AHA.18: US government updates physical activity guidelines for first time since 2008

The American Heart Association and U.S. Department of Health and Human Services (HHS) released the second set of federally recommended physical activity guidelines Nov. 12—the first update in a decade and one that heavily emphasizes the physical, mental and medical benefits of exercise.

“The AHA has long recognized the importance of physical activity as a proven and effective way to lower the chances of heart disease and live a longer, healthier life,” Ivor Benjamin, MD, president of the AHA, told media. “Unfortunately, research has found only 26 percent of men, 19 percent of women and 20 percent of adolescents report enough activity to meet the physical activity recommendations.

“This is of particular concern to the AHA, because low physical activity, combined with excessive sedentary behavior, can impact the most prevalent and expensive medical conditions, including heart disease and stroke.”

The second edition of the Physical Activity Guidelines for Americans, presented at this year’s Scientific Sessions by Admiral Brett P. Giroir, MD, the assistant secretary for health at HHS, focuses on a broad database of evidence collected since 2008. 

What’s changed and what hasn’t

Though the team behind this year’s recommendations considered an expansive pool of new evidence, exercise guidelines for adults and children aged 6 through 17 remained largely the same. For children, that means at least an hour of moderate-to-vigorous activities like walking, running or “anything that makes their hearts beat faster” each day. The guidelines also recommend strength and muscle conditioning for kids in the form of climbing on playground equipment or jumping rope.

As for adults, experts still recommend anywhere between 150 and 300 minutes of moderately intense aerobic activity, like power walking or dancing, each week in addition to two days of strength training. As a whole, recommendations for seniors also stayed the same.

The new guidelines expanded on recommendations for preschoolers aged 3 through 5, who Giroir and colleagues said should be active throughout the day to enhance growth and development. They recommend at least three hours of activity a day, ideally in a variety of settings.

A breadth of new evidence

According to Giroir, new data allowed the guideline committee to take into account a series of unique health considerations. We’re now more aware of the extensive health benefits that come with physical activity, as well as the risks associated with being sedentary.

Sedentary behavior, in particular, was a major talking point for this year’s guidelines. The first key recommendation for adults is to “move more and sit less”—a tip based in evidence that increased sedentary behavior leads to more heart disease, high blood pressure and all-cause death. Giroir also underlined the fact that evidence now suggests exercise has immediate health benefits, including reducing anxiety and blood pressure, improving sleep quality and increasing insulin sensitivity.

The new guidelines also account for unique patient populations, like pregnant women and those with chronic health conditions or disabilities. Those groups are advised to aim for 150 minutes of physical activity a week and should consult with their specialists before beginning any kind of training program.

The case for less rigidity

If Giroir was clear on one thing about this year’s guidelines, it's that they’re easy to follow.

“This edition tells us that it’s easier to achieve the recommendations in the physical activity guidelines,” he said. “Opposed to everything being harder and harder and harder, it is actually easier to achieve the recommendations in the physical activity guidelines. Everyone can dramatically improve their health just by moving, anytime, anywhere and by any means that gets you active.”

The recommendations outline the fact that any amount of physical activity does have at least some health benefit—something physicians didn’t always believe. The first edition of the Physical Activity Guidelines for Americans stated that physical activity only “counted” toward meeting recommendations if it was completed in bouts of 10 minutes or more. The new guidelines remove that requirement “to encourage Americans to move more frequently throughout the day as they work toward meeting the guidelines.”

Moving forward

It’s one thing to publish the guidelines, Giroir said, but another entirely to implement them. And it’s not just individuals whose lives are being shaped by their physical actions—the country can suffer, too.

“Lack of physical activity is also a threat to our national security, because obesity disqualifies nearly one-third of American youths aged 17 to 24 years for military service,” Giroir said. And that’s in addition to the young adults who are unable to enroll because of substance abuse or a lack of education.

The new guidelines also push for preventive action, encouraging schools to step up and promote active movement before, during and after school and to enrich their physical education programs.

“When you look on average, only about 20 percent of our overall health is due to the specific medical care that we get,” he said. “So much more is due to behaviors, like smoking, lack of activity, substance use disorders that lead to adverse health outcomes. So much is due to social determinants of health, the economic situation, the lack of employment, the lack of schools, safe sidewalks, etc. So there needs to be an overall national change.”