Presentation to Washington Semester Class

On Wednesday, October 17, I gave a presentation based on my latest report to SBRnet to a class of undergraduates in American University's Washington Semester program. A text version is below. If you would like the Powerpoint slides, I can email them to you.

Thank you for that nice introduction, Steve.

America—and, increasingly, the rest of the world—face a new kind of health crisis—one created by our civilization—lack of exercise. Physicians, since the time of ancient Greece, have thought that exercise is essential for good health for most people, and, since the second half of the 20th century, medical opinion has increasingly favored more exercise for more people, most recently including even heart patients and pregnant women on bed rest. Yet, health survey data consistently show that a majority of Americans and people around the world do not exercise as much as health authorities recommend, and those recommendations are not terribly stringent. The result is a slew of unnecessary medical problems, especially obesity and diseases like diabetes and heart disease resulting from it, depression and other unhealthy mental conditions, and muscular degeneration. Of course, bad diets are also partly to blame for these medical problems, but my focus is on exercise. Even if you eat some unhealthy food—and we all do—you won’t get fat if you burn at least as many calories as you eat. The medical community is truly alarmed about obesity in America and the rest of the world, especially in children. Childhood obesity in America has tripled in the last three decades, so that an Institute of Medicine study suggested that this generation of American children could be the first one not to have a longer life expectancy than its parents’.MoM

Our civilization is the root cause of most people not getting enough exercise. You can get enough exercise in four phases of life—transport, employment, domestic chores, and leisure. Our grandparents and great-grandparents, unless they were in the privileged few, probably got as much or more exercise than they needed in the first three phases of life. Most of them relied on walking for some of their transport needs. Many did hard physical labor for a living, especially in agriculture, and they used their muscles for household chores like washing clothes and hauling water from the well. They were probably glad to sit by the fire and talk or read by candlelight after a strenuous dawn-to-dusk day. Children and adults were in much the same situation. Today, in the developed world and increasingly in the urban developing world, adults are in exactly the opposite position. They must devote some of their leisure time to exercise or they won’t get enough. Why? I see three reasons:

1. The private automobile is the preferred, and often the only practical, mode of transport for most people. American metropolitan areas are designed for automobile transport. As the first slide shows, both the number and percentage of Americans traveling to work by private automobile increased between 1990 and 2000. In addition, even though many Americans would like to walk more to do their errands or to go to places of entertainment, distances and the lack of sidewalks make this impossible. Of course, if you travel by automobile, you ride from a point close to your residence to a point close to your destination, and you don’t benefit from the extra steps you would take if you walked or biked the whole way or took public transportation.

2. We have all manner of labor saving devices to make our life at home more pleasant, and we will have more. Robot vacuum cleaners that you don’t need to push are on the market, and there are systems that let you turn your lights on and off without leaving your chair. Elevators for the home are now hot sellers. Many of these devices have become necessities rather than luxuries, and our homes themselves will take over many domestic chores because, for the most part, we don’t like to do domestic chores, and consumer advertising pressures us to keep buying the latest and best appliances.

3. Paid employment is increasingly sedentary. More and more people create, collect, process and store information to earn a living, and studies by the U.S. Department of Labor and the Rand Corporation forecast that almost all the job growth in the future will be in professional and technical jobs whereas job openings in the most physically active occupations farming, fishing and forestry will be mostly to replace retirees.

Children and adolescents also must devote some of their leisure to exercise. I see two reasons why.

1. Many cannot easily walk or bicycle to school. Distances and safety concerns have made riding the school bus or being driven by parents the main modes of transport to school. The Centers for Disease Control and Prevention (CDC) estimate that bicycling and walking account for only 1 in 7 trips to school.

2. School physical education programs and recess periods are not sufficient in length and intensity. For students to get enough exercise from school physical education and recess programs, they would have to spend 60 minutes on physical education and recess daily, or 300 minutes per week. But, available data show they spend at most 178 minutes a week on physical education and 150 minutes per week on recess. But the numbers are not the whole story.

Here’s why:

a. Physical education standards are lax. All states except one require physical education in the schools. Yet, they leave the actual duration and content of the physical education programs up to local school districts;
b. Typically, only one physical education credit (i.e., one semester’s worth) is required for high school graduation; and
c. Schools are under pressure to reduce physical education and recess for budgetary reasons and to devote more time to academic subjects to meet testing requirements imposed by The No Child Left Behind Act, especially if they are in danger of failing under No-Child-Left-Behind criteria.

Many adults use lack of leisure time as an excuse for not exercising as much as they should. However, objective time-use studies show that American adults do have a lot of leisure time. They just don’t spend much of it exercising. They spend much more of it watching television and surfing the Internet. For example, a Department of Labor Time use study found that Americans over age 15 spent only 17 minutes a day on sports and exercise compared to 2.6 hours a day watching television. And, the recent study Changing Rhythms of American Family Life found that even mothers and fathers of children under 18 have 31 and 35 hours respectively of leisure, but spend only 1.4 hours per week on fitness.

The story of children’s and adolescents’ use of leisure time for exercise is more complicated. Athletically talented American children and adolescents spend a great deal of leisure time playing competitive team sports. These team sports are highly organized by adults and tend to be “cut-down” versions of professional sports. They often emphasize winning rather than participation and fun, even for elementary school children. The most talented can even play on 2 or 3 teams in the same sport in the same season and train for their sport year-round.

No doubt the athletically talented who play regularly on these teams do get enough exercise for good health, but they and society pay a terrible price. The pay a terrible price because the constant training and heavy game schedules subject them to overuse injuries that can require major medical treatment and prematurely end their athletic careers. An estimated 3.5 million sports injuries to children under 14 require medical treatment annually—quadruple the number in 1995--, and the American Academy of Pediatrics estimates that half of these are overuse injuries. The athletically talented also pay a terrible price because they sacrifice other aspects of their lives that are essential for their social as well as physical development—often in hopes of college or professional careers that only a few will ever have.

The social cost includes the following:

1. Children and adolescents who do not make the team at all or who do but do not play regularly become discouraged and retreat to inactive pursuits

2. Family life including precious time for parents to interact with each other as adults and with their children becomes sporadic as a result of the need to keep up with the child-athlete’s training and game schedules.

Children could get enough exercise in their leisure time if their parents would allow them time for free play—especially outdoor free play. Free play is a time children need for their physical and social development. It is a time without adult supervision when children can explore themselves and interact with their peers. However, many parents do not allow their children sufficient free play for a variety of reasons. If they work full-time, they may require their children to stay inside after school while they are without adult supervision for safety reasons. They may feel that, to build up resumes for college applications and to prepare their children adequately for adult life, they must organize and schedule an endless round of activities, including sports, for their children. Or, they may hope that they will be able to brag about their children’s achievements to other parents. Or, they may over schedule their children in order to re-live their own childhoods, as they wish they had been, through their own children. This phenomenon is called hyper-parenting, and the mental health community is sufficiently alarmed that psychiatrists and psychologists have written several books about it.

Many children and adolescents, like their parents, spend large amounts of time watching television, playing electronic games and surfing the Internet in preference to active play. It is easy for them to do so. Many American of them have their own television sets. Thirty-two percent of two to seven year olds and 65 percent of eight to eighteen year olds have sets in their bedrooms. The American Academy of Pediatrics urges parents not to allow leisure screen time for children under age 2 and to limit it to 2 hours a day for older children.
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CDC Exercise Recommendations
Age Group Amount & Intensity of Exercise Examples
Under 18 60 minutes daily. Moderate intensity. Playing tag. Jumping rope.
18-64 Alternative 1 30 minutes a day, 5 or more days a week. Moderate intensity. Walking 3-4.5 MPH on a level surface
18-64 Alternative 2 20 minutes a day, 3 days a week. Vigorous intensity. Jumping rope
65+ 30 minutes 3-5 days a week of moderate intensity aerobics. Stretch every day for flexibility. Strength building 2-3 days per week. Swimming (aerobics)

Flexibility (yoga/tai chi)

Strength (carrying groceries)


People don’t have to devote large amounts of leisure time to exercise enough for good health. Yet, a majority of Americans and people worldwide do not exercise enough to meet CDC and World Health Organization (WHO) recommendations. The CDC recommendations are on the next slide. Both the CDC and WHO recommend 30 minutes a day 5 days a week for adults. Yet, CDC data show that in 2005 only 48 percent of Americans exercised that much, and the WHO estimates that a minimum of 60 percent of the world’s populations does not do so. Even worse, over 25 percent of Americans engage in no leisure physical activity at all.

The CDC data show that people with less than a high-school education, senior citizens, racial minorities and females are far more at risk for not exercising enough than college graduates, young people, Caucasians and males. My opinion is that these demographic data tell us that discretionary income is an underlying reason why people do or do not exercise enough. You can get enough exercise with little or no expenditure just by walking briskly or repeatedly lifting heavy household objects, but you probably will not for two reasons:
1. People hear or read advice to exercise, and they think they need to do what people usually think of as exercise like running, swimming, and cycling and to buy special equipment for it;

2. Let’s face it! Without a nice place to exercise and nice equipment exercise can be boring.

If you have cash left over after meeting your needs for food, clothing, shelter and health care, you can afford exercise equipment, special clothing and footwear, and pool and health club memberships. Also, if you have a job that pays well enough that you have cash left over after meeting basic needs, you likely have a job that allows enough time off to give you some leisure time for exercise.

So far, I have told you only the bad news. The good news is that about 15 trends are countering the trend for Americans not to exercise enough for good health—12 for adults and 3 for children and adolescents. I have summarized these on the next slide. I’ll now talk in some detail about 5 of these trends—3 for adults and 2 for children and adolescents—the ones in boldface type on the next slides

The first counter trend I will talk about is that American adults have an increasing number of opportunities to engage in organized athletic events. Years ago, there were very few such opportunities for adults after high school or college. Now there are many. These include triathlons, duathlons, aquathlons, shorter distance runs and walks, bike rides, golf tournaments and multi-sport adventure races. Most of these events are open to the public, and many have thousands of participants. They also contribute to building a habit of regular exercise in those who participate because many are strenuous and therefore require training for preparation. Also, more people are willing to participate because merely taking part in and completing strenuous events rather than competing to win have become socially acceptable goals for most people.

Charities are major sponsors of mass-participation athletic events. For example, the National Multiple Sclerosis Society sponsors about 100 MS bike rides throughout the United States. About 100 thousand people participated in these rides in 2006. Participants typically pay a registration fee, and then solicit their co-workers, friends and neighbors for contributions to the charity. Other charities like the Leukemia and Lymphoma Society sponsor training programs that prepare people for major events like marathons and long distance bike rides in exchange for donations.

In addition to charities, many other organizations and cities and states sponsor athletic events to promote themselves or their areas. For example, the Weyerhauser company, many smaller Michigan businesses and Kirtland Community College sponsor the AuSable River Canoe Marathon, which is a race across Michigan by canoe that requires participants to carry their canoes from one body of water to the next. And, the annual Elk Mountains Grand Traverse is a 38-mile cross-country ski race from Crested Butte to Aspen, Colorado, conducted mostly at night.

Now, I turn to recreational trails. The number and miles of recreational trails that provide car-free places for Americans to exercise keep increasing and are likely to continue to do so. Americans use these trails in large numbers for running, walking, bicycling, skateboarding, skiing cross-country and snowshoeing. Many of these trails are on abandoned railroad rights of way such as the Capital Crescent Trail between Silver Spring, MD, and Georgetown. The Rails-to-Trails conservancy estimates that there are over 1,400 of these trails, and that collectively they are nearly 14,000 miles in length. States, cities, park authorities and private organizations with federal financial support build and maintain the trails. With America’s population likely to grow by another 100 million people by mid-century, those government and private bodies will face the challenges of building and maintaining enough trail capacity and of regulating trail traffic and keeping trail users safe from crime.

Another trend favoring adult exercise is that laws, regulations and changing social attitudes are making exercise more possible for more people. Participating in sports and fitness activities has over the last generation become a mainstream activity for women and girls. One big changing factor was passage of a federal law called Title IX in 1972 that required schools and colleges to provide equal opportunity to girls and women in sports and fitness. Before Title IX, girls and women had far fewer opportunities to participate in school and college sports than boys and men. There are still disparities, and the law remains controversial, but now schools and colleges offer about the same number of sports for boys and girls and men and women, and the sexes participate in roughly equal numbers. Because of Title IX and the general movement towards women’s equality, women now are a majority of participants in a number of sports and fitness activities including cheerleading, tai chi/yoga, volleyball, swimming, softball, and inline skating, and they are a large minority of participants in bowling, hiking, camping, bicycling, and canoeing. Also, in some areas of the country, girls compete against other girls and against boys in high school wrestling and weight lifting. The sporting goods industry has responded to this trend with a wide variety of sports footwear, apparel, and equipment especially designed for women, and sporting goods companies and other organizations sponsor many women-only athletic events.

The other great change in the demographics of exercise is that people from age 40 to age 100 are exercising more than ever before. This is partly because the mass participation events and the recreational trails I talked about give them more opportunities to exercise and partly because medical advances have postponed the period of frail old age to later in life than ever before. But, it is also because societal attitudes about what is appropriate behavior for older people have changed. Medical opinion embodied in the CDC recommendations that people over 65 engage in a mix of aerobic, resistance and flexibility exercises no doubt has been a major driver of the change. AARP’s embrace of the importance of fitness has been another. In any case, exercise programs and sports competition are now the norm for seniors. The retirement community industry recognizes this trend. A 2006 survey by the International Council on Active Aging revealed that 45 percent of retirement community managers planned to develop new or expand their existing fitness facilities in 2007 and 2008. People over 55 are largely responsible for the growth in health club membership, and a magazine and website called Geezerjock are entirely devoted to senior fitness and sports. When the Marine Corps marathon started here in Washington in 1976, the oldest finisher was 58; on its 30th anniversary last year, the oldest participant was 82.

There is also good news in regard to children’s physical fitness. One positive counter trend is that serious efforts are being made to change the value system in youth sports from emphasis on professionalism and winning to emphasis on participation and fun. There are 4 leading players in this movement:

1. An online organization called MomsTeam acts as an information clearinghouse for parents of children participating in sports from age 5 through high school. It publishes periodic news bulletins online giving parents useful advice on many topics such as how to organize teams to ensure that all team members get equal playing time and how to talk with coaches. Its Editor-in-Chief Brooke deLench wrote a book entitled Home Team Advantage: The Critical Role of Mothers in Youth Sports. The book is both a devastating critique of the professionalism in youth sports and a treasure trove of advice for parents on how to deal with it.

2. The State of Maine’s Sports Done Right initiative has sparked youth sports reform in Maine and attracted the interest of other states. It has established 7 core principles for youth sports programs in the state and set forth practices that should be followed in complying with those principles and practices which are out of bounds.

3. A company called Sports Potential tests how ready boys and girls aged 8-12 are to participate in 38 different sports and fitness activities. Parents receive a detailed analysis of the test results. This is important because it tempers unrealistic expectations parents may have for their children’s sports achievements.

4. The National Alliance for Youth Sports has published a set of 11 National Standards for Youth Sports covering such things as selection of the proper sport for each child, parental conduct and commitment, and the proper place of sports participation in a child’s life and development.

The efforts of these organizations, coupled with media attention to excesses of youth sports, and concern in the medical community may well lead to general youth sports reform.

The final favorable counter trend in children’s fitness is that

So far I have told you about a serious new health problem created in large measure by modern civilization—lack of exercise, and I have told you about some of the things that are working against this trend. What I haven’t told you is what the future outcome will be, and I can’t tell you what it will be for certain.

I have four scenarios for how the opposing trends could play out over the next quarter century. Two are positive, and two are not. I believe the determining forces will be economic prosperity and public opinion about exercise. If we have economic prosperity and that prosperity results in most people having more income than necessary to meet basic needs and if most people have a favorable opinion about exercise—not just agreeing in principle that it is a good thing but acting on it as well, health problems caused by lack of fitness will fade away. On the other hand, if most people disregard advice to exercise or if they lack income to meet even basic needs, this new health problem will become more acute.

In the first positive scenario, which I call The Home Health Club, America resolves its long-term economic problems in the second decade of the 21st century with a bi-partisan package of economic reform legislation leading to unprecedented prosperity and wealth. People get the message that everyone must devote some leisure time to exercise for good health and that exercise is a great way to relieve the stress of the highly competitive business world. They also are motivated to exercise by financial incentives given them by their employers and health insurers. Some adults become active by substituting walking and bicycling for automobile transport, but most do so by joining country clubs, private gymnasiums and health clubs, and by creating increasingly elaborate home health clubs. Children become active because parents limit their leisure screen time, specialized children’s sports medicine clinics provide counseling on sports and fitness participation and injury treatment and rehabilitation programs, and youth sports reform efforts succeed in tempering parents’ expectations about children’s sports participation and performance.

In the second positive scenario, which I call Frolic in the Park, people become active for 4 main reasons. First, growing environmental consciousness motivates them to have contact with the natural world by engaging in outdoor activities like hiking, cross country skiing and canoeing. Second, reforms in important public policies including universal access to health care, mandatory conversion to renewable energy and living wage laws create a new wave of prosperity. Third, government and voluntary action make children be more active. Physical education programs become more imaginative, fun and effective when physical education achievements become required for compliance with the No Child Left Behind Act, and children and youth sports reform efforts succeed in efforts to emphasize participation and fun rather than professionalism and winning. Fourth, people get and act on the message that exercise is good for them.

In the first negative scenario, which I call The Media Room, America resolves its long-term economic problems in the second decade of the 21st century with a bipartisan package of legislation leading to unprecedented prosperity and individual wealth. However, most people reject the message that active leisure is essential for good health and opt for increasingly inactive leisure time dominated by passive viewing of increasingly sophisticated electronic media in well-appointed home media rooms. They reject the message for two main reasons:

1. Medical science breakthroughs yield cures for chronic diseases like diabetes, thus taking away a main motivation for people to exercise; and
2. Partly because medicine eliminates the health motivation for exercise and partly because of emphasis on individual freedom in a prosperous free-market environment, people come to regard medical advice to exercise as an invasion of privacy.

Sports participation comes to be regarded as preparation for Olympic-level amateur or professional competition seen on television and the Internet. Consequently, children and adolescents drop out of sports participation at increasing rates as they move from elementary to high school and fail to make increasingly competitive teams. And, they retreat to passive electronic leisure activities.

In the second negative scenario, which I call $5 Night at the Ballpark, economic conditions steadily worsen because the federal government does nothing to resolve America’s long-term economic problems like chronic federal budget deficits and lack of access to healthcare. As a result, most working age adults are either unemployed or hold multiple low-paying jobs to make ends meet. Adults agree that they should exercise for good health, but physical fitness becomes a secondary concern. The working poor lack the necessary leisure time, and, in what little leisure time they have, seek escape in sedentary entertainment like baseball games on low-cost promotional nights. The unemployed keep active through low-cost walks and runs in public parks and playing with children. Children’s sports programs outside of the public schools falter, and schools economize on physical education programs.

To sum up, I have told you that America and much of the rest of the world face a new kind of health crisis—one of disease caused by lack of exercise. The root cause of this lack of exercise is the comfort and convenience of our civilization—comfort and convenience which our ancestors would have loved to have had. I have told you that there are 15 trends countering this health crisis and told you of the 4 possible outcomes I envision for it. Recognizing the sobering obesity statistics, continually improving comforts of modern life, and the lack of action on pressing policy issues that could cause much worse economic times, I can certainly respect anyone who believes in either of the two negative scenarios I have presented or a variant of them. However, I am optimistic about the future for these reasons:
1. Medical opinion: The medical community unanimously recommends more exercise for more people. The American Academy of Pediatrics urges parents to ban TV altogether for children under age 2 and to limit it to 2 hours per day for older children in order for children to develop physically as well as socially and intellectually;
2. Prosperity: While partisan bickering about how to solve long-term economic problems America faces like excessive dependence on foreign oil, chronic budget deficits and Social Security reform seem endless, the problems are recognized and debated. Some, and perhaps all, of them will be solved, perhaps not in comprehensive legislation but bit by bit. More Americans are likely to have the wherewithal for enjoyable exercise.
3. Public opinion: Americans seem not to exercise enough more because of circumstances than distaste. Surveys by American Sports Data consistently show that more than 60 percent believe in the importance of exercise and 15-17 percent are firmly committed to it.
4. What’s happening: In my own experience, I have seen thousands of people get up early on a chilly fall morning to ride their bicycles 62 or 100 miles in a day and hundreds work tirelessly to raise money for charity, so they can spend 4 days riding a bicycle in hot weather, and I know from media coverage and my research that these are not isolated cases. I have also seen “traffic jams” on the Capital Crescent and other recreational trails here in the Washington area, and I know these are not isolated examples from media coverage and my research. The momentum created by such events will be hard to reverse.

Thus, even though neither I nor anybody else can predict the future, I bet my grandchildren, should I have any, when they are my age now will wonder what the fuss was about.