Exercise Guidelines for Health: Official Recommendations
Stan Reents, PharmD
07/18/2012 10:42 AM
Last Revision: 03/21/2022 01:20 PM
So you decided to get back into shape. That's good! However, you may not know how much exercise you need to reach your goal. You might be thinking that you have to run 5 miles per day, or, you have to join a gym so you can lift weights. It turns out that this may not be necessary.
BENEFITS OF EXERCISE
Before you can determine how much you need to exercise, the first question that must be answered is: what is your goal? Different goals require different exercise programs:
- improve quality-of-life (eg., for older adults)
- improve health (eg., for sedentary people)
- improve fitness (eg., for otherwise healthy & active people)
- improve athletic performance (eg., for serious athletes)
For example, if your goal is to run a 10-K in under 40 minutes, you'll need to exercise (train) a lot differently than if your goal is to lower your risk of a heart attack.
If your goal is to improve your health or just your quality-of-life (ie., the ability to do daily tasks), you don't have to exercise very hard. And you don't have to join a gym either! This review will summarize how much exercise is needed to improve and maintain your health. (Exercise guidelines for persons with specific diseases such as diabetes, hypertension, etc. are not reviewed here. These topics are discussed in other reviews in the Articles Library.)
HISTORY OF "OFFICIAL" RECOMMENDATIONS
A variety of health organizations produce "official" exercise guidelines. These are summarized below.
The US Department of Health and Human Services (HHS) released their first "Physical Activity Guidelines for Americans" in 2008. (If you would like to read the complete document, go to www.Health.gov.) While the Guidelines are excellent, it's pretty sad that it took that long for the federal government to issue formal exercise recommendations. (Prior to 2008, they included exercise recommendations in the document "Dietary Guidelines for Adults", a report that has been issued regularly since 1995.)
However, the American College of Sports Medicine (ACSM) has been developing and refining exercise recommendations for adults since 1975, when they published their first edition of "Guidelines for Graded Exercise Testing and Exercise Prescription." Their first "official" set of guidelines was published in 1978.
Along the way, other groups either participated in, or, published their own set of exercise guidelines. These include the CDC, the US Surgeon General, the American Heart Association, and the World Health Organization.
"EXERCISE" vs. "PHYSICAL ACTIVITY"
For a while, there was confusion over how much exercise the average person requires to improve/maintain their health. The 2008 report from HHS, followed by the 2011 Position Statement from ACSM, appears to have resolved much of the confusion.
One important detail needs to be pointed out: When "official" exercise guidelines were first created, there was no distinction between "exercise" and "physical activity." Exercise was, as you might guess, equivalent to lacing up the running shoes and hitting the road, or, joining a gym to pump iron.
That was the "traditional" view of exercise. Today, it is no longer considered necessary to exercise that hard to improve your health.
In 1995, an important paper on the health benefits of exercise was published in the medical journal JAMA. This paper shows that sedentary people can improve their health dramatically with very little effort (Pate RR, et al. 1995). The main recommendation was this:
"Every adult should accumulate 30 minutes or more of moderate-intensity exercise on most, preferably all, days of the week."
This recommendation has been the basis of all "official" sets of exercise guidelines published since then.
A good example of "moderate-intensity" exercise is brisk walking. Thus, if you just want to maintain good health, plain old walking works pretty well. But, even household chores are now considered beneficial, too (Pate RR, et al. 1995):
|"PHYSICAL ACTIVITY" ||"MODERATE" EXERCISE ||"VIGOROUS" EXERCISE|
|slight increase |
in heart rate
|moderate increase |
in heart rate
in heart rate
|• bowling |
• painting the house
• washing the car
|• brisk walking |
• cycling, slow
• jogging, slow
• swimming, slow
• cycling, fast
• lawn mowing (push mower)
• moving heavy furniture
• singles tennis
• stair machine
• swimming, fast
OFFICIAL EXERCISE RECOMMENDATIONS TO MAINTAIN AND IMPROVE HEALTH
"Official" exercise recommendations from the World Health Organization, the Department of Health and Human Services, and from the American College of Sports Medicine are summarized below.
EXERCISE RECOMMENDATIONS FROM THE WORLD HEALTH ORGANIZATION (2020):
The World Health Organization (WHO) issues exercise recommendations every 10 years. Their most recent set of guidelines was published November 2020 (Bull FC, et al. 2020).
For Otherwise Healthy Adults:
- Both AEROBIC exercise and MUSCLE-STRENGTHENING exercise should be performed every week
- AEROBIC exercise does not have to be performed in one, continuous session. Multiple, short bouts are effective. Even sessions shorter than 10 minutes count (Jakicic JM, et al. 2019).
- Minimizing SEDENTARY ACTIVITY is just as important as obtaining enough exercise
Specific AEROBIC exercise recommendations are:
- MODERATE-intensity physical activity for 150-300 minutes per week, or,
- VIGOROUS-intensity physical activity for 75-150 minutes per week
Specific MUSCLE-STRENGTHENING exercise recommendations are:
- Moderate-intensity muscle-strengthening exercises that involve all major muscle groups should be performed 2 or more days a week
For Adults 65 Years and Older:
- The exercise recommendations for Otherwise Healthy Adults summarized above should be followed. But, in addition:
- Older adults should also perform exercises that improve BALANCE on 3 or more days a week
For Children and Adolescents ages 5-17 years:
- At least 60 minutes per day of mostly aerobic exercise
- To minimize sedentary behavior, "screen" time should be limited
EXERCISE RECOMMENDATIONS FROM ACSM (2011):
In July 2011, ACSM published their latest Position Stand: "Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for exercise prescription." (This report updated their previous one which was issued in 1998.) The current ACSM recommendations for Otherwise Healthy Adults state:
"A program of regular exercise that includes cardiorespiratory, resistance, flexibility, and neuromotor exercise training beyond activities of daily living to improve and maintain physical fitness and health is essential for most adults." The ACSM recommends that most adults engage in:
- MODERATE-intensity cardiorespiratory training for at least 30 min/day on 5 or more days per week, or,
- VIGOROUS-intensity cardiorespiratory training for at least 20 min/day on 3 or more days per week, or,
- a COMBINATION of moderate- and vigorous-intensity exercise that totals at least 500 MET-min/week
Exercise intensity and exercise duration should be considered together. A general rule of thumb is this: 1 minute of vigorous activity is equivalent to 2 minutes of moderate activity.
The term "MET-min/week" also requires explanation. The calories you burn while sitting at rest is classified as "1 MET." During a slow jog, you might burn calories at 5 times that rate. If so, then, jogging, for you, would be classified as "5 MET's". If you jog at this pace for 20 minutes, then, you have generated 100 "MET-minutes" of effort. So, "MET-minutes" reflects both exercise intensity and exercise duration.
In addition to the above, ACSM recommends:
- STRENGTH exercise 2-3 days per week, and
- NEUROMOTOR exercise 2-3 days per week, and
- FLEXIBILITY exercise at least 2 days per week
"Neuromotor" exercise is a new term. Here, ACSM is describing exercises that improve balance. Examples are yoga, tai chi, and Bosu ball exercises.
EXERCISE RECOMMENDATIONS FROM HHS (2008):
For Otherwise Healthy Adults:
- Aerobic exercise: For "substantial" health benefits: Perform moderate intensity activity 150 minutes per week (this works out to 30 min/day, 5 days/week), or, vigorous intensity activity 75 minutes per week. For "additional" health benefits: Perform moderate intensity activity 300 minutes per week, or, vigorous intensity activity 150 minutes per week.
- Muscle-strengthening exercise: Perform moderate-to-intense muscle-strengthening exercises at least twice per week.
For Older Adults:
- Aerobic exercise: While the guideline of "150 minutes per week" still applies, older adults should not push themselves too hard. Rather, they should do what their bodies will permit. "Physical activity" is more appropriate than "exercise" for many older adults.
- Balance exercise: Because the risk of falling increases with age, older adults should also perform some type of balance exercises.
For Children and Adolescents:
- Perform physical activity at least 60 minutes per day. Part of this time should be devoted to muscle-strengthening activities 3 days per week, and, part of this time should include bone-strengthening activities at least 3 days per week.
EXERCISE RECOMMENDATIONS FOR ADULTS AT RISK OF CARDIOVASCULAR DISEASE (2013):
In November 2013, the American College of Cardiology (ACC) and the American Heart Association (AHA) published their latest "Guidelines for Lifestyle Management to Reduce Cardiovascular Risk" (Eckel RH, et al. 2013). In this report, they recommend that people who have an elevated cholesterol level and/or elevated blood pressure perform aerobic exercise 40 min/day, on 3-4 days/week.
WALKING: 10,000 STEPS AREN'T NECESSARY!
On May 29, 2019, researchers from Harvard published a study in JAMA Internal Medicine showing that protection against premature death was maximum at around 7500 steps per day...ie., you don't need to walk 10,000 steps per day, which is commonly recommended. This is good news because 10,000 steps is roughly 5 miles of walking!
In fact, it appears that 4400 steps per day is enough...7500 steps provided only slightly better improvement (Lee I-M, et al. 2019).
This study was conducted in older women (average age: 72 years) as part of the ongoing Women's Health Study, but there's no real reason why the results would be much different in men.
TIPS FOR DESIGNING YOUR EXERCISE PLAN
At this point, you have the most current "official" exercise recommendations for maintaining your health. Thus, you should be able to design an exercise program that you like and that's effective. Listed below are some tips. (NOTE: Before starting any new exercise program, you need to determine if you have any physical or medical issues that would limit your training regimen. The overweight 55-year-old guy with coronary heart disease will need to exercise much more cautiously than a healthy 25-year old. If you have any medical problem, or, are more than 40 years old, please consult your personal physician before beginning a new exercise routine.)
• Intensity: A very important aspect of your exercise program is the intensity. Intensity and duration should be considered together. Generally, 1 minute of vigorous exercise is considered equivalent to 2 minutes of moderate exercise. You can measure your exercise heart rate to check the intensity of your exercising, or you can do the ''talk test.''
To measure your heart rate, count your heartbeat for 10 seconds, then multiply that by six.
The talk test is easier to accomplish. Just exercise at a pace that allows you to carry on a conversation while you're exercising.
• Strength Exercise: free weights, weight-stack machines, stretch bands, or, exercises where you lift your body weight. Be sure to include exercises for every major muscle group (eg., arms, chest, back, stomach, hips and legs). Start with a weight that allows you to perform eight repetitions. Continue working with this weight until you can complete 12 repetitions. Add more weight when the exercise becomes easy.
• Flexibility Exercise: Proper stretching involves holding a mild stretch of 10 to 30 seconds while you breathe normally. Always warm up before you stretch. Like strength conditioning, flexibility exercises should include stretching for all the major muscle groups.
• Balance Exercise: Use a sturdy chair. Or, you can perform them in the kitchen where you can place one hand on the counter for stability. Read more about this in: "Balance: An Overlooked Element of Fitness?"
"STEPS" YOU SHOULD TAKE
The worst thing you can do for your health is to sit around all day long (Blair SN. 2009)......any form of physical activity is better than that! Even household chores (mowing the lawn, washing the car, vacuuming, etc.) have health benefits if you are currently sedentary.
Since aerobic exercise provides the greatest health benefits, start with that. The fundamental guidelines for how much exercise is necessary to gain health benefits are as follows:
• If you choose MODERATE exercise: Try to do this 150 minutes per week.
• If you choose VIGOROUS exercise: Try to do this 75 minutes per week.
So, to put all this into "conversational" language: Get out there and walk briskly for 30 minutes per day, 5-7 days per week. You don't have to run, compete in triathlons, or exercise at a level where you are breathing so hard you can't talk. As you improve, try to also perform strength exercise, flexibility exercises, and balance exercises each week.
Q: Is running the only way to improve my aerobic fitness?
ANSWER: Absolutely not! Virtually any activity that gets your arms and legs moving and increases your heart rate will improve your aerobic capacity. (Yoga and tai chi generally don't stimulate your heart rate enough to improve aerobic fitness.) In fact, for severely out-of-shape individuals, simply brisk walking (if done regularly) will increase aerobic capacity. The key is to push the heart rate up and keep it there while you are exercising.
Q: I don't have time during the week to exercise. Can I do all of my exercise on weekends?
ANSWER: Surprisingly, this scenario has been studied and the answer is yes! Relatively out-of-shape middle-aged subjects performed the equivalent of the recommended 30 min/day x 5 days/week program only on the weekend (ie., 75 min on Saturday and 75 min on Sunday) and it was found that they attained a similar level of aerobic fitness as subjects who exercised 30 min/day on 5 days (Meyer T, et al. 2006).
Q: Are three 10-min exercise sessions equivalent to one 30-min session?
ANSWER: Yes, this is acceptable. The amount of activity or exercise you do during the day adds up.
Q: I want to lose weight. Is walking "30 min/day, 5 days per week" enough exercise?
ANSWER: Probably not. You may need to exercise 45-60 min/day, or even more.
"Official" exercise and physical activity recommendations now exist. In 2008, the Department of Health and Human Services published "Physical Activity Guidelines for Americans," in 2011, the American College of Sports Medicine updated their Position Stand on recommended amounts of exercise, and in November 2020, the World Health Organization issued updated guidelines on physical activity and sedentary behavior.
Exercise does not have to be strenuous to be beneficial. Significant health benefits can be gained by walking, or, even doing household chores. For weight loss, more exercise is necessary.
FOR MORE INFORMATION
In 2017, ACSM published the 2nd edition of "Complete Guide to Fitness & Health." This book is intended for consumers. It is a very thorough resource, and may be a bit too technical for some readers. However, it is very current and is backed up by solid science.
Web sites for the following organizations also provide a wealth of exercise information:
- American Heart Association
- Centers for Disease Control
- President's Challenge
The following reviews in our Articles Library may also be helpful when designing your exercise plan:
EXPERT HEALTH and FITNESS COACHING
Stan Reents, PharmD, is available to speak on this and many other exercise-related topics. (Here is a downloadable recording of one of his Health Talks.) He also provides a one-on-one Health Coaching Service. Contact him through the Contact Us page.
American College of Sports Medicine. Position statement on the recommended quantity and quality of exercise for developing and maintaining fitness in healthy adults. Med Sci Sports 1978;10(3):vii-x. Abstract
Blair SN. Physical inactivity: The biggest public health problem of the 21st century. Br J Sports Med 2009;43:1-2. Abstract
Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behavior. Br J Sports Med 2020;54:1451-1462. Abstract
Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Circulation 2014;129 (25 Suppl 2):S76-S99. Abstract
Garber CE, Blissmer B, Deschenes MR, et al. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: Guidance for exercise prescription. (ACSM OFFICIAL POSITION STAND) Med Sci Sports Exerc 2011;43:1334-1359. Abstract
Jakicic JM, Kraus WE, Powell KE, et al. Association between bout duration of physical activity and health: Systematic review. Med Sci Sports Exerc 2019;51:1213-1219. Abstract
Lee I-M, Shiroma EJ, Kamada M, et al. Association of step volume and intensity with all-cause mortality in older women. JAMA Intern Med 2019;179:1105-1112. Abstract
Meyer T, Auracher M, Heeg K, et al. Does cumulating endurance training at the weekends impair training effectiveness? Eur J Cardiovasc Prev Rehabil 2006;13:578-584. Abstract
Pate RR, Pratt M, Blair SN, 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;273:402-407. Abstract
Pollock ML, Gaesser GA, Butcher JD, et al. Exercise and physical activity in healthy adults. (ACSM OFFICIAL POSITION STAND) Med Sci Sports Exerc 1998;30:975-991. Abstract
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ABOUT THE AUTHOR
Stan Reents, PharmD, is a former healthcare professional. He has been a member of the American College of Lifestyle Medicine (ACLM) and a member of the American College of Sports Medicine (ACSM). In the past, he was certified as a Health Fitness Specialist by ACSM, as a Certified Health Coach by ACE, as a Personal Trainer by ACE, and as a tennis coach by USTA. He is the author of Sport and Exercise Pharmacology (published by Human Kinetics) and has written for Runner's World magazine, Senior Softball USA, Training and Conditioning and other sports and fitness publications.
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