Gregory W. Heath

Physical Activity and Public Health Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

SUMMARY In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association.

On Line Network is a listserv that creates an international network of physical activity and public health practitioners, researchers, and interested others. To subscribe to this listserv, send an email to listserv@listserv.sc.edu. In the body of the email type: SUBSCRIBE PHYS-ACT, along with your first and last name or anonymous, if you wish to have your subscription hidden. from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention. The University of South Carolina does not discriminate in educational or employment opportunities or decisions for qualified persons on the basis of race Promoting Health Through Physical Activity partners and stakeholders in center activities, and increase participation in cancer prevention and control behaviors among high-risk and disparate populations. Physical Activity Resources We maintain an extensive website (http:// prevention.sph.sc.edu/index.htm) to provide resources and information to researchers, public health practitioners, and others who are interested in promoting physical activity in their communities. The USC Prevention Research Center Notes is a quarterly e-mail newsletter with current information about physical activity and public health. To subscribe to the newsletter, send an email to listserv@listserv.sc.edu. In the body of the email type: SUBSCRIBE PRCNEWS, along with your first and last name or anonymous, if you wish to have your subscription hidden. Please visit the USC PRC website to explore our physical activity tools, many developed by the PRC, often in partnership with local communities.SUMMARY In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation. PRIMARY RECOMMENDATION To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)].

The Effectiveness of Urban Design and Land Use and Transport Policies and Practices to Increase Physical Activity: A Systematic Review

BACKGROUND Although a number of environmental and policy interventions to promote physical activity are being widely used, there is sparse systematic information on the most effective approaches to guide population-wide interventions. METHODS We reviewed studies that addressed the following environmental and policy strategies to promote physical activity: community-scale urban design and land use policies and practices to increase physical activity; street-scale urban design and land use policies to increase physical activity; and transportation and travel policies and practices. These systematic reviews were based on the methods of the independent Task Force on Community Preventive Services. Exposure variables were classified according to the types of infrastructures/policies present in each study. Measures of physical activity behavior were used to assess effectiveness. RESULTS Two interventions were effective in promoting physical activity (community-scale and street-scale urban design and land use policies and practices). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess transportation policy and practices to promote physical activity. CONCLUSIONS Because community- and street-scale urban design and land-use policies and practices met the Community Guide criteria for being effective physical activity interventions, implementing these policies and practices at the community-level should be a priority of public health practitioners and community decision makers.

Evidence-based intervention in physical activity: lessons from around the world

Promotion of physical activity is a priority for health agencies. We searched for reviews of physical activity interventions, published between 2000 and 2011, and identified effective, promising, or emerging interventions from around the world. The informational approaches of community-wide and mass media campaigns, and short physical activity messages targeting key community sites are recommended. Behavioural and social approaches are effective, introducing social support for physical activity within communities and worksites, and school-based strategies that encompass physical education, classroom activities, after-school sports, and active transport. Recommended environmental and policy approaches include creation and improvement of access to places for physical activity with informational outreach activities, community-scale and street-scale urban design and land use, active transport policy and practices, and community-wide policies and planning. Thus, many approaches lead to acceptable increases in physical activity among people of various ages, and from different social groups, countries, and communities.

Associations between Physical Activity and Other Health Behaviors in a Representative Sample of US Adolescents

OBJECTIVES This study examined the associations between physical activity and other health behaviors in a representative sample of US adolescents. METHODS In the 1990 Youth Risk Behavior Survey, 11631 high school students provided information on physical activity; diet; substance use; and other negative health behaviors. Logistic regression analyses examined associations between physical activity and other health behaviors in a subset of 2652 high-active and 1641 low-active students. RESULTS Low activity was associated with cigarette smoking, marijuana use, lower fruit and vegetable consumption, greater television watching, failure to wear a seat belt, and low perception of academic performance. For consumption of fruit, television watching, and alcohol consumption, significant interactions were found with race/ethnicity or sex, suggesting that sociocultural factors may affect the relationships between physical activity and some health behaviors. CONCLUSIONS Low physical activity was associated with several other negative health behaviors in teenagers. Future studies should examine whether interventions for increasing physical activity in youth can be effective in reducing negative health behaviors.

Associations between recommended levels of physical activity and health-related quality of life. Findings from the 2001 Behavioral Risk Factor Surveillance System (BRFSS) survey.

BACKGROUND Although the benefits of regular physical activity on morbidity and mortality are established, relationships between recommended levels of physical activity and health-related quality of life (HRQOL) have not been described. The authors examined whether recommended levels of physical activity were associated with better HRQOL and perceived health status. METHODS Using data from 175,850 adults who participated in the 2001 Behavioral Risk Factor Surveillance System survey, the authors examined the independent relationship between recommended levels of moderate or vigorous physical activity and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for age, race/ethnicity, sex, education, smoking status, and body mass index. RESULTS The proportion of adults reporting 14 or more unhealthy days (physical or mental) was significantly lower among those who attained recommended levels of physical activity than physically inactive adults for all age, racial/ethnic, and sex groups. After multivariate adjustment, the relative odds of 14 or more unhealthy days (physical or mental) in those with the recommended level of activity compared to physically inactive adults was 0.67 (95% CI: 0.60, 0.74) for adults aged 18-44 years, 0.40 (95% CI: 0.36, 0.45) for adults aged 45-64 years, and 0.41 (95% CI: 0.36, 0.46) for adults aged 65 years or older. The results persist even among adults with a chronic condition such as arthritis. CONCLUSIONS These results highlight the need for health programs to increase participation in regular physical activity.

Cost Effectiveness of Community-Based Physical Activity Interventions

BACKGROUND Physical inactivity is associated with the increased risk of many chronic diseases. Such risks decrease with increases in physical activity. This study assessed the cost-effectiveness of population-wide strategies to promote physical activity in adults and followed disease incidence over a lifetime. METHODS A lifetime cost-effectiveness analysis from a societal perspective was conducted to estimate the costs, health gains, and cost-effectiveness (dollars per quality-adjusted life year [QALY] gained, relative to no intervention) of seven public health interventions to promote physical activity in a simulated cohort of healthy U.S. adults stratified by age, gender, and physical activity level. Interventions exemplifying each of four strategies strongly recommended by the Task Force on Community Preventive Services were evaluated: community-wide campaigns, individually adapted health behavior change, community social-support interventions, and the creation of or enhanced access to physical activity information and opportunities. Each intervention was compared to a no-intervention alternative. A systematic review of disease burden by physical activity status was used to assess the relative risk of five diseases (coronary heart disease, ischemic stroke, type 2 diabetes, breast cancer, and colorectal cancer) across a spectrum of physical activity levels. Other data were obtained from clinical trials, population-based surveys, and other published literature. RESULTS Cost-effectiveness ratios ranged between

Associations between Physical Activity Dose and Health-Related Quality of Life

14,000 and

Exercise and the incidence of upper respiratory tract infections

69,000 per QALY gained, relative to no intervention. Results were sensitive to intervention-related costs and effect size. CONCLUSIONS All of the evaluated physical activity interventions appeared to reduce disease incidence, to be cost-effective, and--compared with other well-accepted preventive strategies--to offer good value for money. The results support using any of the seven evaluated interventions as part of public health efforts to promote physical activity.

Realistic Outcomes: Lessons from Community-Based Research and Demonstration Programs for the Prevention of Cardiovascular Diseases

PURPOSE Although the beneficial effects of participation in regular physical activity (PA) are widely accepted, dose-response relationships between PA and health-related quality of life (HRQOL) remain unclear. METHODS We examined relationships between frequency, duration, and intensity of PA and HRQOL among 175,850 adults using data from the 2001 BRFSS. Logistic regression was used to obtain odds ratios (OR) and 95% confidence intervals (CI) adjusted for age, gender, race/ethnicity, education, smoking status, and body mass index. RESULTS The age-standardized prevalence (standard error) of 14 or more unhealthy (physical or mental) days during the previous 30 d was 28.4% (0.50) among physically inactive adults, 16.7% (0.27) among those with insufficient levels of PA, and 14.7% (0.22) among adults who met recommended levels. Overall, participation in no moderate PA (OR: 2.02; 95% CI: 1.85-2.21) was associated with an increased likelihood of having 14 or more unhealthy days. Also for moderate PA, participation every day of the week (5-6 d x wk as referent) (OR: 1.35; 1.26-1.46) was associated with an increased likelihood of 14 or more unhealthy days, as was participation for periods < 20 min (OR: 1.43; 95% CI: 1.30-1.58) or > or = 90 min (OR: 1.22; 95% CI: 1.14-1.31) per day (30-59 min x d as referent). Similar associations were observed for participation in vigorous PA. CONCLUSION Persons achieving recommended levels of PA were more likely to report fewer unhealthy days compared with inactive and insufficiently active persons; however, participation in daily moderate or vigorous PA and participation in very short (< 20 min x d) or extended ( > or = 90 min x d) periods of PA was associated with poorer HRQOL. Further research examining the relationship between the dose of PA and HRQOL as well as other health outcomes is needed.