Major life events influence level of physical activity, may negatively impact heart health, experts say

The statement, entitled "Supporting Physical Activity in Patients and Populations During Life Events and Transitions," focuses on the need to better understand how life changes affect physical activity levels and what can be done to help people maintain good heart health throughout life transitions. The statement writing group members note that because sedentary behavior is an emerging cardiovascular disease risk factor, it's important to recognize how physical activity levels may impact health during major life events and transitions. The statement also provides guidance for health care professionals to identify, address and promote regular physical activity to patients experiencing significant changes in their lives. Options for community-level interventions to promote physical activity are also explored.

"Certain life events and transitions may mark the beginning and end of different phases of a person's life, and these life changes may lead to periods of less physical activity and more sedentary lifestyle behaviors. Physical activity is an important heart-healthy behavior and too much sitting and inactivity is not good for you," said the writing group Chair Abbi D. Lane-Cordova, Ph.D., FAHA, an assistant professor in exercise science at the Arnold School of Public Health at the University of South Carolina in Columbia South Carolina. "This is a particularly important topic right now because, in addition to life's other major events, the COVID-19 pandemic is another disruption of everyone's daily routines and activity levels."

The American Heart Association recommends most adults participate in at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. Children and adolescents 6-17 years old should get at least 60 minutes of moderate-to vigorous-intensity physical activity every day.

According to the U.S. Centers for Disease Control and Prevention's Office of Disease Prevention and Health Promotion "Healthy People 2020" initiative, only 1 in 5 teens (20%) and about 1 in 4 adults (24%) in the U.S. routinely achieved the recommended levels of physical activity in recent years. While these rates are low across the board, data suggest these numbers could change significantly during a major life event or transition. The writing group examined data on 17 different life events or transitions, and found evidence of decreased activity levels during nine events:

• Beginning a new school (elementary, middle, high school or college) -- each distinct life events;
• a first job or career change;
• a marriage or civil union;
• pregnancy;
• parenting;
• retirement; or
• moving into a long-term care facility.

The writing group also assessed the effects of major life changes on various subgroups within the U.S. population to identify people most in need of support during life transitions. People most at risk for significantly lower physical activity during life changes include:

• individuals with lower levels of education;
• those who lived alone during the initial COVID-19 venue closings;
• those who lacked safe access to outdoor space for exercise and physical activity; and
• women during pregnancy and parenthood.

The "socioecological model," which encompasses individual, social, environmental and policy contributors, was the framework used to examine numerous factors that affected levels of physical activity.

The analysis found that general factors affecting physical activity levels among youth (<18 years of age) at the individual level include:

• gender;
• age;
• motor coordination;
• time outside;
• physical activity preferences
• body image;
• perceived barriers;
• involvement in school sports; and
• physical education.

At the interpersonal level, youth were influenced by their weight and physical activity levels, and by their parents' education level. Environmental influencers for youth included neighborhood crime rates, perception of safety, walkability, proximity and access to school programs and recreational facilities. COVID-19-related restrictions and stay-at-home orders have also been related to changes in physical activity in youth and Lane-Cordova noted more data in this area will be important to consider.

The analysis of physical activity levels for adults (18+ year old) found individual influencers included:

• the perceived health benefits of exercise;
• history of and intention to exercise;
• self-efficacy/confidence to achieve goals;
• enjoyment; and
• lower stress levels.

Social and cultural norms affected adults both negatively and positively, while environmental influencers included proximity and access to recreation facilities and greenspaces, transportation, neighborhood walkability and convenience.

Research specific to factors affecting physical activity during life transitions is less robust, so the statement suggests future efforts to identify socioecological factors that may help support routine exercise. Examples of these factors include safer streets for pedestrians ans cyclists, rails-to-trails programs and park upgrades. The writing group proposes public health policies to implement these infrastructure changes would help ensure support for physical activity during major life events.

The statement also suggests practical strategies for health care professionals to support routine physical activity levels during major life events and transitions. Health care

professionals can assess physical activity by asking a few questions as part of the collection of vital signs during a routine health visit. A brief screening tool of questions for individual patient responses may be a low-cost option in a clinical setting to assess physical activity levels and support needed. For daily patient use, the writing group suggests simple, commercially available wearable technology such as pedometers or accelerometers to monitor physical activity levels and changes. Simple metrics like adding 1,000 steps per day to increase daily physical activity levels may result in improved health benefits.

"It's important to maintain or improve physical activity when major life events happen, which is often a time when exercise is most needed," Lane-Cordova said. "There are so many ways people can do this. They could plan family activities that involve exercise, use free videos or websites to exercise at home or take standing breaks while at work. The most important things are to be aware of the positive health and cardiovascular impact of physical activity and make the effort to get moving."

The statement suggests health care professionals have a big role to play when it comes to opening the conversation about physical activity levels with their patients. The writing group recommends health care professionals focus on compassion and understanding. Given that primary care physicians may lack the necessary time and resources for follow-up support, clinicians may look at expanding the roles of other members of the clinical care team, including nurses, medical assistants and health or lifestyle coaches.

The statement also mentions behavioral counseling as another means to provide support for physical activity during major life transitions or events. There are numerous mental and physical health benefits of starting and maintaining regular physical activity during major life events and transitions. Urging regular physical activity along with offering compassion and empathy supports physical and mental health during challenging times.

The statement writing group notes that health care professionals can be an important source of encouragement. Referring to past accomplishments may increase a patient's confidence in their ability to incorporate regular physical activity into their daily routine. Motivational interviewing may be better received during life transitions and events than a more traditional educational approach during life transitions and events. And a variety of health care professionals, such as medical assistants and health or lifestyle coaches, can help provide physical activity counseling.

The writing group said it is crucial "to look beyond the health care setting and engage organizations, communities, workplaces, faith-based communities and assisted living facilities to promote physical activity." The statement provides a list of resources for individuals and health care professionals, many of which are free and online. Future areas of research should include improved surveillance efforts to assess physical activity, sedentary behavior and the corresponding overall health and wellness, particularly among at-risk and underserved populations, according to the writing group. More information is also needed to effectively characterize the impact of life events and transitions on sedentary behavior, especially given the growing body of evidence that too much sitting is associated with worse health outcomes. Finally, the statement highlights the need to develop and test interventions that specifically target life events and transitions linked to declines in physical activity levels.

Co-authors are Vice Chair Bethany Barone Gibb, Ph.D., FAHA; Gerald J. Jerome, Ph.D., FAHA; Amanda E. Paluch, Ph.D.; Eduardo Esteban Bustamante, Ph.D.; Michael J. LaMonte, Ph.D., M.P.H., FAHA; Russel R. Pate, Ph.D.; R. Glenn Weaver, Ph.D.; and Kashica J. Webber-Ritchey, Ph.D., M.H.A., R.N. Authors' disclosures are listed in the manuscript.