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Move more, age well: prescribing physical activity for older adults

Author/s: 
Jane S Thornton, William N Morley, Samir K Sinha

KEY POINTS
Physical activity is a modifiable risk factor for more than 30 chronic conditions relevant to the older adult; 150 minutes per week of moderate physical activity can reduce all-cause mortality by 31% compared with no physical activity.

Physical activity is one of the most important ways to preserve or improve functional independence, including among older adults who are frail or deemed to be at increased risk of falling.

Higher levels of physical activity in older age are associated with improvements in cognition, mental health, and quality of life.

Age, frailty, or existing functional impairments should not be viewed as an absolute contraindication to physical activity but, considering the benefits of physical activity interventions for older adults, a key reason to prescribe exercise.

Keywords 
exercise physical activity aged

Health benefits of physical activity: the evidence

Author/s: 
Warburton, D. E. R., Nicol, C. W., Bredin, S. S. D.

The primary purpose of this narrative review was to evaluate the current literature and to provide further insight into the role physical inactivity plays in the development of chronic disease and premature death. We confirm that there is irrefutable evidence of the effectiveness of regular physical activity in the primary and secondary prevention of several chronic diseases (e.g., cardiovascular disease, diabetes, cancer, hypertension, obesity, depression and osteoporosis) and premature death. We also reveal that the current Health Canada physical activity guidelines are sufficient to elicit health benefits, especially in previously sedentary people. There appears to be a linear relation between physical activity and health status, such that a further increase in physical activity and fitness will lead to additional improvements in health status.

Keywords 
Health Behavior exercise Health Status Chronic Disease physical activity

Twenty-Four-Hour Movement Guidelines and Body Weight in Youth

Author/s: 
Zhu, X, Healy, S, Haegele, JA, Patterson, F

Objective

To examine the prevalence of youth meeting the 24-hour healthy movement guidelines (ie, ≥60 minutes of moderate-to-vigorous physical activity, ≤2 hours of screen time, age-appropriate sleep duration), and which combination of meeting these guidelines was most associated with bodyweight status, in a nationally representative US sample.

Study design

Cross-sectional data from the 2016-2017 National Survey of Children's Health were used. A multinomial regression model of body weight status was generated (underweight, overweight, obese vs healthy weight) and then stratified by sex. Analyses were adjusted for potential confounders.

Results

The sample (n = 30 478) was 50.4% female, 52.4% white, and the mean age was 13.85 ± 2.28 years; 15% percent were obese and 15.2% were overweight. Overall, 9.4% met all 3 of the 24-hour healthy movement guidelines, 43.6% met 2, 37.9% met 1, and 9.1% met none. Meeting zero guidelines (vs 3) was associated with the greatest likelihood of overweight (aOR, 1.85; 95% CI, 1.31-2.61), and obesity (aOR, 4.25; 95% CI, 2.87-6.31). Females (aOR, 4.97; 95% CI, 2.59-9.53) had higher odds of obesity than males (aOR, 3.99; 95% CI, 2.49-6.40) when zero (vs 3) guidelines were met. Meeting the moderate-to-vigorous physical activity guideline, either alone or in combination with screen time or sleep duration (vs all 3), was associated with the lowest odds for overweight and obesity in the full sample.

Conclusion

Meeting all movement guidelines was associated with the lowest risk for obesity, particularly in females. Meeting the moderate-to-vigorous physical activity guideline may be a priority to prevent overweight and obesity in youth.

Keywords 
24-hour healthy movement screen time sleep physical activity children adolescent

Sitting Time and Risk of Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis.

Author/s: 
Bailey, D.P., Hewson, D.J., Champion, R.B., Sayegh, S.M.

Whether physical activity attenuates the association of total daily sitting time with cardiovascular disease and diabetes incidence is unclear. This systematic review and meta-analysis examined the association of total daily sitting time with cardiovascular disease and diabetes with and without adjustment for physical activity.

EVIDENCE ACQUISITION:

PubMed, Web of Science, BASE, MEDLINE, Academic Search Elite, and ScienceDirect were searched for prospective studies, published between January 1, 1989, and February 15, 2019, examining the association of total daily sitting time with cardiovascular disease or diabetes outcomes. Data extraction and study quality assessments were conducted by 2 independent reviewers. Pooled hazard ratios (HRs) were calculated using a fixed-effects model. The quality assessment and meta-analysis procedures were completed in 2018.

EVIDENCE SYNTHESIS:

Nine studies with 448,285 participants were included. A higher total daily sitting time was associated with a significantly increased risk of cardiovascular disease (HR=1.29, 95% CI=1.27, 1.30, p<0.001) and diabetes (HR=1.13, 95% CI=1.04, 1.22, p<0.001) incidence when not adjusted for physical activity. The increased risk for diabetes was unaffected when adjusting for physical activity (HR=1.11, 95% CI=1.01, 1.19, p<0.001). For cardiovascular disease, the increased risk was attenuated but remained significant (HR=1.14, 95% CI=1.04, 1.23, p<0.001).

CONCLUSIONS:

Higher levels of total daily sitting time are associated with an increased risk of cardiovascular disease and diabetes, independent of physical activity. Reductions in total daily sitting may be recommended in public health guidelines.

Keywords 
physical activity sitting exercise

Exercise Videogames, Physical Activity, and Health: Wii Heart Fitness: A Randomized Clinical Trial

Author/s: 
Bock, Beth C., Dunsiger, Shira I., CIccolo, Joseph T., Serber, Eva R., Wu, Wen-Chih, Tilkemeier, Peter, Walaska, Kristen A., Marcus, Bess H.

INTRODUCTION:

Adults who engage in regular physical activity have lower rates of morbidity and mortality than those who do not. Exercise videogames may offer an attractive, sustainable alternative or supplement to traditional modes of exercise. This study compared exercise videogames with standard exercise modalities for improving uptake and maintenance of moderate to vigorous physical activity, and health risk indices.

STUDY DESIGN:

A three-arm clinical RCT including 12 weeks of supervised laboratory-based moderate to vigorous physical activity followed by 6 months follow-up.

SETTING/PARTICIPANTS:

This study was conducted at a university affiliated hospital research lab. Healthy, sedentary adults were eligible.

INTERVENTIONS:

This study compared a 12-week program of supervised exercise videogames versus standard exercise (e.g., treadmill) versus control. Data were collected from January 2012 to September 2017 and analyzed in 2018.

MAIN OUTCOME MEASURES:

The primary outcome was weekly minutes of moderate to vigorous physical activity at end of treatment, assessed at 3 and 6 months post-intervention by using self-report and accelerometer data. Health risk indices (e.g., HbA1c, lipids) were also assessed.

RESULTS:

Participants (N=283) had an average age of 46.2 ±13.5 years; 79% were female. At end of treatment, those in the exercise videogame arm engaged in 30 minutes/week more moderate to vigorous physical activity compared with standard exercise and 85 more minutes/week than controls (all p<0.05). Exercise videogame participants had greater reductions in cholesterol, HbA1c, and body fat versus other groups. Reductions in cholesterol were twice as large in exercise videogame versus standard participants.

CONCLUSIONS:

Exercise videogames produced greater uptake and maintenance of moderate to vigorous physical activity compared with standard exercise and improvements in multiple health risk indices. Exercise videogames may promote sustainable physical activity with significant health benefits.

Keywords 
video games exercise physical activity

New Physical Activity Guidelines A Call to Activity for Clinicians and Patients

Author/s: 
Thompson, Paul D., Eijsvogels, Thijs M. H.

These guidelines update those presented in 2008 and expand the medical conditions for which physical activity is likely beneficial. The final recommendations are based on a systematic literature review by a committee of exercise and health experts and include only those recommendations judged to have strong, or moderately strong, scientific support. Achieving the guideline-recommended levels of physical activity will be difficult for the entire nation, given that approximately 80% of US adults and adolescents do not presently accumulate sufficient physical activity for optimum health.1 Efforts to increase physical activity among people in the United States will require the cooperation of many sectors of society including clinicians, other health care professionals, and health care organizations. Achieving these recommendations will substantially improve individual and population health. So what are the key messages for clinicians, and what should clinicians tell patients?

Keywords 
physical activity lifestyle behaviors

The Physical Activity Guidelines for Americans

Author/s: 
Piercy, Katrina L., Trioano, Richard P., Ballard, Rachel M., Carlson, Susan A., Fulton, Janet E., Galuska, Deborah A., George, Stephanie M., Olson, Richard D.

Importance  Approximately 80% of US adults and adolescents are insufficiently active. Physical activity fosters normal growth and development and can make people feel, function, and sleep better and reduce risk of many chronic diseases.

Objective  To summarize key guidelines in the Physical Activity Guidelines for Americans, 2nd edition (PAG).

Process and Evidence Synthesis  The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. The committee addressed 38 questions and 104 subquestions and graded the evidence based on consistency and quality of the research. Evidence graded as strong or moderate was the basis of the key guidelines. The Department of Health and Human Services (HHS) based the PAG on the 2018 Physical Activity Guidelines Advisory Committee Scientific Report.

Recommendations  The PAG provides information and guidance on the types and amounts of physical activity to improve a variety of health outcomes for multiple population groups. Preschool-aged children (3 through 5 years) should be physically active throughout the day to enhance growth and development. Children and adolescents aged 6 through 17 years should do 60 minutes or more of moderate-to-vigorous physical activity daily. Adults should do at least 150 minutes to 300 minutes a week of moderate-intensity, or 75 minutes to 150 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. They should also do muscle-strengthening activities on 2 or more days a week. Older adults should do multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening activities. Pregnant and postpartum women should do at least 150 minutes of moderate-intensity aerobic activity a week. Adults with chronic conditions or disabilities, who are able, should follow the key guidelines for adults and do both aerobic and muscle-strengthening activities. Recommendations emphasize that moving more and sitting less will benefit nearly everyone. Individuals performing the least physical activity benefit most by even modest increases in moderate-to-vigorous physical activity. Additional benefits occur with more physical activity. Both aerobic and muscle-strengthening physical activity are beneficial.

Conclusions and Relevance  The Physical Activity Guidelines for Americans, 2nd edition, provides information and guidance on the types and amounts of physical activity that provide substantial health benefits. Health professionals and policy makers should facilitate awareness of the guidelines and promote the health benefits of physical activity and support efforts to implement programs, practices, and policies to facilitate increased physical activity and to improve the health of the US population.

Keywords 
physical activity lifestyle behaviors
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