Physical Activity and Exercise Guidelines : SuperFoodsRx

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Physical Activity and Exercise Guidelines

Question: Dear Dr. Harris, I just turned forty and I have started looking at my health. My weight isn’t bad, but my diet and health habits were atrocious. I just finished reading the SuperFoodsRx books and have started making the SuperFoods a part of my diet. I even started the SuperFoodsRx daily supplement. I am feeling great, but I want to get fit. Do you have any advice for an exercise regimen? What do you tell your patients?

Answer: What a timely question. The American Heart Association and the American College of Sports Medicine have just recently released their updated guidelines for “Physical Activity and Public Health.” Back in 1995, the Centers for Disease Control (CDC) and the American College of Sports Medicine issued a generic recommendation that “Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most--preferably all--days of the week.” The goal of this recommendation was to encourage people to become more active in order to promote health, reduce the risk of chronic disease, and prevent premature death. Although it was designed to be clear and concise, it caused a great deal of confusion and was greatly ignored. The specific meanings of “accumulate 30 minutes” and “moderate-intensity” were not clearly stated. Many people continued to think that only vigorous-intensity workouts would actually improve fitness, while other people thought the cumulative light activities of their daily routine were sufficient.

So, now there are new recommendations based on current scientific research from an expert panel of physicians, epidemiologists, exercise scientists, and public health experts. The goal of the panel was to create guidelines that would promote health and fitness and prevent disease. The full journal article can be found in Circulation, the journal of the American Heart Association, or in Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine. The recommendations are far more thorough, comprehensive, and clear this time, which is great for everyone. The problem is that, even since 1995, people in the United States are more and more sedentary. As a physician, I hope people become more active and start to follow the recommendations.

So, what are these glorious new recommendations? Let me start by saying that the guidelines were broken up for healthy adults aged 18 to 65 years old and people older than 65 or individuals 50-64 with chronic conditions or physical limitations. The recommendations include aerobic exercise, muscle strengthening activities, and flexibility and balance activities. Furthermore, I strongly recommend that before you, or anyone, starts any exercise regimen that you consult with your physician. The guidelines are designed for the “public” health. Your individual health needs to be considered by you and your doctor before jumping into something that might actually cause big problems for your health. Be smart, talk to your doctor.

The other thing to think about before reading the recommendations is that these recommendations are not immediate expectations. No one expects that everyone can jump up and start living these recommendations. Many people will need to slowly work their way up to the recommendations. Do not use this information to beat yourself up!!! They are goals. You work up to these goals and then can set goals beyond the recommendations. The important thing is to start being active and understand what the public health experts expect:

1) Healthy Adult (18 to 65 years old)

Aerobic Exercise
	At least five days a week of moderate intensity or at least three days a week of vigorous intensity exercise.
	Aerobic exercise should last 30 minutes if moderate intensity and can be accumulation of multiple 10 or more minute bouts. So, walking the garbage out to the curb doesn’t count unless the time spent is equal to or greater than ten minutes. To count toward the daily 30 minutes the activity must last longer than ten minutes and be moderately intense the whole time.
	Aerobic exercise should last at least 20 minutes for vigorous intensity but should not be broken up. Running up one or two flights of steps doesn’t count toward the 20 minutes. Vigorous activity must last 20 minutes and not be broken up.
	Moderate intensity is defined as 3.0 to 6.0 METS (Metabolic equivalents) which is equivalent to a brisk walk (2.5 to 4 miles per hour) which perceptibly increases the heart rate. One MET is defined as the energy or oxygen used by the body to sit quietly. (For example, sleeping is around 0.9 METS and running a 7-minute mile is around 14 METS.) Three METS would be 3 times the energy of sitting quietly. Typically, you could still have a conversation during a moderate intensity exercise.
	Vigorous intensity is defined as above 6.0 METS which is equivalent to jogging or an activity that causes rapid breathing and a substantial increase in heart rate. Typically, vigorous activity does not include walking unless you are walking very fast (>4 mph). Conversation should be difficult and during vigorous activity, it will be difficult to speak a full sentence.

Muscle Strengthening
	At least 2 days a week, the days should be nonconsecutive.
	To count as a “day,” muscle strengthening should include eight to ten exercises involving the major muscle groups.
	Each exercise should be done with a weight that will cause fatigue at 8 to 12 repetitions.
	The recommendations do not discuss number of sets for each exercise and seem to imply one set for each exercise with 8 to 12 repetitions. Most fitness experts recommend 2 to 3 sets of 8 to 12 repetitions for each exercise for muscle strengthening.
	Muscle strengthening activities listed in the recommendations include: weight training program, weight bearing calisthenics, and stair climbing.

2) Older Adults (>65 years old) or Adults aged 50 to 64 with chronic conditions or physical limitations that affect movement or fitness. If you aren’t sure whether you are in the latter group, ask your doctor.

Aerobic Exercise
	At least 5 days a week of moderate intensity activity lasting an accumulated 30 minutes or at least 3 days a week of vigorous intensity exercise lasting 20 minutes.
	Moderate intensity activity in this group is defined as a 5 or 6 level of effort on a 10-point scale where zero is sitting and 10 is “all-out” effort. Moderate activity can be cumulative for the day as long as each episode of moderate activity is at least 10 minutes in duration. Moderate activity should produce a noticeable increase in heart rate and breathing frequency.
	Vigorous activity in this group is a 7 or 8 on the same 10-point scale as with moderate activity. Vigorous activity must last at least 20 minutes and is not cumulative for the day. Vigorous activity should cause large increases in heart rate and breathing frequency.

Muscle Strengthening
	At least 2 nonconsecutive days of resistance training.
	Each day, 8 to 10 exercises focusing on the major muscle groups should be performed.
	The appropriate weight for the exercise will yield ten to fifteen repetitions before fatigue.
	The level of effort for muscle strengthening should be moderate to high or 5 to 8 on a 10-point scale where 0 is no movement and 10 is maximal effort of the muscle group.

Flexibility Activity and Balance Exercises
	At least 2 days a week for ten minutes each day.
	Balance activities are recommended for individuals at risk for falls.
	Stretching should focus on the major muscle groups and last 10 to 30 seconds for each static stretch and 3 to 4 repetitions for each stretch.
	Ideally, flexibility activities and stretching would be performed before each episode of exercise, whether it is aerobic or strengthening.

The guidelines recommend developing activity plans to help plan and stick to an exercise regimen. Also, the guidelines indicate that “more is better.” By exceeding the recommendations, people can further reduce their risk of inactivity-related chronic disease and realize additional health benefits and physical fitness.

To me, the hardest part of implementing these recommendations is reworking your weekly schedule to include physical activity during your leisure time. Remember, reaching these recommendations should be done in a step-wise fashion. If you have to, start exercising one day a week and increase one day each week until you reach your goal. If 30 minutes is too much, start with ten minutes and work your way up. Be patient and realize that fitness is a process.

Hope this helps,

Geoffrey Harris, MD

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