In this blog for health professionals, Dr Rebecca Gould, Cochrane UK Fellow and Sport and Exercise Medicine Registrar, summarises the recent changes in global and UK physical activity guidelines for adults and looks at some of the Cochrane evidence available.
The last 18 months has seen updates to both the UK Chief Medical Officers’ and World Health Organization (WHO) guidelines on physical activity and sedentary behaviour (Bull et al. 2020; Davies et al. 2019). Both guidelines note the evidence base for physical activity has become more compelling and, for adults, now include improved sleep, improved quality of life and management of stress amongst the benefits. These are in addition to the previously included benefits of reduced mortality and reduced incidence of type II diabetes, cardiovascular disease, falls, depression, joint and back pain, and certain types of cancer (colon and breast).
This is not a comprehensive list of the changes, but for me the main takeaway points from the updated guidelines are:
- Recommendations for adults to aim for at least 150 minutes of moderate intensity (or 75 minutes of vigorous activity, or a combination of the two) aerobic physical activity (MVPA) per week remain, but there is no longer a requirement for this to be done in bouts of 10 minutes or more
- Increased emphasis on the additional benefits of performing muscle strengthening activities on two or more days per week
- Doing some physical activity is better than none – the benefits start to occur at even the lowest levels of activity so individuals should be encouraged to start small, by doing what they can, and then try to build up activity gradually as they are able.
- For people over 65 there are also recommendations to perform additional activities in order to enhance functional capacity (ability to do day to day activities) and prevent falls – there are some slight differences with UK guidance recommending balance activities on 2 days per week, whereas WHO guidance recommends multicomponent functional balance and strength training on 3 or more days per week.
- New advice on minimising sedentary time by breaking up periods of inactivity. There is not enough evidence currently to provide recommendations on thresholds. When discussing sedentary time, it’s important to consider language and use inclusive messages such as ‘don’t be still for too long’ or ‘be active your way’
- For the first time there are additional guidelines for being active during pregnancy and after birth, and for adults living with chronic or disability.
Adults living with chronic conditions or disability should aim to engage in physical activity according to their abilities. They may wish to consult with a physical activity specialist or healthcare professional for advice on the types and amounts of activity appropriate for their individual needs, abilities, functional limitations/complications, medications and overall treatment plan.
I think it is also worth highlighting that both guidelines talk about ‘physical activity’ rather than ‘exercise’. This is a deliberate choice of language reflecting the move away from early guidelines that focused on exercise (i.e. planned and structured activity) to improve fitness, to a more public health orientated approach which aims to incorporate physical activity into daily living to improve physical and mental health and well-being (Ding et al. 2020). I often highlight this distinction when discussing physical activity with people – walking, wheeling a wheelchair, carrying shopping, gardening and housework can all count – people don’t need to start lifting heavy weights at the gym or take up running to improve their health (unless they want to of course!).
Cochrane evidence on physical activity
To coincide with the 2020 update of the WHO guidance, the Cochrane Campbell Global Ageing Partnership have curated a Special Collection of Cochrane Reviews on Physical activity for healthy ageing.
The Special Collection brings together a selection of reviews looking at the effect of physical activity interventions on physical function and/or symptoms in groups of people with specific long-term conditions including visual impairment, colorectal cancer, benign prostatic obstruction, osteoarthritis, chronic pain and breast cancer.
An important aspect of research in this area is behavioural change – what interventions are effective at encouraging people to change their behaviour and increase their physical activity? The Special Collection includes Cochrane Reviews assessing interventions to promote participation in physical activity in people with chronic obstructive pulmonary disease (COPD), and stroke. Additionally, for general populations, there are several reviews which look at physical activity promotion at a larger scale for example, community-wide, workplace-based and mass media interventions.
Discussing physical activity with patients
Another challenge is inspiring more health professionals to discuss physical activity more often with patients. Multiple barriers exist such as lack of time, other clinical priorities and lack of confidence, but as health professionals we are in a unique position to promote physical activity as we often come into contact with the people who have the most to gain from increasing their activity (e.g. the least active). On a practical level there are several resources, aimed at health professionals, I have found helpful to increase my knowledge, confidence and skills around physical activity conversations.
- Moving Medicine – developed by the Faculty of Sport and Exercise Medicine, the Moving Medicine website is designed to support healthcare professionals to have conversations about physical activity by providing condition-specific consultation frameworks. It also contains a toolkit to support the promotion of physical activity within hospitals
- Motivate 2 Move – a series of factsheets for healthcare professionals which summarise the evidence of the benefits of physical activity in multiple long-term conditions
- Physical Activity in the Prevention and Treatment of Disease – this online handbook, by Professional Associations for Physical Activity (Sweden) contains detailed information for healthcare professionals on physical activity and its use in the management of multiple long-term conditions.
Rebecca Gould has nothing to disclose.
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