Encouraging Physical Activity During Key Life Events and Transitions

The 2018 Physical Activity Guidelines provide specific recommendations for children, adults, older adults, and other special populations on the amount of physical activity needed to observe substantial health benefits.¹ The guidelines also recommend individuals sit less and move more throughout the day.¹ However, despite the wealth of information illustrating the benefits of physical activity, a small proportion of individuals across the life course meet the physical activity guidelines.² Emerging evidence also indicates there are important life events and transition periods where physical activity declines further while sedentary behavior may increase. It is imperative to identify these critical windows where reductions in physical activity and increases in sedentary behavior are common to inform and implement effective strategies to promote optimal movement patterns to improve cardiovascular and overall health.

In the recently released American Heart Association Scientific Statement on supporting physical activity during life events and transitions, Dr. Lane-Cordova and the writing group establish a need to better understand periods of physical activity fluctuations that could lead to targeted interventions to help individuals begin or maintain physical activity for optimal health. The scientific statement first provides a comprehensive overview of how physical activity and sedentary behavior change during major life events and life transitions. Second, the document provides guidance for health care providers to identify, address, and promote physical activity during these critical windows and discusses evidence-based community-level approaches to promote physical activity.

There are several important life transitions associated with declines in physical activity, including entry to school (elementary, middle, high school, and college), entry to the labor market, marriage or civil union, pregnancy, parenting, retirement, and entry to long-term care facilities. Further, various subgroups are more susceptible to adverse changes in physical activity, and thus may have greater need for physical activity support during major life events or transitions. Identified subgroups include individuals with lower education, who live alone, have less access to safe outdoor space, Black Americans, sexual/gender minority groups, and women during pregnancy and postpartum. While the evidence examining sedentary behavior and life transitions is less robust, preliminary data indicates that school-level transitions, entry or exist from the labor market, pregnancy, and major illness and injury are associated with increases in sedentary behavior. Identification of these critical life transitions and subgroups particularly susceptible to declines in physical activity and increases in sedentary behavior is a key first step to inform future interventions to promote more optimal movement patterns and improve health outcomes.

The recently published scientific statement on physical activity during life events and transitions is particularly useful for health care providers as it offers specific guidance on how to identify, address, and promote physical activity during these major life events and transition periods. Recommendations include identifying patient’s current level of physical activity using self-report or wearable technology, comparing this to current guidelines, and providing resources or referrals as needed. An example of a simple self-reported two-question tool that has been implemented in the Kaiser Permanente health care system among others nation-wide is the Physical Activity Vital Sign.³ These recommendations clearly align with the Exercise is Medicine® Global Health Initiative managed by the American College of Sports Medicine, where the vision is to make physical activity assessment and promotion a standard in clinical care and connect health care with evidence-based physical activity resources.⁴ This scientific statement also provides examples of specific motivational-interviewing strategies and questions providers can use to more effectively discuss physical activity and sedentary behavior with their patients during major life events and transitions. These suggested approaches focus on opening the conversation, offering insight, and facilitating problem solving with emphasis on compassion and understanding. Looking beyond the health care setting, it is also critical to engage organizations and communities including schools, places of work, faith-based communities, and assisted living centers where these life transitions often occur to promote an active lifestyle.

Areas for future research include improved surveillance efforts to evaluate physical activity, sedentary behavior, and corresponding health and wellness, particularly among underserved groups. Additional research is also needed to better characterize the effects of life events and transitions on sedentary behavior, given the growing evidence that sedentary behavior has distinct and adverse associations with health outcomes, independent of physical activity.⁵ Finally, there is a need to develop and test interventions across the socioecological spectrum that are designed to target the life events and transitions that are linked to declines in physical activity and increases in sedentary behavior. Focusing on these transition periods may help prevent commonly experienced adverse changes in movement patterns, thus improving long-term cardiovascular and overall health across the lifespan.