Transcript 2008 Physical Activity Guidelines for Americans Janet E. Fulton, PhD David M. Buchner, MD, MPH Division of Nutrition, Physical Activity and Obesity Centers for Disease.

2008 Physical Activity
Guidelines for Americans
Janet E. Fulton, PhD
David M. Buchner, MD, MPH
Division of Nutrition, Physical Activity and Obesity
Centers for Disease Control and Prevention
DNPAO Teleconference Goals
•
•
Be familiar with the 2008 Physical Activity
Guidelines for Americans
Understand the role of State Health
Departments in promoting the Guidelines
2
Overview
•
•
Background and development
The Guidelines
– Children and adolescents
– Adults
– Older adults
•
– Special considerations
Promotion of the Guidelines
– CDC’s role
– State’s role
3
2008 Physical Activity Guidelines
for Americans
“
The Federal Government published
comprehensive Physical Activity
Guidelines for Americans for the first
”
time in 2008
4
Developing the Guidelines
Processes
Processes
Products
Products
Proposal to HHS for New PA Guidelines
IOM Workshop (Oct 2006)
Secretary Leavitt Announcement:
HHS to release PA guidelines in Oct 2008
Form HHS Leadership Team:
HHS, ODPHP, PCPFS, CDC
Systematic Evidence Review (CDC)
Searchable Data Base
(now public access)
Developing the Guidelines (2)
Products
Processes
PA Guidelines Advisory Committee (FACA)
650+ page report
summarizing the science
Translate for Practitioners
PA Guidelines Writing Group (HHS)
2008 Physical Activity
Guidelines For Americans
Communications Workgroup (HHS)
Launch “Team” (HHS Staff and Partners)
Evaluation (DNPAO)
Translate for Public
Dissemination plan,
materials for public,
materials for partners,
logo & key messages
What Is New About the Guidelines?
•
•
•
First major science review in more than a decade
– Provides guidance for many groups:
 Children and adolescents
 Healthy adults and older adults
 Pregnant and postpartum women
 People with disabilities and chronic conditions
– Provides guidance for non-aerobic activities:
 Muscle and bone-strengthening, flexibility, balance
Identifies health benefits, amounts necessary to get
the benefits, and provides bridge to PA promotion
Specifies a total amount of activity per week
– People can design own way to meet Guidelines
7
What May Surprise You About the Guidelines
•
•
•
More choices on frequency (days / week)
•
Flexibility activities, and warm-up / cool down
activities are acceptable, but not a guideline
•
Separate guideline to avoid inactivity
Can use either absolute or relative aerobic intensity
Muscle-strengthening activities strongly endorsed,
but not some features of typical training programs
(e.g, no requirement for non-consecutive days)
8
More Surprises About the Guidelines
•
•
•
Revised guidelines on PA and healthy weight;
PAG did not repeat:
– “60 minute guideline” for prevention of wt gain
and “90 minute guideline” for wt regain
– Obesity / healthy wt regarded as one of many
chronic conditions where “more is better”
Clear statement that healthy children and adults
do not need “physician approval” or consultation
prior to engaging in PA
Substantial attention to preventing adverse events
9
General Concepts
Volume is Major Determinant of
Health Benefits
•
Volume
– Total weekly amount of PA
– Product of:
 frequency (episodes / week)
 intensity (level of effort / episode)
– light, moderate, vigorous; METs
 duration (time / episode)
•
Volume more important to health benefits than any
single component
11
Understanding Aerobic Intensity
•
•
Common area of confusion, and concepts
difficult to communicate to public
Two measures of intensity:
– Absolute intensity = rate of energy expenditure
during activity typically measured in METs
 Commonly measured in METs where:
 1 MET = energy expenditure at rest
– Relative intensity = level of effort compared to an
individual’s level of fitness
•
A person can use EITHER measure to
determine if they are meeting the guidelines
– See appendix for detailed explanation why
Absolute Intensity
•
•
Activities are classified into light-, moderate-, or
vigorous-intensity based on amount of energy
expended/minute (METs)
– Moderate = 3.0 to 5.9 METs
– Vigorous = 6.0+ METs
One needs to look up the intensity of an activity
(see tables in guidelines)
– Brisk walk = moderate; Jog/run = vigorous
– Activities can be either light, moderate, or vigorous
based on (usually) speed of doing them
 Leisurely walk = light intensity
 Brisk walk = moderate intensity
 Race-walking = vigorous intensity
Relative Intensity
•
•
•
•
Effort required relative to person’s fitness level
Guidelines use 0-10 scale to communicate relative intensity, where:
–
–
–
–
Sitting is 0
Highest level of effort possible is 10
Moderate-intensity activity = a 5 or 6
Vigorous-intensity activity = a 7 or 8.
To help communication, the PA guidelines endorsed the “talk test”
and advises people to pay attention to heart rate and breathing
– Moderate-intensity = can talk without pausing, but cannot sing
– Vigorous-intensity = cannot say more than a few words without pausing
for breath
Relative intensity of a brisk walk depends on fitness and can be:
–
–
–
–
light-intensity for elite athletes
moderate-intensity for recreational walkers
high intensity for inactive middle-aged adults
Impossible for near-frail older adults
What are the Guidelines?
15
Health Benefits
Health Benefits of Physical Activity:
Strong Evidence
•
Lower risk of:
– Early death
– Coronary heart disease, stroke
– High blood pressure, adverse lipid profile
– Type 2 diabetes
•
•
•
•
– Cancers: Colon and Breast
Prevention of weight gain
Weight loss (with reduction of caloric intake)
Prevention of falls
Depression, cognitive function (older adults)
17
Children and Adolescents
Ages 6-17
Children and Adolescents (ages 6-17)
•
•
60 or more minutes of physical activity daily
 Aerobic: Most of the 60 or more minutes per day
should be either moderate- or vigorous-intensity
aerobic physical activity. Include vigorous-intensity
physical activity at least 3 days per week.
 Muscle-strengthening: Include muscle-strengthening
physical activity on at least 3 days of the week, as
part of the 60 or more minutes.
 Bone-strengthening: Include bone-strengthening
physical activity on at least 3 days of the week, as
part of the 60 or more minutes.
Encourage participation in physical activities that are:
 Age appropriate, enjoyable, and offer variety
19
Comments on
Child and Adolescent Guidelines
•
•
•
•
•
As opposed to adults, no choice on frequency
– Daily PA required
Unstructured play can meet guidelines
Requires some vigorous intensity activity
– Moderate-intensity activity only not sufficient
Insufficient data to specify exact amounts/ranges
of vigorous aerobic, muscle strengthening, and
bone strengthening
Challenge to track youth that meet this guideline
20
Comments on
Child and Adolescent Guidelines (2)
•
•
As children age, structured activity becomes more
appropriate way to get PA
Emphasis on variety of activity reflects attention to:
– Importance of skill development
– Reducing overuse injuries
•
– Fun / adherence
First chapter of PAG affirms importance of PA to
children younger than age 6; science not reviewed
for ages 0-6 years
•
PA recommended for children with disabilities
21
Physical Activity Strategies for Youth
•
Provide time for structured and unstructured
activity during and outside school
– Recess, PA breaks, PE, After-school programs
•
Positive feedback and good role modeling
– Praise, rewards, encouragement
•
– Do NOT use activity as punishment
Help young people learn skills
•
– Understand intensity, set goals, protective gear
Promote lifetime activities
– Allow variety of activities
22
Adults
Ages 18-64
4 Key Adult Guidelines
•
•
Avoid inactivity
•
More health benefits from high amounts of aerobic
activity
•
Muscle-strengthening activities provide additional
health benefits
Substantial health benefits from medium amounts
of aerobic activity
Inactivity
•
“All adults should avoid inactivity. Some physical
activity is better than none, and adults who
participate in any amount of physical activity gain
some health benefits.”
Comments on Inactivity Guideline
•
The dose response relationship between
amount of PA and health benefits =>
– Low amounts of PA have some health benefits
•
PAGAC report
– 60 minutes/week of relatively moderate intensity PA
causes small increases in fitness and lower risk all –
cause mortality and CAD.
– No evidence of threshold level of PA, below which
there are no benefits
•
Don’t allow this inactivity guideline to undermine
the message of the key 150 minute guideline.
Substantial Health Benefits Guideline
•
“For substantial health benefits, adults should do:
– at least 150 minutes (2.5 hours) a week of moderate-intensity
aerobic activity
OR
– 75 minutes (1.25 hours) a week of vigorous-intensity aerobic
physical activity
OR
– an equivalent combination of moderate- and vigorous-intensity
aerobic activity.”
•
“Aerobic activity should be performed
– in episodes of at least 10 minutes,
– And preferably, it should be spread throughout the week.”
Comments on 150 Minute Guideline (1)
•
Minimum intensity = moderate
– A person who does only light-intensity activity is regarded to be
inactive
– If do moderate intensity, need at least 150 minutes/week
•
Minimum duration = 10 minutes
– Episodes of 10 minutes or longer improve aerobic fitness and
some biomarkers
– Total PA in most observational studies is usually accumulated
from activities of varying, but unknown, duration
– Unknown (and difficult to study) if health benefits of one 30
minute bout are exactly the same as from three 10 minute bouts.
Comments on 150 Minute Guideline (2)
•
Minimum Frequency
– There is insufficient evidence to say that the health benefits are
any different from moderate-intensity PA:
•
•
 50 minutes/day on 3 days/week = 150 minutes
 30 minutes/day on 5 days/week = 150 minutes
The 30 minute/day x 5 days/week guideline is too
specific, but still OK to follow
Guidelines suggest 3 days/week as minimum frequency
– Know that 3 days/week produces health benefits
– Concern about injury risk with 150 minutes from only 1 or 2
days/week
– In the observational studies reporting health benefits of medium
(& high) amounts of activity, it appears most people spread the
activity throughout the week.
Comments on 75 Minute Guideline (1)
•
•
•
One minute of vigorous-intensity activity counts the
same as two minutes of moderate-intensity activity.
Why?
– Explained in detail in appendix in guidelines
In brief, adult guidelines based upon total amount of
physical activity measured in MET-minutes
– 500 to 1000 met-minutes/week = range of substantial health
benefits
– 1 MET = rate of energy expenditure at rest
– Moderate-intensity = 3.0 to 5.9 METs (e.g. walking at 3.0 mph =
3.2 METs)
– Vigorous-intensity = 6.0 and higher METs (e.g. running at 10
minutes/mile = 10 METs)
150 minutes x 3.0 METs = 75 minutes x 6.0 METs
Additional & More Extensive
Health Benefits Guideline
•
•
“For additional and more extensive health
benefits, adults should increase their aerobic
physical activity to:
– 300 minutes (5 hours) a week of moderate-intensity,
– OR
– 150 minutes a week of vigorous-intensity aerobic
physical activity
– OR
– an equivalent combination of moderate- and vigorousintensity activity.”
“Additional health benefits are gained by
engaging in physical activity beyond this
amount.”
Comments on
Additional Health Benefits Guideline
•
•
•
Some health benefits of PA occur with as little as 150
minutes/week of moderate-intensity PA e.g.
– Lower risk of coronary heart disease
As total activity increases from 150 to 300 minutes of
moderate-intensity PA/week, two things happen:
– Additional benefits accrue, e.g. lower risk of breast cancer
– More extensive benefits accrue, e.g., risk of heart disease is
significantly lower with 300 minutes/week compared to 150
minutes/week
As total activity increases upward from 300
minutes/week,
– Greater benefits accrue in a dose-response fashion, but
decreasing marginal benefit for each additional minute
– No known upper limit where benefits no longer increase
– Risk of injury increases as volume increases
Muscle-Strengthening Guideline
•
“Adults should also do muscle-strengthening
activities that are moderate or high intensity and
involve all major muscle groups on 2 or more days
a week, as these activities provide additional
health benefits.”
Comments on
Muscle-Strengthening Guideline
•
Requires moderate to high level of intensity or
effort:
– Relatively few repetitions (e.g. 8-12)
– If do resistance training, 1 set sufficient
•
At least 2 days a week:
– Insufficient data to comment on whether these should
be non-consecutive days, or whether there is upper
limit to days/week
•
Major muscle groups:
– legs, hips, back, chest, abdomen, shoulders, arms
What about Physical Activity
and Weight Control?
•
•
•
•
Chapter of the PAGAC report on energy balance.
PA guidelines do NOT include the advice in the Dietary Guidelines
re:
–
–
60 minutes for prevention of weight gain
90 minutes to sustain weight loss
PA guidelines regard obesity as one of many chronic condition for
which “more is better”
– A statement like “30 minutes is commonly not enough to obtain a
healthy weight” is parallel to most other chronic conditions e.g. “30
minutes is commonly not enough to totally reduce risk of heart disease.”
PAGAC report
– Cannot specify the amount of physical activity necessary to control
weight without specifying conditions of dietary intake
– Large variability among individuals as to the amount of physical activity
required for a healthy weight.
Guidance on Physical Activity &
Weight Management (2)
•
•
•
First step = meet minimum level of PA (e.g. 150 min/wk
of moderate-intensity)
Then monitor body weight and, if necessary, increase
amount of physical to a point that is individually effective
in achieving a healthy body weight
– Guidelines note some people require 300+ minutes of moderateintensity PA/week
– Important to both increase PA and control caloric intake
– All activities that expend calories (both baseline and physical
activity) help control body weight
– Vigorous intensity activity is much more time-efficient way to
achieve NET increases in caloric expenditure
“The good news for people needing to lose weight is that
regular physical activity provides major health benefits,
no matter how their weight changes over time.”
What about Flexibility Activities?
•
•
•
Flexibility activities are acceptable
No known health benefits
– Insufficient evidence that activities like stretching
reduce injury risk
– Time spend in flexibility activities by themselves does
not count toward meeting guidelines
Acceptable:
– Flexibility activities are usually part of exercise
programs
– Flexibility is a component of fitness
– People need sufficient flexibility to be active
– Flexibility activities, like stretching, do increase
flexibility
What About Warm-Ups and Cool Down?
•
•
•
Warm-up and Cool Down activities are
acceptable.
Insufficient data that these activities by
themselves reduce injury risk
These activities can count toward guidelines if at
least moderate-intensity
– E.g. walking to warm up for a run
•
Acceptable:
– Commonly part of exercise programs
– May make activity more pleasant
Older Adults
Ages 65+
Key Older Adult Guidelines
•
The 4 key guidelines for adults apply to older
adults, but there are 4 additional qualifying
guidelines
– Guideline for adults who cannot do 150
minutes/week
– Balance exercise
– Only use relative intensity to determine the level
of effort
– Chronic conditions and injury risk
Guideline for Older Adults
Who Cannot Do 150 Minutes/Week
•
•
“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.”
Comment:
– For example, physical activity has a beneficial effect
on functional limitations in older adults, meaning
adults with limitations should be active as their
abilities allow
– Guidelines note that this and other guidelines for
older adults apply to people below age 65 with low
levels of fitness and significant chronic conditions
Balance Exercise Guideline
•
“Older adults should do exercises that maintain
or improve balance if they are at risk of falling.”
•
Comment:
– Insufficient evidence to make this a general guideline
for all older adults
– Research has studied mainly exercise programs, and
hence guideline uses “exercise.”
– Balance training in context of evidence-based fall
prevention programs is preferable
Chronic Conditions and Injury Risk
•
•
“Older adults with chronic conditions should
understand whether and how their conditions
affect their ability to do regular physical activity
safely.”
Comment
– Appropriate for exercise programs to screen
participants for symptoms & chronic conditions.
– So many possible symptoms & conditions,
checklists
Safe And Active
Injury Prevention for All Ages
Key Injury Prevention Guidelines
•
Understand risks, but benefits clearly outweigh
risks.
•
Can lower injury risk though choosing
appropriate activity
– Injury risk of walking is low; football is high
•
•
•
Increase physical activity gradually over time
Follow principles of injury prevention
Consult a health care provider if you have
chronic conditions or symptoms
Increase Gradually Over Time (1)
•
•
“Increase physical activity gradually over time
whenever more activity is necessary to meet
guidelines or health goals. Inactive people
should “start low and go slow” by gradually
increasing how often and how long activities are
done.”
Comment:
– No standard for how to increase gradually over time
– Use relative intensity to guide increases in level of
aerobic activity; generally start with relatively
moderate-intensity; increase frequency and duration
first, later increase intensity
Increase Gradually over Time (2)
•
“The available scientific evidence suggests that
adding a small and comfortable amount of lightto moderate-intensity activity, such as 5 to15
minutes of walking per session, 2 to 3 times a
week, to one’s usual activities has a low risk of
musculoskeletal injury and no known risk of
severe cardiac events.”
•
Comment
– Risk of severe cardiac events only documented for
vigorous activity
Health Care Provider Consultation
•
•
“The protective value of a medical consultation
for persons with or without chronic diseases who
are interested in increasing their physical activity
level is not established.”
Comment:
– Healthy adults and older adults (with no chronic
conditions, no symptoms) do NOT need to see a
health care provider about physical activity (e.g. for
any type of “screening”)
– Not necessary to consult health care provider prior to
vigorous activity, if increase gradually over time and
remain asymptomatic.
Additional Considerations for
Some Adults
Additional Considerations
Other subgroups of the population in the
Physical Activity Guidelines for Americans include:
• Persons with disabilities
•
•
Adults with selected chronic conditions
Women during pregnancy and the postpartum period
50
Persons With Disabilities
•
Regular physical activity provides health benefits
– Cardiovascular, muscular fitness
– Improved mental health
•
– Ability to do tasks of daily life
In consultation with health-care provider
– Understand how disability affects ability to do
physical activity
– If unable, adapt activity program to match abilities
– Matching may require modifications such as:
Using arm ergometer or wheeling on bike path51
People With Chronic Health Conditions
•
•
Provides many health benefits
•
•
Should be under care of health-care provider
Consult health-care provider about types and
amounts of activity appropriate for them
Type and amount of activity determined by
person’s ability and the severity of health condition
52
Women During Pregnancy and
Postpartum Period
•
•
During pregnancy
– Moderate intensity physical activity by healthy women during
pregnancy maintains or increases cardiorespiratory fitness
– Strong scientific evidence shows risks of moderate intensity
physical activity by healthy women during pregnancy are very
low and do not increase risk of:
 Low birth weight, preterm delivery or early pregnancy loss
Postpartum period
– Moderate intensity physical activity during postpartum period
increases cardiorespiratory fitness and improves mood
– Does not appear to have adverse effects on breast milk volume,
breast milk composition, or infant growth
– Helps achieve and maintain healthy weight – when combined
with caloric restriction, helps promote weight loss
53
Taking Action:
Increasing Physical Activity
Levels of Americans
Importance of Taking Action Chapter
•
•
•
No comparable section (currently) in Dietary Guidelines
Issuing guidelines isn’t enough to get people active
Affirms principles of PA promotion
– Socio-ecologic approach
– Importance of both individual and community level
interventions
“Healthy choice should be easy choice”
•
– Work in partnerships across sectors
Emphasizes evidence-based interventions as in
Community Guide
55
Toward a Comprehensive,
Public Health Approach
•
Individual
– Personal goal setting
•
Interpersonal
– Social support, Encouragement
•
Organizational
•
•
– Worksite health promotion
Community
– Access to parks and recreational facilities
Public policy
– Policies that promote active transportation
56
Community Approaches
•
•
•
•
•
•
•
•
Community-wide campaigns
Pont-of-decision prompts
Physical education classes
Increase reach of individual-level interventions
Social support
Create or enhance access
Street-scale design
Community-scale design
57
Sectors to Promote Physical Activity
•
•
•
•
•
•
•
•
•
•
•
Parks and recreation
Law enforcement
Urban planning
Transportation
Education
Architecture
Employers
For-profit organizations
Not-for-profit organizations
Health care
Public health
58
Where Can One Get Information?
•
•
•
HHS:
– www.health.gov/paguidelines
– www.healthfinder.gov (Get Active)
Receive a toolkit filled with outreach information
– Fact sheets
– FAQs
– User’s Guide
– Powerpoint slides
– Drop-in news article
Be listed as a Supporter on the HHS Physical Activity
Guidelines Web site
59
CDC Efforts Underway
•
•
•
•
Website: www.cdc.gov/physicalactivity
– Videos
– PA Guidelines pages for youth, adults, older adults
– Success stories
Fact sheets and FAQs
– Various audiences
– To supplement those from HHS
Session at grantee orientation meeting (Nov 12-14)
Evaluation
60
Thank you!
Questions?
Be Active, Healthy and Happy!
61