Category: In the News

image and a heart-shaped lapel pin and an EKG readout

Listen to Your Heartbeat: Empowering Women with Knowledge

Did you know heart disease is the #1 killer of women, claiming more lives than all forms of cancer combined? High blood pressure accounts for one in five deaths among women in the U.S. and is a major risk factor for cardiovascular disease. While these statistics might surprise you, February as American Heart Health month serves as a crucial reminder: taking charge of your heart health is essential.  

Women of all ages should be aware of heart health risks, especially women with diabetes or obesity and those who smoke. High blood pressure occurs in one in 12 pregnancies in women 20-44 years old, putting both mother and baby at risk. Women in menopause and perimenopause, which can start as early as 35 years old, can start to experience lipid profile changes (high triglycerides and low HDL), accumulating visceral and paracardial fat, and high blood pressure. All of which puts them at increased risk for cardiovascular disease and metabolic syndrome for up to 40% of their lives.  

It’s important to know that while women also experience chest pain as a heart attack symptom, it may not be constant or as severe as in men. Women often describe their symptoms as pressure or tightness and they are more likely to report symptoms unrelated to chest pain, such as:  

  • Neck, jaw, shoulder, upper back or upper abdomen discomfort 
  • Shortness of breath 
  • Pain in one or both arms 
  • Nausea or vomiting 
  • Sweating 
  • Lightheadedness or dizziness 
  • Unusual fatigue 
  • Heartburn 

Given these symptoms and the range of potential causes, it’s extremely important for women to be strong advocates for proper testing and treatment when seeking medical care. Women are less likely than men to be treated with aspirin and statins, to have coronary bypass surgery, or to be referred for cardiac rehabilitation, all of which show benefits in both men and women. Don’t be afraid to be your own advocate. Remember, the squeaky wheel gets the grease.  

  • Gather information: Learn about your family history, risk factors and symptoms. 
  • Ask questions: Don’t hesitate to ask your doctor about any concerns you have, no matter how small they seem.  
  • Seek second opinions: If you feel unheard or unsatisfied with your diagnosis or treatment plan, consider seeking another doctor’s perspective. 

Knowledge is power! By understanding your risks and taking proactive steps, you can significantly reduce your chances of developing heart disease. Empower yourself and the women in your life with the curated blogs and resources offered below to create a plan for a healthier heart and a healthier you.  

 

Resources 

Knowledge is Power: Wearable Heart Health Monitoring 

Healthy Hearts Power Fit Cities 

Blood Pressure Infographic 

ACSM Heart Health | Trending Topic 

Women and Heart Disease | ACSM Handout 

U.S. Surgeon General’s Call to Action to Control Hypertension 

Live to the Beat” Campaign Toolkit (focused on reducing risk in Black adults) | Million Hearts (CDC & CMS initiative) 

High Blood Pressure During Pregnancy | CDC 

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association 

Heart Attack Symptoms in Women | American Heart Association 

several people in a park, someone on a bike, playing fetch with a dog, three people doing yoga, two walking and two on a bench

The Built Environment and Physical Activity

It has been well-established that physical activity and/or exercise can help to reduce the risk of chronic diseases such as obesity, diabetes, cancer and cardiovascular disease.  

To reap these benefits, we only need to accumulate 150 minutes per week of physical activity1. That means that you can be physically active for as little as 10 minutes at a time to accumulate 30 minutes in a day for five days, or be active for about 20 minutes per day for seven days. Even though accumulating physical activity in small increments is just as good for our health as being physically active in one longer bout, many people still find it difficult to incorporate physical activity and/or exercise into their lives.  

Despite public health efforts to encourage more physical activity among the population, the Centers for Disease Control and Prevention (CDC) state that only about 28% of individuals exercise on a regular basis1. However, if the environment was such that it allowed individuals to be more physically active more naturally, perhaps more individuals would meet physical activity recommendations.

Research on the affects of built environment 

The built environment has been shown to have an effect on physical activity. For example, cities that have bike lanes, accessible parks, sidewalks and walking trails typically have higher levels of physical activity among their citizens. Conversely, cities that lack these features, tend to have lower physical activity levels among their residents. Other variables also come into play, including resources to make changes to the built environment, safety, lighting and the weather.  

Some researchers wanted to identify which changes to the built environment increase physical activity in residents at the local level, taking into account cost and socioeconomic status. It was found that enhancements to the infrastructure of a city tended to benefit those of lower socioeconomic status. It appears that improvements in walkability, enhancing parks and playgrounds, and having sufficient active transport within a city will increase physical activity in both children and adults2,3. This is encouraging, because increasing physical activity among all ages is important for the health of our population. 

Although increasing physical activity, and subsequently improving overall health among all ages is important, some researchers have studied whether changes in the built environment specifically increased physical activity levels in older adults (greater than 65 years of age). They found that the factors that led to increased physical activity in older adults included: walkability, how well streets connect, mixed land use, access to facilities, services available, street lighting, having more accessible green space and crime- and traffic-related safety4. It is important that cities take into account all of these variables when they are making decisions about improving infrastructure. The health of their citizens needs to be at the forefront in their decision making. In doing so, not only will this decrease healthcare costs, but it will attract more people to want to visit or reside in that city, helping the economy.  

Even if cities have good built environment infrastructure, it may not lead to increases in physical activity for all. For example, in neighborhoods of low-income it has been reported that when women went to parks, it was largely for the purpose of taking their children to play, whereas men typically went to parks for their own physical activity. Furthermore, it was found that older adults did not get to parks as much as they would like because many of the facilities for them were inadequate5 

Adding green (grass) and blue (water) spaces can also lead to greater physical activity. Some researchers found that putting grass on hard spaces in school yards led to increased physical activity and improved social well-being among children in elementary school6. 

The built environment is extremely vital for both physical activity and social interactions, leading to improved physical and mental health. When making decisions for city infrastructure renovations, policy makers should empower their citizens to help make informed decisions based on age, sex and socioeconomic status. Even if parks have meeting places where people may only go to sit and talk with their friends or play chess, this can still result in more physical activity than if people were to remain at home. If citizens are empowered to help make decisions for their cities and towns, they are more likely to use the facilities, leading to healthier lives. 

 

Author:  Stella L. Volpe, PhD, RDN, ACSM-CEP, FACSM 

Chair, American Fitness Index 

President-elect, American College of Sports Medicine

 

References 

  1. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/index.htm 
  2. Smith M, Hosking J, Woodward A, et al. Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity. Int J Behav Nutr Phys Act. 2017;14(1):158.doi: 10.1186/s12966-017-0613-9. 
  3. Laddu D, Paluch AE, LaMonte MJ. The role of the built environment in promoting movement and physical activity across the lifespan: Implications for public health. Prog Cardiovasc Dis. 2021:64:33-40. doi: 10.1016/j.pcad.2020.12.009. 
  4. Bonaccorsi G, Manzi F, Del Riccio M, et al. Impact of the built environment and the neighborhood in promoting the physical activity and the healthy aging in older people: An umbrella review. Int J Environ Res Public Health. 2020;17(17):6127. doi: 10.3390/ijerph17176127. 
  5. Cohen DA, Han B, Park S, et al. Park use and park-based physical activity in low-income neighborhoods. J Aging Phys Act. 2019;27(3):334-342. doi: 10.1123/japa.2018-0032.  
  6. Raney MA, Hendry CF, Yee SA. Physical activity and social behaviors of urban children in green playgrounds. Am J Prev Med. 2019;56(4):522-529. doi: 10.1016/j.amepre.2018.11.004.  

 

team of people in blue shirts playing ring toss in a park against a team of people wearing red shirts

Urban green spaces: A “green third place” to promote community

I love my local public green spaces. I have two (a town park and a nearby school) within easy walking/biking distance from home. We see friends and acquaintances regularly when at the playground, swimming in the river or attending community events like concerts, fairs or athletic competitions. It is wonderful to connect with your neighbors and really feel part of the community. Public green space is lovely in my rural town, but they are a necessity in urban settings. Urban green spaces have been shown to support healthy behaviors including increased physical activity and social engagement. 

Urban green spaces are public land with vegetation, parks, forests or water features, located within an urban setting. They are typically open spaces to support people gathering for social, leisure and recreational activities, and are critical components in fostering social cohesion and a sense of belonging. Social cohesion refers to the interpersonal dynamics and sense of connection among humans, and higher levels are associated with physical and psychological benefits. Maslow’s Hierarchy of Needs starts with physiological needs (food, water and rest) and safety/security, then the next important need is that of love and belonging. Humans have a need for affiliation; to be part of a team or tribe. From an evolutionary perspective, social bonds have helped humans to survive and thrive. Urban green spaces provide a place for people to gather to build these social connections.  

A “green third place”

To further emphasize this concept, consider that there are several places in our lives where we can connect with others and build relationships. Urban green spaces are ideal “third places”; Ray Oldenburg’s concept of social surroundings for your community life versus your first place (home; personal life) or second place (work life)1. It should be a comfortable, welcoming, and accessible space for social interaction that fosters a sense of belonging. Like Cheers pub in Boston, “Where everybody knows your name.” 

In a third place you are free of obligations, all are of equal social status, newcomers are welcomed, connection is the focus with playful conversation and socializing, and it is a homey, inviting space that is conveniently located. Connections can be through shared leisure interests, activities or hobbies, shared neighborhoods or shared cultures. Third places can be a commercial space like a café, pub, bookstore, barber shops, quilt store; religious places; libraries; shared leisure facilities like gyms or bowling alleys; or outdoor recreation/gathering places such as parks and green spaces (my personal favorite).  

One of the characteristics of a third place is accessibility—ideally being within walking distance of home. One of the key metrics of ACSM’s American Fitness Index rankings is percentage of a population within 10-minute walk to a park. My two closest cities, Boston and New York, tied for highest score (99%) with Arlington, San Francisco and St. Paul. Additionally, that walk should be safe, so the Fitness Index also assesses pedestrian fatalities, Complete Streets policies and bike/walk scores.  Other related community/environment Fitness Index indicators include parks per 10,000 residents, recreation facilities (ball diamonds, basketball hoops, playgrounds, recreational centers, swimming pools and tennis courts), and park expenditure per resident. Perceived pedestrian and leisure facilities (including park density) are key aspects of sense of community belonging2. Having green spaces nearby contributes to the health of the individual and the community while enhancing social cohesion.

See how your city ranks on the above indicators by using our rankings comparison tool

Supporting all aspects of health

Neighborhood/built environment and social/community context are key social determinants of health. Simply having more green spaces nearby can help address some of the disparities in health outcomes that especially affect marginalized communities. Access to urban parks has been shown to decrease the negative effects of inadequate housing and emotional stress as well as increase social cohesion for immigrant families3. There are also climate related benefits with more trees improving air quality and decreasing the temperature of urban areas.  

Urban green spaces are multifunctional and multigenerational, supporting a variety of communal activities. I especially like the physical activity opportunities from athletic courts and fields, playgrounds, skateparks/plazas and water features. Skate parks provide recreational space for various wheels including skateboards,  rollerblades, BMX bikes and scooters, and are an alternative to organized sports where kids coach one another. When there is greater social cohesion in a community parents can feel more comfortable allowing kids more freedom knowing that their neighbors will look out for them. Having places for kids to safely gather can contribute to their sense of belonging and decrease feelings of loneliness. Third places are vital for nurturing healthy relationships where you can let your guard down and can feel part of something bigger than yourself.  

Urban parks provide open spaces for communal gatherings, parties, concerts and games like Mah-Jongg or Ultimate Frisbee. Opportunities for synchronous movement like dancing, yoga, Tai Chi or group training can enhance social cohesion by activating the mirror neural network releasing dopamine, creating feelings of pleasure and bonding. Urban green spaces can also provide commercial space for farmers markets or flea markets and agricultural space for urban or community gardens. This can increase the percentage of residents consuming more fruits and vegetables per day (other Fitness Index indicators!). Exposure to nature and green spaces directly contributes to improved physical and psychological health as also discussed in our previous blogs (here, here and here). 

So, find your local “green third place” to really connect to your community and start living your best life. 

 

Author

Melissa W. Roti, PhD, FACSM

Professor, Director Exercise Science Program

Westfield State University, Westfield, MA

On Twitter: @MelissaRoti 

 

References

 1. Oldenburg, Ray (1989). The Great Good Place: Cafes, Coffee Shops, Community Centers, Beauty Parlors, General Stores, Bars, Hangouts, and How They Get You Through the Day. New York: Paragon House. ISBN 978-1-55778-110-9.

2.  Du, Y, Jiang H, Huang Z, & Yang H. (2023) Associations between neighborhood environment and sense of community belonging in urban China: Examining mediating effects of neighborly interactions and community satisfaction. Front Public Health vol 10: 1105473.

3. Hordyk, SR, J Hanley, & E Richard. (2015) “Nature is there; its free”: Urban greenspace and the social determinants of health of immigrant families. Health Place Vol 34:74-82.  

Woman in a yellow sweatshirt and jeans riding a red bike in a park

Natural Health: Access to Nature Improves Mental Health, Physical Activity and Chronic Diseases

Have you ever wandered to a local park after a long day or a long week, taken a deep breath, and felt stress and tension leave your body? You are not alone. Just 20 minutes per day of exposure to natural environments decreases stress and improves cognitive function, blood pressure, mental health, physical activity and sleep. Chronic stress raises blood pressure and heart rate and is linked to anxiety, depression, heart disease and obesity. The ACSM American Fitness Index 2023 annual report found that, on average, 30% of residents in the 100 most populous U.S. cities have high blood pressure and/or obesity and 10% have diabetes. We know that physical activity can help to prevent and/or treat these chronic conditions. Spending time in nature can too! Some of the best treatments are not found in your local pharmacy.  

Most adults in the United States are not meeting the ACSM and CDC recommendations of 150 minutes of light to moderate intensity activity every week with muscle strengthening added in two times per week. The Fitness Index found that only 50.9% of people in the 100 most populous cities were meeting aerobic activity guidelines and only 23.7% were meeting the guidelines for both aerobic and strength activities. Access to nature and green space can decrease sedentary activity, increase physical activity and have a bonus of decreased anxiety and improved cognitive function.  

It is difficult to explain why communing with nature has so many health benefits – is it the fresh air, cool breeze, sights and sounds? Or the increased physical activity that often happens when outdoors? I think it is a little bit of both.  One study compared individual responses to different levels of nature by looking at an individual’s pre and post exposure stress levels after visiting a natural setting, a built urban municipal park and a local fitness facility featuring an indoor track and free weights. Levels of cortisol (stress hormone) decreased the most in the natural environment setting. The stress reduction response appeared to be dose dependent with both the natural environment and urban environment providing visitors a decrease in stress through less demands and worries and increased levels of joy. The indoor track provided decreased demands and worries but no change in joy. Moving is good for you. But moving in a natural or outdoor urban environment is even better. 

In the cities ranked by the American Fitness Index, an average of 71.5% of residents live within a 10-minute walk to a park. Only 38% percent of people in Louisville, Kentucky live within a 10-minute walk to a park and the city also ranks among the worst 10 cities for elevated blood pressure, heart disease, diabetes, asthma and obesity. While the cause of these chronic conditions is multifactorial, all of these Fitness Index indicators can be improved with increased physical activity and access to nature or parks. Arlington, Virginia was named the fittest city in America for the sixth time! In contrast to Louisville, 99% of Arlington residents live within a 10-minute walk to a park. They also had the highest percentage of residents exercising in the last 30 days and the lowest percentage of residents with diabetes.  

Find your nature prescription!  Seven out of 10 people can walk to a park within their city. Active transportation, like walking, biking and running, is also a great way to incorporate physical activity and the outdoors into a busy day. If you need help finding your nearest park or walking/biking trail, check out AllTrails. Thirty percent of people have less access to a park within their city. Encourage your community leaders and city officials to incorporate green spaces, walking trails and recreation opportunities into new and existing developments.  

I challenge you to at least 20 minutes in nature every day while meeting exercise guidelines for long term mental and physical health. 

 

Author:  Jessie Fudge, M.D., FACSM

woman wearing overalls and young boy in striped shirt harvesting a giant lettuce in a community garden

Community Gardens: Enhancing Nutrition, Physical Activity and Connection in Neighborhoods Across America

Gardening goes in and out of fashion over time, but the COVID-19 pandemic ushered in a new, younger wave of gardeners, many of whom grow in one of the more than 29,000 community garden plots located in city parks in the 100 largest U.S. cities. Community gardens have many benefits, including promoting healthy eating and physical activity, improving mental health and building social connections. With its many advantages, you could consider community gardening a “superfood” of activity. 

One of the most obvious benefits of community gardens is that they increase access to healthy foods. In fact, adults who participate in community gardening eat more fruits and vegetables than those who don’t garden. By growing their own produce, gardeners can specifically plant foods that they like to eat as opposed to being restricted  to what’s available in grocery stores. This is especially important in low-income neighborhoods where access to fresh fruits and vegetables may be limited. Food insecurity, or the limited access to nutritionally adequate food, affects an average of 11.5% of residents in the largest 100 US cities. Community gardens are an important tool to seasonally reduce food insecurity concerns up to 90% in impacted communities. 

Community gardens also promote physical activity. Gardening is a whole-body activity that can burn the same number of calories as a traditional workout. Plus you get the added benefit of time spent in nature! Typical gardening tasks like digging, raking, lifting and squatting are excellent at burning calories, strengthening muscles and increasing physical fitness. Depending on the task, gardening can be a low- to moderate-intensity activity that helps meet the ACSM recommendation for 150 minutes of physical activity each week 

In addition to physical health benefits, community gardens help improve mental health and social connections. Studies have shown that gardening  reduces stress and anxiety and promotes a sense of well-being. Community gardening, in particular, can decrease feelings of isolation and boost self-esteem. These gardens provide a space for people to connect with others and to work collaboratively. This is especially important for people who may be isolated or have limited social networks. 

How can you get involved in a community garden? 

The first step to getting involved is to find a garden in your area. Many cities have organized community garden programs that can help you find local garden plots, lend you tools or teach you how to garden. Local libraries, extension offices and community-based organizations are also great resources for finding community gardens and learning how to grow. (Pro tip: check with your local library to see if they have a seed bank that gives free seeds to library card holders.) Make sure to sign up early since some community gardens fill up quickly!  

If you don’t have a community garden in your area, consider starting one. Talk to your neighbors, local organizations or city officials about the benefits of community gardens and how you can start one in your neighborhood. You may be surprised at how many people are interested in getting involved and how much support you can get from your local community. 

Spring is the perfect season to get your hands dirty and start growing fresh fruits and vegetables. Whether you’re a seasoned gardener or a beginner, there’s a welcoming place for you in a community garden. So, what are you waiting for? Get out there and start gardening!

 

Author:  Gretchen Patch, MPH, CPH (Avid gardener and big supporter of extension offices 😊)

Senior Director  of Strategic Health Initiatives and Partnerships, ACSM

one male and two female coworkers walking and talking outdoors on a nice day

Economic Benefits of Workplace Wellness Programs and Changes since COVID-19

Since the start of the COVID-19 pandemic, more employees have shifted to hybrid and remote work in office work, telehealth, information technology, education and other fields; however, there are many jobs that cannot be performed remotely, such as transportation, hospitality, manufacturing, food service, supermarket and other retail work and the majority of healthcare positions. Therefore, workplace wellness programs need to change along with these shifts in the workplace environment. After all, encouraging more employees to be physically active has social, environmental and economic benefits. 

Physical inactivity has a high cost burden to employers — an estimated $300 billion between 2020 and 2030, according to the World Health Organization (WHO) global status report on physical activity — with even more cost if physical inactivity is not addressed. Inability to address physical inactivity will result in increased chronic diseases as well as declining mental health, and higher-income countries like the United States will incur a larger economic burden. Since half of the world’s population is of working age, the cost of chronic disease and injuries could be as much as 4-6% of global gross domestic product (GDP). Unfortunately, these projections may be conservative, and actual costs may be higher.  

In a recent study, people who met physical activity guidelines of at least 150 minutes per week were found to have lower healthcare utilization, with fewer emergency room visits, hospital admissions and primary care visits compared to those who did not meet the guidelines. Likewise, seniors who participated in a SilverSneakers exercise program had over $2,000 per year savings in healthcare costs compared to nonparticipants. A RAND Corporation study of 50,000 workers reported that for every $1 invested in managing chronic diseases, the employer saved $3.78, but there was less immediate return for just general employee lifestyle management. Seven years of employee engagement in both chronic disease and lifestyle programs led to $30 reduced healthcare costs per month per employee.   

The aforementioned WHO report recommends both government and private sector workplaces provide opportunities for employees to be active during the day as well as promote active transportation methods such as public transit, walking and bicycling. Both strategies can provide good return on investment, contribute to increased productivity, and reduce injuries and missed work.  

In the release of the ACSM Worldwide Survey of Fitness Trends for 2023 there was little support for workplace incentives for physical activity or any other trend mentioning employer-based physical activity in the top 20 trends. It appears that traditional workplace wellness and employer sponsored programs may be falling out of favor following COVID-19. This is unfortunate given the projected economic costs of chronic disease and mental health caused by failing to address physical activity. Some employers may have shifted away from traditional workplace fitness and wellness programs and are now evaluating more programs that look at overall well-being, such as work-life balance, stress management and mental health, as well as promoting flexible physical activity options for onsite, hybrid and remote workers.  

Governments and industry may want to collect prospective data on their employee physical activity and well-being so they can analyze their economic impact, especially following changing workplace environments due to COVID-19. The Physical Activity Alliance advocates for assessing physical activity at work using standardized measures and encouraging CEOs to sign a physical activity pledge to make physical activity a workplace cultural norm. Finally, employers can implement workplace policies to promote physical activity and overall employee well-being. 

 

AUTHOR: Janet R. Wojcik, Ph.D., FACSM, is professor and program director of exercise science at Winthrop University in Rock Hill, South Carolina. She is a member of the ACSM American Fitness Index Advisory Board and the Physical Activity Policy Research and Evaluation Network (PAPREN) worksite work group.    

three people locking bikes to a bike rack

Activity Friendly Spaces Make Good Business “Cents”: How Local Businesses can Support and Advocate for Pedestrians and Cyclists

Without question, activity friendly spaces—those that support walking and bicycling for leisure and transportation—are good for both personal health and the environment. When trips that are usually taken via automobile are taken by foot or bike instead, there is reduced traffic, congestion and pollution. But are these spaces good for businesses? You can bet your bottom dollar they are.   

Research supports the idea that activity friendly spaces can drive economics and spending. Several studies have noted that customers who arrive via bike tend to frequent commercial areas more often than customers who arrive via other modes, and they often spend more, resulting in higher sales.1-5  In New York City, the installation of a bike lane increased the likelihood of travel for both pedestrians and cyclists, creating greater exposure to businesses in the area studied4 and contributed to an increase in retail sales and fewer commercial vacancies in the neighborhood.6 A survey of San Francisco retailers revealed that the majority (65%) perceived that bike lanes had a positive impact on their sales and noted few negatives.7 Communities designed to promote active living (i.e. provisions for pedestrians and cyclists, greenspace, trails) also are noted to have greater property values and result in greater revenue from property taxes than communities that do not include these features.8 Areas with greater walkability and active living supports are tied to the benefits of decreased pollution, improved social capital, more community activism and less car use, which was related with improved office, retail and apartment values.9  

Promoting walking or bicycling to work offers significant benefits to employers; the many health benefits associated with biking and regular exercise include decreased healthcare costs, improved productivity, reduced absenteeism and aligns with the goals of most worksite wellness programs.10 The League of American Bicyclists, as a part of their Bicycle Friendly AmericaTM11 program, has a Bicycle Friendly BusinessTM initiative which allows businesses to apply to be recognized as bicycle friendly at different levels (bronze, silver, gold or platinum). League-recognized Bicycle Friendly Businesses have noted a wide range of motivation for promoting cycling among their employees and customers (e.g. economic outcomes, reduced healthcare costs, sustainability goals12 ). They have also noted the importance of serving as a good example for their community and that cycling represents a core part of their company’s identity.  

Other strategies that local businesses can employ to promote active transportation can include participation in advocacy for infrastructure that encourages walking and biking. Partnering with local pedestrian and cyclist coalitions or advocacy groups to support policies, legislation or funding for capital improvements to local spaces can be helpful, as buy-in from additional stakeholders bolsters confidence in those policies. For example, advocating for greater bicycle parking may result in some controversy if it is accompanied by the elimination of car parking spots. However, initiatives to replace on-street parking in commercial districts with a bike corral typically yields spots for 8-10 bikes where one car could have parked. It has been well documented that this swap typically does not harm sales, rather, it can lead to an increase in revenue.13 After seeing the impact in other areas, merchants in Portland, OR, indicated their overwhelming support for the swap to improve business and enhance the overall streetscape.14 Additionally, increased spending in a commercial area could generate greater sales tax for the region, helping the community to pay for the installation and upkeep of the supportive infrastructure, possibly leading to expanded efforts. 

Businesses have an important role to play in cultivating activity-friendly spaces as key stakeholders in local economies. The potential for impact beyond commercial benefit is substantial, influencing health and environmental outcomes throughout the community where they live and work. Investments in cycling and pedestrian infrastructure just make good “cents” for businesses.  

 

Author: Melissa Bopp, Ph.D., FACSM 

 

References

  1. Popovich N, Handy SL. Bicyclists as Consumers. Mode Choice and Spending Behavior in Downtown Davis, California. Transportation Research Record. 2014;2468:47-54.
  2. Clifton KJ, Muhs C, Morrissey S, Morriss T, Currans K, Ritter C. Consumer Behavior and Travel Mode Choices. Portland, OR: Oregon Transportation Research and Education Consortium (OTREC); 2012.
  3. Bent E, Singa K. Modal Choices and Spending Patterns of Travelers to Downtown San Francisco, California: Impacts on of Congestion Pricing on Retail Trade. Transportation Research Record: Journal of the Transportation Research Board. 2009;2115:66-74.
  4. Bernier-Heroux L, Ryan J. East Village Shoppers Study: A Snapshot of Travel and Spending Patterns of Residents and Visitors in the East Village. 2012; https://www.transalt.org/cdn/farfuture/9efumRfRqlXm_tZbqTYHclU2lQLb2uDlCiQiGakdKms/mtime:1472894797/sites/default/files/news/reports/2012/EV_Shopper_Study.pdf. Accessed November 16, 2016.
  5. Rowe K. Bikenomics: Measuring the Economic Impact of Bicycle Facilities on Neighborhood Business Districts. Seattle, WA: University of Washington College of Built Environments; 2013.
  6. Arancibia D. Cyclists, Bike Lanes and On-Street Parking: Economic Impacts. Toronto, ON: Toronto Cycling; 2013.
  7. Drennan E. Economic Effects of Traffic Calming on Urban Small Businesses. 2003; http://www.sfbike.org/download/bikeplan/bikelanes.pdf. Accessed November 17, 2016.
  8. Active Living Research. The Economic Benefits of Open Space, Recreation Facilities and Walkable Community Design. San Diego: Robert Wood Johnson Foundation; 2010.
  9. Pivo G, Fisher JD. The Walkability Premium in Commercial Real Estate Investments. Real Estate Economics. 2011;39(2):185-219.
  10. Tran M, Forst L, Buchanan S. Not on the Radar: Active Commuting as a Workplace Wellness Issue. Journal of Occupational and Environmental Medicine. Sep 2015;57(9):E91-E92.
  11. League of American Bicyclists. Building A Bicycle Friendly America. Washington DC: League of American Bicyclists; 2013.
  12. Vairo N, Bopp M, Sims D. Best practices for businesses promoting bicycling. International Journal of Health Promotion and Education. 2017/11/02 2017;55(5-6):298-310.
  13. Lee A, March A. Recognising the Economic Role of Bikes; Sharing Parking in Lygon Street, Carlton. Australian Planner. 2010;47(2):85-93.
  14. Meisel D. Bike Corrals: Local Business Impacts, Benefits, and Attitudes. Portland, OR: Portland State University School of Urban Studies and Planning; 2010.
man in bed grabbing his head, frustrated that he cannot sleep

The Role of Stress in Sleep Quality

Have you ever gone to sleep at night and woke up the next day feeling groggy and unrested? Or not be able to fall asleep at all due to stress? The need for and benefits of quality sleep cannot be overemphasized, but how can people actually get to a point where they are reaching adequate sleep? What actions can an individual take to ensure a full night’s rest? Research suggests that there are multiple ways to help get a good night’s sleep and reduce stress in doing so (good sleep hygiene). We’ll discuss some stress-related reasons individuals struggle to get adequate sleep, and some research-backed sleep hygiene recommendations to combat those challenges.  

Daily stress can have an impact on an individual’s sleep schedule, and persistent stress can contribute to the development of sleep disorders. It is estimated that 10-30% of adults are diagnosed with insomnia, a sleep disorder in which it is difficult for an individual to fall asleep, stay asleep or return to sleep after waking up. Whether short- or long-term, the effects of insomnia include excessive daytime sleepiness, fatigue, irritability and other impairments while awake. Stress-induced sleeping disorders such as insomnia are commonly seen in college students, especially student-athletes who may struggle to balance the various demands on their time and energy. When this stress disrupts sleep, it can have an impact on students’ academic  performance, mood and athletic performance. For individuals of all ages, the continuation of interrupted sleep will not only take a toll on the individual and their own body, but those around them will begin to experience the effects as well. 

The hypothalamic-pituitary-adrenal (HPA) axis is one of the main neuroendocrine systems active during sleep. Stress-related insomnia activates the HPA. When the HPA is activated as a defensive mechanism to maintain homeostasis, it results in the release of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), cortisol, epinephrine and norepinephrine, which are associated with attention and arousal. Since the hypothalamus plays a key role in sleep regulation, studying it allows researchers to understand the neural mechanisms of sleep disorders, see how each body system is affected, and develop interventions for better sleep. 

Some types of stress can develop into mental disorders such as Post-Traumatic Stress Disorder (PTSD) and/or depression. PTSD is a condition caused by severe trauma and can affect people of all age groups. Increased levels of Interleukin-6 (IL-6) and C-reactive protein (CRP) in the body are often a sign of stress. These inflammatory markers have been found to be directly linked to symptoms of depression, especially when sleep quality is poor. Overall, individuals who have been diagnosed with a mental disorder often are characterized by their exhaustion levels and the lack of the ability to get proper sleep. 

Awareness of the connection between stress and sleep is the first step in making positive lifestyle changes. Some of the most recommended methods of sleep hygiene are having a consistent pre-sleep routine, a steady bedtime paired with a consistent wake time, developing a bedtime routine such as limiting caffeine intake and screens 90 minutes before bedtime and only using a bed for sleeping. Specific recommendations to reduce stress to assist with better sleep are to participate in regular physical activity (at least 30 minutes per day, 3-5 days per week), using relaxation and deep breathing techniques and participation in other behavioral stress management activities.  The goal behind all these methods is to train the brain to associate similar circumstances and times with sleep and in doing so, making it easier to fall asleep. These methods, when combined, can really make a noticeable and positive difference in an individual’s sleep patterns.  

Treatment for stress-related sleep disorders for athletes at all levels is similar to treatment for the general population, but the athletes’ sport-specific needs should be kept in mind. Napping is a common sleep disorder intervention, particularly among student-athletes, but the findings are mixed with respect to athletic performance. 

 

Want to learn more about the connection between sleep and athletic performance? Check out  this online course: Sleep Tactics for Better Performance.

 

Authors: Nicole Weiss (lead), River Anderson, Serenity Collier, Vivian Gardner, Reid Moser, Christian Peters, John Hampton Ratcliffe, Paolo Tedesco 

Winthrop University, Rock Hill, SC EXSC 484 Exercise Physiology II Lecture, Fall 2022 

Instructor: Janet R. Wojcik, Ph.D., FACSM 

 

group of 4 people hiking in cold weather

Get Active to Combat Stress this Holiday Season

Feeling overwhelmed at the thought of the holiday season? You are not alone. Seasonal illnesses, end-of-year work pressures, potential holiday tension and cold weather challenges can add up this time of year, and can  all lead to negative physical and mental health outcomes. Unchecked stress can contribute to high blood pressure and heart disease as well as increased anxiety and depression. In fact, in the 2022 Fitness Index, 30% of residents in the largest 100 U.S. cities have high blood pressure and 39.6% reported poor mental health. Adding seasonal stress to that mix is not a winning recipe.

A key (and free) way to reduce stress and anxiety is to be physically active. Research tells us even small amounts of activity can help reduce stress, enhance your mood, improve sleep and even strengthen your immune system – something we can all use this time of year! Even a 30-minute brisk walk provides immediate immune benefits that can last for several hours afterwards. Every active minute counts and can add up to better health.

What counts as physical activity? A lot actually! You do not have to prove you are an Ironman champion and go all out over the holidays. Moderate-intensity activities that allow you to talk, but not sing, during the activity are an ideal place to start. Walk the dog. Dance with your partner. Play catch with your kids. Ride your bike to the store. Even household chores like raking leaves, vacuuming and lifting laundry baskets will rack up activity minutes. Looking for a structured workout option? Check out this  video playlist of free workouts  from ACSM’s International Health & Fitness Summit.

Want more out of your activity? Take it outside. Being active in nature amplifies the reduction in stress and anxiety and reduces blood pressure. Walk down a tree-lined street, be active in your backyard or find a local park or green space. Be sure to treat nature gently – stay on designated trails, take your trash home with you and leave plants and animals exactly where you see them.

For more information on the connection between physical activity and mental health, or for more mental health resources, check out ACSM’s Mental Health Resource Page.

Fitness Professionals

In the lead-up to, during and following the holiday season, your clients are likely dealing with additional stress. Check out this blog and handout to learn about ways to support both your clients’ mental and physical well-being.

For even more in-depth information and tools, check out ACSM’s Health & Fitness Journal®’s 2020 article of the year, “Promoting Physical Activity for Mental Well-Being” by Stephanie Cooper, Ph.D., FACSM, ACSM-EP.

From all of us at the American Fitness Index, we wish you a happy and healthy holiday season!

pillows on a scale

Don’t “Weight” to Focus on a Good Night’s Sleep

I am a poor sleeper. I am not the only one: The CDC reports one third of the U.S. population does not get the recommended amount of sleep. I recently decided to redouble my efforts to get more sleep. I am generally healthy, as I eat well and exercise regularly, so I primarily focused on improving my sleep hygiene (avoiding food/alcohol close to bedtime, consistent sleep times, relaxation techniques and a dark, cool room). For more severe sleep issues, talk to your doctor about other options, including pharmacotherapy, cognitive behavior therapy and non-invasive brain stimulation techniques (6).  

As I began to get more sleep, I noticed I was losing a few pounds. It wasn’t dramatic, but it was those couple extra pounds I had had a difficult time getting rid of. Especially with approximately 42% of the U.S. population now considered obese, I had to explore the relationship between sleep and body weight. 

It is well known that sleep is very important to our physical and mental health (more on the mental health side in next month’s blog). Sleep is not only measured in total sleep time (quantity), but also in quality (number of disturbances/awakenings, minutes awake after sleep onset and percent of time asleep). Ideal sleep amounts for adults are 7-9 hours (higher for children) with less than six awakenings, less than 30 minutes awake after sleep onset and 85% of time asleep (3). Between-day variability also plays a role, with increased variability contributing to lower-quality sleep. Sleep research varies in terms of measurement of sleep, ranging from self-report (e.g., Pittsburg Sleep Quality Index) to actigraphy or wearable device to the gold standard of a polysomnogram. Poor sleep increases the risk of chronic diseases and conditions such as cardiovascular disease, obesity, Type 2 diabetes, some cancers and depression, as well as poor performance in school, work, athletics and while driving. I discovered there is a reciprocal and complex relationship (and which varies by gender, age and race) between sleep quality/quantity and body weight.   

Insufficient sleep negatively impacts metabolism and is associated with increased body mass index (BMI), abdominal body fat and obesity. There are several mechanisms involved, including systemic inflammation, hormonal and metabolic changes and behavioral issues (11). Inflammation increases risk of cardiometabolic disease risk and hypertension, and decreases insulin sensitivity. Changes in the neuroendocrine system include increased ghrelin and orexin-A and decreased leptin, leading to increased appetite and hunger (9). With decreased sleep, there is a tendency towards increased energy intake due to associated behaviors such as increased secondary (not at mealtime) late-night eating and disinhibited (distracted) eating (4,13). These changes in sleep and food intake can also contribute to circadian misalignment, which further disrupts sleep (2). Increased daytime sleepiness may also decrease physical activity. We also see obesity (body weight gain) causing poor sleep due to comorbidities such as hypertension, pain, sleep apnea or exacerbated menopausal symptoms (1,12). 

There is also a positive bidirectional relationship between sleep and body weight change. Body weight loss is associated with improved sleep, and improved sleep is associated with body weight loss (10,14). Body weight loss often coincides with healthy behaviors such as increased physical activity and improved nutrition/eating patterns, which can contribute to improved sleep. Weight loss may also contribute to decreased pain, thus decreasing sleep disturbances. Better sleep health was associated with greater weight and fat loss with a weight-loss intervention (7). Optimizing sleep during a resistance training program provided body composition benefits of higher muscle mass and lower fat mass compared to resistance training alone (5).  

There is still much to learn about the complex connections between sleep and body weight, but this all sounds promising. As I approach the potential for weight gain associated with middle age and menopause, I will continue to include a healthy diet and varied physical activity — and you can bet I will be keeping sleep a priority.  

 

Author: Melissa W. Roti, Ph.D., FACSM

Professor, Director Exercise Science Program

Westfield State University, Westfield, Massachusetts

Twitter: @MelissaRoti 

 

References 

  1. Al-Safi ZA, Polotsky AJ. Obesity and menopause. 2015;29(4):548-53. 
  2. Barot N, Barot I. Nutrition and Sleep. In: Encyclopedia of Sleep. 2013. p. 108-13.  
  3. Berger AM et al. Sleep wake disturbances in people with cancer and their caregivers: state of the science Oncol Nurs Forum. 2005;32(6):E98-126. 
  4. Blumfield ML, Bei B, Zimberg IZ, Cain SW. Dietary disinhibition mediates the relationship between poor sleep quality and body weight. Appetite. 2018;120:602-8. 
  5. Jåbekk P, Jensen RM, Sandell MB, Haugen E, Katralen LM, Bjorvatn B. A randomized controlled pilot trial of sleep health education on body composition changes following 10 weeks’ resistance exercise. The Journal of Sports Medicine and Physical Fitness. 2020;60(5):743-8. 
  6. Jackowska M, Koenig J, Vasendova V, Jandackova VK. A two-week course of transcutaneous vagal nerve stimulation improves global sleep: Findings from a randomised trial in community-dwelling adults. Auton. Neurosci. 2022;240:102972. 
  7. Kline CE et al. The association between sleep health and weight change during a 12-month behavioral weight loss intervention. Int J Obes. 2021;45:639-49.  
  8. Leger D, Bayon V, Sanctis A. The role of sleep in the regulation of body weight. Molecular and Cellular Endocrinology. 2015;418(2):101-7. 
  9. Littman AJ et al. Sleep, ghrelin, leptin and changes in body weight during a 1-year moderate intensity physical activity intervention. International J Obesity. 2007;31:466-75. 
  10. O’Brien EM et al. Sleep duration and weight loss among overweight/obese women enrolled in a behavioral weight loss program. Nutrition & Diabetes 2:e43. 
  11. Schmid SM, Hallschmid M, Schultes B. The metabolic burden of sleep loss. The Lancet Diabetes & Endocrinology. 2015;3(1):52-62. 
  12. Shade MY, Berger AM, Dizona PJ, Pozehl BJ, Pullen CH. Sleep and health-related factors in overweight and obese rural women in a randomized controlled trial. J Behav Med. 2016;39:386-97. 
  13. Tajeu GS, Sen B. New pathways from short sleep to obesity? Associations between short sleep and “secondary” eating and drinking behavior. Amer J Health Promotion. 2017;31(3):181-8. 
  14. Thomson CA et al. Relationship between sleep quality and quantity and weight loss in women participating in a weight-loss intervention trial. Obesity. 2012;20:1419-25.