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Parks and recreation departments and public health organizations both work to improve the well-being of their communities. Measuring residential proximity to parks could be a specific area of shared interest, given that proximity to parks is needed for walking access, and the use of parks is, in turn, associated with many physical, social, and mental health benefits. The CDC’s publicly available National Environmental Public Health Tracking Network (NEPHTN) Access to Parks Indicator (API) focuses on one major component of access, residential proximity to parks. The API uses a commercial parks database and U.S. Census data to estimate the number and percentage of individuals in the U.S. that live within a half-mile of a park boundary, a measure commonly used to represent park proximity. The API is calculated at the state and county levels and is available for all states and counties in the U.S. Using estimates from the API, we examined the distribution of residential proximity to parks by geography and race/ethnicity. Additionally, we evaluated differences in park proximity by rural/urban status of counties. In 2010, 39% of the total U.S. population lived within a half-mile of a park. This percentage varied widely between states, ranging from 9% in West Virginia to 67% in Hawaii and 88% in the District of Columbia (DC). Park proximity was lowest among non-Hispanic whites (34.2%) and highest among individuals belonging to the non-Hispanic other race category (52.0%). Metropolitan counties had the highest percentage of residents living within a half-mile of a park (43.3%); the percentage was lower in non-metropolitan counties adjacent to a metropolitan county (15.0%) and non-metropolitan counties not adjacent to a metropolitan county (18.5%). Park proximity was higher in metropolitan counties with a larger population size and in non-metropolitan counties with a higher degree of urbanization. The NEPHTN Access to Parks Indicator provides an opportunity to understand park proximity in counties and states throughout the U.S., including identifying disparities that may exist between population subgroups and comparing geographic areas. Parks and recreational professionals can use this information to compare their county or state to other geographic areas and, in combination with local data on parks within their jurisdiction, inform decisions to improve the distribution of parks and the well-being of their communities.

The purpose of the American College of Sports Medicine's (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Recent studies have suggested that using the current ACSM exercise preparticipation health screening guidelines can result in excessive physician referrals, possibly creating a barrier to exercise participation. In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit. Consequently, a scientific roundtable was convened by the ACSM in June 2014 to evaluate the current exercise preparticipation health screening recommendations. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individual's current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. Identifying cardiovascular disease risk factors remains an important objective of overall disease prevention and management, but risk factor profiling is no longer included in the exercise preparticipation health screening process. The new ACSM exercise preparticipation health screening recommendations reduce possible unnecessary barriers to adopting and maintaining a regular exercise program, a lifestyle of habitual physical activity, or both, and thereby emphasize the important public health message that regular physical activity is important for all individuals.

Although the American Heart Association/American College of Sports Medicine's Preparticipation Questionnaire (AAPQ) is a recommended preexercise cardiovascular screening tool, it has never been systematically evaluated. The purpose of this research is to provide preliminary evidence of its effectiveness among adults aged ≥40 years.Under the assumption that participants would respond to AAPQ items as they responded to a general health survey, we calculated the sex- and age-specific proportions of adult participants in the National Health and Nutrition Examination Survey 2001 to 2004 who would receive a recommendation for physician consultation based on AAPQ referral criteria. Additionally, we compared recommended AAPQ referrals to a similar assessment using the Physical Activity Readiness Questionnaire in the study sample. AAPQ referral proportions were higher with older age. Across all age groups ≥40 years, 95.5% (94.3% to 96.8%) of women and 93.5% (92.2% to 94.7%) of men in the United States would be advised to consult a physician before exercise. Prescription medication use and age were the most commonly selected items. When referral based on AAPQ was compared with that of the Physical Activity Readiness Questionnaire, the 2 screening tools produced similar results for 72.4% of respondents.These results suggest that90% of US adults aged ≥40 years would receive a recommendation for physician consultation by the AAPQ. Excessive referral may present an unnecessary barrier to exercise adoption and stress the healthcare infrastructure.

To describe the development and preliminary evaluation of the Multicontext Sitting Time Questionnaire (MSTQ).During development of the MSTQ, contexts and domains of sitting behavior were utilized as recall cues to improve the accuracy of sitting assessment. The terms "workday" and "nonworkday" were used to disambiguate occupational and discretionary sitting. An expert panel evaluated content validity. Among 25 participants, test-retest reliability of the MSTQ items was assessed with intraclass correlation coefficients (ICCs). Convergent validity was assessed versus relative and absolute accelerometer-estimated sedentary time and activity log using Pearson (r) or Spearman (p) correlation coefficients where appropriate.Pilot testing revealed Web-based MSTQ administration was rapid, scalable, and inexpensive. Most items in the MSTQ demonstrated acceptable reliability (ICCs.70). Compared with accelerometer-estimated sedentary time relative to total wear time, the MSTQ exhibited a low correlation on workdays (r = .34) and a moderately high correlation on nonworkdays (r = .61).The systematic development of the MSTQ resulted in several improvements over previous tools and may serve as a model for purpose-driven questionnaire design. Additional validation is needed to conclusively determine the utility of the MSTQ.

Context Physical activity is a leading cause of death in the world. Although state and local public health planning is a useful strategy to address noncommunicable disease health concerns such as heart disease, diabetes, cancer, and obesity, physical activity frequently is subsumed in such disease-centric planning efforts. This strategy could dilute broader efforts to promote physical activity, create administrative silos that may be trying to accomplish similar goals, and weaken efforts to more collectively address a variety of noncommunicable diseases. Currently, few stand-alone state plans directed specifically at physical activity exist. The reasons and barriers for this situation are not understood. Objective In 2011, we surveyed public health care practitioners to describe state and local efforts for physical activity planning. Design Cross-sectional study. Setting Survey of physical activity practitioners in the United States. Participants A total of 227 former or current members of the US National Society of Physical Activity Practitioners in Public Health who completed a survey. Results Overall, 48.0% of respondents indicated that they were aware of public health plans for physical activity promotion in their state, whereas 36.6% indicated that they did not know. Respondents at the state level more frequently reported awareness of a plan (62.1%) than those with local-level (52.4%) or other job responsibilities (36.0%). A greater proportion of respondents reported that stand-alone physical activity plans existed in their state than actually did exist in the respective states. Integration with the National Physical Activity Plan was least often identified as a moderately or extremely relevant aspect of a state-level physical activity plan, although it was chosen at a high percentage (75.7%). Respondents identified financial support (88.0%) and political will and support (54.6%) most frequently as very or somewhat difficult barriers to moving forward with state-level physical activity plans. Conclusions These data suggest that despite efforts to increase development and use of stand-alone physical activity plans, most practitioners rely on existing chronic disease- or obesity-related plans to guide their efforts. Barriers to developing stand-alone physical activity plans must be addressed to develop such plans.

Purpose: The study�s purpose was to characterize accelerometer-derived estimates of physical inactivity collected during five consecutive weeks in middle-age women. Methods: Data were obtained from 63 participants (95.5%) enrolled in the Evaluation of Physical Activity Measures in Middle-Age Women Study. Inactive time (min·d-1) was estimated as the sum of activity counts

Physical activity (PA) has shown consistent positive effects on cardiovascular risk, yet the individual contributions of frequency, intensity and duration remain unclear. The purpose of this investigation was to explore the associations between objectively-measured PA frequency and cardiometabolic risk factors, independent of total PA volume. Data were analyzed for 5,549 adults with at least four valid days of accelerometry from the 2003 – 2006 US National Health and Nutrition Examination Survey (NHANES). Meeting PA guidelines was defined as 150+ minutes of moderateto vigorous-intensity PA per week, accumulated in 10+ minute bouts. Frequency was defined as the number of days containing at least one bout, and categorized as 1-3, 4-5, or 6-7 days per week (d·wk-1). Risk factors were described for frequency categories after direct age adjustment and stratification by total weekly duration. Multivariate linear regression was used to analyze the independent associations between risk factors and PA frequency. Among those meeting PA guidelines, people in the lower total volume stratum and with higher frequency (4-5 or 6-7 d·wk-1) showed significantly higher C-reactive protein (CRP) compared to those in the lowest frequency category (1-3 d·wk-1) (0.12 and 0.14 mmol/L vs. 0.08 mmol/L, respectively, p < 0.05). Similar results were seen in the higher duration stratum, though differences in CRP between frequency categories did not reach significance. Small differences in hemoglobin-A1c and HDL-c were seen between frequency categories at both levels of duration (p

Background: It is unknown if a history questionnaire can effectively categorize athletes into risk strata for directed ECG/echocardiography (ECHO) use in community cardiac screening. The purpose of this study was to compare referral and diagnosis patterns in adolescent athletes after questionnaire-based risk stratification. Methods: Between May 2010 and December 2011, 3,181 adolescents (age 14-18 y) were screened using an 11-item history questionnaire, 12-lead ECG, and limited 2D-ECHO. Athletes were grouped into those with uniform "no" history responses (low risk) or those with any "yes" or "unknown" responses (high risk). We compared referral patterns in high- vs low-risk athletes for (1) ECG+ECHO; (2) ECG-only; (3) ECHO-only; and (4) ECG or ECHO for SCD-related conditions. Follow-up results from cardiology evaluations (n=173) were also compared. Results: Athletes were categorized from history as high- (57.3%) and low-risk (42.7%) and 8.4% were referred for cardiology evaluation. The proportion referred among high- and low-risk athletes was similar (table). Among 76 athletes with any confirmed abnormality, the relative odds (95% CI) of high- vs low-risk classification were 0.91 (0.50-1.68); among 7 with confirmed SCD-related abnormalities, the relative odds were 6.00 (0.68-52.6). Six of the 7 athletes with a confirmed SCD-related condition were classified as high-risk. View this table: Table 1. Percent (95% confidence interval) referred for four criteria, stratified by questionnaire-assessed risk group: TAAHSR 2010–2011 Conclusion: History data alone may be of little use in targeting ECG/ECHO in community screening, but may identify athletes diagnosed with an SCD-related condition