The Physical Activity Guidelines for Americans – HHS Recommendations

CLINICAL ACTIONS:

Not meeting physical activity guidelines has been associated with approximately 10% of premature deaths in the US and billions of dollars in avoidable healthcare costs. The Physical Activity Guidelines Advisory Committee reviewed the evidence and has produced the 2^nd edition of the Physical Activity Guidelines for Americans (PAG). The HHS is responsible for “all aspects of development” of the Physical Activity Guidelines for Americans, 2nd edition (PAG).

• Preschool-Aged Children (3-5 years)
• Children and Adolescents (6-17 years)
• Adults
• Older Adults
• Pregnancy and the Postpartum Period
• Chronic Health Conditions and Disabilities
• New Evidence for Benefit
• Known Health Benefits
• Activity Definitions
• Intensity Definitions

Preschool-Aged Children (3-5 years)

• Preschool-aged children (ages 3 through 5 years) should be physically active throughout the day to enhance growth and development
• Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types.

Children and Adolescents (6-17 years)

• It is important to provide young people opportunities and encouragement to participate in physical activities that are appropriate for their age, that are enjoyable, and that offer variety
• ≥60 minutes/day of moderate-to-vigorous physical activity daily
  • Aerobic: Most of the 60 minutes or more per day should be either moderate- or vigorous-intensity aerobic physical activity and should include vigorous intensity physical activity on at least 3 days a week
  • Muscle-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include muscle-strengthening physical activity on at least 3 days a week.
  • Bone-strengthening: As part of their 60 minutes or more of daily physical activity, children and adolescents should include bone-strengthening physical activity on at least 3 days a week

Adults

• Adults should move more and sit less throughout the day
  • Some physical activity is better than none
  • Adults who sit less and do any amount of moderate-to vigorous physical activity gain some health benefits
• For substantial health benefits
  • ≥150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity or
  • ≥75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity or
  • an equivalent combination of moderate- and vigorous-intensity aerobic activity.
• Preferably, aerobic activity should be spread throughout the week
• Additional health benefits are gained by engaging in physical activity >300 minutes of moderate-intensity physical activity a week
• Muscle-strengthening activities
  • Moderate or greater intensity that involve all major muscle groups on 2 or more days a week

Older Adults

• The guidelines for adults also apply to older adults
• In addition, the following are just for older adults
  • Also include multicomponent physical activity that includes balance training as well as aerobic and muscle strengthening activities
  • Older adults should determine their level of effort for physical activity relative to their level of fitness
  • Older adults with chronic conditions should understand whether and how their conditions affect their ability to do regular physical activity safely
  • When older adults cannot do 150 minutes of moderate-intensity aerobic activity a week because of chronic conditions, they should be as physically active as their abilities and conditions allow

Pregnancy and the Postpartum Period

• ≥150 minutes (2 hours and 30 minutes) of moderate intensity aerobic activity a week during pregnancy and the postpartum period
  • Preferably, aerobic activity should be spread throughout the week
• Women who habitually engaged in vigorous-intensity aerobic activity or who were physically active before pregnancy can continue these activities during pregnancy and the postpartum period
• Women who are pregnant should be under the care of a health care provider who can monitor the progress of the pregnancy
  • Women who are pregnant can consult their health care provider about whether or how to adjust their physical activity during pregnancy and after the baby is born

Chronic Health Conditions and Disabilities

• ≥150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate-intensity or
• 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous-intensity aerobic physical activity or
• An equivalent combination of moderate- and vigorous-intensity aerobic activity
• Preferably, aerobic activity should be spread throughout the week
• Muscle-strengthening activities
  • Moderate or greater intensity that involve all major muscle groups on 2 or more days a week
• If not able to meet the above key guidelines
  • Individuals with chronic health conditions and disabilities should engage in regular physical activity according to their abilities and should avoid inactivity
• Adults with chronic conditions or symptoms should be under the care of a health care provider
  • People with chronic conditions can consult a health care professional or physical activity specialist about the types and amounts of activity appropriate for their abilities and chronic conditions

SYNOPSIS:

The PAG committee incorporated new data as well as established evidence to produce the updated guidelines on physical activity for Americans. The primary audience for these guidelines are healthcare providers. While there have been some gains with respect to physical activity, the risk for chronic disease and increased mortality remain a serious public health concern.

KEY POINTS:

New Evidence for Benefit

• Improved bone health and weight status for children aged 3 through 5 years
• Improved cognitive function for youth aged 6 to 13 years
• Reduced risk of cancer at additional sites
• Brain health benefits, including improved cognitive function, reduced anxiety and depression risk, and improved sleep and quality of life
• Reduced risk of fall-related injuries for older adults
• For pregnant women, reduced risk of excessive weight gain, gestational diabetes, and postpartum depression
• For people with various chronic medical conditions, reduced risk of all-cause and disease-specific mortality, improved function, and improved quality of life

Known Health Benefits

Children and Adolescents

• Reduced risk of depression (6 to 13 years)
• Improved
  • Bone health (ages 3 through 17 years)
  • Weight status (ages 3 through 17 years)
  • Cardiorespiratory and muscular fitness (ages 6 through 17 years)
  • Cardiometabolic health (ages 6 through 17 years)
  • Cognition (ages 6 to 13 years)

Adults and Older Adults

• Reduced risk of
  • All-cause mortality
  • Cardiovascular disease mortality and disease (including heart disease and stroke)
  • Hypertension
  • Type 2 diabetes
  • Adverse blood lipid profile
  • Cancers (bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach)
  • Dementia (including Alzheimer disease)
    Anxiety | Depression
• Improved
  • Cognition
  • Quality of Life
  • Sleep
  • Bone Health
  • Physical Function
• In addition
  • Slowed or reduced weight gain
  • Weight loss, particularly when combined with reduced calorie intake
  • Prevention of weight regain after initial weight loss

Older Adults

• Lower risk of falls
• Lower risk of fall-related injuries

Activity Definitions

• Aerobic Activity
  • Large muscles move (rhythmically) for a sustained amount of time, improving cardiorespiratory fitness
  • Examples: Brisk walking, running, or bicycling
• Muscle-Strengthening Activity
  • Increases skeletal muscle strength, power, endurance, and mass
  • Examples: Weight lifting or resistance training
• Bone-Strengthening Physical Activity
  • Produces a force on the bones, which promotes bone growth and strength
  • Examples: Jumping rope or running
• Balance Activity
  • Improves individuals’ ability to resist forces within or outside of the body that cause falls while a person is stationary or moving
  • Examples: Lunges or walking backward
• Multicomponent Physical Activity
  • Includes more than 1 type of physical activity, such as aerobic, muscle strengthening, and balance training
  • Examples: Some dancing or sports

Intensity Definitions

• Absolute Intensity
  • Rate of work being performed and does not consider the physiologic capacity of the individual
    • Expressed in Metabolic Equivalent of Task (MET) units
  • Light-intensity physical activity (<3 METs)
    • Walking slowly at ≤2 mph | Light household chores
  • Moderate-intensity physical activity(3 to 5.9 METs)
    • Walking briskly 2 to 4 MPH | playing volley ball | Raking the yard
  • Vigorous-intensity (≥6 METs)
    • Jogging or running | Carrying heavy groceries | Participating in a strenuous fitness class
  • Relative Intensity
    • Adjusts for a person’s cardiorespiratory fitness
    • Someone who is more fit will perceive an exercise to be easier and thus rate it as of lower relative intensity than someone who is less fit

Notes on intensity

• “Talk test”
  • Moderate-intensity aerobic activity can talk, but not sing
  • Vigorous-intensity activity generally cannot say more than a few words without pausing for a breath
• 2 minutes of moderate-intensity activity counts the same as 1 minute of vigorous-intensity activity
  • Example: 30 minutes of moderate-intensity (3-4 METs) activity is roughly the same as 15 minutes of vigorous-intensity (6-8 METs) activity

Learn More – Primary Sources:

Office of Disease Prevention and Health Promotion (HHS): Physical Activity Current Guidelines

The Physical Activity Guidelines for Americans

Is Midlife Cardiovascular Fitness Associated with Reduced Risk for Dementia?

BACKGROUND AND PURPOSE:

• Multiple studies have reported an association between physical activity and decreased risk of dementia and preserved cognitive function
• Research is limited by self-reporting of physical activity
  • Improved cognitive function may be related to social interaction rather than actual physical fitness
• Hörder et al. (Neurology, 2018) tracked dementia incidence for 44 years to determine whether there is an association between midlife cardiovascular fitness and decreased risk for dementia

METHODS:

• Population-based sample of women aged 38 to 60 years
• Data derived from prospective Population Study of Women (PPSW), begun in 1968
• Women were admitted to an exercise test
• A stepwise-increased maximal ergometer cycling test (until exhaustion) to evaluate cardiovascular function was used, under physician supervision
• Fitness Description: Crude peak workload into
  • Low: ≤80W or interrupted at submaximal workload)
  • Medium (88–112W)
  • High(≥120W)
• Follow-up tests for dementia were conducted in 1974, 1980, 1992, 2000, 2005, and 2009
• Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012
• Socioeconomic, lifestyle, and medical confounders were adjusted for in the cox regression test

RESULTS:

• Data was collected from 1,462 women; the symptomatic cardiovascular subgroup consisted of 191 woman
  • 29 were 38 years
  • 41 were 46 years
  • 37 were 50 years
  • 47 were 54 years
  • 37 were 60 years
• Compared to medium fitness (referent population), high cardiovascular fitness was associated with significantly reduced risk of dementia
  • High fitness: Hazard ratio (HR) 0.12 (95% CI, 0.03–0.54)
  • Low fitness: HR 1.41 (95% CI, 0.72–2.79)
• High fitness delayed age at dementia onset by 9.5 years and time to dementia onset by 5 years, compared to medium fitness
• Based on the peak workload, the cumulative incidence of all-cause dementia was 32% for low fitness, 25% for medium fitness, and 5% for high fitness

CONCLUSION:

• Among Swedish women, high cardiovascular fitness in midlife was correlated with reduced risk of subsequent dementia
• High compared to medium fitness decreased the risk of dementia by 88%
• Fitness and physical activity are not identical and the former may have an underlying genetic component
• Findings demonstrate a strong association between physical fitness and dementia but are associative and not causal
• Future areas of study include understanding the underlying mechanisms
• The authors state

The risk reduction of high fitness on dementia was stronger for the crude peak workload than for peak workload/body weight. This is similar to studies on all-cause mortality in which obese fit individuals have a mortality risk similar to that of normal-weight fit individuals. This highlights the need for fitness-driven, rather than weight loss–driven, approaches.

Learn More – Primary Sources:

Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women