Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association

William L. Haskell; I-Min Lee; Russell R. Pate; Kenneth E. Powell; Steven N. Blair; Barry A. Franklin; Caroline A. Macera; Gregory W. Heath; Paul D. Thompson; Adrian Bauman

Disclosures

Med Sci Sports Exerc. 2007;39(8):1423-1434. 

In This Article

Abstract and Introduction

Summary: In 1995 the American College of Sports Medicine and the Centers for Disease Control and Prevention published national guidelines on Physical Activity and Public Health. The Committee on Exercise and Cardiac Rehabilitation of the American Heart Association endorsed and supported these recommendations. The purpose of the present report is to update and clarify the 1995 recommendations on the types and amounts of physical activity needed by healthy adults to improve and maintain health. Development of this document was by an expert panel of scientists, including physicians, epidemiologists, exercise scientists, and public health specialists. This panel reviewed advances in pertinent physiologic, epidemiologic, and clinical scientific data, including primary research articles and reviews published since the original recommendation was issued in 1995. Issues considered by the panel included new scientific evidence relating physical activity to health, physical activity recommendations by various organizations in the interim, and communications issues. Key points related to updating the physical activity recommendation were outlined and writing groups were formed. A draft manuscript was prepared and circulated for review to the expert panel as well as to outside experts. Comments were integrated into the final recommendation.
Primary Recommendation: To promote and maintain health, all healthy adults aged 18 to 65 yr need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week. [I (A)] Combinations of moderate- and vigorous-intensity activity can be performed to meet this recommendation. [IIa (B)] For example, a person can meet the recommendation by walking briskly for 30 min twice during the week and then jogging for 20 min on two other days. Moderate-intensity aerobic activity, which is generally equivalent to a brisk walk and noticeably accelerates the heart rate, can be accumulated toward the 30-min minimum by performing bouts each lasting 10 or more minutes. [I (B)] Vigorous-intensity activity is exemplified by jogging, and causes rapid breathing and a substantial increase in heart rate. In addition, every adult should perform activities that maintain or increase muscular strength and endurance a minimum of two days each week. [IIa (A)] Because of the dose-response relation between physical activity and health, persons who wish to further improve their personal fitness, reduce their risk for chronic diseases and disabilities or prevent unhealthy weight gain may benefit by exceeding the minimum recommended amounts of physical activity. [I (A)]

In 1995 the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) issued a public health recommendation that "Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week".[49] The purpose of the recommendation was to provide a "clear, concise, public health message" that would "encourage increased participation in physical activity" by a largely sedentary US population.

More than 10 years have passed since this recommendation was issued. New science has added to our understanding of the biological mechanisms by which physical activity provides health benefits and the physical activity profile (type, intensity, amount) that is associated with enhanced health and quality of life. The intent of the original recommendation, however, has not been fully realized. Physical inactivity remains a pressing public health issue. Technology and economic incentives tend to discourage activity, technology by reducing the energy needed for activities of daily living, and economics by paying more for sedentary than active work.

In addition, there are people who have not accepted, and others who have misinterpreted, the original recommendation. Some people continue to believe that only vigorous-intensity activity will improve health while others believe that the light activities of their daily lives are sufficient to promote health.[53] Compounding these challenges, physical activity recommendations have been published in the interim that could be interpreted to be in conflict with the 1995 recommendation.[4,26,57,71]

Favorable trend data from 1990 to 2004 in the United States based on the CDC Behavioral Risk Factor Surveillance System indicate that over time fewer men and women reported no leisure-time physical activity.[13] The prevalence of leisure-time physical inactivity remained fairly constant through 1996, but more recently has declined in both genders (Fig. 1). In 2005 23.7% of adults reported no leisure-time activity.[14]

Prevalence of no reported leisure-time physical activity among U.S. men and women, 1990-2005.

However, there remains a broad range of evidence to underscore concern that US adults are still not active enough. For example, data from 2005 indicate that less than half (49.1%) of U.S. adults met the CDC/ACSM physical activity recommendation.[12] Men were more likely to meet the recommendation (50.7%) than women (47.9%). For men and women combined, younger people were more likely to be active than older people, with the prevalence of those meeting the recommendation declining from 59.6% among those 18-24 yr of age to 39.0% among those 65 years and older (Fig. 2). White, non-Hispanics (51.1%) were most likely to meet the recommendation followed by "other" racial or ethnic groups (46.3%), Hispanics, (44.0%) and African-Americans (41.8%). Persons with a college degree were the most likely to meet the recommendation (53.2%) followed by those with some college education (50.2%), a high school education (45.9%), and less than high school (37.8%).

Prevalence of U.S. men and women meeting the CDC/ACSM physical activity recommendations by age, 2005.

Disease outcomes inversely related to regular physical activity in prospective observational studies include cardiovascular disease, thromboembolic stroke, hypertension, type 2 diabetes mellitus, osteoporosis, obesity, colon cancer, breast cancer, anxiety and depression.[33] Scientific evidence continues to accumulate, with more recent efforts focused on the nature of the relation between physical activity and health, rather than trying to determine if such a relation exists.[33] This additional evidence includes compelling new data on women,[21,39,40] and more conclusive evidence on stroke,[77] some cancers,[69] and cognitive function.[78,83] The primary limitation of much of the data linking physical activity to morbidity and mortality due to chronic diseases is that for many conditions few randomized trials of adequate design have been conducted. However, this situation is not all that different from data regarding the relation between some other health-related behaviors and clinical outcomes, such as cigarette smoking or saturated fat intake and coronary heart disease (CHD). No adequately designed randomized controlled study in the general population has shown that stopping smoking or decreasing saturated fat or trans-fatty acid intake significantly decreases CHD mortality yet getting the public to stop smoking or reduce their intake of saturated fat or trans-fatty acids are major components of national public health campaigns.[50]

The purpose of this report is to update the 1995 CDC/ACSM recommendation. The intent is to provide a more comprehensive and explicit public health recommendation for adults based upon available evidence of the health benefits of physical activity.

Expert Panel Process. In February 2003, an expert panel was convened and charged with reviewing and updating the original CDC/ACSM recommendation for physical activity and public health.[49] This panel, which consisted of physicians, epidemiologists, exercise scientists and public health experts, reviewed scientific advances since the publication of the original recommendation, newly issued recommendations provided by other organizations and communications issues such as clarity and consistency.

For scientific input, the panel initially relied heavily on published evidence from a meeting held in 2000 jointly sponsored by CDC and Health Canada on Dose-Response Aspects of Physical Activity and Health.[33] The conclusion and consensus statement from this meeting were based on systematic reviews of the literature. Panel members also conducted extensive searches of the literature on physical activity and health to 2006.

In addition to scientific updates, the expert panel considered issues and advances in understanding roles and strategies in communication of health messages in the update and clarification of the prior recommendations. A second CDC-Health Canada workshop on communicating physical activity messages was held in 2001 and identified several key strategies for improving the communication of physical activity recommendations.[59] A different expert panel developed a recommendation for older adults as a companion recommendation to that presented in this article.[47] Manuscripts describing the recommendation for adults generally and for older adults as a companion were circulated for comments, revised, and edited for consistency before review and approval by ACSM and the American Heart Association (AHA). For current physical activity guidelines directed at school-age youth the reader is referred to the recent publication by Strong and colleagues.[65]

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