Cardinal BJ, Sachs ML. Prospective analysis of stage-of- exercise movement following mail-delivered, self-in- structional exercise packets. American Journal of Health Promotion 1995;9:430-432. Carleton RA, Lasater TM, Assaf AR, Feldman Ha, McKinlay Ss, Pawtucket Heart Health Program Writing Group. The Pawtucket Heart Health Program: community changes in cardiovascular risk factors and projected disease risk. American Journal of Public Health 1995;85:777-785. Centers for Disease Control and Prevention. Guidelines for school and community health programs to promote physical activity among youth. Atlanta: U.S. Depart- ment of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report (in press). Centers for Disease Control and Prevention. Guidelines for school health programs to promote lifelong healthy eating. Morbidity and Mortality Weekly Report 1996;45 (No. RR-9): 1-42. Centers for Disease Control. Promoting physical activity among adults; a CDC community intervention hand- book. Atlanta: U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control, 1988. Centers for Disease Control and Prevention. Worksite and community health promotion/risk reduction project-Virginia, 1987-1991. Morbidity and Mortality Weekly Report 1992;41:55-57. Collins JL, Small ML, Kann L, Pateman BC, Gold RS, Kolbe LJ. School health education. Journal of School Health 1995,65:302-311. Courneya KS. Understanding readiness for regular physi- cal activity in older individuals: an application of the theory of planned behavior. Health Psychology 1995,14:80-87. Courneya KS, McAuley E. Are there different determi- nants of the frequency, intensity, and duration of physical activity? Behavioral Medicine 1994;20:84-90. Courneya KS, McAuley E. Cognitive mediators of the social influence-exercise adherence relationship: a test of the theory of planned behavior. Journal of Behavioral Medicine 1995;18:499-515. Crow R, Blackburn H, Jacobs D, Hannan P, Pirie P, Mittelmark M, et al. Population strategies to enhance physical activity: the Minnesota Heart Health Pro- gram. Acta Medica Scandinavica Supplementum 1986;711:93-112. 251 Understanding and Promoting Physical Activity DempseyJM, KimiecikJC, Horn TS, Parental influence on children’s moderate to vigorous physical activity par- ticipation: an expectancy-value approach. Pediatric Exercise Science 1993;5:151-167. DePue JD, Wells BL, Lasater TM, Carleton RA. Volunteers as providers of heart health programs in churches: a report on implementation. American Journal of Health Promotion 1990;4:361-366. Desmond AW, Conrad KM, Montgomery A, Simon KA. Factors associated with male workers engagement in physical activity. AAOHN Journal 1993;41:73-83. Dietz WH. Children and television. In: Green M, Hagerty RJ, editors. Ambulatory pediatrics 1V. Philadelphia: W B. Saunders, 1990:39-41. DiGilio DA, Howze EA, Schack FK. The cost-effectiveness of peer-led exercise programs. In: Harris S, Harris R, Harris WS, editors. Physical activity, aging, and sports. Vol. 2. Practice, program, and policy. Albany, NY: Cen- ter for the Study of Aging, 1992:226-231. Dishman RK. Increasing and maintaining exercise and physical activity. Behavior Therapy 1991;22:345-378. Dishman RK, Steinhardt M. Health locus of control pre- dicts free-living, but not supervised, physical activity: a test of exercise-specific control and outcome-expect- ancy hypotheses. Research Quarterly for Exercise and Sport 1990;61:383-394. Donovan RJ, Owen N. Social marketing and population interventions. In: Dishman RK, editor. Advances in exercise adherence. Champaign, IL: Human Kinetics, 1994:249-290. DuCharme KA, Brawley LR. Predicting the intentions and behavior of exercise initiates using two forms of self-efficacy. Journal of Behavioral Medicine 1995;,18: 479-497. Duffy ME, MacDonald E. Determinants of functional health of older persons. Gerontologist 1990;30:503-509. Duncan HH, Travis SS, McAuley WJ. An emergent theo- retical model for interventions encouraging physical activity (mall walking) among older adults. Journal of Applied Gerontology 1995;34:64-77. Duncan TE, McAuley E. Social support and efficacy cogni- tions in exercise adherence: a latent growth curve analy- sis. Journal of Behavioral Medicine 1993;16:199-218. Dwyer T, Coonan WE, Leitch DR, Hetzel BS, Baghurst RA. An investigation of the effects of daily physical activity on the health of primary school students in South Australia. International Journal of Epidemiology 1983;12:308-313. Physical Activity and Health Dwyer T, Coonan WE, Worsley A, Leitch DR. An assess- mentof the effects of two physical activity programmes on coronary heart disease risk factors in primary school children. Community Health Studies 1979;111:196-202. Eaton CB, Reynes J, Assaf AR, Feldman H, Lasater T, Carleton RA. Predicting physical activity men and women in two change in New England communi- ties. American Journal of Preventive Medicine 1993;9: 209-219. Edmundson E, Parcel GS, Perry CL, Feldman HA, Smyth M, Johnson CC, etal. The effects of the Child and Adolescent Trial for Cardiovascular Health in- tervention on psychosocial determinants of cardio- vascular disease risk behavior among third-grade students. American Journal of Health Promotion 1996;10:217-225. Flward K, Larson E, Wagner E. Factors associated with regular aerobic exercise in an elderly population. Journal of the American Board of Family Practice 1992;5: 467-474. Eng E, Hatch], Callan A. Institutionalizing social support through the church and into the community. Health Education Quarterly 1985;12:81-92. Eng E, Hatch JW. Networking between agencies and black churches: the lay health advisor model. Preven- tion in Human Services 1991-10:123-146. Epstein LH, McCurley J, Wing RR, Valoski A. Five-year follow-up of family-based behavioral treatments for childhood obesity. Journal of Consulting and Clinical Psychology 1990;58:66 1-664. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. Journal of the American Medical Asso- ciation 1990-264:2519-2523. Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for child- hood obesity. Health Psychology 1994,13: 373-383. Epstein LH, Wing RR, Valoski A. Childhood obesity. Pediatric Clinics of North America 1985.32:363-379. Errecart MT, Ross JG, Robb W, Warren CW, Kann L, Collins JL, etal. Methodology. Journal of School Health 1995;65:295-301. Farquhar JW, Foartmann SP, FloraJA, Taylor CB, Haskell WL, Williams PT, Maccoby N, Wood PD. Effects of communitywide education on cardiovascular disease risk factors; the Stanford Five-City Project. Journal of the American Medical Association 1990;264:359-365. 252 Felton GM, Parsons MA. Factors influencing physical activity in average-weight and overweight young women. Journal of Community Health Nursing 1994:11:109-119. Ferguson KJ, Yesalis CE, Pomrehn PR, Kirkpatrick MB. Attitudes, knowledge, and beliefs as predictors of exer- cise intent and behavior in schoolchildren. Journal of School Health 1989-,59:112-115. Fishbein M, Ajzen I. Belief, attitude, intention, and behay- ior: an introduction to theory and research. Boston: Addison-Wesley, 1975. Fletcher GF, Blair SN, Blumenthal J, Caspersen Cc, Chaitman B, Epstein S, et al. Benefits and recommen- dations for physical activity programs for all Ameri- cans, A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association. Circulation 1992:96:340-344. Flora JA, Maccoby N, Farguhar JW. Communication campaign to prevent cardiovascular disease: the Stanford Community Studies. In: Rice RD, Atkin, CK, editors. Public communication campaigns. 2nd ed. Newbury Park, CA: Sage Publications 1989:233-252. Fries JF, Bloch DA, Harrington H, Richardson N, Beck R. Two-year results of a randomized controlled trial of a health promotion program in aretiree population: the Bank of America study. American Journal of Medicine 1993:94:455-462. Frost H, Moffett JAK, Moser JS, Fairbank JCT. Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain. British Medical Journal 1995:310:151-154. Glanz K, Rimer BK. Theory ata glance: a guide for health promotion practice. Bethesda, MD: U.S. Department of Health and Human Services, Public Health Service, National Institutes of Health, National Cancer Insti- tute, July 1995. Garcia AW, Broda MAN, Frenn M, Coviak C, Pender NJ, Ronis DL. Gender and developmental differences in exercise beliefs among youth and prediction of their exercise behavior. Journal of School Health 1995.65: 213-219. Godbey G, Graefe A, James Sw. The benefits of local recreation and park services: 4 nationwide study of the perceptions of the American public. Arlington, VA: Na- tional Recreation and Park Association, 1992. Godin G, Desharnais R, Valois P, Bradet R. Combining behavioral and motivational dimensions to identify and characterize the stages in the process of adherence to exercise. Psychology and Health 1995;10:333-344. Godin G, Shephard RJ. Psychosocial factors influencing intentions to exercise of young students from grades 7 to 9. Research Quarterly for Exercise and Sport 1986;57:41-52. Godin G, Desharnais R, Jobin J, Cook J. The impact of physical fitness and health-age appraisal upon exercise intentions and behavior. Journal of Behavioral Medicine 1987,10:241-250. Godin G, Valois P, Jobin], Ross A. Prediction of intention to exercise of individuals who have suffered from coronary heart disease. Journal of Clinical Psychology 1991:47:762-772. Godin G, Valois P, Lepage L. The pattern of influence of perceived behavioral control upon exercising behav- ior. an application of Ajzen’s theory of planned behav- ior. Journal of Behavioral Medicine 1993;16:81-102. Gossard D, Haskell WL, Taylor CB, Mueller JK, Rogers F, Chandler M, et al. Effects of low- and high-intensity home-based exercise training on functional capacity in healthy middle-aged men. American Journal of Cardiol- ogy 1986;57:446-449. Gottheb NH, Chen M. Sociocultural correlates of child- hood sporting activities: their implications for heart health. Social Science and Medicine 1985:21:533-339. Green LW, Simons-Morton DG. Education and life-style determinants of health and disease. In: Holland WW, Detels R, Knox G, editors. Oxford textbook of public health. 2nd ed. Vol. |: Influences of public health. New York: Oxford University Press, 1996:181-195. (Greenan-Fowler E, Powell C, Varni JW. Behavioral treat- ment of adherence to therapeutic exercise by children with hemophilia. Archives of Physical Medicine and Rehabilitation 1987;68:846-849. Hatch JW, Cunningham AC, Woods WW, Snipes FC. The Fitness Through Churches project: description of a community-based cardiovascular health promotion intervention. Hygic 1986;5:9-12. Hawkes JM, Holm K. Gender differences in exercise determinants. Nursing Research 1993-42:166-172. Heath GW, Leonard BE, Wilson RH, Kendrick JS, Powell KE. Community-based exercise intervention: Zuni Dia- betes Project. Diabetes Care 1987;10:579-583. 253 Understanding and Promoting Physical Activity Heath GW, Wilson RH, Smith J, Leonard BE. Commu- nity-based exercise and weight control: diabetes risk reduction and glycemic control in Zuni Indians. Ameri- can Journal of Clinical Nutrition 1991-53: 16425-16465. Heirich MA, Foote A, Erfurt JC, Konopka B. Work-site physical fitness programs: comparing the impact of different program designs on cardiovascular risks. Journal of Occupational Medicine 1993;35:510-517. Hochbaum GM. Public participation in medical screening programs: a sociopsychological study. Washington, DC: U.S. Public Health Service, 1958. Publication No. (PHS)572. Hofstetter CR, Hovell MF, Macera C, Sallis JF, Spry V, Barrington E, et al. Illness, injury, and correlates of aerobic exercise and walking: a community study. Research Quarterly for Exercise and Sport 1991,62:1-9. Horne TE. Predictors of physical activity intentions and behaviour for rural homemakers. Canadian Journal of Public Health 1994-85:132-135. Hovell MF, Barrington E, Hofstetter R, Sallis JF, Rauh M, Black D. Correlates of physical activity in overweight and not overweight persons: an assessment. Perspec- tives in Practice 1990-90:1260. Hovell M, Sallis J, Hofstetter R, Barrington E, Hackley M, Elder J, et al. Identification of correlates of physical activity among Latino adults. Journal of Community Health 1991,16:23-36. Howze EH, Smith M, DiGilio DA. Factors adoption of exercise behavior among sedentary older adults. Health Education Research, Theory and Practice 1989-;4:173-180. affecting the Indianapolis Department of Parks and Recreation. India- napolis greenways plan. Indianapolis: Indianapolis De- partment of Parks and Recreation, 1994. Israel BA, Schurman SJ. Social support, control, and the stress Process. In: Glanz K, Lewis EM, Rimer BK, editors. Health behavior and health education: theory, research, and practice. San Francisco: Jossey-Bass Pub- lishers, 1990:187-215. Jeffery RW. Community programs for obesity prevention: the Minnesota Heart Health Program. Obesity Research 1995;3 Supplement:283s—288s. Kann L, CollinsJL, Pateman BC, Small ML, Ross JC, Kolbe LJ. The School Health Policies and Programs Study (SHPPS): rationale for a nationwide status report on school health programs. Journal of School Health 1995; 65:291-294. Physical Activity and Health Kelder SH, Perry CL, Klepp KI. Community-wide youth exercise promotion: long-term outcomes of the Min- nesota Heart Health Program and the Class of 1989 Study. Journal of School Health 1993;63:218-223. Kelder SH, Perry CL, Peters RJ Jr, Lytle LL. Klepp KI. Gender differences in the Class of 1989 Study: the school component of the Minnesota Heart Health Program. Journal of Health Education 1995;26 (Supplement):S36-S44. Killen JD, Telch MJ, Robinson TN, Maccoby N, Taylor CB, Farquhar JW. Cardiovascular disease risk reduc- tion for tenth graders: a multiple-factor school-based approach. Journal of the American Medical Association 1988;260:1728-1733. Kimiecik J. Predicting vigorous physical activity of corpo- rate employees: comparing the theories of reasoned action and planned behavior. Journal of Sport and Exercise Psychology 1992;14:192-206. King AC. Community intervention for promotion of physical activity and fitness. Exercise and Sport Sciences Reviews 1991;19:21 1-259. King AC, Blair SN, Bild DE, Dishman RK, Dubbert PM, Marcus BH, etal. Determinants of physical activity and interventions in adults. Medicine and Science in Sports and Exercise 1992;24:S221-S223. King AC, Carl F,BirkelL, Haskell WL. Increasing exercise among blue-collar employees: the tailoring of worksite programs to meet specific needs. Preventive Medicine 1988:17:357-365. King AC, Frederiksen LW. Low-cost strategies for in- creasing exercise behavior; relapse preparation train- ing and social support. 1984,8:3-21. Behavior Modification King AC, Frey-Hewitt B, Dreon DM, Wood PD. Diet vs exercise in weight maintenance: the effects of minimal intervention strategies on long-term outcomes in men. Archives of Internal Medicine 1989-149:2741-2746. King AC, Haskell WL, Young DR, Oka RK, Stefanick ML. Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years. Circulation 1995:91:2596-2604. King AC, Jeffery RW, Fridinger F, Dusenbury L, Provence S, Hedlund §, et al. Environmental and policy ap- proaches to cardiovascular disease prevention through physical activity: issues and opportunities. Health Edu- cation Quarterly 1995:22:499-511. 254 King AC, Taylor CB, Haskell WL, Debusk RF. Strategies for increasing early adherence to and long-term main- tenance of home-based exercise training in healthy middle-aged men and women. American Journal of Cardiology 1988;61:628-632. Klesges RC, Coates TJ, Moldenhauer -Klesges LM, Holzer B, Gustavson J, Barnes J. The fats: an observational system for assessing physical activity in children and associated parent behavior. Behavioral Assessment 1984,6:333-345. Klesges RC, Eck LH, Hanson CL, Haddock CK, Klesges LM. Effects of obesity, social interactions, and physical environmenton physical activity in preschoolers. H ealth Psychology 1990;9:435-449, Klesges RC, Malcott JM, Boschee PF, Weber JM. The effects of parental influences on children’s food intake, physical activity, and relative weight. International Journal of Eating Disorders 1986;5:335-346. Kuczmarski RJ, Flegal KM, Campbell SM, Johnson CL. Increasing prevalence of overweight among US adults. The National Health and Nutrition Examination Sur- veys, 1960 to 1991. Journal of the American Medical Association 1994:272:205-211. Lasater TM, Wells BL, Carleton RA, Elder JP. The role of churches in disease prevention research studies. Public Health Reports 1986;101:125-131. Lee C. Attitudes, knowledge, and stages of change: a survey of exercise patterns in older Australian women. Health Psychology 1993;12:476-480. Leonard B, Leonard C, Wilson R. Zuni Diabetes Project. Public Health Reports 1986;101:282-288. Lewis CE, Raczynski JM, Heath GW, Levinson R, Hilyer JC Jr, Cutter GR. Promoting physical activity in low- income African-American communities: the PARR project. Ethnicity and Disease 1993,3:106-118. Logsdon DN, Lazaro CM, Meier RV. The feasibility of behavioral risk reduction in primary medical care. Ameri- can Journal of Preventive Medicine 1989-:5:249-256. Lombard DN, Lombard TN, Winett RA. Walking to meet health guidelines: the effect of prompting frequency and prompt structure. Health Psychology 1995;14: 164-170. Luepker RV. Community trials. Preventive Medicine 1994-23:602-605. Luepker RV, Murray DM, Jacobs DR Jr, Mittelmark MB, Bracht N, Carlaw R, et al. Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program. American Journal of Public Health 1994;84:1383-1393. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, etal. Outcomes ofa field trial to improve children’s dietary patterns and physical activity: the Child and Adolescent Trial for Cardiovascular Health (CATCH). Journal of the American Medical Association 1996:275:768-776. Lynch DJ, Birk TJ, Weaver MT, Gohara AF, Leighton RF, Repka FJ, et al. Adherence to exercise interventions in the treatment of hypercholesterolemia. Journal of Be- havioral Medicine 1992;,15:365-377. Macera CA, Croft JB, Brown DR, Ferguson JE, Lane MJ. Predictors of adopting leisure-time physical activity among a biracial community cohort. American Journal of Epidemiology 1995;142:629-635 Marcus BH, Banspach SW, Lefebvre RC, RossiJS, Carleton RA, Abrams DB. Using the stages of change model to increase the adoption of physical activity among com- munity participants. American Journal of Health Promo- tion 1992:6:424-429. Marcus BH, Eaton CA, Rossi JS, Harlow LL. Self-efficacy, decision-making, and stages of change: an integrative model of physical exercise. Journal of Applied Social Psychology 1994;,24:489-508. Marcus BH, Owen N. Motivational readiness, self-effi- cacy, and decision making for exercise. Journal of Applied Social Psychology 1992;22:3-16. Marcus BH, Pinto BM, Simkin LR, Audrain JE, Taylor ER. Application of theoretical models to exercise behavior among employed women. American Journal of Health Promotion 1994;9:49-55. Marcus BH, Rakowski W, Rossi JS. Assessing motiva- tional readiness and decision making for exercise. Health Psychology 1992;11:257-261. Marcus BH, Selby VC, Niaura RS, Rossi JS. Self-efficacy and the stages of exercise behavior change. Research Quarterly for Exercise and Sport 1992;63:60-66. Marcus BH, Stanton AL. Evaluation of relapse prevention and reinforcement interventions to promote exercise adherence in sedentary females. Research Quarterly for Exercise and Sport 1993,64:447-452. Marlatt GA, George WH. Relapse prevention and the maintenance of optimal health In: Shumaker SA, Schron EB, Ockene, editors. The Handbook of Health Behavior Change, New York: Springer Publishing Company, 1990: 44-63. Marlatt GA, Gordon JR. Relapse prevention: maintenance strategies in the treatment of addictive behaviors. New York: Guilford Press, 1985. 255 Understanding and Promoting Physical Activity Mayer JA, Jermanovich A, Wright BL, Elder JP, Drew JA, Williams SJ. Changes in health behaviors of older adults: the San Diego Medicare Preventive Health Project. Preventive Medicine 1994;23:127-133. McAuley E. Efficacy, attributional, and affective responses to exercise participation. Journal of Sport & Exercise Psychology 1991,13:382-393. McAuley E, Courneya KS, Rudolph DL, Lox CL. Enhanc- ing exercise adherence in middle-aged males and fe- males. Preventive Medicine 1994;,23:498-506. McAuley E, Lox C, Duncan TE. Long-term maintenance of exercise, self-efficacy, and physiological change in older adults. Journal of Gerontology 1993;,48:218-224. McKenzie TL, Feldman H, Woods SE, Romero KA, Dahlstrom V, Stone EJ, et al. Children’s activity levels and lesson context during third-grade physical educa- tion. Research Quarterly for Exercise and Sport 1995;66:184-193. McKenzie TL, Nader PR, Strikmiller PK, Yang M, Stone EJ, Perry CL, etal. School physical education: effect of the Child and Adolescent Trial for Cardiovascular Health (CATCH). Preventive Medicine (in press). McKenzie TL, Sallis JF, Faucette N, Roby JJ, Kolody B. Effects of a curriculum and inservice program on the quantity and quality of elementary physical education classes. Research Quarterly for Exercise and Sport 1993;64:178-187. McKenzie TL, Sallis JF, Nader PR, Patterson TL, Elder, JP, Berry CC, Ruff JW, Atkins CJ, Buono MJ, Nelson JA. Beaches: an observational system for assessing children’s eating and physical activity behavior and associated events. Journal of Applied Behavior Analysis 1991, 24: 141-151. McKenzie TL, Strikmiller PK, Stone EJ, WoodsSE, Ehlinger S, Romero KA, etal. CATCH: physical activity process evaluation in a multicenter trial. Health Education Quarterly 1994,21(2 Suppl):$73-S89. McLeroy KR, Bibeau D, Steckler A, Glanz K. An ecological perspective on health promotion programs. Health Education Quarterly 1988;15:35 1-377. McMurray RB, Bradley CB, Harrell JS, Bernthal PR, Frauman AC, Bangdiwala SI. Parental influences on childhood fitness and activity patterns. Research Quar- terly for Exercise and Sport 1993;64:249-255. Minor MA, Brown JD. Exercise maintenance of persons with arthritis after participation in a class experience. Health Education Quarterly 1993,20:83-95. Physical Activity and Health Mirotznik J, Feldman L, Stein R. The health belief model and adherence with a community center-based, super- yised coronary heart disease exercise program. Journal of Community Health 1995;20:233-247. Mittelmark MB, Luepker RV, Jacobs DR, Bracht NF, Carlaw RW, Crow RS, et al. Community-wide preven- tion of cardiovascular disease: education strategies of the Minnesota Heart Health Program. Preventive Medi- cine 1986:15:1-17. Moore LL, Lombardi DA, White MJ, CampbellJL, Oliveria SA, Ellison C. Influence of parents’ physical activity levels on activity levels of young children. Journal of Pediatrics 1991,118:215-219. Mullen PD, Tabak ER. Patterns of counseling techniques used by family practice physicians for smoking, weight, exercise, and stress. Medical Care 1989:27:694-704. Nader PR, Sallis JF, Patterson TL, Abramson IS, RuppJW, Senn KL, etal. A family approach to cardiovascular risk reduction: results from the San Diego Family Health Project. Health Education Quarterly 1989;16:229-244. Nader PR, Taras HL, Sallis JF, Patterson TL. Adult heart disease prevention in childhood: a national survey of pediatricians’ practices and attitudes. Pediatrics 1987;79:843-850. National Association for Sport and Physical Education. Moving into the future: national physical education stan- dards—a guide to content and assessment. New York: Mosby, 1995. National Association of Governor's Councils on Physical Fitness and Sports. Information brochure. Indianapolis: National Association of Governor's Councils on Physi- cal Fitness and Sports, 1996. National Center for Health Statistics. Health, United States, 1990. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service. Centers for Dis- ease Control, National Center for Health Statistics, 1991. National Center for Health Statistics, Kovart MG, LaCroix AZ. Aging in the eighties: ability to perform work- related activities. Data from the supplement on aging to the National Health Interview Survey: United States, 1984. Advance data from Vital and Health Statistics, No. 136. Hyattsville, MD: U.S. Department of Health and Human Services, Public Health Service, National Cen- ter for Health Statistics, May 8, 1987. DHHS Publica- tion No. (PHS)87-1250. National Coalition for Promoting Physical Activity. Na- tional Coalition for Promoting Physical Activity sets its sites (sic) on motivating America (press release). May 31, 1995. 256 National Park Service. An Americans’ network of parks and open space: creating a conservation and recreation legacy. Washington, DC: U.S. Department of the Interior, National Park Service, National Park System Advisory Board, 1994. Neuberger GB, Kasal S, Smith KV, Hassanein R, DeViney S. Determinants of and aerobic fitness in outpatients with arthritis. Nursing Research 1994;43: 11-17. exercise Oldridge NB, Streiner DL. The health belief model: pre- dicting compliance and dropout in cardiac rehabilita- tion. Medicine and Science in Sports and Exercise 1990;22:678-683. Orleans CT, George LK, Houpt JL, Brodie KH. Health promotion in primary care: a survey of U.S. family practitioners. Preventive Medicine 1985;14:636-647. Osler M, Jespersen NB. The effect of a community-based cardiovascular disease prevention project ina Danish municipality. Danish Medical Bulletin 1993:40:485-489. Owen N, Bauman A, Booth M, Oldenburg B, Magnus P. Serial mass-media campaigns to promote physical ac- tivity: reinforcing oF redundant? American Journal of Public Health 1995;85:244-248. Owen N, Lee C, Naccarella L, Haag K. Exercise by mail: a mediated behavior-change program for aerobic exer- cise. Journal of Sport Psychology 1987:9:346-357. Parcel GS, Simons-Morton BG, O'Hara NM, Baranowski T, Kolbe LJ, Bee DE. School promotion of healthful diet and exercise behavior: an integration of organiza- tional change and social learning theory interventions. Journal of School Health 1987;57:150-156. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health: a recommendation from the Centers for Disease Con- trol and Prevention and the American College of Sports Medicine. Journal of the American Medical Asso- ciation 1995;273:402-407. Pate RR, Small ML, Ross JG, Young JC, Flint KH, Warren CW. School physical education. Journal of School Health 1995;65:312-318. Perri MG, McAllister DA, Gange JJ, Jordan RC, McAdoo WG, Nezu AM. Effects of four maintenance programs on the long-term management of obesity. Journal of Consulting and Clinical Psychology 1988;56:529-534. Perry CL, Parcel GS, Stone E, Nader P, McKinlay SM, Luepker RV, Webber LS. The Child and Adolescent Trial for Cardiovascular Health (CATCH): overview of the intervention program and evaluation methods. Cardiovascular Risk Factors 1992.2:36-44. Perry CL, Stone EJ, Parcel GS, Ellison RC, Nader PR, Webber LS, et al. School-based cardiovascular health promotion: the Child and Adolescent Trial for Cardio- vascular Health (CATCH). Journal of School Health 1990;60:406-413. Perusse L, Tremblay A, Leblanc C, Bouchard C. Genetic and environment influences on level of habitual physi- cal activity and exercise participation. American Jour- nal of Epidemiology 1989:129:1012-1022. Poag-DuCharme KA, Brawley LR. Self-efficacy theory: use in the prediction of exercise behavior in the com- munity setting. Journal of Applied Sport Psychology 1993;5:178-194. Poest CA, Williams JR, Witt DD, Atwood ME. Physical activity patterns of preschool children. Early Child- hood Research Quarterly 1989;4:367—-376. Ponichtera-Mulcare JA. Exercise and multiple sclerosis. Medicine and Science in Sports and Exercise 1993;25: 451-465. Powell KE, Dysinger W. Childhood participation in orga- nized school sports as precursors of adult physical activity. American Journal of Preventive Medicine 1987;3:276-281. President's Council on Physical Fitness. The physician’s Rx: exercise. Washington, DC: President's Council on Physi- cal Fitness and Sports, 1992. President's Council on Physical Fitness and Sports and Sporting Goods Manufacturers Association. American attitudes toward physical activity and fitness: a national survey. Washington, DC: President's Council on Physi- cal Fitness and Sports, 1993. Princeton Survey Research Associates. Prevention maga- zines children’s health index. Prevention 1994 Sep. Prochaska JO, DiClemente CC. The transtheoretical ap- proach: crossing traditional boundaries of change. Homewood, IL: Dorsey Press, 1984. Prochaska JO, DiClemente CC. Transtheoretical therapy: toward a more integrative model of change. Psycho- therapy: Theory, Research, and Practice 1982;20:161-173. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behav- iors. American Psychologist 1992.47:1102-1114. Resnicow K, Cohn L, Reinhardt J, Cross D, Futterman R, Kirschner E, et al. A three-year evaluation of the Know Your Body program in inner-city schoolchildren. Health Education Quarterly 1992-19:463-480. 257 Understanding and Promoting Physical Activity Reynolds KD, Killen JD, Bryson SW, Maron DJ, Taylor CB, Maccoby N, etal. Psychosocial predictors of physi- cal activity in adolescents. Preventive Medicine 1990;19:541-551. Robertson D, Keller C. Relationships among health be- liefs, self-efficacy, and exercise adherence in patients with coronary artery disease. Heart and Lung 1992.21:56-63. Robison JI, Rogers MA, Carlson JJ, Mavis BE, Stachnik T, Stoffelmayr B, et al. Effects of a 6-month incentive- based exercise program on adherence and work capac- ity. Medicine and Science in Sports and Exercise 1992;24:85-93. ° Rosenstock IM. The health belief model: explaining health behavior through expectancies. In: health behavior and health education. Theory, research, and practice. San Francisco: Jossey-Bass Publishers, 1990:39-62. Rosenstock IM, What research in motivation suggests for public health. American Journal of Public Health 1960;50:295-301. Rosenstock IM. Why people use health services. Milbank Memorial Fund Quarterly 1966;44(Suppl):94-124. Rosenstock IM, Strecher VJ, Becker MH. Social learning theory and the health belief model. Health Education Quarterly 1988-15:175-183. Rowland TW. Exercise and children’s health. Champaign, IL: Human Kinetics, 1990. Sallis JF, Alcaraz JE, McKenzie TL, Hovell MF, Kolody B, Nader PR. Parental behavior in relation to physical activity and fitness in 9-year-old children. American Journal of Diseases of Children 1992:146:1383-1388. Sallis JF, Hovell MF, Hofstetter CR. Predictors of adoption and maintenance of vigorous physical activity in men and women. Preventive Medicine 1992;21:237-251. Sallis JF, Hovell MF, Hofstetter CR, ElderJP, Hackley M, Caspersen CJ, et al. Distance between homes and exercise facilities related to frequency of exercise among San Diego residents. Public Health Reports 1990; 105:179-185. Sallis JF, Hovell MF, Hofstetter CR, Faucher P, Elder JP, Blanchard J, et al. A multivariate study of determinants of vigorous exercise ina community sample. Preventive Medicine 1989;18: 20-34. Sallis JF, McKenzie TL, Alcaraz JE. Habitual physical activity and health-related physical fitness in fourth- grade children. American Journal of Diseases of Children 1993,147:890-896. Physical Activity and Health Sallis JF, Nader PR, Broyles SL, Berry Cc, Elder JP, McKenzie TL, et al. Correlates of physical activity at home in Mexican-American and Anglo-American pre- school children. Health Psychology 1993;12:390-398. Sallis JF, Patterson TL, Buono MJ, Atkins CJ, Nader PR. Aggregation of physical activity habits in Mexican- American and Anglo families. Journal of Behavioral Medicine 1988;11:31-41. Sallis JF, Patterson TL, McKenzie TL, Nader PR. Family variables and physical activity in preschool children. Journal of Developmental and Behavioral Pediatrics 1988;9:57-61. Sallis JF, Simons-Morton BG, Stone EJ, Corbin CB, Epstein LH, Faucette N, etal. Determinants of physical activity and interventions in youth. Medicine and Science in Sports and Exercise 1992:24(6 Suppl):$248-S257. Schmid TL, Pratt M, Howze E. Policy as intervention: environmental and policy approaches to the preven- tion of cardiovascular disease. American Journal of Public Health 1995;85:1207-12H1. Sharp PA, Connell CM. Exercise beliefs and behaviors among older employees: a health promotion trial. Gerontologist 1992:32,444-449. Shephard RJ. Worksite fitness and exercise programs: a review of methodology and health impact. American Journal of Health Promotion (in press). Simons-Morton BG, Parcel GS, Baranowski T, Forthofer R, O'Hara NM. Promoting physical activity and a healthful diet among children: results of a school- based intervention study. American Journal of Public Health 1991;81:986-991. Simons-Morton BG, Parcel GS, O'Hara NM. Implement- ing organizational changes to promote healthful diet and physical activity at school. Health Education Quar- terly 1988-15:115-130. Simons-Morton BG, Parcel GS, O'Hara NM, Blair SN, Pate RR. Health-related physical fitness in childhood: status and recommendations. Annual Review of Public Health 1988;9:403-425. Simons-Morton BG, Taylor WC, Snider SA, Huang IW. The physical activity of fifth-grade students during physical education classes. American Journal of Public Health 1993;83:262-264. Simons-Morton BG, Taylor WC, Snider SA, Huang IW, Fulton JE. Observed levels of elementary and middle school children’s physical activity during physical edu- cation classes. Preventive Medicine 1994,23:437-441. 258 Simons-Morton DB, Simons-Morton BG, Parcel GS, Bunker JF. Influencing personal and environmental conditions for community health: a multilevel inter- vention model. Community Health 1988;11:25-35. Skinner BF. Science and human behavior. New York: Free Press, 1953. Skinner CS, Strecher VJ, Hospers H. Physicians’ recom- mendations for mammography: do tailored messages make a difference? American Journal of Public Health 1994:84:43-49. Stokols D. Establishing and maintaining healthy environ- ments: toward a social ecology of health promotion. American Psychologist 1992;47:6-22. Stone EJ. Foreword to process evaluation in the Multicenter Child and Adolescent Trial for Cardiovascular Health (CATCH). Health Education Quarterly 1994;21(2 Suppl):S3-S4. Stone EJ, Baranowski T, Sallis JF, Cutler JA. Review of behavioral research for cardiopulmonary health: em- phasis on youth, gender, and ethnicity. Journal of Health Education 1995;26(Suppl):S9-S17. Strasburger VC. Children, adolescents, and television. Pediatrics in Review 1992-13:144-151. Stucky-Ropp RC, DiLorenzo IM. Determinants of exercise in children. Preventive Medicine 1993;22:880-889. Taggart HM, Connor SE. The relation of exercise habits to health beliefs and knowledge about osteoporosis. Jour- nal of American College Health 1995;44:127-130. Tappe Mk, Duda JL, Menges-Ehrnwald P. Personal in- vestment predictors of adolescent motivation orienta- tion toward exercise. Canadian Journal of Sport Sciences 1990;15:185-192. Tinsley BJ, Holtgrave DR, Reise SP, Erdley C, Cupp RG. Developmental status, gender, age, and self-reported decision-making influences on students’ risky and preventive health behaviors. Health Education Quar- terly 1995,22:3244-259. Treiber FA, Baranowski T, Braden DS, Strong WB, Levy M, Knox W. Social support for exercise: relationship to physical activity in young adults. Preventive Medi- cine 1991;20:737-750. Troiano RP, Flegal KM, Kaczmarski RJ, Campbell SM, Johnson CL. Overweight prevalence and trends for children and adolescents. The National Health and Nutrition Examination Surveys, 1963 to 1991. Ar chives. Pediatriatrics and Adolescent Medicine 1995; 149:1085-1091. Trost SG, Pate RR, Dowda M, Saunders R, Ward DS, Felton G. Gender differences in physical activity and determinants of physical activity in rural fifth grade children. Journal of School Health 1996,66:145-150. U.S. Department of Agriculture, U.S. Department of Health and Human Services. Nutrition and your health: di- etary guidelines for Americans. 4th ed. Washington, DC: U.S. Department of Agriculture, 1995. Home and Garden Bulletin No. 232. U.S. Department of Health and Human Services. Healthy people 2000: national health promotion and disease pre- vention objectives. Washington, DC: U.S. Department of Health and Human Services, Public Health Service, 1990, DHHS Publication No. (PHS)91-50212. U.S. Department of Health and Human Services. 1992 National Survey of Worksite Health Promotion Activities. Washington, DC: Office of Disease Prevention and Health Promotion, Winter and Spring 1993. U.S. Department of Transportation. Final report: the Na- tional Bicycling and Walking Study: transportation choices for achanging America. Washington, DC: U.S. Depart- ment of Transportation, Federal Highway Administra- tion, 1994. Publication No. FHWA-PD-94-023. U.S. Department of Transportation, Zehnpfenning G. Measures to overcome impediments to bicycling and walk- ing: the National Bicycling and Walking Study, case study No. 4. Washington, DC: U.S. Department of Transportation, Federal Highway Administration, 1993. Publication No. FHWA-PD-93-031. U.S. Preventive Services Task Force. Guide to clinical preventive services. Baltimore: Williams and Wilkins, 1989. US. Preventive Services Task Force. Guide to clinical preventive services. 2nd ed. Baltimore: Williams and Wilkins, 1996. Walter HJ. Primary prevention of chronic disease among children: the school-based Know Your Body intervention trials. Health Education Quarterly 1989;16:201-214. Weber J, Wertheim EH. Relationships of self-monitoring, special attention, body fat percent, and self-motivation to attendance at a community gymnasium. Journal of Sport and Exercise Psychology 1989;11:105-114. Wechsler H, Levine S, Idelson RK, Schor EL, Coakley E. The physician's role in health promotion revisited—a survey of primary care practitioners. New England Journal of Medicine 1996,334:996-998. 259 Understanding and Promoting Physical Activity Weiss CH. Research evaluation; methods for assessing pro- gram effectiveness. Englewood Cliffs, NJ; Prentice-Hall, Inc., 1972. Wells KB, Lewis CE, Leake B, Schleiter MK, Brook RH. The practices of general and subspecialty internists in counseling about smoking and exercise. American Jour- nal of Public Health 1986;76:1009-1013. Wells KB, Lewis CE, Leake B, Ware JE Jr. Do physicians preach what they practice? A study of physicians’ health habits and counseling practices. Journal of the American Medical Association 1984;252:2846-2848. Wilbur CS. The Johnson and Johnson program. Preven- tive Medicine 1983:12:672-681. Williams CL, Carter BJ, Eng A. The Know Your Body program: a developmental approach to health educa- tion and disease prevention. Preventive Medicine 1980, 9:371-383. Wilson MG, Crossman L, Davis D, McCarthy. Pychosocial and organizational characteristics of fitness program participants. American Journal of Health Promotion 1994: 8;422-424. Wing RR. Changing diet and exercise behaviors in indi- viduals at risk for weight gain. Obesity Research 1995, 3(Suppl 2):277-282. Winkleby MA. The future of community-based cardio- vascular disease intervention studies. American Jour- nal of Public Health 1994;84: 1369-1372. Yordy GA, Lent RW. Predicting aerobic exercise partici- pation: social cognitive, reasoned action, and planned behavior models. Journal of Sport and Exercise Psychol- ogy 1993;,15:363-374. Young DR, Haskell WL, Taylor CB, Fortmann SP. Effect of community health education on physical activity knowledge, attitudes, and behavior: the Stanford Five- City Project. American Journal of Epidemiology (in press). Zakarian JM, Hovell MF, Hofstetter CR, Sallis JF, Keating KJ. Correlates of vigorous exercise ina predominantly low SES and minority high school population. Preven- tive Medicine 1994,23:314-321. Physical Activity and Health LIST OF TABLES AND FIGURES Chapter 2: Historical Background, Terminology, Evolution of Recommendations, and Measurement en ac een cc ee Table 2-1. | Glossary of terms Table 2-2. Selected physical activity recommendations in the United States (1965-1996) Table 2-3. Assessment procedures and their potential use in epidemiologic research Table 2-4. Classification of physical activity intensity, based on physical activity lasting up to 60 minutes Table 2.5. Correlation of twosurvey instruments with physiologic measures of caloric exchange Chapter 3: Physiologic Responses and Long-Term Adaptations to Exercise Table 3-1. | A summary of hormonal changes during an episode of exercise Table 3-2. Ahypothetical example of alterations in selected physiological variables consequent to a 6-month endurance training program in a previously sedentary man compared with those of a typical elite endurance runner Figure 3-1. Changes in cardiac output (A), heart rate (B), and stroke volume (C) with increasing rates of work on the cycle ergometer Figure 3-2. Changes in arterial and mixed venous oxygen content with increasing rates of work on the cycle ergometer Figure 3-3. Changes in oxygen uptake and blood lactate concentrations with increasing rates of work on the cycle ergometer Figure 3-4. Changes in VO, max with increasing age from 6 to 18 years of age in boys and girls Figure 3-5. Changes in VO, max with aging, comparing an active population and sedentary population (the figure also illustrates the expected increase in VO, max when a previously sedentary person begins an exercise program) Chapter 4: The Effects of Physical Activity on Health and Disease Table 4-1. Population-based studies of association of physical activity or cardiorespiratory fitness with total cardiovascular diseases Table 4-2. Population-based studies of association of physical activity or cardiorespiratory fitness with coronary heart disease Table 4-3. Population-based studies of association of physical activity with stroke (CVA) Table 4-4. Population-based cohort studies of association of physical activity with hypertension 261 A Report of the Surgeon General Table 4-5. Table 4-6. Table 4-7. Table 4-8. Table 4-9. Epidemiologic studies of leisure-time oF leisure-time plus occupational physical activity and colon cancer Epidemiologic studies of leisure-time OT leisure-time plus occupational physical activity and hormone-dependent cancers in women Epidemiologic studies of leisure-time or total physical activity or cardiorespiratory fitness and prostate cancer Cohort studies of association of physical activity with non-insulin-dependent diabetes mellitus (NIDDM) Longitudinal population-based studies of physical activity as related to depressive symptoms Table 4-10. Duration of various activities to expend 150 kilocalories for an average 70 kg adult Chapter 5: Patterns and Trends in Physical Activity Table 5-1. Table 5-2. Table 5-3. Table 5-+. ‘Table 5-5. Table 5-6. Table 5-7. Sources of national and state-based data on physical activity Percentage of adults aged 18+ years reporting no participation in leisure-time physical activity, by various demographic characteristics, National Health Interview Survey (NHIS), Third National Health and Nutrition Examination Survey (NHANES If), and Behavioral Risk Factor Surveillance System (BRFSS), United States Percentage of adults aged 18+ years reporting participation in no activity; regular, sustained activity; and regular, vigorous activity, by state,” Behavioral Risk Factor Surveillance System (BRFSS), 1994, United States Percentage of adults aged 18+ years reporting participation in regular, sustained physical activity (5+ times per week for 30+ minutes per occasion), by various demographic characteristics, National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS), United States Percentage of adults aged 18+ years participating in regular, vigorous physical activity (3+ times per week for 20+ minutes per occasion at 50+ percent of estimated age- and sex-specific maximum cardiorespiratory capacity) by various demographic characteristics, National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS), United States Percentage of adults aged 18+ years reporting participation in selected common physical activities in the prior 2 weeks, by sex and age, National Health Interview Survey (NHIS), United States, 1991 Percentage of adults aged 18+ years reporting participation in any strengthening activities or stretching exercises in the prior 2 weeks, by various demographic characteristics, National Health Interview Survey (NHIS), United States, 1991 262 Table 5-8. Table 5-9. Table 5-10. Table 5-11. Table 5-12. Table 5-13. Table 5-14. Table 5-15. Table 5-16. Figure 5-1. Figure 5-2. Figure 5-3. Figure 5-4. Physical Activity and Health Trends in the percentage of adults aged 18+ years reporting participation in no activity; regular, sustained activity; and regular, vigorous activity, by sex, National Health Interview Survey (NHIS) and Behavioral Risk Factor Surveillance System (BRFSS), from 1985-1994 Percentage of young people reporting no participation in vigorous or moderate physical activity during any of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS-YRBS) and 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of young people reporting participation in vigorous physical activity during 3 or more of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS- YRBS) and 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of young people reporting participation in strengthening or toning activities during 3 or more of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS-YRBS) and 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of young people reporting participation in stretching activities during 3 or more of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS-YRBS) and 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of young people reporting participation in walking or bicycling for 30 minutes or more during 5 or more of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS-YRBS) and 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of young people reporting participation in selected physical activities during 1 or more of the 7 days preceding the survey, by demographic group, 1992 National Health Interview Survey-Youth Risk Behavior Survey (NHIS-YRBS), United States . Percentage of students in grades 9-12 reporting enrollment in physical education class, daily attendance in physical education class, and participation in exercise or sports for at least 20 minutes during an average physical education class, by demographic group, 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of students in grades 9-12 reporting participation on at least one sport team run by a school or by other organizations during the year preceding the survey, by demographic group, 1995 Youth Risk Behavior Survey (YRBS), United States Percentage of adults aged 18+ years reporting no participation in leisure-time physical activity by sex and age Percentage of adults aged 18+ years reporting no participation in leisure-time physical activity by month Trends in leisure-time physical activity of adults aged 18+ years, NHIS Trends in the percentage of adults aged 18+ years participating in no leisure-time activity, BRFSS 263 A Report of the Surgeon General Chapter 6: Understanding and Promoting Physical Activity Table 6-1. Table 6-2. Table 6-3. Table 6-4. Table 6-5. Figure 6-1. Figure 6-2. Summary of theories and models used in physical activity research Studies of interventions to increase physical activity among adults Summary of progress toward Healthy People 2000 objective 1.10 Percentage of all physical education courses in which more than one class period was devoted to each activity, by activity, School Health Policies and Programs Study, 1994 Studies of interventions to increase physical activity among children and adolescents Results of the Minnesota Heart Health Program on physical activity. Graph compares the percentage of respondents reporting regular physical activity in intervention cities and the secular trend estimated from control cities Moderate-to-vigorous and vigorous physical activity observed during Child and Adolescent Trial for Cardiovascular Health (CATCH) physical education classes 264