information about health consequences is typically not, by itself, an effective approach. Counseling should help the adoles- cent develop self-regulatory and physical activity skills. Counseling should build self-efficacy in using these skills to minimize barriers to engaging in physical activity. Counseling should also facilitate social supports in families, peer groups, and the community that encourage physical activity.
Physical activity assessment and counseling practices by clinicians are likely to be enhanced if providers themselves are good role models. Adolescents, perhaps more than any other group, connect the message with the messenger. Health care professionals should receive training in effective physical activity assessment and counseling strategies at all levels of their education. Practitioners should seek opportunities to become skilled in this area, and professional societies and others responsible for medical continuing education should assure the avail- ability of such opportunities.
Advocacy for Community-Based Adolescent Physical Activity
Successfully promoting physical activity in adolescents requires a multifaceted community-wide effort. Increased physical activity is more likely to occur when adolescents receive the consistent message that physical activity is beneficial. The message they receive from their health care provider must be repeated in homes, schools, recreation facilities, the media, and work sites. Physicians should advocate appropriate physical education cumcula in the schools and promote the availability of a range of physical activity programs and opportunities that accommodate the unique needs of adolescents in their communities.
Comment These guidelines represent the consensus of leading scientists and clinicians. More definitive recommendations must await the advancement of knowledge in
Consensus Statement - 31 1
a variety of areas, including "dose-response" information for differing levels of physical activity, the relationships between physical activity in adolescence and specific health outcomes during adolescence and later adult life, and effectiveness research evaluating individual and community-based interventions to optimize adolescent physical activity.
Despite the limitations of the current database, there is substantial evidence that regular physical activity produces multiple beneficial physiological and psy- chological outcomes during adolescence. The strength and consistency of these findings lead to recommendations for all adolescents to be physically active on a regular basis. Physicians and other health care professionals should make the promotion of physical activity in adolescents a standard part of preventive care. It is hoped that this consensus statement will encourage health care professionals to promote physical activity in their adolescent patients and to advocate school and community-based resources and programs.
References 1. Bouchard, C., R.J. Shephard, and T. Stephens. (Eds.). Physical Activity, Fitness, and
Health: International Proceedings and Consensus Statement. Champaign, IL: Human Kinetics, 1994.
2. American College of Sports Medicine. Guidelines for Exercise Testing and Prescrip- tion (4th ed.). Philadelphia: Lea & Febiger, 1991.
3. Fletcher, G.F., S.N. Blair, J. Blumenthal, C. Caspersen, B. Chaitman, S. Epstein, H. Falls, E.S.S. Froelicher, and I.L. Pina. Statement on exercise: Benefits andrecommen- dations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation 86:340-344, 1992.
4. U.S. Department of Health and Human Services. Healthy People 2000: National Health Promotion and Disease Prevention Objectives (DHHS Pub. No. PHS 91- 50212). Washington, DC: U.S. Government Printing Office, 1991.
5. American Academy of Pediatrics Committees on Sports Medicine and School Health. Physical fitness and the schools. Pediatrics 80:449-450, 1987.
6. Riopel, D.A., R.C. Boerth, T.J. Coates, C.H. Hennekens, W.M. Miller, and W.H. Weidman. Coronary risk factor modification in children: Exercise. A statement for physicians by the Committee on Atherosclerosis and Hypertension in Childhood of the Council on Cardiovascular Disease in Young. Circulation 74: 1 189A-119 1 A, 1986.
7. American College of Sports Medicine. Opinion statement on physical fitness in children and youth. Med. Sci. Sports Exerc. 20:422-423, 1988.
8. American Medical Association. Guidelines for Adolescent Preventive Services. Chicago: Author, 1992.
9. Caspersen, C.J., K.E. Powell, and G.M. Christenson. Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Rep. 100:126-131, 1985.
10. Blair, S.N., H.W. Kohl, N.F. Gordon, and R.S. Paffenbarger. How much physical activity is good for health? Ann. Rev. Public Health 13:99-126, 1992.
11. Morrow, J.R., Jr., and P.S. Freedson. Relationship between habitual physical activity and aerobic fitness in adolescents. Ped. Exerc. Sci. 6:315-329, 1994.
12. Bailey, D.A., and A.D. Martin. Physical activity and skeletal health in adolescents. Ped. Exerc. Sci. 6:330-347, 1994.
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13. Bar-Or, O., and T. Baranowski. Physical activity, adiposity, and obesity among adoles- cents. Ped. Exerc. Sci. 6:348-360, 1994.
14. Alpert, B.S., and J.H. Wilmore. Physical activity and blood pressure in adolescents. Ped. Exerc. Sci. 6:361-380, 1994.
15. Armstrong, N., and B. Simons-Morton. Physical activity and blood lipids in adoles- cents. Ped. Exerc. Sci. 6:381-405, 1994.
16. Calfas, K.J., and W.C. Taylor. Effects of physical activity on psychological variables in adolescents. Ped. Exerc. Sci. 6:406-423, 1994.
17. Macera, C., and W.J. Wooten. Epidemiology of sports and recreation injuries among adolescents. Ped. Exerc. Sci. 6:424-433, 1994.
18. Centers for Disease Control and Prevention. Prevalence of sedentary lifestyle: Behav- ioral risk factor surveillance system, United States, 1991. MMWR 42576-579, 1993.
19. Pate, R., B.J. Long, and G. Heath. Descriptive epidemiology of physical activity in adolescents. Ped. Exerc. Sci. 6:434-447, 1994.
20. DuRant, R.H., and A.C. Hergenroeder. Promotion of physical activity among adoles- cents by primary health care providers. Ped. Exerc. Sci. 6:448-463, 1994.
Appendix
Steering Committee
James F. Sallis, PhD, Chair, Sun Diego State University Kevin Patrick, MD, MS, Co-chair, University of California, Sun Diego & San Diego
State University Barbara J. Long, MD, Conference Coordinator, Sun Diego State University Karen J. Calfas, PhD, Sun Diego State University Wilma J . Wooten, MD, MPH, University of California, Sun Diego
Advisory Committee
Oded Bar-Or, MD, McMaster University Steven N. Blair, PED, Cooper Institute for Aerobics Research Art Elster, MD, American Medical Association Sally Harris, MD, MPH, Palo Alto CliniclAmerican Academy of Pediatrics Gregory W. Heath, DHSc, MPH, Centers for Disease Control and Prevention Russell R. Pate, PhD, University of South Carolina Thomas W. Rowland, MD, Baystate Medical Center Bruce Simons-Morton, EdD, MPH, National Institute of Child Health and Human
Development Mary Vernon, MD, MPH, Centers for Disease Control and Prevention
Consensus Group
Neil Armstrong, PhD, University of Exeter, England Donald A. Bailey, PED, University of Saskatchewan, Canada Oded Bar-Or, MD, McMaster University, Canada Tom Baranowski, PhD, Emory University Karen J. Calfas, PhD, Sun Diego State University Robert H. DuRant, PhD, Harvard University
Consensus Statement - 313
Art Elster, MD, American Medical Association Ronald Feinstein, MD, University of AlabamalSociety of Adolescent Medicine Patty S. Freedson, PhD, University of MassachusettslAmerican Alliance of Health,
Physical Education, Recreation and Dance Dean Griffin, MD, American Academy of Family Physicians Matthew Guidry, PhD, President's Council on Physical Fitness and Sports Sally Harris, MD, Palo Alto Medical CliniclAmerican Academy of Pediatrics Ash Hayes, MD, American Council on Exercise Gregory W. Heath, DHSc, MPH, Centers for Disease Control and Prevention Albert C. Hergenroeder, MD, Baylor College of Medicine Joe Jopling, MD, Salt Lake City Barbara J. Long, MD, Sun Diego State University Alan D. Martin, MD, University of British Columbia, Canada Thomas L. McKenzie, PhD, Sun Diego State University James R. Morrow, Jr., PhD, University of North Texas Neville Owen, PhD, University of Adelaide, Australia Russell R. Pate, PhD, University of South Carolina Kevin Patrick, MD, MS, University of California, Sun Diego & San Diego State
University Tom Robinson, MD, MPH, Stanford University School of Medicine David Rosen, MD, MPH, C.S. Mott Children's HospitallArnerican College of
Physicians Thomas Rowland, MD, Baystate Medical Center James F. Sallis, PhD, Sun Diego State University Bruce Simons-Morton, EdD, MPH, National Institute of Child Health and Human
Development Denise Simons-Morton, MD, PhD, National Heart, Lung, and Blood Institute Wendell C. Taylor, PhD, MPH, University of Texas at Houston Mary Vernon, MD, MPH, Centers for Disease Control and Prevention Jack H. Wilmore, PhD, University of Texas at Austin Wilma J. Wooten, MD, MPH, University of California, San Diego Kimberly K. Yeager, MD, MPH, Sun Diego State University
Reviewers of the Background Papers
Charles Corbin, PhD, Arizona State University Michael H. Criqui, MD, MPH, University of California, Sun Diego William Dietz, MD, PhD, Tufts University Rod K. Dishman, PhD, University of Georgia Barbara Drinkwater, PhD, University of Washington Patricia M. Dubbert, PhD, VAMC, Jackson, MS Larry J. Durstine, PhD, University of South Carolina Art Elster, MD, American Medical Association Kenneth Fox, PhD, University of Exeter, England Sally Harris, MD, Palo Alto Medical CliniclAmerican Academy of Pediatrics Joe Jopling, MD, Salt Lake City, Utah Lyle Micheli, MD, Boston Children's Hospital Philip R. Nader, MD, University of California, Sun Diego Patricia Patterson, PhD, Sun Diego State University
314 - Sallis and Patrick
Tom Robinson, MD, MPH, Stanford University Denise Simons-Morton, MD, PhD, National Heart, Lung, and Blood Institute William B. Strong, MD, Medical College of Georgia Kimberly K. Yeager, MD, MPH, San Diego State University
Participating Organizations
American Academy of Pediatrics American Academy of Family Physicians, Commission on Special Issues and Clinical
Interests American Alliance of Health, Physical Education, Recreation and Dance American College of Physicians American College of Sports Medicine American Heart Association American Medical Association, Department of Adolescent Health Centers for Disease Control and Prevention, Division of Adolescent and School Health National Heart, Lung, and Blood Institute National Institute for Child Health and Human Development President's Council on Physical Fitness and Sport Society for Adolescent Medicine U.S. Department of Health and Human Services, Office of Disease Prevention and
Health Promotion
Financial Support Provided By
American Academy of Pediatrics American College of Sports Medicine American Heart Association American Medical Association, Department of Adolescent Health Centers for Disease Control and Prevention, Division of Adolescent and School Health National Heart, Lung, and Blood Institute San Diego State University, Division of Student Affairs, Student Health Services Sugar Association University of California, San Diego Medical Center University of California, San Diego School of Medicine University of California, San Diego, Department of Family and Preventive Medicine University of California, San Diego-San Diego State University, General Preventive
Medicine Residency Program U.S. Department of Health and Human Services, Office of Disease Prevention and
Health Promotion
Note. Institutional and organizational affiliations are listed for participant identification purposes only and do not imply endorsement of this consensus statement either in part or in whole.
