Physical Activity

        The Tennessee Department of Health has identified physical activity as a crucial indicator of the status of health in Tennessee. Physical activity simply means movement of the body that uses energy. Walking, gardening, pushing a baby stroller, climbing the stairs, dancing, or playing soccer are all good examples of being active. For maximum health benefits, physical activity should be of moderate or vigorous intensity. The Vital Sign Indicator that is used for physical activity is “the percent of adults who reported doing any physical activity during the past 30 days other than their regular job.”  

        In 2017, 69.4% of Tennesseans engaged in some form of physical activity during the past 30 days, a decrease from previous years. This measure does not take into account the regularity, length, or intensity of physical activity, just whether or not adults participated in some form of physical activity at least once during the past 30 days.  

        National health care costs associated with inadequate physical activity are estimated at $117 billion annually. Meanwhile, the CDC estimates that adequate physical activity could prevent 1 in 10 premature deaths nationwide. These heavy economic, social, and personal costs indicate that inadequate physical activity remains a significant public health challenge. Physical activity is important for both physical and mental health, but many schools and workplaces are not conducive to physical activity. The fact that more than 30% of Tennesseans are not engaging in any regular physical activity presents a considerable challenge to the state and is indicative of Americans’ increasingly sedentary lifestyles.  

        Community design and infrastructure is an important predictor of physical activity. Communities that are walkable, connected, and safe allow residents to be physically active and mobile without a vehicle. The Centers for Disease Control and Prevention recommend that adults get 150-300 minutes of moderate physical activity, or 75-150 minutes of vigorous physical activity per week. Physical activity is beneficial for people of all ages, and those benefits can include: reduced risk of dying from heart disease, reduced risk of developing colon cancer, reduced risk of developing diabetes and high blood pressure, weight control, development of lean muscle, and reduced symptoms of anxiety and depression.  

        Disparities in levels of physical activity continue to constrain efforts to improve health in Tennessee. Rural populations often experience reduced access to public parks or well-lit and maintained outdoor spaces to walk and exercise when compared with suburban populations. Urban populations have reduced access to parks and greenways compared to suburban populations and often the spaces they can access present safety challenges. Older Americans are more likely to face health concerns that make physical activity challenging, and are likely to fear injury due to physical activity. Women report safety concerns and time constraints as barriers to physical activity, as women are more likely to be caregivers for children, the elderly, and the infirm. People of low socioeconomic status cite facility cost, access to childcare, access to transportation, and safety as barriers to experiencing enough physical activity. Black and Hispanic populations are less likely to have regular contact with a health care provider and less likely to receive official physical activity recommendations. Additional barriers to physical activity for individuals and communities of color include safety, access to facilities/resources, and lack of time. The barriers preventing these different groups from getting regular physical activity frequently overlap, so similar solutions can be implemented and adapted to increase levels of physical activity for each group.    

Vital Sign Actions Guide

The following are lists of intervention strategies that you, your health council, and other local stakeholders could use to address physical activity in your community. 


1. Activity Breaks in the Classroom (GoNoodle, Morning Movement) 

Physical activity breaks in the classroom setting are scientifically supported and recommended by the Robert Wood Johnson Foundation. GoNoodle is an online program that uses short, engaging videos to get kids moving during school or at home. These “brain breaks” include running or jumping, dancing, stretching, and other activities. This program can also be used outside of the classroom, such as at after-school programs, at home, and in child care settings. Morning Movement is a physical activity program that aims to get students moving every morning before school starts. 


2. Bike Share Program 

Bike Share Programs allow individuals to rent a bicycle at a self-serve station and return it at any other self-serve station. This program encourages individuals to engage in active transportation in their daily lives, especially for those who can’t afford to buy a bicycle. Similarly, a “bike library” allows an individual to “check out” a bike for a short period of time. These bike sharing programs are ideal for popular downtown areas, college campuses, and parks or greenway systems. Further, this idea can be expanded to other type of recreational equipment such as skateboards, stand up paddleboards, or kayaks. 


3. Healthy Aging in Parks 

The National Recreation and Parks Association and the Centers for Disease Control promote three programs that specifically target older audiences and individuals who suffer from arthritis to increase daily physical activity. These programs are Walk With Ease, Active Living Every Day, and Fit & Strong. Each program is evidence-based and provides a safe location for seniors to engage in physical activity with other participants of a similar age and ability. Example settings for program implementation include parks, recreational facilities, in downtown public squares, at an outdoor mall, and many other indoor and outdoor spaces. Programs that serve seniors may also partner with local gyms to provide access to an indoor walking track for participants. 


4. Install a Walking/Jogging Track 

Walking and jogging trails provide safe spaces for individuals to engage in physical activity. Ideally, tracks should be easily accessible to individuals of varying ability, clean and aesthetically appealing, and accommodating of other needs such as water fountains and trashcans in order to increase perception of park quality and community involvement. Some ideas on where to implement tracks include at schools, rural community centers, in parks, around sporting stadiums, around a business or building, in or around malls, or other public places. 


5. Mile (Walk/Run) Clubs 

Walk or Run clubs are designed to encourage students to run before or after school in a group with their peers. Unlike athletic teams, walk/run clubs allow students of any physical activity level or skill to join. By naming a program “Mile Club”, the club can be inclusive of students who might wish to walk or those who need wheelchairs or other assistive devices. This type of program can be expanded to local hospitals (Walk with a Doc), faith-based organizations, and local businesses such as breweries or outdoors stores. 


6. Organized Physical Activity Event

Supervised and organized activities increase the duration and intensity of physical activity. Supervised activities should target various demographics, ages, and levels of physical ability. Some ideas include youth organized sports, a community race, yoga classes, “boot camp” classes, and more. These events can be held at after-school establishments, in parks and greenways, at a downtown square/public space, in a hosting restaurant or business, or at other indoor or outdoor recreational facilities. Additionally, it’s important to consider individuals with various levels of physical ability. Modified 5K races or a Special Olympics event is a great way to involve disabled individuals. 


7. Outdoor Fitness Zone 

An open-air fitness zone is an area in a park and other public space that has permanent fitness equipment (such as pull up bars or an ab station) for the public to access for free. Studies show that these fitness zones increase the level of physical activity that individuals engage in when visiting a park. These fitness zones can be installed in parks, at schools, or at other public spaces such as near a downtown square. When designing an outdoor fitness zone, consider individuals with disabilities and how to increase access for all persons. To teach individuals about new equipment and help familiarize the public with an outdoor fitness zone, consider organizing a class or other programming with a skilled instructor.


8. Physical Activity Program fror Caregivers 

Caregivers of chronically ill patients often suffer from poor mental and physical health, as a result of the demanding attention required of care giving. Physical activity programs in hospitals, senior centers, and adult care centers that are specifically for caregivers can decrease stress and depression, and help manage physical wellness. Caregivers who aren’t able to commit to an entire physical activity session may benefit from tips such as breaking up a workout into “mini-workouts.” See the link below for more advice and an infographic for caregivers. 


9. Ride and Read 

Ride & Read is a program that gets kids active and reading during school. Schools can either buy new stationary bikes or collect unused ones from the community to offer for kids to ride while reading through magazines or books. This program promotes physical activity and a stress-free reading activity for children to practice literacy skills. This is a great opportunity to partner with Coordinated School Health or the Project Diabetes. 


10. Safe Routes to School and Walking School Bus 

Safe Routes to School is a federally funded program that aims to encourage students to walk or bike to school.  Its programs aim to improve safety for children and the community and provide opportunities to increase daily physical activity. Creating safe routes for children to walk can include mechanisms for enforcing traffic laws, changes to the built environment (complete streets, connecting sidewalks, etc.), walking school bus, and simply educating families on the importance of daily physical activity. 


11. StairWELL To Better Health 

Studies show that when prompted at the point-of-decision, individuals are more likely to choose the stairs over an elevator, increasing daily physical activity and improving health and wellness. These prompts can be as simple as a sign encouraging stair use or bright paint and arrows on the walls. Similar signage can be used to prompt individuals to park farther away or walk around a building or in the parking lot. See the link below for more examples of how to encourage stairwell use.


12. Universal Park/Playground Design 

Universal Design allows parks to be used by all people of all abilities. Universal Design differs from Accessible Design by building infrastructure that is fully usable by all individuals with a range of ability. Accessible design meets only the minimum requirements set by the American Disability Act, and can tend to segregate children with disabilities from those without. Existing and future parks should consider the needs and abilities of all residents when designing infrastructure and planning community activities. For example, play equipment should be nonspecific to ability, sidewalks and walking tracks should be level and wide enough to accommodate a walker or wheelchair, stairs should have handrails, and there should be ample seating and for rest during physical activity. 


1. Access to Health Built Environment Grants (TDH) 

Purpose: The Tennessee Department of Health offers two grants through the Office of Primary Prevention to increase options for daily physical activity—the Access to Health through Healthy Active Built Environment grants. One round is not competitive and is distributed to all 95 counties, and the other round is competitive and application based.  These grants can be used for convenings, programs, planning and infrastructure related to increasing publicly accessible opportunities for physical activity through the built environment.

Duration: 1 year (non-competitive); two years (competitive)

Amount: $20,000 per county (non-competitive); Up to $85,000 (competitive)


2. America Walks Community Change Grants 

Purpose: America Walks awards grants of $1,500 for projects that aim to create healthy, active, and engaged places to live, work, and play. Grant funding supports walkability initiatives that increase physical activity and improve health outcomes for an entire community. 

Duration: One year

Amount: $1,500


3. BlueCross BlueShield Grants 

Purpose: BlueCross BlueShield of Tennessee awards funding for programs that help to create active, healthy spaces across the state. BCBS manages two funding opportunities—BlueCross Healthy Place and Community Trust grants. Click on the link for specific funding criteria and exclusions. 

Duration: Varies

Amount: Varies


4. Cultivating Healthy Communities Grants 

Purpose: The Cultivating Health Communities grant, administered by Aetna, provides funding for programs that make underserved communities healthier places to live, work, learn, play, and pray. The primary focus of this grant program is addressing social determinants of health. Specific activities that are funded through the CHC program include walkability/bike-ability projects (including tactical urbanism and educational campaigns), public safety, increased physical activity, and built environment policy work. 

Duration: 1-2 years

Amount: $50,000-$100,000 (total)


5. Fuel Up to Play 60: Jump Start Healthy Changes 

Purpose: Fuel Up to Play 60 manages the Jump Start Healthy Changes grant that provides funding to K-12 schools to implement nutrition and physical activity “Plays” from the Fuel Up to Play 60 Playbook. To qualify, schools must participate in the National School Lunch Program.  

Duration: 1 year

Amount: $300-$4,000


6. National Recreation and Park Association 

Purpose: The National Recreation and Park Association (NRPA) funds parks and recreation departments and affiliated nonprofits to increase physical activity and the use of parks and green spaces. Recent NRPA grant funding examples include “10-Minute Walk Technical Assistance” and “Grants for Physical Activity Programs.” NRPA also provides grant funding to train instructors on evidence-based programs that address chronic disease and physical activity (limited to Walk With Ease, Active Living Every Day, and Fit and Strong!; see option 2.g).

Duration: Varies

Amount: Varies


7. People For Bikes 

Purpose: People For Bikes is an organization that supports and funds projects that focus on bicycling, active transportation and community development. Specifically, grants can be used for bike paths/lanes/trails/bridges, mountain bike facilities, bike parks, BMX facilities, bike racks and storage, open streets, and campaigns. Projects must have other funding sources such that People For Bikes funds up to 50% of project costs.

Duration: One year 

Amount: Up to $10,000


8. Racial and Ethnic Approached to Communiy Health (REACH)

Purpose: The REACH grant is administered by the CDC, focusing on reducing racial and ethnic disparities in health outcomes. In particular, this grant funds programs that address disparities in chronic diseases including hypertension, heart disease, Type 2 diabetes, and obesity—all of which are affected by the lack of physical activity. Programs must be culturally tailored and address preventable risk behaviors of these chronic diseases. 

Duration: 1 year

Amount: Up to $800,000


9. Safe Routes to Park/Safe Routes to Schools 

Purpose: Safe Routes to Parks is a program that provides grants for communities who wish to increase safe access to parks. Safe Routes to School is a similar, federally funded program that provides grant funding to increase safe, walkable routes to schools. These programs aim to increase physical activity in communities across the U.S. while advancing racial and social equity.

Duration: 1 year (SRTP)

Amount: $12,500 (SRTP)


10. Tennessee Project Diabetes 

Purpose: The Tennessee Department of Health administers Project Diabetes grants that focus on reducing the rate of Tennesseans who are overweight or obese. One goal of Project Diabetes is to encourage physical activity as an integral and routine part of life by enhancing the physical and built environment. Grants are administered in two categories, Category A and Category B.

Duration: Up to 3 years (Cat. A); up to 2 years (Cat. B)

Amount: Up to $150,000 per year (Cat. A); up to $15,000 per year (Cat. B)


11. Transportation Alternatives Program (TDOT) 

Purpose: The Tennessee Department of Transportation awards grants annually to communities for projects that improve access and provide a better quality of life for Tennesseans by increasing access to alternate modes of transportation. Grants must be applied for through local planning organizations. Projects may include management of sidewalks, bike lanes, abandoned railways, scenic overlooks, and other activities to improve access. Additionally, the Tennessee Department of Transportation funds cities and counties that fall outside of an MPO planning boundary in order to develop community transportation plans for future transportation systems, land use, and growth management. 

Duration: $250,000 - $1,000,000 (general); up to $125,000 (transportation planning)

Amount: 1 year


1. American Heart Month 

American Heart Month is sponsored by the American Heart Association each year in February. This campaign aims to educate the public about the risk factors associated with heart disease and how to combat it. Click on the link for a toolkit of ideas for American Heart Month. 


2. Child Health Month 

Child Health Week occurs in Tennessee each year during the first week of October, with Child Health Day occurring on October 1st. Child Health Week is a great opportunity to promote activities and programs that improve the health of children in Tennessee communities. See the Tennessee Department of Health website below for a calendar of events and toolkit from the 2018 CHW. 


3. Every Kid Healthy Week 

Every Kid Healthy Week is a campaign that celebrates school-based initiatives that get kids eating healthy and physically active. This campaign occurs during the last week of April each year. Schools can host events for families including games and educational sessions. Click on the link for more ideas, fliers, and a toolkit of resources to plan your school’s Every Kid Healthy Week. 


4. Go4Life

Go4Life is an exercise and physical activity campaign, from the National Institute on Aging at NIH, designed to help older adults fit exercise and physical activity into their daily life. Go4Life provides workout recommendations, posters, and other promotional materials to member partners. Go4Life promotes September as Go4Life Month with the goals of encouraging older adults to prepare to be more active, get moving with all four types of exercise, stay on track with exercise, and make regular exercise a habit. 


5. Healthy Parks, Healthy Person App

The Tennessee Department of Health’s Healthy Parks, Healthy Person website encourages Tennesseans to get outside and exercise. Participants earn points for spending time outdoors, which can in turn be used to redeem rewards provided by Tennessee State Parks. This program also includes prescription pads for clinicians to prescribe park time to patients. The app is designed to be used by people of all ages and abilities, so all Tennesseans can participate.


6. Move Your Way 

Move Your Way is a website managed by the Department of Health and Human Services that encourages adults and parents to incorporate more physical activity into their daily lives and their families’ daily lives. The Move Your Way websites provides users with workout tips, fact sheets for adults and older participants, and an interactive weekly activity planner. 


7. National Physical Fitness and Sports Month 

The National Physical Fitness and Sports Month is celebrated each May. This time can be used to educate families about the importance of physical activity and get individuals engaged in fun activities or sports.


8. National Walk/Bike to School Day 

National Walk to School Day encourages children across the U.S. to walk or bike to school. By supporting a community walk, families and individuals are shown that walking or biking to school is possible and safe. This event may also spur changes to local policy about street design and traffic laws. Walk to School Day can be expanded to include adults as a Walk to Work Day.


9. Promote Running/Walking Trails 

The Trail Run Project relies on crowd-sourcing to produce a map of local walking and running trials. Each trail includes information such as difficulty, photos, parking, etc. A county can boost its number of accessible walking and running trails by crowd-sourcing local favorites, including trails that run through neighborhoods, a downtown square, or in a park. This tool is a great addition to a running or walking club, to motivate participants and encourage others to join. The Park Path App is a similar tool that allows users to locate parks near them and parks with particular amenities. 


10. Silver Sneakers 

The Silver Sneakers is a program administered through Medicare that aims to get seniors to engage in more physical activity. The program includes access to fitness centers, physical activity classes in parks and recreation centers, and an app to track progress. Promoting Silver Sneakers to seniors can help improve health outcomes and quality of life. 


11. Small Starts (Healthier Tennessee) 

Small Starts is an initiative within Healthier Tennessee that encourages individuals to make small, incremental changes to their lifestyle to become healthier one step at a time. Healthier Tennessee focuses on physical activity, nutrition, and tobacco use, among other healthy behaviors. Promoting this tool to families, employees, faith-based congregations, and other groups can help to change the health behaviors of a community. 


12. Worksite Wellness Recognition/Awards 

One way to publicly promote worksite wellness is by recognizing businesses that have comprehensive and supportive wellness policies. Small awards or public recognition create a sense of accomplishment among local organizations. Click on the source for award examples. 


1. Gold Sneaker Policies 

The Gold Sneaker initiative is a voluntary certification program that provides policy and programming recommendations to licensed child care facilities in Tennessee. These policies aim to set standards regarding daily physical activity, nutrition requirements, screen time limits, and other health-promoting behaviors in schools and child care facilities. Gold Sneaker is managed and funded through the Department of Health. 


2. Joint Use Agreement or Open Use Policies

Schools, faith-based organizations, or other community organizations with a recreational area or playground can implement a Joint Use Agreement or an Open Use Policy to allow the public to use their space without fear of legal liability. Additionally, consider informing the community of policies that already exist through press releases or signage at playgrounds. These policies expand access to outdoor recreational space at little to no extra expenses. Creating more spaces for the public to engage in physical activity is important to increasing health equity in a community. 


3. Walkability and Connectivity Zoning Policies

Daily physical activity is increased in a community when individuals are willing and able to walk from their homes to schools, places of employment or other routine establishment. Several factors can lead to safer, more walkable routes including proper (connected) sidewalks and lighting, lower speed limits for adjacent traffic, shade to mediate warmer weather, and adequate pedestrian signage. These zoning policies increase access to walkable areas and encourage more daily physical activity. Communities can push for walkability and mixed use policies when new businesses apply for zoning approval. 


4. Workplace Wellness Policies

A comprehensive worksite wellness program should encourage physical activity during work and outside of work. Increased employee physical activity benefits the individual and the business by decreasing loss of productivity due to sick leave absences and increasing work efficiency. Worksite wellness programs can provide opportunities for physical activity such as a walking track, wellness breaks, standing desks and sitting cycles, walking meetings, or an on-site workout room, as well as providing incentives such as health club memberships and changes in health insurance benefits. Some organizations may be able to partner with local gyms to provide worksite fitness classes to employees. 


1. Physical Activity Counseling for Pregnant Women 

Clinical policies should encourage clinicians to carefully review physical activity recommendations with their pregnant patients and encourage activities such as prenatal yoga and walking when possible. The Physical Activities Guidelines for Americans, published by the Department of Health and Human Services, notes that pregnant and postpartum women benefit from continuing to exercise during and after pregnancy. Specifically, moderate-intensity activity yields very low risk of adverse effects for the mother or infant. Another recommendation is that pregnant women should avoid physical activities that include contact or collision sports, and activities that involve women lying on their backs as this could restrict blood flow to the fetus. 


2. Universal Physical Activity Assessment and Prescribing 

Provider policy should encourage assessing the physical activity level of all patients, and the use of physical activity prescription or the referral of patients to a certified fitness professional. Research shows that physical activity assessment and counseling in the clinical setting can lead to increased levels of physical activity in youth. The Exercise is Medicine Initiative supports health care providers in prescribing physical activity to patients as treatment and management of various chronic diseases. Exercise is Medicine provides exercise prescription pads, office flyers, and physician action guides for providers. 


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This document is not a Department endorsement of legislative policy.