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Both the United Nations (UN) and the World Health Organization (WHO) are focused on noncommunicable diseases (NCDs), chronic diseases of long duration resulting from a combination of genetic, physiological, environmental, and behavioral factors (WHO, 2018). NCDs affect people of all ages and countries. The Global Burden of Diseases, Injuries, and Risk Factors Study 2015 estimated that mortality from NCDs increased from 57% of total mortality in 1990 to 65% in 2010; 80% of these deaths, often premature, occurred in low- and middle-income countries (Hunter & Reddy, 2013). Both the UN Millennial Development Goals 2030 (UN General Assembly, 2015) and WHO aim for a 25% reduction in mortality from NCDs by 2025. Two of the four most modifiable behavioral risk factors for NCDs are physical inactivity and unhealthy eating, both behaviors that can be influenced by physical therapists. Sport can be a valuable tool to increase physical activity, and physical therapists facilitate safe sports participation for able-bodied children and for children with other abilities.

Several national health initiatives that address improvement in life quality and reduction in NCDs focus on physical activity and healthy eating. The Physical Activity Guidelines for Americans, 2nd Edition, created by the U.S. Department of Health and Human Services (2018), provide evidence-based guidance on physical activity. New recommendations state that preschool children should be physically active throughout the day, and those ages 6 to 17 years should do 60 minutes or more of at least moderate physical activity daily with part of this time involving muscle strengthening and bone-strengthening activities 3 days per week each (Piercy & Troiano, 2018). The Dietary Guidelines for Americans (U.S. Department of Health and Human Services & U.S. Department of Agriculture, 2015) promote a healthy dietary intake. Healthy People (HP2020) (Centers for Disease Control and Prevention [CDC], 2017) initiatives have also focused on objectives to improve the health of all Americans and reduce the risk for disease. These initiatives promote healthy eating and increased physical activity, fitness, and sport as methods to improve health and reduce secondary conditions, such as obesity, diabetes, and high blood pressure.

Recent data from HP2020 Midcourse Review (CDC, 2017) demonstrate that only 27.1% of adolescents meet current federal physical activity guidelines for aerobic physical activity, and 51.7% meet muscle strengthening activity guidelines. Likewise, the 2018 U.S. Report Card on Physical Activity for Children and Youth documents that only 24% of those ages 6 to 17 years meet the guideline of 60 minutes of physical activity daily, with a significant drop noted with increasing age (National Physical Activity Plan Alliance, 2018). Despite these low levels of reported physical activity, only 3.6% of elementary schools, 3.4% of middle and junior high schools, and 4% of high schools required daily physical education in 2014.

Additionally, HP2020 reports that only 16.3% of school districts made fruits or vegetables available (...

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