We’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 www.myplate.gov.

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

Originally published on March 23, 2022

When 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.

Sources:

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 medicine, 166(16), 1768–1774. https://doi.org/10.1001/archinte.166.16.1768
2. Pacheco, D. (2021, June 24). Physical health and sleep: How are they connected? Sleep Foundation. https://www.sleepfoundation.org/physical-health.
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. https://doi.org/10.1136/oem.57.10.649

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

There 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.

References

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/ethnicity. SSM-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 quality. BMC 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

There is incontrovertible evidence linking poor air quality to adverse health outcomes. This is especially true for people with pre-existing conditions such as heart disease, stroke, asthma and chronic obstructive pulmonary disease. However, healthy people are at risk too. Exposure to air pollution has been linked to a higher risk of developing asthma, and recent studies have identified links between air pollution and adverse pregnancy outcomes.

The American Fitness Index added air quality as an indicator of a healthy and fit city for the first time with the 2019 rankings release. The Fitness Index used the Air Quality Index (AQI) from the Environmental Protection Agency which measures major air pollutants, including particle pollution, ground level ozone, sulfur dioxide and nitrogen dioxide, and carbon monoxide. The Fitness Index’s 2019 Summary Report notes that the 100 largest cities in the U.S. average only 62 percent of the year with good air quality. That means for over a third of the year residents in these cities are breathing polluted air that is harmful to their health.

The AQI provides guidance as to the safety of the air quality. You can download the airnow.gov app for your smart phone or visit www.airnow.gov, and review the AQI for an entered zip code.

Of course, we want people to be physically active, and better yet, to be active outdoors. While air pollution can affect your health, the health benefits of being physically active outweigh the risks of air pollution for most healthy individuals. However, it is important to keep in mind that an adult exercising at a moderate level of exertion exchanges about six liters of air per minute! An athlete running at 70 percent of their maximal oxygen uptake for the length of a marathon inhales the same volume of air as a sedentary person does in two days!

Tips to maintain an active lifestyle when air quality is poor:

• Exercise earlier in the day. Both particulate pollution and ground level ozone tend to accumulate throughout the day.
• The vast majority of air pollution comes from tailpipes – cars and trucks on the road – so avoid outdoor activity during commuting time (7:30 a.m. – 9:00 a.m., and 4:00 p.m. – 7:00 p.m.), and when possible avoid exercise next to heavily trafficked roadways.
• Consider indoor activity opportunities like going to the gym, walking laps at the mall or working out along with an exercise video (local libraries often lend these for free).
• It is important to note that a scarf or paper mask does not protect you from the poor air quality.

Finally, think about what you can do as an individual to reduce your contribution to poor air quality by using public transportation when possible, walking or biking to work or school, combining driving trips, eliminate idling, avoiding wood-burning and replacing or installing ultra-low nitrogen oxide water heaters. If we all do our part to clean the air, it will make the environment safer for the outdoor activities we love.

Author: Liz Joy, M.D., MPH, FACSM, Intermountain Healthcare

Originally published on July 16, 2019

In 2008, the US Department of Health and Human Services (DHHS) issued the federal government’s first-ever Physical Activity Guidelines for Americans (Guidelines) to help Americans understand the types and amounts of physical activity that offer important health benefits. Given the extensive amount of new information available over the past decade, DHHS released the second edition of the Physical Activity Guidelines for Americans on November 12, 2018.

#1 How many Americans meet the Physical Activity Guidelines?

In 2017, only about 20% of high school students and 25% of adults reported getting enough physical activity to meet the aerobic and muscle-strengthening guidelines.

#2 How much physical activity do school-aged youth and adults need?

The guidelines for children and adolescents are as follows:

• It is important to provide young people opportunities and encouragement to participate in physical activities that are appropriate for their age, that are enjoyable and that offer variety.
• Children and adolescents aged six through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily:
  • Aerobic: Most of the 60 minutes or more per day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity on at least three days a week.
  • Muscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least three days a week.
  • Bone-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least three days a week.

The guidelines for adults are as follows:

• Adults should move more and sit less throughout the day. Some physical activity is better than none. Adults who sit less and do any amount of moderate-to-vigorous physical activity gain some health benefits.
• For substantial health benefits, adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Preferably, aerobic activity should be spread throughout the week.
• Additional health benefits are gained by engaging in physical activity beyond the equivalent of 300 minutes of moderate-intensity physical activity a week.
• Adults should also do muscle-strengthening activities of moderate or greater intensity and that involve all major muscle groups on two or more days a week, as these activities provide additional health benefits.

See  Physical Activity Guidelines for Americans, 2nd Edition for additional key guidelines for the following populations:

• Preschool-aged children.
• Older adults.
• Women during pregnancy and the postpartum period.
• Adults with chronic health conditions and adults with disabilities.
• Safe physical activity.

#3 To meet the current Physical Activity Guidelines, do Americans need to be more or less active compared to what was first recommended in 2008?

The new evidence reinforces the amounts and types of physical activity recommended for youth and adults in the 2008 Guidelines. The total amount of physical activity didn’t change in the second edition of the Guidelines. However, unlike the 2008 Guidelines, with the current Guidelines, moderate- and vigorous-intensity physical activity no longer needs to occur in bouts of at least 10 minutes to count towards meeting the adult aerobic activity guideline.

#4 What has changed in this second edition of the Guidelines?

This second edition of the Guidelines reflects the extensive amount of new knowledge gained since the 2008 release of the first edition of the Guidelines. This second edition of the Guidelines discusses the proven benefits of physical activity and outlines the amounts and types of physical activity recommended for different ages and populations. For example, new aspects include discussions of:

• Immediate and longer-term benefits for how people feel, function and sleep after being physically active.
• Additional health benefits of physical activity related to brain health, additional cancer sites and fall-related injuries.
• Further benefits of being active among older adults and people with additional chronic conditions.
• Risks of sedentary behavior and their relationship with physical activity.
• Guidance on activity levels for preschool children aged three through five years.
• Elimination of the requirement for physical activity of adults to occur in bouts of at least 10 minutes.
• Tested strategies that can be used to get the population more active.

#5 Where can I find more information?

Learn more about the latest Physical Activity Guidelines for Americans. You can also explore the Move Your Way for interactive tools (like the one below), motivational videos, and helpful tips to make it easier to move more and sit less. Remember, physical activity can make you feel better right away including:

• Boosting your mood,
• Sharpening your focus,
• Reducing your stress, and
• Improving your sleep.

Author: Kathleen B. Watson, Ph.D. 

Originally published February 27, 2019