Guidelines from the United States (US) Department of Health and Human Services recommended that healthy adults get 150-300 minutes per week of moderate-intensity activity due to its numerous health benefits which have been outlined in the table below.1 The guidelines define moderate-intensity activity as requiring 3.0 to <6.0 metabolic equivalent of task (METs), such as walking briskly, mopping, vacuuming, or raking. Vigorous-intensity activity is defined as requiring ≥6.0 METs, such as walking 4-5 miles per hour, running, carrying heavy groceries or other loads upstairs, shoveling snow by hand, mowing grass with a push mower, or participating in an aerobics class.
Table 1. Physical activity-related health benefits1
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Children
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3 to <6 years of age
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· Improved bone health
· Improved weight status
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6 to 17 years of age
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· Improved cognitive function (ages 6-13)
· Improved cardiorespiratory and muscular fitness
· Improved bone health
· Improved cardiovascular risk factor status
· Improved weight status or adiposity
· Fewer symptoms of depression
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Adults, all ages
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All-cause mortality
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· Lower risk
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Cardiometabolic conditions
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· Lower cardiovascular incidence and mortality (including heart
· disease and stroke)
· Lower incidence of hypertension
· Lower incidence of type 2 diabetes
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Cancer
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· Lower incidence of bladder, breast, colon, endometrium,
· esophagus, kidney, stomach, and lung cancers
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Brain health
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· Reduced risk of dementia
· Improved cognitive function
· Improved cognitive function following bouts of aerobic activity
· Improved quality of life
· Improved sleep
· Reduced feelings of anxiety and depression in healthy people and in people with existing clinical syndromes
· Reduced incidence of depression
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Weight status
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· Reduced risk of excessive weight gain
· Weight loss and the prevention of weight regain following initial weight loss when a sufficient dose of moderate-to-vigorous physical activity is attained
· An additive effect on weight loss when combined with moderate dietary restriction
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Older Adults
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Physical function
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· Reduced incidence of falls and fall-related injuries
· Improved physical function in older adults with and without frailty
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Women who are Pregnant or Postpartum
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During pregnancy
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· Reduced risk of excessive weight gain
· Reduced risk of gestational diabetes
· No risk to fetus from moderate-intensity physical activity
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Postpartum
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· Reduced risk of postpartum depression
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Individuals with Pre-Existing Medical Conditions
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Cancer
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· Reduced risk of all-cause mortality for breast and colorectal cancer
· Reduced risk of cancer mortality for breast, colorectal, and prostate cancer
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Osteoarthritis
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· Decreased pain
· Improved function and quality of life
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Hypertension
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· Reduced risk of progression of cardiovascular disease
· Reduced risk of increased blood pressure over time
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Type 2 diabetes
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· Reduced risk of cardiovascular mortality
· Reduced progression of disease indicators: hemoglobin A1c, blood pressure, blood lipids, and body mass index
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Multiple sclerosis
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· Improved walking
· Improved physical fitness
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Dementia
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· Improved cognition
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Conditions with impaired executive function
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· Improved cognition in the following conditions: attention deficit hyperactivity disorder, schizophrenia, multiple sclerosis, Parkinson’s disease, and stroke
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The American College of Cardiology and American Heart Association also include aerobic physical activity in their recommendations to reduce CVD risk by reducing low-density lipoprotein (LDL) cholesterol, non-high-density lipoprotein (HDL) cholesterol, and blood pressure.2
Studies of the general population have shown that exercise is associated with a decreased risk of coronary heart disease, stroke, and heart failure. In a 2013 meta-analysis using 43 studies for ischemic heart disease and 26 for ischemic stroke, being moderately active (150 minutes of exercise each week) was associated with a decreased risk of 23% (Relative Risk [RR] 0.769, Confidence Interval [CI] [0.698-0.838]) for ischemic heart disease and 19% (RR 0.810, CI [0.690-0.937)) for stroke.3
Exercise has an inverse dose-response relationship with CVD mortality in the general population. A meta-analysis used data from 36 prospective cohort studies, 33 concerning CVD and three concerning type 2 diabetes, to examine the relationship between physical activity and CVD incidence and mortality.4 The meta-analysis found that an increase from no physical activity to the recommended levels of activity was associated with a 23% decreased risk in CVD mortality (RR 0.77, CI [0.71-0.84]) and a 17% decreased risk of CVD incidence (RR 0.83, CI [0.77-0.89]).
Exercise is also beneficial to those with chronic conditions, such as rheumatoid arthritis (RA). A 2013 case-control study examining the effects of exercise on CVD risk factors in patients with RA compared the effects of a six-month high-intensity exercise program with advice on exercise and lifestyle changes for 40 patients with RA.5 At six months, the study found that the aerobic capacity (VO2 max) of the exercise group significantly increased by 17% as compared to the control group (p=0.002). They also found a significant decrease in body fat percentage at six months (2.5%, p<0.05), systolic blood pressure (7.1 mmHg, p<0.001), triglyceride level (0.3 mmol/L, p<0.05), total cholesterol to high-density lipoprotein (HDL) ratio (0.4, p<0.05), and the resultant 10-year predicted CVD risk of a heart attack or stroke (p<0.05) calculated based on these risk factors.
A 2016 cross-sectional study of 98 patients with RA found that even very light-intensity activity defined as 1.1-1.9 MET, such as washing the dishes, was inversely associated with cardiovascular markers such as systolic blood pressure (beta -0.35, 95% CI [0.16-0.51], p<0.001), BMI (beta=-0.65, CI [0.51-0.75], p<0.001), and insulin resistance (beta -0.32, CI [0.12-0.48], p=0.002).6 A 2009 cross-sectional study of 65 patients with RA divided the subjects up into inactive, moderately active, and active groups, using the 33rd and 66th percentiles of the International Physical Activity Questionnaire (IPAQ).7 The results of this study showed a significant difference between the active and inactive groups for systolic blood pressure (17.8, CI [1.3-34.3], p=0.031), cholesterol level (1.0, CI [0.2-19], p=0.014), insulin resistance (1.4, CI [0.4-2.3], p=0.004), and 10-year predicted CVD risk (12.9%, CI [6.4-19.4], p<0.001).
References
- 2018 Physical Activity Guidelines Advisory Committee Scientific Report. Washington, D.C.: U.S. Department of Health and Human Services; 2018.
- Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. Jun 24 2014;129(25 Suppl 2):S76-99. doi:10.1161/01.cir.0000437740.48606.d1
- Kyu HH, Bachman VF, Alexander LT, et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ (Clinical research ed). Aug 9 2016;354:i3857. doi:10.1136/bmj.i3857
- Wahid A, Manek N, Nichols M, et al. Quantifying the Association Between Physical Activity and Cardiovascular Disease and Diabetes: A Systematic Review and Meta-Analysis. J Am Heart Assoc. Sep 14 2016;5(9)doi:10.1161/jaha.115.002495
- Stavropoulos-Kalinoglou A, Metsios GS, Veldhuijzen van Zanten JJ, Nightingale P, Kitas GD, Koutedakis Y. Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis. Ann Rheum Dis. Nov 2013;72(11):1819-25. doi:10.1136/annrheumdis-2012-202075
- Khoja SS, Almeida GJ, Chester Wasko M, Terhorst L, Piva SR. Association of Light-Intensity Physical Activity With Lower Cardiovascular Disease Risk Burden in Rheumatoid Arthritis. Arthritis Care Res (Hoboken). Apr 2016;68(4):424-31. doi:10.1002/acr.22711
- Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF, et al. Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. Apr 2009;16(2):188-94. doi:10.1097/HJR.0b013e3283271ceb
