Editorials

Physical Activity Goals for Sedentary Patients



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Am Fam Physician. 2004 Feb 15;69(4):816-818.

Fewer active persons develop coronary heart disease (CHD) than those who are sedentary, and the beneficial effects of exercise on risk factors for CHD are well documented.1 Despite this, inactive lifestyles and overeating remain the norm for most Americans, as illustrated by the rising epidemic of obesity over the past three decades.2 In response to this situation, the Institute of Medicine recently raised the bar for sedentary Americans, suggesting that we all engage in at least 60 cumulative minutes of moderate-intensity physical activity on most, and preferably all, days of the week rather than the 30 minutes suggested by other organizations.36 Besides restricting calorie intake and portion size based on each person's height, weight, and gender, increasing the cumulative duration of daily activity to 60 minutes could help reduce the risk of several chronic diseases and premature mortality.

The added benefit of increasing daily physical activity is supported by prospective data showing a graded benefit of brisk walking for more than an average of 30 minutes daily (i.e., for those walking at least three hours per week).7,8 The new recommendations suggest that 60 minutes of continuous daily activity is not necessary to derive benefit, but that the accumulated amount can be spread over a given day from several shorter episodes. For example, in one study,9 similar cardiovascular risk reduction was achieved when comparing longer versus shorter durations spent on each episode of daily exercise after accounting for a person's average weekly amount of expended energy. Initiation of a lifestyle change that includes a structured dietary approach and an episode of low-to-moderate physical activity 5 to 10 minutes a day (above a patient's baseline sedentary level) could establish modest risk reductions if ultimately ramped up to the goal of 60 cumulative minutes.

Several strategies can be used to help patients achieve the new physical activity recommendations. For example, use of a stationary bicycle for 20 to 30 minutes daily could be combined with household and occupational activities, such as walking up and down stairs once a day at work, an hour of weekly housework, and gardening for an hour per week. The accompanying table lists other activities that could be performed to achieve these goals.10 Note that vigorous activities are not necessary to achieve the recommended amount of physical activity, and that patients may be more compliant with lower intensity activities that they perceive as enjoyable.

Despite the apparent simplicity of the new recommendations, initiative and commitment from the patient are required to increase physical activity to 60 minutes daily and to maintain at that level. Starting with small, achievable steps can facilitate the adoption of the new national recommendations for physical activity and nutrition to promote health.

Active Alternatives for Sedentary Patients

Sedentary Active alternative

Desk work or watching television, seated (1 to 2 METs)

Using foot pedals while seated (3 METs)

Riding escalator, standing (2 METs)

Walking upstairs (4 METs)

Driving to work (1 to 2 METs)

Walking 3 miles per hour (3 to 4 METs)

Standing on a moving walkway (2 METs)

Cutting lawn using riding lawnmower (2 to 3 METs)

Cutting lawn using push lawn mower (3 to 5 METs)

Golfing, riding in cart (2 to 3 METs)

Golfing, carrying clubs (4 to 5 METs)

Washing car, sitting in drive-through car wash (1 to 2 METs)

Washing car by hand (6 to 7 METs)

Sitting, limited mobility (1 to 2 METs)

Swimming slowly (4 to 5 METs)

Wheelchair, sitting (1 to 2 METs)

Wheelchair, wheeling (3 to 4 METs)

Lying down, sunbathing (1 to 2 METs)

Canoeing, leisurely pace (2 to 3 METs)


MET = metabolic equivalent, or one unit of sitting/resting oxygen uptake.

Information from reference 10.

Active Alternatives for Sedentary Patients

View Table

Active Alternatives for Sedentary Patients

Sedentary Active alternative

Desk work or watching television, seated (1 to 2 METs)

Using foot pedals while seated (3 METs)

Riding escalator, standing (2 METs)

Walking upstairs (4 METs)

Driving to work (1 to 2 METs)

Walking 3 miles per hour (3 to 4 METs)

Standing on a moving walkway (2 METs)

Cutting lawn using riding lawnmower (2 to 3 METs)

Cutting lawn using push lawn mower (3 to 5 METs)

Golfing, riding in cart (2 to 3 METs)

Golfing, carrying clubs (4 to 5 METs)

Washing car, sitting in drive-through car wash (1 to 2 METs)

Washing car by hand (6 to 7 METs)

Sitting, limited mobility (1 to 2 METs)

Swimming slowly (4 to 5 METs)

Wheelchair, sitting (1 to 2 METs)

Wheelchair, wheeling (3 to 4 METs)

Lying down, sunbathing (1 to 2 METs)

Canoeing, leisurely pace (2 to 3 METs)


MET = metabolic equivalent, or one unit of sitting/resting oxygen uptake.

Information from reference 10.

An initial step on the pathway to improved compliance with the new lifestyle recommendations is raising awareness about a patient's current actual level of physical activity versus the recommended level.

The Authors

Lori Mosca, M.D., M.P.H., PhD., is director of preventive cardiology at Columbia Weill Cornell Heart Institute, New York-Presbyterian Hospital, and associate professor of medicine at Columbia University, New York.

Ronald McKechnie, M.D., is a cardiology fellow at the University of Michigan Hospitals, Ann Arbor.

Address correspondence to Lori Mosca, M.D., M.P.H., Ph.D., Director, Preventive Cardiology, New York-Presbyterian Hospital, 622 W. 168th St., New York, NY 10032. Reprints are not available from the authors.

REFERENCES

1. McKechnie RS, Mosca L. Physical activity and coronary heart disease: prevention and effect on risk factors. Cardiol Rev. 2003;11:21–5.

2. Mokdad AH, Borman BA, Ford ES, Vinicor F, Marks JS, Kaplan JP. The continuing epidemics of obesity and diabetes in the United States. JAMA. 2001;286:1195–200.

3. Dietary reference intakes for energy, carbohydrates, fiber, fat, protein and amino acids (macronutrients). The Standing Committee on the Scientific Evaluation of Dietary Reference Intakes, Food and Nutrition Board. Accessed January 22, 2004, at: http://nap.edu/books/0309085373/html. National Academies' Institute of Medicine 2002: 697–736.

4. U.S. Department of Health and Human Services. Physical activity and health: a report of the surgeon general. Atlanta, Ga.: Dept. of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, 1996.

5. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;2735:402–7.

6. NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. . Physical activity and cardiovascular health. JAMA. 1996;276:241–6.

7. Manson JE, Hu FB, Rish-Edwards JW, Colditz GA, Stampfer MJ, Willett WC, et al. A prospective study of walking as compared with vigorous exercise in the prevention of coronary heart disease in women. N Engl J Med. 1999;341:650–8.

8. Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. 2002;347:716–25.

9. Lee I, Sesso HD, Paffenbarger RS Jr. Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk?. Circulation. 2000;102:981–6.

10. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training. A statement for healthcare professionals from the American Heart Association. Circulation. 2001;104:1694–740.



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