Am Fam Physician. 2004;69(4):816-818
Fewer active persons develop coronary heart disease (CHD) than those who are sedentary, and the beneficial effects of exercise on risk factors for CHD are well documented.1 Despite this, inactive lifestyles and overeating remain the norm for most Americans, as illustrated by the rising epidemic of obesity over the past three decades.2 In response to this situation, the Institute of Medicine recently raised the bar for sedentary Americans, suggesting that we all engage in at least 60 cumulative minutes of moderate-intensity physical activity on most, and preferably all, days of the week rather than the 30 minutes suggested by other organizations.3–6 Besides restricting calorie intake and portion size based on each person's height, weight, and gender, increasing the cumulative duration of daily activity to 60 minutes could help reduce the risk of several chronic diseases and premature mortality.
The added benefit of increasing daily physical activity is supported by prospective data showing a graded benefit of brisk walking for more than an average of 30 minutes daily (i.e., for those walking at least three hours per week).7,8 The new recommendations suggest that 60 minutes of continuous daily activity is not necessary to derive benefit, but that the accumulated amount can be spread over a given day from several shorter episodes. For example, in one study,9 similar cardiovascular risk reduction was achieved when comparing longer versus shorter durations spent on each episode of daily exercise after accounting for a person's average weekly amount of expended energy. Initiation of a lifestyle change that includes a structured dietary approach and an episode of low-to-moderate physical activity 5 to 10 minutes a day (above a patient's baseline sedentary level) could establish modest risk reductions if ultimately ramped up to the goal of 60 cumulative minutes.
Several strategies can be used to help patients achieve the new physical activity recommendations. For example, use of a stationary bicycle for 20 to 30 minutes daily could be combined with household and occupational activities, such as walking up and down stairs once a day at work, an hour of weekly housework, and gardening for an hour per week. The accompanying table lists other activities that could be performed to achieve these goals.10 Note that vigorous activities are not necessary to achieve the recommended amount of physical activity, and that patients may be more compliant with lower intensity activities that they perceive as enjoyable.
Despite the apparent simplicity of the new recommendations, initiative and commitment from the patient are required to increase physical activity to 60 minutes daily and to maintain at that level. Starting with small, achievable steps can facilitate the adoption of the new national recommendations for physical activity and nutrition to promote health.
| Sedentary | Active alternative |
|---|---|
| Desk work or watching television, seated (1 to 2 METs) | Using foot pedals while seated (3 METs) |
| Riding escalator, standing (2 METs) | Walking upstairs (4 METs) |
| Driving to work (1 to 2 METs) | Walking 3 miles per hour (3 to 4 METs) |
| Standing on a moving walkway (2 METs) | |
| Cutting lawn using riding lawnmower (2 to 3 METs) | Cutting lawn using push lawn mower (3 to 5 METs) |
| Golfing, riding in cart (2 to 3 METs) | Golfing, carrying clubs (4 to 5 METs) |
| Washing car, sitting in drive-through car wash (1 to 2 METs) | Washing car by hand (6 to 7 METs) |
| Sitting, limited mobility (1 to 2 METs) | Swimming slowly (4 to 5 METs) |
| Wheelchair, sitting (1 to 2 METs) | Wheelchair, wheeling (3 to 4 METs) |
| Lying down, sunbathing (1 to 2 METs) | Canoeing, leisurely pace (2 to 3 METs) |
An initial step on the pathway to improved compliance with the new lifestyle recommendations is raising awareness about a patient's current actual level of physical activity versus the recommended level.