Physical Activity Guidelines

Key research & issues

One outcome of the 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 engagement with the evidence that underpins 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.

Find out more about the latest UK Physical Activity Guidelines here -

Critical questions relating to Physical Activity Guidelines (PAGs)

(These are not in any order of importance and some may even be overlapping or repeated in some way)

What are health-related physical activity guidelines?

  • What is health?

  • What is physical activity (PA)? (e.g. Caspersen et al, 1985; Piggin, 2020)

  • What are the physical activity guidelines (PAGs) for your country (and for other countries)

  • How do PAGs vary for different population groups? e.g. older people (Bauman et al, 2016, Tavoian et al, 2020)

  • How are the various guidelines developed? What are the key stages of development?

  • What is the purpose of guidelines?

  • Who are the guidelines for? (think about this yourself but don't be happy with your response until you've read the actual aims and target population in the briefing for the guidelines)

  • What is the evidence that they achieve their stated aims?

  • What is the importance of national and international consensus?

  • What are the commonalities and differences between various guidelines (geographic, condition specific, age specific)

  • What is the balance between producing clear and concise guidance and guidance that is appropriate to as many people as possible?

  • What might the political or organisational tensions be surrounding the content of the finalised guidelines?

What's the evidence that underpins PAGs?

  • How sure are we that physical activity makes us live longer? (see Cheng, 2018 for signposting, Kujala, 2018)

  • What role do the Bradford-Hill Criteria play in establishing the importance of physical activity for health?

  • How much longer might people live if they are more active? (see Moore et al, 2012; Kujala, 2018)

  • How does this vary for different conditions?

  • What is the dose-response (duration & intensity) for activity and health and why the cut-off points? (e.g. Ekelund et al, 2019)

  • How do systematic reviews play a role in the development of guidelines?

  • 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?

  • How little activity is enough? Is Light PA of value? (LaCroix et al, 2019)

  • 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? See guidance in the 2018 US PAGs (youtube explanation)

  • What could be the issue with having minimal activity guidelines?

  • What are the benefits of having guidelines that promote both a minimal and optimal amount of total MVPAs (see the Australian PA Guidelines, 2014)

  • In 2015, Malhotra et al published a paper claiming that you "cannot outrun a bad diet". What are the arguments around this viewpoint? (see Borg, 2018; Phillips and Joyner, 2018)

  • What is the level of variation in the strength of evidence that links PA levels to various health conditions?

  • Is there a threshold intensity of exercise needed to improve cardiorespiratory fitness and to reduce cardiometabolic risk?

  • 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 might publication bias influence physical activity guidelines? How can publication bias be assessed or accounted for in this case?

  • Is there such a thing as a non-responder to exercise (see Pickering & Kiely, 2018)

  • 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?

  • Should the recommendations come in ranges to encourage more people to increase their levels?

  • What are the correlates of Physical Activity and are there any genetic reasons why some people are more active (Bauman et al, 2012; Kelly & Pomp, 2013)

  • How do PA behaviours correlate with other health related behaviours? (Pharr et al, 2020)

  • How well are they communicated? (see Ratner/Riis)

  • How much should enjoyment play a role in exercise guidelines? (See Ekkekakis, 2013; Decker & Ekkekakis, 2017)

  • How much does and should sleep play a role in the activity guidelines?

  • What are some of the issues in interpreting the data? (see this fullfact critique of how one study was reported in the news)

  • What are the research gaps in this area?

How do measurement issues impact the guidelines?

  • How do we measure physical activity levels? (e.g. Strain et al, 2019)

  • What are the issues around measuring physical activity?

  • What are the issues around measuring health?

  • How might analysis methods impact upon the guidelines? (e.g. this comment by Paul Kelly; Candio et al, 2020)

  • 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?

What role do strength/resistance recommendations play in the guidance?

  • Does strength exercise confer unique health benefits?

  • Who benefits the most by undertaking resistance exercises?

  • What role might grip strength measurement play in development of the guidelines (see Celis-Morales et al, 2018)

  • What role does strength and balance have as we get older (see this special issue of JFSF, see Mcleod et al, 2019. Tavoian et al, 2020)

  • How are any recommendations for strength framed and what considerations are present when considering the messaging around strength training?

  • How many people do resistance exercise? (e.g. Bennie et al, 2020)

  • see El-Kotob et al, 2020, Stamatakis et al, 2017; Strain et al, 2016; Hunter et al, 2011, Hillsdon & Foster, 2018; Steele et al, 2017, DiPietro et al, 2019, Foster & Armstrong, 2018

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?

  • What are the arguments around recommending high intensity interval training to the general population?

  • What's the least amount of interval training that will have significant patient/person benefit?

  • See Biddle & Batterham, 2015; Hardcastle et al, 2014, Decker & Ekkekakis, 2017; Phillips et al, 2017, Batacan et al, 2016, Ross et al, 2016, Campbell et al, 2019 plus anything by Martin Gibala

  • Also see High Intensity Interval Training for Health on this website

Does the pattern of exercise/activity behaviour make a difference?

  • Does being active at different times of the day have any purpose? (e.g. Weitzer et al, 2020)

  • 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 does the pattern affect whether someone is deemed active or not? (Thompson et al, 2015)

  • How much should variety play a role in the guidance on activity? (Sylvester et al, 2016)

How is sedentary behaviour dealt with in physical activity guidelines?

  • What is sedentary behaviour? (Tremblay et al, 2017; Sedentary Behaviour Research Network, 2012; Leitzmann et al, 2018)

  • What is the evidence for the links between sedentary behaviour, inactivity, activity, obesity and poor health? (Read this by Stuart Biddle, see Biddle et al, 2018)

  • Is sedentary behaviour just the same as physical inactivity? (van der Ploeg & Hillsdon, 2017; Ekelund et al, 2016, Maher et al, 2014)

  • Does the amount of sedentary time correlate with obesity levels. Is there a causal link?

  • Should screen time be a separate consideration?

  • Is there enough evidence to have a meaningful guideline? (Stamatakis et al, 2018)

Guidelines are one thing but what works in the pursuit of increased pa levels?

  • What works in promoting PA? (see NIHR, Moving Matters, 2019)

  • How effective are the guidelines themselves in making a difference to PA levels? (Tomasone et al, 2020)

  • 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 much should enjoyment play a role in exercise guidelines? (See Ekkekakis, 2013; Decker & Ekkekakis, 2017)

  • What is meaningful exercise and how to communicate this to the greatest amount of people

  • How can a knowledge translation strategy play a part in the development of PA guidelines? (Warburton & Bredin, 2018)

  • How familiar are various populations with the guidelines? (public, health professionals, exercise professionals, comparative countries)

(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 (2019) UK Chief Medical Officers' Physical Activity Guidelines. London: Crown. Retrieved from [Infographics]

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.

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. (click here for the insightful rapid responses/comments)

Rhodes, R. E., Janssen, I., Bredin, S. S., Warburton, D. E., & Bauman, A. (2017). Physical activity: Health impact, prevalence, correlates and interventions. Psychology & health, 32(8), 942-975.

Warburton, D. E., & Bredin, S. S. (2017). Health benefits of physical activity: a systematic review of current systematic reviews. Current Opinion in Cardiology, 32(5), 541-556. [video abstract]

A special edition of Applied Physiology, Nutrition, and Metabolism covering the research behind the Canadian 2020 Guidelines


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

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

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.

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

Ekkekakis, P. (2013). Redrawing the model of the exercising human in exercise prescriptions. In Rippe, J. 2013) Lifestyle Medicine. Boca Raton, FL: CRC Press

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.

Leitzman, M.F., Jochem, C. & Schmid, D. (eds.) (2018) Sedentary Behaviour Epidemiology Springer.

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]

Rose, D. J., & Fisher, K. L. (2018). The Role of Government Policy in Promoting Physical Activity. In The Palgrave Handbook of Ageing and Physical Activity Promotion (pp. 607-626). Palgrave Macmillan.

Warburton, D. E., & Bredin, S. S. (2018). Lost in Translation: What Does the Physical Activity and Health Evidence Actually Tell Us?. In Lifestyle in Heart Health and Disease (pp. 175-186).

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

Recent Guidelines

World Health Organization Guidelines - Nov 2020

World Health Organization. (‎2020)‎. WHO guidelines on physical activity and sedentary behaviour. World Health Organization.

World Health Organization. (‎2020)‎. WHO guidelines on physical activity and sedentary behaviour: at a glance. World Health Organization.

BJSM Special Issue - December 2020 - Volume 54 - 24 -

IJBNPA Special Issue - Nov 2020 - Vol 17 -

Ding, D, Mutrie, N., Bauman, A., Pratt, M., Hallal, P.R.C., & Powell, K.E. (2020) Physical activity guidelines 2020: comprehensive and inclusive recommendations to activate populations. The Lancet.

Image from: Ding, D, Mutrie, N., Bauman, A., Pratt, M., Hallal, P.R.C., & Powell, K.E. (2020) Physical activity guidelines 2020: comprehensive and inclusive recommendations to activate populations. The Lancet.

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.

Arem, H., Moore, S. C., Patel, A., Hartge, P., De Gonzalez, A. B., Visvanathan, K., ... & Linet, M. S. (2015). Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Internal Medicine, 175(6), 959-967. doi:10.1001/jamainternmed.2015.0533.

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

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.

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.

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 diseases, Progress 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.

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,

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]

Bauman, A., Merom, D., Bull, F. C., Buchner, D. M., & Fiatarone Singh, M. A. (2016). Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “active aging”. The Gerontologist, 56(Suppl_2), S268-S280.

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]

Bennie, J. A., Kolbe-Alexander, T., Seghers, J., Biddle, S. J., & De Cocker, K. (2020). Trends in Muscle-Strengthening Exercise Among Nationally Representative Samples of United States Adults Between 2011 and 2017. Journal of Physical Activity and Health, 17(5), 512-518.

Berryman, J. W. (2010). Exercise is medicine: a historical perspective. Current Sports Medicine Reports, 9(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

Biddle, S. J., Pearson, N., & Salmon, J. (2018). Sedentary behaviors and adiposity in young people: causality and conceptual model. Exercise and Sport Sciences Reviews, 46(1), 18-25. [full text]

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 Medicine, 162(2), 123-132.

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.

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.

Børg, H. W. (2018). Exercise and Diet: Different Tools for Different Jobs. Journal of American Physicians and Surgeons, 23(4), 115-120.

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.

Brannan, M.G.T. Foster, C.E. et al. (2019) Active 10 – a New Approach to Increase Physical Activity in Inactive People in England. Progress in Cardiovascular Disease.

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, (Also see the rest of this edition which is all about screening prior to exercise)

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,

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).

Campbell, J. P., & Turner, J. E. (2018). Debunking the myth of exercise-induced immune suppression: Redefining the impact of exercise on immunological Health Across the Lifespan. Frontiers in Immunology, 9, 648.

Campbell, W.W., Kraus, W.E., Powell, K.E., Haskell, W.L., Janz, K.F., Jakicic, J.M., Troiano, R.P., Sprow K, Torres, A., Piercy, K.L., Bartlett, D.B. and 2018 Physical Activity Guidelines Advisory Committee. (2019) High-Intensity Interval Training for Cardiometabolic Disease Prevention. Med Sci Sports Exerc. 51(6):1220-1226. DOI: 10.1249/MSS.0000000000001934

Candio, P., Meads, D., Hill, A. J., & Bojke, L. (2020). Modelling the impact of physical activity on public health: A review and critique. Health Policy, 124(10), 1155-1164.

Caspersen, C. J., Powell, K. E., and Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 100, 126–131

Celis-Morales, C. A., Welsh, P., Lyall, D. M., Steell, L., Petermann, F., Anderson, J., ... & Pell, J. P. (2018). Associations of grip strength with cardiovascular, respiratory, and cancer outcomes and all cause mortality: prospective cohort study of half a million UK Biobank participants. BMJ, 361, k1651.

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:

Churchward-Venne, T. A., Tieland, M., Verdijk, L. B., Leenders, M., Dirks, M. L., de Groot, L. C., & Van Loon, L. J. (2015). There are no nonresponders to resistance-type exercise training in older men and women. Journal of the American Medical Directors Association, 16(5), 400-411.

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 Activity, 14(58)

De Cocker, K, Teychenne, M. White, R.L., Bennie, J. (2020) Adherence to aerobic and muscle-strengthening exercise guidelines and associations with psychological distress: A cross-sectional study of 14,050 English adults. Preventive Medicine Volume 139, October 2020, 106192

de Souto Barreto, P. (2015). Time to challenge public health guidelines on physical activity. Sports Medicine, 45(6), 769-773.

de Souto Barreto, P. (2015). Global health agenda on non-communicable diseases: has WHO set a smart goal for physical activity?. BMJ, 15.

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 Exercise, 28, 1-10.

Després, J. P. (2016). Physical Activity, Sedentary Behaviours, and Cardiovascular Health: When Will Cardiorespiratory Fitness Become a Vital Sign?. Canadian Journal of Cardiology, 32(4), 505-513.

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 Lancet.

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.

Dipietro, L., Campbell, W. W., Buchner, D. M., Erickson, K. I., Powell, K. E., Bloodgood, B., … Olson, R. D. (2019). Physical Activity, Injurious Falls, and Physical Function in Aging. Medicine & Science in Sports & Exercise, 51(6), 1303–1313.

Ekblom-Bak, E., Ekblom, B., Vikström, M., de Faire, U., & Hellénius, M. L. (2013). The importance of non-exercise physical activity for cardiovascular health and longevity. Br J Sports Med, bjsports-2012.

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 Lancet. [full text]

Ekelund, U., Tarp, J., Steene-Johannessen, J., Hansen, B. H., Jefferis, B., Fagerland, M. W., ... & Larson, M. G. (2019). Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: systematic review and harmonised meta-analysis. BMJ, 366, l4570. doi:

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

El-Kotob, R., Ponzano, M., Chaput, J.-P., Janssen, I., Kho, M. E., Poitras, V. J., … Giangregorio, L. M. (2020). Resistance training and health in adults: an overview of systematic reviews. Applied Physiology, Nutrition and Metabolism, 179, S165-S179.

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. [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.

Farrell, L., Hollingsworth, B., Propper, C., & Shields, M. A. (2014). The socioeconomic gradient in physical inactivity: evidence from one million adults in England. Social Science & Medicine, 123, 55-63.

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

Foster, C., & Armstrong, M. (2018). What types of physical activities are effective in developing muscle and bone strength and balance. Journal of Frailty, Sarcopenia and Falls, 3(2), 58-65. DOI:10.22540/jfsf-03-058

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Hamer, M., O’Donovan, G., Lee, I. M., & Stamatakis, E. (2017). The ‘weekend warrior’physical activity pattern: how little is enough? (also see O'Donovan et al 2017)

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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]

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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 Activity, 13(1), 36.

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]

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Kujala, U. M. (2018). Is physical activity a cause of longevity? It is not as straightforward as some would believe. A critical analysis. Br J Sports Med, 52(14), 914-918.

Kang, M., & Rowe, D. A. (2015). Issues and challenges in sedentary behavior measurement. Measurement in Physical Education and Exercise Science, 19(3), 105-115.[full text]

Katzmarzyk, P. T. (2010). Physical activity, sedentary behavior, and health: paradigm paralysis or paradigm shift?. Diabetes, 59(11), 2717-2725.

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 Med, 8, e57873. [researchgate] [see Malhotra et al, 2015 for original article]

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

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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]

Kujala U.M. (2018) Is physical activity a cause of longevity? It is not as straightforward as some would believe. A critical analysis. Br J Sports Med

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. (click here for the insightful rapid responses/comments)

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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.

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Image from Mcleod, et al (2019). Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease. Frontiers in Physiology, 10, 645. DOI: 10.3389/fphys.2019.00645

Mcleod, J. C., Stokes, T., & Phillips, S. M. (2019). Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease. Frontiers in Physiology, 10, 645. DOI: 10.3389/fphys.2019.00645

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Comparison of Exercise Guidelines from Leading Organisations

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

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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]

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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.

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Phillips, B. E., Kelly, B. M., Lilja, M., Ponce-González, J. G., Brogan, R. J., Morris, D. L., ... & Rooyackers, O. (2017). A Practical and Time-efficient high-intensity interval Training Program Modifies cardio-Metabolic risk Factors in adults with risk Factors for Type ii Diabetes. Frontiers in Endocrinology, 8, 229.

Phillips, S.M. and Joyner, M.J. (2018) Out-running ‘bad’ diets: beyond weight loss there is clear evidence of the benefits of physical activity Br J Sports Med

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Piggin, J. (2020). What is physical activity? A holistic definition for teachers, researchers and policy makers. Frontiers in Sports and Active Living, 2, 72.

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]

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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.

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

Robertson-Wilson, J., & Fortier, M. (2017). Exercise is...?: A commentary response. Journal of Sport and Health Science, 6(1), 52-53.

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Ross, L. M., Porter, R. R., & Durstine, J. L. (2016). High-intensity interval training (HIIT) for patients with chronic diseases. Journal of Sport and Health Science, 5(2), 139-144.

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 Outcomes, 5(1), 68.

Schoenfeld, B., & Dawes, J. (2009). High-intensity interval training: Applications for general fitness training. Strength & Conditioning Journal, 31(6), 44-46.

Sedentary Behaviour Research Network. (2012) Letter to the editor: standardized use of the terms “sedentary” and “sedentary behaviours”. Appl Physiol Nutr Metab. 37(3):540–2 DOI: 10.1139/h2012-024

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.

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Stamatakis, E., Lee, I. M., Bennie, J., Freeston, J., Hamer, M., O'Donovan, G., ... & Mavros, Y. (2017). Does strength promoting exercise confer unique health benefits? A pooled analysis of eleven population cohorts with all-cause, cancer, and cardiovascular mortality endpoints. American Journal of Epidemiology. Vol.187, No. 5: 1102–1112,

Stamatakis E, Ekelund U, Ding D, Hamer, M, Bauman, A E and Lee, I-M (2018) Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings Br J Sports Med doi:10.1136/bjsports-2018-099131

Stamatakis, E., Hang, B. H., Maher, C., Thogersen-Ntoumani, C., Stathi, A., Dempsey, P., ... & Daley, A. J. (2020). Untapping the health enhancing potential of vigorous intermittent lifestyle physical activity (VILPA): rationale, scoping review, and a 4-pillar research framework. Sports Medicine.

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Further Resources

WHO (2010). Global recommendations on physical activity for health. [full text]
The National Physical Activity Plan Alliance hosted an informational webinar about the updated Physical Activity Guidelines for Americans on November 13th, 2018. Watch it above or find where it is posted online.