In This Section:

  • Economic Benefits of Workplace Wellness Programs and Changes since COVID-19

    by Caitlin Kinser | Jun 12, 2024

    one man and two women walking and talking wearing business casual attireSince the start of the COVID-19 pandemic, more employees have shifted to hybrid and remote work in office work, telehealth, information technology, education and other fields; however, there are many jobs that cannot be performed remotely, such as transportation, hospitality, manufacturing, food service, supermarket and other retail work and the majority of healthcare positions. Therefore, workplace wellness programs need to change along with these shifts in the workplace environment. After all, encouraging more employees to be physically active has social, environmental and economic benefits. 

    Physical inactivity has a high cost burden to employers — an estimated $300 billion between 2020 and 2030, according to the World Health Organization (WHO) global status report on physical activity — with even more cost if physical inactivity is not addressed. Inability to address physical inactivity will result in increased chronic diseases as well as declining mental health, and higher-income countries like the United States will incur a larger economic burden. Since half of the world’s population is of working age, the cost of chronic disease and injuries could be as much as 4-6% of global gross domestic product (GDP). Unfortunately, these projections may be conservative, and actual costs may be higher.  

    In a recent study, people who met physical activity guidelines of at least 150 minutes per week were found to have lower healthcare utilization, with fewer emergency room visits, hospital admissions and primary care visits compared to those who did not meet the guidelines. Likewise, seniors who participated in a SilverSneakers exercise program had over $2,000 per year savings in healthcare costs compared to nonparticipants. A RAND Corporation study of 50,000 workers reported that for every $1 invested in managing chronic diseases, the employer saved $3.78, but there was less immediate return for just general employee lifestyle management. Seven years of employee engagement in both chronic disease and lifestyle programs led to $30 reduced healthcare costs per month per employee.   

    The aforementioned WHO report recommends both government and private sector workplaces provide opportunities for employees to be active during the day as well as promote active transportation methods such as public transit, walking and bicycling. Both strategies can provide good return on investment, contribute to increased productivity, and reduce injuries and missed work.  

    In the release of the ACSM Worldwide Survey of Fitness Trends for 2023 there was little support for workplace incentives for physical activity or any other trend mentioning employer-based physical activity in the top 20 trends. It appears that traditional workplace wellness and employer sponsored programs may be falling out of favor following COVID-19. This is unfortunate given the projected economic costs of chronic disease and mental health caused by failing to address physical activity. Some employers may have shifted away from traditional workplace fitness and wellness programs and are now evaluating more programs that look at overall well-being, such as work-life balance, stress management and mental health, as well as promoting flexible physical activity options for onsite, hybrid and remote workers.  

    Governments and industry may want to collect prospective data on their employee physical activity and well-being so they can analyze their economic impact, especially following changing workplace environments due to COVID-19. The Physical Activity Alliance advocates for assessing physical activity at work using standardized measures and encouraging CEOs to sign a physical activity pledge to make physical activity a workplace cultural norm. Finally, employers can implement workplace policies to promote physical activity and overall employee well-being. 


    AUTHOR: Janet R. Wojcik, Ph.D., FACSM, is professor and program director of exercise science at Winthrop University in Rock Hill, South Carolina. She is a member of the ACSM American Fitness Index Advisory Board and the Physical Activity Policy Research and Evaluation Network (PAPREN) worksite work group. 

    Originally published on March 27, 2023

  • Physical Activity in School-Aged Children

    by Caitlin Kinser | Jun 12, 2024

    group of young student soccer players cheeringSchool-aged children should get at least 60 minutes of moderate- or vigorous-intensity physical activity every day of the week. Only 26% of adolescents met these physical activity guidelines in 2018, and that percentage has remained stable since 2011. 

    The COVID-19 pandemic made it even more difficult for children to meet these guidelines. At the start of the pandemic, my son switched to online school, and the community park was blocked off with bright-yellow caution tape. Despite knowing the risk of sedentary behavior and decreased physical activity, we found our kids were less likely to engage in free play without friends, parks and school. 

    The rate of increase in body mass index (BMI) in children 2-19 years of age nearly doubled during the COVID-19 pandemic compared to pre-pandemic rates. This faster increase in BMI was most pronounced in children who were already overweight, and in younger school-aged children. The number of children and teens classified as obese increased from 19% pre-pandemic to 22% at the time of publication. 

    The COVID-19 pandemic shut down schools, sports, after-school programs and community parks. In addition to disruptions in physical activity opportunities, there was also loss of income, increased food insecurity, increased stress and increased screen time. Despite the return of school and community-based programs, sports participation has not rebounded back to pre-pandemic levels. BMI changes during the COVID-19 pandemic highlight the importance schools play in the health of our children and the community. 

    Activity Guidelines for School-Age Children InfographicPhysically active children have lower rates of obesity in childhood, and a lower risk of obesity and chronic medical conditions in adulthood. In addition, higher levels of physical activity improve cognition, executive function, attention and academic performance. Increasing physical activity in schools through daily recess, physically active classroom lessons, longer or more frequent physical education classes and before- and after-school activities helps children reach physical activity guidelines and build the foundation of a healthy lifestyle into adulthood.  

    Fortunately, 93 of the 100 largest U.S. cities (listed in the ACSM American Fitness Index®) are located in states that require physical education* in elementary, middle and high school. This ensures millions of children learn how to be physically active for a lifetime. Families should also be encouraged to stay active as a family, provide opportunities for free play, participate in active transportation and limit screen time. My kids were happier, slept better and were more engaged when the parks opened back up, they went back to school and they had much less computer time. 

    The extra time needed to increase physical activity both in school and after school is easily made up for with improved concentration, attention span and academic performance. Utilizing school-based physical activity programs has never been more important!

    Download the infographic. 

    Author: Jessie Fudge, M.D., FACSM, Kaiser Permanente Washington 

    Originally published on August 18, 2022

    *The Fitness Index’s physical education indicator is based on state-level policies requiring a minimum amount of physical education for all schools in the state. Policies are coded 0-3 depending on the amount of physical education required. States requiring physical education at all three grade levels (elementary, middle, and high school) are given the highest score. Two states represented in the Fitness Index were coded zero for having no state policy requiring physical education: Colorado and Hawaii.

  • #EatingHealthy: Can Nutrition Apps Do the Job?

    by Caitlin Kinser | Jun 12, 2024

    Hand holding a phone showing a nutrition appWe’ve all seen the increase in the number of available apps to monitor lifestyle behaviors such as physical activity, sleep and stress. There is also clear interest in apps that monitor diet and nutrition. So, how do you know if a nutrition app will be helpful? In the last few years, millions of users have downloaded and installed nutrition-related apps. The latest research supports that “if the shoe fits” then maybe it is worth using! Mobile apps can provide an opportunity for assessing and improving nutrition by providing personalized information and instant feedback.

    What are the benefits?

    Apps can be an effective tool to evaluate and monitor eating behavior and diet-related health risk factors. Apps can provide autonomy and help people take charge of their nutrition choices. Monitoring food intake, setting goals, and viewing progress can all occur privately which may be appealing for those who desire less in-person contact with health care providers.

    What type of apps are available?

    The number and type of nutrition apps are only growing and with many being free, apps have the potential to reach large numbers of people world-wide. Here are some of the most common types of nutrition apps available.

    • Calorie Trackers/Food Tracking/Food Diary Programs
    • Macronutrient (carb, protein and fat) and Micronutrient (vitamins/minerals) tracking
    • Recipe Builders or Meal Planning
    • Restaurant and Grocery Finders
    • Diet Specialty – Example: carb counting for people with Type 2 diabetes
    • Food Allergy or Food Intolerances
    • Hydration
    • Grocery and Money Saving
    • Prompts or Timing
    • Nutrition Counseling and Education
    • Mindfulness/Intuitive Eating
    • Diet Specific – Example: Weight loss or Low sodium
    • Condition specific – Example: Pregnancy nutrition

    Apps can offer a wide range of personalization and unique features that may help in managing conditions or reaching personal goals.

    What are the cons?

    It takes effort to enter in every bite of food. It can be hard to remember to enter your food intake and to remember what exactly you ate. In addition, some apps don’t contain all products in their database. Rather, they may include broad categories of foods. For instance, some apps are unable to distinguish between Kraft’s macaroni and cheese and Annie’s brand macaroni and cheese.

    Nutrition apps are also generally harder to use than physical activity monitors. Unlike the automatic activity tracking (passive data input) that comes with a Fitbit, Apple watch or a pedometer, entering food into an app requires time and energy.

    Another consideration is the cost. Some diet-tracking apps may not be transparent about extra fees and may not provide satisfactory customer support. Many are subscription based and require full price to unlock useful features.

    A major downside to using apps is that you miss out on professional insight/advice that comes from interacting with a well-trained health care provider. Depending on the app and your specific goals, communication with a professional may not be included. Further, some apps fail to provide long-term and in-depth support, which are key for sustaining behavior change.

    Finally, not all apps are evidence or science based. If an app promises to help you lose 20 pounds in one week, chances are the quality is poor. Apps tailored to specific needs are more promising for prolonged use and effectiveness. Lifestyle changes take time and while the short-term use of apps can be effective, the long term use is largely unstudied.

    The bottom line

    Apps can be a great tool to improve health through better eating and planning. Smartphones offer inexpensive options allowing for more engagement, empowerment, self-monitoring and communication with health care providers. Research has shown that apps can be superior to traditional methods at helping track food intake, making better food choices and losing weight.

    So if you come across a helpful app, walk it around and it give it a try! Nutrition apps can help make life easier. A great place to start is with the MyPlate App that allows you to pick daily food goals, see real-time progress and earn fun badges through a simple program to start building healthy eating habits one goal at a time!

    Additional information on eating healthy, meal planning, tools and resources can be found at


    Author:  Laura Young, Ph.D., American College of Sports Medicine

    Originally published on March 23, 2022

  • The Importance of Sleep for Health

    by Caitlin Kinser | Jun 12, 2024

    man sleeping with a white pillow and blanketWhen we think about the most important actions that we can take to protect our health, we usually consider behaviors such as partaking in regular physical activity or eating a nutritious diet. Yet, an often-overlooked aspect of maintaining a healthy lifestyle is sleep. Sleep has serious implications for your physical and mental health. Adequate sleep will help you recover from exercise, enable your immune system to fight off pathogens and increase cognitive performance. In fact, to highlight its importance to health, the number of hours that people sleep is included as an indicator in the annual ACSM American Fitness Index.

    Despite the proven benefits of sleep on overall health, many of us tend to view it as a luxury and fail to get enough sleep. In fact, the Fitness Index reports that less than 65% of those who live in America’s 100 biggest cities get enough sleep (this number improves only modestly to 70% when we look at the entire U.S. population). Chronic sleep deprivation can have serious consequences on your health. For example, data have shown that lack of sleep can impair your body’s insulin response1—which can potentially contribute to the onset of diabetes. Moreover, chronic sleep deprivation has been associated with an increased risk of obesity and cardiovascular disease2. Lack of sleep can also alter memory retention, cause a negative mood, and inhibit your capacity to operate a motor vehicle. Data show that sleep deprivation impairs your ability to function to a greater extent than if you were intoxicated3.

    Considering the negative ramifications of sleep deprivation, it is important to develop good sleep hygiene that contributes to a healthy lifestyle. To accomplish this goal, we must first commit to making sleep a priority. This sounds pretty intuitive but can also be difficult to do if you are juggling several responsibilities. To find balance, try building your daily schedule around your sleep (in much the same way you schedule other important activities like doing regular exercise or eating). Remember, if you make something a priority, you will always find time for it! Another way of developing good sleep hygiene is to go to sleep and wake up at roughly the same time every day, regardless of whether it is a weekend or vacation day. Doing this will help you fall asleep faster and make sleep less stressful.

    Another key trait in those who have great sleep hygiene is having a pre-sleep ritual. Developing a routine that you can implement at least thirty minutes before going to bed will help “tell” your body it is time to go to sleep. Adopt activities that will help you relax, such as, taking a hot shower, reading a book or reducing your screen time. The bright light emitted from screens can alter how our bodies release melatonin and adenosine, two key chemicals that initiate our sleep cycles. In turn, it is best to just avoid looking at screens altogether before you go to bed. Lastly, do your best to make your bed your sleep sanctuary. Obviously depending on your circumstances, this may not be possible, but definitely try to use your bed for nothing other than sleep. You can make your space more conducive to promoting sleep by limiting the amount of light that enters your room and setting the room to a cooler temperature. Making these adjustments will contribute to a more restful night of sleep and help you build a sustainable habit.


    Authors: Rafael Alamilla, M.S. and NiCole Keith, Ph.D., FACSM, IUPUI, Indiana University, Regenstrief Institute, Inc.


    1. Knutson, K. L., Ryden, A. M., Mander, B. A., & Van Cauter, E. (2006). Role of sleep duration and quality in the risk and severity of type 2 diabetes mellitus. Archives of internal medicine166(16), 1768–1774.
    2. Pacheco, D. (2021, June 24). Physical health and sleep: How are they connected? Sleep Foundation.
    3. Williamson, A. M., & Feyer, A. M. (2000). Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occupational and environmental medicine, 57(10), 649–655.

    Infographic Sources:

    1. Markwald, Rachel R. Ph.D.; Iftikhar, Imran M.D., FACP, FCCP; Youngstedt, Shawn D. Ph.D. BEHAVIORAL STRATEGIES, INCLUDING
      EXERCISE, FOR ADDRESSING INSOMNIA, ACSM’s Health & Fitness Journal: March/April 2018 – Volume 22 – Issue 2 – p 23-29
    2. Bushman, Barbara A. Ph.D., FACSM Exercise and Sleep, ACSM’s Health & Fitness Journal: September/October 2013 – Volume 17 – Issue 5
      – p 5-8
    3. Pujalte, George G.A. MD, FACSM1; Benjamin, Holly J. MD, FACSM2 Sleep and the Athlete, Current Sports Medicine Reports: April 2018 –
      Volume 17 – Issue 4 – p 109-110
    4. American Academy of Sleep Medicine Public Safety Committee. TIP SHEET FOR HEALTH CARE PROVIDERS:
      Prioritizing Sleep & Managing Fatigue, 2021.

    Infographic Author: Laura Young, Ph.D.

    Originally published on September 15, 2021

  • Disparities in the Quality of Physical Activity Environments

    by Caitlin Kinser | Jun 12, 2024

    Denver city parkThere are race, ethnic and socioeconomic status (SES) disparities in physical activity. The disparities differ by domain of physical activity (e.g., occupation, transportation), but there is consistent evidence that leisure time physical activity is lower among individuals with lower income and members of most race and ethnic minority groups. One possible explanation of these disparities is that communities of color and those living in lower-SES neighborhoods have lower quality physical activity environments. Environments can be designed to make it easier to be active or to create barriers to physical activity. There are national health objectives and public health imperatives to reduce physical activity disparities and improving environments in disadvantaged neighborhoods could be a strategy for long-term benefits for entire communities.

    Our research group has studied disparities in two general types of physical activity environments, or places where people are often active. One is the park environment, the other is the streetscape environment, and both are relevant to leisure time physical activity. Parks are obvious places for recreational activity, but walking is the most common type of activity at virtually all ages, and the most common place to walk is on sidewalks and streets in the neighborhood.

    Access to parks and park quality

    Past studies of access to parks have produced mixed results about whether there are fewer parks in low-income communities of color. Our research group was particularly interested in whether there were disparities in the quality of parks. We defined quality as the number of different types of sports and physical activity facilities, such as ball fields, trails, basketball courts and playgrounds, as well as number of amenities such as restrooms and water fountains.

    We observed 543 parks in and around Baltimore, MD and Seattle, WA neighborhoods selected to vary widely on SES. The results were very different across regions. In the Baltimore region we found the expected lower quality of physical activity facilities and amenities in mostly-minority neighborhoods. In the Seattle region, the surprising result was that lower-income areas had parks with more sports and physical activity facilities and more amenities. We referred to the Seattle pattern as “equitable differences,” meaning these economically deprived neighborhoods needed higher quality parks because they did not have access to fitness centers and exercise programs that required fees and transportation.

    Streetscape quality

    Studies of overall community design, such as having shops and schools within walking distance, often do not find disparities across race, ethnic and SES groups. However, our interest was in the quality of streetscapes, or the extent to which streets and sidewalks are designed to be comfortable, attractive and safe for pedestrians. We conducted observations in over 2200 locations in Baltimore, MD, Seattle, WA and San Diego County, CA regions. We coded presence and quality of sidewalks, quality and safety of street crossings, aesthetic features like landscaping and indicators of social disorder such as graffiti.

    Again, the results were complex. Though there were some differences across regions, there were many more common findings. We found disparities, such that low-income and mostly-minority neighborhoods had worse aesthetic and social-disorder features, such as graffiti, litter, broken windows and fewer trees. But we also saw evidence of “equitable differences,” with high-income and mostly white neighborhoods generally having worse crosswalks, intersections and sidewalks.

    Lessons learned: Patterns of environmental disparities are local

    Our studies found some evidence of environmental “disparities:” park quality and pedestrian features that were worse in low-income and/or mostly-minority neighborhoods. We also found “equitable differences:” park quality and pedestrian features that were worse in high-income and/or mostly white neighborhoods. These patterns had not been reported before. The park and streetscape features that exhibited disparities varied between cities, but we discovered a clue that helps explain some of the differences by region. In the Seattle region, a King County ordinance guaranteed equal facilities and services across neighborhoods that could explain the high-quality parks in low-income neighborhoods. This is evidence that local policies determine whether there are disparities in physical activity environments.

    It should not be assumed that parks and pedestrian streetscapes are lower quality in low-income areas and communities of color. It should also not be assumed all neighborhoods have equal quality physical activity environments. The only way to determine local patterns of environmental disparities is to collect local data, but such data are rarely collected.

    Park and streetscape features are modifiable and offer a feasible and affordable approach to creating activity-friendly environments in all neighborhoods.  Conducting observations in numerous neighborhoods can help local policy makers, planners and community groups identify disparities, recommend targeted changes and increase physical activity opportunities for all residents, regardless of race, ethnicity or income. Simple observational measures are available that can be used by community residents to assess their neighborhood environments. Community groups are encouraged to work with government agencies to document the quality of physical activity environments in their neighborhoods and use local data to develop plans for improvement.


    Thornton, C.M., Conway, T.L., Cain, K.L., Gavand, K.A., Saelens, B.E., Frank, L.D., Geremia, C.M., Glanz, K., King, A.C., and Sallis, J.F. (2016). Disparities in pedestrian streetscape environments by income and race/ethnicitySSM-Population Health, 2, 206-216.

    Engelberg, J.K., Conway, T.L., Geremia, C., Cain, K.L., Saelens, B.E., Glanz, K., Frank, L.D., and Sallis, J.F. (2016). Socioeconomic and race/ethnic disparities in observed park qualityBMC Public Health, 16:395.

    Research brief

    James F. Sallis, Ph.D, FACSM, is former Vice President of ACSM and is a member of the ACSM Strategic Health Initiative on Health Equity. He has been studying physical activity about 40 years, and his research interests are promoting physical activity and understanding policy and environmental influences on physical activity, nutrition, and obesity.  He has authored over 700 scientific publications, is one of the world’s most cited authors, and is a member of the National Academy of Medicine.

    Originally published on December 11, 2019