National agenda: exercise standards - National Recreation and Park Association's Active Living/Healthy Lifestyles program

Our purpose in this article is to illustrate how the new ACSM/CDC recommendations are indeed consistent with achieving desirable health outcomes. We also want to suggest how this measure may be utilized most appropriately to educate and promote physical activity among sedentary Americans.

Americans are sedentary

and at risk

In spite of the mistaken belief that there has been a fitness revolution in the United States, the most recent evidence suggests that only about 22% of Americans engage regularly in physical activity that would produce a health benefit. that health burden of a sedentary society has been well documented. Thus, there is a substantial need to devise multiple approaches aimed at increasing the level of physical activity among Americans who are the least active. In fact, just recently the American Heart Association has added physical inactivity as the fourth major controllable risk factor for coronary heart disease, in addition to smoking, high blood pressure and high cholesterol.

Have Americans adopted

optimal activity levels?

None of us will change the premise that individuals who exercise more often, at higher intensity and for longer periods will accrue the greatest benefits. the past 25 years of research has made that clear. These are desirable goals and made consistent with what we have all been promoting for decades - but with what degree of success? It is clear from the available data that we have not been successful in convincing the majority of Americans, nearly 80%, to participate at these desirable levels. After decades of promoting physical activity by the media, government and health promotion groups, what have we learned? We have learned that we need a different strategy if we are going to have a significant impact on physical activity levels of the vast majority of Americans. Up to now, they have resisted the structured approach to acquiring maximum benefits, which requires exercise at an intensity of 60% to 90% of the maximal heart rate, for a minimum of 20 minutes, least three times per week. It simply has not worked.

Community strategies are

needed to increase activity in

less-active Americans

The majority of Americans are unlikely to attend a spa, gym or health club. In addition, a sedentary lifestyle is most prevalent among the less-educated and those in the lower socioeconomic strata. They are harder to reach with our traditional methods. We should not expect everyone to move to the highest levels of fitness immediately. Our objective should be to get the sedentary to become moderately active and the moderately active to become vigorously active. Even low levels of physical activity may elicit improved health, functional benefits and fitness improvements among those who are least active. In other words, our short-term goal should not be to elevate 100% of Americans to the ideal but, rather, to move each group upward from one physical activity level to the next.

The meaning of Exercise Lite

Proper interpretation for the actual activity threshold indicated by Exercise Lite is a point of considerable importance. Consider that the recommendation is to "accumulate 30 minutes or more of moderate-intensity physical activity on most preferably all, days of the week." This equates with a brisk walk or other activity with a similar metabolic cost, performed to accumulate a distance of two or more miles per day. Another way to demonstrate the health goal of the activity plan for the most sedentary individuals is to point to out the need to accumulate activity that adds an energy expenditure of no less than 200 calories per day and results in a total of 1,000 to 1,400 calories in any seven-day period. It is somewhat surprising to compare the foregoing values to the minimums derived from the benchmarks we have used for so many years. Consider that the ACSM position stand advocates 20 to 60 minutes of moderate to vigorous endurance exercise, performed at 60% to 90% of the maximal heart rate, three days per week. the low end of this range would suggest that some aerobic conditioning benefit begins to accrue at 1,020 calories per week (accepting approximately 7 calories per minute as vigorous, performed 20 minutes per day for three days week) - a level fully consistent with the advocated Exercise Lite.

Guidelines for communicating

Exercise Lite to the public

Health and fitness professionals have unique opportunities to educate and motivate. Speeches given before employee groups at the work site, as well as service and social groups, are opportunities to improve awareness, educate and explain appropriate ways to apply Exercise Lite in different settings. Media interviews represent another valuable opportunity. Many in these audiences include those who are most in need of understanding the health implications of physical inactivity and what is meant by their potential to act on the recommendations of Exercise Lite. Some already may be contemplating starting physical activity. Others may be responsive to new alternatives, having previously experienced insurmountable start-up difficulties with structured and vigorous approaches. In these efforts, we believe that professionals can have a great effect. The following factors may be helpful in presenting the message:

1) American adults at the low end of the physical activity continuum should begin performing, almost on a daily basis, a combination of sustained or intermittent muscular activities that are systematically integrated into their routine. 2) Proper application of the physical activity dose-responded curve for this subgroup of the population suggests that the relative gains in function, disease prophylaxis, aerobic fitness and emotive-psychological benefits should be far greater than the gains that may be made by those who are initially more fit and are advancing their activity status at the upper levels of the dose-responsive curve. 3) Since the intensity recommended is for moderate, rather than vigorous, activity, these sedentary individuals should be exposed to less risk of activity-related injuries and health complications, and less likely to need individualized physician's evaluations before starting. Certainly, these factors will not pose the degree of concern that faces the sedentary middle-aged individual who tries to start at the vigorous point of the dose-responsive curve. 4) From the outset, those who follow Exercise Lite should be encouraged to do more than the minimum. Current research evidence is not precise on the optimal level of aerobic activity or cardiorespiratory fitness that, for example, is needed to reduce risks for premature coronary heart disease - the optimal level likely is somewhat higher than the high end of the Exercise lite recommendation of 1,4000 5) Exercise Lite does not contradict what we have learned from scientific research and prior professional experience about the quantity and quality of exercise needed to develop aerobic fitness. It does not encompass what individuals need to do to maintain muscular strength or flexibility, nor does it by omission seek to diminish the importance of these essential fitness components. Strength and flexibility should continue to be viewed as important for performance activities for daily living. they have inherent value relative to health, and are highly desirable for minimizing injury potential and enhancing quality and enjoyment for those who follow highly vigorous lifestyles.

References

[1.] Pate, R.R., et.al. Physical activity and public health: A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. Journal of the American Medical Association. 1995; 273:402-407. [2.] U.S. Department of Health and Human Services. Healthy People 200. National Health Promotion and Disease Prevention Objectives. Washington, DC: USD-HHS; 1991, DHHS publication PHS 91-50212. [3.] Powell, K.E., & S.N. Blair The Public health burdens of sedentary living habits: Theoretical but realistic estimates. Medicine and Science in Sports and Exercise. 1993; 26(7):851-856. [4.] Morris, J.N., Exercise in the prevention of coronary heart disease: Today's best buy in public health. Medicine and Science in Sports and Exercise. 1993: 26(7):807-814. [5.] Fletch, G.F, et.al. Statement on exercise: Benefits and recommendations for physical activity programs for all Americans. Circulation. 1992; 86(l):340-344. [6.] American College of Sports Medicine. Position stand on the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness in health adults. Medicine and Science in Sports and Exercise. 1992; 22(7):265-274.

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