Health department urges Kentuckians to walk regularly; state ranks high in obesity, low in physical activity

With summer here, the state health department is urging Kentuckians to adopt a regular walking schedule to connect with friends and neighbors and improve health and fitness in a state that ranks high in obesity and low in physical activity.

“Summer is the perfect time to renew your commitment to get outdoors and take a walk,” Health Commissioner Stephanie Mayfield, said in a news release. “We all know walking is healthy, but it’s also fun, relaxing, and a great way to connect with others. You can invite a friend or loved one out for a nightly walk after dinner, take care of weekend errands on foot, or invite neighbors or co-workers to start a regular walking group. The more you walk, the more you’ll connect and be part of building a stronger, healthier community.”

In Kentucky, 31.3 percent of adults are obese. “Obesity is linked to multiple chronic conditions, including diabetes, heart disease and stroke – and is one of the major chronic conditions affecting the health of Kentuckians,” said Elaine Russell, the Department for Public Health's obesity-prevention coordinator. “Regular walking could greatly reduce our state’s obesity burden.”

Russell's program and the Partnership for a Fit Kentucky have created a guide for obesity prevention and health policy for Kentucky communities, at http://www.fitky.org/wp-content/uploads/sites/2/2015/04/PA-Vision-Slidedoc.pdf. ). Kentucky is one of four states that will get technical assistance from America Walks to improve walkable community design, such as complete streets, lower traffic speeds, livable communities and economic benefits.

“We’re also working directly with communities and funding projects through a public health grant program to help cities and towns across Kentucky develop pedestrian plans,” Russell said. The department selected 11 communities for funding to start work on a pedestrian plan.

“We’re very excited about recent developments in obesity prevention and increasing physical activity in the commonwealth,” Russell said. “We hope everyone will not only become more physically active, but take some time to learn more about our vision and support our communities in their work to become more active, healthier places to live, work and play.”

Mount Sterling follows lead of another KentuckyOne Health hospital, in Bardstown, to host monthly 'Walk With a Doc'

Saint Joseph Mount Sterling is the second KentuckyOne Health hospital to host monthly "Walk With a Doc" events as part of a nationwide program that promotes walking as a great way to improve your health, while at the same time offering a place to get to know your local physicians in an informal setting as you walk together. The program also offers a complimentary health screenings at the event, says a news release from KentuckyOne Health.

Flaget Memorial Hospital in Bardstown, also part of KentuckyOne Health, began its "Walk With a Doc" program in March.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein and even reduce risks of bone fracture. Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer," says the release.

The Mount Sterling walks begin at 9 a.m. on Saturday, April 25 at Easy Walker Park, located at 1395 Osborne Rd. For more information call 859-497-5556.

Researchers discuss physical activity as a way of maintaining or improving health; daily walking is still the best exercise

By Melissa Patrick
Kentucky Health News

Obesity worsens the damage that arthritis does to joints, but simply telling patients to go home and diet and exercise is not working, and health care providers must proactively monitor their patients and help them find affordable solutions to succeed. And daily walking is still the best exercise.

Those were examples of research findings discussed at the 10th annual Center for Clinical and Translational Science conference sponsored by the University of Kentucky on March 25. More than 700 researchers, students, policymakers and guests discussed research with a focus on physical activity across the lifespan.

Stephen Messier, professor and director of a biomechanics laboratory at Wake Forest University, said obesity has a significant effect on joint health, particularly osteoarthritis, which he said is quite painful. He called for closer attention to obese patients with arthritis.

He said a study found that a combination of diet and exercise over an extended period of time offers the best results for less pain and less disability. He said that a separate study found those who lost 10 percent of their body weight had the most "significant outcomes" related to function, which included walking speed.

The conference featured 31 oral presentations and 270 poster presentations, addressing a vast array of topics including physical inactivity in children, physical inactivity in chronic disease and biomedical informatics.

"The conference was designed to raise awareness of the science behind the benefits of exercise and the dangers of physical inactivity," Charlotte Petterson, professor and associate dean of research in the College of Health Sciences, who chaired this year's conference, said in a UK press release.

The keynote speaker, Duke University medicine professor William E. Kraus, encouraged walking as a proven and simple activity that can improve health and actually extend life. "Fitness always trumps fatness," he said, noting that a "culture of convenience" and conditions of built environments, such as absence of sidewalks, deter people from physical activity.

Research on fourth and fifth graders in two Clay County schools, while in the early stages of analysis, found that obesity and inactivity begins early.

Karyn Esser, professor of physiology at the UK College of Medicine, said her research was examining the circadian rhythms and physical activities of students because changes in natural circadian rhythms "can create pre-cursors to disease" in just seven days, even in healthy young people. She said her study is intended to help schools improve students' health by adjusting meal times and offering physical activities to best coincide with circadian rhythms.

The data for Esser's study was gathered through electronic devices that the 136 students wore for seven days to measure activity, heart rate and skin temperature. The students also kept a daily journal to record their activities. So far, Esser said, the data show 33 percent of the students are considered obese, their initial blood pressure measurements are on the high end of normal, and the students are less active on weekends and nights than during the school week.

Another UK study found that students who are more active during the school day do better in mathematics.

Alicia Fedewa and Heather Erwin of the College of Education said they found that increased physical activity levels "significantly improved" math scores and slightly improved reading scores of the students who got an extra 20 minutes of movement on each school day. They recommended two short 15-minute recesses per day, rather than one long one. They also said that classroom "energizers" and stability balls also help students with these behaviors.

The researchers said many studies show that students who participate in recess and physical education during the school day are more focused and less fidgety, show less listlessness, and have better overall classroom behavior. They said more controlled studies need to be conducted, but said most studies to date have found that fit kids have less anxiety and better overall well-being. Also, a regimen of consistent physical activity is best for kids with attention deficit hyperactivity disorder (ADHD).

Beshear cites signs toward better health: kids are more active and getting more dental care; adults are getting more screenings

Kentucky Health News

Kentucky is moving toward achieving the broad, ambitious goals for better health that Gov. Steve Beshear laid out when he started the "Kyhealthnow" initiative in February 2014, his office says.

"More Kentuckians have health insurance, are covered by smoke-free policy, can access physical activity resources, seek care for heart disease and cancer prevention, and get dental services" since the initiative began, Beshear said in a press release.

The program builds on federal health reform, which has made Medicaid or private insurance available to hundreds of thousands of Kentuckians, many of whom were previously uninsured and unable to afford health coverage. According to a Gallup Poll released in February, 9.8 percent of Kentucky’s population is uninsured, down from 20.4 percent in 2013.

Kyhealthnow targets seven major health goals to be met by 2019, focusing on increasing health insurance coverage; reducing the smoking rate and tobacco use; lowering the prevalence of obesity; lowering cancer deaths; reducing cardiovascular disease; treating and reducing dental decay; and reducing drug overdoses and mental health issues in Kentucky.

The report said more adults have been screened and identified as having high blood pressure and are able to control their hypertension, and more adults have had their cholesterol checked.

Significantly more children on Medicaid are being seen by dentists, and the number of children enrolled in Medicaid receiving two fluoride dental varnishes per year has increased. The state has given money to five health departments for dental-hygiene programs, and will fund five more this year. "These programs broaden access to hygiene services, such as cleanings, screening and referrals, by providing staff and resources to supply mobile units to deliver care in schools," the release said.

School districts are showing an increase in the amount of time devoted to physical activity, the state reports. The Comprehensive School Physical Activity Program has been implemented at proficient or distinguished levels at all grade levels in 515 of the state's 746 elementary schools, 186 of the 329 middle schools and 109 of the 228 high schools. Also, more schools report they are using body-mass index data to inform school wellness policy.

The state health department is using federal funds to implement physical activity and obesity-prevention curricula in early-childhood care centers. "The goal is to develop healthy habits in children before the age of 5 and prevent obesity," the news release says.

To increase physical activity and deter obesity among older children and adults, the state is establishing “trail towns.” Morehead and Olive Hill were recently certified by the state Office of Adventure Tourism and eight more are expected to be certified this year. The Dawkins Trail, an ongoing rail-to-trail project in Eastern Kentucky, has reached a length of 18 miles.

Diabetes management has improved among adults, and a study of Medicaid patients showed an overall decrease in those with poor diabetes control, the release said. State employees now have easier access to the nationally recognized Diabetes Prevention Program, which helps people who are at risk of developing diabetes reverse the onset of the disease.

Dr. Stephanie Mayfield, the state health commissioner and vice chair of Kyhealthnow, has emphasized the importance of reducing tobacco use to make Kentuckians healthier. Beshear has expanded the ban on tobacco products and e-cigarettes on executive branch properties, making Kentucky one of only five states in the country with such a policy. Smoking bans exist in 24 communities, 37 school districts and 51 college or university campuses.

Kyhealthnow, chaired by Lt. Gov. Crit Luallen, includes people from many areas of state government who develop innovative strategies for addressing the state’s health woes and challenge local governments, businesses, schools, nonprofits and individuals to take meaningful steps toward improving health in their communities, the release said.

Bardstown hospital sponsors monthly 'Walk With a Doc'

Here's an interesting idea to promote physical activity and maybe even health literacy: take a walk with your doctor.

Flaget Memorial Hospital in Bardstown hosts monthly "Walk With a Doc" events as part of a nationwide program. Participants can also receive complementary health screenings at the event, says a news release from KentuckyOne Health, which owns Flaget.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein, and even reduce risks of bone fracture," the release says. "Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer."

The walks begin at 10 a.m. on the second Saturday of each month, so the next one is March 14. The walks begin at the Court Square in the middle of Bardstown. For more information, call 502-350-5040.

Grant will fund Lexington signs, maps to encourage walking

A $182,000 grant will fund a pilot project in Lexington to encourage citizens to walk more, by erecting way-finding signs for pedestrians and updating walking maps.

The new Walk Lexington program will also feature signs that tell people how easy it is to get from one spot to another such as "It's only two minutes to the library." The signs are used to help people realize that walking is often faster than driving.

The grant is from the John S. and James L. Knight Foundation, which awards grants to programs in cities where the Knight brothers once owned newspapers, including the Lexington Herald-Leader.

A Herald-Leader report on the grant indicted that the recipient is the NoLi Community Development Corp., a nonprofit trying to make the North Limestone corridor a more livable place, through the Blue Grass Community Foundation, which announced it.

Another study suggests that lack of walking and other physical activity damages blood vessels and causes many health issues

If you are looking for a reason to commit to daily exercise in 2015, here are two: The U.S. surgeon general says most of us only exercise about half the recommended amount to be healthy, and a new study shows that this lack of activity damages our blood vessels, which contributes to much of what ails us.

Research at the University of Missouri School of Medicine, published in Medicine and Science in Sports and Exercise, found that going from high (10,000 steps a day) to low levels of daily physical activity (5,000 steps a day) for just five days decreases the function of the inner lining of the blood vessels in the legs, according to a news release from the university.

“The impairment we saw in just five days was quite striking,” Paul Fadel, associate professor of medical pharmacology and physiology at the university, said in the release. “It shows just how susceptible the vascular system is to physical inactivity.” Previous studies have found that a decrease in blood-vessel function is linked to early cardiovascular death and hypertension.

Kentucky is the ninth most inactive state, with almost one-third (30.2 percent) of Kentuckians reporting in a national survey that they did not engage in physical activity or exercise during the previous 30 days other than doing their regular jobs, according to the State of Obesity report.

A collective New Year's resolution by Kentuckians to increase their physical activity, if kept, would help improve almost every health issue that plagues our state: obesity, diabetes, high blood pressure, heart disease. Kentucky ranks fifth in obesity, 17th in diabetes and fifth in hypertension, and is projected to have more than 1 million cases of heart disease by 2010, the report says.

“Inactivity is typically going to lead to people being overweight and obese,” Fadel said. “The next step after that is insulin resistance, which leads to Type 2 diabetes and cardiovascular disease.”

So, how much activity do we need to keep our blood vessels healthy? 10,000 steps every day, says the surgeon general. But the reality is that most of us only take 5,000 steps a day, which is considered a low activity level. The research for this study is based on 30 minutes of moderate activity a day.

“We need to teach and explain to people about the physiology of their bodies and the physiology of the disease process and help them understand that inactivity plays a foundational role in the disease process,” John Thyfault, associate professor of nutrition and exercise physiology at the university, said.

“Then we give them behavioral tools, like pedometers, to monitor and help them achieve higher physical activity so they start to see and feel health improvements. These studies are proof we need to get people to understand their activity every day plays a role in their health, and that their health is not simply a matter of body weight and how they look in the mirror.”

Kentucky drops two spots in America's Health Rankings, based on data since 2012 or earlier

Kentucky dropped two spots in the 25th annual America's Health Rankings report this year and finds itself once again as one of the bottom five healthiest (or unhealthiest) states.

Since the rankings were first released in 1990, with the exception of 2008 when it ranked 39th, Kentucky has ranked in the bottom 10 states for health. This year it ranks 47th.

The rankings are based on data gathered in the last two to three years, or even earlier, a fact state officials noted as they mentioned the Patient Protection and Affordable Care Act.

"While we have made much headway in the last year, we still have much work to do," said a statement from the Cabinet for Health and Family Services. "We expect that Kentucky’s statistics will begin to improve over time as the full effect of the ACA is reflected in future rankings. However, this change may take time, as Kentucky will be compared to other states that may more quickly see their health outcomes improve.”

Gov. Steve Beshear has made changing health behaviors to create a healthier population a priority for the state. He initiated the Kyhealthnow initiative, which established seven major measurable goals to improve the health status of Kentuckians over the next five years. He has also banned the use of tobacco products on most state properties.

Kentucky's latest ranking should come as no surprise since the state ranks in the bottom five states for eight of the measures: smoking, drug deaths, obesity, children in poverty, preventable hospitalizations, poor mental health days, poor physical health days and cancer deaths. Additionally, it ranks in the bottom 10 states for physical inactivity, air pollution, cardiovascular deaths and premature deaths.

Kentucky has already shown an improvement in smoking. While Kentucky still ranks second in smoking, fewer Kentuckians are smoking. In the past two years, smoking has decreased by 9 percent to 26.5 percent from 29 percent. In 1990, 35.3 percent of Kentuckians smoked.

"The decline in smoking rates stands out as a significant health improvement over the past 25 years," says the American Health Rankings news release. "Cigarette smoking is still associated with one of every five deaths in the United States, making it the leading cause of preventable death in the country."

Kentucky, like the rest of the nation, is getting fatter and becoming more sedentary.

Kentucky ranks fifth in obesity, with 33.2 percent of its adults having a body mass index of 30.0 or higher. In 1990, only 12.2 percent were obese. Kentucky doesn't fare much better with physical inactivity, ranking ninth with 27.4 percent reporting inactivity in the last 30 days.

Nationwide, obesity rates increased by 7 percent to 29.4 percent from 27.6 percent and the percentage of adults reporting inactivity in the last 30 days increased to 23.5 percent from 22.9 percent.

Kentucky has also seen a steady increase in the percentage of its adults with diabetes. Kentucky ranks 33rd in diabetes, with 10.6 percent of its adults reporting they have been told by a doctor that they have diabetes. In 1996, 3.6 percent of Kentuckians reported having diabetes.

Drug deaths have increased by 30 percent in the last two years, to 24 per 100,000 population from 18. Kentucky ranks third in this measurement.

Kentucky ranks first in four measures: children in poverty (31.8 percent), preventable hospitalizations (94.4 per 1,000 Medicare beneficiaries), poor mental health days (4.5 days reported in the previous 30 days), and cancer deaths (228.3 deaths per 100,000 population).

The number of children in poverty has increased by 36 percent in the past two years (31.8 percent from 23.3 percent).

Kentucky does have a few bright spots on the evaluated health measures including a low prevalence of binge drinking, a low violent crime rate and high immunization coverage among children.

Hawaii, Vermont, Massachusetts, Connecticut and Utah are ranked as the top five healthiest states. Mississippi is ranked 50th this year, preceded by Arkansas (49), Louisiana (48), Kentucky (47) and Oklahoma (46). West Virginia and Alabama moved out of the bottom five.

The report, published by United Health Foundation in partnership with American Public Health Association and Partnership for Prevention, uses data from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau.

To see the Rankings in full, visit www.americashealthrankings.org.

Leaders in health care and education meet on child obesity and what can be done about it, and not just in the schools

By Al Cross

Kentucky Health News

Children who are physically active are likely to be better learners, but not enough Kentucky schools seem to put that knowledge into practice, speakers suggested at last week's Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.

Kentucky ranks eighth in child obesity, and nationally, adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

"Many of the adults who will be obese in 2030 are the children in Kentucky schools today," said Dr. Mary Lynne Capilouto, the wife of UK President Eli Caiplouto. The couple hosted an opening brunch for the conference, and at one small-group session.

The conference was an unusual gathering of people from education and health care, who don't discuss common interests enough, said Terry Brooks, executive director of Kentucky Youth Advocates, which staffed the conference. "Our intent is to put together a guiding coalition . . . and make something happen in 2015-16."

That would probably include legislation, but "We can't legislate ourselves out of this problem," educator Leon Mooneyhan told the group. "We need to change the mindset of our society," with multifaceted solutions. Mooneyhan, a former superintendent in Shelby County, is CEO of the Ohio Valley Educational Cooperative, which assists school districts.

He said each district needs a strong "wellness committee" to focus on health, nutrition and physical activity and promote such measures as integrating physical activity into the classroom and not using denial of recess as punishment for misbehavior. "We really need to focus at the elementary schools," he said. "That's where it starts."

The biggest obstacle may be the educational system itself.

An example of classroom-based physical activity,
from Dr. Heather Erwin's PowerPoint presentation

Some schools are reluctant to carve out time for physical activity because of pressure to spend time preparing students for annual achievement tests, but research shows that more physical-activity time "does not appear to to adversely impact academic performance," said Heather Erwin, Ph.D., a UK specialist in kinesiology, the study of human movement.

Erwin said some schools have started intensive math instruction lasting 90 minutes, and students could benefit from two of three physical-activity breaks in such a long classroom session. She said, "So many teachers will say after implementing physical activity, why haven't we been doing this all along?"

"If your butt is numb, your brain is, too," said Jamie Sparks, director of the School Health and Physical Education Network for the state Department of Education.

Sparks said it's unfortunate that some schools are using recess as extra study time before achievement tests. Stu Silberman, executive director of the Prichard Committee for Academic Excellence, said research has shown that students do better on achievement tests on days that they have physical activity.

"There is an achievement gap related to obesity," but many teachers don't see the connection, Silberman said. When students take part practical, in-class programs like those Erwin mentioned, "it becomes a habit for the rest of their lives. . . . Frankfort's not the answer on this.

Tom Shelton, who succeeded Silberman as superintendent in Fayette County, said asking teachers "to do one more thing is almost criminal," they are so busy, but nations such as India and China emphasize physical activity, and "It's amazing to me that we're going the other way. . . . We know for a fact that healthy students are better learners."

Shelton said "Poverty is the number-one barrier to student achievement," and part of that is "lack of good food options."

The face of poverty has changed to one of obesity, said David Jones Jr., a member of the Jefferson County school board and a Louisville venture capitalist. Poor people often eat poor food and don't get enough exercise. "The problem is, we don't know how to eat. We don't know how to deal with calorie-rich environments," Jones said.

Jones was among those who said the solution to child obesity lies in the community at large, not just in its schools.

"It has to be parents and schools and the community and legislators," said Susan Zepeda, president of the Foundation for a Healthy Kentucky, which funded the conference. "This challenge is about nutrition policies, physical-activity policies and building our environment with health in mind."