Physical Activity Guidelines 

Find out about the latest UK Physical Activity Guidelines here - https://www.gov.uk/government/collections/physical-activity-guidelines 

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; Izquierdo et al 2021), children with disabilities (OHID/DHSC, 2022)

• 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?

• How do they differ when it comes to recommending physical activity for people with chronic conditions? (Dempsey et al, 2020) 

• Is exercise medicine? (Berryman et al, 2010; Eijsvogels & Thompson, 2015; Lieberman, 2015; Pedersen & Saltin, 2015; MacAuley et al, 2016; Nunan, 2016)

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 active are people? (e.g. Garcia-Hermoso et al, 2023)

• 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? (e.g. Diabetes, Smith et al, 2016)

• What differences are there between ethnic origin groups and their activity levels and physical responses to the same amount of activity/exercise? (Biddle et al, 2019; Muilwijk et al, 2018)

• What is the dose-response (duration & intensity) for activity and health and why the cut-off points?  (e.g. Ekelund et al, 2019; Ekelund et al, 2020)

• 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) (e.g. Ahmadi et al, 2022)

• 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?

• What are the effects of physical exercise on cognitive functioning? (e.g. Mandolesi et al, 2018, Kirk-Sanchez et al 2014)

• What are the effects of physical activity on mental health and wellbeing? (e.g. Singh et al, 2023)

• 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 research exists and where are the gaps in this area? (e.g. Ramirez Verlea et al, 2021, Izquierdo et al, 2021)

• What is the relationship between pain and physical activity? (e.g. Ray et al, 2023)

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? (see Ch 2, Gill, The nature of the evidence in Stensel et al, 2021)

• What are the issues around measuring health? 

• How might analysis methods impact 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? 

• Measuring total or leisure time PA alone may miss critical patterns in other domains affected by sociodemographic factors. How might effective physical activity interventions take into account how different populations accumulate PA & where inequalities exist? (e.g. Gage et al, 2023)

• How can differences in measurement and analysis occur? (Stamatakis, et al, 2021) 

• Also see Strain et al, 2020; Matthews et al, 2020

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

• Does strength exercise confer unique health benefits? (e.g. Ashton et al, 2020, Abou Sawan et al 2023)

• 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 Abou Sawan et al 2023, 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? (e.g. Reid et al, 2021)

• What are the injury rates for those that are physically active? 

• Does too much exercise reduce immune function (see Simpson et al, 2020)

• Does running increase the likelihood of osteoarthritis? (See Chakravarty et al, 2008)

• Also see Coenen et al, 2018; Julian et al, 2021; Bouchard et al, 2012; Arem et al, 2015; Eijsvogels et al, 2016

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? How much is screen time a problem? (e.g. Przybylski et al, 2020)

• 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?

• What do we know about PA messaging (e,g, Williamson et al, 2021)

• What do we know about using step counts? (e.g. Paluch et al 2022) 

• 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)

• To what degree are our activity behaviours malleable? What are the evolutionary dynamics? (see Cheval et al, 2018; Lieberman (2020) "Exercised")

• What is meaningful exercise and how to communicate this to the greatest amount of people (see Ekkekakis, 2012)

• How can a knowledge translation strategy play a part in the development of PA guidelines? (Warburton & Bredin, 2018, Polster et al, 2021)

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

• Do PA Guidelines take social inequalities into consideration? (see Kay, 2017)

• How does the communication of guidelines work for different sub-populations like people with disabilities? (See Smith et al, 2018; Smith et al, 2021) 

Communicating the guidelines

• Who needs to know the guidelines? (e.g. Mutrie et al 2018)

• Is awareness raising enough to facilitate a change in PA behaviour?

• Should true social marketing principles be followed in any broader communications campaign? (e.g. Chau et al 2017)

• What are the key differences in messaging content and delivery for the general public and professionals? (e.g. Hollman et al, 2022) 

• How are the needs of under-served communities met in the guidelines? (e.g. Nobles et al 2020)

• Are loss or gain framed messages the most effective? (e.g. Williamson et al 2020)

(NB: Please tweet me or email if you have any more to add) (thanks to @PHjohnb for the communication prompts and references - Jan 2021)

Recommended Key Reading

Two articles to get started

These are two good articles to get you started on this body of work, to focus your reading. Both have some of the most used evidence in them but also content and ideas that should stimulate a level of critical thinking:

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). https://doi.org/10.1016/B978-0-12-811279-3.00013-6  

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. http://dx.doi.org/10.1136/bjsports-2017-098639

Other key reading

Chief Medical Officers for England, Northern Ireland, Scotland and Wales (2019) UK Chief Medical Officers' Physical Activity Guidelines. London: Crown. Retrieved from https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report  [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)

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. https://doi.org/10.1080/08870446.2017.1325486

Stamatakis, E., Ding, D., Ekelund, U., Bauman, A.E. (2021) Sliding down the risk factor rankings: reasons for and consequences of the dramatic downgrading of physical activity in the Global Burden of Disease 2019 British Journal of Sports Medicine https://doi.org/10.1136/bjsports-2021-104064  

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. https://doi.org/10.1097/HCO.0000000000000437  [video abstract]

A special edition of Applied Physiology, Nutrition, and Metabolism covering the research behind the Canadian 2020 Guidelines https://cdnsciencepub.com/toc/apnm/45/10+%28Suppl.+2%29 

Books/Textbooks/Chapters

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.

Bornstein, D. B., Eyler, A. A., Maddock, J. E., & Moore, J. B. (Eds.). (2019). Physical activity and public health practice. Springer Publishing Company. [Ch 1] [podcasts]

Stensel, D.J., Hardman, A.E. and Gill, J.M.R. (2021) Physical Activity and Health: The Evidence Explained. (3rd Ed) Routledge. [companion website] 

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

Foreman, J. (2019). Exercise is Medicine: How Physical Activity Boosts Health and Slows Aging. Oxford University Press. https://global.oup.com/academic/product/exercise-is-medicine-9780190685461 

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. https://core.ac.uk/download/pdf/153398096.pdf 

Lieberman, D. (2020). Exercised: The Science of Physical Activity, Rest and Health. Penguin UK. [book review]

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. https://doi.org/10.1007/978-3-319-71291-8_30  

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). https://doi.org/10.1016/B978-0-12-811279-3.00013-6 

Wasfy, M. M., & Baggish, A. L. (2019). Truth About Physical Fitness and Risk of Acute Myocardial Infarction: The HUNT Is On. Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, 8(9). https://doi.org/10.1161/JAHA.119.012567 

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

Journal Articles

Abou Sawan, S., Nunes, E. A., Lim, C., McKendry, J., & Phillips, S. M. (2023). The Health Benefits of Resistance Exercise: Beyond Hypertrophy and Big Weights. Exercise, Sport, and Movement, 1(1), e00001. https://doi.org/10.1249/ESM.0000000000000001 

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]

Ahmadi, M. N., Clare, P. J., Katzmarzyk, P. T., del Pozo Cruz, B., Lee, I. M., & Stamatakis, E. (2022). Vigorous physical activity, incident heart disease, and cancer: how little is enough?. European Heart Journal. https://doi.org/10.1093/eurheartj/ehac572 

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., 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 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

Ashton, R. E., Tew, G. A., Aning, J. J., Gilbert, S. E., Lewis, L., & Saxton, J. M. (2020). Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis. British journal of sports medicine, 54(6), 341-348.  http://dx.doi.org/10.1136/bjsports-2017-098970  

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

Banach, M., Lewek, J., Surma, S., Penson, P.E., Sahebkar, A., Martin, S.S., Bajraktari, G., Henein, M.Y., Reiner, Ž., Bielecka-Dąbrowa, A., Bytyçi, I. (2023) The association between daily step count and all-cause and cardiovascular mortality: a meta-analysis, European Journal of Preventive Cardiology,zwad229, https://doi.org/10.1093/eurjpc/zwad229 

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. 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., 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.  https://doi.org/10.1093/geront/gnw031 

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.  https://doi.org/10.1123/jpah.2019-0472 

Berryman, J. W. (2010). Exercise is medicine: a historical perspective. Current Sports Medicine Reports, 9(4), 195-201.[full text]

Biddle, G. J., Edwardson, C. L., Rowlands, A. V., Davies, M. J., Bodicoat, D. H., Hardeman, W., ... & Yates, T. (2019). Differences in objectively measured physical activity and sedentary behaviour between white Europeans and south Asians recruited from primary care: cross-sectional analysis of the PROPELS trial. BMC Public Health, 19(1), 1-12. https://doi.org/10.1186/s12889-018-6341-5  

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

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. 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

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 

Børg, H. W. (2018). Exercise and Diet: Different Tools for Different Jobs. Journal of American Physicians and Surgeons, 23(4), 115-120. http://www.jpands.org/vol23no4/borg.pdf 

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.

Bouchard, C., Blair, S. N., Church, T. S., Earnest, C. P., Hagberg, J. M., Häkkinen, K., ... & Rankinen, T. (2012). Adverse metabolic response to regular exercise: is it a rare or common occurrence?. PloS one, 7(5), e37887. https://doi.org/10.1371/journal.pone.0037887 

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. https://doi.org/10.1016/j.pcad.2019.02.001 

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)

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/

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