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Physical Activity Guidelines: Key issues

posted Jun 18, 2015, 7:21 AM by Ben Jane   [ updated ]

A key outcome of research into the relationship between physical activity and health is the development of physical activity guidelines.

National guidance, condition specific advice or age-related guidelines are intended to provide information to individuals, professionals and policy makers with the aim of influencing activity levels and consequently reducing the prevalence of non-communicable diseases attributable to physical inactivity.

This resource list is intended to support students and practitioner’s understanding of the various guidelines and includes examples of critical issues worthy of consideration.

Primarily designed as a resource for my students it contains a series of questions and a reading list to help examine some of these areas.

 

Critical Questions regarding Physical Activity Guidelines
(These are not in any order of importance and some may even be overlapping or repeated in a slight way)

What are health-related exercise guidelines?
  • What is health? 
  • What is physical activity (PA)?
  • What are the physical activity guidelines (PAGs) for your country (and for other countries)
  • How do PAGs vary for different population groups? 
  • How can we be sure that physical (in)activity levels are the primary determinant of (ill) health and not other confounding factors such as diet? 
  • In 2015, Malhotra et al published a paper claiming that you "cannot outrun a bad diet". What are the arguments around this viewpoint? 
  • How are the various guidelines developed? What are the key stages of development? 
  • What is the level of variation in the strength of evidence that links PA levels to various health conditions? 
  • What is the purpose of guidelines? What is the evidence that they achieve this aim? 
  • What is the importance of national and international consensus? 
  • How do systematic reviews play a role in the development of guidelines? 
  • What are the research gaps in this area? 
  • Might historical cohort studies be less relevant in recent years as the new social norms of activity are significantly less than they were 50 years ago? 
  • How much should enjoyment play a role in exercise guidelines? 
  • How might publication bias influence physical activity guidelines? How can publication bias be assessed or accounted for in this case?
  • What are the commonalities and differences between various guidelines (geographic, condition specific, age specific) 
  • What is the dose-response (duration & intensity) for activity and health and why the cut-off points? 
  • How little activity is enough? 
  • What could be the issue with having minimal activity guidelines? 
  • What might the minimum meaningful dose of PA be? Start Active, Stay Active recommends bouts of at least 10 min are needed to accumulate total MVPA but why not less? 
  • How does this vary for different conditions? 
  • If 150min is used as a cut-off point for healthy activity levels how many interventions are we ignoring that might support behaviour changes that result in less total physical activity? 
  • What are the benefits of having guidelines that promote both a minimal and optimal amount of total MVPAs (see the Australian PA Guidelines, 2014) 
  • Is there a threshold intensity of exercise needed to improve cardiorespiratory fitness and to reduce cardiometabolic risk?
  • What is the balance between producing clear and concise guidance and guidance that is appropriate to as many people as possible? 
  • What is the balance between setting the minimum versus the optimal thresholds for guidelines? 
  • Should the recommendations come in ranges to encourage more people to increase their levels? 
How do measurement issues impact the guidelines?
  • What are the issues of measuring physical activity? What are the issues of measuring health? 
  • What does the term surveillance mean and what are the issues? 
  • What are the issues of developing guidelines that people will follow using an activity tracker? 
  • Should different guidelines be developed for different activity trackers? 
Can one do too much exercise? What is too much? 
  • What are the risks of more people being more active? 
  • How can we be sure that people are safe to exercise? 
  • What are the injury rates for those that are physically active? 
What role might high intensity interval training play in the exercise guidelines? 
  • What type of interval training sessions have been evaluated?
  • What physiological adaptations is interval training associated with?
  • Why is interval training an attractive recommendation?
  • Why might high intensity interval training not be a suitable message to promote to the general population?
Does the pattern of exercise/activity behaviour make a difference?
  • Does being active at different times of the day have any purpose? 
  • How important are the different domains of physical activity? 
  • What is the evidence for the accumulation of physical activity and are there minimum meaningful amounts of PA? 
  • Can being active at the weekends attenuate the impact of being more sedentary during the week? 
  • Does performing vigorous activity at some point in the day attenuate the impact of being more sedentary for most of the day? 
How is sedentary behaviour dealt with in physical activity guidelines? 
  • What is sedentary behaviour?
  • What is the evidence for the links between sedentary behaviour, inactivity, activity, obesity and poor health? 
  • Is sedentary behaviour just physical inactivity by another name?
  • Does the amount of sedentary time correlate with obesity level. Is this a causal link? 
Guidelines are one thing but what works in the pursuit of increased pa levels? 
  • What examples of health promotion policies operate in parallel to these activity guidelines? 
  • How can the impact of PA guidelines be evaluated?
  • How much should broader human behaviour factors play a role in the guidelines? 
  • How can a knowledge translation strategy play a part in the development of PA guidelines? 
  • How familiar are various populations with the guidelines? (public, health professionals, exercise professionals) 

(NB: Please tweet me or email if you have any more to add)




Recommended Key Reading


Chief Medical Officers for England, Northern Ireland, Scotland and Wales (2011) Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Crown.Available at: https://www.gov.uk/government/publications/uk-physical-activity-guidelines [Gov.uk infographics]

Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., ... & Cercy, K. (2016). 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, 354, i3857. http://www.bmj.com/content/354/bmj.i3857 (click here for the insightful rapid responses/comments)



Textbooks

Ainsworth, B. E., & Macera, C. A. (2012). Physical Activity and Public Health Practice. CRC Press.[google books]

Bouchard, C., Blair, S. N., & Haskell, W. (2012). Physical Activity and Health (2nd Ed). Human Kinetics.

Dishman, R., Heath, G., & Lee, I. M. (2013). Physical Activity Epidemiology (2nd Ed). Human Kinetics.

Eyler, A.A., Chriqui, J.F., Moreland-Russell, S., & Brownson, R. C. (2016). Prevention, policy, and public health. Oxford University Press. Chapter 8 Public Policy and Physical Activity

Hardman, A.E. and Stensel, D.J.(2009) Physical Activity and Health: The Evidence Explained. (2nd Ed) Oxon, Routledge

Kohl, H.W., & Murray, T. (2012). Foundations of physical activity and public health. Champaign, IL: Human Kinetics.

Rahl, R. (2010). Physical activity and health guidelines: recommendations for various ages, fitness levels, and conditions from 57 authoritative sources. Champaign, IL: Human Kinetics.[google books]

Zhu, W., & Owen, N. (Eds.). (2017). Sedentary Behavior and Health: Concepts, Assessments, and Interventions. Human Kinetics. [google books]


Journal Articles

Ainsworth, B. E., Haskell, W. L., Herrmann, S. D., Meckes, N., Bassett Jr, D. R., Tudor-Locke, C., ... & Leon, A. S. (2011). 2011 Compendium of Physical Activities: a second update of codes and MET values. Medicine and Science in Sports and Exercise, 43(8), 1575-1581.[abstract]

Alexander, S. A., & Coveney, J. (2013). A critical discourse analysis of Canadian and Australian public health recommendations promoting physical activity to children. Health Sociology Review, 22(4), 353-364.

Alexander, S. A., Fusco, C., & Frohlich, K. L. (2015). ‘You have to do 60 minutes of physical activity per day… I saw it on TV’: Children's constructions of play in the context of Canadian public health discourse of playing for health. Sociology of health & illness, 37(2), 227-240.

Andersen, L. B., Mota, J., & Di Pietro, L. (2016). Update on the global pandemic of physical inactivity. The Lancet. http://dx.doi.org/10.1016/S0140-6736(16)30960-6

Arem H, DiPietro L. (2017) Physical Activity on the Weekend. Can It Wait Until Then?. JAMA Intern Med. doi:10.1001/jamainternmed.2016.8050 http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2596003

Artinian, N. T., Fletcher, G. F., Mozaffarian, D., Kris-Etherton, P., Van Horn, L., Lichtenstein, A. H., ... & Meininger, J. C. (2010). Interventions to promote physical activity and dietary lifestyle changes for cardiovascular risk factor reduction in adults. A scientific statement from the American Heart Association. Circulation. http://circ.ahajournals.org/content/early/2010/07/12/CIR.0b013e3181e8edf1

Bakrania, K., Edwardson, C. L., Bodicoat, D. H., Esliger, D. W., Gill, J. M., Kazi, A., ... & Khunti, K. (2016). Associations of mutually exclusive categories of physical activity and sedentary time with markers of cardiometabolic health in English adults: a cross-sectional analysis of the Health Survey for England. BMC Public Health, 16(1), 25. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-2694-9

Barnett, I., van Sluijs, E. M., & Ogilvie, D. (2012). Physical activity and transitioning to retirement: a systematic review. American Journal of Preventive Medicine, 43(3), 329-336.

Barry, V. W., Baruth, M., Beets, M. W., Durstine, J. L., Liu, J., & Blair, S. N. (2014). Fitness vs. fatness on all-cause mortality: a meta-analysis. Progress in cardiovascular diseasesProgress in Cardiovascular Diseases 56(4), 382-390. 

Bassett, D. R., Troiano, R. P., McClain, J. J., & Wolff, D. L. (2015). Accelerometer-based physical activity: total volume per day and standardized measures. Med Sci Sports Exerc, 47(4), 833-8. https://www.ncbi.nlm.nih.gov/pubmed/25102292

Batacan, R. B., Duncan, M. J., Dalbo, V. J., Tucker, P. S., & Fenning, A. S. (2016). Effects of high-intensity interval training on cardiometabolic health: a systematic review and meta-analysis of intervention studies. British Journal of Sports Medicine, http://bjsm.bmj.com/content/51/6/494

Bauman, A. E., Macniven, R., & Gebel, K. (2013). Influencing Policy and Environments to Promote Physical Activity Behavior Change. In Nigg, C. (Ed) ACSM's Behavioral Aspects of Physical Activity and Exercise, 191.

Bauman, A. E., Nelson, D. E., Pratt, M., Matsudo, V., & Schoeppe, S. (2006). Dissemination of physical activity evidence, programs, policies, and surveillance in the international public health arena. American Journal of Preventive Medicine, 31(4), 57-65.

Bauman, A. E., Reis, R. S., Sallis, J. F., Wells, J. C., Loos, R. J., Martin, B. W., & Lancet Physical Activity Series Working Group. (2012). Correlates of physical activity: why are some people physically active and others not?. The Lancet, 380(9838), 258-271.

For the full Lancet Physical Activity Series (2012 or 2016) click either image below

              


Bauman, A., Finegood, D. T., & Matsudo, V. (2009). International perspectives on the physical inactivity crisis—Structural solutions over evidence generation?. Preventive medicine, 49(4), 309-312. [full text]

Bélanger, M., Townsend, N., & Foster, C. (2011). Age-related differences in physical activity profiles of English adults. Preventive Medicine, 52(3), 247-249.

Bellew, B., Bauman, A., Martin, B., Bull, F., & Matsudo, V. (2011). Public policy actions needed to promote physical activity. Current Cardiovascular Risk Reports, 5(4), 340-349. [full text]

Berryman, J. W. (2010). Exercise is medicine: a historical perspective. Current Sports Medicine Reports9(4), 195-201.[full text]

Biddle, S. J., & Asare, M. (2011). Physical activity and mental health in children and adolescents: a review of reviews. British journal of sports medicine, bjsports90185.

Biddle, S. J., & Batterham, A. M. (2015). High-intensity interval exercise training for public health: a big HIT or shall we HIT it on the head?. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 95 [fulltext]


Biddle, S.J., Bengoechea García, E., Pedisic, Z. et al. (2017) Screen Time, Other Sedentary Behaviours, and Obesity Risk in Adults: A Review of Reviews Curr Obes Rep doi:10.1007/s13679-017-0256-9  

Biddle SJH, Bengoechea EG, Wiesner G (2017) Sedentary behaviour and adiposity in youth: a systematic review of reviews and analysis of causality. International Journal of Behavioral Nutrition and Physical Activity. doi: 10.1186/s12966-017-0497-8 http://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0497-8

Biswas, A., Oh, P. I., Faulkner, G. E., Bajaj, R. R., Silver, M. A., Mitchell, M. S., & Alter, D. A. (2015). Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: A systematic review and meta-analysis. Annals of internal medicine162(2), 123-132. http://annals.org/aim/article/2091327/sedentary-time-its-association-risk-disease-incidence-mortality-hospitalization-adults

Booth, F. W., Roberts, C. K., & Laye, M. J. (2012). Lack of exercise is a major cause of chronic diseases. Comprehensive Physiology. 2:1143–1211. https://www.ncbi.nlm.nih.gov/pubmed/23798298

image from Booth et al (2017)

Booth, F. W., Roberts, C. K., Thyfault, J. P., Ruegsegger, G. N., & Toedebusch, R. G. (2017). Role of Inactivity in Chronic Diseases: Evolutionary Insight and Pathophysiological Mechanisms. Physiological Reviews, 97(4), 1351-1402. http://physrev.physiology.org/content/97/4/1351 

Bouchard, C., Blair, S. N., & Katzmarzyk, P. T. (2015, November). Less sitting, more physical activity, or higher fitness?. In Mayo Clinic proceedings (Vol. 90, No. 11, pp. 1533-1540). Elsevier.

British Heart Foundation National Centre for Physical Activity and Health (2010) Technical report: Physical Activity guidelines in the UK: review and recommendations Leicestershire, UK: School of Sport, Exercise and Health Sciences, Loughborough University

Buchan, D. S., Ollis, S., Thomas, N. E., & Baker, J. S. (2012). Physical activity behaviour: an overview of current and emergent theoretical practices. Journal of Obesity, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3388376/

Buffart, L. M., Galvao, D. A., Brug, J., Chinapaw, M. J. M., & Newton, R. U. (2014). Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treatment Reviews, 40(2), 327-340.

Bull, F. C., & Bauman, A. E. (2011). Physical inactivity: the “Cinderella” risk factor for noncommunicable disease prevention. Journal of health communication, 16(sup2), 13-26.

Bull, F. C., Milton, K., & Kahlmeier, S. (2014). National policy on physical activity: the development of a policy audit tool. Journal of physical activity & health, 11(2), 233-240.

Bull, F., Milton, K., Kahlmeier, S., Arlotti, A., Juričan, A. B., Belander, O., ... & Vlasveld, A. (2014). Turning the tide: national policy approaches to increasing physical activity in seven European countries. British journal of sports medicine, bjsports-2013.

Cameron, C., Craig, C. L., Bull, F. C., & Bauman, A. (2007). Canada's physical activity guides: has their release had an impact? Can. J. Public Health 98 (Suppl. 2).

Chief Medical Officers for England, Northern Ireland, Scotland and Wales (2011) Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. London: Crown. Available at: https://www.gov.uk/government/publications/uk-physical-activity-guidelines

Condello et al (2017) Behavioral determinants of physical activity across the life course: a “DEterminants of DIet and Physical ACtivity” (DEDIPAC) umbrella systematic literature review. International Journal of Behavioral Nutrition and Physical Activity14(58) https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-017-0510-2 

de Souto Barreto, P. (2015). Time to challenge public health guidelines on physical activity. Sports Medicine45(6), 769-773. https://link.springer.com/article/10.1007/s40279-015-0326-7 

de Souto Barreto, P. (2015). Global health agenda on non-communicable diseases: has WHO set a smart goal for physical activity?. BMJ, 15. http://www.bmj.com/content/350/bmj.h23?sso=

Decker, E. S., & Ekkekakis, P. (2017). More efficient, perhaps, but at what price? Pleasure and enjoyment responses to high-intensity interval exercise in low-active women with obesity. Psychology of Sport and Exercise28, 1-10. http://www.sciencedirect.com/science/article/pii/S1469029216301285  

Després, J. P. (2016). Physical Activity, Sedentary Behaviours, and Cardiovascular Health: When Will Cardiorespiratory Fitness Become a Vital Sign?. Canadian Journal of Cardiology32(4), 505-513. http://dx.doi.org/10.1016/j.cjca.2015.12.006  

Ding, D., Lawson, K. D., Kolbe-Alexander, T. L., Finkelstein, E. A., Katzmarzyk, P. T., van Mechelen, W., ... & Lancet Physical Activity Series 2 Executive Committee. (2016). The economic burden of physical inactivity: a global analysis of major non-communicable diseases. The Lancethttp://dx.doi.org/10.1016/S0140-6736(16)30383-X 

Ding, D., Kolbe-Alexander, T., Nguyen, B., Katzmarzyk, P. T., Pratt, M., & Lawson, K. D. (2017). The economic burden of physical inactivity: a systematic review and critical appraisal. Br J Sports Med, bjsports-2016. http://bjsm.bmj.com/content/early/2017/04/26/bjsports-2016-097385

Dugdill, L., Crone, D., & Murphy, R. (2009). Physical activity and health promotion: evidence-based approaches to practice. John Wiley & Sons.


Ekelund, U., Luan, J. A., Sherar, L. B., Esliger, D. W., Griew, P., Cooper, A., & International Children's Accelerometry Database (ICAD) Collaborators. (2012). Moderate to vigorous physical activity and sedentary time and cardiometabolic risk factors in children and adolescents. JAMA, 307(7), 704-712.

image from Ekelund et al (2016)

Ekelund, U., Steene-Johannessen, J., Brown, W. J., Fagerland, M. W., Owen, N., Powell, K. E., ... & Lancet Sedentary Behaviour Working Group. (2016). Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancethttp://dx.doi.org/10.1016/S0140-6736(16)30370-1 [full text]

Eijsvogels, T. M., & Thompson, P. D. (2015). Exercise is medicine: at any dose?. JAMA, 314(18), 1915-1916. [full text]



Image from Engelen et al, 2016


Engelen, L., Gale, J., Chau, J. Y., Hardy, L. L., Mackey, M., Johnson, N., ... & Bauman, A. (2016). Who is at risk of chronic disease? Associations between risk profiles of physical activity, sitting and cardio‐metabolic disease in Australian adults. Australian and New Zealand Journal of Public Health. http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12627/full [researchgate]

Fan, J. X., Brown, B. B., Hanson, H., Kowaleski-Jones, L., Smith, K. R., & Zick, C. D. (2013). Moderate to vigorous physical activity and weight outcomes: does every minute count?. American Journal of Health Promotion, 28(1), 41-49.

Foster, C., Hillsdon, M., Thorogood, M., Kaur, A., & Wedatilake, T. (2005). Interventions for promoting physical activity. Cochrane database of systematic Reviews, 1.

Foulds, H. J., Bredin, S. S., Charlesworth, S. A., Ivey, A. C., & Warburton, D. E. (2014). Exercise volume and intensity: a dose–response relationship with health benefits. European Journal of Applied Physiology, 114(8), 1563-1571. 

Füzéki, E., Engeroff, T., & Banzer, W. (2017). Health Benefits of Light-Intensity Physical Activity: A Systematic Review of Accelerometer Data of the National Health and Nutrition Examination Survey (NHANES). Sports Medicine, 1-25. https://link.springer.com/article/10.1007/s40279-017-0724-0 

Garber, C. E., Blissmer, B., Deschenes, M. R., Franklin, B. A., Lamonte, M. J., Lee, I. M., ... & Swain, D. P. (2011). American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Medicine and science in sports and exercise, 43(7), 1334-1359.

Gaesser, G. A., & Angadi, S. S. (2011). High-intensity interval training for health and fitness: can less be more?. Journal of Applied Physiology, 111(6), 1540-1541. http://jap.physiology.org/content/111/6/1540.short

Guasch, E., & Nattel, S. (2013). CrossTalk proposal: Prolonged intense exercise training does lead to myocardial damage. The Journal of Physiology, 591(20), 4939-4941. (see also Ruiz, J. R., Joyner, M., & Lucia, A. (2013). CrossTalk opposing view: prolonged intense exercise does not lead to cardiac damage. The Journal of Physiology, 591(20), 4943-4945.) [www]

Gennuso, K. P., Gangnon, R. E., Matthews, C. E., Thraen-Borowski, K. M., & Colbert, L. H. (2013). Sedentary behavior, physical activity, and markers of health in older adults. Med Sci Sports Exerc, 45(8), 1493-1500. 

Gibala, M. J., Little, J. P., MacDonald, M. J., & Hawley, J. A. (2012). Physiological adaptations to low‐volume, high‐intensity interval training in health and disease. The Journal of Physiology, 590(5), 1077-1084.

Global Advocacy Council for Physical Activity, International Society for Physical Activity and Health (2010). The Toronto Charter for Physical Activity: a global call for action. Journal of Physical Activity and Health, 7(3), S370-S373.[full text

Greaves, C. J., Sheppard, K. E., Abraham, C., Hardeman, W., Roden, M., Evans, P. H., & Schwarz, P. (2011). Systematic review of reviews of intervention components associated with increased effectiveness in dietary and physical activity interventions. BMC public health, 11(1), 119.[full text]

Hall, K. D., Heymsfield, S. B., Kemnitz, J. W., Klein, S., Schoeller, D. A., & Speakman, J. R. (2012). Energy balance and its components: implications for body weight regulation. The American journal of clinical nutrition, 95(4), 989-994.

Hallal, P. C., Andersen, L. B., Bull, F. C., Guthold, R., Haskell, W., Ekelund, U., & Lancet Physical Activity Series Working Group. (2012). Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet, 380(9838), 247-257. [full text]

Hamer, M., Sabia, S., Batty, G. D., Shipley, M. J., Tabák, A. G., Singh-Manoux, A., & Kivimaki, M. (2012). Physical activity and inflammatory markers over 10 years follow-up in men and women from the Whitehall II Cohort Study. Circulation, 126(8), 928-933.

Hamer, M., O’Donovan, G., Lee, I. M., & Stamatakis, E. (2017). The ‘weekend warrior’physical activity pattern: how little is enough? http://bjsm.bmj.com/content/early/2017/02/23/bjsports-2017-097538 (also see O'Donovan et al 2017)

Hardman, A. E., & Stensel, D. J. (2009). Physical activity and health: The evidence explained. Routledge.

Heath, G. W., Parra, D. C., Sarmiento, O. L., Andersen, L. B., Owen, N., Goenka, S., ... & Lancet Physical Activity Series Working Group. (2012). Evidence-based intervention in physical activity: lessons from around the world. The Lancet, 380(9838), 272-281. [full text]

Heesch, K. C., Van Uffelen, J. G., van Gellecum, Y. R., & Brown, W. J. (2012). Dose–response relationships between physical activity, walking and health-related quality of life in mid-age and older women. Journal of epidemiology and community health, 66(8), 670-677.

Hunter, R. F., Tully, M. A., Donnelly, P., Stevenson, M., & Kee, F. (2014). Knowledge of UK physical activity guidelines: Implications for better targeted health promotion. Preventive medicine, 65, 33-39.
Hurley, B. F., Hanson, E. D., & Sheaff, A. K. (2011). Strength training as a countermeasure to aging muscle and chronic disease. Sports Medicine, 41(4), 289-306.

Jarvis, J. W., Gainforth, H. L., & Latimer-Cheung, A. E. (2014). Investigating the effect of message framing on parents’ engagement with advertisements promoting child physical activity. International Review on Public and Nonprofit Marketing, 11(2), 115-127.

Jefferis, B. J., Parsons, T. J., Sartini, C., Ash, S., Lennon, L. T., Wannamethee, S. G., ... & Whincup, P. H. (2016). Does duration of physical activity bouts matter for adiposity and metabolic syndrome? A cross-sectional study of older British men. International Journal of Behavioral Nutrition and Physical Activity13(1), 36. https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-016-0361-2 

Kahlmeier, S., Popp, C., Martin, B. W., Backovic-Jurican, A., Banzer, W., Berggren, F., ... & van Mechelen13, W. (2014). A systematic overview of institutions and bodies active in physical activity promotion in Europe. Médecine et traumatologie du sport Rivista svizzera di Medicina e traumatologia dello sport, 62(2), 13-18. [full text]

Kahlmeier, S., Wijnhoven, T. M., Alpiger, P., Schweizer, C., Breda, J., & Martin, B. W. (2015). National physical activity recommendations: systematic overview and analysis of the situation in European countries. BMC public health, 15(1), 133. [full text]

Katzmarzyk, P. T. (2014). Standing and mortality in a prospective cohort of Canadian adults. Med Sci Sports Exerc, 46(5), 940-6. [full text]

Kay, M. C., Carroll, D. D., Carlson, S. A., & Fulton, J. E. (2014). Awareness and knowledge of the 2008 physical activity guidelines for americans. Journal of physical activity & health, 11(4), 693-698.

Kelly, P., Fitzsimons, C., & Baker, G. (2016). Should we reframe how we think about physical activity and sedentary behaviour measurement? Validity and reliability reconsidered. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1. [full text]


Kelly, P., Baker, G., McAdam, C., Milton, K., Richards, J., Foster, C., ... & Mutrie, N. (2015). Critique of ‘The physical activity myth’paper: discussion of flawed logic and inappropriate use of evidence. Br J Sports Med8, e57873. [researchgate] [see Malhotra et al, 2015 for original article]

Kesäniemi, A., Riddoch, C. J., Reeder, B., Blair, S. N., & Sørensen, T. I. (2010). Review Advancing the future of physical activity guidelines in Canada: an independent expert panel interpretation of the evidence. The International Journal of Behavioral Nutrition and Physical Activity, 7, 41.

Khan, K. M., Thompson, A. M., Blair, S. N., Sallis, J. F., Powell, K. E., Bull, F. C., & Bauman, A. E. (2012). Sport and exercise as contributors to the health of nations. The Lancet, 380(9836), 59-64.

Kirk-Sanchez, N. J., & McGough, E. L. (2014). Physical exercise and cognitive performance in the elderly: current perspectives. Clinical interventions in aging, 9, 51.

Knox, E. C., Esliger, D. W., Biddle, S. J., & Sherar, L. B. (2013). Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better?. BMJ open, 3(12), e003633. [full text]

Kohl, H. W., Craig, C. L., Lambert, E. V., Inoue, S., Alkandari, J. R., Leetongin, G., ... & Lancet Physical Activity Series Working Group. (2012). The pandemic of physical inactivity: global action for public health. The Lancet, 380(9838), 294-305.

Kolbe-Alexander, T. L., Bull, F., & Lambert, E. V. (2012). Physical activity advocacy and promotion: the South African experience: original research. South African Journal of Sports Medicine, 24(4), 112-116.

Kraus, W. E., Bittner, V., Appel, L., Blair, S. N., Church, T., Després, J. P., ... & Whitsel, L. (2015). The National Physical Activity Plan: A Call to Action From the American Heart Association A Science Advisory From the American Heart Association. Circulation, 131(21), 1932-1940.[full text]

Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., ... & Cercy, K. (2016). 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. BMJ354, i3857. http://www.bmj.com/content/354/bmj.i3857  (click here for the insightful rapid responses/comments)

Latimer-Cheung, A. E., Rhodes, R. E., Kho, M. E., Tomasone, J. R., Gainforth, H. L., Kowalski, K., ... & Duggan, M. (2013). Evidence-informed recommendations for constructing and disseminating messages supplementing the new Canadian Physical Activity Guidelines. BMC public health, 13(1), 419.

Lee, D. C., Pate, R. R., Lavie, C. J., Sui, X., Church, T. S., & Blair, S. N. (2015). Reply:“Add 10 Min for Your Health”: The New Japanese Recommendation for Physical Activity Based on Dose-Response Analysis. Journal of the American College of Cardiology, 65(11), 1154-1155.

Lee, I. M., & Paffenbarger, R. S. (2000). Associations of light, moderate, and vigorous intensity physical activity with longevity The Harvard Alumni Health Study. American journal of epidemiology, 151(3), 293-299.

Lee, I. M., Shiroma, E. J., Lobelo, F., Puska, P., Blair, S. N., Katzmarzyk, P. T., & Lancet Physical Activity Series Working Group. (2012). Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. The Lancet, 380(9838), 219-229.[full text]

Linke, S. E., Gallo, L. C., & Norman, G. J. (2011). Attrition and adherence rates of sustained vs. intermittent exercise interventions. Annals of Behavioral Medicine, 42(2), 197-209.

Loprinzi, P. D., & Cardinal, B. J. (2013). Association between biologic outcomes and objectively measured physical activity accumulated in≥ 10-minute bouts and< 10-minute bouts. American Journal of Health Promotion27(3), 143-151. http://journals.sagepub.com/doi/abs/10.4278/ajhp.110916-QUAN-348

MacInnis, M. J., & Gibala, M. J. (2017). Physiological adaptations to interval training and the role of exercise intensity. The Journal of Physiology595(9), 2915-2930. http://onlinelibrary.wiley.com/doi/10.1113/JP273196/full 

Malhotra, A., Noakes, T., & Phinney, S. (2015). It is time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. 967-968. http://bjsm.bmj.com/content/49/15/967.short [see Kelly et al, 2015 for response]

Metcalf, B., Henley, W., & Wilkin, T. (2012). Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). Bmj, 345.

Milton, K., & Bauman, A. (2015). A critical analysis of the cycles of physical activity policy in England. International Journal of Behavioral Nutrition and Physical Activity, 12(1), 8.

Milton, K., Bull, F. C., & Bauman, A. (2010). Reliability and validity testing of a single-item physical activity measure. British Journal of Sports Medicine, bjsports68395.

Milton, K., Macniven, R., & Bauman, A. (2014). Review of the epidemiological evidence for physical activity and health from low-and middle-income countries. Global public health, 9(4), 369-381.

Moe, B., Eilertsen, E., & Nilsen, T. I. (2013). The combined effect of leisure-time physical activity and diabetes on cardiovascular mortality. Diabetes Care36(3), 690-695. http://care.diabetesjournals.org/content/36/3/690.short



Comparison of Exercise Guidelines from Leading Organisations 

[Table from Moore et al (2016: 16)]



Moore, G., Durstine, J. L., Painter, P., & American College of Sports Medicine. (2016). ACSM's Exercise Management for Persons With Chronic Diseases and Disabilities, 4E. Champaign, IL: Human Kinetics.


Morris, J. N., Heady, J. A., Raffle, P. A. B., Roberts, C. G., & Parks, J. W. (1953). Coronary heart-disease and physical activity of work. The Lancet262(6796), 1111-1120.[full text]


Morris, J. N. (1994). Exercise in the prevention of coronary heart disease: today's best buy in public health. Medicine and science in sports and exercise26(7), 807-814.


Murray, A., Calderwood, C., O'Connor, N., & Mutrie, N. (2016). Scotland's progress in putting policy about physical activity into practice. British Journal of Sports Medicine, bjsports-2015.[fulltext]


Newton, J. N., Briggs, A. D., Murray, C. J., Dicker, D., Foreman, K. J., Wang, H., ... & Vos, T. (2015). Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet386(10010), 2257-2274. http://www.sciencedirect.com/science/article/pii/S0140673615001956

Ng, S. W., & Popkin, B. M. (2012). Time use and physical activity: a shift away from movement across the globe. Obesity Reviews, 13(8), 659-680.

Nielsen, G., Wikman, J. M., Jensen, C. J., Schmidt, J. F., Gliemann, L., & Andersen, T. R. (2014). Health promotion: The impact of beliefs of health benefits, social relations and enjoyment on exercise continuation. Scandinavian journal of medicine & science in sports24(S1), 66-75. [full text]

Nigg, C. R. (2013). ACSM's Behavioral Aspects of Physical Activity and Exercise.

Nocon, M., Hiemann, T., Müller-Riemenschneider, F., Thalau, F., Roll, S., & Willich, S. N. (2008). Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. European Journal of Cardiovascular Prevention & Rehabilitation, 15(3), 239-246.

Norton, K., Norton, L., & Sadgrove, D. (2010). Position statement on physical activity and exercise intensity terminology. Journal of Science and Medicine in Sport, 13(5), 496-502.[full text]

O'Donovan, G., Lee, I. M., Stamatakis, E., & Hamer, M. (2017). The ‘weekend warrior’and other leisure-time physical activity patterns and the risks of all-cause, cardiovascular disease and cancer mortality. JAMA Intern Med. doi:10.1001/jamainternmed.2016.8014 (also see Hamer et al, 2017)

O'Donovan, G., Blazevich, A. J., Boreham, C., Cooper, A. R., Crank, H., Ekelund, U., ... & Stamatakis, E. (2010). The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. Journal of Sports Sciences, 28(6), 573-591.

Oja, P., Kelly, P., Pedisic, Z., Titze, S., Bauman, A., Foster, C., ... & Stamatakis, E. (2016). Associations of specific types of sports and exercise with all-cause and cardiovascular-disease mortality: a cohort study of 80 306 British adults. British Journal of Sports Medicinehttp://bjsm.bmj.com/content/51/10/812

Oja, P., Bull, F. C., Fogelholm, M., & Martin, B. W. (2010). Physical activity recommendations for health: what should Europe do?. BMC Public Health, 10(1), 10.[full text]

Paffenbarger, R. S., Gima, A. S., Laughlin, E., & Black, R. A. (1971). Characteristics of longshoremen related fatal coronary heart disease and stroke. American Journal of Public |Health61(7), 1362-1370. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1529748/pdf/amjph00742-0089.pdf 

Paffenbarger Jr, R. S., Hyde, R., Wing, A. L., & Hsieh, C. C. (1986). Physical activity, all-cause mortality, and longevity of college alumni. New England Journal of Medicine314(10), 605-613. www.nejm.org/doi/pdf/10.1056/NEJM198603063141003 

Pate, R. R., Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., ... & Wilmore, J. H. (1995). Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Jama, 273(5), 402-407.

Paterson, D. H., & Warburton, D. E. (2010). Review Physical activity and functional limitations in older adults: a systematic review related to Canada's Physical Activity Guidelines. International Journal of Behavioral Nutrition and Physical Activity, 7(38), 1-22.

Pedersen, B. K., & Saltin, B. (2015). Exercise as medicine–evidence for prescribing exercise as therapy in 26 different chronic diseases. Scandinavian journal of medicine & science in sports, 25(S3), 1-72. http://onlinelibrary.wiley.com/doi/10.1111/sms.12581/full

Powell, K. E., Paluch, A. E., & Blair, S. N. (2011). Physical activity for health: What kind? How much? How intense? On top of what?. Public Health, 32(1), 349.

Pratt, M., Norris, J., Lobelo, F., Roux, L., & Wang, G. (2014). The cost of physical inactivity: moving into the 21st century. British Journal of sports medicine, 48(3), 171-173.

Pratt, M., Sarmiento, O. L., Montes, F., Ogilvie, D., Marcus, B. H., Perez, L. G., ... & Lancet Physical Activity Series Working Group. (2012). The implications of megatrends in information and communication technology and transportation for changes in global physical activity. The Lancet, 380(9838), 282-293. [full text]

Riebe, D., Franklin, B. A., Thompson, P. D., Garber, C. E., Whitfield, G. P., Magal, M., & Pescatello, L. S. (2015). Updating ACSM’s recommendations for exercise preparticipation health screening. Med Sci Sports Exerc, 47(11), 2473-9.[full text]

Rhodes, R. E., Janssen, I., Bredin, S. S., Warburton, D. E., & Bauman, A. (2017). Physical activity: Health impact, prevalence, correlates and interventions. Psychology & Health, 1-34. www.tandfonline.com/doi/abs/10.1080/08870446.2017.1325486 

Rhodes, R. E., Lubans, D. R., Karunamuni, N., Kennedy, S., & Plotnikoff, R. (2017). Factors associated with participation in resistance training: a systematic review. Br J Sports Med http://bjsm.bmj.com/content/early/2017/04/12/bjsports-2016-096950

Rock, C. L., Doyle, C., DemarkWahnefried, W., Meyerhardt, J., Courneya, K. S., Schwartz, A. L., ... & Gansler, T. (2012). Nutrition and physical activity guidelines for cancer survivors. CA: a cancer journal for clinicians, 62(4), 242-274.

Samitz, G., Egger, M., & Zwahlen, M. (2011). Domains of physical activity and all-cause mortality: systematic review and dose–response meta-analysis of cohort studies. International journal of epidemiology, 40(5), 1382-1400.

Sanchis-Gomar, F., Pérez, L. M., Joyner, M. J., Löllgen, H., & Lucia, A. (2016). Endurance Exercise and the Heart: Friend or Foe?. Sports Medicine, 1-8. [abstract]


Sattelmair, J., Pertman, J., Ding, E. L., Kohl, H. W., Haskell, W., & Lee, I. M. (2011). Dose response between physical activity and risk of coronary heart disease a meta-analysis. Circulation, 124(7), 789-795.

Sawatzky, R., Liu-Ambrose, T., Miller, W. C., & Marra, C. A. (2007). Physical activity as a mediator of the impact of chronic conditions on quality of life in older adults. Health and Quality of Life Outcomes5(1), 68. https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-5-68

Schoenfeld, B., & Dawes, J. (2009). High-intensity interval training: Applications for general fitness trainingStrength & Conditioning Journal31(6), 44-46.

Sesso, H. D., Paffenbarger, R. S., & Lee, I. M. (2000). Physical activity and coronary heart disease in men the Harvard Alumni Health Study. Circulation, 102(9), 975-980.

Shephard, R. J. (2003). Limits to the measurement of habitual physical activity by questionnaires. British journal of sports medicine, 37(3), 197-206.

Shilton, T., Bauman, A., Bull, F., & Sarmiento, O. (2007). Effectiveness and challenges for promoting physical activity globally. In Global perspectives on health promotion effectiveness (pp. 87-106). Springer New York. [full text]

Skelly, L. E., Andrews, P. C., Gillen, J. B., Martin, B. J., Percival, M. E., & Gibala, M. J. (2014). High-intensity interval exercise induces 24-h energy expenditure similar to traditional endurance exercise despite reduced time commitment. Applied Physiology, Nutrition, and Metabolism, 39(7), 845-848.

Sparling, P. B., Howard, B. J., Dunstan, D. W., & Owen, N. (2015). Recommendations for physical activity in older adults. BMJ, 350, h100 [fulltext]

Stamatakis, E., Pulsford, R. M., Brunner, E. J., Britton, A. R., Bauman, A. E., Biddle, S. J., & Hillsdon, M. (2017). Sitting behaviour is not associated with incident diabetes over 13 years: the Whitehall II cohort study. British Journal of Sports Medicine, doi:10.1136/bjsports-2016-096723. http://bjsm.bmj.com/content/early/2017/01/24/bjsports-2016-096723.abstract

Stefan, N., Häring, H. U., Hu, F. B., & Schulze, M. B. (2013). Metabolically healthy obesity: epidemiology, mechanisms, and clinical implications. The Lancet Diabetes & Endocrinology, 1(2), 152-162.

Strain, T., Fitzsimons, C., Kelly, P., & Mutrie, N. (2016). The forgotten guidelines: cross-sectional analysis of participation in muscle strengthening and balance & co-ordination activities by adults and older adults in Scotland. BMC Public Health, 16(1), 1108. https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3774-6 

Sun, F., Norman, I. J., & While, A. E. (2013). Physical activity in older people: a systematic review. BMC Public Health, 13(1), 449.

Swift, D. L., Lavie, C. J., Johannsen, N. M., Arena, R., Earnest, C. P., O’Keefe, J. H., ... & Church, T. S. (2013). Physical activity, cardiorespiratory fitness, and exercise training in primary and secondary coronary prevention. Circulation Journal, 77(2), 281-292.

Thompson, D., Batterham, A. M., Peacock, O. J., Western, M. J., & Booso, R. (2016). Feedback from physical activity monitors is not compatible with current recommendations: A recalibration study. Preventive Medicine91, 389-394.[full text]

Thornton, J. S., Frémont, P., Khan, K., Poirier, P., Fowles, J., Wells, G. D., & Frankovich, R. J. (2016). Physical activity prescription: a critical opportunity to address a modifiable risk factor for the prevention and management of chronic disease: a position statement by the Canadian Academy of Sport and Exercise Medicine. British Journal of Sports Medicine, 50(18), 1109-1114. http://bjsm.bmj.com/content/50/18/110



Tremblay, M. S., Aubert, S., Barnes, J. D., Saunders, T. J., Carson, V., Latimer-Cheung, A. E., … Chinapaw, M. J. M. (2017). Sedentary behavior research network (SBRN) – Terminology consensus project process and outcome. International Journal of Behavioral Nutrition and Physical Activity, 14, 75. http://doi.org/10.1186/s12966-017-0525-8 

Tremblay, M. S., Kho, M. E., Tricco, A. C., & Duggan, M. (2010). Process description and evaluation of Canadian Physical Activity Guidelines development. International Journal of Behavioral Nutrition and Physical Activity, 7(1), 42.

Tremblay, M. S., LeBlanc, A. G., Carson, V., Choquette, L., Connor Gorber, S., Dillman, C., ... & Timmons, B. W. (2012). Canadian physical activity guidelines for the early years (aged 0–4 years). Applied Physiology, Nutrition, and Metabolism, 37(2), 345-356.

Tremblay, M. S., LeBlanc, A. G., Carson, V., Choquette, L., Connor Gorber, S., Dillman, C., ... & Spence, J. C. (2012). Canadian sedentary behaviour guidelines for the early years (aged 0–4 years). Applied Physiology, Nutrition, and Metabolism, 37(2), 370-380.

Tremblay, M. S., Warburton, D. E., Janssen, I., Paterson, D. H., Latimer, A. E., Rhodes, R. E., ... & Duggan, M. (2011). New Canadian physical activity guidelines. Applied Physiology, Nutrition, and Metabolism, 36(1), 36-46.

Troiano, R. P., McClain, J. J., Brychta, R. J., & Chen, K. Y. (2014). Evolution of accelerometer methods for physical activity research. British journal of sports medicine48(13), 1019-1023.[full text]

Trost, S. G., Blair, S. N., & Khan, K. M. (2014). Physical inactivity remains the greatest public health problem of the 21st century: evidence, improved methods and solutions using the ‘7 investments that work’as a framework. British journal of sports medicine, 48(3), 169-170.

Tucker, J. M., Welk, G. J., & Beyler, N. K. (2011). Physical activity in US adults: compliance with the physical activity guidelines for Americans. American journal of preventive medicine, 40(4), 454-461.


Tudor-Locke, C., & Schuna Jr, J. M. (2012a). Steps to preventing type 2 diabetes: exercise, walk more, or sit less?. Frontiers in endocrinology, 3, 142. 



Tudor-Locke, C., Craig, C. L., Thyfault, J. P., & Spence, J. C. (2012b). A step-defined sedentary lifestyle index:< 5000 steps/day. Applied Physiology, Nutrition, and Metabolism, 38(2), 100-114.


van der Ploeg, H. and Hillsdon, M. (2017) Is sedentary behaviour just physical inactivity by another name? International Journal of Behavioral Nutrition and Physical Activity Vol. 14: 142 https://doi.org/10.1186/s12966-017-0601-0

Warburton, D. E., & Bredin, S. S. (2016). Reflections on Physical Activity and Health: What Should We Recommend?. Canadian Journal of Cardiology, 32(4), 495-504.[abstract] Warburton, D. E., Jamnik, V. K., 

Bredin, S. S., McKenzie, D. C., Stone, J., Shephard, R. J., & Gledhill, N. (2011). Evidence-based risk assessment and recommendations for physical activity clearance: an introduction Applied Physiology, Nutrition, and Metabolism, 36(S1): S1-S2, https://doi.org/10.1139/h11-060 (Also see the rest of this edition which is all about screening prior to exercise)

Warburton, D. E., Charlesworth, S., Ivey, A., Nettlefold, L., & Bredin, S. S. (2010). A systematic review of the evinewton dence for Canada’s Physical Activity Guidelines for Adults. Int J Behav Nutr Phys Act, 7(1), 39.

Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. Canadian medical association journal, 174(6), 801-809. www.cmaj.ca/content/174/6/801.short 

Weed, M. (2016). Evidence for physical activity guidelines as a public health intervention: efficacy, effectiveness, and harm–a critical policy sciences approach. Health Psychology and Behavioral Medicine, 4(1), 56-69.[full text][news story and radio interview with the author ]

Wen, C. P., Wai, J. P. M., Tsai, M. K., Yang, Y. C., Cheng, T. Y. D., Lee, M. C., ... & Wu, X. (2011). Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. The Lancet, 378(9798), 1244-1253.[full text]

Westcott, W. L. (2012). Resistance training is medicine: effects of strength training on health. Current sports medicine reports, 11(4), 209-216. [full text]

Wilmot, E. G., et al (2012). Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia, 55, 2895-2905 [full text]

Woodcock, J., Franco, O. H., Orsini, N., & Roberts, I. (2011). Non-vigorous physical activity and all-cause mortality: systematic review and meta-analysis of cohort studies. 
International Journal of Epidemiology40(1), 121-138. https://academic.oup.com/ije/article/40/1/121/658816/Non-vigorous-physical-activity-and-all-cause 

World Health Organization. (2010). Global recommendations on physical activity for health. [full text

Yancey, A. K. T., & Sallis, J. F. (2009). Physical activity: Cinderella or Rodney Dangerfield?. Preventive medicine, 49(4), 277-279.[full text]

Zenko, Z., & Ekkekakis, P. (2015). Knowledge of Exercise Prescription Guidelines Among Certified Exercise Professionals. The Journal of Strength & Conditioning Research, 29(5), 1422-1432. [full text]




Further Resources



New Zealand PA Guidelines (children's updated May 2017 to include sleep)

The Global Energy Balance Network [Wikipedia]

Belluz, J. & Zarracina, J. (2016) Why you shouldn't exercise to lose weight, explained with 60+ studies [available at http://www.vox.com/2016/4/28/11518804/weight-loss-exercise-myth-burn-calories

University of Minnesota Resource - A History of Cardiovascular Disease Epidemiology

Physical Activity Guidelines Advisory Committee Report. Part G. Section 10: Adverse Events


CDC (2015) How much physical activity do children need?