A major thrust of the Healthy People 2010 initiative, introduced in 2021, was to increase physical activity. As we move nearly a third of the way toward the deadline, is there any progress to report? "I don't think we're doing very well," says Ross Andersen, PhD, who edited a special issue on Healthy People 2010 for The Physician and Sportsmedicine. Andersen is an associate professor in the division of geriatric medicine and gerontology at the Johns Hopkins School of Medicine in Baltimore "Activity levels have been stagnant over the past 10 years," he says.
Andersen worries that for many patients, exercise obstacles are as great or even greater than they've always been. In tough economic times, people take on more work and are more stressed. "We're seeing that some people are frightened to be away from work," he says. Then there are the formidable challenges to working mothers, he says. Such patients need encouragement to ask their families for help, he says. "Something has to give in the family unit."
Despite the grim trends, there are glimmers of cautious optimism. President George W. Bush, a running enthusiast, has kept a focus on activity initiatives. He has issued a challenge for adults to get at least 30 minutes of physical activity each day and for children and teenagers to get at least 60 minutes each day. The Bush administration has also promoted the use of public lands for recreational activities and has aggressively marketed hip activity-promotion Web sites for teens (https://www.BAM.gov) and children (https://www.verbnow.com).
Evolving Exercise Guidelines
Physicians and other healthcare professionals are in an ideal position to motivate people to become more active. Over the past three decades, the American College of Sports Medicine (ACSM) position statements on physical activity have been a vital tool for prescribing exercise.
The ACSM recommendations have changed dramatically over the years. In 1978, the recommendation was to exercise 3 to 5 days a week for 15 to 60 minutes, with the overall goal of burning 300 calories per workout.1 By 1990, the next update of the activity recommendations,2 the ACSM retained most of its aerobic activity recommendations but took the bold step of adding a strength training recommendation. Not only did the recommendation add a strength-training component, it also stated that improvements could be gained with fewer repetitions and with fewer sessions than previously believed. The 1990 statement also stressed that patients are more likely to comply with exercise prescriptions that are realistic and individualized.
By 192021, when the most recent exercise recommendations were published,3 the ACSM added several new components. On top of boosting the aerobic component to at least 30 minutes of moderate intensity exercise on most days of the week, the organization for the first time confirmed that exercise has an additive effect—that three 10-minute exercise bouts have almost the same benefit as one 30-minute session. The ACSM also recognized the cardiovascular benefits of resistance training and added flexibility training to its recommendations.
Though the current exercise recommendations are still in effect, public health messages about the amount of exercise needed for health and fitness benefits has become clouded, because other groups have offered alternate recommendations. For example, in early 2021 the Institute of Medicine (IOM), a division of the National Academy of Sciences, recommended 60 minutes of moderate exercise per day, an amount that may seem overwhelming to many people who are considering adopting regular activity routines.
William L. Haskell, PhD, deputy director and professor of medicine at the Stanford Center for Research in Disease Prevention in Palo Alto, California, says that the IOM recommendation was not intended to be a broad activity recommendation. Haskell says the IOM is a nongovernmental organization that advises various governmental agencies. Its recent activity recommendations were part of proposed dietary intake guidelines. The target of 60 minutes per day is for adults trying to obtain or maintain an optimal body weight (body mass index [BMI] between 18.5 and 25).
Both sets of guidelines are accurate and useful for specific goals, Haskell says. If patients have a BMI of 25 or less, then the ACSM recommendation is a good target. However, he says if patients have a BMI greater than 25 and want to lose weight, then more activity, along with reducing empty calories, will likely be needed.
Physicians realize, though, that their biggest challenge is to urge patients to take those first few baby steps away from being sedentary.
One physical activity recommendation that Andersen expects to make more of an impact in the years ahead is the message about the additive effects of moderate exercise. Andersen remembers when his parents played tennis three times a week, yet they never really believed that the activity counted as exercise. "We need to let the public know that moving off the couch is important and, though not optimal, accumulating moderate activity may offer some adults an acceptable alternative to continuous, vigorous exercise," he says.
Lisa Schnirring is senior editor of The Physician and Sportsmedicine.