1. M E L I C I A C . W H I T T - G L O V E R , P H . D .
G R A M E R C Y R E S E A R C H G R O U P
W I N S T O N - S A L E M , N C
E M A I L : M W H I T T G L O V E R @ G R A M E R C Y R E S E A R C H . C O M
W E B S I T E S : W W W . I N S T A N T R E C E S S . C O M
W W W . G R A M E R C Y R E S E A R C H . C O M
Instant Recess®: Building a Fit
Nation 10 Minutes at a Time!

2. Age-adjusted Prevalence of Obesity and Diagnosed
Diabetes Among U.S. Adults Aged 18 Years or Older
Obesity (BMI ≥30 kg/m2)
Diabetes
1994
1994
2000
2000
No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% 26.0%
No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%
CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at
http://www.cdc.gov/diabetes/statistics
2010
2010

3. What has changed?
1980 2004
Overweight children (ages 6-11) 7.0% 18.8%
Overweight adolescents (ages 12-19) 5.0% 17.1%
then
then
then
then
now
now now
now

4. Whitt-Glover MC, Taylor WC, Floyd MF, Yore MM, Yancey AK, and Matthews CE. Disparities in Physical Activity among US
Children and Adolescents: Prevalence, Correlates, and Intervention Implications. Journal of Public Health Policy 2009, 30
(Supplement 1): S309 – S334.
Physical Activity Prevalence in Children

5. Physical Activity Prevalence in Adolescents

6. Physical Activity Prevalence in Adolescents

7. Source: http://www.statehealthfacts.org/comparemaptable.jsp?ind=92&cat=2
Percent of adults who participated in
moderate or vigorous PA, 2011

8. Percentage of adults who were highly active according
to the 2008 Guidelines: NHIS 2009
Sex
8

9. What is sedentary?
 1. Characterized by or requiring a sitting posture: a
sedentary occupation.
 2. Accustomed to sit or rest a great deal or to take
little exercise.
 3. Chiefly Zoology .
 A. abiding in one place; not migratory.
 B. pertaining to animals that move about little or are
permanently attached to something, as a barnacle.
www.dictionary.com

10. Sedentary Behavior Research Network
 We suggest that journals formally define sedentary
behaviour as any waking behaviour
characterized by an energy
expenditure ≤1.5 METs while in a sitting or
reclining posture. In contrast, we suggest that
authors use the term “inactive” to describe those
who are performing insufficient amounts of MVPA
(i.e., not meeting specified physical activity
guidelines).
Sedentary Behaviour Research Network. 2012. Standardized use of the terms “sedentary”
and “sedentary behaviours”. Appl Physiol Nutr Metab. 37: 540–542.

11. THIS is…..

12. What is
contributing to
sedentariness?

15. Recess!

17. Quality family time….

18. SITTING IS HAZARDOUS TO OUR HEALTH
 Each 2-hr increment in sitting associated with 7%
increase in Type 2 diabetes & 5% increase in obesity
 Increasingly sedentary work over the past 50 yrs may
account for the energy imbalance (+100 Calories)
causing the obesity epidemic
 Men who sit >23 hours a week of sedentary activity had
a 64% greater risk of dying from heart disease than
those who sit <11 hours a week, including many who
routinely exercised
 Work days are associated with nearly 1 hour more sitting
than non-work days

19. Effects of Prolonged Sitting
 Increase in sedentary work, entertainment &
transportation means 95% of Americans don’t get
enough physical activity
 Sitting increases risk of death up to 40% & doubles
the risk of cardiovascular disease:
 Shuts off electrical activity in leg muscles
 Drops rates of calorie burning to 1/minute
 Drops fat-burning enzymes by 90%
 Drops good cholesterol & insulin effectiveness

20. SITTING
4 STEPS
GETTING OUT
OF A CHAIR
STANDING
Sitting induces muscular inactivity
Hamilton, M.T., Hamilton, D.G. and Zderic, T.W. (2007). Role of low energy expenditure and sitting in obesity,
metabolic syndrome, type 2 diabetes, and cardiovascular disease. Diabetes, 56, 2655-2667

22. Social activities promote sedentariness

23. Sociocultural
 Sedentary attitudes
 Enjoyment of sedentary behaviors
 Even more emphasis on family time
 Peer influence
 Cultural attitudes/Importance of rest

24. Airhihenbuwa et al., AJHP, 1995
 Rest more important than/necessary for exercise
 “You will be too pooped to pop—that’s ruining your
system right there….”
 Daily activity is exercise
 “I work the third shift….I’m just always wiped
out…”
 No fear of death like other cultures
 “Whites have the best bodies in the morgue”
Compensatory effect of exercise?

25. Sociocultural
 Sedentary attitudes
 Enjoyment of sedentary behaviors
 Even more emphasis on family time
 Peer influence
 Cultural attitudes/Importance of rest
 Pre-existing health conditions
 Chronic disease prevalence
 Gender roles/differences
 Preferred/expected activities
 Safety

26. Can you be active and sedentary?

27. YES!!!

28. Leisure Time Physical Activity Levels:
Little Change in >2 Decades

29. The evolution of (wo)man

30. Hunter-gatherers 5000
cal
Agriculture 6000 cal
Laborers 3000 cal
Office workers 1800 cal
1 million
yrs ago
10,000 yrs
ago
1915
2000
AVERAGE ENERGY EXPENDITURE
ESTIMATES
Mouse potatoes 1500 cal?2010

31. A solution

32. Prevention vs. Treatment
 Most experts agree that diet is most critical for weight
loss (treating obesity), but physical activity (PA) is
most critical for preventing weight gain (PAGAC,
2008)
 Without increases in PA at a population level,
impossible to decrease caloric intake sufficiently to
achieve energy balance and get essential
micronutrients (Hill et al., 2005)
 White hunger drives eating, there is no inherent
biological drive to be active in adulthood—therefore
push strategies necessary to achieve population-wide
PA increases (Yancey, 2009; 2010)

33. Population benefit estimates of risk factor
change: PA
 3-minute bouts of PA 10 times per day lowers serum
triglycerides to same extent as 1 continuous 30-minute
bout of PA (Miyashita et al., 2006)
 Sedentary behaviors (e.g., TV watching) as well as sub-
optimal >moderate PA levels contributed to DM & obesity
risk over 6 yrs in women (Hu et al., 2003)
 Number of bouts as well as volume of PA correlated with
youth overweight (Mark & Janssen, 2009)
 “Bouts” more efficient at weight and waist control than
“non-bout” PA in adults (Strath et al., 2008)

34. Manufacturing Facility
 Has provided brief stretch breaks on company
time since 1982
 Productivity measurements indicate 30 min.
returned productivity for every 15 min. invested
in exercise (5-min. breaks 3x/day)
 Reduced work-related injuries from 14/yr to
essentially none within 1st 3 years
 Stretch breaks are viewed as a safety measure
similar to wearing safety glasses
 Have now increased to a few minutes every hour!

35. PAAC Cluster Randomized Controlled
Trial Outcomes
Donnelly et al., Prev Med 2009
•Main effects on:
(1) accelerometry-monitored daily PA, in-school,
and outside school—both weekend, weekday
(2) improved academic achievement for reading,
math, spelling & compos. scores
•Disaggregated by exposure:
(1) 9 of 14 intervention schools averaged 75+ min.
active lessons/wk
(2) these schools showed signif. less increase in
BMI
When teacher were active with students, student PA levels were significantly higher!

36. “Push” vs. “Pull”
Pull strategies: Majority of physical activity promotion efforts,
including traditional worksite prog. rely on individual
motivation--largely unsuccessful at population level
--Improvements greater in individual inclined to be active
Examples: gym membership subsidies, stair prompt posters,
lunchtime or after-work exercise classes
Push strategies: Efforts to make the active choice the
default option—the path of least resistance, requiring
individuals to “go out of their way” to make inactive choice
--Promise of broader engagement, including those at greater
risk for obesity—including ethnic minority groups
Examples: walking meetings, exercise breaks during non-
discretionary time at work, nearby parking restricted to
disabled, scheduling meetings at a distance from workspace

39. What Is Instant Recess®?

40. What is Instant Recess®?
 Instant Recess® is a 10-minute low-impact physical activity
break that consists of:
 7 – 8 aerobic-based callisthenic, dance, or sports related movements
 Upbeat, rhythmic music set at a moderate pace.
 Tailored to represent cultural values and assets, popular sports,
and setting-specific elements
 e.g. California Endowment “Here and Now” IR
 A “low-maintenance” physical activity strategy:
 Low-cost (both money and time)
 No change of clothes necessary
 Can be modified to meet specific needs of an
individual or organization.
 Can be used anytime, anywhere, by anybody

41. Basic Structure of an Instant Recess® Break
 IR Breaks are designed to maximize energy
expenditure
 Moves engage large muscle groups in the upper and lower
body.
 IR Breaks are choreographed to be “do-able” for all
ages, body types, and levels of coordination
 Each move is easy to learn, so that everyone can participate.
 Modifications available to tailor each move to your level, and
personal flair is highly encouraged!
 IR breaks are designed to minimize risk of injury
 Your neck, back, and knees are protected to avoid injury

42. How Does Instant Recess® Work?
 Creates opportunity on “paid time”
 Gives employees a brief mental and physical break
from the work day
 Provides a boost of energy during the “mid-
afternoon slump”
 Also encourages changes to improve
the food environment at work
 With increased energy from taking daily recess
breaks, healthier snacks will taste better.
 Employs multiple levels of influence:
 “Deliberate Practice”
 Social Support and Group Dynamics
 Motivational “teachable” moment

43. Studies

44.  10-min. Instant Recess® during staff / training
meetings longer than 1 hour
 449 employees, mostly overweight, middle-aged
women, ethnically diverse
 90+% participation
 Demonstrated feasibility of engagement regardless of
weight or physical activity levels
 Found group breaks add social conformity factor that
positively influenced participation
 “Teachable moment” - increased individual awareness
of poor physical conditioning and health status

45. Pausa para tu Salud
Mexican Ministry of Health, Mexico City
 10-15 minute exercise breaks to music
broadcast thru intercom system
 Mandatory
 Secondary analysis of data,
n=335, collected annually on all employees
 Not study volunteers—75% retention at 1 yr
 1 kg weight loss (0.4 kg/m2) + 1.6 cm
“waist” loss after 1 year

46. California Fit WIC
Staff Wellness Training
Significant findings:
 Increased perceived workplace support
for staff PA (96 vs. 58%, p=0.002)
and healthy food choices
(85 vs. 28%, p=0.001)
 Change in types of foods served during meetings (72 vs.
24%, p=0.002) & PA priority in workplace (96 vs. 71%,
p<0.02)
 Increased self-reported counseling behaviors with WIC
parents promoting physical activity (64 vs. 35%, p<.05)
& sensitivity in handling weight-related issues (92 vs.
58%, p<0.01)

47. Pilot Study Outcomes
Baseline sample:
 N =391 across 25 sites, health and human services gov’t & non-profit wk units
 Predominantly female (89.77%) & African American or Latino (78.24%)
 Mean age = 43.5 yrs
 Mean BMI = 30.0 kg/m2
 Mean WC = 90.5 cm (35.6 in)
6-Month follow-up sample (Cohort 3 only):
 N = 130 individual participants (90% reten.)
 8 work units: 6 Intervention, 2 Control
 Preliminary findings:
Intervention Control
BP (mm Hg) 1.3 1.2 (effect size = -2.5)
BMI (kg/m2) 0.01 0.4 (effect size = -0.4)

48. REACH Dissemination Mid-Point Evaluation
Outcomes
 36 health & human services agency worksites in
LA and Orange Co, CA
 Significant increases in:
1. Exercise break policies (meetings &
scheduled time of workday)
2. Nutrient-rich food procurement policies
3. Policies requiring nutrient-rich
foods/beverages in company meetings
Maxwell et al., Prev Chr Dis, 2011

49. South Bay Health Center
 Launched Instant Recess® Jan 2011 in call
center, Apr in lab/path, Jun in in-pt unit 3000
 Compared to 2010 data from same period,
reduced sick days by 1.8 days/FTE (7.5 – 5.7) in
call center, 1.9 days in an in-pt unit (6.2-4.3)
 Injury rates--“accepted workers’ comp claims”--
decreased from 3 to 0 (call center x 8 mos), 18 to
12 (lab x 4 mos), 1 to 0 (in-pt x 2 mos)

50. Instant Recess®
Champion Schools, Phoenix
Pre-tested at the Champion charter school in a low-income
Phoenix, AZ area
Hosted “Think You Got Moves?” contest
Comments from teachers:
 “feasible to use daily because helps kids settle down after
lunch”
 “kids, girls especially, perform better in PE class because IR
exercises build their confidence”
 “kids are taking ownership and bringing their own music”

51. Percent of Time Spent in Fitness Skills
% time in fitness skills (Instant Recess) increased
in intervention (8.7%) and control (0.5%)
schools, p > 0.05

52. Percent Time in On Task Behavior
% time in on-task behavior increased in intervention
schools (+6.4%) and decreased in control schools (-5.2%),
p = 0.03

53. Mean Minutes of PA in School
Classrooms by Intervention Type
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
Spring baseline Spring followup Fall baseline Fall followup
MeanMinutes
Intervention Schools Crossover Schools
Control Schools Instant Recess Classrooms
Bar = SE

54. Minutes of Fitness Skills and MVPA in Classrooms
by Level of Enthusiasm for Instant Recess
-2
0
2
4
6
8
10
12
14
16
0 5 10 15 20
MinutesofMVPA
Minutes of Fitness Skills
No Instant Recess
Mixed Enthusiasm
Min FS Min MVPA
No Instant Recess 0.64 0.61
Mixed enthusiasm 4.79a 0.54
Enjoyed Instant Recess 6.47b 2.57b
a p = 0.0008 vs No Instant Recess
b p < 0.0001 vs No Instant Recess

55. Instant Recess® @ LAUSD
 Active Living Research dissertation grant
 6 schools, n=647 students with baseline + follow-up data,
68 participating teachers/classrooms
 Cluster RCT with early intervention-delayed intervention
control groups--main outcome = school day pedometer
readings (measured beginning & end of school day)
 Final model: Linear regression of post-treatment steps on
both intervention groups and baseline steps, clustered by
school, and student ID (R2 = 0.2292, F = 78.41 (p < .001))
 Results: Adjusting for intervention group, mean steps
significantly increased with IR intervention (+1910.3
steps; p<.001)

56. Forsyth County, NC
Community-Based Dissemination of Lift Off! Breaks
 Focused on feasibility of dissemination in
schools and churches
 $500 mini-grants given to 10 organizations
 Develop innovative ways to incorporate the Lift Off
concept into regularly scheduled organizational
activities
 Each funded site recruited 20 participants
 Organizations conducted activities for at least 6
months and participated in pre- and post-program
evaluation
 Physical activity data were collected using
accelerometers and questionnaire. Demographic
data and process measures were also collected

57. Results
0
200
400
600
800
1000
1200
Walking Moderate Vigorous Total
Physical Activity Change
measured by IPAQ - Continous
Activity
Pre Mean (SE)
Post Mean (SE)

58. Dissemination

59. HEALCitiesCampaign.org
CA League of Cities & CCPHA
22 cities have now
adopted policies
advocating PA breaks in
meetings lasting an hour
or longer
First 5 LA Commission formally passed PA
break integration policy 10/13/11!

60. Organizational Profiles & Case Studies
 City of Duarte, CA – 3-min. PA breaks every City Council
meeting x 6 yrs
 Delta Sigma Theta Sorority, LA – turns up AC 15 min. pre-IR
break & reimburses only for healthy refreshments x 5 yrs
 City/County of San Francisco Dept of Public Works, CA
conducts stretch breaks with gen. svcs. employees every day
 Orange Co. Health Care Agency, CA – trained entire health
promotion staff in implementing & dissem. IR breaks x 3 yrs
 St. John’s CME Church, NC – occasional IR breaks during
Sunday service increased particip. in gospel aerobics classes
 WPFW Pacifica Radio Station, Washington DC – broadcast
10- min. IR breaks daily 1:05 ET x 6 mos

61. San Diego Padres’
PETCO Park on
Sunday home game
“family” days

62. Related Changes

63. Adopts Instant Recess® in support of Let’s Move!
Plymouth UCC
(North
Houston, TX)
“Musical Pews”
IR break

64. The Jesus Shuffle

66. Common Factors of Instant Recess Success Stories
Physical Layout
and Social Climate
Pre-Existing
Wellness
Infrastructure
Dedicated group of
IR “Sparkplugs”
Persistence in
Troubleshooting
Efforts
Leadership
Support and Active
Participation
Innovation and
Creativity
Hopkins et al (2012). Implementing organizational physical activity and healthy eating strategies on paid time. Health
Education Research. Available at http://her.oxfordjournals.org

67. ENABLE CHANGE
Partnered with Dr. Yancey
to create the Instant
Recess Toolkit
Build the case for recess:
•Health & productivity
evidence
•Return on investment
figures for implementing
recess
•Case studies
Provide tools for
implementation:
•Step-by-step guide
•Engagement ideas
•Tracking charts
•Motivational materials http://corptoolkit.keenfootwear.com

68. RECESS COST BENEFIT CALCULATOR

69. IGNITE A REVOLUTION
• 13,712 individual pledges
to take recess
• 215 media mentions on
the Toolkit
• Public Health Institute
acknowledgement
• Association of Clinicians
for the Underserved
(ACU) distribution via
website
• Kaiser Permanente
activation of Instant
Recess ®

70. UC Press, released November 2010

71. Instant Recess:
Book chapter headings
INTRODUCTION
CHAPTER ONE The High Price of a Sedentary America & Challenge of
Getting Us Moving
CHAPTER TWO The Benefits of Widespread Physical Activity &
Opportunities to Move the Needle
CHAPTER THREE The Evolution of an Idea
CHAPTER FOUR The Marketing and Social Marketing of Physical Activity
and Fitness
CHAPTER FIVE The Case for the Recess Model
CHAPTER SIX Instant Recess—What’s Good for the Waistline Is Good for the
Bottom Line!
CHAPTER SEVEN A Glimpse of the Future—How Instant Recess sparked a
physical activity movement

72. Why Does Instant Recess® Work?
 Minimal Cost
 For companies, minimal cost of time and money
 For employees, ability to use paid time to “recharge”
 The return on investment in terms of employee productivity is often
greater than the time invested
 Made for Groups
 Group setting provides social support to engage in healthy behaviors
 Group setting also provides time to improve employee relationships and
boost morale
 Reduces Barriers to Activity
 Initiated as a “default” activity rather than a “voluntary” option.
 Adjustable for all shapes, sizes, abilities, and fitness levels
 Minimizes perspiration, so prevents messing up hairstyles or work
clothes

73. Public Health Successes of the late
20th Century
Tobacco control
Drinking & driving
Seatbelts & child safety seats
Breastfeeding initiation
Organization change = catalyst or sweet spot!

74. Recess breaks:
The smoking ban of the
physical activity movement?

75. “You must be the change
you wish to see in the
world.”
-- Mahatma Gandhi
“Never doubt that a small group of
thoughtful, committed citizens can
change the world. Indeed it’s the only
thing that ever has!”
--Margaret Mead
Together we can make a difference!

76. Take Home Points
 Continue to promote exercise/physical activity
 Adults
 150 min/wk of moderate or 75 minutes/wk vigorous
 Muscle strengthening > 2 d/wk
 Children
 Aerobic activity > 60 min/d
 Muscle strengthening > 3 d/wk
 Bone strengthening > 3 d/wk
 Move toward reducing sedentary time for all
 Incorporate physical activity into daily routines

77. THE INSTANT RECESS® LIBRARY IS GROWING
RAPIDLY!
…and more!

78. Facebook.com/InstantRecess @InstantRecess
Instant Recess Materials are available:
For purchase at: http://www.journeyworks.com/Instant-
Recess/products/255/
For viewing online at: www.youtube.com/gramercync
*Materials are available in audio (CD) and video (DVD) format