Over the past 25 years, this journal has published nearly 300 articles focused on public health practice and research related to physical activity (PA). Instrumental to the surge of publications on PA as a public health issue was the publication of the first Surgeon General's Report on Physical Activity and Health in 1996.1 The key finding of the report was the recognition that regular PA improves the quality of life across the life span and has significant health benefits. For the first time, a federal public health agency linked PA with reduced risk of premature mortality (in general), and coronary heart disease, hypertension, colon cancer, and diabetes mellitus, specifically.
In addition, PA was noted as a method to improve mental health and strengthen bones, muscles, and joints. However, despite these benefits, 60% of American adults were not active regularly and 25% reported no PA at all. Likewise, almost half of 12- to 21-year-olds were not regularly engaged in PA, with significant declines in PA during adolescence. As such, the report called for the study of ways to facilitate individual PA habits and identify community environments, policies, practices, and social norms to support them.1
The purpose of this commentary is to highlight the progress we have made over the past 25 years and outline the pathway to future public health practice and research related to PA across the life span.
Physical activity as a public health issue has seen tremendous advances over the past 25 years. The fields of PA practice and research have greatly expanded, with significant funding by federal agencies (eg, National Institutes of Health, Centers for Disease Control and Prevention) and private foundations such as the Robert Wood Johnson Foundation's Active Living by Design and Active Living Research programs. This collective work has shown the importance of social ecological models2 to improve PA participation across the life span. Publications such as those in the Collections section of the Journal of Public Health Management & Practice (JPHMP) demonstrate the positive impact of multisector collaborations (including city planning, transportation, parks and recreation, local government, public health, business), community capacity building, and cultural tailoring when designing supportive environments for individuals to achieve and maintain regular PA.
In addition, technology advances (eg, accelerometers, wearable trackers, GPS, GIS) have led to better ways to assess PA more objectively and in real time. These advances enable reaching larger and broader audiences at lower costs by delivering interventions via electronic and mobile technologies.
Finally, the past 25 years have given us deeper understandings of which populations are at greater risk of insufficient PA and related health consequences. Publications in JPHMP and elsewhere have documented disparities in PA by gender, race and ethnicity, age, socioeconomic status, and geographic region (rural vs urban; US region). Concerted efforts to achieve health equity have been endorsed by leading public health agencies and local health departments.
Despite progress over the past 25 years of PA promotion, as reflected in the ongoing themes in JPHMP, several important gaps remain, including issues of broad implementation and scaling up of PA programs, increasing access to PA opportunities, promotion of rural active living, surveillance of PA, and advancing the training of the next generation of PA practitioners and researchers.
The rapid expansion of the field of implementation science promises to help address gaps between the development of evidence-based programs and their widespread use in practice. A recent systematic review described the need for scaling up or "outgrowing" PA programs originating from research and practice settings to a point where they are embedded in a broader system and can be sustained over time.3 To achieve widespread scale-up of programs, it is critical to recognize the diverse contexts from which these programs could both originate and be more broadly integrated. Given evidence of the need to involve diverse stakeholders in the development and dissemination of PA programs, published research in this area should also be written and made accessible in a way that can reach people from outside the immediate public health domain.
Growing evidence supports the use of built environment approaches to PA promotion, specifically those that pair 1 or more interventions to improve safety for pedestrians and/or bicyclists with 1 or more interventions to change land use or environmental design.4 However, challenges to active living efforts include both the inequities in access to supportive environments5 and the potential unintended consequences of built environment interventions.6 An emerging area of inquiry in public planning explores the potential for these programs to specifically contribute to neighborhood gentrification and displacement,7,8 as has been observed after public investment in resources such as transit infrastructure. It is critical for public health practitioners and researchers to consider and measure neighborhood composition and affordability as they plan PA promotion projects that could have broader environmental impacts.
Furthermore, the disproportionate burden of chronic disease and physical inactivity in rural compared with urban populations necessitates attention. A recent call to action published in JPHMP outlined priorities for future practice and research efforts, including expanded knowledge about intrapersonal influences on PA in rural contexts, use of multilevel approaches to PA promotion, and policy considerations.9
In addition to effective programs to promote PA across a variety of contexts, there is a pressing need for expanded PA monitoring as a component of public health surveillance systems. An ad hoc group of interdisciplinary experts recently provided recommendations for closing gaps in PA surveillance systems including devoting resources to gaps in context-specific surveillance (eg, health care settings, workplaces) and monitoring the implementation and impact of community supports for active transportation (eg, built environment design and policies).10
Finally, the importance of providing responsive and ongoing education to the next generation of PA practitioners and researchers cannot be understated. Most major public health issues can only be addressed by the work of interdisciplinary teams, necessitating strong training in cross-sector collaboration and team science. Intensive courses, such as the Physical Activity and Public Health practitioner11 and researcher12 courses, have provided crucial capacity building for domestic and international PA work, and programs such as these will continue to be important resources.
The next 25 years of public health promotion of PA promise to be critical to expanding the reach of evidence-based programs, monitoring PA program impacts, and reducing associated health inequalities.
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