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The health benefits of regular physical activity and the relation between physical inactivity and chronic disease morbidity and mortality are well established. Also clear is the fact that efforts to increase physical activity at the population level will require collective action by government, nongovernment, for-profit, and nonprofit entities working together at the local, state, and national levels. The US National Physical Activity Plan (NPAP), developed by the National Physical Activity Plan Alliance, of which the American Heart Association (AHA) is a member, is designed to facilitate this collective action, to help organizations from all sectors of society work together to increase physical activity in all segments of the American population. The purposes of this advisory are to summarize the data that describe the health benefits of regular physical activity and the public health burden of low levels of physical activity, to describe the NPAP and the role it will play in increasing population levels of physical activity, and to encourage readers of Circulation to join the AHA’s efforts to promote its implementation. As summarized in Table 1, there is substantial evidence supporting the benefits of regular physical activity to prevent a wide variety of disease conditions and to enhance quality of life. Interestingly, there is less of an appreciation of noncardiovascular benefits of lifestyle physical activity and structured exercise, and this is an area of great opportunity for educating the public and healthcare practitioners. View this table: Table 1. The Health Benefits of Regular Physical Activity Physical inactivity is rapidly becoming a major global concern and is the fourth leading cause of death worldwide.2,3 As noted by Kohl and colleagues, “In view of the prevalence, global reach, and health effect of physical inactivity, the issue should be appropriately described as pandemic, with far-reaching health, economic, environmental, and social consequences.”4 According …

Introduction: Consuming fruits, vegetables and whole grains is associated with lower risk of cardiovascular disease. Community-based nutrition programs are an effective approach to changing attitudes and behaviors around food and health in underserved populations. The American Heart Association and Aramark launched Healthy for Life 20 by 20, a five-year initiative to increase fruits, vegetables and whole grains by 20 percent. A major focus of their collaboration was the development and implementation of a 12-week community-delivered nutrition engagement pilot. The purpose of this pilot was to evaluate the effectiveness of this health program in improving healthy food purchasing behaviors, nutrition and lifestyle choices. Methods: A 12-week pilot intervention was designed and implemented in three cities at five community centers March-June 2016. Weekly sessions were focused on enhancement of healthy cooking and shopping skills, nutrition education, and assessment of personal cardiovascular risk factors. Participating centers had the option to choose from two delivery methods: optimal and flexible. Participant fruit and vegetable intake, whole grain intake, and number of meals prepared at home were assessed before and after completion of the intervention. Results: Study participants (n=119) were predominately female (79%), Hispanic (60%) and African-American (27%), had high school or lower educational attainment (67%), lower income (39% < $20K, 40% $20K-$39.9K), young and middle ages (45% Conclusions: The use of industry and non-profit partnerships in a community engagement format can be an effective way to facilitate programs focused on increasing consumer trust for shopping and cooking, to build confidence of new skills, and to empower individuals to improve their health and potentially the health of their family. These results suggest that this community engagement partnership approach can positively transform health in communities and drive the American Heart Association’s goal of improving Americans’ health by 20% by 2020.

Background— To examine the influence active-play video gaming (also referred to as exergaming, exertainment, and active gaming) might have on improving health-related skills, enhancing self-esteem and self-efficacy, promoting social support, and ultimately motivating positive changes in health behaviors, the American Heart Association convened The Power of Play: Innovations in Getting Active Summit. The summit, as well as a follow-up science panel, was hosted by the American Heart Association and Nintendo of America. Methods and Results— The science panel discussed the current state of research on active-play video gaming and its potential to serve as a gateway experience that might motivate players to increase the amount and intensity of physical activity in their daily lives. The panel identified the need for continued research on the gateway concept and on other behavioral health outcomes that could result from active-play video games and considered how these games could potentially affect disparate populations. Conclusions— The summit represented an exciting first step in convening healthcare providers, behavioral researchers, and professionals from the active-play video game industry to discuss the potential health benefits of active-play video games. Research is needed to improve understanding of processes of behavior change with active games. Future games and technologies may be designed with the goal to optimize physical activity participation, increase energy expenditure, and effectively address the abilities and interests of diverse and targeted populations. The summit helped the participants gain an understanding of what is known, identified gaps in current research, and supported a dialogue for continued collaboration.

Background— A 2-day forum was convened to (1) discuss ways to translate the 2009 American Heart Association added sugars recommendations into actions in areas such as regulation, food labeling, nutrient content claims, and practical application in the American diet; (2) review surveillance methodology and metrics for tracking and understanding the impact of reducing added sugars in the diet; and (3) initiate the development of a framework for future collaboration to help Americans implement science-based guidance relative to added sugars. Methods and Results— More than 100 multinational participants representing scientists from academia and government and stakeholders engaged in food production, development, and processing, food manufacturing and servicing, food and nutrition policy, and nutrition recommendations for the public attended the conference. Presentations included definitions and examples of added sugars, current US and international added sugars perspectives, added sugars in diets of individuals and in the food supply, food technology behind added sugars, added sugars and health, food manufacturer perspectives, added sugars food-labeling considerations, and examples of positive approaches to improve eating behaviors and the food environment. Facilitated breakout sessions were conducted after the plenary sessions to allow participants to contribute their expertise and thoughts. Conclusion— The American Heart Association Added Sugars Conference is the first step in an important process that facilitates collaboration across science, public health, and industry to foster innovation, partnerships, policy, and implementation of new products and services for the benefit of the health and well-being of the American public. Science has advanced in the area of added sugars and health, creating mounting pressure to use better methods for translation and dissemination of the science for consumer education and for food companies to respond by producing foods and beverages with fewer added sugars. The new science also reinforces the importance of preventing, rather than simply treating diseases, especially overweight and obesity, diabetes mellitus, high blood pressure, heart disease, and stroke. Reducing added sugars consumption is a good target for addressing obesity, along with other sources of excess calories. However, the potential unintended consequences of substituting added sugars with ingredients that may not reduce calories and of increasing other macronutrients or food groups that may not result in a net health gain must be considered. Although there are many challenges to incorporating added sugars to the food label as was discussed during the conference, disclosure of added sugars content on food and beverage labels is an essential element in consumer education and can provide the information and motivation for making healthier food choices. This conference demonstrated the value of interactive dialogue among multiple sectors and disciplines. More disciplines should be at the table to bring expertise to discuss cross-cutting issues related to public policies and offer diverse insights to finding a solution.

Introduction: Less than 1% of Americans consume a diet that is consistent with the American Heart Association (AHA) definition for ideal cardiovascular health. In-home food preparation is associated with healthier dietary patterns and is more likely to align with current AHA recommendations for healthy eating. Hypothesis: The AHA’s Simple Cooking with Heart (SCwH) program aims to increase the healthfulness of family meals by addressing common barriers to cooking at home (lack of time, lack of skill, lack of budget). By increasing self-efficacy, individuals will demonstrate changes in attitudes and intention to choose wisely when shopping, as well as prepare and consume more meals at home, resulting in improved diet quality. Exposure to a “live” demonstration program that engages participants will improve cooking confidence and change attitudes in low-socioeconomic populations, compared to an online only, skills-building video exposure. The theoretical framework for this intervention is based upon the Health Belief Model. Methods: A 4-week, 2-cell controlled exposure study design measured the discrete impact of SCwH on low-income individuals exposed to a live cooking demonstration experience compared to individuals who received an online only exposure. All individuals were assessed via questionnaire post baseline for changes in attitude/intention, skill acquisition, frequency of meals prepared in home, dietary consumption and relevance of materials and information received; 337 participants completed the 4 week study. Results: Participation in “live” cooking demonstrations had a near immediate positive impact on participants’ intentions to: increase number of meals at home, reduce added salt and sugar/sweeteners, eat more fruits/vegetables/whole grains, and decrease unhealthy items. Participants who receive a “live” exposure have increased outcomes compared to those who received an online-only exposure. Demonstration participants, compared to web-only participants, reported: more often using new information in-home and reported a significant increase in the frequency of consuming healthy food items and a decrease in unhealthy items. Online-only cell respondents reported no significant difference in the mean frequency an item (healthy or unhealthy) was consumed. Both cells reported learning new information/skills. Conclusions: Culinary skill development, changing perceptions about affordable meals and addressing barriers to preparing and consuming meals in-home can be an effective way to improve dietary quality in low-socioeconomic populations. Exposure to “live” demonstration programs can increase effectiveness and promote healthier cooking at home; however, online-only intervention can still have a positive impact.

Background— A 2-day interactive forum was convened to discuss the current status and future implications of reducing sodium in the food supply and to identify opportunities for stakeholder collaboration. Methods and Results— Participants included 128 stakeholders engaged in food research and development, food manufacturing and retail, restaurant and food service operations, regulatory and legislative activities, public health initiatives, healthcare, academia and scientific research, and data monitoring and surveillance. Presentation topics included scientific evidence for sodium reduction and public health policy recommendations; consumer sodium intakes, attitudes, and behaviors; food technologies and solutions for sodium reduction and sensory implications; experiences of the food and dining industries; and translation and implementation of sodium intake recommendations. Facilitated breakout sessions were conducted to allow for sharing of current practices, insights, and expertise. Conclusions— A well-established body of scientific research shows that there is a strong relationship between excess sodium intake and high blood pressure and other adverse health outcomes. With Americans getting >75% of their sodium from processed and restaurant food, this evidence creates mounting pressure for less sodium in the food supply. The reduction of sodium in the food supply is a complex issue that involves multiple stakeholders. The success of new technological approaches for reducing sodium will depend on product availability, health effects (both intended and unintended), research and development investments, quality and taste of reformulated foods, supply chain management, operational modifications, consumer acceptance, and cost. The conference facilitated an exchange of ideas and set the stage for potential collaboration opportunities among stakeholders with mutual interest in reducing sodium in the food supply and in Americans’ diets. Population-wide sodium reduction remains a critically important component of public health efforts to promote cardiovascular health and prevent cardiovascular disease and will remain a priority for the American Heart Association.

Recent reports of selected observational studies and a meta-analysis have stirred controversy and have become the impetus for calls to abandon recommendations for reduced sodium intake by the US general population. A detailed review of these studies documents substantial methodological concerns that limit the usefulness of these studies in setting, much less reversing, dietary recommendations. Indeed, the evidence base supporting recommendations for reduced sodium intake in the general population remains robust and persuasive. The American Heart Association is committed to improving the health of all Americans through implementation of national goals for health promotion and disease prevention, including its recommendation to reduce dietary sodium intake to

Blood pressure (BP)-related diseases, specifically, stroke, coronary heart disease, heart failure, and kidney disease, are leading causes of morbidity and mortality in the United States and throughout the world. In the United States, coronary heart disease and stroke are the leading causes of mortality, whereas heart failure is the leading cause of hospitalizations.1 Concurrently, the prevalence of chronic kidney disease remains high and is escalating.2,3 The direct and indirect costs of these conditions are staggering, over $400 billion just for cardiovascular disease (CVD) in 2009.1,4 The human consequences are likewise enormous. The relation between BP and adverse health outcomes is direct and progressive with no evidence of a threshold, that is, the risk of CVD, stroke, and end-stage kidney disease increases progressively throughout the range of usual BP starting at a level of ≈115/75 mm Hg.5,–,7 Overall, elevated BP is the second leading modifiable cause of death, accounting for an estimated 395 000 preventable deaths in the United States in 2005.8 Worldwide, elevated BP accounts for 54% of stroke and 47% of coronary heart disease events; importantly, about half of these events occur in persons without hypertension.9 The 2020 goal of the American Heart Association (AHA) is to improve the cardiovascular heath of all Americans by 20% while continuing to reduce deaths from CVD and stroke by 20%.4 Two of the key metrics for ideal cardiovascular health are a BP of