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New physical activity guidelines encourage movement ‘anytime, anywhere’
The new HHS Physical Activity Guidelines for Americans emphasize that any exercise for people of any age is better than none and make new recommendations for children and adolescents aged 3 to17 years.
Experts applauded the guidelines’ emphasis on preventing a sedentary lifestyle, but said that words alone cannot make the needed societal and infrastructure changes to better promote physical activity and heart-healthy living.
“Writing ‘move more, sit less’ on a piece of paper doesn’t mean that we’ve created an infrastructure and incentive to do it,” Michael S. Emery, MD, MS, FACC, medical director the Center for Cardiovascular Care in Athletics at Indiana University Health and assistant professor of clinical medicine – cardiology at Krannert Institute of Cardiology, Indiana University School of Medicine, told Cardiology Today. “That’s where we have to take this next big step, is to create the infrastructure and the incentives for people and help them truly understand how important this is to their health in addition to nutrition, not smoking and other things that drive chronic disease.”
Simpler to follow
When the guidelines were unveiled at the American Heart Association Scientific Sessions in November, the authors stated that a goal was to make them simpler for anyone to follow.
“This edition tells us that it’s easier to achieve the recommendations in the physical activity guidelines,” Adm. Brett P. Giroir, MD, assistant secretary for health for HHS, said during a press conference. “As opposed to everything being harder and harder, it is actually easier to achieve the recommendations in the physical activity guidelines. The new guidelines demonstrate based on the best science everyone can dramatically improve their health just by moving anytime, anywhere and by any means that gets you active.”
John P. Higgins, MD, MBA, MPhil, FACC, FAHA, professor of cardiovascular medicine at McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth) and chief of cardiology, Harris Health System’s Lyndon B. Johnson Hospital, agreed.
“It all adds up,” he said. “The idea is that everything, no matter how minimal, is a good thing that counts. The idea is to have someone start off small. For example, the authors recommend that walking is the easiest exercise for most individuals — and I agree with that for most individuals — and then people can build on what they’re doing. These mini-wins of activity will add up to maxi-wins down the line.”
The first edition of the guidelines was released a decade ago. Although physical activity has improved since the release of the original guidelines, only 26% of men, 19% of women and 20% of adolescents report that they perform sufficient amounts of physical activity, according to the guidelines.
Perils of inactivity
“Inactivity causes 10% of premature mortality in the United States,” Giroir said during the press conference. “That means if we can just get 25% of inactive people to be active and meet the recommendations, almost 75,000 deaths would be prevented in the United States.”
The scientific evidence that was reviewed to develop the updated guidelines showed the additional health benefits of physical activity. There are immediate health benefits that are achieved with physical activity, including quality of sleep improvement, reduction of anxiety, BP reduction and improved insulin sensitivity.
More long-term benefits result from meeting recommendations in these guidelines, including reduced risk for injuries from falls for older adults and improvements in cognition for children, postpartum depression for pregnant women, dementia including Alzheimer’s disease and excessive weight gain for all age groups.
Children aged 3 to 5 years are recommended to be active throughout the day, as it boosts growth and development. At least 3 hours of daily active play should be encouraged.
At least 60 minutes of moderate to vigorous activity is recommended for children and adolescents aged 6 to 17 years to attain the most health benefits. Activity can include anything that increases heart rate such as running or walking. Climbing on playground equipment, jumping rope and playing basketball can also make this group’s bones and muscles strong.
The guidelines recommend that adults perform at least 150 to 300 minutes per week of moderate-intensity aerobic activity like fast dancing or brisk walking. Muscle-strengthening activity is also recommended 2 days per week.
Move more, sit less
Adults are also recommended to move more and sit less, as evidence has shown that increased sedentary behavior is associated with elevated risk for high BP, heart disease and all-cause mortality.
In addition, some health benefits are achieved with any amount of physical activity. The first edition of the guidelines recommended 10-minute bouts of physical activity, but with this edition, there is less emphasis on time ranges and Americans are recommended to move more frequently during the day.
“Although I am somewhat skeptical about the adverse physiological consequences of sitting by itself, and am not convinced that there are biological benefits of brief periods of standing or walking short distances, I am very much in favor of people who are previously very sedentary becoming active,” Ben Levine, MD, founder and director, Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, and professor of internal medicine/cardiology and distinguished professor of exercise sciences, UTSouthwestern Medical Center, said in an interview. “I agree completely with that focus of the guidelines (to do anything that gets you moving) as the place to start because the key to adopting an active lifestyle is making it part of your personal hygiene.”
The AHA announced during the press conference that it will support the HHS guidelines.
“The American Heart Association will leverage these new guidelines to amplify our efforts to develop programs and advocate for policies that make it easier for everyone to get more physical activity regardless of where you live,” said AHA President Ivor J. Benjamin, MD, FACC, FAHA, director of the cardiovascular center at the Medical College of Wisconsin.
Major changes needed
“Two-thirds of Americans don’t have a park/playground within walking distance of their homes, and we need to fix this,” Higgins said. “Playgrounds can be a part of new communities, and we need to transform existing communities. We make immunization mandatory in a lot of schools and exercise is medicine, so this is just as important as that; therefore, we should consider making exercise mandatory at school.”
“Two-thirds of Americans don’t have a park/playground within walking distance of their homes, and we need to fix this,” Higgins said. “We still don’t have that and that’s an important thing that we can do. We make immunization mandatory in a lot of schools and exercise is medicine, so this is just as important as that.”
Also, he said, “work is a big portion of people’s time. It’s typically 40 to 100 hours a week, so anything that businesses can do to try to increase activity will help.”
The next step, Levine said in an interview, “is to ensure that practices are reimbursed for spending time with patients providing advice about how to increase physical activity. A new ICD-10 code was just released last month to allow exercise counseling, and I’d like to see this promoted as part of the effort to advance the guidelines. Perhaps more importantly though, I’d like to see exercise professionals be compensated like physical therapists for working with patients to improve their fitness, not just in cardiac rehab or after an injury, but for overall health promotion.” – by Darlene Dobkowski
- References:
- Giroir B, et al. Department of Health and Human Services’ Physical Activity Guidelines for Americans. Presented at: American Heart Association Scientific Sessions; Nov. 10-12, 2018; Chicago.
- Giroir BP, et al. JAMA. 2018;doi:10.1001/jama.2018.16998.
- Piercy KL, et al. JAMA. 2018;doi:10.1001/jama.2018.14854.
- Thompson PD, et al. JAMA. 2018;doi:.10.1001/jama.2018.16070.
- For more information:
- Ivor Benjamin, MD, FACC, FAHA, can be reached at ibenjamin@mcw.edu.
- Michael S. Emery, MD, MS, FACC, can be reached at msemery@iu.edu.
- Adm. Brett P. Giroir, MD, can be reached at ash@hhs.gov.
- John P. Higgins, MD, MBA, MPhil, FACC, FAHA, can be reached at john.p.higgins@uth.tmc.edu.
- Ben Levine, MD, can be reached at benjaminlevine@texashealth.org.
Disclosures: Benjamin, Emery, Giroir, Higgins and Levine report no relevant financial disclosures.