Federal Physical Activity Guidelines Research Articles

Comparison of Self-Reported and Accelerometer-Assessed Physical Activity in Older Women

BackgroundSelf-reported physical activity measures continue to be validated against accelerometers; however, the absence of standardized, accelerometer moderate-to-vigorous physical activity (MVPA) definitions has made comparisons across studies difficult. Furthermore, recent accelerometer models assess accelerations in three axes, instead of only the vertical axis, but validation studies have yet to take incorporate triaxial data.MethodsParticipants (n = 10 115) from the Women’s Health Study wore a hip-worn accelerometer (ActiGraph GT3X+) for seven days during waking hours (2011–2014). Women then completed a physical activity questionnaire. We compared self-reported with accelerometer-assessed MVPA, using four established cutpoints for MVPA: three using only vertical axis data (760, 1041 and 1952 counts per minute (cpm)) and one using triaxial data (2690 cpm).ResultsAccording to self-reported physical activity, 66.6% of women met the US federal physical activity guidelines, engaging in ≥150 minutes per week of MVPA. The percent of women who met guidelines varied widely depending on the accelerometer MVPA definition (760 cpm: 50.0%, 1041 cpm: 33.0%, 1952 cpm: 13.4%, and 2690 cpm: 19.3%).ConclusionsTriaxial count data do not substantially reduce the difference between self-reported and accelerometer-assessed MVPA.

Exercise

Numerous observational studies have demonstrated an inverse relationship between physical activity and risk of many chronic illnesses. The protective effect of exercise is strongest against coronary artery disease, hypertension, stroke, type 2 diabetes mellitus, obesity, anxiety, depression, osteoporosis, and cancers of the colon and breast. Despite these proven benefits, only 25% of adults in the United States exercise at recommended levels. Globally, physical inactivity is the fourth leading risk factor for death, followed by overweight and obesity. This module describes exercise physiology, including cardiovascular response to dynamic exercise, pulmonary response, musculoskeletal response, metabolic effects, effects on blood lipid levels, hematologic effects, effects on vascular inflammation, effects on body fluids, and psychological effects. Exercise and the elderly and the relationship between exercise and longevity are reviewed. Prescribing exercise and complications of exercise are also discussed. Tables describe the categories of patients screened for possible coronary artery disease, exercise time required to consume 2,000 kcal, and exercise advice for patients. Figures include a graph showing the number of adults who met the federal physical activity guidelines criteria, the top 10 global risk factors for death in 2004, the process of providing energy for the muscle, and trends in physician prescriptions for exercise. This module contains 4 highly rendered figures, 3 tables, 35 references, and 5 MCQs.

Exercise

Numerous observational studies have demonstrated an inverse relationship between physical activity and risk of many chronic illnesses. The protective effect of exercise is strongest against coronary artery disease, hypertension, stroke, type 2 diabetes mellitus, obesity, anxiety, depression, osteoporosis, and cancers of the colon and breast. Despite these proven benefits, only 25% of adults in the United States exercise at recommended levels. Globally, physical inactivity is the fourth leading risk factor for death, followed by overweight and obesity. This module describes exercise physiology, including cardiovascular response to dynamic exercise, pulmonary response, musculoskeletal response, metabolic effects, effects on blood lipid levels, hematologic effects, effects on vascular inflammation, effects on body fluids, and psychological effects. Exercise and the elderly and the relationship between exercise and longevity are reviewed. Prescribing exercise and complications of exercise are also discussed. Tables describe the categories of patients screened for possible coronary artery disease, exercise time required to consume 2,000 kcal, and exercise advice for patients. Figures include a graph showing the number of adults who met the federal physical activity guidelines criteria, the top 10 global risk factors for death in 2004, the process of providing energy for the muscle, and trends in physician prescriptions for exercise. This module contains 4 highly rendered figures, 3 tables, 35 references, and 5 MCQs.

Identifying Potential Usability Challenges for Xbox 360 Kinect Exergames for Older Adults

Many older adults could benefit from additional exercise. In 2011, over 54% of adults between the ages of 65 and 74 and 68% of adults ages 75 and above did not meet the 2008 U.S. Federal Physical Activity guidelines for either aerobic or muscle strengthening activities, according to the National Center for Health Statistics (Schiller, Lucas, & Peregoy, 2012, p. 100). Exergames, video games where players engage in physical activity, could help older adults elevate their levels of physical activity in order to gain associated health benefits. However, most exergames on the market are not designed for older users. Two exergames for Microsoft Xbox 360 with Kinect were evaluated using heuristic task analysis and heuristic evaluation with consideration of older adults’ abilities and limitations. Implications for developing training programs to maximize effective use of exergames for older adults are discussed.

The Development and Content of the 2008 Physical Activity Guidelines for Americans

The U.S. Department of Health and Human Services' 2008 Physical Activity Guidelines for Americans represents a major milestone in public health efforts to address inactivity. These comprehensive federal physical activity guidelines affirm the strong scientific evidence for the health benefits of regular physical activity. The document contains key guidelines for children and adolescents, adults, older adults, women during pregnancy and the postpartum period, adults with disabilities, and people with chronic medical conditions. There are also key guidelines for injury prevention. The 2008 guidelines provide benchmarks for assessing the health burden of inactivity and inform the design of public health initiatives to promote physical activity in Americans. This article provides a brief review of the evolution of guidelines in the United States, the process for developing the guidelines, and the key recommendations of the guidelines.

Relationship of meeting physical activity guidelines with quality-adjusted life-years

ObjectiveThe quality-adjusted life-year (QALY) is a standard outcome measure used in cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines is associated with higher QALY estimates among adults with or at an increased risk for knee osteoarthritis. MethodsThis is a prospective study of 1794 Osteoarthritis Initiative participants. Physical activity was measured using accelerometers at baseline. Participants were classified as (1) Meeting Guidelines [≥150min of moderate-to-vigorous (MV) activity per week acquired in sessions ≥10min], (2) Insufficiently Active (≥1 MV session[s]/week but below the guideline), or (3) Inactive (zero MV sessions/week). A health-related utility score was derived from participant responses to the 12-item Short-Form Health Survey at baseline and 2 years later. The QALY was calculated as the area under utility curve over 2 years. The relationship of physical activity level to median QALY adjusted for socioeconomic and health factors was estimated using quantile regression. ResultsRelative to the Inactive group, median QALYs over 2 years were significantly higher for the Meeting Guidelines (0.112, 95% CI: 0.067–0.157) and Insufficiently Active (0.058, 95% CI: 0.028–0.088) groups, controlling for socioeconomic and health factors. ConclusionWe found a significant graded relationship between greater physical activity level and higher QALYs. Using the more conservative estimate of 0.058, if an intervention could move someone out of the Inactive group and costs <$2900 over 2 years, it would be considered cost effective. Our analysis supports interventions to promote physical activity even if recommended levels are not fully attained.

Relationship of Meeting Physical Activity Guidelines With Health‐Related Utility

Health-related utility measures overall health status and quality of life and is commonly incorporated into cost-effectiveness analyses. This study investigates whether attainment of federal physical activity guidelines translates into better health-related utility in adults with or at risk for knee osteoarthritis (OA). Cross-sectional data from 1,908 adults with or at risk for knee OA participating in the accelerometer ancillary study of the Osteoarthritis Initiative were assessed. Physical activity was measured using 7 days of accelerometer monitoring and was classified as 1) meeting guidelines (≥150 bouted moderate-to-vigorous [MV] minutes per week); 2) insufficiently active (≥1 MV bout[s] per week but below guidelines); or 3) inactive (zero MV bouts per week). A Short Form 6D health-related utility score was derived from patient-reported health status. Relationship of physical activity levels to median health-related utility adjusted for socioeconomic and health factors was tested using quantile regression. Only 13% of participants met physical activity guidelines, and 45% were inactive. Relative to the inactive group, median health-related utility scores were significantly greater for the meeting guidelines group (0.063; 95% confidence interval [95% CI] 0.055, 0.071) and the insufficiently active group (0.059; 95% CI 0.054, 0.064). These differences showed a statistically significant linear trend and strong cross-sectional relationship with physical activity level even after adjusting for socioeconomic and health factors. We found a significant positive relationship between physical activity level and health-related utility. Interventions that encourage adults, including persons with knee OA, to increase physical activity even if recommended levels are not attained may improve their quality of life.

Adherence to the 2008 Adult Physical Activity Guidelines and Mortality Risk

Mortality differentials by level and intensity of physical activity have been widely documented. A comprehensive review of scientific evidence of the health benefits of physical activity led the USDHHS to issue new Federal Guidelines for physical activity in 2008. Reductions in mortality risk associated with adherence to these Guidelines among the general U.S. adult population have not yet been studied. This study compared the relative mortality risks of U.S. adults who met the 2008 Guidelines with adults who did not meet the recommendations. Cox proportional hazards models were used to examine the relative mortality risks of U.S. adults aged ≥18 years, using data from the 1997-2004 National Health Interview Survey and linked mortality records for deaths occurring in 1997-2006 (analyzed in 2010). Risks for adults with and without chronic health conditions were examined separately. Meeting the recommendations for aerobic activity was associated with substantial survival benefits, especially among the population having chronic conditions, with estimated hazard ratios ranging from 0.65 to 0.75 (p<0.05). While strengthening activities by themselves did not appear to reduce mortality risks, they may provide added survival benefits to those already engaged in aerobic activities. The relative benefits of physical activity were greatest among adults who had at least one chronic condition. Adherence to the 2008 Physical Activity Guidelines was associated with reduced all-cause mortality risks among U.S. adults, after controlling for sociodemographic characteristics, BMI, smoking, and alcohol use.

Physical Activity and Cardiac Protection

Epidemiologic data clearly show that men and women with higher levels of physical activity have lower rates of cardiovascular disease. While the precise biologic mechanisms for this relation have not been elucidated completely, several plausible mechanisms involving traditional and novel cardiovascular risk factors have been described. In line with the 2008 federal guidelines for physical activity, the available evidence indicates that 150 min.wk(-1) of moderate-intensity aerobic activity, or the equivalent in vigorous, or moderate plus vigorous activities, is sufficient to reduce risk. There is a dose-response relation in that additional amounts of physical activity exceeding this level are associated with additional reductions in cardiovascular disease risk, supporting the 2008 federal guidelines, which further recommend 300 min.wk(-1) of moderate-intensity aerobic activity, or the equivalent in vigorous, or moderate plus vigorous activities, for additional health benefits. Among patients with established coronary artery disease, physical activity also reduces all-cause and cardiovascular disease mortality rates.

Move More, Sit Less: A First-Line, Public Health Preventive Strategy?

Despite the widely cited Centers for Disease Control and Prevention (CDC) ⁄American College of Sports Medicine (ACSM) exercise guidelines, the much-heralded surgeon general’s report, and the recently published ACSM ⁄American Heart Association exercise statement and federal physical activity guidelines (Table I), the conventional model for getting people to be more physically active (ie, structured exercise program) has been only marginally effective. Traditional exercise programs have typically reported dropout rates of 50% or more at 1 year, highlighting the compliance problem among those who voluntarily initiate exercise, regardless of health status. Other enrollees, who do not technically meet the criteria for ‘‘exercise dropout,’’ may continue exercising at a subthreshold intensity, frequency, or duration. According to the CDC, only 31% of American adults meet contemporary physical activity recommendations (ie, moderate-intensity activity for 30 min ⁄d, 5 or more d ⁄wk, or vigorous activity for 20 min ⁄d, 3 or more d ⁄wk), and 24% of the adult population reportedly engage in no leisure time physical activity. Men are more likely to meet the recommendation than women, and black and Hispanic or Latino persons demonstrate the lowest prevalence of regular leisure time physical activity: 25% and 23%, respectively. Morbidly obese individuals in particular are often completely sedentary. According to a recent report, morbidly obese adults (mean SD body mass index, 53.6 11.7 kg ⁄m) were asked to wear an activity sensor that monitored their caloric expenditure, minute-by-minute physical activity, and number of steps per day. The participants spent an average of 23 hours and 52 min ⁄d sleeping, sitting, lying down, or performing sedentary activities (<3 metabolic equivalents [METs; 1 MET=3.5 mL O2 ⁄kg ⁄min]). Collectively, these data suggest that structured exercise is not unlike other health-related behaviors in that only a fraction of those who initiate the behavior will continue, regardless of their age, sex, race, ethnicity, education level, or health status. To understand why people sometimes lack the motivation for a structured exercise commitment, one must first acknowledge a simple yet important fact: exercise is voluntary and time-consuming. Therefore, planned exercise may extend the day or compete with other valued interests and responsibilities of daily life. In addition, considerable time may be spent in transit, driving to and from a health club or recreation facility. In one study, coronary patients undergoing medically supervised gymnasium-based exercise training spent more time in their cars going to and from the programs than patients in a home training comparison group spent on their cycle ergometers. Other investigators have reported that structured rehabilitation exercise training is associated with a low caloric expenditure and has little impact on body weight and selected coronary risk factors.

Diagnostic Radiology Resident Compliance with Recommended Health Guidelines: Effect of Resident Work Environment

To determine diagnostic radiology resident compliance with recommended health guidelines for physical activity, body weight, diet, related health indicators, and the effects of the resident work environment on compliance.A request was electronically mailed to members of the Association of Program Directors in Radiology and the Association of Program Coordinators in Radiology in May 2007 and again in June 2007, asking members to forward to their radiology residents an invitation to complete an online health survey. Frequency counts and Fisher's exact test, respectively, were used to summarize results and to determine statistically significant relationships between survey variables.A total of 811 radiology residents completed the survey, representing 18% of 4,412 diagnostic radiology residents. Five hundred forty-five (67.2%) of 811 were male and 264 (32.6%) female. Two hundred ten (25.9%) were first-year, 239 (29.5%) second-year, 201 (24.8%) third-year, and 161 (19.9%) fourth-year residents. Three hundred two (37.2%) engaged in recommended guidelines for physical activity and < or =465 (57.3%) complied with each of multiple federal dietary guidelines (excluding alcohol intake). Up to 329 (40.6%) residents did not know whether they were in compliance with various dietary guidelines. A total of 426 (52.5%) residents reported working > or =60 hours/week, which significantly correlated with less physical activity (P = .013).A substantial number of residents are out of compliance with federal guidelines for physical activity and diet and are not knowledgeable about their personal dietary intake. Long work hours are related to a lack of physical activity. Radiology programs may be able to influence resident health practices by modifying work hours and the working environment, encouraging healthy dietary intake and physical activity, and instituting campaigns to inform residents and faculty about health guidelines and available wellness programs.