Physical Activity Guidelines

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					2008 Physical Activity Guidelines
        for Americans

         Janice Huy, R.D., M.S., L.D.
      Former Chief Dietitian Officer (2005 – 2009)
            Office of the Surgeon General
     US Department of Health and Human Services

               Bluegrass Dietetic Association
                     February 27, 2010




                                                     1
         Physical Activity Guidelines
               for Americans




http://www.health.gov/paguidelines

                                        2
Process for Developing PAGs
           Processes                           Products
 Systematic Evidence Review (CDC)         Searchable Data Base
                                         (now publicly accessible)


    PAG Advisory Committee (FACA)          650+ Page Report
                                         summarizing the science


    PAG Writing Group (HHS Staff)         2008 Physical Activity
                                         Guidelines For Americans


Communications Workgroup (HHS Staff)
                                          Dissemination plan,
                                          materials for public,
                                         materials for partners,
Launch “Team” (HHS Staff and Partners)   logo & key messages
                                                                   3
              Literature Review

•   Managed by CDC Physical Activity Branch
•   Examined original research published since
    January 1995
•   Stratified by age groups
    – Children and youth (6-18 years)
    – Adults (19-64 years)
    – Older adults (65 + years)
    – Mixed ages

                                                 4
                     Physical Activity Guidelines For Americans:
                 Conceptual Framework for Scientific Literature Review

Physical Activity Exposure                                                                        Health Outcomes
                                        Cardio-             Metabolic          Musculo-
                                        respiratory         Health             skeletal Health         Cancer           Function-              Mental              All-
                                        Health                                                                          al Health              Health              Cause
                                                            (including         (Including                                                                          Mortality
                                        (Including          Diabetes and       Osteoporosis)
                                        CHD, PAD,           Obesity)
                                        Stroke)
Intensity

Frequency                                                                                                              • Quality of life
                                        • Dyslipidemias     • Insulin          • Bone                • Bowel transit                       •   Anxiety         • Strength
                                                              Resistance                               time            • Functional                            • Balance
                                        • Blood                                  mineralization                                            •   Depression
                                          Pressure          • Insulin          • Flexibility         • Hormonal          independence
                                                                                                                                           •   Self-concept    • Fitness
 Duration                                                     Sensitivity                              factors         • Balance                               • Previous
                                        • Hemostatic/                          • Strength                                                  •   Sleep quality
                                                            • Glucose                                • Immune          • Pain                                    Injury
                                        • Coagulation                          • Balance                                                   •   Cognitive
                                                              uptake                                   Function        • Fall prevention                       • Family history
                                          Factors                              • Maturation/                                                   Function
                                        • Asthma            • Metabolic          Growth              • Linkages with
                                        • Fitness             Syndrome         • Fitness               other
                                        • Cardiac           • Overweight       • Motor skill           behaviors
                                          Function          • Constipation       development
                                        • Lung Function     • Fitness          • Muscle fiber
                                                            • Hormonal
Pattern                                                       influences
                                                            • Sleep quality


Type

                                                                                                    Risk Factors

Caloric Expenditure
                                                                              Adverse events and Risks of Physical Activity


                         All arrows will be examined for heterogeneity across demographic characteristics (e.g. gender, age, race/ethnicity). Evidence will also
                         be examined for select special population groups.

                                                                                                                                                                               5
    Physical Activity Guidelines
Proposed Initial Research Questions
What is the evidence that:
1. Physical activity is associated with [Outcome]?

2. The dose of physical activity that is associated with [Outcome]
    or precursors varies by:

   Differing intensities?
   Accumulation of multiple short periods of participation?
   A specific pattern of weekly regularity?
   Different modes (types) of physical activity?

3. Physical activity might increase the risk of a certain [Outcome]?

4. An exposure of physical activity other than 30 minutes/day on most,
    preferably all, days each week is associated with [Outcome]?
                                                                         6
  Physical Activity Guidelines
     Scientific Database


      MEDLINE literature
      January 1, 1995 -
       November 2007               14,472
                                  abstracts
                                   triaged



                  n=1,598
                   papers
                 abstracted


                                                      7
http://apps.nccd.cdc.gov/PhysicalActivityGuidelines
Number of Studies with the Following Health Outcomes in
 Physical Activity Guidelines Scientific Review Database

       Adiposity                                       561


         Mental                            254


           CVD                            242


 Musculoskeletal                     219


         Cancer                     199


 Adverse events                177


      Functional              163


       Diabetes         104


       All-cause       88
                                                              8
                   0           200               400    600
Number of Studies of Physical Activity and Adiposity by Study Design,
  US Physical Activity Guidelines Scientific Database -- March, 2008


   Cross-sectional                                             219




      Experimental                                       195




           Cohort                            108




            Other            32




  Case-comparison        9


                                                                           9
                     0            50   100         150   200         250
      Definition of Physical Activity

•   PAGs divide physical activity into two types:

    – Baseline activity: light intensity activities of daily living
      and very short bouts of moderate or vigorous intensity
      activity

    – Health-enhancing physical activity: activities which
      count toward meeting guidelines

        PAGs just use “physical activity” to refer to HEPA.


                                                                      10
    Volume is Major Determinant of
          Health Benefits
•   Volume
    – Total weekly amount of PA
    – Product of:
       absolute intensity (METs / episode)
       frequency (episodes / week)
       duration (time / episode)
•   Volume more important to health benefits than any
    component

                                                    11
Framework: Categories of Volume

Level      Time at Moderate     Health Benefit
           Intensity
Inactive   No activity beyond   None
           baseline
Low        Above baseline but Some
           less than 150 min
Medium     150 to 300 min       Substantial

High       Above 300 min        Additional



                                                 12
Preventive 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)
                                                     13
Preventive Health Benefits of Physical
    Activity: Moderate Evidence
•   Functional ability (older adults)
•   Hip fracture, bone density, osteoporosis
•   Lung cancer and endometrial cancer
•   Weight maintenance after weight loss
•   Sleep quality


•   Evidence was insufficient for other conditions, e.g.
     – Anxiety disorders
     – Prostate cancer

                                                           14
              Major Conclusions

•   Regular activity reduces risk of many adverse
    health outcomes.
•   Some activity is better than none.
•   Added health benefits generally occur as the
    amount of activity increases.
•   Most health benefits require at least 2 hours and
    30 minutes (150 minutes) a week of moderate-
    intensity physical activity.


                                                        15
        Major Conclusions (cont.)

•   Both aerobic & muscle-strengthening activity
    are beneficial.
•   For fitness benefits, aerobic activity should be
    episodes of at least 10 minutes.
•   Health benefits apply to people of all types, sizes,
    ages, and abilities.
•   Physical activity can be done safely by everyone.
    Benefits far outweigh possible risks.


                                                           16
           Continuum of Benefits

•   Adults who participate in any amount of physical
    activity gain some health benefits.
•   A total of 150 minutes a week of moderate-
    intensity aerobic activity substantially reduces
    the risk of many chronic diseases and other
    adverse health outcomes.
•   As a person moves from 2 1/2 hours per week
    toward 5 hours per week, he/she gains
    additional and more extensive health benefits.

                                                       17
 Be Active Your Way!
Be Active, Healthy, and
        Happy!
                  Background
•   Americans are largely inactive.
•   Many opportunities for physical activity have been
    engineered out of daily life.
            Aims of the Physical
     Activity Guidelines for Americans
•   Stem the tide toward inactivity and its
    consequences
•   Move toward a prevention oriented society
       Does Everyone Need the Same
        Amount of Physical Activity?
•   The amount and type of activity needed
    depends on:
     – age; and
     – special conditions
•   Many choices—“Be Active Your Way”
    means meeting the guidelines based
    on setting personal goals.
       Key Guidelines – Children and
         Adolescents (ages 6–17)
•   1 hour (60 minutes) or more of daily physical
    activity that is at least moderate:
     – Most of the 1 or more hours a day should be
       either moderate- or vigorous-intensity aerobic
       physical activity.
    – Do vigorous-intensity physical activity at least
      3 days a week.
       Key Guidelines – Children and
       Adolescents (ages 6–17) (cont.)
    – As part of 1 or more hours of daily physical
      activity, include muscle-strengthening activities
      at least 3 days a week.
     – As part of 1 or more hours of daily physical
        activity, include bone-strengthening activities at
        least 3 days a week.
•   It is important to encourage young people to
    participate in physical activities that are age
    appropriate, enjoyable, and offer variety.
           Key Guidelines – Adults
                (ages 18–64)
•   Minimum levels a week
     – 2 hours and 30 minutes (150 minutes)
       moderate-intensity aerobic activity; or
     – 1 hour and 15 minutes (75 minutes) vigorous-
       intensity aerobic activity; or
     – An equal combination
•   Muscle-strengthening activities that involve all
    major muscle groups should be performed on
    2 or more days of the week.
            Key Guidelines – Adults
              (ages 18–64) (cont.)
•   For additional health benefits
    – 5 hours (300 minutes) moderate-intensity
      aerobic activity a week; or
    – 2 hours and 30 minutes (150 minutes) vigorous-
      intensity aerobic activity a week; or
    – An equivalent combination
       Key Guidelines – Older Adults
         (ages 65 years and older)
•   Follow adult guidelines. When not possible, be as
    physically active as abilities and conditions allow.
•   Do exercises that maintain or improve balance if at
    risk for falling.
•   Those without chronic conditions and symptoms
    (e.g., chest pain or pressure, dizziness, or joint
    pain) do not need to consult a health care provider
    about physical activity.
        Additional Considerations

Other subgroups of the population in the
Physical Activity Guidelines for Americans include:
• Persons with disabilities
•   Women during pregnancy and the postpartum
    period
•   Adults with selected chronic conditions
          What About Most People
            Who are Inactive?
People Getting Started Should:
•   Do what they can and then look for ways to
    do more.
•   Pick an activity they like that fits their lifestyle.
•   Get support from friends & family.
•   Gradually build up over time. Add more time, then
    more days before increasing intensity of activity.
               For More Information




http://www.health.gov/paguidelines




                                 http://www.healthfinder.gov/getactive
U.S. National Physical Activity Plan


              Vision
 All Americans are physically active
 and live, work, and play in
 environments that facilitate regular
 physical activity.
U.S. National Physical Activity Plan


             Mission
Develop a National Plan for Physical
Activity that produces a marked and
progressive increase in the percentage
of Americans who meet physical
activity guidelines throughout life.
U.S. National Physical Activity Plan

                     What it Is
A Formal Statement:
•   Defines PA as a priority
•   Identifies specific targets
•   Provides a specific plan
•   Describes actions for multiple sectors
•   Addresses accountability
8 Sectors for Organization of the
         National Plan
    • Public Health
    • Education
    • Voluntary/Not for Profit
      Organizations
    • Transportation/Urban
      Design/Community Planning
    • Mass Media
    • Healthcare
    • Business/Industry
    • Parks/Recreation/Sports
U.S. National Physical Activity Plan


                 What it Isn’t

•   A government plan
•   A public health plan
•   An obesity plan
•   A directive for state programs
                     Websites-PAG
For Everyone:
www.health.gov/paguidelines

For Consumers:
www.healthfinder.gov
www.fitness.gov
www.cdc.gov/physicalactivity/everyone/guidelines/index.html

For Researchers:
http://appliedresearch.cancer.gov/funding/pa_guidelines.html

Scientific Literature Database:
https://apps.nccd.cdc.gov/PhysicalActivityGuidelines/SearchAC.aspx



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    Be Active Your Way!
Be Active, Healthy, and Happy!
          Thank you!

          Janice Huy, R.D., M.S., L.D.
   Former Chief Dietitian Officer (2005-2009)
        Office of the Surgeon General
                Jhuy@cdc.gov
                 513-533-8642




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