Instant Recess: Building a Fit Nation 10 Minutes at a Time - Softcover

Yancey, Toni

Softcover

ISBN 10: 0520263766 ISBN 13: 9780520263765

Publisher: University of California Press, 2010

Synopsis

This lively, inspiring, and informative book zeroes in on the state of American fitness-persistently sedentary, plagued by obesity-and issues a clarion call to action that reaches across economic, racial, and educational lines. Toni Yancey finds that despite our best intentions and repeated resolutions to exercise, as well as a 40-year investment in fitness education and counseling, physical activity in all levels of society continues to plummet. In a warm, reader-friendly narrative that draws on solid scientific research, personal experience, and her own poetry, Yancey calls for a radically different approach: one that respects diversity and is grounded in the cultures of those most at risk. Instant Recess proposes regular ten-minute exercise breaks that utilize music and dance and are easily incorporated into school, work, and community life. Rather than encouraging unhealthful habits like cigarette breaks or high fat snacks, these "instant recesses" make the active choice the natural one. Here is a new paradigm for fitness and public health that promises vitality, well being, and a greater sense of community-demonstrating, as Yancey argues, that what's good for the waistline is good for the bottom line.

About this title

About the Author

Toni Yancey, MD, MPH, is Professor in the Department of Health Services and Co-Director of the UCLA Kaiser Permanente Center for Health Equity at the School of Public Health, University of California, Los Angeles.

From the Back Cover

"Toni Yancey's book is a terrific tool as we work together to promote healthy and active lifestyles."--Bill Clinton

"Instant Recess is a call to all of us to get up and move. Part personal memoir, part public health manifesto, and part poetry, Yancey's warmth and enthusiasm shine through this book. I'm betting that she can convince anyone that moving more is not only good for health, but easy and lots of fun to do."--Marion Nestle, author of What to Eat

"In Instant Recess, Dr. Yancey provides the tools to get America moving, in a very accessible style with the scientific research to back it up. Her call to incorporate short exercise breaks into routine, daily activities is one step that can create a true wellness society."--Senator Tom Harkin (D-IA), Chairman, Senate HELP Committee

"Dr. Toni (Antronette) Yancey has influenced and impacted community health and fitness in a number of profound ways! Her book is a must read for anyone interested in living a longer, healthier, and more fulfilling life. Recently, at the First AME Church of Los Angeles, we incorporated a quick but effective fitness interlude into all three of our Sunday worship services. The enthusiastic response from our congregation was tremendous! Thank you, Dr. Yancey, for waking us up to the dangers of our sedentary lives and for awakening our desire to get into better physical shape."--Rev. Dr. John & Denise Hunter, Pastor and First Lady of First AME Church of Los Angeles, the White House-designated local lead agency for Michelle Obama's Let's Move LA

"Instant Recess is a necessary part of a complex solution to our society's epidemic of inactivity. It can work equally well in the corporate boardroom, school classroom, or for fans at a sporting event for that matter. It is a great place to start if we don't want to leave anyone behind. I'm all for breaking our national inertia with a musical beat and a smile on our faces."--Dave Winfield, National Baseball Hall of Fame 2001, Executive Vice President and Senior Advisor, San Diego Padres

"Dr. Yancey writes on a topic about which she is both passionate and knowledgeable. Doable in just about any setting, Instant Recess could get America moving again."--David Satcher, M.D., Ph.D., 16th Surgeon General of the United States

"Instant Recess is an excellent, easy to read, informative book describing how we must all change our lifestyle patterns and incorporate activity into our day. Yancey poignantly shows why 'instant recesses' are needed by corporate Americans, educators, public health and medical professionals. This isn't just a simple how-to book, but also a how-come."--Francine Kaufman, Head of the Center for Diabetes, Endocrinology and Metabolism at Childrens Hospital Los Angeles

"For the average person who continues to yo-yo between the hype of miracle weight loss gimmicks and the allure of fast food franchises, Instant Recess offers an easy and free solution to creating a healthier lifestyle."--Sharon Baucom, Medical Director of the Department of Public Safety and Correctional Services for the State of Maryland

"A thoughtful and innovative approach to community-wide physical activity from a lay person's perspective. This book is well grounded in scientific evidence that is also contextualized in simple examples and in real life experiences people will be able to relate to."--Adrian Bauman, University of Sydney

"I've seen everyone from curmudgeonly researchers and uptight bureaucrats to former elite athletes to avowed non-exercisers sucked in by the warm, inclusive energy and ease of her approach to getting people physically active. Most are smiling, some outright laughing as they rediscover the joy of moving. Thankfully, Toni captures the essence of that joy in her book, along with the practical guidance necessary to help anyone start making physical activity a part of their life and their community again."--Mark Fenton, PBS television host and author of The Complete Guide to Walking for Health, Weight Loss, and Fitness

"I read Instant Recess and couldn't help but jump for joy. Dr. Yancey's got the recipe for success to help turn around the epidemic of inactivity in our country. Finally we have a book that shows Americans how to build that strong base of fitness, 10 minutes of hip hopping at a time. Now, if you'll excuse me. It's time for me to take my Instant Recess."--Pam Peeke MD, MPH, FACP, author of Body for Life for Women, Chief Medical Correspondent for Nutrition and Fitness, Discovery Health TV

"Through the San Diego Padres organization we've worked with Dr. Toni Yancey for nearly 4 years on various healthy eating and fitness related projects ... Dr. Yancey is an educated, dynamic, trusted and respected colleague who has a thorough knowledge of public health issues. Her knowledge, advocacy and connection to community service organizations across the country has been key. She's recruited a great number of them to enter the fight against childhood obesity by offering a wide variety of active lifestyles options. Influencing America to move towards healthy eating, better nutrition, and into her activity routine called Instant Recess is a significant and continuous task ... It's a pleasure working with this former collegiate athlete, Ph.D. and public servant. We need more people like Dr. Toni Yancey combatting this nationwide health crisis."--David Winfield, member of the Baseball Hall of Fame, and Co-Director at UCLA Kaiser Permanente Center for Health Equity

Excerpt. © Reprinted by permission. All rights reserved.

Instant Recess

Building a Fit Nation 10 Minutes at a Time

By Toni Yancey

UNIVERSITY OF CALIFORNIA PRESS

Copyright © 2010 Antronette K. Yancey, MD, MPH
All rights reserved.

ISBN: 978-0-520-26376-5

Contents

Preface, ix, 
Acknowledgments, xi, 
Abstract, xiii, 
Introduction, 1, 
1 The High Price of a Sedentary America and the Challenge of Getting Society Moving, 22, 
2 The Benefits of Widespread Physical Activity and Opportunities to Move the Needle, 54, 
3 The Evolution of an Idea, 78, 
4 The Marketing and Social Marketing of Physical Activity and Fitness, 108, 
5 The Case for the Instant Recess Model, 140, 
6 Instant Recess—What's Good for the Waistline Is Good for the Bottom Line!, 175, 
7 A Glimpse into the Future: How the Recess Model Sparked a Physical Activity Movement, 219, 
References, 241, 
About the Author, 253, 
Index, 255, 

CHAPTER 1

The High Price of a Sedentary America and the Challenge of Getting Society Moving

THE LURE OF THE COUCH IS COSTING US AND KILLING US!

Health

Unless trends change quickly, the current generation will be the first to lead shorter and sicker lives than their parents (Olshansky et al. 2005). Many of them won't live to see their grandchildren!

Hollywood images aside, being sedentary is the norm in America. According to the National Health and Nutrition Survey, 95 percent of Americans do not get enough physical activity (Troiano et al. 2008), but even that figure is an underestimate of Americans' love affair with their couches. We get an average of 10 minutes of moderate to vigorous physical activity every day, at best, and spend most of our waking time—more than nine hours per day—sitting, reclining, or lying down (Owen, Bauman, and Brown 2009).

That's the national average. Physical activity levels are even lower in less affluent or ethnic minority populations. In Los Angeles County, one of the most culturally diverse locales in the nation, more than 40 percent of residents report less than 10 minutes of continuous physical activity per week (Yancey, Wold, et al. 2004).

Physical inactivity drives up the risks for many chronic diseases (Physical Activity Guidelines Advisory Committee 2008; Breslow and Breslow 1993; Mokdad et al. 2004). It's on a par with smoking and high blood lipid levels as an independent risk factor for heart disease and stroke, and it also increases the risk of diabetes, osteoporosis and hip fractures, breast and colon cancer, Alzheimer's disease, depression, and other chronic conditions (Physical Activity Guidelines Advisory Comm. 2008).

Physical inactivity also contributes to the energy imbalance producing obesity. Obesity is pandemic in modern society, with two in three US adults now classified as overweight or obese (Ogden et al. 2006). Obesity and sedentariness are a lethal combination driving illness, disability, and death. Obesity not only exacerbates inactivity-related health conditions but also adds a litany of indirectly related problems: cancers of the uterus, ovary, prostate, esophagus, stomach, lung, pancreas, rectum, and liver; gall bladder disease; knee osteoarthritis and gout; low back pain; increased risk from anesthesia; reproductive hormone abnormalities, impaired fertility, and fetal defects; and sleep apnea (US Department of Health and Human Services 2001). The epidemics of obesity and sedentariness are projected to take a tremendous toll on American health, productivity, and economic growth, exacerbated by the browning and graying of the population. Sedentariness and obesity are clearly eroding the strides we've made in fighting heart disease and diabetes (Olshansky et al. 2005).

I spoke of the browning of society: lower-income communities and communities of color continue to be plagued by higher levels of obesity and illness, disability, and death due to chronic diseases (Flegal et al. 2002; Truong and Sturm 2005). For example, among middle-aged Americans, 60 percent of white women were overweight or obese in 2001–2, compared with 80 percent of black and Mexican American women (Flegal et al. 2002).

Childhood obesity is a growing problem (Ogden et al. 2006; Freedman et al. 2006). About 16 percent of school-age children and adolescents are obese (Ogden et al. 2006). That's a threefold increase in young kids, and a fourfold increase for teenagers, from past decades. In communities of color, childhood obesity is much more common (Freedman et al. 2006). Rates of overweight and obesity top 50 percent in many urban school districts (Slusser et al. 2005). A similar escalation in excess weight has even occurred in infants and toddlers (Wang and Lobstein 2006).

Wealth

The dangerous combination of expanding waistlines and pervasive sedentary behavior may spell disaster for the health, economic, and social security of the United States. Beyond the high toll on individuals and families from loss of earnings, job and income security, and retirement flexibility, the costs are mounting for employers. Physically inactive or obese workers have higher rates of absenteeism, attrition, health care costs, injury, short- and long-term leaves, and workers' comp claims (Anderson et al. 2005; Chenoweth 2005). Moreover, from the standpoint of the company's bottom line, productivity and morale are down and "presenteeism" (occupying your chair but doing little or no work) is up among these employees.

At a time when youth are increasingly at risk for diabetes and heart disease, health care demand and costs for young workers are expected to rise considerably over the next few decades. This will coincide with the time of peak demand from aging baby boomers, overwhelming our medical care system, and the nation's increasing ethnic diversity—over half ethnic minority by 2060 (Yancey, Bastani, and Glenn 2007). However, the intangible costs of obesity are also highly significant: fewer years of productivity and a diminished quality of life, like not living to see your grandchildren grow up. Medicare data suggest that obese seventy-year-olds will spend 40 percent more time disabled than normal-weight people of that age (Lakdawalla, Bhattacharya, and Goldman 2004). Personal losses due to the obesity crisis are not as easy to quantify but do have a tremendous impact on society. These costs will only escalate as obesity continues to affect younger and younger populations.

Sedentariness and obesity affect not only our national productivity but also US corporations' global competitiveness in a tightening economy. Physical inactivity has become so commonplace that the costs imposed on society by people with sedentary lifestyles (for example, for the treatment of diabetes and other chronic diseases in the uninsured) rival those imposed by smokers and heavy drinkers (Keeler et al. 1989; Sturm 2002). In fact, the majority of the population fails to achieve the amount of regular activity necessary to maintain a desirable weight—no matter how little they eat! US expenditures related to overweight, obesity, and low levels of physical activity have been estimated at 27 percent of the total costs of health care in 2005. More than 10 percent were attributed to physical inactivity alone (Anderson et al. 2005).

Obesity is estimated to have cost the United States $117 billion in 2000 and $147 billion in 2008 (Finkelstein et al. 2009). In California alone, the total direct and indirect costs of physical inactivity, obesity, and overweight were more than $21 billion in 2005 (Chenoweth 2005). That's $638 per resident, $1,516 per worker, and $28,011 per work site—or one out of thirteen health care dollars. These costs were projected to rise 32 percent over a five-year period, making a convincing case for effective and immediate intervention (Chenoweth 2005).

Meanwhile, resources are short and dwindling. A survey distributed to the health officers from seventeen of the largest US metropolitan areas revealed that on average less than 2 percent of their budgets were allocated to chronic disease even though chronic diseases account for 70 percent of all deaths nationwide (Georgeson et al. 2005). Another startling stat from the Centers for Disease Control and Prevention is that public health measures like enforcing housing standards and ensuring clean water were responsible for twenty-five of the thirty years of life expectancy added during the twentieth century. But the lion's share of the $1.3 trillion spent annually on health went to curative medicine, which added only five years to our lives (Kessel, Beato, and Royall 2004). And if chronic disease overall gets little funding, physical activity's share is minuscule. My colleagues and I reported in a review published a few years ago that few schools of public health or local health departments have physical activity programs (Yancey et al. 2007). The California Department of Public Health, for example, the largest state health department in the nation, only recently increased the number of employees available to address the physical activity needs of more than 33 million residents, from two to thirteen (Dorfman and Yancey 2009). Consequently, attention to physical activity has often been assigned by default to nutrition staff with few additional resources and variable levels of interest or training in the subject.

THE CHALLENGE: THE DECK IS STACKED AGAINST US!

The American Nightmare

It may sound odd after all those dismal figures, but Americans are highly motivated to get fit. Starting or resuming exercise regimens is the most popular New Year's resolution, mostly because of our desire to lose weight. Obesity is almost universally stigmatized in mainstream American culture, particularly in women. Being heavy is equated with stupidity and laziness. One study found that the quality of life for a severely obese child is equivalent to that of a pediatric cancer patient undergoing chemotherapy (Schwimmer, Burwinkle, and Varni 2003). And being skinny is equated with intellect, drive, and attractiveness. Americans spend $40 billion a year on weight loss products (Bryant 2001). At any given time, more than one-third of men and nearly half of women say they are trying to lose weight (Timperio et al. 2000). But only 5 percent, at best, of people who start weight loss programs achieve long-term success (Mann et al. 2007). Most people only exacerbate the problem by repeatedly losing fat and muscle, then regaining only fat. This amplifies the trends toward heavier and less fit Americans seen since the 1970s. This is, in large part, an unintended consequence of the generally greater focus on dieting for quick results on the scale, with insufficient attention to, or success at, increasing physical activity, particularly resistance exercise.

So what exactly is the solution to our collective yo-yo attempts at fitness, leanness, and wellness? Better understanding the problem is the first step toward solving it.

Biology Is Destiny

Genetically, we haven't changed much from our hunter-gatherer and agrarian ancestors. We have been programmed by evolution over the millennia as behavioral opportunists—to avoid exercise as adults and to prefer sweet, salty, and fatty foods (Eaton et al. 2002; Rowland et al. 2008). These predilections enhanced our survival odds during famine. For most of our history on this planet, we expended more than 5,000 calories every day securing food and shelter and escaping or eliminating predators (Bellisari 2008). There's no intrinsic biological drive concomitant to hunger that prompts activity in adulthood. Quite the contrary—conserving energy for utilitarian purposes probably kept our ancestors from starving. Acquiring enough calories for survival at the lowest possible energy cost has been a powerful selective force throughout human evolutionary history (Bellisari 2008; Katzmarzyk and Mason 2009; Landsberg 2008; Reaven 1999). So people who disdained activity in their leisure time probably had a survival advantage, and most of us got those genes! But that was thousands of years ago. Why are we fatter and less fit than our mothers and fathers? Little change has occurred in leisure time physical activity during the past several decades of the accelerating obesity and chronic disease epidemic, suggesting a significant decrease in obligatory or incidental physical activity as the culprit (Brownson, Boehmer, and Luke 2005). Obligatory activity, unlike exercise per se, is utilitarian in nature, not aimed at enhancing health or enjoying leisure time. Certainly, even as dietary quality erodes, calorie density and portion sizes—along with the ever-growing palatability, accessibility, and commercial marketing of food—are expanding right along with our waistlines and contributing to "diabesity" (Kaufman 2005; Passe, Horn, and Murray 2000).

Movement Squeezed Out of Work, Leisure, and Transport

Americans didn't suddenly lose our discipline and resolve—times have changed! We're surrounded by a plethora of people-moving machines and seductive entertainment that keeps us riveted to our seats, just as we're inundated with a smorgasbord of succulent, pervasively and insidiously marketed, cheap, highly processed, nutrient-poor but calorie-dense foods.

Good ol' American ingenuity in engineering and technology development has robbed us of the need to burn calories as we move (more often sit) through the day. People used to be paid to be active because many jobs required hard physical labor. While there are still many low-wage jobs that are extremely demanding physically (such as hotel workers who clean ten to fifteen rooms an hour, or dockworkers who unload shipped goods), overall occupational activity has plunged, while sitting has skyrocketed. Labor-saving technology and globalization have shifted workers away from agricultural and manufacturing occupations and toward service and entertainment jobs, which demand far less energy. Computers, e-mail, text messaging, webcasting, and other technology-based communications continue the trend toward small but significant reductions in calorie burning across a broad range of types of work.

The other major trend, this one partially subsidized by the federal government and supported by commercial interests, is the increasing use of private transportation, favoring the car over the pedestrian, bicyclist, or transit rider. Walking or biking churns through calories, and even catching trains and buses requires more walking than driving door to door. So while leisure time activity has remained stagnant, the proportion of US workers commuting by car, truck, or van has increased over the past several decades, as has the use of autos for all types of trips (French, Story, and Jeffery 2001). Based on Department of Transportation data, calculations by the Centers for Disease Control and Prevention suggest that one in four trips we took in the late 1990s was less than a mile and that three in four of those were made by car (UCLA School of Public Health 2003). Kids commute, too—to school. Two-thirds walked or biked to school in 1974, but that dropped to less than 15 percent in 2001 (US Centers for Disease Control and Prevention 2007). That means millions of kids losing an excellent, easy opportunity to burn off some of the pop and chips they eat at lunch.

Urban sprawl and suburbanization have contributed to our dependence on automobiles. This is a result not only of limited or inconvenient public transportation and mega-malls but also of a lack of sidewalks, protected crosswalks and bridges, foot or bike paths connecting neighborhoods or areas of a city or town, and other pedestrian amenities. Public policy has also undermined active leisure. Tax dollars have gone to spectator sports like stadium construction rather than community recreational facilities. School physical education has traditionally been geared more toward cultivating elite athletic talent for revenue-generating collegiate and professional sports, such as men's football and basketball, than teaching kids skills for lifetime physical activity pursuits for their leisure time. This hurts the vast majority of youth, especially girls, as I discussed in a Richmond Times Dispatch editorial (1997), "Sports Are Good for Girls," when I was a local public health director. Athletics, I wrote,

can decrease their engagement in risky behaviors such as substance use and sexual activity, prevent depression.... Importantly, developing athletic competence can help focus girls more on what their bodies can do than just how they look. Small triumphs in sports can support the confidence and self-esteem for independent and aggressive pursuits in other areas....

In our society, however, engagement in physical activity has been considered unfeminine. This parallels the far-too-frequent overshadowing of competence by appearance in its treatment of women.

Women are told how to look, act and be, and are ridiculed or labeled derisively when they don't conform. That message is obviously received and validated by pubescent girls. For instance, middle school girls of color in focus group studies conducted at UCLA and the University of Texas identified an unwillingness to disturb their hair and make-up as the primary barrier to their participation in exercise. Not surprisingly, another major barrier was gender inequity in their instruction by male PE teachers. In the words of one girl, "[I]f there's only one ball, the boys get it!"

(Continues...)

Excerpted from Instant Recess by Toni Yancey. Copyright © 2010 Antronette K. Yancey, MD, MPH. Excerpted by permission of UNIVERSITY OF CALIFORNIA PRESS.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Edition details

• Publisher: University of California Press
• Publication date: 2010
• Language: English
• ISBN 10: 0520263766
• ISBN 13: 9780520263765
• Binding: Paperback
• Edition number: 1
• Number of pages: 278