Sit Less, Move More: New Physical Activity Guidelines Stress Movement at All Ages

CHICAGO, IL—The US Department of Health and Human Services (HHS) continues to recommend the same amount of weekly physical activity for adults in their new 2018 guidelines, but has changed the way in which adults can accumulate these bouts of moderate- and vigorous-intensity physical activity.

While the HHS still recommends 300 minutes of moderate-intensity physical activity each week—or 150 minutes of vigorous-intensity physical activity—the agency has abandoned the previous recommendation that stated only blocks of at least 10-minutes of activity counted toward achieving the goal. Now, adults are simply encouraged to move more and sit less throughout the day.

“We took a very concerted effort to look at the requirement for 10-minute bouts to count toward the accumulated physical activity during the week,” said William Krauss, MD (Duke University School of Medicine, Durham, NC), one of the experts who advised the HHS on the new guidelines. “We wanted to do that because we felt it was a barrier for people achieving physical activity. ‘If I can’t do 10 minutes, it won’t count, then why should I should it?’”

Moreover, there was some dissonance between that 10-minute requirement and existing lifestyle recommendations, such as taking the stairs when possible or parking further from the entrance at work or a shopping mall, according to Krauss. “Those activities don’t take 10 minutes,” he said.

Everyone can dramatically improve their health just by moving. Anytime, anywhere, and by any means that gets you active. Brett Giroir

Admiral Brett Giroir, MD, the Assistant Secretary for Health at the HHS, who presented the updated physical activity guidelines during a special session at the American Heart Association 2018 Scientific Sessions, said the new guidelines should make it easier for adults to achieve the physical activity recommendations. “Everyone can dramatically improve their health just by moving,” said Giroir. “Anytime, anywhere, and by any means that gets you active.” Walking, dancing, and all household chores—the smallest of physical activity—now counts toward achieving recommended targets, he said.

The 2018 Physical Activity Guidelines for Americans were published simultaneously in JAMA.

Obesity Is a Threat to National Security

Speaking with the media, Giroir said the new guidelines “reflect the best, and most current, science about the many benefits of physical activity and how Americans can more easily achieve these benefits.” The overarching vision of the department of the HHS is to transform the current “sick-care system” to a “health-promoting system” and this is an opportunity to implement that vision directly, he added.

Physical inactivity causes 10% of premature deaths in the United States, said Giroir. If just one-quarter of currently inactive people got moving, this would prevent 75,000 deaths each year. Worldwide, if 25% of physically inactive people became active such that they met the US guidelines, this would prevent more than 1,300,000 deaths annually. By the most recent estimates, just 26% of men, 19% of women, and 20% of adolescents get enough physical exercise each week.

“This has health and economic consequences for the nation, with nearly $117 billion in annual healthcare costs attributable to failure to meet the aerobic physical activity levels recommended in the guidelines,” said Giroir. “Lack of physical activity is also a threat to our national security because obesity disqualifies nearly one-third of American youth, aged 17 to 24 years, from military service.” 

The new guidelines are only the second edition from the US government. The first edition was published in 2008. The guidelines are developed first with a review of the scientific data by an independent advisory committee who submitted their report to the department of HHS. In addition, the HHS develops the guidelines with input from the public, other government agencies, and extensive peer review, according to Don Wright, MD, the Deputy Assistant Secretary for Health at the HHS.

Despite all this work, Wright said, their research shows less than 1% of Americans can identify the correct amount of recommended physical activity in the guidelines. As part of the campaign rolling out the new recommendations, he said they would like to see more Americans make physical activity part of their recreational time instead of sedentary choices.

“And because of the drop-off of physical activity among children, which starts around age 12, we knew we wanted to encourage families to find ways to get active together,” Wright said in the press briefing.

What’s New in the Second Edition?   

In the latest guidelines, the experts highlight an expanded scope of health benefits associated with physical activity. In addition to lower risks of mortality, cardiovascular disease, hypertension, type 2 diabetes, and hypercholesterolemia, physical activity lowers the risk of certain cancers (bladder, breast, colon, endometrium, esophagus, kidney, lung, and stomach), improves cognition, reduces the risk of dementia, improves quality of life, reduces anxiety and depression, and improves sleep, among other benefits.

“When we move, we have better cardiovascular health, we’re stronger and less susceptible to disease, we feel better, and we actually think better, too,” said Giroir.

The guidelines now provide physical activity recommendations for preschool-aged children. These kids, aged 3 to 5 years old, should be active throughout the entire day to enhance growth and development, with a target of 3 hours of activity per day. For children 6 to 17 years old, a full 60 minutes of either moderate- or vigorous-intensity aerobic physical activity is recommended per day, with the goal being at least 3 hours of vigorous physical activity per week, Muscle strengthening and activities that develop strong bones, such as weight-bearing exercises, are recommended at least 3 days per week, too. In these young people, physical activity improves weight status, cardiorespiratory and muscular fitness, cardiometabolic health, and cognition and it lowers the risk of depression, said Giroir.

The physical activity guidelines also highlight the immediate health benefits of exercise, noting that a single session can reduce anxiety and blood pressure, as well as improve sleep. 

Swimming Upstream? Keep Swimming

Commenting on how the new guidelines can combat the obesity epidemic, especially given that there has been no increase in the recommended amount of weekly physical activity, Russel Pate, MD (University of South Carolina, Columbia), said they have tried to emphasize the role of physical activity in the prevention of excessive weight gain in children, adolescents, and adults and that this wasn’t part of the previous iteration. The second edition also includes an extensive section on the promotion of physical activity. This includes a scientific review and summary of various physical activity interventions that can be implemented at the individual and community level, said Pate. 

In an editorial, Paul Thompson, MD (Hartford Hospital, CT), and Thijs Eijsvogels, PhD (Radboud University Medical Center, Nijmegen, the Netherlands), contend that clinicians and other healthcare professions need to be part of this “call to activity” and that clinical exams should routinely include an assessment of physical activity. Kaiser Permanente and Intermountain Healthcare, they write, now include physical activity as the “fifth vital sign” during exams.

“This both shows the patient that physical activity is important to the clinician and helps to identify inactive patients, a group who can benefit the most,” write Thompson and Eijsvogels. “Clinicians and other healthcare practitioners need to encourage physical activity in their patients but also encourage physical activity opportunities in workplaces, schools, and communities.”

To TCTMD, Janet Fulton, PhD (Centers for Disease Control and Prevention, Atlanta, GA), one of the guideline authors and liaison to the American Heart Association, said entire communities almost need to be transformed so that there is a natural, organic promotion of physical activity.

I’m not sure if we’re swimming upstream or not, but we’ll certainly keep swimming. Janet Fulton

“If we can do that, we can make really safe and easy for everyone to participate,” she said. “People should have the right to walk or bike in their neighborhood. People should be able to walk from their home to a park, to be able to walk to work. Those are the things from a community perspective we’re trying to transform [in] environments so that they really promote physical activity. I’m not sure if we’re swimming upstream or not, but we’ll certainly keep swimming.”

To help support physical activity at the community level, the HHS is developing a national strategy to expand youth participation in sports. Giroir noted that sports participation drops off as young people enter middle school and high school, with cost often a barrier in underserved, poorer communities. The HHS is planning on offering funding opportunities to communities with the goal of increasing access to affordable programs.