Eye disease is one of the most common and debilitating complications of diabetes. NIH especially encourages people with diabetes to take steps to avoid vision loss by having the exam each year.

Diabetes is the leading cause of blindness in adults nationwide. An eye disorder known as diabetic retinopathy arises in about 40% of U.S. adults with diabetes. It occurs when blood vessels of the retina swell and leak fluid. In some cases, blood vessels become blocked and rupture, or new vessels grow on the retina, leading to permanent vision loss.

People with diabetes are also at risk for cataracts, which cause clouding of the eye lens, and glaucoma, which damages the optic nerve.

Comprehensive, dilated eye exams allow eye care professionals to monitor the eye, including the retina, for signs of disease. Diabetic retinopathy usually has no symptoms until vision loss occurs, but annual dilated eye exams can identify signs of it. In fact, about 90% of diabetes-related blindness is preventable through early detection, timely treatment and appropriate follow-up care.

Diabetes Increases in Children and Teens

The study found a rise in the rate of new cases of diabetes in youths under the age of 20.MarkHatfield/iStock/Thinkstock

A recent study found that rates of new cases of diabetes in children and teens rose during 2002 to 2012. The researchers reported increases in the rates of both type 1 and type 2 diabetes.

More than 29 million Americans are living with diabetes. People with diabetes have sugar (glucose) levels that are too high. Over time, high levels of blood glucose can cause many health problems.

In type 1 diabetes, the body does not produce insulin. People with type 1 diabetes need to take insulin every day to stay alive. Type 2 diabetes is caused when the body doesn’t make or use insulin well.

Researchers found that, for each year between 2002 and 2012, the rate of new cases of type 1 diabetes in youths under 20 rose by about 2%. The rate of new cases of type 2 diabetes in youths ages 10 to 19 increased by about 5%. Unlike type 1 diabetes, type 2 is seldom diagnosed in children younger than 10.

The researchers noted that rates of diabetes rose significantly in certain racial and ethnic groups. For type 1 diabetes, the rate of new cases increased in Hispanics, non-Hispanic blacks, and non-Hispanic whites. For type 2 diabetes, the rate of new cases rose in Hispanics, non-Hispanic blacks, Asian Americans/Pacific Islanders, and Native Americans.

The study also detected differences in the rates for male and female youths. For type 1 diabetes, the rate rose more in males. For type 2 diabetes, the rate increased more in females.

“The differences among racial and ethnic groups and between genders raise many questions,” says Dr. Barbara Linder, NIH’s senior advisor for childhood diabetes research. “We need to understand why the increase in rates of diabetes development varies so greatly and is so concentrated in specific racial and ethnic groups.”

NIH-funded studies are now examining what factors may increase the risk of diabetes.

Experimental Therapy Shows Promise for Type 1 Diabetes

People with type 1 diabetes need to closely monitor their blood glucose levels.AndreyPopov/iStock/Thinkstock

Patients with difficult cases of type 1 diabetes were helped by transplants of insulin-producing islet cells. The experimental therapy helped to prevent dangerous drops in blood sugar levels.

People with diabetes have trouble managing and using blood glucose, a sugar that serves as fuel for the body. When blood glucose levels rise, islet cells in the pancreas normally make and secrete hormones such as insulin. Insulin triggers cells to take up sugar from the blood.

In type 1 diabetes, the immune system attacks and destroys these insulin-producing cells. People with type 1 diabetes must regularly measure their blood glucose and use insulin injections to maintain their blood sugar levels.

When blood sugar levels drop too low (hypoglycemia), symptoms like shaking or sweating usually warn people to eat or drink to raise their blood sugar levels. However, many people with type 1 diabetes can’t tell when their blood sugar is too low. This raises their risk for severe hypoglycemia, which can cause seizures, loss of consciousness, and death.

One strategy to treat type 1 diabetes is to transplant pancreatic islets from deceased human donors. To test this experimental procedure, NIH-funded researchers studied 48 people with hard-to-treat type 1 diabetes. Participants received at least one transplant of pancreatic islets.

During the first year after treatment, 88% of participants were free of severe hypoglycemic events, had near-normal control of blood glucose levels, and were able to tell when their blood sugar was low. After 2 years, 71% still had these positive effects. Some people had side effects. Researchers are still monitoring the patients to assess the benefits and risks of this therapy.

“While still experimental, and with risks that must be weighed carefully, the promise of islet transplantation is undeniable and encouraging,” says Dr. Griffin P. Rodgers, director of NIH’s National Institute of Diabetes and Digestive and Kidney Diseases.

Fact Sheet Highlights Diabetes Blood Test

About 7 million Americans today have diabetes but don’t realize it. This puts them at risk for the serious complications that can arise when diabetes is left untreated.

A new fact sheet from NIH describes a blood test called A1C, which can diagnose type 2 diabetes and even prediabetes. Prediabetes raises your risk for developing type 2 diabetes.

You don’t need to fast before taking the A1C test, so it’s more convenient than other glucose tests often used to diagnose diabetes. The A1C test can also help patients with type 1 and type 2 diabetes to monitor their blood sugar (glucose) levels.

The new fact sheet covers a wide range of details about the A1C test, including how the test works, other blood tests for type 2 diabetes and prediabetes, the accuracy of blood tests and more.

4 Steps to Manage Your Diabetes for Life

Each year, 1.7 million Americans, ages 20 and up, are diagnosed with diabetes. People with diabetes have high levels of blood glucose (also called blood sugar). If left undiag­nosed or untreated, diabetes can lead to heart disease, stroke, kidney disease, blindness, and other health problems. That’s why it’s important to manage your diabetes ABCs: A1C (blood glucose), blood pressure, and cholesterol. The 4 steps below are a good start.

Step 1: Learn about diabetes. If you’ve got diabetes, you need to make healthy food choices, move more every day, stay at a healthy weight, and take recommended medicines even when you feel good.

Step 2: Talk to your health care team about how to manage your A1C, blood pressure, and cholesterol. Know your ABC goals, and track your progress.

Step 3: Learn how to live with diabetes. Even if you know the steps you should take to stay healthy, you may have trouble sticking with these steps over time. Work with your health care team to make a plan that will work for you.

Step 4: Get routine care to stay healthy. See your health care team at least twice a year to find and treat any problems early. Once each year, be sure to get a dilated eye exam and a complete foot exam.

Managing Diabetes

New Technologies Can Make It Easier

Your body takes care of countless tasks for you. You might not notice all it’s doing to keep you healthy until something goes wrong.

Diabetes is a serious disease that happens when your body has trouble managing and using blood glucose, a sugar that your body uses as fuel. When you have diabetes, you must actively take on this process yourself. New technologies are being tested to make it easier for you to control diabetes and to help you stay healthy.

More than 100 million Americans are living with diabetes or prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. People with diabetes must frequently check their blood glucose (or blood sugar) and take quick action if it gets too high or low. They must also constantly consider how all meals, physical activity, and things like stress will affect their blood glucose.

Types of Diabetes

How people with diabetes manage their blood glucose levels depends, in part, on the type of diabetes they have. The most common are type 1, type 2, and gestational diabetes.

With type 1 diabetes, your body doesn’t make enough of a hormone called insulin. Insulin signals the body’s cells to let glucose inside. The body can’t produce enough insulin because the immune system, your body’s defense against germs and foreign substances, mistakenly attacks and destroys the cells in your pancreas that make insulin.

Type 2 diabetes is the most common. It occurs when either your body’s cells have trouble using insulin or your body doesn’t produce enough insulin to handle the glucose in your blood.

Both types can develop at any age. Type 1 is most often diagnosed in children and young adults, while type 2 shows up most in middle-age and older people. Gestational diabetes occurs only during pregnancy, but increases your chances of developing type 2 later in life.

Diabetes symptoms can vary by type. Some shared symptoms include increased thirst, hunger, and urination. Symptoms of type 1 can start quickly, over a few weeks. Type 2 symptoms tend to develop slowly over years, making them less noticeable.

Blood Glucose Control

Many people with diabetes check their blood glucose with a blood glucose meter. This portable machine measures how much glucose is in the blood. You get a drop of blood by pricking the side of your fingertip with a small, specialized needle. Then you apply the blood to a test strip. The meter shows you how much glucose is in your blood at that moment.

People with type 1 diabetes, and some people with type 2, correct and manage their blood glucose with injections of synthetic insulin. A missed, or miscalculated, dose can lead to serious complications, immediately and over time. Diabetes increases your risk for blindness, heart disease, stroke, kidney failure, and amputation.

“It’s a significant burden to self-test sugar levels several times a day, count carbohydrates with each meal, take into account the impact of physical activity, and then calculate the amount of insulin you need to inject multiple times a day with a syringe or the help of an insulin pump,” explains Dr. Guillermo Arreaza-Rubín, who heads NIH’s Diabetes Technology Program. Any error in this management may lead to life-threatening complications like severe hypoglycemia, which is very low blood glucose.

“Hypoglycemia is one of the main reasons people with type 1 visit hospital emergency rooms every day,” Arreaza-Rubín says. “It happens more frequently during the night and is a major cause of fear and anxiety among people with diabetes and their families.”

Help From Technology

NIH funded-scientists are testing promising technologies to help people better manage diabetes. For example, “artificial pancreas” systems monitor blood glucose levels and provide insulin, or a combination of insulin and another important hormone, automatically. The devices vary in how easy they are to set up and use.

“Our device, called the iLet, is designed to minimize the guesswork and time drain that comes with managing type 1 diabetes,” says Dr. Edward Damiano, a biomedical engineering expert at Boston University who’s co-founded a company to further develop the technology. The device only requires that you type in your body weight to get started. “The system does the heavy lifting of regulating blood glucose, freeing up the user to live a less burdened and more spontaneous life.”

Previous studies have shown that artificial pancreas systems can be safer than the current standard for insulin delivery. Several different devices are now being tested in more people for longer periods of time. Researchers are looking at safety, user-friendliness, the physical and emotional health of the participants, and cost.

Safety is a priority for researchers. “When people with type 1 exercise, their blood glucose can respond in unpredictable and potentially dangerous ways,” explains University of Virginia engineer Dr. Marc Breton. He led a recent study that showed an artificial pancreas system improved glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they participated in winter sports, like skiing and snowboarding.

“The artificial pancreas performed very well in an extremely challenging environment,” he says. “Eventually, it may allow people with diabetes the freedom to participate safely in physical activities that they likely avoided in the past.”

One FDA-approved artificial pancreas is already available for people with diabetes. Devices that are more fully automated may become available to the public within the next couple years. Researchers are considering how to use these systems for people with type 2, gestational diabetes, and other conditions involving elevated blood glucose levels.

Other scientists are taking different approaches to replace insulin more effectively. For example, “smart insulins” would become active only when needed. Researchers are also looking for ways to regenerate or replace insulin-producing cells—and to stop the body from attacking them.

“These technologies will help make managing diabetes easier and will help make people who use them healthier,” says Damiano. “I see them as a bridge to a cure for type 1 diabetes.”

While future tools may make it easier to manage your diabetes, you can learn how to manage diabetes with the tools we have now to live a long, healthy life. Medications, glucose monitors, and insulin pumps are all available now to help people with diabetes. If you have diabetes, talk with your health care provider about your options.

Preventing Type 2 Diabetes

Steps Toward a Healthier Life

People with diabetes have a problem with blood sugar. Their blood sugar, or blood glucose, can climb too high. Having high levels of sugar in your blood can cause a lot of trouble. Diabetes raises your risk for heart disease, blindness, amputations, and other serious issues. But the most common type of diabetes, called type 2 diabetes, can be prevented or delayed if you know what steps to take.

About 29 million Americans, or nearly 1 in 10 people, have diabetes. Many more have a condition called prediabetes. People with prediabetes usually have no symptoms, yet they’re at risk for eventually developing type 2 diabetes, heart disease, and stroke.

Research shows that you can greatly reduce your risk for type 2 diabetes and prediabetes by eating a healthy diet, getting plenty of physical activity, and losing excess weight.

Type 2 diabetes arises because of problems related to a hormone called insulin. When our bodies digest the foods we eat, they’re broken down and converted to glucose and other molecules, which then travel through the bloodstream. Insulin signals cells to let glucose in for use as an energy source. When a person has type 2 diabetes, either the body’s cells have trouble using insulin, or the body isn’t producing enough insulin. As a result, glucose can build up to harmful levels in the blood.

Type 2 diabetes occurs most often in people who are middle-aged or older, but younger people can get it too. “Before the mid- to late-1990s, we almost never saw type 2 diabetes in youth,” says Dr. Barbara Linder, an NIH expert on childhood diabetes. But now, type 2 diabetes is becoming more common in young people, alongside increasing rates of childhood obesity.

Some factors that raise people’s risk for type 2 diabetes are beyond their control. Having an immediate family member with diabetes increases your risk. Type 2 diabetes is also more common in some races or ethnicities, including African-Americans, Alaska Natives, American Indians, Asian-Americans, Pacific Islanders, and Hispanic/Latinos.

People who are overweight, obese, or inactive are also much likelier to develop type 2 diabetes. But these are risk factors that you can change, and doing so will greatly reduce your risk for diabetes.

To understand how weight loss might affect diabetes risk, NIH launched a study in the early 1990s called the Diabetes Prevention Program. Doctors already knew that being overweight or obese was a risk factor for diabetes, but they didn’t know if losing weight would reduce that risk.

The study enrolled more than 3,000 people who were overweight and had prediabetes. They were randomly assigned to different groups.

One group met regularly with study staff to focus on healthy behaviors, such as eating fewer calories and exercising more; they aimed to lose at least 7% of their body weight and to do at least 150 minutes of physical activity per week. Another group received metformin, a drug commonly used to treat type 2 diabetes, along with standard advice on diet and exercise. A control group received standard advice and an inactive placebo pill, which had no drug effects.

After an average of around 3 years, the researchers found that diabetes risk dropped by 58% in the group encouraged to make healthy lifestyle changes. About 38% in that group had achieved and maintained their weight loss goals and 58% their physical activity goals. The group taking metformin was also less likely to develop diabetes; their risk dropped by 31% compared to the control group.

In a follow-up study, both lifestyle changes and metformin continued to reduce the risk of developing diabetes, although their effects declined. After 10 years, people who continued with lifestyle changes delayed diabetes by about 4 years compared to people in the control group. People who continued to take metformin delayed diabetes by about 2 years.

Metformin has long been used and approved for treating type 2 diabetes. However, the U.S. Food and Drug Administration hasn’t approved the drug for preventing type 2 diabetes. Research suggests that the drug’s preventive effects may work best in younger and heavier people. For older people, lifestyle changes were especially helpful; they lowered diabetes risk by 71%.

“Weight loss is key, and physical activity is very important, but lifestyle changes are never easy,” says NIH’s Joanne Gallivan, director of the National Diabetes Education Program (ndep.nih.gov). The program offers resources to help with weight loss, healthy eating, and physical activity. Specific tips are provided for certain groups of people, such as children and older adults. Most materials are offered in Spanish, and some are available in other languages.

As the Diabetes Prevention Program showed, diet and exercise can reduce the risk of developing type 2 diabetes. You’re most likely to succeed at weight loss, Linder says, “if you can find some physical activity that you enjoy and can do every day.”

To lose weight, you need to burn more calories than you consume. Participants in the Diabetes Prevention Program followed a low-fat, low-calorie diet. Experts now recognize that different people may need different diets. “If you’re eating a lot of fat, that’s what you need to cut out. If you’re eating a lot of candy, then that’s what you need to cut,” Linder says. “You have to individualize it.”

Experts recommend that people at risk for type 2 diabetes should exercise weekly at moderate intensity for 150 minutes. That’s 30 minutes, 5 times a week.

“Get your heart rate up a bit. Work up a mild sweat,” says Harvard’s Dr. David Nathan, who leads the Diabetes Prevention Program studies. The training program used in the study is now widely available; for instance, the YMCA now offers a program based on the study.

If you think you might have prediabetes or diabetes, your doctor can help you decide what to do. A blood test called the A1C test can check your average blood glucose level to see if you have prediabetes.

Nathan says that people over 45 should be screened for diabetes, as should other people at increased risk. Risk factors and warning signs for type 2 diabetes include high blood pressure, high cholesterol, or a history of gestational diabetes or cardiovascular disease.

In 2012, 1.7 million Americans ages 20 and older were newly diagnosed with diabetes. “That’s not good, but it’s actually less than the 1.9 million new cases we had in 2010,” Nathan says. “It may just be that we are turning the corner a little bit.”

Feeling Stressed?

Stress Relief Might Help Your Health

Winter holidays—do they fill you with joy or with worries about gift-giving and family gatherings? Do summer vacations leave you relaxed or fretful over travel and money? If you’re feeling stressed out over supposedly fun things, it might be time to reassess. Take a few moments to learn how stress affects your health and what you can do about it.

Everyone feels stressed from time to time. Stress can give you a rush of energy when it’s needed most—for instance, competing in sports, working on an important project, or facing a dangerous situation. The hormones and other chemicals released when under stress prepare you for action. You breathe faster, your heartbeat quickens, blood sugar rises to give you energy, and your brain uses more oxygen as it shifts into high alert.

But if stress lasts a long time—a condition known as chronic stress—those “high-alert” changes become harmful rather than helpful. “Stress clearly promotes higher levels of inflammation, which is thought to contribute to many diseases of aging. Inflammation has been linked to cardiovascular disease, diabetes, arthritis, frailty, and functional decline,” says Dr. Janice Kiecolt-Glaser, a leading stress researcher at Ohio State University. She and other researchers have found that stress affects the body’s immune system, which then weakens your response to vaccines and impairs wound healing.

Research has linked chronic stress to digestive disorders, urinary problems, headaches, sleep difficulties, depression, and anxiety.

“Some studies have found the physical, emotional, and social effects of a disease like cancer to be stressful for patients, caregivers, and long-term cancer survivors,” says NIH’s Dr. Paige Green McDonald, an expert on stress and cancer biology. “However, there’s no definitive evidence that stress causes cancer or is associated with how long one survives after a cancer diagnosis.”

The top causes of stress in the U.S. are money and work-related pressures, according to a 2013 survey from the American Psychological Association. Stress can also arise from major life changes, such as the death of a loved one, divorce, illness, or losing a job. Traumatic stress is brought on by an extreme event such as a major accident, exposure to violence, or a natural disaster such as a hurricane or flood.

Caring for a person with severe illness—such as dementia or cancer—can also be a significant source of stress. More than a decade ago, studies by Kiecolt-Glaser and others showed that the stressful demands placed on caregivers can lead to poorer health, lower responses to vaccines, increased inflammation, and a more than 60% higher death rate compared to non-caregivers.

It’s not clear why some people can sidestep or recover more quickly from stress than others. These resilient people seem to “bounce back” more easily after stressful situations. Recent studies of animals suggest that resiliency may depend at least in part on our genes. But learning healthy ways to cope with stress can also boost your resilience.

“There are many different ways to cope with stress. We know from a lot of different studies that having close personal relationships—people with whom you can talk, with whom you can share your feelings—can be helpful,” says Kiecolt-Glaser. “So spending time with family and friends in order to maintain those relationships is perhaps one of the most crucial things you can do as a stress reducer.”

Unfortunately, Kiecolt-Glaser adds, “when we’re stressed, we tend to do the worst things that are not at all helpful to our health.”

For instance, stressed out people may tend to isolate themselves and not seek social support. “Exercise is a great stress reducer. But when people are stressed, exercise becomes less common and less appealing,” Kiecolt-Glaser says. “Instead of maintaining a healthy diet—also important to reducing stress—some people who are stressed tend to eat more donuts than vegetables.”

You may think that the agitation brought on by stress might help to burn calories. But evidence hints that the opposite is more likely. Kiecolt-Glaser and colleagues found that, compared to nonstressed people, those who were stressed burned fewer calories after high-fat meals and they produced more of the hormone insulin, which enhances fat storage. “So stress may contribute to weight gain and obesity through these biological routes,” Kiecolt-Glaser adds.

Getting enough sleep is also key to resilience and stress relief—although stress itself can interfere with sleep. To improve your sleep habits, go to bed the same time each night and get up the same time each morning, and limit the use of light-emitting electronics like computers and smartphones before bed. The light can reduce production of a natural sleep hormone called melatonin, which then makes it hard to fall asleep.

Beyond recommendations for exercise, healthy diet, social contacts, and getting enough sleep, Green McDonald says, “studies have also shown that mindfulness (focused attention on one’s own emotions) and other meditative practices can effectively relieve stress.”

“Mindfulness means staying aware and conscious of your experiences. No matter what we’re doing, we can always make time to bring our attention to our breath and body and stay there for a short period of time,” says NIH psychologist Dr. Rezvan Ameli, who specializes in mindfulness practice. “Recent studies show that even short periods of mindful attention can have a positive impact on health and well-being.”

Other NIH-funded studies have shown that mindfulness meditation can reduce stress, alter brain structure and function, and have a positive effect on the immune system.

“Mindfulness is a simple and effective tool that anybody can use to reduce stress,” Ameli says. Although the concept is simple, becoming more mindful requires commitment and practice. You can learn more about mindfulness meditation from local resources like yoga or meditation classes, mindfulness-based stress-reduction programs, or books.

If you feel overwhelmed by stress, talk with a health care provider or mental health professional. Medications or other therapies might help you cope. In the long run, reducing stress may help you to slow down and enjoy your time with the people and activities you really care about.

Opportunities Abound for Moving Around

Get Active, Wherever You Are

You know that physical activity can help you live a longer, healthier life. But did you know you don’t need to join a gym or use costly equipment to be physically active? No matter where you live, work, or go to school, you can find ways to move more and sit less throughout your day. In addition to helping your health, you might have fun without spending a lot of money.

Moving more and sitting less can reduce your risk for many serious conditions, including heart disease, diabetes, osteoporosis, and certain kinds of cancer. Some studies suggest that physical activity can have mental benefits as well, helping to relieve depression and maintain thinking abilities as you age. Healthful physical activity includes exercise as well as many everyday activities, such as doing active chores around the house, yard work, or walking the dog.

Activities that cause you to breathe harder are called aerobic activities. These make your heart and blood vessels healthier. Aerobic activities include brisk walking, dancing, swimming, and playing basketball. Strengthening activities, like push-ups and lifting weights, help make your muscles and bones stronger and can also improve your balance.

But even though many of us know that physical activity is a good thing, most adults nationwide don’t meet even the minimum recommended amounts of physical activity. (That’s at least 30 minutes of brisk walking or other moderate activity, 5 days a week.)

Why aren’t we more active? “Lack of time is a common reason for not exercising,” says Dr. Mary Evans, an NIH expert on physical activity and nutrition. “Another important factor is location—having safe places to walk and engage in different activities. That can mean having sidewalks, public parks with well-lit walking paths, a shopping mall where you can walk, or other features that can make activity inviting and easy to do.”

NIH-funded research has found that your environment—where you live, work, or go to school—can have a big impact on how much you move and even how much you weigh.

Some communities don’t have safe playgrounds or sidewalks, so kids tend to spend their free time indoors. Sitting instead of moving makes it hard to maintain a healthy weight. Many adults sit behind the wheel driving to work and then sit most of the day at a computer, taking few breaks to stand up and move around. In suburban neighborhoods, people often have to drive rather than walk to get to grocery stores, shops, and even public transportation.

“Our environments have become less friendly to being active. But studies show that people will walk more if the environment provides them with opportunities to do so,” says Dr. Brian E. Saelens, a health psychologist and behavioral scientist at the University of Washington in Seattle. “How close are you to a library? Can you walk to a store? Is there a safe path for walking to school? All of these factors affect how active we are each day.”

Having places to walk and have fun can help more people get moving and active. “It’s not just dangerous neighborhoods, broken streets, and crime that can keep people indoors and away from being physically active,” says Dr. Allen Glicksman, director of research at the Philadelphia Corporation for Aging. “We’ve also found that, from ages 18 to 80, if a neighborhood has someplace nice to walk to—desirable destinations like a book store, grocery store, coffee shop, a place to eat or meet—it can have a healthful effect on how much people weigh and how much they walk.”

Research also shows that taking public transportation—like buses and trains—can help boost activity. In a recent Seattle-area study, Saelens and colleagues found that people tend to add about 15 minutes of activity to their day when they take public transportation, in part by walking to and from the mass transit site instead of taking a car from door to door. “That’s half the recommended amount of physical activity added to their day,” Saelens says.

Having opportunities to connect with others can also have a positive effect. “Many people are more likely to walk if they’ve got one or more buddies to walk with,” Glicksman says. “When you think about what brings people together, what brings people out and active, the answer can vary depending on your community.” In urban Philadelphia, Glicksman and others have found that neighborhood features like access to public transportation, better bus shelters, and even murals in some neighborhoods seem to encourage more physical activity.

When community gardens were created for older adults in Philadelphia, Glicksman says, “we wanted people to garden to help them eat fresh foods and get them out and moving in the nice weather.” When younger adults joined in as well, the gardens had the added bonus of connecting people across generations. The older adults acted as gardening mentors, while the younger people helped with heavy lifting and digging. “Bringing people together is not only a way to encourage more activity; it’s also a way to get people thinking about how we can change our neighborhoods for the good.”

So take a look around your neighborhood, your workplace, or your school. Can you think of changes that might make the surroundings more inviting for walking or exercise?

“Consider: How can we change our environment so activity is an easier choice for us to make?” Saelens says. In many communities, people have gotten together to organize activities and improve their environments to encourage more physical activity. Steps might include improving local parks, requesting safe and usable bike paths and sidewalks, or asking for more physical activity and healthier meals at schools. If you have some ideas for improving your surroundings, discuss them with your neighbors or local leaders.

Although your environment can affect how active you are, you can still look for new ways to use the world around you to add some movement to your day.

“If you’re at work, try climbing the stairs instead of using the elevator. And get up from your chair and move around at least once an hour,” Evans says. Stand up and walk to a colleague’s office instead of sending an email. Try standing instead of sitting when you’re on the phone, or have “walking” meetings with co-workers instead of sitting in a conference room. And take a brisk walk on your lunch break to get some activity in.

“It’s not really necessary to engage in vigorous physical activity like running to have beneficial health effects. Just 30 minutes of brisk walking most days, in at least 10-minute segments, can have a positive effect,” Evans says.

“We have to look for opportunities to fit physical activity into our days,” Saelens adds. “Some people love to put on their sneakers and to go to the gym, and that’s great for them, but it’s not the only way to get active.”