Expanding Active Living Applications

The 2023 Active Living Conference (ALC) commenced with a guided walk and run in Bethesda, Maryland, an area bordering the northwest edge of Washington, DC, and home of the National Institutes of Health (NIH) and Walter Reed National Medical Center. As a way to foreshadow, the soon to be discussed 2023 ALC theme and its relation to park equity, it would be helpful to share a bit of background on Bethesda. It is a wealthy unincorporated area that in recent years has developed into a vibrant downtown with excellent transportation via Metro to Washington, DC. Most of the large green spaces in Bethesda are controlled by exclusive private country clubs. The public parks are small and intended to serve surrounding single-family neighborhoods. Originally, planners did not anticipate downtown Bethesda becoming a popular place to live and work for a demographically diverse population. Now the Maryland-National Capital Park and Planning Commission, a regional planning body that develops and maintains public parks in the county, has found itself struggling to provide equitable access to public green space. Access issues are especially important for the apartment dwellers who have household incomes substantially lower than those of the surrounding neighborhoods. This dilemma highlights the importance of outdoor physical activity opportunities and accessibility for everyone, including the mixed income residents who live in wealthy and well-resourced jurisdictions like Bethesda. The aforementioned guided walk and run was hosted by Montgomery County’s Girls on the Run and started in downtown Bethesda. Following this kickoff event, several workshops on youth sports, park technology use, trail development and much more were imparted for ALC attendees who were geared and ready to go for these Day One sessions.

The morning of Day Two for ALC attendees was set in motion with brisk and unseasonably cold walks that proceeded north on Wisconsin Avenue from Bethesda area hotels to the Natcher Conference Center on the NIH campus, this year’s conference venue. We were not in Clearwater, Florida listening to beach waves and basking in summer like 70°F temperatures as we had done at prior ALC events, but we certainly did not expect 45°F for our March meeting in Maryland! Despite these chilly conditions, heart rates rose, joyful faces smiled, and open arms hugged when we all convened in the NIH Natcher Auditorium for the first time and not remotely since the beginning of the COVID-19 pandemic. No zoom, just real life humans!

Similar to a much-needed family reunion, Jim Sallis, Active Living Research Visionary and Program Director Emeritus, launched the conference program with Active Living 101, an overview of physical activity and health basics, ecological model applications, role of environments and policy, and principles of transdisciplinary research. The morning session offered a review for active living veterans and an introduction for folks new to the field. Themed “Expanding Active Living Applications beyond Chronic Diseases to Synergistic Epidemics,” the 2023 ALC highlighted the mitigative force of human movement on many pandemic consequences. For example, early on it was found that physical activity was associated with large reductions in COVID-19 mortality.^[1-3] We also recognized that physical activity alleviated some of the mental consequences and stressors of confinement and restriction experienced early during the pandemic as well as the pressures and sorrows of the accompanying structural racism epidemic. Through this syndemic, the realities of historic and contemporary inequities related to race and place that subsequently are related to active living inequities were abundantly revealed. As such, the 2023 ALC captured this theme throughout speaker presentations and poster sessions over the four day gathering.

David Berrigan, Program Director at National Cancer Institute, continued with the conference welcome and then panel speakers Tara Blackshear, Associate Professor at Towson University, and Amy A. Eyler, Professor at Washington University, along with Jim Sallis were welcomed to the stage. These scholars addressed intersecting factors, such as structural racism, and income inequity, on active living behaviors and outcomes, as well as research opportunities. Specifically, Blackshear unapologetically interrogated the biases of NIH’s grant review process and its deficiency in awarding non-White physical activity scholars, particularly those who conduct race-based disparities and inequities research among communities of color. When asked during the Q/A segment what could be done to change or improve these funding biases, Blackshear suggested that NIH directly seek out underrepresented scholars who have already produced promising and distinguished work in this area instead of having them fight through an adversarial White supremist grant funding system. As the session closed with a much-needed stretch break, the impassioned and stirring conversations continued into the hallways and lunchroom.

Presentations, Posters and Stretching

The 2023 ALC theme permeated throughout oral presentations, posters, sidebar discussions, dinners, physical activity breaks and much more. On Day Two, there were several speed talks covering everything from active travel, youth physical activity and holistic health. Late afternoon poster sessions examined the impact of COVID-19 on physical activity in older adults, rural and urban areas, and natural spaces. Other posters focused on active living inequities in regard to gentrification, school recreational assets, play spaces and aging populations. Throughout the munching of light snacks and long overdue in-person networking, the poster session brought to light many of the conference theme issues and the intersectionality of their influence. Some posters highlighted how parks and recreational spaces were a key resource during and coming out of the COVID-19 pandemic. Eager to catch-up and socialize, networking dinners were planned and sprinkled all throughout Bethesda’s bustling downtown district.

“And you may need those gloves; today we will reach a high of 45°F, but tonight we may dip below 30°F.”

Fictitious Washington DC Weather Reporter

On Day Three, we all woke up to a Washington DC area weather reporter something like the above, but these frosty temperatures did not stop ALC attendees.^[4] We started our mornings searching for coffee and tea and warming up for the “Whole-of-Government Approach to Increase Physical Activity” session. The panel speakers included Keith Benjamin, Federal Highway Administration, Katrina Piercy, U.S. Department of Health And Human Services, and Ken Rose, U.S. Centers for Disease Control and Prevention. Discussions on the government’s role to promoting active living for adults and youth, everything from street scale design efforts and Move Your Way® communications campaigns to building societal and individual resilience, initiated the day, which was filled with more presentations on zoning and development policy, community health initiatives as well as parks and green space. In the “Implementing Physical Activity Community-Wide Campaigns with the Move Your Way® Community Playbook” session, Malorie Polster described how community organizations can use a campaign's implementation guide to design publicity materials that integrate health promotion and activity-friendly environmental design tools. Also, in the “Physical Activity Promotion in North Carolina: A Reassessment of Public Park and Recreation Directors” presentation, Jared Jones showed how he updated a 2007 survey to ask local park and recreation directors about opportunities and barriers to promoting physical activity across their communities. From the 2022 update and post-COVID-19 results, he found that there was a greater recognition of the links between the quality of parks, recreation opportunities and the health of the local community.

With full bellies from a delicious Mediterranean lunch, ALC attendees headed back to the NIH Natcher Auditorium for a keynote presentation by Shannon N. Zenk. A distinguished nurse by training and leader of the Neighborhoods and Health Lab in the Division of Intramural Research at the National Institute on Minority Health and Health Disparities, Zenk discussed the role of structural factors and social determinants of health on syndemics. She reminded us that as of March 1, 2023 more than 103 million COVID-19 cases and 1.1. million deaths in the U.S. had been reported and that people who identified as American Indian/Alaska Native, Black or Hispanic were two to three time more likely to be hospitalized from COVID-19 in comparison to their non-Hispanic White counterparts. With calculated intent, Zenk followed these sobering statistics with a statement and notice for what the COVID-19 pandemic exposed.

“It is increasingly understood that these outcomes are a consequence of an even broader syndemic. The perfect storm of clustering, interacting disease states for which long-standing structural inequalities, racism and violence set the stage for who got sick, why they got sick, and their outcomes.”

Shannon N. Zenk, 2023 ALC

Zenk exposed the structurally racist and discriminatory policies, including expropriation of land from Indigenous Peoples and raced-based residential segregation, as the source of many of inequalities persisting today, which has been shown to inhibit or discourage active living. She closed her talk with a call to develop solutions for tackling inequitable conditions in order to improve physical activity and to use active living as a means to impact the syndemics we face today. Inspired by this call to solve the most pressing health challenges faced by our nation, ALC attendees wrapped up Day Three with informationally filled and data packed presentations on everything from basic physical activity guidelines and promotion to mobility justice, public engagement and community building.

We Want Tara Back!

The 2023 ALC final day delivered a 10 degree jump in temperature, reaching nearly 60°F! Under this warmth and sunshine, ALC attendees were still riding the high from catching up with colleagues and friends who many had not seen for nearly three years. After the final round of presentations, many of which focused on the consequences of environmental and infrastructure inequities for activity living, Day Four concluded with a town hall discussion in the NIH Natcher Auditorium. It was a time to reflect and share one’s 2023 ALC experience. Many attendees spoke about what they learned and how they will move forward with creating more equitable and activity supportive communities. During this town hall discussion, a tool for submitting responses to questions via mobile phone was used and projected on a large screen. While there were overwhelmingly positive responses about the sessions, presenters, posters, venue and many other aspects, one name kept popping on the screen and that was Tara Blackshear, one of the 2023 ALC Day One panelists. Many said that they were moved by her presentation, her message and her presence. The accolades she received were exceptional, but there was one suggestion that resonated the most. ALC attendees requested to have Tara Blackshear as the key note speaker for the 2024 ALC. While the town hall meeting was a bit under attended, not surprisingly since attendees needed to catch flights, etc., and many did not witness this glowing endorsement for Tara Blackshear, the championing of this scholar who just happens to identify as a Black woman, served as a final testament to themes of the 2023 ALC. Together, we are expanding active living applications, addressing intersecting factors and promoting equity; and remarkably, the 2023 ALC ended on a final note that should make us all proud. We look forward to seeing you all next year at the 2024 ALC!