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Carol West Suitor and Vivica I. Kraak, Rapporteurs
Food and Nutrition Board
Board on Population Health and Public Health Practice
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THE NATIONAL ACADEMIES PRESS • 500 Fifth Street, N.W. • Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Gov-
erning Board of the National Research Council, whose members are drawn from
the councils of the National Academy of Sciences, the National Academy of
Engineering, and the Institute of Medicine. The members of the planning com-
mittee responsible for the workshop were chosen for their special competences
and with regard for appropriate balance.
The study was supported by Contract No. HHSP23320042509XI, Task Order
No. 07 between the National Academy of Sciences and the United States De-
partment of Health and Human Services. Any opinions, findings, conclusions, or
recommendations expressed in this publication are those of the authors and do
not necessarily reflect the views of the organizations or agencies that provided
support for the project.
International Standard Book Number-13 978-0-309-10402-9
International Standard Book Number-10 0-309-10402-5
Additional copies of this report are available from the National Academies
Press, 500 Fifth Street, N.W., Box 285, Washington, DC 20055. Call (800) 624-
6242 or (202) 334-3313 (in the Washington metropolitan area), Internet,
http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page
at: www.iom.edu.
Copyright 2007 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America.
Suggested citation: Institute of Medicine (IOM). 2007. Adequacy of evidence for
physical activity guidelines development: Workshop summary. Washington, DC:
The National Academies Press.
The serpent has been a symbol of long life, healing, and knowledge among al-
most all cultures and religions since the beginning of recorded history. The ser-
pent adopted as a logotype by the Institute of Medicine is a relief carving from
ancient Greece, now held by the Staatliche Museen in Berlin.
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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of
distinguished scholars engaged in scientific and engineering research, dedicated to the
furtherance of science and technology and to their use for the general welfare. Upon the
authority of the charter granted to it by the Congress in 1863, the Academy has a mandate
that requires it to advise the federal government on scientific and technical matters.
Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the
National Academy of Sciences, as a parallel organization of outstanding engineers. It is
autonomous in its administration and in the selection of its members, sharing with the
National Academy of Sciences the responsibility for advising the federal government.
The National Academy of Engineering also sponsors engineering programs aimed at
meeting national needs, encourages education and research, and recognizes the superior
achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of
Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences
to secure the services of eminent members of appropriate professions in the examination
of policy matters pertaining to the health of the public. The Institute acts under the re-
sponsibility given to the National Academy of Sciences by its congressional charter to be
an adviser to the federal government and, upon its own initiative, to identify issues of
medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute
of Medicine.
The National Research Council was organized by the National Academy of Sciences in
1916 to associate the broad community of science and technology with the Academy’s
purposes of furthering knowledge and advising the federal government. Functioning in
accordance with general policies determined by the Academy, the Council has become
the principal operating agency of both the National Academy of Sciences and the Na-
tional Academy of Engineering in providing services to the government, the public, and
the scientific and engineering communities. The Council is administered jointly by both
Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are
chair and vice chair, respectively, of the National Research Council.
www.national-academies.org
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PLANNING COMMITTEE ON THE ADEQUACY
OF EVIDENCE FOR PHYSICAL ACTIVITY
GUIDELINES DEVELOPMENT
WILLIAM L. HASKELL (Chair), Stanford Prevention Research
Center, Stanford University School of Medicine, Stanford, CA
RODNEY K. DISHMAN, Kinesiology Department, University of
Georgia, Athens
JOSEPH E. DONNELLY, Energy Balance Laboratory and The Center
for Physical Activity and Weight Management, The Schiefelbusch
Institute for Lifespan Studies, The University of Kansas, Lawrence
BRUCE H. JONES, Epidemiology and Disease Surveillance, U.S.
Army Center for Health Promotion and Preventive Medicine,
Aberdeen, MD
MIRIAM E. NELSON, John Hancock Center for Physical Activity and
Nutrition, The Gerald J. and Dorothy R. Friedman School of Nutrition
Science and Policy, Tufts University, Boston, MA
Consultant and Rapporteur
CAROL WEST SUITOR, Northfield, VT
Staff
VIVICA I. KRAAK, Study Director
LINDA D. MEYERS, Director, Food and Nutrition Board
ROSE MARIE MARTINEZ, Director, Board on Population Health and
Public Health Practice
GERALDINE KENNEDO, Administrative Assistant
v
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FOOD AND NUTRITION BOARD
DENNIS M. BIER (Chair), Children’s Nutrition Research Center,
Baylor College of Medicine, Houston, TX
MICHAEL P. DOYLE (Vice Chair), Center for Food Safety, University
of Georgia, Griffin
DIANE BIRT, Center for Research on Dietary Botanical Supplements,
Iowa State University, Ames
YVONNE BRONNER, School of Public Health and Policy, Morgan
State University, Baltimore, MD
SUSAN FERENC, Chemical Producers and Distributors Association,
Alexandria, VA
NANCY F. KREBS, Department of Pediatrics, University of Colorado
Health Sciences Center, Denver
REYNALDO MARTORELL, Hubert Department of Global Health,
Rollins School of Public Health, Emory University, Atlanta, GA
J. GLENN MORRIS, JR., Department of Epidemiology and Preventive
Medicine, University of Maryland School of Medicine, Baltimore
SUZANNE P. MURPHY, Cancer Research Center of Hawaii, University
of Hawaii, Honolulu
JOSE M. ORDOVAS, Jean Mayer USDA Human Nutrition Research
Center on Aging, Tufts University, Boston, MA
JIM E. RIVIERE, College of Veterinary Medicine, North Carolina State
University, Raleigh
NICHOLAS J. SCHORK, Department of Psychiatry, Polymorphism
Research Laboratory, University of California, San Diego
REBECCA J. STOLTZFUS, Division of Nutritional Sciences, Cornell
University, Ithaca, NY
JOHN W. SUTTIE, Department of Biochemistry, University of
Wisconsin, Madison
WALTER C. WILLETT, Department of Nutrition, Harvard School of
Public Health, Boston, MA
Staff
LINDA D. MEYERS, Director
GERALDINE KENNEDO, Administrative Assistant
ANTON L. BANDY, Financial Associate
vi
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BOARD ON POPULATION HEALTH AND
PUBLIC HEALTH PRACTICE
JAMES W. CURRAN (Chair), The Rollins School of Public Health,
Emory University, Atlanta, GA
SUSAN M. ALLAN, Oregon Department of Human Services, Portland
RONALD BAYER, Joseph L. Mailman School of Public Health,
Columbia University, New York, NY
GEORGES C. BENJAMIN, American Public Health Association,
Washington, DC
DAN G. BLAZER, Duke University Medical Center, Durham, NC
R. ALTA CHARO, School of Law, University of California, Berkeley
HELEN B. DARLING, National Business Group on Health,
Washington, DC
STEPHEN B. FAWCETT, Human Development & Family Life,
University of Kansas, Lawrence
JONATHAN E. FIELDING, Department of Health Services, Los
Angeles County, CA
MARK SCOTT KAMLET, H. John Heinz III School of Public Policy
and Management, Carnegie Mellon University, Pittsburgh, PA
ROXANNE PARROTT, Department of Communication Arts and
Sciences, The Pennsylvania State University, University Park
THOMAS A. PEARSON, Department of Community and Preventive
Medicine, University of Rochester, NY
SAMUEL SO, Stanford University School of Medicine, CA
DAVID J. TOLLERUD, Institute of Public Health Research, University
of Louisville, School of Public Health, KY
WILLIAM A. VEGA, University Behavioral HealthCare, Robert Wood
Johnson Medical School, Piscataway, NJ
PATRICIA WAHL, School of Public Health and Community Medicine,
University of Washington, Seattle
PAUL J. WALLACE, Kaiser Permanente Care Management Institute,
Oakland, CA
LAUREN ZEISE, Office of Environmental Health Hazard Assessment,
California Environmental Protection Agency, Oakland, CA
ELENA O. NIGHTINGALE, Member Emerita, Scholar-in-Residence,
Institute of Medicine, The National Academies, Washington, DC
vii
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Staff
ROSE MARIE MARTINEZ, Director
HOPE R. HARE, Administrative Assistant
These two IOM boards did not review or approve this workshop sum-
mary. The responsibility for the content of the summary rests with the
rapporteurs and the institution.
viii
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Independent Report Reviewers
This workshop summary has been reviewed in draft form by indi-
viduals chosen for their diverse perspectives and technical expertise, in
accordance with procedures approved by the National Research Coun-
cil’s Report Review Committee. The purpose of this independent review
is to provide candid and critical comments that will assist the institution
in making its published summary as sound as possible and to ensure that
the summary meets institutional standards for objectivity, evidence, and
responsiveness to the study charge. The review comments and draft
manuscript remain confidential to protect the integrity of the deliberative
process. We wish to thank the following individuals for their review of
this summary:
I-MIN LEE, Harvard Medical School and Harvard School of Public
Health, Boston, MA
JAMES R. MORROW, JR., Department of Kinesiology, Health
Promotion, and Recreation, University of North Texas, Denton
MIRIAM E. NELSON, John Hancock Center for Physical Activity
and Nutrition, The Gerald J. and Dorothy R. Friedman School of
Nutrition Science and Policy, Tufts University, Boston, MA
KENNETH E. POWELL, Public Health Consultant, Atlanta, GA
Although the reviewers listed above have provided many
constructive comments and suggestions, they did not see the summary
before its release. The review of this summary was overseen by HUGH
H. TILSON, University of North Carolina, who was appointed by the
ix
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x INDEPENDENT REPORT REVIEWERS
Institute of Medicine. He was responsible for making certain that an
independent examination of this summary was carried out in accordance
with institutional procedures and that all review comments were
carefully considered.
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Acknowledgments
The collective efforts of many individuals made it possible to plan
and conduct the Institute of Medicine (IOM) workshop on the Adequacy
of Evidence for Physical Activity Guidelines Development and to pre-
pare this workshop summary within a very short time frame. We are
grateful for the assistance of many individuals. RADM Penelope Slade-
Royall from the U.S. Department of Health and Human Services, Office
of Public Health and Science, Office of Disease Prevention and Health
Promotion (DHHS, OPHS, ODPHP) secured DHHS resources to sponsor
this effort. CAPT Richard Troiano and Jennifer Tucker from ODPHP,
Melissa Johnson from the President's Council on Physical Fitness and
Sports, and Harold W. (Bill) Kohl III from the Centers for Disease Con-
trol and Prevention provided useful suggestions in planning the work-
shop. Members of the planning committee (Bill Haskell, Rodney
Dishman, Joseph Donnelly, Bruce Jones, and Miriam Nelson) provided
invaluable input in planning the workshop agenda and speakers and pro-
vided feedback on specific issues related to the written summaries of the
presentations. The session speakers prepared insightful presentations,
and the discussants were instrumental in identifying areas of controversy
and providing supplementary information. The moderators kept the pre-
senters and discussants on task and synthesized the evidence presented in
the closing session.
We also appreciate the oversight for the National Academies’ review
process provided by Bronwyn Schrecker Jamrock and Clyde Behney,
skillful copyediting by Mark Goodin, formatting by Judy Estep,
manuscript preparation and reference checks conducted by Shannon
Wisham, and the careful review and oversight of the report production
process by Lara Andersen, Sally Stanfield, and others at the National
xi
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xii ACKNOWLEDGMENTS
Academies Press. We also thank Linda Meyers, Director of the Food and
Nutrition Board; Rose Marie Martinez, Director of the Board on
Population Health and Public Health Practice; Anton Bandy, Financial
Associate; and Shannon Wisham, Research Associate, for assistance.
Special thanks are extended to Geraldine Kennedo, Administrative
Assistant, for her skillful logistical coordination of the workshop.
Carol West Suitor and Vivica I. Kraak, Rapporteurs
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Contents
OVERVIEW 1
1 INTRODUCTORY SESSION 5
2 PHYSICAL ACTIVITY, HEALTH PROMOTION, AND
CHRONIC DISEASE PREVENTION 17
3 PHYSICAL ACTIVITY, OBESITY, AND WEIGHT
MANAGEMENT 59
4 PHYSICAL ACTIVITY AND RISK—MAXIMIZING
BENEFITS 73
5 PHYSICAL ACTIVITY AND SPECIAL CONSIDERATIONS
FOR CHILDREN, ADOLESCENTS, AND PREGNANT AND
POSTPARTUM WOMEN 95
6 PHYSICAL ACTIVITY AND SPECIAL CONSIDERATIONS
FOR OLDER ADULTS 111
7 PHYSICAL ACTIVITY AND CONSIDERATIONS FOR
PERSONS WITH DISABILITIES 125
8 CLOSING SESSION 141
xiii
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xiv CONTENTS
APPENDIXES
A Workshop Agenda 159
B Presenter Biographical Sketches 165
C Workshop Participants 183
D Acronyms and Abbreviations 193
E Glossary 195
