Raising an Active and Healthy Generation

A Comprehensive Public Health Initiative

Russell R. Pate; Marsha Dowda


Exerc Sport Sci Rev. 2019;47(1):3-14. 

In This Article

Abstract and Introduction


Physical activity (PA) provides important health benefits to youth, but most U.S. children and adolescents fail to meet federal PA guidelines. The purpose of this article is to present a plan for a large-scale public health initiative aimed at producing population-level increases in PA among U.S. youth.


For well over a century, multiple professional groups in the United States have worked to promote physical activity (PA) and physical fitness in youth. In the late 19th century, based largely on the recommendations of highly regarded physicians, the American educational system established and ultimately institutionalized physical education for students.[1] In the mid-20th century, President Eisenhower, concerned by a report that American children were less physically fit than their European counterparts, established a President's Council on Youth Fitness. Eisenhower's successor, John F. Kennedy, broadened the role of the Council to include promotion of physical fitness in all segments of the population, but maintained an emphasis on youth. In addressing a Conference on Physical Fitness in Youth in 1961, Kennedy said, "I want to urge that this be a matter of great priority. 'A sound mind and a sound body' is one of the oldest slogans of the Western World. I am hopeful that we will place a proper weight on intellectual achievement, but in my judgment, for the long-range happiness and well-being of all of you, for the strengthening of our country, for a more active and vigorous life, all of you as individuals and as groups will participate in strengthening the physical well-being of young American boys and girls."

In retrospect, President Kennedy's words have an ironic ring, given that American children of the 1960s were almost certainly more physically active and fit than are today's children.[2,3] Because public health surveillance systems did not include measures of PA in the 1960s, we cannot be certain of the extent to which PA levels in youth have declined over the past 60 yr. But what is certain is that, today, millions of American children are less physically active and fit than experts recommend.[4,5] It is also certain that a substantial public health burden is associated with low PA in youth and that this burden includes rates of overweight and obesity that have skyrocketed over the past 30 yr.[6,7]

This article is based on the premise that, for the United States and most economically developed nations, promotion of PA in children and youth constitutes one of the great public health challenges of the 21st century. Our primary purpose in this article is to lay out a comprehensive plan that we believe has the potential to meet that challenge. The plan is composed of specific strategies for which both evidence supporting intervention effectiveness and experience with implementation in large-scale applications exist. The selected strategies are applied across multiple societal sectors. Furthermore, we make the case that the plan's ultimate success will depend upon effective application of public health methods that have succeeded in advancing the public's health in other areas, such as tobacco control. We begin with a concise summary of the body of knowledge that constitutes the rationale for launching a large-scale public health effort to promote PA in U.S. children and youth.