Archive

Archive for the ‘exercise and fitness’ Category

CDC — New state physical activity indicator report now available online

July 17, 2014 Comments off

New state physical activity indicator report now available online
Source: CDC

More than half of youth in the United States have access to parks or playground areas, recreation centers, boys’ and girls’ clubs, and walking paths or sidewalks in their neighborhoods, according to a new report, State Indicator Report on Physical Activity, 2014.
The report also finds that 27 states have adopted policies that formalize their intent to plan, design and maintain streets so they are safe for all users including pedestrians, bicyclists, motorists, transit riders, and those in wheelchairs.
The report includes physical activity behavior, environment and policy information for each state and is available at www.cdc.gov/physicalactivity/downloads/pa_state_indicator_report_2014.pdf

About these ads

TV Watching and Computer Use in U.S. Youth Aged 12–15, 2012

July 15, 2014 Comments off

TV Watching and Computer Use in U.S. Youth Aged 12–15, 2012
Source: National Center for Health Statistics

Key findings

Data from the National Health and Nutrition Examination Survey (NHANES) and the NHANES National Youth Fitness Survey, 2012

  • Nearly all (98.5%) youth aged 12–15 reported watching TV daily.
  • More than 9 in 10 (91.1%) youth aged 12–15 reported using the computer daily outside of school.
  • In 2012, 27.0% of youth aged 12–15 had 2 hours or less of TV plus computer use daily.
  • Among youth aged 12–15, girls (80.4%) were more likely to use the computer 2 hours or less daily when compared with boys (69.4%).
  • Fewer non-Hispanic black youth aged 12–15 (53.4%) reported watching 2 hours or less of TV daily than non-Hispanic white (65.8%) and Hispanic (68.7%) youth.

Excessive screen-time behaviors, such as using a computer and watching TV, for more than 2 hours daily have been linked with elevated blood pressure, elevated serum cholesterol, and being overweight or obese among youth (1–3). Additionally, screen-time behavior established in adolescence has been shown to track into adulthood (4). The National Heart, Lung, and Blood Institute-supported Expert Panel and the American Academy of Pediatrics (AAP) recommend that children limit leisure screen time to 2 hours or less daily (5,6). This report presents national estimates of TV watching and computer use outside of the school day.

Treadmill walking during vocabulary encoding improves verbal long-term memory

July 14, 2014 Comments off

Treadmill walking during vocabulary encoding improves verbal long-term memory
Source: Behavioral and Brain Functions

Moderate physical activity improves various cognitive functions, particularly when it is applied simultaneously to the cognitive task. In two psychoneuroendocrinological within-subject experiments, we investigated whether very low-intensity motor activity, i.e. walking, during foreign-language vocabulary encoding improves subsequent recall compared to encoding during physical rest. Furthermore, we examined the kinetics of brain-derived neurotrophic factor (BDNF) in serum and salivary cortisol. Previous research has associated both substances with memory performance.In both experiments, subjects performed better when they were motorically active during encoding compared to being sedentary. BDNF in serum was unrelated to memory performance. In contrast we found a positive correlation between salivary cortisol concentration and the number of correctly recalled items. In summary, even very light physical activity during encoding is beneficial for subsequent recall.

Canada — Increasing opportunities for children living with intellectual disabilities to participate in physical activity

June 25, 2014 Comments off

Increasing opportunities for children living with intellectual disabilities to participate in physical activity
Source: Public Health Agency of Canada

The Public Health Agency of Canada has partnered with Special Olympics Canada, the RBC Foundation and the Samuel Family Foundation to increase opportunities for children living with intellectual disabilities to participate in physical activity.

Special Olympics Canada currently runs two initiatives, called “Active Start” and “FUNdamentals,” that provide children with an intellectual disability the opportunity to improve physical, social and cognitive abilities, thereby establishing a foundation for being physically active and healthy. With funding from the Government of Canada, the RBC Foundation and the Samuel Family Foundation, these programs will be expanded, reaching more children across Canada.

The goal of this partnership is to promote healthy living and healthy weights among children living with intellectual disability.

Obesity and Economic Environments

May 28, 2014 Comments off

Obesity and Economic Environments (PDF)
Source: CA: A Cancer Journal for Clinicians

This review summarizes current understanding of economic factors during the obesity epidemic and dispels some widely held, but incorrect, beliefs. Rising obesity rates coincided with increases in leisure time (rather than increased work hours), increased fruit and vegetable availability (rather than a decline in healthier foods), and increased exercise uptake. As a share of disposable income, Americans now have the cheapest food available in history, which fueled the obesity epidemic. Weight gain was surprisingly similar across sociodemographic groups or geographic areas, rather than specific to some groups (at every point in time; however, there are clear disparities). It suggests that if one wants to understand the role of the environment in the obesity epidemic, one needs to understand changes over time affecting all groups, not differences between subgroups at a given time. Although economic and technological changes in the environment drove the obesity epidemic, the evidence for effective economic policies to prevent obesity remains limited. Taxes on foods with low nutritional value could nudge behavior toward healthier diets, as could subsidies/discounts for healthier foods. However, even a large price change for healthy foods could close only part of the gap between dietary guidelines and actual food consumption. Political support has been lacking for even moderate price interventions in the United States and this may continue until the role of environmental factors is accepted more widely. As opinion leaders, clinicians play an important role in shaping the understanding of the causes of obesity. CA Cancer J Clin 2014;000:000-000. VC 2014 American Cancer Society.

Inactivity Related to Chronic Disease in Adults with Disabilities

May 13, 2014 Comments off

Inactivity Related to Chronic Disease in Adults with Disabilities
Source: Centers for Disease Control and Prevention

Working age adults with disabilities who get no aerobic physical activity are 50 percent more likely to have a chronic disease such as cancer, diabetes, stroke, or heart disease than their active peers, according to a Vital Signs report released today by the Centers for Disease Control and Prevention. Most adults with disabilities are able to participate in physical activity, yet nearly half (47 percent) of them get no aerobic physical activity. An additional 22 percent aren’t active enough. However, only about 44 percent of adults with disabilities who saw a doctor in the past year got a recommendation for physical activity.

Treadmill Workstations: The Effects of Walking while Working on Physical Activity and Work Performance

April 28, 2014 Comments off

Treadmill Workstations: The Effects of Walking while Working on Physical Activity and Work Performance
Source: PLoS ONE

We conducted a 12-month-long experiment in a financial services company to study how the availability of treadmill workstations affects employees’ physical activity and work performance. We enlisted sedentary volunteers, half of whom received treadmill workstations during the first two months of the study and the rest in the seventh month of the study. Participants could operate the treadmills at speeds of 0–2 mph and could use a standard chair-desk arrangement at will. (a) Weekly online performance surveys were administered to participants and their supervisors, as well as to all other sedentary employees and their supervisors. Using within-person statistical analyses, we find that overall work performance, quality and quantity of performance, and interactions with coworkers improved as a result of adoption of treadmill workstations. (b) Participants were outfitted with accelerometers at the start of the study. We find that daily total physical activity increased as a result of the adoption of treadmill workstations.

Boomers and Physical Fitness: An AARP Bulletin Survey

April 15, 2014 Comments off

Boomers and Physical Fitness: An AARP Bulletin Survey
Source: AARP

Aimed at exploring the U.S. Boomers’ perceptions and behavior around physical health and fitness, this survey was conducted via telephone by AARP Research, on behalf of the AARP Bulletin, in January 2014, among a national representative sample of 760 Boomers (ages 49-67 years).

Key findings include:

  • Over four-in-ten (43%) Boomers rate their physical health excellent or very good while three-in-ten (29%) rate it fair or poor.
  • Two-thirds (67%) of Boomers say physical fitness exercise is a priority for them today.
  • “It keeps me mobile, not dependent on others (48%), “I enjoy it/it’s fun” (30%), “I have always had this as a priority” (26%), “Doctor recommended it as a must” (26%), and “It makes me feel younger” (25%) are the top-five reasons why physical fitness exercise is a priority for them today.
  • While asking the reasons to those who say physical fitness exercise is not a priority for them today, the highest proportion reported “I don’t have time” (30%), followed by “I am disabled/physically impaired” (22%), “I have chronic illness/I am sick” (21%), and “I have other more important priorities” (20%).
  • About one-in-six (16%) Boomers are currently a member of a health, fitness, or exercise club. Use of personal fitness mobile apps is infrequent among Boomers – only 7% reported using them over the past five years.

Dynamic Association of Mortality Hazard with Body Shape

March 3, 2014 Comments off

Dynamic Association of Mortality Hazard with Body Shape
Source: PLoS ONE

Background
A Body Shape Index (ABSI) had been derived from a study of the United States National Health and Nutrition Examination Survey (NHANES) 1999–2004 mortality data to quantify the risk associated with abdominal obesity (as indicated by a wide waist relative to height and body mass index). A national survey with longer follow-up, the British Health and Lifestyle Survey (HALS), provides another opportunity to assess the predictive power for mortality of ABSI. HALS also includes repeat observations, allowing estimation of the implications of changes in ABSI.

Methods and Findings
We evaluate ABSI z score relative to population normals as a predictor of all-cause mortality over 24 years of follow-up to HALS. We found that ABSI is a strong indicator of mortality hazard in this population, with death rates increasing by a factor of 1.13 (95% confidence interval, 1.09–1.16) per standard deviation increase in ABSI and a hazard ratio of 1.61 (1.40–1.86) for those with ABSI in the top 20% of the population compared to those with ABSI in the bottom 20%. Using the NHANES normals to compute ABSI z scores gave similar results to using z scores derived specifically from the HALS sample. ABSI outperformed as a predictor of mortality hazard other measures of abdominal obesity such as waist circumference, waist to height ratio, and waist to hip ratio. Moreover, it was a consistent predictor of mortality hazard over at least 20 years of follow-up. Change in ABSI between two HALS examinations 7 years apart also predicted mortality hazard: individuals with a given initial ABSI who had rising ABSI were at greater risk than those with falling ABSI.

Conclusions
ABSI is a readily computed dynamic indicator of health whose correlation with lifestyle and with other risk factors and health outcomes warrants further investigation.

Fact Sheet — Physical activity

February 27, 2014 Comments off

Physical activity
Source: World Health Organization

Key facts

  • Physical inactivity is the fourth leading risk factor for death worldwide.
  • Approximately 3.2 million people die each year due to physical inactivity.
  • Physical inactivity is a key risk factor for noncommunicable diseases (NCDs) such as cardiovascular diseases, cancer and diabetes.
  • Physical activity has significant health benefits and contributes to prevent NCDs.
  • Globally, one in three adults is not active enough.
  • Policies to address physical inactivity are operational in 56% of WHO Member States.
  • WHO Member States have agreed to reduce physical inactivity by 10% by 2025.

Active lifestyles related to excellent self-rated health and quality of life: cross sectional findings from 194,545 participants in The 45 and Up Study

January 17, 2014 Comments off

Active lifestyles related to excellent self-rated health and quality of life: cross sectional findings from 194,545 participants in The 45 and Up Study
Source: BMC Public Health

Background
Physical activity and sitting time independently contribute to chronic disease risk, though little work has focused on aspirational health outcomes. The purpose of this study was to examine associations between physical activity, sitting time, and excellent overall health (ExH) and quality of life (ExQoL) in Australian adults.

Methods
The 45 and Up Study is a large Australian prospective cohort study (n = 267,153). Present analyses are from 194,545 participants (48% male; mean age = 61.6 ± 10.7 yrs) with complete baseline questionnaire data on exposures, outcomes, and potential confounders (age, income, education, smoking, marital status, weight status, sex, residential remoteness and economic advantage, functional limitation and chronic disease). The Active Australia survey was used to assess walking, moderate, and vigorous physical activity. Sitting time was determined by asking participants to indicate number of hours per day usually spent sitting. Participants reported overall health and quality of life, using a five-point scale (excellent—poor). Binary logistic regression models were used to analyze associations, controlling for potential confounders.

Results
Approximately 16.5% of participants reported ExH, and 25.7% reported ExQoL. In fully adjusted models, physical activity was positively associated with ExH (AOR = adjusted odds ratio for most versus least active = 2.22, 95% CI = 2.20, 2.47; Ptrend < 0.001) and ExQoL (AOR for most versus least active = 2.30, 95% CI = 2.12, 2.49; Ptrend < 0.001). In fully adjusted models, sitting time was inversely associated with ExH (AOR for least versus most sitting group = 1.13, 95% CI = 1.09, 1.18; Ptrend < 0.001) and ExQoL (AOR for least versus most sitting group = 1.13, 95% CI = 1.10, 1.17; Ptrend < 0.001). In fully adjusted models, interactions between physical activity and sitting time were not significant for ExH (P = 0.118) or ExQoL (P = 0.296).

Conclusions
Physical activity and sitting time are independently associated with excellent health and quality of life in this large diverse sample of Australian middle-aged and older adults. These findings bolster evidence informing health promotion efforts to increase PA and decrease sitting time toward the achievement of better population health and the pursuit of successful aging.

Do Workplace Wellness Programs Save Employers Money?

January 13, 2014 Comments off

Do Workplace Wellness Programs Save Employers Money?
Source: RAND Corporation

Examines the return on investment (ROI) that companies realize from workplace wellness programs, focusing on the ROI provided by disease management programs versus lifestyle management programs.

Cycling, Health and Safety

December 24, 2013 Comments off

Cycling, Health and Safety
Source: Organisation for Economic Co-operation and Development

Many jurisdictions around the world are trying to retain or increase the share of cycling in urban traffic in order to benefit from the many health and transport efficiency benefits. Safety is a key concern and should be accounted for in these policies.

This report of the International Transport Forum’s Cycling Safety Working Group monitors international trends in cycling, safety and policy, and explores options that may help decision makers design safe environments for cycling. Key messages relate to strategic goal-setting for cycling policy and managing crash risks while increasing health benefits. The report also discusses how to better capture crash and bicycle usage statistics. The safety impacts of a wide range of pro-cycling measures are examined in detail.

Educating the Student Body: Taking Physical Activity and Physical Education to School

November 7, 2013 Comments off

Educating the Student Body: Taking Physical Activity and Physical Education to School
Source: Institute of Medicine

Physical inactivity is a key determinant of health across the lifespan. A lack of activity increases the risk of heart disease, colon and breast cancer, diabetes mellitus, hypertension, osteoporosis, anxiety and depression and others diseases. Emerging literature has suggested that in terms of mortality, the global population health burden of physical inactivity approaches that of cigarette smoking. The prevalence and substantial disease risk associated with physical inactivity has been described as a pandemic.

The prevalence, health impact, and evidence of changeability all have resulted in calls for action to increase physical activity across the lifespan. In response to the need to find ways to make physical activity a health priority for youth, the Institute of Medicine’s Committee on Physical Activity and Physical Education in the School Environment was formed. Its purpose was to review the current status of physical activity and physical education in the school environment, including before, during, and after school, and examine the influences of physical activity and physical education on the short and long term physical, cognitive and brain, and psychosocial health and development of children and adolescents.

Educating the Student Body makes recommendations about approaches for strengthening and improving programs and policies for physical activity and physical education in the school environment. This report lays out a set of guiding principles to guide its work on these tasks. These included: recognizing the benefits of instilling life-long physical activity habits in children; the value of using systems thinking in improving physical activity and physical education in the school environment; the recognition of current disparities in opportunities and the need to achieve equity in physical activity and physical education; the importance of considering all types of school environments; the need to take into consideration the diversity of students as recommendations are developed.

This report will be of interest to local and national policymakers, school officials, teachers, and the education community, researchers, professional organizations, and parents interested in physical activity, physical education, and health for school-aged children and adolescents.

Does doing housework keep you healthy? The contribution of domestic physical activity to meeting current recommendations for health

October 22, 2013 Comments off

Does doing housework keep you healthy? The contribution of domestic physical activity to meeting current recommendations for health
Source: BMC Public Health

Background
Recent lifestyle approaches to physical activity have included the promotion of domestic physical activities such as do-it-yourself or home maintenance, gardening and housework. Although it is acknowledged that any activity is better than none, there is a danger that those undertaking domestic ‘chores’ may assume that this activity is moderate intensity and therefore counts towards this 150 minute per week target The purpose of this paper was to report the contribution domestic physical activity makes to total weekly physical activity and the relationship between domestic physical activity and leanness in the Northern Ireland population.

Methods
4563 adults participated in this cross-sectional survey of physical activity behaviour. Data were collected through face-to-face interviews using computer assisted personal interviewing. were not normally distributed, Gender and age group differences in domestic MVPA activity and the ratio of domestic to total MVPA were explored using non-parametric Kruskal-Wallis tests. Self-reported volume and intensity of physical activity (in bouts of 10 minutes or more) in the home and self-reported height and weight were used to determine the association between domestic physical activity and leanness using an ANCOVA having controlled for age, gender, socio-economic and smoking status.

Results
42.7% of the population report levels of physical activity which meet or exceed the current United Kingdom recommendations. Domestic physical activity accounts for 35.6% of the reported moderate to vigorous physical activity (MVPA). For women, if domestic physical activity was excluded from total MVPA, only 20.4% would be deemed to meet current recommendations. Time spent in domestic physical activity at moderate or vigorous intensity was found to be negatively associated with leanness (P = 0.024), [R Squared = .132 (Adjusted R Squared = .125)].

Conclusions
Domestic physical activity accounts for a significant proportion of self-reported daily MVPA particularly among females and older adults however such activity is negatively associated with leanness suggesting that such activity may not be sufficient to provide all of the benefits normally associated with meeting the physical activity guidelines.

CDC releases 2012 School Health Policies and Practices Study results

August 30, 2013 Comments off

CDC releases 2012 School Health Policies and Practices Study results
Source: Centers for Disease Control and Prevention

School districts nationwide are showing improvements in measures related to nutritional policies, physical education and tobacco policies, according to the 2012 School Health Policies and Practices Study (SHPPS). SHPPS is the largest and most comprehensive survey to assess school health policies.

Key findings include:
Nutrition:

  • The percentage of school districts that allowed soft drink companies to advertise soft drinks on school grounds decreased from 46.6 percent in 2006 to 33.5 percent in 2012.
  • Between 2006 and 2012, the percentage of districts that required schools to prohibit offering junk food in vending machines increased from 29.8 percent to 43.4 percent.
  • Between 2006 and 2012, the percentage of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55.1 percent to 73.5 percent.
  • Between 2000 and 2012, the percentage of districts that made information available to families on the nutrition and caloric content of foods available to students increased from 35.3 percent to 52.7 percent.

Physical education/physical activity:

  • The percentage of school districts that required elementary schools to teach physical education increased from 82.6 percent in 2000 to 93.6 percent in 2012.
  • More than half of school districts (61.6 percent) had a formal agreement, such as a memorandum of agreement or understanding, between the school district and another public or private entity for shared use of school or community property. Among those districts, more than half had agreements with a local youth organization (e.g., the YMCA, Boys or Girls Clubs, or the Boy Scouts or Girl Scouts) or a local parks or recreation department.

Tobacco:

  • The percentage of districts with policies that prohibited all tobacco use during any school-related activity increased from 46.7 percent in 2000 to 67.5 percent in 2012.

</blockquote>

 

Factors Predicting Physical Activity Among Children With Special Needs

August 28, 2013 Comments off

Factors Predicting Physical Activity Among Children With Special Needs
Source: Preventing Chronic Disease

Introduction
Obesity is especially prevalent among children with special needs. Both lack of physical activity and unhealthful eating are major contributing factors. The objective of our study was to investigate barriers to physical activity among these children.

Methods
We surveyed parents of the 171 children attending Vista Del Mar School in Los Angeles, a nonprofit school serving a socioeconomically diverse group of children with special needs from kindergarten through 12th grade. Parents were asked about their child’s and their own physical activity habits, barriers to their child’s exercise, and demographics. The response rate was 67%. Multivariate logistic regression was used to examine predictors of children being physically active at least 3 hours per week.

Results
Parents reported that 45% of the children were diagnosed with attention deficit hyperactivity disorder, 38% with autism, and 34% with learning disabilities; 47% of children and 56% of parents were physically active less than 3 hours per week. The top barriers to physical activity were reported as child’s lack of interest (43%), lack of developmentally appropriate programs (33%), too many behavioral problems (32%), and parents’ lack of time (29%). However, child’s lack of interest was the only parent-reported barrier independently associated with children’s physical activity. Meanwhile, children whose parents were physically active at least 3 hours per week were 4.2 times as likely to be physically active as children whose parents were less physically active (P = .01).

Conclusion
In this group of students with special needs, children’s physical activity was strongly associated with parental physical activity; parent-reported barriers may have had less direct effect. Further studies should examine the importance of parental physical activity among children with special needs.

Daily time use among men and women in 2012

July 31, 2013 Comments off

Daily time use among men and women in 2012
Source: Bureau of Labor Statistics

On an average day in 2012, people age 15 and over spent 8.7 hours each day sleeping. Men spent 8.6 hours per day sleeping, while women spent 8.9 hours, on average. Nearly everyone age 15 and over engaged in some sort of leisure activity on average day, such as watching TV, socializing, or exercising. Overall, people spent 5.4 hours each day on leisure activities, on average; men spent more time in these activities (5.8 hours) than did women (5.0 hours).

Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action

July 19, 2013 Comments off

Prevalence of physical activity and obesity in US counties, 2001-2011: a road map for action
Source: Institute for Health Metrics and Evaluation

Research objective
Obesity and lack of physical activity are associated with several chronic conditions, such as heart disease and diabetes, increased health care costs, and premature death. Since different local governments have pursued different approaches to address both risks, levels of obesity and physical activity are likely to vary substantially across counties. To understand local trends in physical activity and obesity that would help identify successful and less successful strategies, researchers examined county-level changes in physical activity and obesity between 2001 and 2011.

Analytical approach
The researchers used data from the Behavioral Risk Factor Surveillance System (BRFSS), a state-based random-digit telephone survey that covers the majority of United States counties, and the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US civilian noninstitutionalized population. They calculated body mass index (BMI) from self-reported weight and height in BRFSS, adjusting for self-reporting bias using NHANES, and calculated self-reported physical activity—both any physical activity and physical activity meeting recommended levels—from self-reported data in BRFSS. To generate estimates of obesity and physical activity prevalence for each county annually for 2001 to 2011, they used validated small area estimation methods.

Findings
Results showed that physical activity in US counties is increasing. Levels were generally higher in men than in women, but increases were greater in women than men, and counties in California, Florida, Georgia, and Kentucky reported the largest gains. However, this increase in level of activity was matched by an increase in obesity in almost all counties during the same time period. Increases in physical activity in counties were not shown to be strongly related to decreases in obesity – from 2001 to 2009, for every 1 percentage point increase in physical activity prevalence, obesity prevalence was 0.11 percentage points lower, controlling for changes in poverty, unemployment, number of doctors per 100,000 population, percent rural, and baseline levels of obesity.

Conclusions
While the increases in physical activity seen at the county level will have a positive impact on the health of Americans, these increases have a small impact on the prevalence of obesity. This means that other strategies are likely needed. Coordinated actions involving the health care and public health systems, non-governmental organizations, and food labeling, taxation, and incentive programs should be considered to curb the obesity epidemic and its burden.

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study

July 10, 2013 Comments off

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study
Source: Institute for Health Metrics and Evaluation

The State of US Health: Innovations, Insights, and Recommendations from the Global Burden of Disease Study presents key findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) for the US and documents trends in nearly 300 different diseases and injuries that are killing people prematurely and disabling them. The report sheds light on the substantial health threat posed by potentially modifiable risk factors such as poor diet, high body mass index, and lack of physical activity. It also provides an in-depth look at life expectancy, obesity, and physical activity in US counties.

In the US, males and females are living longer than ever before, but their progress lagged behind that of their peers in other wealthy countries. As the US population grows older, the number of years Americans can expect to live with disability from causes such as depression and low back and neck pain has increased. The study reveals that thousands of lives could be saved by implementing policies that improve Americans’ diets and levels of physical activity and reduce smoking, high body mass index, and high blood pressure.

At the local level, this report reveals the massive and growing disparities in life expectancy across US counties. Females in almost half of US counties made no significant progress in improving life expectancy between 1985 and 2010, compared to only 5% in males. It is also important to note that more Americans are getting recommended levels of exercise than ever before, which is likely to have positive effects on health. These increases in sufficient physical activity, however, have done little to mitigate rising obesity rates around the country.

Follow

Get every new post delivered to your Inbox.

Join 893 other followers