Physical Activity Guidelines for Americans

Abstract

FigureQ: What messages are the same, and what is new, within the recently released Physical Activity Guidelines for Americans? What resources are available related to the Guidelines? A In 2008, the first federal set of guidelines related to physical activity was released by the U.S. Department of Health and Human Services (1). This inaugural edition of the Physical Activity Guidelines for Americans (PAGA) has become a foundation for recommendations related to physical activity programs for youth and adults in America (2). Physical Activity Guidelines for Americans Midcourse Report: Strategies to Increase Physical Activity Among Youth was released 5 years later in 2013, building on the 2008 PAGA and exploring ways to encourage youth to reach the recommended 60 minutes per day of physical activity (2,3). Then in 2015, Step It Up! The Surgeon General’s Call to Action to Promote Walking and Walkable Communities was released with the intent to increase walking opportunities in the United States (2,4).FigureThe need to update the 2008 PAGA was realized as additional research accumulated in the area of physical activity and health along with documentation of poor adherence to the recommendations found in the 2008 PAGA (2). In the United States, participation in aerobic and muscle-strengthening activities is low and, as shown in Figure 1, participation levels for both males and females decrease over adulthood (5). Aerobic activities have higher participation compared with muscular strengthening but still far from an ideal of 100% of individuals meeting both aerobic and muscle-strengthening activity recommendations (see Figure 2) (5). Similarly, for youth, about 20% meet aerobic and muscle-strengthening guidelines (6).Figure 1: Participation by males and females in aerobic and muscular-strengthening activities that meet guidelines (5).Figure 2: Participation by adults in both aerobic and muscular-strengthening activities that meet guidelines (5).A call for nominations for an advisory committee was initiated in 2015 (7); members were selected in 2016 and began work on analyzing the wealth of research on physical activity and health (2). This was a major undertaking, as reflected by nearly 1,300 references found throughout the report (8). The 2018 Physical Activity Guidelines Advisory Committee Scientific Report is a lengthy document, nearly 700 pages, focused on studies published since the 2008 PAGA (8). The Scientific Report provides evidence-based recommendations that were submitted to the secretary of Health and Human Services. Public comments were received along with feedback from several federal agencies. The new edition of the PAGA was developed with input from these sources and was released in November 2018 (2,6). HEALTH AND FITNESS BENEFITS OF PHYSICAL ACTIVITY The message of the 2018 PAGA is summarized nicely in the first sentence in the document: “Being physically active is one of the most important actions that people of all ages can take to improve their health” (6). The role of physical activity in preventing disease described in the 2008 PAGA is strengthened by subsequent research, with supporting evidence for lowering risk of coronary heart disease, stroke, high blood pressure, type 2 diabetes, and colon and breast cancer (2). Based on new research, additional benefits of physical activity are included in the 2018 PAGA: improved bone health and weight status for those 3 to 5 years of age; improved cognitive function for those 6 to 13 years of age; reduced cancer risk (in addition to colon and breast cancers, the new edition includes bladder, endometrium, esophagus, kidney, lung, and stomach cancers); benefits for brain health (i.e., potential benefits are improved cognitive function, reduced anxiety and depression risk, improved sleep, and improved quality of life); reduced risk of excessive weight gain, gestational diabetes, and postpartum depression for pregnant women; reduced risk of fall-related injuries for older adults; and reduced risk of all-cause and disease-specific mortality, improved physical function, and improved quality of life for those with various chronic medical conditions (6). Expanding on the disease prevention focus of the 2008 PAGA, the 2018 PAGA infuses a focus on both disease prevention and health promotion throughout the document (6). For example, when considering timing of benefits, immediate and long-term benefits are noted. A single session of physical activity can bring positive changes (e.g., reduce blood pressure, improve insulin sensitivity, reduce symptoms of anxiety, and improve some aspects of cognition). Ongoing regular physical activity can expand on these improvements along with reduction in risk of many chronic diseases and enhanced physical function (6). Health and fitness professionals have an excellent opportunity to reach out to those not yet meeting activity recommendations and now have even more research-backed evidence for the myriad of benefits regular physical activity can afford — in both the short- and long-term. Selected highlights, along with resources for use by the public, are included in the remainder of this article. Readers are encouraged to review the entire 117-page 2018 PAGA document for more background and details (6). RECOMMENDATIONS CONFIRMED, EXPANDED, AND ADDED The original recommendations for youth (ages 6 to 17 years) and adults have been substantiated and thus remain unchanged (2,6): Youth should include at least 60 minutes of age-appropriate moderate-to-vigorous activity every day including mostly aerobic activity (moderate or vigorous intensity, at least 3 days per week should include vigorous) as well as muscle strengthening on at least 3 days per week and bone strengthening on at least 3 days per week. Adults should include moderate-intensity aerobic activity for 150 to 300 minutes per week, or vigorous-intensity activity 75 to 150 minutes per week, or an equivalent combination along with muscle-strengthening activities on two or more days per week. New to this edition is guidance for those as young as 3 years old; the 2008 PAGA recommendations started at age 6 years (1). Preschool-age children (3 to 5 years of age) should be physically active throughout the day, and adult caregivers should encourage a variety of play (e.g., throwing games; bike/tricycle riding; activities with hopping, skipping, jumping, and tumbling). The duration of activity is not yet defined, and thus no formal recommendation is presented; however, 3 hours per day of activity is given as a reasonable target (all types and intensities count) (6). Although the overall physical activity recommendations for adults remain the same, insights on how activity can be accumulated have been updated. To count toward meeting aerobic activity recommendations in the 2008 PAGA, physical activity bouts needed to be at least 10 minutes in duration. Within the new PAGA, 10-minute bouts are supported for improvement of a number of health outcomes, but new evidence also suggests that moderate-to-vigorous physical activity of any duration contributes to health benefits (6). Guidelines for older adults are similar to those for adults related to aerobic and muscular-strengthening activities, including 150 to 300 minutes per week of moderate intensity, 75 to 150 minutes per week of vigorous intensity, or an equivalent combination of moderate and vigorous aerobic activity along with muscle-strengthening activities on two or more days per week (6). Guidelines also include additional aspects reflecting the varied health and fitness levels in older adults as a group including doing multicomponent physical activity as part of weekly physical activity (i.e., balance training as well as aerobic and muscle-strengthening activities), determining effort level relative to personal fitness level, understanding the impact of chronic conditions on safety of physical activity, and being as physically active as possible if unable to reach recommended levels because of chronic conditions (6). In 2008, limited research was available on the relationship between sedentary behavior and health. Since then, researchers have noted the prevalence of sedentary behavior for children and adults to be high; approximately 7.7 hours per day during waking hours are spent being sedentary (6). A strong relationship has been found between sedentary time and risk of all-cause mortality and cardiovascular disease mortality in adults (6). However, at this time, specific targets related to healthy amounts of sedentary time or how many times sedentary time should be interrupted by activity are not defined (6). Difficulty in determining targets on these aspects is related to the relationship between risks due to sedentary behavior and the amount of physical activity being performed (see Figure 3) (6). The colors on the figure represent all-cause mortality risk; red reflects higher risk, green represents lower risk, and orange and yellow represent transitional decreases in risk. For those who are most sedentary, all-cause mortality risk decreases with even small amounts of moderate-to-vigorous activity (note color change from red in the top left corner toward orange as physical activity increases). As shown in the figure, the risk is low even if sedentary level is high for those who have the most activity (i.e., this level seems to be 60 to 75 min/d of moderate or 30 to 40 min/d of vigorous activity) (note color shifts to green in the top right corner). Given the data showing high prevalence of sitting and low physical activity levels in the United States, the value of moderate-to-vigorous activity along with reducing sitting time is clear (6). The lower corner of the figure (shown in green) reflects low sedentary time and higher levels of activity — a winning combination.Figure 3: Relationship among moderate-to-vigorous physical activity, sitting time, and risk of all-cause mortality in adults (6).Most of the PAGA is focused on physical activity guidelines, but the final chapter is focused on strategies to encourage the population to be more active (6). Knowing what to do is a first step, but engaging in regular physical activity is the goal. Individuals are encouraged to develop their own plans and set personal goals, with their unique motivators in mind. Evidence-based strategies for individuals or small groups include receiving guidance from professionals or peers (e.g., health professionals, trained peers), support from others (e.g., buddy systems, exercise groups), and technology (e.g., virtual coaching, wearable activity monitors, smartphone apps, telephone and Internet delivery systems) (6). Communities can encourage people to be physically active; strategies include point-of-decision prompts (e.g., signs suggesting to take the stairs rather than the elevator, wayfinding signs pointing to walkable destinations), school policies and practices (e.g., physical education, classroom physical activity breaks, pre- and postschool activity opportunities), access to indoor and outdoor recreation facilities or outlets (e.g., worksite fitness rooms, parks or trails), community-wide campaigns (e.g., wide-spread physical activity messaging with community activities), and community design (e.g., active transportation options) (6). Although not discussed in this article, the reader is directed to two other information-packed chapters in the PAGA. The chapter entitled “Additional Considerations for Some Adults” includes helpful guidelines for women during pregnancy and the postpartum period as well as people with chronic health conditions or disabilities, including special considerations for adults with osteoarthritis, type 2 diabetes, hypertension, adult cancer survivors, and select other physical disabilities (e.g., Parkinson’s disease, multiple sclerosis, spinal cord injury, stroke) (6). There also is an entire chapter devoted to promoting safety, including understanding risks, selecting appropriate activities for health and fitness level, gradual progression, and consulting with a health care professional or physical activity specialists for those with chronic conditions or symptoms that may require assistance with determining appropriate activities (6). RESOURCES TO TRANSLATE THE GUIDELINES INTO MESSAGES FOR THE PUBLIC The target audience for the PAGA is health professionals and policy makers (6). As a resource, the PAGA helps in the design and implementation of physical activity programs and in the development of policies and promotion initiatives (6). With this in mind, the Move Your Way campaign is a resource that can be used to translate the guidelines into messages for the general public (9). One example of a graphic from the campaign is found in Figure 4. A handout for older adults is found in Figure 5. Health and fitness professionals can access many resources that can be used with clients and patients at https://health.gov/paguidelines/moveyourway/; this Web site includes fact sheets, posters, videos, interactive tools, and Web badges and widgets. The Web page for consumers is https://health.gov/moveyourway/. At this page, individuals can get started by using an interactive tool to build a personalized activity plan https://health.gov/MoveYourWay/Activity-Planner/.Figure 4: Sample of a Move Your Way graphic for adults (6).Figure 5: Sample of a Move Your Way handout for older adults (9).CONCLUSIONS In the 10 years since the first PAGA was released, the scientific evidence on the benefits of physical activity throughout the lifespan has grown. Based on a thorough review of the latest research, the 2018 PAGA is an information-backed resource that provides guidelines for physical activity for Americans starting at age 3 years. With a focus on disease prevention and health promotion, the PAGA is a valuable resource for those within the health and fitness profession when developing individual physical activity programs as well as more broadly in providing opportunities for physical activity within families and communities. As stated in the PAGA (6), “Everyone has a role to play to increase physical activity levels of Americans.” What will your role be?