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1、Wellness Policy Toolkit:Physical ActivityApril 2023Wellness Policy SeriesWellness Policy Toolkit:Physical ActivityApril 2023Wellness Policy SeriesCopyright 2023 by the Global Wellness InstituteQuotation of,citation from,and reference to any of the data,findings,and research methodology from this rep
2、ort must be credited to“Global Wellness Institute,Wellness Policy Toolkit:Physical Activity,April 2023.”For more information,please contact researchglobalwellnessinstitute.org or visit www.globalwellnessinstitute.org.Contents Preface:About the Wellness Policy Series1Background:What Is Wellness Polic
3、y?5Defining wellness5Defining wellness policy7Wellness Policy Toolkit:Physical Activity9Making the case for wellness policy:Physical activity12Three levels of policy action:Physical activity15Who can champion wellness policy for physical activity16Policy actions for physical activity191:Encourage ph
4、ysical activity via the built environment212:Make recreational physical activity accessible,convenient,and affordable243:Improve access to physical activity for underserved populations304:Integrate physical activity into the health system375:Encourage youth to build lifelong habits for physical acti
5、vity416:Encourage adults to be physically active during the workday46Key resources:Physical activity51Industry Research Sponsors 61About the AuthorsAbout the Global Wellness InstituteThe Global Wellness Institute(GWI),a 501(c)(3)non-profit organization,is considered the leading global research and e
6、ducational resource for the global wellness industry and is known for introducing major industry initiatives and regional events that bring together leaders and visionaries to chart the future.GWI positively impacts global health and wellness by advocating for both public institutions and businesses
7、 that are working to help prevent disease,reduce stress,and enhance overall quality of life.Its mission is to empower wellness worldwide.www.globalwellnessinstitute.orgAbout the AuthorsWellness Policy Toolkit:Physical Activity was prepared by Katherine Johnston,Ophelia Yeung,and Tonia Callender.As G
8、WIs principal researchers,they are the team that defines and measures the size of the global wellness economy.Their academic and professional background is in public policy and international development,and Ms.Johnston,Ms.Yeung,and Ms.Callender received post-graduate degrees from Georgetown,Princeto
9、n,and Harvard Universities,respectively.Together,they bring many decades of experience conducting research,impact assessments,and strategy development for countries,regions,industry consortia,companies,and nonprofit institutions.Wellness Policy Toolkit:Physical Activity|1Preface:About the Wellness P
10、olicy SeriesWhy is GWI releasing a Wellness Policy Series?Since its inception,the Global Wellness Institute(GWI)has embraced the vision of“empowering wellness worldwide.”Even as we study and advocate for the multi-trillion dollar wellness economy,we also recognize that the private wellness market an
11、d consumer action alone cannot bring about wellness for all.Widespread adoption of preventive approaches and healthy lifestyles is essential if we are to address our mounting global health crises and spiraling economic costs.And yet,not everyone has the resources,motivation,knowledge,or enabling env
12、ironment to do so.Public policy is essential to fill these gaps.This realization is the genesis of GWIs Wellness Policy Series.Who is the Wellness Policy Series for?When we talk about policy,the implication is that we are speaking to governments,but this series is not just for government stakeholder
13、s.Policies to advance the cause of wellness for all require the attention,participation,and cooperation of public,private,and nonprofit/community stakeholders.In fact,the separate development streams and“siloes”across consumer/business wellness,public health systems,and preventive health/medicine ha
14、ve impeded us from making greater strides toward this goal.GWIs Wellness Policy Series was created to support anyone who would like to leverage policy as a tool to promote better human health and well-being.Whether you are a government leader,policymaker,public servant,private business,nonprofit,or
15、concerned citizen,this series will provide you with cross-cutting and actionable ideas for policies,programs,collaborations,and advocacy efforts to address gaps,meet the needs of different population groups,and expand access to wellness for all.What is covered in the Wellness Policy Series?The Welln
16、ess Policy Series is a compilation of nine reports,which aim to define wellness policy,articulate why it is needed,and provide a framework and set of strategies for implementing wellness policies across many domains of wellness.The series includes the following reports:Defining Wellness Policy(Novem
17、ber 2022)Health,Happiness,and the Wellness Economy:An Empirical Analysis(January 2023)Seven Wellness Policy Toolkits(2023-2024)Healthy Eating Physical Activity Mental Wellness Traditional&Complementary Medicine Wellness in the Built Environment Wellness at Work Wellness in Tourism2|Global Wellness I
18、nstitute:Wellness Policy SeriesWhat are the Wellness Policy Toolkits?The Wellness Policy Toolkits are a core part of GWIs Wellness Policy Series.The toolkits focus on seven domains of wellness(see table below).Each toolkit addresses both the why and how of wellness policy:What is the rationale and n
19、eed for wellness policy action in each domain?How can stakeholders(governments,businesses,communities,nonprofits)take action to address important issues and gaps?Wellness Policy Domains Covered in GWIs Wellness Policy ToolkitsWellness Activities and LifestylesWellness-Supporting Environments Healthy
20、 Eating Physical Activity Mental Wellness Traditional&Complementary Medicine Wellness in the Built Environment Wellness at Work Wellness in TourismSome of the domains covered in the toolkits already have a massive body of research,literature,strategies,and action plans behind them(e.g.,physical acti
21、vity,healthy eating),while other domains do not(e.g.,mental wellness,wellness in tourism).A major new contribution of the Wellness Policy Toolkits is to consolidate and codify all of the domains and policy actions that fall under the large umbrella of“wellness policy.”In addition,the toolkits emphas
22、ize the numerous areas of intersection across the seven wellness domains and how policy actions in one domain can have impacts across other areas.For example,policies focusing on the built environment can affect our individual behaviors related to physical activity,mental wellness,and healthy eating
23、.Policies that encourage physical activity can have an impact on mental wellness.The Wellness Policy Toolkits are intended to spark thinking,conversations,analyses,advocacy,and concrete efforts that will promote access to wellness modalities and deliver well-being outcomes for people across all demo
24、graphic groups and regions.The toolkits are designed to be modular and general enough that they can be applied across many different political,geographic,and demographic contexts.They are a starting point that provides a menu of possible actions and can be used in many different ways.Some readers ma
25、y use the toolkits as inspiration for developing their own comprehensive strategy or action plan to target the specific wellness needs of their city,region,or country.Some readers may use the toolkits to identify one or two very specific areas where they can contribute or take action within their ow
26、n job,professional field,or organization.Those who are not already immersed or working in these wellness domains can use the toolkits as a quick-start guide to understanding the issues,opportunities,and where to find more information.Wellness industry stakeholders can use the toolkits to spark new i
27、deas on building partnerships to expand wellness offerings,as well as advocacy efforts to encourage governments to prioritize wellness services/businesses as essential public services.Wellness Policy Toolkit:Physical Activity|3 Business leaders can use the toolkits to identify areas where they can t
28、ake action and contribute to improving wellness for their employees,clients,constituents,communities,and stakeholders(without waiting for the government to mandate it).Individuals can use the toolkits to lobby their government leaders for specific policies and programs that expand access to wellness
29、 in their own communities,cities,and countries.Much more work needs to be done in wellness policy to ensure that it is embedded in all policymaking and government investment decisions,and to help us understand which kinds of policies are most effective across different settings and populations.We ho
30、pe that this Wellness Policy Series will spark a wellness policy movement that can be championed by any interested stakeholder groups.We invite all stakeholders in the public,private,nonprofit,and academic communities to join in this movement.4|Global Wellness Institute:Wellness Policy SeriesWellnes
31、s Policy Toolkit:Physical Activity|5Background:What Is Wellness Policy?Defining wellness.To understand wellness policy,we must first understand wellness.The Global Wellness Institute(GWI)defines wellness as:the active pursuit of activities,choices,and lifestyles that lead to a state of holistic heal
32、th.There are two important aspects to this definition.First,wellness is not a passive or static state,but rather an“active pursuit”that is associated with intentions,choices,and actions as we work toward an optimal state of health and well-being.Second,wellness is linked to holistic health that is,i
33、t extends beyond physical health and incorporates many different dimensions that should work in harmony(see figure).Wellness is often confused with terms like health,well-being,and happiness.While there are common elements among them,wellness is different in that it is not associated with a static s
34、tate(i.e.,being happy,in good health,or a state of well-being),but rather an active process of being aware and working toward optimal holistic health and well-being.Wellness is both behavioral and environmental.Wellness is an individual pursuit based on self-responsibility,but it is also significant
35、ly influenced by the physical,social,and cultural environments in which we live.Research on the determinants of health indicates that environmental,socioeconomic,and lifestyle factors can account for 80-90%of our disease risks and health outcomes.1 Those who are very young,elderly,disabled,or poor a
36、re particularly vulnerable to these external factors.21 Magnan,S.(2017).Social Determinants of Health 101 for Health Care:Five Plus Five.NAM Perspectives.Washington,DC:National Academy of Medicine.https:/nam.edu/social-determinants-of-health-101-for-health-care-five-plus-five/.See also:Hood,C.M.,et
37、al(2016).County health rankings:Relationships between determinant factors and health outcomes.American Journal of Preventive Medicine,50(2),129-135.https:/doi.org/10.1016/j.amepre.2015.08.024.2 See:1)Braveman,P.,et al(2011).Issue Brief#8:Neighborhoods and Health.Robert Wood Johnson Foundation.http:/
38、www.rwjf.org/en/library/research/2011/05/neighborhoods-and-health-.html.2)Institute of Medicine and National Research Council(2013).U.S.Health in International Perspective:Shorter Lives,Poorer Health.Washington,DC:The National Academies Press.https:/doi.org/10.17226/13497.SOCIALPHYSICALMENTALSPIRITU
39、ALEMOTIONALWELLNESSENVIRON-MENTALWellness Is MultidimensionalNote that the content presented in this section is condensed from GWIs November 2022 report,Defining Wellness Policy(the first report in the Wellness Policy Series).For a more in-depth discussion of these topics,see:https:/globalwellnessin
40、stitute.org/industry-research/2022-defining-wellness-policy/.6|Global Wellness Institute:Wellness Policy SeriesA complex web of factors(access to healthcare,socioeconomic factors,and our natural and built environments)form a“wellness ecosystem”that can augment or mitigate our genetic disposition for
41、 disease.Our wellness ecosystem has a direct effect on our health by transmitting communicable and environmental diseases.It also indirectly affects our health by influencing our behaviors and lifestyles,which can lead to noncommunicable diseases.Public policies shape our wellness ecosystems.Governm
42、ents and public policies exert enormous influence on our wellness ecosystem from economic and social policies,to urban planning and transportation infrastructure,to environmental regulations,and much more.They can create wellness-supporting environments,establish incentives for adopting healthy beha
43、viors and lifestyles,reduce costs,and expand access to wellness modalities and facilities for underserved populations.In these areas,wellness policy fills critical gaps and complements existing healthcare systems and public health policies.Wellness policy is essential to help us stay physically and
44、mentally well,to stave off preventable disease,to become resilient,and to move us closer to the goal of wellness for all.Source:Global Wellness InstituteWELLNESSECOSYSTEMBuilt&Natural EnvironmentHealth CareEnvironmentGenetic/BiologicalFactorsUp to 80-90%of our health outcomes depend upon the externa
45、l and environmental factors in our wellness ecosystemSocioeconomicEnvironmentDirectBehaviors&LifestyleHEALTH OUTCOMESWellness Policy Toolkit:Physical Activity|7Defining wellness policy.Wellness is a lens through which we can reshape public policy and work toward improving human health,happiness,and
46、well-being outcomes.Wellness policy complements and supports health,public health,and happiness/well-being policies,but it is not the same thing.Levels of action for wellness policy.Public policies can be formulated to shape our wellness at three levels(see further discussion in the Toolkit section
47、of this document):1.Micro-level wellness policy:Encouraging individuals to proactively make healthy choices,establish healthy habits,and live healthy lifestyles.2.Meso-level wellness policy:Creating living environments that support and encourage healthy behaviors and lifestyles.3.Macro-level policy:
48、Reshaping all policies related to our wider society and economy,with the aim of improving human health and well-being.In many cases,macro-level policies such as reducing poverty,stopping armed conflicts,or addressing climate change will have a greater impact on our health and well-being than the mes
49、o-and micro-level policies targeting individual behaviors and community environments.Macro-level policies covering the entire range of public policy action are vitally important to human health and well-being.Addressing these issues is critical,but it requires long-term,systemic changes,as well as p
50、olitical will and compromises,which can be difficult to achieve.In GWIs Wellness Policy Series,we focus primarily on actions at the micro-and meso-levels.Wellness policies at the micro-and meso-levels complement national-level well-being policy efforts.They can be implemented and have benefits for p
51、eople immediately,even while we wait for the glacial progress in solving our long-term macro crises and shifting our overarching policy priorities toward well-being.The Global Wellness Institute defines wellness policy as follows:Wellness policy is a set of cross-cutting actions that encourage healt
52、hy lifestyles and create supportive environments for human health and well-being.8|Global Wellness Institute:Wellness Policy SeriesSeven wellness domains covered in GWIs Wellness Policy Toolkits.As noted above,we have identified seven domains in which wellness policy can encourage healthy behaviors
53、and lifestyles and that create wellness-supporting environments.These seven domains do not function independently from one another.They are closely interrelated,and policy actions within one domain can have impacts across other areas.For example,policies focusing on the built environment can affect
54、our individual behaviors related to physical activity,mental wellness,and healthy eating.Policies that encourage physical activity can have an impact on mental wellness.Each Wellness Policy Toolkit will address these areas of intersection wherever they appear.We also address the wellness needs of sp
55、ecific populations and lifespan groups,including underserved and vulnerable groups such as children and older adults,wherever relevant.Stakeholders working in many government functions,industry sectors,and communities can take action across these domains,in both large and small ways,to spearhead bri
56、nging wellness to all.Wellness Policy Domains Covered in GWIs Wellness Policy SeriesWellness Activities and LifestylesHealthy EatingExpanding access to nutritious diets and encouraging everyone to make healthy eating choices.Physical ActivitySupporting people of all ages to engage in the recommended
57、 levels of physical activity to stay healthy.Mental WellnessImproving individual and community resilience,especially to address stress and loneliness.Traditional&Complementary MedicineIncreasing the safety,quality,and efficacy of T&CM;expanding consumer access;and protecting T&CM resources.Wellness-
58、Supporting EnvironmentsWellness in the Built EnvironmentCreating physical environments that support all dimensions of wellness and encourage healthy lifestyles.Wellness at WorkEnabling everyone to work in an environment that improves rather than reduces their health and well-being.Wellness in Touris
59、mEnsuring that all tourism is wellness-enhancing for visitors,destinations,and local communities.Wellness Policy Toolkit:Physical ActivityWellness Policy Toolkit:Physical Activity|910|Global Wellness Institute:Wellness Policy SeriesWellness Policy Toolkit:Physical Activity|11Wellness Policy Toolkit:
60、Physical ActivityWellness Policy Toolkit:Physical Activity takes a deep dive into physical activity as a domain of wellness policy.It provides the rationale for why wellness policy in physical activity is necessary,and it outlines different types of policy actions that can support people to engage i
61、n sufficient physical activity to stay healthy,both in their daily lives and during their leisure time.It discusses the many challenges that contribute to high and rising levels of physical inactivity,and it examines specific ways in which new policies,government resources,and cross-sector partnersh
62、ips can address those gaps and constraints.We recognize that physical activity is a field with a massive body of research and literature behind it.Numerous strategies and action plans have been formulated all over the world to address the global crisis of inactivity.A unique contribution of this too
63、lkit is that it situates physical activity policies within the broader context of wellness policy,and it identifies opportunities for policies that can simultaneously address multiple dimensions of health and well-being(e.g.,physical activity and metal wellness).This toolkit will provide a starting
64、point for readers not already immersed in this field to understand the wide range of issues and policy options to address them,to consider what role you might play in supporting physical activity,and to know where to look for more information and potential partners.In the final section of this toolk
65、it(see Key Resources),we identify a variety of other research reports,guides,and action plans that drill-down on specific topics discussed in the toolkit and/or provide more details on research evidence,case studies,and strategies related to physical activity promotion.In addition,GWIs 2019 report,M
66、ove to be Well,provides extensive examples,across every region of the world,of strategies and initiatives that are being used to encourage physical activity and expand access.For more information,see:https:/globalwellnessinstitute.org/industry-research/global-economy-physical-activity/.Who should us
67、e the physical activity toolkit?This toolkit supports anyone who would like to use policy tools to promote physical activity as an important pathway to good health.Anyone policymaker or public servant,private business,nonprofit,or a concerned citizen can become a champion for using public resources
68、and public policy actions to increase physical activity,among all population groups,and in all settings(such as schools,communities,workplaces,and public places and institutions).The policy actions described here are not confined to the government bodies that are typically associated with fitness an
69、d physical activity(e.g.,national sports authorities or departments of parks and recreation).They are cross-cutting and require multi-sectoral support to be implemented.Whether you are a fitness entrepreneur,an educator,an urban planner,an architect,a physician,an employer,or a human resource direct
70、or,there are opportunities to advocate for policies that increase physical activity in your community,and we hope this report will be useful to assist in your endeavor.12|Global Wellness Institute:Wellness Policy SeriesMaking the case for wellness policy:Physical activity.Physical activity is intrin
71、sic to wellness.As advocated by physicians and public health authorities around the world,a regular and adequate level of physical activity is vital to our health and well-being in all aspects.Physiologically,physical activity can lower the risks of many chronic diseases(hypertension,coronary heart
72、disease,stroke,diabetes,various types of cancer);improve cardiorespiratory fitness and bone health;manage weight;improve sleep and energy;and maintain balance,agility,and mobility as we age.Recent studies have found that cardiovascular exercise may help reduce the mortality risk of COVID-19 patients
73、.i The mental benefits of physical activity are also well-established,ii helping us to relax and de-stress,bringing a sense fun and joy,improving our mental resilience,and preventing cognitive decline.Where and how we exercise can produce additional rewards.For example,when we play sports or attend
74、class with other people,we build vital social connections.Likewise,when we exercise outdoors,we get the added mental and emotional benefits of being in nature.To receive these benefits,our engagement in physical activity needs to be regular,consistent,and sustained not intermittent,only during holid
75、ays,or only when we want to lose weight or can find the time.According to the WHO,physical activity is not only important for individual health and well-being,but also brings many societal,economic,and environmental benefits.It helps alleviate burdens on healthcare systems and“contributes to social
76、inclusion,gender equity,employability and education.”Recreational physical activities support critical global agendas,“including COVID-19 recovery,improving socio-economic development,reducing inequalities,addressing climate change,and contributing to the sustainable development agenda.”iii What Is
77、Physical Activity?The World Health Organization(WHO)defines physical activity as“any bodily movement produced by skeletal muscles that requires energy expenditureincluding during leisure time,for transport to get to and from places,or as part of a persons work.”The WHO recommends 60 minutes of moder
78、ate-to vigorous-intensity physical activity daily for children and adolescents,and 150-300 minutes of moderate-intensity physical activity,or 75-150 minutes of vigorous-intensity physical activity,for adults on a weekly basis in order to maintain good health.ivWellness Policy Toolkit:Physical Activi
79、ty|13We are not getting enough physical activity to stay healthy.Over the past few decades,physical activity rates have been on the decline in many countries around the world(especially higher-income countries),v to the extent that sedentary behavior has been called a“global pandemic.”vi An estimate
80、d 27.5%of the worlds adult population is physically inactive based on WHO standards,and there has been no improvement in global levels of physical activity since 2001.vii Research shows that women and girls tend to be less active than men and boys,viii and adults become less active as they age.Adole
81、scents are also less active than adults.A WHO study covering 146 countries and territories found that more than 80%of those aged 1117 years have insufficient physical activity.ix Recent studies indicate that overall physical activity levels declined further during the COVID-19 pandemic,along with re
82、duced participation in recreational and leisure-time physical activities.This was especially true during the peak of COVID-related shutdowns,but for many people has endured as the pandemic has continued.x The pandemic has exacerbated the constraints and inequities that prevent many populations and c
83、ommunities from being physically active,while simultaneously emphasizing how essential physical activity is for good health.There are many challenges that contribute to physical inactivity,which can be addressed through targeted policy actions(summarized in the table below and discussed further in t
84、he rest of this Toolkit).Summary:Key gaps and constraints leading to physical inactivity.1.Our modern built environment discourages physical activity.2.Our modern lifestyles are increasingly sedentary,and we lack the time to exercise.3.The private fitness industry often leaves out marginalized popul
85、ations who are at higher risk for physical inactivity(e.g.,women/girls,older adults,rural,lower-income populations).4.The health system is disconnected from the physical activity sector,while people who have physical and chronic conditions(e.g.,chronic disease,disabled,elderly)face many barriers to
86、exercising.5.Youth are increasingly sedentary,are not engaging in sufficient physical activity,and are not building lifelong habits for exercise.6.The nature and demands of our jobs are a major driver of sedentary behaviors.14|Global Wellness Institute:Wellness Policy SeriesOur lack of physical acti
87、vity has many costs,both individual and societal.Physical inactivity is a key lifestyle risk factor that directly contributes to the rise of chronic or noncommunicable diseases(including heart disease,stroke,cancer,diabetes,chronic lung disease,etc.),which are collectively responsible for 74%of deat
88、hs worldwide every year.xi Across the world,physical inactivity is the fourth leading cause of death,responsible for more than 5 million preventable deaths annually.xii The COVID-19 pandemic has increased sedentary behavior across the world,and there is growing public health concern that it may redu
89、ce our resilience to fight the disease now,and to ward off other chronic and infectious diseases in the future.xiii Beyond the human and societal costs of disease,disability,and premature deaths,physical inactivity also imposes major economic costs,due to health expenditures and productivity losses.
90、The WHOs most recent estimates indicate that physical inactivity will cause 500 million new cases of preventable NCDs and$300 billion in treatment costs alone from 2020-2030,if the current rates of inactivity do not change.If these estimates were broadened to incorporate productivity losses,the cost
91、 burden of physical inactivity would be even greater.xiv Conversely,increasing physical activity rates would have significant potential benefits.One study estimates that if everyone met the WHOs recommended level of physical activity,it would increase global GDP by$314-446 billion annually,adding$6.
92、0-8.6 trillion cumulatively to global GDP from 2020-2050(in 2019 prices).xvWellness Policy Toolkit:Physical Activity|15Three levels of policy action:Physical activity.Public policy can address the many constraints and factors that influence our interest and ability to engage in regular physical acti
93、vity some of which are in our control,and others of which are not.These policies can be formulated to enable and support physical activity at three different levels(see figure below).Micro-level policies:As individuals,we make a daily choice about engaging in various types of physical activity.Many
94、barriers can affect our behaviors,including a lack of time,motivation,interest,convenient facilities,and/or energy,as well as physical or health conditions.xvi These barriers can be addressed through policies that help make physical activity more convenient and accessible for different populations.M
95、eso-level policies:Environmental factors(including built environment,natural environment,and social environment)have a major influence on our ability to engage in physical activity.Public policies and investments can support infrastructure and facilities for both recreational physical activity and n
96、atural movement.Such infrastructure is especially critical for the poor,marginalized,and underserved populations and regions that are largely ignored by the mainstream fitness and exercise industry.Macro-level policies:There are many broad,macro-level factors that influence individuals levels of phy
97、sical activity or inactivity,including:socioeconomic status or wealth,education or literacy level,gender and gender-related discrimination,crime and safety,war and conflict,and so on.Policies,programs,and initiatives addressing these macro-level factors will also have an important influence on physi
98、cal activity participation.MESOImmediate Living Environments&CommunitiesMICROIndividual Practices&BehaviorsMACROSociety-&Economy-Wide FactorsSource:Global Wellness Institute We acknowledge that macro-level policies covering the entire range of public policy actions are vitally important to human hea
99、lth and well-being.In many cases,macro-level policies(such as reducing poverty,stopping armed conflicts,or addressing climate change)will have a greater impact on physical activity/inactivity than the meso-and micro-level policies targeting individual behaviors and community environments.Top-down po
100、licy approaches are critical,but they require long-term,systemic changes,as well as political will and compromises,which can be difficult to achieve.In this toolkit,we focus primarily on micro-and meso-level policies,which can be implemented and have benefits for people immediately,even while we wai
101、t for the glacial progress in solving our long-term macro issues.16|Global Wellness Institute:Wellness Policy SeriesWho can champion wellness policy for physical activity.Promoting physical activity is not just a function of governments.While many policy actions may require government leadership,fun
102、ding,or mandates,the participation of the private and nonprofit sectors is also essential.Many actors and stakeholders must work in parallel and in partnership in order to increase levels of physical activity,expand access to wellness for all,and improve our health and well-being.It is important to
103、recognize that the responsibility for spearheading and implementing these policies rests with many different agencies,businesses,organizations,professions,and stakeholders who probably do not even see themselves as playing a role in facilitating physical activity and wellness.If you are a national/r
104、egional government leader or policymaker:Opportunities(and responsibilities)for promoting physical activity cut across many different government departments and functions.Depending on each countrys political structure,these functions may sit at the national,regional,and/or city levels.For far too lo
105、ng,the design of cities,neighborhoods,and buildings has been driven by efficiency and convenience,with little regard to how such priorities encourage sedentary behavior and have adverse impacts on our health and resilience.Leaders and policymakers involved with urban planning,transportation,infrastr
106、ucture,and housing can help people be physically active by designing and building neighborhoods and cities in a way that makes movement a default in daily life.Those involved in regulation of construction/development must ensure that regulatory policies(zoning,building codes,etc.)encourage movement-
107、friendly built environments.Policymakers working in parks and recreation,sports,and youth affairs can adopt a“sports for all”framework and can focus on expanding recreational physical activity facilities and programming that are free and accessible to all(but especially targeting youth and underserv
108、ed populations).Health policymakers should explore how to adopt an“exercise is medicine”platform and interventions within the healthcare system.Public leaders who shape education policy should ensure that children are engaging in sufficient movement each day and are building healthy,lifelong interes
109、ts in physical and recreational activities.Tax and fiscal policies can be deployed in many ways to subsidize recreational activities for individuals/families;to incentivize the development of movement-friendly built environments;to encourage the development of facilities/programs for underserved pop
110、ulations;and to expand important research/data collection on physical activity participation and program outcomes.If you are a local/community leader or nonprofit organization:Many of the most important regulatory and investment decisions that affect physical activity participation are driven by cit
111、y-and regional-level decisionmakers,including planning and prioritization of major infrastructure projects,and regulations related to zoning,building codes,etc.It is critical that local planners and policymakers recognize their role in shaping their citizens health and well-being,and that they prior
112、itize active transit,physical activity,and wellness across all infrastructure and development projects.Local government planners,schools,churches,and community organizations are also in the best position to create and maintain public recreational infrastructure for exercise,such as playgrounds,outdo
113、or gym equipment,swimming pools,community recreation centers,sports facilities,walking/biking paths,hiking trails,etc.Public Wellness Policy Toolkit:Physical Activity|17physical activity infrastructure is especially critical for those living in poor and marginalized areas where populations are more
114、vulnerable to inactivity,poor health,and infectious and chronic diseases,and are largely ignored by the mainstream fitness and exercise industry.Community leaders and organizations can help to promote active lifestyles by sponsoring regular free and low-cost activities and events(e.g.,exercise class
115、es,social dances,walking/running clubs),especially targeting older adults,lower-income groups,and people with health and physical conditions.Religious and community facilities can be a safe and nurturing space for people who are intimidated by exercise and gyms.Social connections and a sense of comm
116、unity are typically the greatest motivators for people to exercise;camaraderie can turn exercise into a fun and popular activity.Community organizations that work with children and youth can develop sports and active recreation programs,but should also ensure that these programs are fun,inclusive,an
117、d not overly competitive.Community organizations can also build movement into regular events and gatherings,so that being physically active and feeling strong in our bodies becomes part of the local culture and the norm in the community.If you are a business leader or employer:All private companies
118、can play a role in supporting physical activity,both for their employees and for the communities in which they operate.Workplace culture,workplace design,and workplace wellness programming can all be shaped to encourage employees to engage in more movement throughout the workday and these offerings
119、can improve employee satisfaction/retention as well as employee health/productivity.Companies can build local partnerships to support physical activity facilities and initiatives in the communities where they do business,as part of corporate social responsibility(CSR)efforts.In addition,companies in
120、 specific industries and sectors play other direct roles in encouraging physical activity for all:Companies in building/real estate/development can ensure that their projects incorporate features that support physical activity.Companies in healthcare,caregiving,exercise/fitness,and related areas can
121、 integrate physical activity into the healthcare system(e.g.,exercise prescriptions/referrals,medical fitness centers,training health/exercise professionals on exercise for those with health conditions or risks,etc.).Industry/occupational organizations can ensure that educational curricula and crede
122、ntialing requirements incorporate physical activity literacy for key professions such as:built environment professions(e.g.,urban planners,architects,etc.),transportation planners and engineers,health professions/caregivers,and schoolteachers.Fitness,sports,and other physical activity-related compan
123、ies can expand their offerings to reach a wider target population,and they can educate governments on the critical role they play in supporting population health and well-being.18|Global Wellness Institute:Wellness Policy SeriesIf you are a member of the media:Members of the press and media can play
124、 a pivotal role in educating the public about the benefits of physical activity,showcasing fitness and recreational events and venues,and disseminating the latest evidence-based research.At the same time,journalists need to take responsibility for what they write about and promote,being careful to h
125、ighlight evidence-based practices for physical activity that are relevant for all populations,and not constantly hyping the latest short-lived or expensive fitness fad.Community leaders and nonprofit organizations can partner with local media to enhance their message,increase support,and encourage p
126、articipation.If you are a member of the research community:The research community(in academia,government entities,or nonprofit organizations),can have a significant impact on physical activity policy,programs,and practices.Ongoing research about the benefits of physical activity,as well as the amoun
127、t/types of exercise needed for different health benefits,has an important influence on fitness and recreational products,services,and spaces.Research findings on the most cost-effective physical activity policies and programs can help local agencies in making program design and implementation choice
128、s.The research community can also contribute to further educating the public by disseminating research findings,engaging with the media,and engaging in advocacy with local government and community groups.Wellness Policy Toolkit:Physical Activity|19Policy actions for physical activity.This section of
129、 the toolkit outlines a wide array of policy actions that different stakeholders can pursue in order to promote physical activity participation and access.For each item,we describe the objective or“problem”it is trying to address,elaborate on the different policy actions that can be deployed,and pro
130、vide a list of sample policy tools.Our aim in this toolkit is to address some of the most pressing issues hampering physical activity participation;the policies and actions discussed are wide-ranging but not exhaustive.The Key Resources section,at the end of this report,will provide readers with oth
131、er detailed resources on policies,strategies,case studies,and research evidence related to physical activity promotion.Summary of key policy objectives and actions:Physical activity.POLICY OBJECTIVESACTIONS1Encourage physical activity via the built environment.Action 1:Design cities,neighborhoods,an
132、d buildings to facilitate natural movement and active transit.1.1.Use urban/regional planning to encourage walking and cycling as transport.1.2.Incorporate active design into real estate developments.2Make recreational physical activity accessible,convenient,and affordable.Action 2:Invest in recreat
133、ional physical activity infrastructure,facilities,and programs.2.1.Treat recreational physical activity as an essential public service.2.2.Establish a“sports for all”policy framework or physical activity action plan.2.3.Create more free and accessible public spaces for outdoor recreation and exercis
134、e.2.4.Sponsor free exercise classes,programs,and educational campaigns.2.5.Invest in subsidized and public-private fitness facilities.3Improve access to physical activity for underserved populations.Action 3:Target physical activity infrastructure investments to increase access and reduce cost barri
135、ers for high-risk populations and underserved communities.3.1.Develop safe and comfortable spaces for women and girls to exercise.3.2.Support fitness options for older adults.3.3.Make physical activity accessible to persons living with disabilities.3.4.Address racial and ethnic disparities in physic
136、al activity.20|Global Wellness Institute:Wellness Policy SeriesPOLICY OBJECTIVESACTIONS4Integrate physical activity into the health system.Action 4:Incorporate physical activity into prevention and treatment protocols,working in cooperation with the health system.4.1.Implement exercise as medicine a
137、nd exercise prescription initiatives.4.2.Develop medical fitness centers.5Encourage youth to build lifelong habits for physical activity.Action 5:Increase opportunities for youth to learn and participate in a variety of physical activities through schools and sports.5.1.Ensure that all children rece
138、ive physical education(PE)classes regularly in school.5.2.Encourage movement throughout the school day.5.3.Put the“play”back into youth sports.6Encourage adults to be physically active during the workday.Action 6:Realign company benefits and culture to reduce sedentary behavior and increase opportun
139、ities for physical activity during the workday.6.1.Provide opportunities for physical activity during the workday.6.2.Reduce sitting during the workday.Wellness Policy Toolkit:Physical Activity|21Encourage physical activity via the built environment.This policy action is cross-posted in the Built En
140、vironment Toolkit.Issue 1:Our modern built environment discourages physical activity.Our modern built environment encourages sedentary behavior and makes it difficult to stay active.Around the world,economic development has brought rapid urban growth and the mounting pressures of crowding,congestion
141、,traffic,and sprawl.In response,urban planning has increasingly prioritized vehicular traffic flow over pedestrians and public transit,leading to widening of roads,stripping of sidewalks,increases in speed,and other auto-centric features that make it more difficult,less attractive,and even dangerous
142、 for people to walk or ride bicycles.Too many people automatically drive short(and walkable)distances,from work to school to errands,simply because there are no sidewalks,or no easy ways to cross a highway on foot or to walk from one shopping center or office park to another.In dense and sprawling u
143、rban areas,many people do not have access to parks,green spaces,or sports/recreational facilities near their homes.Some people live in areas where crime and safety concerns discourage them from being active outdoors.Some stay indoors because of poor air quality and pollution.And indoors,most modern
144、buildings have been designed for efficiency and comfort,rather than encouraging movement for example,placing elevators prominently in lobbies,while hiding narrow and dark stairways.All those missed opportunities to move in our daily lives(short distances not walked,flights of stairs eschewed,etc.)ha
145、ve now become the“steps”that we need to make up each day in order to meet our daily requirements for physical activity.Action 1:Design cities,neighborhoods,and buildings to facilitate natural movement and active transit.1.1Use urban/regional planning to encourage walking and cycling as transport.The
146、 physical attributes of our neighborhoods and cities have a strong impact on our level of physical activity.xvii An important way to engage more people in physical activity is by making movement a default in daily life,through infrastructure,design,and convenient amenities.During the 2020 COVID-19 s
147、hutdowns,many city-dwellers turned to walking and cycling both for exercise and for essential travel,exposing the inadequacy of active transit infrastructure across every metropolitan area.City governments around the world took action to help people move around more easily for example,closing street
148、s to vehicular traffic to make room for pedestrians/cyclists(New York,Seattle,Brussels);lowering speed limits(Milan);providing free access to bike sharing systems(London,Glasgow,Chicago);expanding bike lanes(Bogota,Mexico City,Berlin,Paris,Milan,Washington,D.C.);widening sidewalks(London);and making
149、 automated pedestrian crossing signals“touch-free”(Sydney,Auckland,Boston).In many of these places,cities were able to fast-track active transit plans that were in place for the longer-term,and many are now making the pandemic changes permanent.xviii In spite of these shifts,current efforts are far
150、from sufficient.The WHO reports that only 42%of countries have a national policy(and only 15%have subnational/regional policies)to encourage walking and cycling as transport.xix122|Global Wellness Institute:Wellness Policy SeriesOver the last couple of decades,numerous planning frameworks and design
151、 approaches have emerged that provide comprehensive and detailed guidance to policymakers on how to make physical movement the more convenient,attractive,and default/preferred way to go from place to place including New Urbanism,Form-Based Codes,Traditional Neighborhood Development principles,Active
152、 Design Guidelines,Complete Streets policies,Smart Growth policies,the 15-minute city concept,and so on.xx Key approaches include“complete street”design(e.g.,wide sidewalks,accessible crosswalks,pedestrian signals,narrower vehicle lanes,separated bike lanes);attractive and people-friendly streetscap
153、es(e.g.,street/shade trees,lighting,benches,wayfinding signs);and movement-friendly urban planning and zoning(e.g.,higher density buildings,mixed-use development).Examples and best practices of how communities have improved walkability and bikeability exist across every country and region around the
154、 world.These features help add natural movement back into daily life and can go a long way towards helping people meet the daily requirement of moderate physical activity.1.2 Incorporate active design into real estate developments.In addition to broad-scale urban planning,individual buildings and re
155、al estate developments can also be planned in a way that encourages physical movement.A growing number of residential,commercial/office,medical,hospitality,and other types of buildings are prioritizing physical activity in their design,with amenities such as walking/biking paths,swimming pools,recre
156、ation centers,exercise facilities,parks,playgrounds,bike parking/storage,and more.The more these features are convenient and are located right within peoples homes,neighborhoods,and workplaces,the more likely people will access them regularly to be active.Interior design features that encourage move
157、ment include attractive and well-located stairways(and signage)that steer people away from elevators,as well as attractive and accessible common areas,corridors,and amenities that encourage circulation and walking from place-to-place.Outside,buildings should be situated to maximize connectivity to s
158、idewalks,public transit,parks,plazas,and open spaces.xxiWhile real estate developments and buildings are primarily the domain of the private sector,public policy can play a role in encouraging active design through tax and fiscal incentives and regulations(e.g.,zoning,building codes,land use regulat
159、ions)that encourage movement-friendly developments.Governments can lead by example,by incorporating active design features into publicly funded facilities(including schools,government agencies,hospitals,military installations,parks/recreation/tourism facilities,prisons,etc.).The public sector also h
160、as a critical role to play in encouraging the use of active design in affordable/subsidized housing,schools,and community facilities in underserved and high-risk areas.xxii This can be accomplished via partnerships among municipal and public housing authorities,nonprofits,and private developers,as w
161、ell as via incentive programs for developers.For example,in 2017,the U.S.government-sponsored mortgage securitization corporation(“Fannie Mae”)introduced the Healthy Housing Rewards program,which provides a variety of financial incentives for borrowers who incorporate active design and health-promot
162、ing features into newly constructed or rehabilitated affordable multifamily rental properties.Properties are qualified by meeting or exceeding minimum standards of the Fitwel,WELL,or Enterprise Green Communities certification systems.xxiiiWellness Policy Toolkit:Physical Activity|23Action 1:Sample p
163、olicies to encourage physical activity via the built environment.Invest in infrastructure features that encourage active transit:complete streets,better connectivity,attractive streetscapes,multi-use trails/greenways,car-free zones,traffic calming/reduction measures,public transit,bike-sharing,etc.P
164、rioritize building projects located near walking/cycling routes and public transit.Adjust zoning,building codes,and land use regulations to encourage higher density,mixed-use,and other health-promoting features.Create regional master plans and dedicated budgets for active transit and physical activi
165、ty.Conduct health impact assessments for infrastructure and real estate development projects.Expand research on outcomes from infrastructure investments to promote physical activity.Tax incentives for commuters using active/public transit.Grants,tax incentives,and special lending instruments for dev
166、elopers incorporating active transit,active design,and other health-promoting features in their projects,especially in high-risk and underserved communities.Incorporate training on active transit/active design/physical activity into the curricula for professions that plan the built environment(e.g.,
167、urban planners,civil engineers,architects,etc.).This is a sample of policies that can be used to encourage physical activity,but not an exhaustive list.Please see Key Resources,at the end of this report,for more details on policies,strategies,case studies,and research evidence related to physical ac
168、tivity promotion.24|Global Wellness Institute:Wellness Policy Series2 2Make recreational physical activity accessible,convenient,and affordable.Issue 2:Our modern lifestyles are increasingly sedentary,and we lack the time to exercise.For most of human history,physical movement was not done for exerc
169、ise but for survival.We were hunters and gatherers,farmers and fishermen,building our own houses,carrying water,and washing clothes by hand.But today,our modern lifestyles and livelihoods require much less physical exertion than those of previous generations.With urbanization,new technologies,and th
170、e rise of the service economy,a growing share of people work in jobs that require sitting for most of the day.At home,physical chores such as cooking and cleaning have been greatly eased by modern appliances and industrialized food production.Meanwhile,the digital revolution has enabled us to shop,s
171、ocialize,and consume news and entertainment without leaving our homes or even our sofas.As essential physical tasks steadily disappear in our daily lives,they have not been replaced by other types of built-in movement.Physical activity has become less natural and more structured and intentional.Syst
172、ematic reviews of data for adults in wealthier countries find that work-related physical activity and use of active transit have been decreasing over time,while leisure-time physical activity(e.g.,fitness and sports)has been increasing.xxiv In many countries,fewer children are walking or biking to s
173、chool.xxv In order to stay active,we now have to schedule time to exercise,and we increasingly have to spend money to do so.However,with long working hours,long commutes,dual income families,and other pressures of modern life,many simply cannot find time to exercise during their limited leisure hour
174、s.Others may find it unaffordable or inconvenient to do so.GWI research found that only 35.6%of the worlds population participated in recreational/leisure physical activities or exercise on a regular basis in 2019,and this rate fell to 31.6%in 2020,due to pandemic-related facility shutdowns,stay-at-
175、home orders,etc.xxvi GWIs review of surveys and studies across over 60 countries revealed that the biggest barrier for both adults and adolescents to engage in physical activity is a lack of time,followed by lack of interest(adults),and lack of convenient facilities near home(children and teens).xxv
176、iiWellness Policy Toolkit:Physical Activity|25Action 2:Invest in recreational physical activity infrastructure,facilities,and programs.Public investments in parks,playgrounds,trails,sporting/exercise facilities,mass recreation events,free classes,and other recreational amenities and programming can
177、play a major role in making leisure-time physical activities convenient,easy to access,and low-cost(or free).Although the global fitness and exercise industry has expanded rapidly in recent decades,it is only meeting the needs of a very small share of the worlds population(i.e.,those with the time,m
178、oney,and ability to access these services).Around the world,recreational physical activity participation rates tend to be the highest in the places where governments have adopted“sports for all”approaches and aggressively invest in such infrastructure for the public.2.1Treat recreational physical ac
179、tivity as an essential public service.To encourage widespread participation in recreation and exercise,governments need to treat physical activity as an essential public service,and they can even partner with the nonprofit and private sectors to deliver high-quality,low-cost facilities.Too often,phy
180、sical activity infrastructure is treated by governments as a nice-to-have leisure amenity,and not as an essential public good.This view was clearly demonstrated during the pandemic,in terms of which businesses and services faced shutdowns and which were allowed to remain open.Unfortunately,the physi
181、cal activity sector(including for-profit and nonprofit gyms,community sports and recreation centers,sports leagues,etc.)was among the first to shut down and the last to reopen in many countries.Exercise facilities were treated as places of leisure,like bars and restaurants,and not as essential servi
182、ces that support physical activity,mental wellness,and other wellness needs that are vital to maintaining good health.Governments need to change their perception of physical activity from an optional leisure pursuit to an integral part of protecting and promoting public health,and thereby give the p
183、hysical activity sector greater recognition,priority,support,and investments.This shift in viewpoint does not simply mean special treatment for private gyms,but rather embracing a very broad definition of the physical activity sector(i.e.,encompassing all private,nonprofit,and community-based fitnes
184、s and exercise facilities;youth/adult/amateur sporting facilities,teams,and leagues;active recreation activities like martial arts and dance;outdoor recreation;and public infrastructure like parks,playgrounds,and trails).2.2Establish a“sports for all”policy framework or physical activity action plan
185、.In most countries,public funding and programs for sports have historically focused on training a pipeline of elite athletes for the Olympics and other high-level competitions,as a matter of national pride and reputation.This narrow focus has started to change with the growing awareness of the risin
186、g health crisis stemming from physical inactivity.In recent decades,many countries especially in Europe and Latin America have shifted their national policy focus toward“sports for all”approaches,which aim to increase sports,active recreation,and physical activity participation across the population
187、(rather than channeling resources to elite sports and high-prestige events).A national“sports for all”policy(starting with the national Ministry of Sports or agency responsible for sports/recreation/leisure)will help to guide limited resources toward investments,facilities,and programs that will ben
188、efit the entire population,and will also encourage public/private/community 26|Global Wellness Institute:Wellness Policy Seriescollaborations to reach diverse and underserved groups.A 2018 WHO survey of 28 EU countries found that all of them had at least one sports-for-all or health-enhancing physic
189、al activity(HEPA)action plan,with a total of 148 physical activity promotion policies in place across these countries.xxviii For example,the United Kingdoms Sport England focuses on reducing inactivity by offering programs designed to get a wider group of people moving,and it has redefined“sport”to
190、encompass many forms of physical activity(such as table tennis,walking and dance)that are eligible for financial support.Looking globally,only 38%of countries have a standalone national physical activity strategy or action plan that is currently operational(and most of these are higher income countr
191、ies).In addition,only 30%of countries have national guidelines for physical activity across all age groups,and only 27%of countries gather data on physical activity participation across all age groups(under 5,children/adolescents,and adults).xxix Establishing a national agenda or strategy for physic
192、al activity is critical because it provides a mandate for public policy action,for allocating resources to address it,and for gathering data to track progress.2.3Create more free and accessible public spaces for outdoor recreation and exercise.Physical activity does not require specialized facilitie
193、s and equipment,and it does not have to cost anything to exercise.Governments,especially at the local and municipal level,can create more outdoor infrastructure to increase their citizens access to various recreation and exercise options.There are more than 23,000 free outdoor gyms worldwide(also kn
194、own as“biosaludables,”“senior playgrounds,”and calisthenics parks),which offer pull-up bars,metal bikes and elliptical machines,and other simple equipment.xxx These are particularly popular across Latin America,Europe,and some parts of Asia(China,South Korea,India,Singapore);many are located in deve
195、loping countries without a robust sector of private gyms,and many target older adults(see Action 3).For example,in New Delhi,India,members of parliament have used local development funds to install 1,700 open-air gyms in parks throughout the city since 2016,and hundreds more are in development,each
196、costing about US$10,000 to install.xxxi Other outdoor public infrastructure that is critical for supporting physical activity includes parks,playgrounds,running/biking paths,greenways,and sports courts/fields.Numerous studies have shown that conveniently located and well-designed neighborhood parks
197、are often associated with higher levels of physical activity,especially for older adults,children,and disadvantaged populations.xxxiiPhysical activity infrastructure can be as simple as well-designed,accessible,and safe open spaces and green spaces.Public spaces such as parks and public squares are
198、widely used venues for exercise and recreation activities in urban areas,especially in countries that are not well-served by private fitness and sports facilities.In many African countries,people living in both rural and urban communities gather before and after work to exercise in parking lots and
199、stadiums,on beaches,in the streets,and even in cemeteries.In China,older men and women gather daily in public parks to do tai chi,while millions of people,mostly women,meet in urban plazas and squares to do“plaza dancing.”Simple greening interventions such as adding street trees and greening public
200、plazas can support spontaneous outdoor exercise,especially when designed with input from community groups and potential users,and when done in conjunction with social engagement activities and programs to promote usage(see Action 2.4 below).xxxiii Wellness Policy Toolkit:Physical Activity|272.4Spons
201、or free exercise classes,programs,and educational campaigns.Programming,education,and engagement of stakeholders is just as important as infrastructure in promoting physical activity.In fact,systematic reviews have found that public investments in outdoor infrastructure(parks,trails,and greenways)ar
202、e more effective at increasing physical activity when they are combined with programming,community engagement,public awareness activities,and access enhancements(e.g.,expanded hours of operation).xxxiv According to the WHO,community education and communication campaigns are a highly cost-effective a
203、pproach for promoting physical activity on multiple levels.They not only raise knowledge and encourage behavior change among individuals,but also can stimulate community discussions and influence policy agendas toward more access and support for physical activity infrastructure/programming.And yet,t
204、he WHO reports that only 52%of countries have implemented a physical activity communication campaign in the last two years.xxxvThese activities can take many forms.Some regions have developed campaigns and incentive-based promotions to educate the public and encourage exercise,often working in partn
205、ership with the private sector.For example,in Singapore,ActiveSG and the Singapore Health Promotion Board(HPB)run a variety of national challenges and events to encourage residents to walk and get more exercise,and some of these offer cash incentives and prizes(such as free fitness trackers).Singapo
206、res annual GetActive!Singapore Festival includes hundreds of run,walk,and sporting events sponsored by communities,schools,and corporate partners.xxxvi In the United Kingdom,the ParkLives program(which ran from 2014-2019 as a collaboration between Coca-Cola GB and ten local municipalities)offered fr
207、ee exercise and recreation activities in local parks and green spaces,reaching over 500,000 unique attendees.xxxvii A similar program in Australia,called“Live Life Get Active,”offers free daily fitness classes in outdoor spaces in over 100 communities across the country,operating as a partnership am
208、ong nonprofits,governments,health networks,and commercial organizations.xxxviiiGovernments across numerous Latin American countries(e.g.,Mexico,Chile,Ecuador,Colombia,Brazil)activate their existing public spaces by sponsoring free and low-cost exercise classes and sports activities in community cent
209、ers,public parks,plazas,shopping malls,and city streets,serving millions of people each year.City-sponsored open streets,“car free”days,and mass recreation events(following the model of Bogots Ciclova)are another low-cost and high-impact way for governments to make walking,running,biking,and outdoor
210、 recreation accessible to all.These kinds of public facilities and programs play a major role in boosting physical activity participation across Latin America.National surveys conducted in Brazil,Mexico,Argentina,and Chile all indicate that two-thirds to three-quarters of people who participate in s
211、ports and recreational physical activities do these activities in public or free facilities that require no payment for access.xxxix Free and mass-participation events can be highly effective at engaging large numbers of people in exercise,engaging those who are not regularly active,providing opport
212、unities for people to try out new physical activities,and fostering local partnerships.28|Global Wellness Institute:Wellness Policy Series2.5Invest in subsidized and public-private fitness facilities.In a smaller number of countries(mostly higher-income regions),governments provide subsidized and lo
213、w-cost public gyms and community recreation centers for their citizens either for free or for a nominal fee.Community centers with basic workout areas,fitness classes,walking tracks,swimming pools,and sports facilities are common in communities across the United States(typically run by municipal par
214、ks and recreation departments),and city-run gyms,leisure centers,and sports/recreation centers are also abundant in the Nordic countries,Japan,Singapore,and Hong Kong.In Western European countries,such as Germany and Austria,governments fund and subsidize a massive network of nonprofit sporting club
215、s(found in nearly every town,large or small),which provide competition and training for millions of children and adults across all segments of the population.Fees to join these clubs are very affordable for most people(often just$50-100 per year),and lower-income children/families can get government
216、 support or waivers for the fees.Governments can partner with the private fitness industry to develop and run their public fitness and recreation facilities.The United Kingdom,Ireland,and Australia use a public-private model in which gyms and leisure centers are subsidized by national and local gove
217、rnments but often operated by private contractors.The facilities and services in these centers can sometimes rival those of higher-end commercial gyms,and the private outsourcing helps keep the quality of facilities high when public budgets are under pressure.In the United Kingdom,public expenditure
218、s on these kinds of recreational and sporting facilities and services topped$4.6 billion in 2021/2022,xl while in Finland municipalities spend over$700 million per year subsidizing fitness and sports facilities and clubs.xli While there have not been extensive,rigorous studies on the impacts of subs
219、idized and free fitness facilities,one study in the northwest of England found that introducing universal free access to leisure facilities,alongside outreach activities,led to“an increase in swimming and gym attendances at these facilities,an increased proportion of the population participating in
220、swimming or gym activity and increased overall physical activity levels.The increases in participation were greatest in the most disadvantaged socioeconomic group decreasing inequalities.”xlii As more nations implement“national fitness and exercise”and“sports for all”plans,public investments in such
221、 infrastructure,programs,and activities will likely increase,expanding accessibility to more people and also competing with fitness businesses operating at the lower end of the market.Wellness Policy Toolkit:Physical Activity|29Action 2:Sample policies to treat recreational physical activity as an e
222、ssential public service.Establish and implement a“sports for all”framework/plan or a national physical activity strategy,in order to prioritize resources/initiatives for programs that increase physical activity for all.Invest in community-based exercise/sports/recreation infrastructure that is low-c
223、ost or free and accessible to all(e.g.,public-access and subsidized fitness/sports/recreation facilities;outdoor gyms;walking/biking paths;etc.).Develop public-private partnerships to build and operate community facilities for physical activity.Sponsor free/low-cost exercise classes in public spaces
224、.Launch“open streets”and mass recreation events that encourage physical activity.Organize public awareness campaigns,special events,and/or“challenges”to catalyze interest in physical activity(e.g.,national fitness week,national fitness challenge with incentives/prizes).Expand government data collect
225、ion efforts on physical activity participation rates.Expand research on the factors influencing physical activity participation and the outcomes of different interventions and investments for different populations.Improve and expand training/credentialing of physical activity professionals/sports co
226、aches for those working in community/public facilities and programs.Offer tax incentives for peoples out-of-pocket expenditures on physical activities.Offer tax incentives to promote development of community/public spaces and facilities for physical activity programs.This is a sample of policies tha
227、t can be used to encourage physical activity,but not an exhaustive list.Please see Key Resources,at the end of this report,for more details on policies,strategies,case studies,and research evidence related to physical activity promotion.30|Global Wellness Institute:Wellness Policy Series2 3Improve a
228、ccess to physical activity for underserved populations.Issue 3:The private fitness industry often leaves out marginalized populations who are at higher risk for physical inactivity.Physical activity participation is not evenly distributed across all groups.For example,rates of physical activity tend
229、 to drop from youth to adolescence and adulthood,and often fall further among people ages 60+.Women and girls tend to be more inactive than men and boys.Globally,an estimated 23.4%of men are physically inactive,while 31.7%of women are inactive,and this disparity is even greater in certain countries
230、and regions(e.g.,South Asia).xliii According to the WHO,“women,minority ethnic groups,disadvantaged communities,and people living with disability and chronic disease are more likely to be inactive in all countries.”xliv There is a large and growing divide between the people who have access to privat
231、e facilities and public infrastructure that enable them to be physically active,and those who do not.The Covid-19 pandemic has made those inequities more obvious and more alarming from both a personal wellness and public health perspective.Although the global fitness sector has been fast growing,the
232、se businesses primarily target those who are more able and likely to exercise the educated,more affluent,younger demographics,and those living in major urban centers and wealthy suburban areas.xlv According to GWI research,the fitness industry serves just 3-4%of the worlds population,while the entir
233、e recreational physical activity sector(encompassing fitness,sports and active recreation,and mindful movement modalities like yoga)is only engaging about one-third of the worlds population.xlvi Recent analysis of the“geography of fitness”found that the availability of fitness and recreational facil
234、ities across the United States tracks closely with key socioeconomic indicators(e.g.,higher incomes,education levels,and“creative class”and high-tech occupations).xlvii If this kind of analysis could be conducted on a global level,the disparities would likely be even more stark.The reality is that p
235、articipating in exercise remains a privilege that is not accessible for many people around the world.Another major reason for the lower rates of physical activity among women and girls in many countries is that gender and social norms can discourage female participation in sports and outdoor recreat
236、ion,prevent activities in co-ed settings,or prohibit physical activity for females in general.In surveys,women often cite personal safety and being uncomfortable at a gym as reasons for not exercising.For example,in one study in Central America,girls reported multiple barriers,such as:lack of access
237、 to fields and facilities;lack of equipment;lack of money;lack of parental permission;lack of clothing;and safety.In the same study,boys rarely mentioned these as constraints,and they regarded the lack of time as their most important barrier.xlviiiWellness Policy Toolkit:Physical Activity|31Action 3
238、:Target physical activity infrastructure investments to increase access and reduce cost barriers for high-risk populations and underserved communities.Global minority populations which can be defined by ethnic and cultural background,race,gender identification,religious affiliation,disability status
239、,and other factors face many types of discrimination and bias that can lead to higher-than-average rates of physical inactivity,putting them at higher risk for chronic disease.To stay active,these populations need public recreational spaces and amenities that are affordable,safe,convenient,welcoming
240、/accessible,and culturally relevant.It does not have to cost anything to be physically active,if people can access public infrastructure,parks,green spaces,running and biking paths,outdoor gyms,and recreational facilities and programs.All of the policy initiatives proposed in Action 1 and Action 2 o
241、f this toolkit(e.g.,active transit,active design in real estate,sports for all initiatives,free and accessible public spaces for outdoor recreation,free exercise classes and programs,subsidized and public-private fitness facilities,etc.)should be targeted at the marginalized and underserved communit
242、ies and populations that are at the highest risk for physical inactivity,to improve accessibility and lower cost barriers for them.In addition,other policy steps can be taken to specifically support these underserved populations:3.1Develop safe and comfortable spaces for women and girls to exercise.
243、In some countries,social/religious norms and government regulations can prevent women and girls from being physically active for example,societal pressures against women exercising in public,and religious policies that prohibit mixed gender facilities/classes and certain types of exercise/movement.H
244、owever,as governments recognize the inactivity crisis and its ramifications,especially among women,they are implementing policy changes to support greater female participation in physical activity.For example,in the Middle East,some countries are lifting laws that prohibit physical activities for wo
245、men and facilitating the development of segregated,women-only facilities.Women across Iran,Saudi Arabia,and Oman have gone from using mens gyms at off-peak(ladies)hours to having their own dedicated gyms and outdoor venues to exercise.In 2017,Saudi Arabia started granting licenses for boutique women
246、-only gyms for the first time(although these must be specifically for fitness,and women-only competitive sports facilities are still not allowed).Women have been flocking to these new facilities,and some companies are converting their existing male-only gyms into womens gyms to meet demand.In some p
247、laces,the fear of harassment and even violence can greatly discourage women and girls from exercising outdoors.In these cases,governments can take the lead in creating dedicated public parks to provide a safe place for women to engage in outdoor recreation and exercise,or simply to get some fresh ai
248、r,without being accompanied by male family members.For example,in 2012,the city of Lahore,Pakistan opened its first“women only”park in a four-acre space secured behind 7-foot-high walls,with its own jogging track,gymnasium,and badminton court.xlix Women-only parks have also been developed in India,S
249、audi Arabia,and Iran.Irans parks have also received widespread criticism,however,because they were designed by men,are largely located in secluded suburban locations that can be difficult to access,and are seen as perpetuating the segregation and second-class status of women.l 32|Global Wellness Ins
250、titute:Wellness Policy Series3.2Support fitness options for older adults.Rising life expectancies and the associated rise in chronic disease mean that it is increasingly important to stay active as we age.And yet,many older adults especially those with health conditions or limited mobility do not fe
251、el comfortable or safe exercising at conventional private gyms and fitness studios,or they may need a lot of support to do so.Many older adults face transportation constraints,have limited access to exercise facilities,or cannot afford gym memberships.Public and nonprofit fitness facilities(in addit
252、ion to medical fitness centers,see Action 4)can help fill this gap for the older segment of the population.In the UK,publicly supported leisure centers offer discounted or free memberships and classes for older adults.In the United States,community centers and nonprofit YMCAs make concerted efforts
253、to serve this population,offering lower-cost classes and memberships;providing accessible equipment,classes,and programming;and generally creating a welcoming and inclusive atmosphere for this demographic.Also in the United States,certain types of Medicare(government-sponsored health insurance for a
254、ges 65+)include SilverSneakers,a program that offers free access to 14,000 recreation centers,exercise classes,and other fitness amenities across the country.Studies of this program have demonstrated many positive impacts on older adults physical,emotional,and social health,as well as a reduction in
255、 healthcare expenses for participants.li The availability and cost of fitness centers are not the only barriers for older adults;the exercise offerings also need to be tailored toward what older adults want and need when they exercise.A study in the UK identified older adults as a significant growth
256、 driver for the public leisure sector,while revealing that older clients tend to feel more self-conscious when exercising in public and,as a result,work out less often than other age groups.lii An extensive 2021 study by the ukactive Research Institute outlined a variety of strategies for attracting
257、 more older adults to public and private fitness centers,including:the structure,range,and frequency of offerings targeting older adults;categorizing offerings by ability and intensity rather than age;having a welcoming atmosphere for older adults;the knowledge and skill of instructors in teaching o
258、lder adults;and opportunities for social interaction and intergenerational mixing.liii During the pandemic,the UK also launched a country-wide“10 today”radio campaign(modeled on the popular radio calisthenics in Japan)as an experimental approach to make exercise convenient,accessible,and fun for old
259、er adults with transportation constraints.livIn countries with a less well-developed fitness sector,outdoor recreation infrastructure can play an important role in serving the older population.As mentioned in Action 2,there are thousands of outdoor gyms worldwide,many of which were installed to targ
260、et older adults.In China,over 600,000 pieces of equipment have been installed in neighborhood parks(e.g.,jungle gyms,pull-up bars,ping pong tables,metal bikes,elliptical machines,exercise pavilions,etc.)to facilitate outdoor exercise among the older population,many of whom do not have the space or e
261、quipment at home,nor the means to pay for a fitness club membership.In fact,parks across China are primarily used by older adults,and their design and equipment typically target older users rather than youth.This concept of“senior playgrounds”first originated in China in the 1990s,but quickly spread
262、 in Asia(Taiwan,Japan),Europe,and North America.In Europe and North America,senior playground facilities tend to be co-located with childrens playgrounds(so grandparents can exercise while minding their grandchildren)or designed as multigenerational spaces.lv Exercising in public spaces provides oth
263、er benefits,such as regular social interactions for older adults who are susceptible to loneliness and social isolation.Wellness Policy Toolkit:Physical Activity|333.3Make physical activity accessible to persons living with disabilities.About 19%of the worlds population(1.5 billion people)lives with
264、 a physical,mental,sensory,or intellectual disability.While there is very little data available to measure or track physical activity participation among this population,The Lancet has estimated that persons with disabilities are 16-62%less likely to meet recommended levels of physical activity than
265、 those without disabilities,putting them at higher risk for poor physical and mental health.lvi Persons with disabilities face many obstacles to being physically active,including personal barriers(e.g.,self-confidence,self-consciousness about exercising in public,physical strength/symptoms,pain,perc
266、eption of exercise being too difficult),environmental barriers(e.g.,lack of accessible facilities/equipment,lack of transportation),institutional barriers(e.g.,untrained staff,lack of accessible classes/programs,discriminatory practices),and social barriers(e.g.,family support,stereotypes).The disab
267、led population is largely ignored by the private exercise/recreation industry and has been long overlooked and underfunded in terms of all aspects of physical activity(research/data collection,support,programming,etc.).Very few of the public policy initiatives,strategies,communications/educational c
268、ampaigns,and infrastructure projects focusing on physical activity and active living have put a priority on accommodating persons with disabilities.lvii In the UK,ukactive and Sport England have recently launched what may be the only national,sector-wide initiative to support disabled persons in bei
269、ng more active.The“Everyone Can”task force is focused on improved data collection,examining the physical activity landscape for the disabled,and enhancing the service and facilities offered for this population across the sector and country.lviii Keep in mind that this is a very large,diverse group o
270、f people in terms of types of disabilities,levels of function,barriers/concerns,etc.,so there are no one-size-fits-all solutions.Also,while there is clearly a need for more dedicated funding and adapted services/facilities targeting the disabled population,all physical activity programs should be ma
271、de more inclusive for those with disabilities,through universal design,adaptability,and mainstreaming.lix Disability inclusion in physical activity is a very large field of inquiry,too broad to be covered thoroughly in this toolkit,but some of the key issues are summarized below.lx Education/communi
272、cation:Raise awareness of the physical activity inequities experienced by persons with disabilities.Ensure that communications campaigns on physical activity avoid ableist language and accommodate persons with disabilities.Environment/infrastructure:Ensure that physical activity infrastructure,facil
273、ities,equipment,and services are accessible and inclusive for those with disabilities,and/or use universal design principles.Ensure that active transit infrastructure is accessible.Programming:Ensure that all community-based physical activity programs offer disability-specific accommodations and ada
274、ptations.Invest in physical activity programs that specifically target people with disabilities(e.g.,parasports/adaptive sports).Training/staff:Improve training for all professionals who are involved with physical activity to ensure they understand how to meet the needs of those with disabilities(e.
275、g.,physical education teachers,staff in public/private fitness facilities,sports coaches,staff in rehab/care centers,etc.).Include dedicated disability support staff in physical activity programs and facilities.34|Global Wellness Institute:Wellness Policy Series Partnerships:Ensure that persons with
276、 disabilities and disability service organizations are involved in the development of programs targeting them.Research:Expand research and data collection on all aspects of physical activity and disability(participation rates,barriers,guidelines,etc.)to inform better policy solutions and interventio
277、ns.3.4Address racial and ethnic disparities in physical activity.In countries around the world,racial and ethnic minority populations tend to have lower rates of physical activity participation.These populations often reside in lower-income and resource-poor urban and rural areas with fewer opportun
278、ities and facilities for physical activity.lxi Other obstacles include a lack of disposable income and insufficient leisure time,in addition to unsafe environments,cultural norms,discrimination,and language differences.lxii All of these factors have led to measurable differences in physical activity
279、 rates,comparatively shorter lifespans,and higher rates of NCDs for racial and ethnic minorities.lxiii These disparities have a ripple effect across all facets of a nations economy and society.To reduce these disparities and improve health outcomes,racial and ethnic minority populations need physica
280、l activity policies that specifically support them,including:educating targeted populations about the need for physical activity and ways to engage in it;increasing their access to safe and affordable exercise opportunities;and mandating funding for more inclusive programs.There are a variety of dif
281、ferent approaches that have been successful in meeting the needs of these populations:Targeted programs:Local governments and community organizations can design and promote programs with the specific goal of disparity reduction.For example,the Race Equality First(REF)program in Wales focuses on achi
282、eving equal opportunities and participation in sport and physical activity for Black and minority ethnic communities,especially Muslim women and girls.A variety of free events targeting these populations are offered in different regions across Wales,including womens yoga,fitness,and walking groups;f
283、amily and women-only swimming sessions;and more.lxiv Cultural relevance:In order to improve effectiveness,combat stigma,and increase engagement,these types of targeted physical activity programs and policies should be culturally relevant,incorporating particular groups social norms,languages,and cus
284、toms.lxv For example,in Singapore,government agencies have partnered with mosques,temples,and other religious organizations to design community-based physical activity programs targeted towards specific ethnic groups,and they have disseminated educational materials about physical activity in four di
285、fferent languages.lxvi Studies have shown that,in addition to creating language-specific information and learning opportunities,focusing on the specific social norms and family systems of ethnic and racial minorities will help to reduce the physical activity disparities found in these communities.Fo
286、r example,exercise initiatives that incorporate families and community events,such as group cultural dances or exercise in public places,can have greater success for some targeted populations.Wellness Policy Toolkit:Physical Activity|35 Geographic relevance:Creating physical activity opportunities f
287、or indigenous populations that are easily adaptable to rural settings(e.g.,outdoor ball games)can also encourage participation in some targeted communities.For example,the Pan American Health Organization,recognizing the disparities faced by its ethnic and racial minorities(i.e.,indigenous and Afro-
288、descendent),emphasizes an intercultural policy approach that seeks to incorporate different traditions,value systems,and social systems into physical activity program design and implementation.lxviiLack of representation in the program and policy design process often leads to unequal access and poor
289、ly targeted initiatives.Community leaders,local gyms,and policymakers can collectively shape physical activity opportunities and community messaging for these populations.Groups representing marginalized minority populations can partner with local governments and policymakers to assess the quality a
290、nd accessibility of physical activity opportunities and to identify areas for improvement and possible solutions.Stakeholders can seek out groups already operating in specific racial and ethnic communities to increase the likelihood of program success.The Inter-American Development Bank has used suc
291、h partnerships to bring sports programs and physical activity to almost 90,000 people in 18 of its member nations across Latin American and the Caribbean.lxviii One of its programs,“A Ganar,”partners with companies and development organizations to bring sports programs to marginalized youth,such as
292、indigenous and ethnic communities in Brazil and Ecuador.36|Global Wellness Institute:Wellness Policy SeriesAction 3:Sample policies to improve access to physical activity for underserved populations.Prioritize underserved populations and regions for investments in active design and active transit in
293、frastructure(see Action 1).Establish dedicated budgets and initiatives targeting underserved populations within existing sports and recreation policies/programs and“sports for all”plans(see Action 2).Prioritize underserved populations and regions for investments in community-based exercise/sports/re
294、creation infrastructure(e.g.,outdoor gyms for older adults,women-only facilities)and free/low-cost exercise classes and programs(see Action 2).Ensure that members of underserved communities are involved in designing the physical activity programs that target them.Promote laws and regulations designe
295、d to decrease physical activity disparities,such as drafting local government regulations requiring the provision of equal quality services,parks,and recreation facilities for all neighborhoods.Establish joint-use agreements for community members to use school-based sports/recreation facilities in r
296、egions that do not have other public-access facilities.Provide free access to community-funded exercise/sports/recreation facilities and programs(or subsidized access to private facilities)for youth,older adults,and other underserved populations.Ensure that public exercise/sports/recreation faciliti
297、es and programs are accessible for persons with disabilities.Ensure that programs targeting racial and ethnic minority populations are culturally relevant and language specific.Support people of diverse backgrounds to become trained physical activity professionals.Educate physical activity professio
298、nals on addressing biases,in order to better serve underserved populations.Improve training of physical activity professionals to work with older adults and persons with disabilities.Support/train caregivers and staff in assisted living/nursing facilities and rehab centers to deliver movement progra
299、ms safely for these populations.Expand research on physical activity for persons with disabilities,including participation rates,guidelines,barriers/constraints,health benefits,and effective interventions.Promote data collection,research,and information dissemination on the disparities,pressing need
300、s,and factors affecting physical activity participation for racial and ethnic minorities.This is a sample of policies that can be used to encourage physical activity,but not an exhaustive list.Please see Key Resources,at the end of this report,for more details on policies,strategies,case studies,and
301、 research evidence related to physical activity promotion.Wellness Policy Toolkit:Physical Activity|374Integrate physical activity into the health system.Issue 4:The health system is disconnected from the physical activity sector.According to the WHO,“primary health and other health and social care
302、professionals are at the forefront of direct,face-to face patient assessment and are ideally positioned to provide effective interventions on physical activity for the prevention and management of chronic diseases and mental health.”lxix Promoting physical activity as part of routine patient care is
303、 especially important for the least active people and for those at risk of chronic disease and related disabilities.Currently,only 40%of countries report having evidence-based national protocols or standards for addressing physical inactivity within primary care,and even within those countries,the p
304、rotocols are not being applied at the majority of primary health care facilities.lxx Within the fitness and exercise sector,the activities and facilities that exist today mainly serve people who are already active or are capable of physical activity.GWIs review of surveys and studies across over 60
305、countries found that one of the top barriers for adults not engaging in regular physical activity is physical conditions such as poor health/illness and disability.lxxi They may feel uncomfortable in a mainstream fitness facility,where the staff are not trained to support or instruct those with phys
306、ical/health conditions,or they may be unsure how to exercise on their own safely given their physical/health issue.This means that many individuals are not engaging in regular exercise that may help to alleviate their symptoms,improve mobility,and slow the progression or even help to eliminate a chr
307、onic health condition.Action 4:Incorporate physical activity into prevention and treatment protocols,working in cooperation with the health system.4.1Implement exercise as medicine and exercise prescription initiatives.Public health authorities and publicly funded healthcare systems can be leaders i
308、n prescribing exercise as part of patient care for those whose health conditions are partly caused or exacerbated by a lack of physical activity.The WHO has developed a toolkit to support countries in developing protocols for addressing physical activity within primary care,and it is developing a fr
309、ee online training course for policymakers and healthcare providers(via the WHO Academy,expected to launch in 2023 or 2024).lxxii Exercise is Medicine(or EIM,co-launched by the American College of Sports Medicine and the American Medical Association in 2007)is an international initiative that provid
310、es a framework for the inclusion of people in any health or physical condition in the delivery and support of physical activity.EIM advocates for physical activity to be included as a standard part of medical treatment and the patient care process,with physicians providing assessments,counselling,a
311、prescription for exercise where appropriate,and a referral to available resources.Having a physician prescribe exercise as part of a treatment plan can give patients a powerful nudge,especially to those who had been prevented by their health condition from being physically active in the past.38|Glob
312、al Wellness Institute:Wellness Policy SeriesHowever,appropriate resources including accessible facilities and trained professionals need to be available to serve their needs.Many countries are experimenting with different approaches to exercise referrals or“prescriptions”and to building collaboratio
313、ns between the health sector and community/private service providers:The United Kingdom is a leader in social prescribing,and specifically in prescribing exercise as a part of medical treatment.The United Kingdoms National Health Service(NHS)has a well-established exercise referral scheme,whereby pa
314、tients are referred to government-funded public leisure centers to access appropriate exercise and activity programs and can access these services for free.lxxiii In 2022,NHS England launched a 3-year pilot program in 11 local authority areas to experiment with social prescriptions for walking and c
315、ycling(developed in coordination with infrastructure improvements for walking/cycling).The scheme is a first-ever partnership between the health sector and transport officials and is part of a broader national action plan for improving active transit.lxxiv In Australia,“accredited exercise physiolog
316、ists”(AEPs)have been recognized as an allied health profession and integrated into clinical guidelines for major chronic diseases since 2006.AEPs deliver services for people with acute or chronic conditions throughout the national health system(including public and private hospitals,primary care fac
317、ilities,rehab facilities,and specialist clinics),and patients can receive a referral from their primary care provider and have these services covered by the national Medicare system.The AEP referral system has shown to be cost effective for treating chronic conditions for example,one study estimated
318、 savings of US$3,900 per patient with type 2 diabetes who goes through an AEP-led exercise intervention.lxxv Singapore,part of the EIM global network,has launched Active Health Labs as a collaboration between Sports Singapore and other public health institutions.Active Health Labs conduct assessment
319、s and take referrals from physicians in order to prescribe and implement appropriate physical activity for patients,in order to treat,manage,and prevent common chronic health conditions.France is piloting schemes whereby physician prescribed fitness/exercise can be partially reimbursed by social sec
320、urity.Wellness Policy Toolkit:Physical Activity|394.2Develop medical fitness centers.Chronic health conditions,illness,and injury can discourage many people of all ages from physical activity,and when they do so,they need to proceed with supervision and care.In the United States,medical fitness cent
321、ers typically established by,or in partnership with,hospital systems have emerged to bridge this gap and provide a continuum of care,from rehabilitation and physical therapy,to physician-supervised exercise,to recovery and prevention.Medical fitness centers,which have grown steadily and exceed 1,400
322、 in 2018,are helping to reach an important demographic that is not well served by the commercial fitness market.According to the Medical Fitness Association,40-50%of individuals who join a medical fitness center have never been a member of any type of fitness center before;60-70%of participants in t
323、ransitional/specialized medical/fitness programs will become full fitness club members.Members of medical fitness centers also tend to be older,averaging 49.3 years old,versus 37 years for traditional multipurpose gyms.lxxvi In 2016,the UK launched a public-private partnership between ukactive/Sport
324、 England and the National Health Service to transform its publicly funded leisure centers into“community wellness hubs”that combine exercise/sport/recreational facilities with primary healthcare centers,libraries,and other public services.Co-locating physical activity and health services under one r
325、oof makes it easier for physicians to prescribe exercise for patients with chronic conditions and connect them with the right services.It also enables these centers to better serve the inactive population,older adults,and those with disabilities.lxxvii A separate pilot initiative is creating musculo
326、skeletal(MSK)health hubs at community leisure centers,swimming pools,and gyms across the UK,as a partnership between ukactive,Orthopaedic Research UK,and other organizations.The program aims to provide individualized exercise,rehab,and education to patients before and after surgery for persons with
327、arthritis,knee replacements,and other MSK conditions,which are the primary cause of disability among older adults and often cause them to enter nursing care homes early.The MSK program launched at 15 sites in 2022 and is expanding to 85 additional leisure centers and swimming pools in 2023.lxxviii B
328、oth programs in the UK are examples of how the fitness sector can partner with the health system to expand value-added services,address health inequities,improve quality of life,and reduce burdens on acute healthcare facilities and social services.As another approach to meet the needs of these popul
329、ations,Floridas Orlando Health is partnering with CrossFit coaches to adapt workouts for patients with spinal cord injuries,with the goal of creating an inclusive,non-intimidating,and safe community where patients can continue their rehabilitation and build their strength in a mainstream gym setting
330、.There are many opportunities for publicly supported healthcare systems to partner with the private sector to implement medical fitness centers and programs,with the potential for reducing health expenditures and positively impacting patients.One of the first long-term studies of medical fitness cen
331、ters in Canada found that membership in a medical fitness center was associated with a 60%lower risk of all-cause mortality and a 13%lower risk of hospitalization as compared to non-members.lxxix40|Global Wellness Institute:Wellness Policy SeriesAction 4:Sample policies to integrate physical activit
332、y into the health system.Adopt an“Exercise is Medicine”platform within the health system.Make physical activity a key“vital sign”that health professionals monitor and discuss with patients,and integrate physical activity promotion into clinical guidelines.Develop exercise referrals/prescription prog
333、rams(e.g.,as a partnership between health systems and public/community/nonprofit exercise facilities and programs).Develop medical fitness centers and/or co-locate physical activity and healthcare facilities.Fund or subsidize peoples exercise activities through the health system or health insurance.Expand research on the outcomes and cost effectiveness/ROI of promoting physical activity for those