The National Physical Activity Plan: Implications for you and your practice

Health care providers are key sources of health care information, but they often do not address physical activity on a regular basis. For our patients’ health and our own health, physical activity cannot be ignored.

When the Department of Health and Human Services released the 2008 Physical Activity Guidelines for Americans, which are intended for health care professionals and policymakers, no national physical activity plan existed. The 2008 guidelines underscored the importance and need for a national physical activity plan to combat the growing incidence of obesity and type 2 diabetes in the United States. Recently the National Physical Activity Plan (NPAP) was released. It outlines strategies and tactics within numerous sectors, including the health care sector, to promote physical activity. The NPAP provides direction to practitioners and the health care community to promote physical activity and to incorporate physical activity as a measure of health status.

History of the plan

Mary M. Austin

Development of the first NPAP began in October 2006, and the project received funding from the CDC in September 2007. The mission of the NPAP was to “develop a national plan for physical activity that produces a marked and progressive increase in the percentage of Americans who meet physical activity guidelines throughout life.”

Historically, other national plans in smoking cessation, diabetes and arthritis have proved successful in the United States. Other countries, including Australia, Finland, Canada and the United Kingdom, have implemented similar national physical activity plans.

The US NPAP process began with a coordinating committee of national physical activity and public health organizations establishing eight Sector Working Groups of approximately 300 representatives from government, nongovernment, private, industry and nonprofit organizations. Representatives from the health care community on the coordinating committee included the American Medical Association, American Diabetes Association, American Dietetic Association, American Cancer Society, American Academy of Pediatrics, American Heart Association, and others. The eight Sector Working Groups included Business and Industry; Education; Health Care; Mass Media; Parks, Recreation, Fitness and Sports; Public Health; Transportation, Land Use, and Community Design; and Volunteer and Non-Profit. Each group was responsible for developing specific strategies and tactics that would promote and support actions for short- and long-term progress in increased physical activity for all Americans. Experts within each sector group developed a white paper outlining their evidence-based recommended actions and presented them at a 2-day working national conference in Washington, D.C., in July 2009. (The white papers were published as a supplement in the November 2009 Journal of Physical Activity and Health.) The goal of the 2-day forum was to develop the content of the first NPAP and an implementation plan.

The first-ever NPAP was launched in May 2010.

Physical activity as a priority

The stated vision of the NPAP is “all Americans are physically active and live, work, and play in environments that facilitate regular physical activity.”

The NPAP is a formal document that established physical activity as a national priority area, as well as providing a specific plan or framework for taking action. The document describes the actions that the government, nongovernment and private sector partners must take to promote physical activity in the population. There are five overarching strategies and some specific strategies and accountability metrics for each Working Group Sector. Some strategies encompass more than one Group Sector and have crossover support from different Group Sectors.

As clinicians, the white paper from the Health Care Sector (Patrick 2009) examining whether and how physical activity should be promoted in health care is of particular interest. In examining the evidence for interventions that improve physical activity behaviors based in health care settings and offered by health care providers, the findings are mixed. Physical activity interventions provided as standalone brief counseling by physicians have not been shown to be effective. However, when office-based screenings and physical activity advice, followed by telephone and community support are provided, this has been shown to be effective in creating lasting physical activity behavior improvement. This finding underscores the importance of utilizing a team approach to promoting physical activity and provides an opportunity for diabetes educators to work more closely with office-based practices.

Six strategies and numerous tactics have been proposed in the NPAP for the Health Care Sector. Strategy 1 states: “Make physical activity a patient ‘vital sign’ that all health care providers assess and discuss with their patients.” Some of the tactics suggested to support this strategy include: Ensure that all health care professional organizations encourage their members to assess patients’ physical activity and help set physical activity goals; physical activity tracking capability in the electronic medical and health record; develop a Health care Effectiveness and Data Information Set (HEDIS) measure for physical activity; and encourage health care professionals to be active-lifestyle role models for their patients.

Another strategy suggests: “Include physical activity education in the training of all health care professionals.” There are five tactics with this strategy, including adding physical activity education to licensing exams and offering provider incentives to attend continuing education on effective population physical activity promotion approaches.

Use by diabetes educators

It is clear that the NPAP was developed through a thoughtful, methodic process; its success, however, depends on how well the eight sectors (stakeholders) embrace and act on the strategies.

The release of the NPAP provides the opportunity for diabetes educators to examine and evaluate the state of their current practice in addressing physical activity to promote and maintain good health.

Additionally, now may be the time to evaluate one’s comfort level in providing counseling in physical activity. Diabetes educators may need to incorporate a physical activity curriculum as part of their diabetes education program; track physical activity in an electronic record; attend continuing education programs in physical activity; and advocate for new service codes with the Centers for Medicare and Medicaid Services (CMS) as the NPAP is embraced within the current health care system. If the NPAP is to create a national culture that encourages physical activity and ultimately improve health, prevent disease and disability, and improve quality of life, all health care professionals need to become aware of the NPAP and promote its implementation.

For more information on the NPAP, visit physicalactivityplan.org. View the NPAP at physicalactivityplan.org.

Mary M. Austin, MA, RD, CDE, FAADE, is principal partner of the Austin Group LLC, in Shelby Township, Mich. She is also an Endocrine Today Editorial Board member.

For more information:

• Bornstein D. J Phys Act Health. 2009;6 (Suppl 2):S245-S264.
• Colberg SR. Diabetes Care. 2010:33:e147-e167.
• Patrick K. J Phys Act Health. 2009;6 (Suppl 2):S211-S219.
• US Department of Health and Human Services. 2008 physical activity guidelines for Americans. October 2008. Available at: health.gov/paguidelines.

Disclosure: Austin reports no relevant financial disclosures.