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Until her final days, Dr. Toni Yancey was a leading advocate for making healthy eating and exercise the “default” choices in our daily environments. Now her signature “Instant Recess®” is gaining momentum across the country.
IN THE FACE of a growing obesity epidemic disproportionately affecting low-income and minority populations, Dr. Antronette (Toni) Yancey became a leading voice for a new approach to promoting healthy eating and physical activity.
Yancey, a Fielding School professor who died in April, argued that expecting busy, often stressed people in low-resource neighborhoods to find opportunities to be physically active and eat nutrient-rich foods wasn’t working. Instead, efforts should focus on engaging captive audiences in the settings they already frequent – schools, workplaces, churches, sporting events. Make healthy foods and beverages the norm at meetings and events, in cafeterias and in vending machines, so that people have to go out of their way to eat poorly. Incorporate exercise opportunities into adults’ work time as default options that can be avoided only with deliberate effort or by “opting out.” Send the same message about the value of healthy living from all sectors of society, so that it is reinforced.
Starting in the 1990s, when surprisingly few obesity prevention efforts were focused on promoting physical fitness, Yancey became a powerful and unrelenting advocate for what would become known as Instant Recess®– a 10-minute bout of activity in the form of low-impact dance movements. Requiring only a boom box and culturally relevant music, Instant Recess® was designed by Yancey to be fun, accessible for people of all fitness levels, and easily incorporated into school, work and community life. “For many people – especially in lower-income communities where park space is scarce and the neighborhood might not be safe – the outside environment isn’t always conducive to physical activity,” she explained. “Instant Recess® can be done inside, and it doesn’t require a lot of space or a fitness room.”
Yancey’s commitment was such that even as her energy waned in the final weeks of her life, she led a successful effort by a team of Fielding School faculty from the UCLA Kaiser Permanente Center for Health Equity to secure funding from the U.S. Centers for Disease Control and Prevention for a national program promoting these principles. Healthy by Default – part of the CDC’s Racial and Ethnic Approaches to Community Health (REACH) initiative – aims to systematically influence the social and cultural environments in which people live, learn, work, play and worship. Following Yancey’s death, the grant is led by Dr. Roshan Bastani; Bastani and Yancey were the founding co-directors of the UCLA Kaiser Permanente Center for Health Equity, in the Fielding School.
In 14 urban metropolitan areas throughout the United States, the Healthy by Default REACH project is working with community organizations to promote policies and other research-tested strategies that make enjoyable physical activity and appealing nutritious options default choices in people’s everyday settings. The Fielding School team provides organizations that have deep roots in a community with funding, training, technical assistance and support in the implementation and dissemination of the strategies; it’s left to the organizations to bring together a coalition of community stakeholders to choose the evidence-based strategies most likely to make a sustainable local impact. For some of the participating communities – and in a growing number of settings across the country, outside of the CDC project – one way to introduce exercise is through Instant Recess®.
When Yancey, as director of the L.A. County health department’s Division of Health Promotion and Disease Prevention, first introduced the Instant Recess® concept (at the time it was called the Los Angeles Liftoff), at least one of her colleagues was skeptical. “She said this was going to be a great way to improve the health of workers,” says Dr. William McCarthy, a professor at the Fielding School and longtime research collaborator of Yancey’s, who is co-investigator of the CDC study. “I told her, ‘But it’s only 10 minutes, and the federal recommendation is 30. You’re not going to see any benefits.’ She said, ‘Oh yes you will.’ ” McCarthy became less skeptical and figured that Yancey might be on to something as they analyzed the results from the first study of the approach. It wasn’t so much the physical benefits as it was the behavioral impact: The 10-minute activity served as a wake-up call for adults who had been sedentary for years, motivating many of them to do more.
Yancey’s rationale for the strategy was compelling. “She pointed out that in workplace settings many of the clerical staff were minorities, that they were the ones who were most likely to be overweight or obese, and that they were the least likely to be able to find their own time for physical activity,” McCarthy says. “She argued that to reach those who most need more physical activity, you had to get them in the workplace, and a 10-minute bout might be as much as they were capable of doing when starting out.”
McCarthy also appreciated the other appealing aspects of what came to be known as Instant Recess®. “It’s intrinsically fun,” he says. “She made a variety of culturally specific invitations to engage in rhythmic dance – gospel music, salsa music, Native American pow-wow music – where all you need is a boom box and a CD.” From the beginning, Yancey was also adamant that Instant Recess® be an “opt out” rather than an “opt in” program. “When workplaces open up gyms for employees, people who are already in great shape tend to be the only ones who use them,” McCarthy notes.
Yancey’s 2010 book, Instant Recess®: Building a Fit Nation 10 Minutes at a Time, issued a call to action for a sedentary nation, and the response has been profound. Instant Recess® materials have been purchased by organizations in 47 states as well as in 10 foreign countries. Partnerships with professional athletes and teams have promoted the Instant Recess® model, both within sports venues and in outreach to schools and other youth-serving programs.
A Washington, DC, Instant Recess® initiative involving the local health department and public employees’ union was launched in the summer of 2010, featuring three months of daily Instant Recess® broadcasts on a public radio station with a predominantly African American audience. Through a collaboration with a wellness campaign of the California League of Cities and a health advocacy group, 22 of the state’s cities have adopted policies advocating activity breaks in meetings lasting an hour or longer. Since 2008, Instant Recess® has been part of the San Diego Padres’ FriarFit initiative, incorporated outside the baseball stadium before every Sunday home game. The Instant Recess® concept has been embraced by First Lady Michelle Obama’s “Let’s Move” campaign, for which Yancey was an advisor.
“We save souls in the sanctuary and we kill bodies in the fellowship hall.”
The observation of a fellow pastor hit home for Rev. Dr. Art Cribbs, executive director of Clergy and Laity United for Economic Justice, California (CLUE CA), a federation of faith-based organizations throughout the state advocating on behalf of low-income workers, migrants, immigrants and communities of color. “What he meant is that the good word is preached from the pulpit, and then after church we serve unhealthy food, in quantities that contribute to these health disparities,” Cribbs says.
Two years ago, Cribbs changed his own eating and physical activity habits, losing 40 pounds, and decided he wanted to share his story to help other preachers and congregants. Soon he was introduced to Yancey. Together they launched Faith, Fitness, and Fellowship on the Move to promote physical activity and nutrition education in predominantly African American, Latino and Samoan churches in Los Angeles. The program, which introduces Instant Recess® to the congregations, is based on the notion that if clergy and their spouses become interested in healthy eating and physical activity, their congregants will be motivated to follow.
“You look around the sanctuaries and see smiles and laughter on people’s faces as they and their fellow congregants are standing, stretching and moving together,” Cribbs says. “They’re supporting each other in an experience of laughter, joy and health.” A similar movement is underway in North Carolina, where the health department’s Faithful Families program is adopting Instant Recess® as part of a statewide effort to improve nutrition and increase physical activity in church congregations.
Dr. Melicia Whitt-Glover, president and CEO of Gramercy Research Group, began working with Yancey in 2008 to disseminate and study the effects of Instant Recess® in churches and schools in Winston-Salem, where Whitt-Glover’s research firm is based. Impressed by the effects of the physical activity breaks (she found, for example, that elementary school children showed improved attention and increased overall physical activity after Instant Recess® was introduced), Whitt-Glover has spearheaded an effort that has led to a substantial increase in Instant Recess® use in settings throughout the state – from schools and churches to workplaces and day care facilities. “It’s gotten to the point where, when our staff walks into a meeting, people get excited because they know someone will be leading an exercise break,” Whitt-Glover says. “It’s becoming the norm, which was Dr. Yancey’s goal – ‘healthy by default.’ Instant Recess® is helping to change the culture here.”
Part of the success of Instant Recess® can be attributed to the determination and charisma of its messenger. “Toni was amazing,” says Bastani of her friend and colleague – a onetime college basketball player and fashion model who, in addition to her work as an academic scholar and public health practitioner, was a published poet. “She felt very strongly about it, she was enthusiastic, and she had a lot of credibility.” Yancey was also convincing – she once quipped that the biggest compliment she had been paid was that she could “talk a hungry dog off a meat wagon.”
Denise Woods, DrPH ’11, a former student of Yancey’s who now serves as project director of Healthy by Default, knows all about her former mentor’s powers of persuasion.
Woods met Yancey at a pickup basketball game in 2005. They were the two tallest players – Woods 6-3, Yancey about an inch shorter – so they guarded each other. After the game, a mutual friend introduced them. “Toni started telling me about her vision and the things she was doing, and I was in awe,” Woods recalls. Having recently earned a graduate degree in communications, Woods at the time was unsure of what she wanted to do next. By the end of the brief conversation, she knew. “I had always been interested in talking to people about physical activity and eating healthy, but I didn’t know what public health was,” she says. “Toni told me about it and said I would be perfect for the doctoral program. I don’t think she realized how persuasive she was. I went home, called my parents and told them I thought I had found what I was going to do.”
Woods enrolled in the Fielding School’s doctoral program in 2006 and accompanied Yancey as she worked with policymakers and community leaders in promoting physical activity breaks. Now, Woods is one of many Yancey admirers at UCLA and in communities across the country working to spread the Instant Recess® gospel.
“The thing I took away from my work with Toni more than anything was that she was an advocate for social justice, and she wanted to make it easier for people in disadvantaged communities to live healthier lives,” Woods says. “She believed in this and promoted it until her last day. It’s an honor to carry that work forward.”
Healthy by Default
Racial and Ethnic Approaches to Community Health (REACH)
UCLA Kaiser Permanente Center for Health Equity
San Diego Padres’ FriarFit initiative
Clergy and Laity United for Economic Justice, California (CLUE CA)
Faith, Fitness, and Fellowship on the Move
Faithful Families program
Gramercy Research Group