Indicators, Trends, and Recommendations for Living a Longer, Healthier Life

Physical Activity 

Regular physical activity reduces people’s risk for heart attack, colon cancer, diabetes, and high blood pressure and may reduce their risk for stroke. It also helps control weight; contributes to healthy bones, muscles, and joints; reduces falls among older adults; helps relieve the pain of arthritis; reduces symptoms of anxiety and depression; and is associated with fewer hospitalizations, physician visits, and medications [4]. Regular physical activity is associated with lower death rates for adults of any age, even when only moderate levels of physical activity are performed [5]. It need not be strenuous to be beneficial; people of all ages benefit from moderate-intensity physical activity. The goals of Healthy People 2010 and the recommendations of the American College of Sports Medicine are to increase the proportion of adults who engage regularly, preferably daily, in moderate physical activity for at least 30 minutes per day or vigorous-intensity activities for at least 20 minutes per day, at least 3 days per week [5, 6, 7]. Moderate-intensity activity is described as any activity that causes small increases in breathing and heart rate and burns 3.5 to 7 calories per minute. Vigorous-intensity activity is described as any activity that causes large increases in breathing or heart rate and burns more than 7 calories per minute [8, 9].

Overall fitness is made up of several components [10]. Cardiorespiratory endurance is the ability of the body’s circulatory and respiratory systems to supply fuel during sustained physical activity. Optimal cardiorespiratory endurance requires activities that keep the heart rate elevated to a safe level for a sustained length of time, such as walking, swimming, or bicycling. Muscular strength is the ability of the muscle to exert force during an activity. The key to making muscles stronger is working them against resistance, such as by lifting weights. Children and adolescents need weight-bearing exercise for normal skeletal development, and adults need such exercise to achieve and maintain peak bone mass. Flexibility is the range of motion around a joint. Good flexibility in the joints can help prevent injuries through all stages of life. The US Department of Agriculture (USDA) recommendations for the general population include the achievement of physical fitness through cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance [11].

Despite the proven benefits of physical activity, more than 50% of US adults do not get enough physical activity to provide health benefits, and 24% are not active at all in their leisure time [4]. These statistics are based on a definition of leisure-time physical activity as participating in any physical activity or exercise, such as running, calisthenics, golf, gardening, or walking for exercise, other than that performed as part of a regular job, during the past month [12]. From the period January 2006 through June 2006, only 31.1% of US adults aged 18 years and older engaged in regular leisure-time physical activity [13]. The prevalence of leisure-time activity among adults between 18 and 24 years of age and 25 and 64 years of age was 39.2% and 31.7%, respectively.

In 2004, only 21.9% of men and 17.5% of women (age adjusted) reported strength training 2 or more times per week [14]. The age-adjusted prevalence of strength training 2 or more times per week for men aged 25 to 34, 35 to 44, 45 to 64, and greater than 65 years was 27.2%, 21.6%, 17.3%, and 14.1%, respectively. The prevalence for women in the same age groups was 20.8%, 18.2%, 17.6%, and 10.7%. These numbers are substantially lower than the Healthy People 2010 objective of 30% in all age groups and underscore the need for additional programs to increase strength training among adults.

Sallis and Hovell [15] reported on the 10 most common reasons adults cite for not adopting more physically active lifestyles (Table 2). The Centers for Disease Control and Prevention [16] developed a quiz titled “Barriers to Being Active,” which can help in identifying the types of barriers to physical activity that undermine the ability to make regular physical activity an integral part of one’s life and that offers suggestions on how to overcome the barriers that affect an individual most. For example, when “lack of time” is a substantial barrier, individuals can add physical activity to their daily routines (eg, walking or riding a bike to work or shopping, organizing work activities around physical activity, walking a dog, exercising while watching television, parking farther from a destination). If “lack of motivation” is a barrier, a suggestion is to make physical activity a regular part of the daily or weekly schedule and write it on the calendar. When travel is a barrier, individuals can put jump ropes in their suitcases, walk the halls and climb the stairs in hotels, stay at places with swimming pools or exercise facilities, or visit local shopping malls and walk for half an hour or more.

Table 2. Most common reasons adults cite for not adopting more physically active lifestyles

	1. Do not have enough time to exercise
	2. Find it inconvenient to exercise
	3. Lack self-motivation
	4. Do not find exercise enjoyable
	5. Find exercise boring
	6. Lack confidence in their ability to be physically active
	7. Fear being injured or have been injured recently
	8. Lack self-management skills, such as the ability to set personal goals, monitor progress, or reward progress toward such goals
	9. Lack encouragement, support, or companionship from family and friends
	10. Do not have parks, sidewalks, bicycle trails, or safe and pleasant walking paths convenient to their homes or offices

Source: Sallis and Hovell [15].

In October 2006, the secretary of the DHHS, Mike Leavitt, announced that the department would develop comprehensive guidelines, drawn from science, to help Americans fit physical activity into their lives [17]. These physical activity guidelines will be issued in late 2008. According to the secretary, “Good health—wellness—doesn’t just happen. Wellness has to be a habit.”

Overweight and Obesity 

On average, higher body weights are associated with higher death rates and substantially raise the risk for illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances, breathing problems, and certain types of cancers. Obese individuals also may suffer from social stigmatization, discrimination, and lowered self-esteem. Obese persons are significantly more likely to report fair or poor health and activity limitations and to make more than 10 visits during the preceding 12 months to health care providers than persons of normal weight or those who are overweight but not obese [18]. Total costs (medical costs and lost productivity) attributable to obesity alone amounted to an estimated $117 billion in the United States in 2000 [4].

Obesity is a result of a complex variety of social, behavioral, cultural, environmental, physiological, and genetic factors. Efforts to maintain a healthy weight should start early in childhood and continue throughout adulthood, because this approach is likely to be more successful than efforts to lose substantial amounts of weight and maintain weight loss once obesity is established [5].

Data from the National Health and Nutrition Examination Survey and state-level data from the Behavioral Risk Factor Surveillance System indicate that the prevalence of obesity among adults continued to increase during the past decade. In these surveys, self-reported weight and height were used to calculate body mass index (BMI). Overweight was classified as BMI greater than 25.0 kg/m2, obesity as BMI greater than 30.0 kg/m2, and extreme obesity as BMI greater than 40.0 kg/m2. In 2005, among the total US adult population surveyed, 60.5% were overweight, 23.9% were obese, and 3.0% were extremely obese [19]. Obesity prevalence ranged from 17.7% among adults aged 18 to 29 years to 29.5% among adults aged 50 to 59 years. The prevalence of obesity increased from 1995 to 2005 in all states, moving further from the Healthy People 2010 target of a 15% prevalence of obesity. To put this in a more historical perspective, both men and women, on average, gained more than 24 pounds between the early 1960s and 2002, while height increased by approximately 1 inch during the same time period [20]. In this same time period, the mean BMI for men and women aged 20 to 74 years increased from just over 25 to almost 28 kg/m2. In 2002, the mean BMIs for men and women aged 30 to 39 years were 27.5 and 27.9 kg/m2, respectively. The mean BMI at all age intervals of adults over 20 years of age was greater than 26.6 kg/m2. To reverse this trend, a sustained and effective public health response is needed, including surveillance, research, policies, and programs directed at improving environmental factors, increasing awareness, and changing behaviors to increase physical activity and decrease caloric intake [19]. Changes must be made at multiple levels (eg, individual, family, community, state, and nation) and across multiple sectors (eg, education, government, and business) [19].

The prevalence of cardiovascular disease risk factors is generally low among young adults in their 20s but increases by middle age. Studies have suggested an etiologic role for weight in cardiovascular disease risk factor progression [21]. Data suggest that if weight gain is avoided, risk factor progression by middle age may be reduced. In US adults aged 25 to 74 years, major weight gain over 10 years, defined as increased BMI of 5 kg/m2, was highest at 25 to 34 years of age [22]. In the Coronary Artery Risk Development in Young Adults study, aging-related weight gain was larger in the early to mid-20s than for older ages [23]. Avoiding excess weight gain during early adult years may be pivotal in preventing adverse changes in risk factors and subsequent cardiovascular disease and in reducing, delaying, or obviating the need for drug therapy later in life. In addition, interventions may establish an early foundation for maintaining lifelong healthy habits in adulthood, and as parents, young adults will serve as lifestyle role models for their children [21]. In 2005, the National Heart, Lung, and Blood Institute’s [21] NHLBI Working Group Report: Preventing Weight Gain in Young Adults recommended that specific research be undertaken to identify strategies to improve the engagement of largely asymptomatic young adults in adopting and maintaining adequate levels of physical activity and healthy eating behaviors. They recommended that research target young adults aged 18 to 35 years who are of normal weight, overweight, and obese.

Diet and Nutrition 

Research shows that good nutrition can help lower people’s risk for many chronic diseases, including heart disease, stroke, hypertension, some cancers, type 2 diabetes, and osteoporosis [4, 24]. Furthermore, poor diet and physical inactivity are the most important factors contributing to the increase in overweight and obesity in the United States.

The USDA and DHHS jointly publish the Dietary Guidelines for Americans, first released in 1980 and revised in 1985, 1990, 1995, 2000, and most recently in January 2005. Because almost two-thirds of Americans are overweight or obese, and more than half get too little physical activity, the 2005 dietary guidelines place a stronger emphasis on caloric control and physical activity. The Food Guide Pyramid, developed by the USDA in 1992, was an educational tool aimed at helping Americans select healthful diets. In 2005, the USDA developed MyPyramid, an educational tool designed to help consumers make healthier food and physical activity choices for a healthy lifestyle that are consistent with the newest Dietary Guidelines for Americans. The name MyPyramid emphasizes the individual approach to healthy eating and physical activity that it offers consumers. In addition to familiar cartoon representations of recommended foods, the pyramid includes a stick-figure human climbing steps to its top, a symbol meant to emphasize physical activity. Consumers can obtain a quick online estimate of what and how much they need to eat by entering their ages, sex, and activity levels in the MyPyramid Plan Box [25]. They can obtain detailed assessments of food intake and physical activity level through MyPyramid Tracker. “The new food pyramid is not a diet plan, but rather a plan for healthy eating,” says Eric Hentges, PhD, executive director of the Center for Nutrition Policy Programs at the USDA and one of the chief architects of the revised pyramid [26].

The USDA’s [11] 2005 Dietary Guidelines for Americans are outlined in Table 3 and include weight management and physical activity recommendations as well as dietary guidelines. The recommendations are based on a 2,000-calorie level as a reference. Recommended caloric intake will differ for individuals on the basis of age, gender, and activity level. At each calorie level, individuals who eat nutrient-dense foods may be able to meet their recommended nutrient intake without consuming their full calorie allotments. The remaining calories—the discretionary calorie allowance—allows flexibility to consume some foods and beverages that may contain added fats, added sugars, and alcohol.

Table 3. US Department of Agriculture Dietary Guidelines for Americans 2005

	Adequate nutrients within calorie needs
	•Consume a variety of nutrient-dense foods and beverages within and among the basic food groups while choosing foods that limit the intake of saturated and trans fats, cholesterol, added sugars, salt, and alcohol
	Weight management
	•To maintain a body weight in a healthy range, balance calories from foods and beverages with calories expended
	•To prevent gradual weight gain over time, make small decreases in food and beverage calories and increase physical activity
	Physical activity
	•To reduce the risk of chronic disease in adulthood: engage in at least 30 minutes of moderate-intensity physical activity, above usual activity, at work or home on most days of the week
	•For most people, greater health benefits can be obtained by engaging in physical activity of more vigorous intensity or longer duration
	•To help manage body weight and prevent gradual, unhealthy body weight gain in adulthood: engage in approximately 60 minutes of moderate- to vigorous-intensity activity on most days of the week while not exceeding caloric intake requirements
	•To sustain weight loss in adulthood: participate in at least 60 to 90 minutes of daily moderate-intensity physical activity while not exceeding caloric intake requirements.
	•Achieve physical fitness by including cardiovascular conditioning, stretching exercises for flexibility, and resistance exercises or calisthenics for muscle strength and endurance
	Encouraged food groups
	•Consume a sufficient amount and variety of fruits and vegetables while staying within energy needs; 2 cups of fruits and 2.5 cups of vegetables per day are recommended for a reference 2,000-calorie intake, with higher or lower amounts depending on the calorie level
	•Consume 3 or more ounce-equivalents of whole-grain products per day
	•Consume 3 cups per day of fat-free or low-fat milk or equivalent milk products
	Fats
	•Consume less than 10% of calories from saturated fatty acids and less than 300 mg/day of cholesterol, and keep trans fatty acid consumption as low as possible
	•Keep total fat intake between 20% and 35% of calories
	•When selecting and preparing meat, poultry, dry beans, and milk or milk products, make choices that are lean, low fat, or fat free
	•Limit intake of fats and oils high in saturated or trans fatty acid
	Carbohydrates
	•Choose fiber-rich fruits, vegetables, and whole grains often
	•Choose and prepare foods and beverages with little added sugars or caloric sweeteners
	•Reduce the incidence of dental cavities by practicing good oral hygiene and consuming sugar- and starch-containing foods and beverages less frequently
	Sodium and potassium
	•Consume less than 2,300 mg (approximately 1 teaspoon of salt) of sodium per day
	•Choose and prepare foods with little salt; at the same time, consume potassium-rich foods, such as fruits and vegetables
	Alcoholic beverages
	•Those who choose to drink alcoholic beverages should do so sensibly and in moderation, defined as the consumption of up to 1 drink per day for women and up to 2 drinks per day for men

Note: The Dietary Guidelines for Americans 2005 contain additional recommendations for specific populations. The full document is available at www.healthierus.gov/dietaryguidelines.

From 1971 to 2000, a statistically significant increase in average energy intake occurred. Average energy intake increased from 2,450 to 2,618 kilocalories for men and from 1,542 to 1,877 kilocalories for women (kilocalorie and calorie are common and equivalent terms used to describe food energy, or 1 “food calorie”) [27]. Factors contributing to the increase in energy intake in the United States include the consumption of food away from home; increased energy consumption from salty snacks, soft drinks, and pizza; and increased portion sizes. A large gap remains between recommended dietary patterns and what Americans actually eat. For example, in 2003, only about one fourth of US adults ate the recommended 5 or more servings of fruits and vegetables each day [4].

Lipid Disorders 

High levels of total cholesterol (TC) and low-density lipoprotein (LDL) cholesterol and low levels of high-density lipoprotein (HDL) cholesterol are important risk factors for coronary heart disease, the leading cause of mortality and morbidity in the United States [28]. According to National Center for Health Statistics data from 1988 to 1994, 17.5% of men and 20% of women aged 20 to 74 years had high levels of TC (≥240 mg/dL) [28]. A desirable TC level is less than 200 mg/dL; a level between 200 and 239 mg/dL is considered borderline high risk, and a level greater than 240 mg/dL is considered high risk [29]. People who have TC levels of 240 mg/dL have twice the risk for coronary heart disease as people whose cholesterol levels are 200 mg/dL [29]. Low-density lipoprotein cholesterol levels greatly affect the risk for heart attack and stroke and are a better gauge of risk than levels of TC [29]. An LDL cholesterol level less than 100 mg/dL is optimal, and a level of 190 mg/dL or higher is considered very high risk. In the average man, HDL cholesterol levels range from 40 to 50 mg/dL. In the average woman, they range from 50 to 60 mg/dL. High-density lipoprotein cholesterol less than 40 mg/dL is low and puts a person at high risk for heart disease [29].

The US Preventive Services Task Force strongly recommends that clinicians routinely screen men aged 35 years and older and women aged 45 years and older for lipid disorders and treat abnormal lipids in people who are at increased risk for coronary heart disease [28]. Men and women should be screened earlier (ages 20 to 35 and 20 to 45 years, respectively) if they have other risk factors for coronary heart disease (eg, diabetes, a family history of cardiovascular disease before 50 years of age in male relatives or 60 years of age in female relatives, a family history suggestive of familial hyperlipidemia, and multiple coronary heart disease risk factors such as tobacco use and hypertension). Screening should include the measurement of TC and HDL cholesterol, which can both be measured using nonfasting or fasting samples. Measuring LDL cholesterol requires a fasting sample and is more expensive. The routine measurement of TC and HDL every 5 years is recommended by the National Cholesterol Education Program’s Adult Treatment Panel II, sponsored by the National Institutes of Health [30]. The Preventive Services Task Force concluded that the evidence is insufficient to recommend for or against triglyceride measurement as a part of routine screening for lipid disorders [28].

High Blood Pressure 

High blood pressure in adults is defined as a consistently elevated blood pressure of 140 mg Hg systolic and 90 mg Hg diastolic or higher. Prehypertension is defined as systolic pressure of 120 to 139 mm Hg or diastolic pressure of 80 to 89 mg Hg. Half of Americans aged 55 to 64 years, or about 1 in 4 adults aged 18 years and older, have high blood pressure, a major risk factor for heart disease, stroke, kidney failure, and peripheral artery disease [31, 32]. High blood pressure is the number one modifiable risk factor for stroke [33]. Recent studies show that in adults ages 40 to 89 years, the risk for death from heart disease and stroke begins to rise at blood pressures as low as 115/75 mm Hg. The risk doubles for each increased increment of 20 mm Hg in systolic blood pressure or 10 mm Hg in diastolic blood pressure [33]. What makes high blood pressure important is that it usually causes no symptoms but can still cause serious complications. Many people have high blood pressure and don’t know it, which has given rise to the term silent killer.

In about 10% of people, high blood pressure is caused by other diseases, such as chronic kidney disease (secondary hypertension). In the other 90% of cases, the cause of high blood pressure is not known (primary hypertension). As a person ages, the risk for developing high blood pressure increases as the arteries get stiffer. High blood pressure tends to run in families and is more common in men than women. Other factors related to high blood pressure are obesity, sodium intake, alcohol use, the use of oral contraceptives and certain other drugs, lack of exercise, and stress. Drinking more than 1 or 2 drinks of alcohol per day tends to raise blood pressure in those who are sensitive to alcohol [32]. Obese people are 2 to 6 times more likely to develop high blood pressure than people whose weights are within a healthy range [32]. Reducing stress is among the recommended strategies for preventing high blood pressure from developing [32].

Psychological Distress 

For the period January 2006 through June 2006, the Centers for Disease Control and Prevention [34] reported that 2.9% of adults aged 18 years and older experienced serious psychological distress during the past 30 days. Stress can have several effects on the body. No one knows if stress directly causes heart disease, but it can change chemicals in the body that contribute to the disease. Stress may also contribute to high blood pressure, high cholesterol, asthma, depression, ulcers and ulcerative colitis, smoking, overeating, and lack of exercise, which can lead to heart disease [35, 36]. It increases the risk for musculoskeletal disorders of the back and upper extremities and may also exacerbate existing health problems and interfere with their treatment [37]. The total health and productivity cost of worker stress to American business is estimated at $50 billion to $150 billion annually [38].

Numerous studies and surveys confirm that occupational pressures and fears are far and away the leading sources of stress for American adults and that these have steadily increased over the past few decades [39]. The National Institute for Occupational Safety and Health (NIOSH), part of the DHHS, is directed by Congress to study the psychological aspects of occupational safety and health, including stress at work. NIOSH reported that 40% of workers felt that their jobs were very or extremely stressful, 25% of workers viewed their jobs as the number one stressors in their lives, and job stress was more strongly associated with health complaints than financial or family problems [37]. A 2001 telephone survey conducted by Harris Interactive of employed American workers aged 18 years and older showed that 35% of workers said that their jobs were harming their physical or emotional health [39]. The same poll showed that 48% of workers at least sometimes had too many unreasonable deadlines or too much work to do; 42% felt that they sometimes, rarely, or never had adequate control or input over their work duties; 36% said that they at least sometimes found it difficult to express their opinions or feelings about their job conditions to their superiors; and 26% said that they rarely or never received appropriate recognition or rewards for good performance. Stress has been described as the “emotional toothache of the workplace” [39]. A 2000 annual Gallup poll sponsored by the Marlin Company found that 80% of workers felt stress on the job [39]. A 1992 United Nations report labeled job stress “the 20th century disease” [39]. Research on job stress has been furthered by a relatively new field of study known as occupational health psychology.

The kinds of stress we face today are different from the stressors that prompted the evolution of our stress response. In times past, when humans were running from predators, the sources of stress were intense but short lived. Today, the struggle for survival more often involves chronic, ongoing sources of stress, such as battling bad bosses and traffic jams and grappling with impossible schedules [36]. Chronic stress is what undermines health. Unrelenting stress that occurs without adequate opportunity for recovery can be a slow killer.

Clinically speaking, job stress is a set of harmful physical and psychological responses that occur when the requirements of a job do not match the capabilities, resources, or needs of a worker. Stress is a highly personalized phenomenon. What is stressful to one person may be relaxing or invigorating to another. Not all stress is bad. Positive stress can lead to increased creativity and productivity, a general feeling of well-being, and an optimally functioning immune system. Warning signs that stress has become negative include reduced productivity and creativity, a reduced feeling of well-being, a preoccupation with daily stress that limits ability to focus or concentrate, avoidance of social contact, a poorly functioning immune system, failing organs and systems, and the acceleration of the aging process due to the increased metabolism associated with uncontrolled stress [36]. One study showed that stress felt by physicians in training correlated with job dissatisfaction, lower morale, and poorer work performance [40].

The severity of job stress depends on the magnitude of the demands that are being made and individuals’ senses of control or decision-making latitude they have in dealing with them. Scientific studies confirm that workers who perceive that they are subjected to high demands but have little control are at increased risk for cardiovascular disease [39]. Opinions differ on the primary sources of job stress. Some studies have shown that personal and situational factors, such as personality, coping skills, and attitude, influence whether stress will develop on the job. This point of view has given rise to stress management education, health promotion, and other workplace programs designed to help workers cope with demanding conditions. Other studies place more emphasis on working conditions as a key source of job stress. The NIOSH model of job stress is that stressful working conditions lead to risk for injury and illness [37]. In this model, conditions that commonly lead to stress include unrealistic deadlines and workloads, a lack of control over the working environment, a lack of supervisory support, and poorly defined work roles. Unhealthy environmental conditions, such as noise, crowding, or ergonomic problems, can also lead to work-related stress. The NIOSH model suggests that the most direct way to prevent stress is not through stress management programs (which are beneficial in the short term but do not address the root causes of stress because they focus on workers, not the environment), but through the improvement of working conditions.

As a first step to reduce stress in the workplace, organizations should identify the problem. Workers should be asked about working conditions, stress levels, health concerns, job satisfaction, and other relevant issues. Some examples of organizational changes that can prevent job stress include defining workers’ roles and responsibilities, allowing workers to fully use their skills, establishing work schedules that are compatible with demands outside of work, involving workers in decisions that affect their jobs, and reducing uncertainty about future job prospects [37]. Strategies that individuals can use include the elimination of avoidable sources of chronic stress, such as adjusting work hours or relocating to avoid a bad commute, living within financial means, letting go of stressful relationships, saying no a little more often, enlisting the help of stress management professionals, seeking outlets such as regular exercise and hobbies to blow off steam, creating a supportive circle of loving friends and family, and taking time to relax after a stressful project before tackling another.

Workplace Interventions 

Worksites provide access to 65% of the population over 16 years [41], which makes them ideal settings to implement strategies for reducing the prevalence and burden of overweight, obesity, and other health problems. As a means of reducing risk for employees, many companies over the last several decades have introduced worksite health promotion programs. Such programs have historically resulted in reduced absenteeism, increased employee retention, reduced health care costs, and employee satisfaction [42]. Early in the development of a comprehensive wellness program, it is necessary for a company to assess its needs. The involvement of employees is necessary for a successful program. Employee risk assessment is beneficial to program development. This can be accomplished through monitoring cholesterol levels, blood pressure, and weight, and by providing employees with health risk appraisals or assessments.

Opportunities for environmental and policy change to foster healthy dietary practices and increase activity are readily available. For example, worksites can provide easier access to stairwells than to elevators and adopt policies that provide employees with exercise breaks during work hours. They can provide bicycle racks to encourage people to cycle to work, purchase corporate memberships at local sporting facilities or health clubs, provide on-site exercise facilities, provide incentives to promote physical activity, and support sports and activity clubs such as work football and hockey teams. A federal task force on community preventative services recommends combination nutrition and physical activity programs as worksite-based interventions [43]. One of the more innovative changes that has been introduced into the workplace is an adjustable workstation that allows workers to stand and walk slowly on a treadmill as they read e-mail, take calls, and work on their computers. James Levine, MD, a Mayo Clinic obesity researcher, developed and began using such a workstation a year ago, and now 10 other employees and the Mayo Foundation’s president use an enhanced version of the adjustable workstation [44]. Dr Levine also created a track around the office perimeter so meetings could be held on foot instead of seated at a table. These interventions support the NEAT theory (nonexercise activity thermogenesis), which refers to energy spent on physical activities of daily living, and says there is more metabolic benefit from frequent fidgeting and small movements than from sitting still for days with an occasional hard-core workout.

Stress reduction activities may include the provision of relaxation tapes or a relaxation room, support groups, stress management and relaxation training, flextime, psychological counseling, the reduction of environmental stressors, training in time management, exercise activities, and assertiveness training courses or courses for dealing with difficult persons or situations.

Summary 

The goals of Healthy People 2010 are to increase the quality and years of healthy life and eliminate health disparities. Data show that Americans are living longer, but not necessarily in good health. Studies show that maintaining a healthy weight, participating in regular physical exercise, following recommended dietary guidelines, recognizing and limiting the effects of stress, and screening for and treating high cholesterol and blood pressure lead to longer and healthier lives. Yet data show that the majority of American adults do not follow recommended guidelines for physical activity and diet, worker stress among American adults is high, 1 in 4 American adults have high blood pressure, and more than 20% have high levels of TC. The increasing prevalence of overweight and obese adults, now more than 60%, has reached epidemic proportions. Average American adult kilocalorie consumption has increased significantly, especially kilocalories of nonnutritious and unhealthy foods. Studies show that once this lifestyle pattern is established, it is very difficult to undo. Avoiding excess weight gain during early adult years may be pivotal in preventing adverse changes in risk factors and subsequent cardiovascular disease and may establish an early foundation for maintaining lifelong healthy habits in adulthood and for serving as healthy role models for children. Accomplishing the goals of Healthy People 2010 will require the cooperative efforts of individuals, communities, and professionals. Worksite interventions are promising because of the large population they target. Such interventions, if they are to be successful, will require workers and employers to be open to personal changes and changes in the work environment. I challenge myself and all radiologists and radiology trainees to examine their personal lifestyles and working environments and work together to develop and implement strategies aimed at fostering healthier lifestyles.