Physical Activity Guidelines Advisory Committee Report

683 Pages·2008·4.59 MB·English

Physical Activity
Guidelines Advisory
Committee Report,
2008

To the Secretary of
Health and Human Services

U.S. Department of Health and Human Services
The findings of this report are those of the Physical Activity
Guidelines Advisory Committee. They do not necessarily reflect the
views of the Office of Disease Prevention and Health Promotion or the
U.S. Department of Health and Human Services.
Suggested citation: Physical Activity Guidelines Advisory Committee. Physical
Activity Guidelines Advisory Committee Report, 2008. Washington, DC: U.S.
Department of Health and Human Services, 2008.
Physical Activity
Guidelines Advisory
Committee Report, 2008

Prepublication Copy
Issued June 2008
DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary

Assistant Secretary for Health
Office of Public Health and Science
Washington D.C. 20201
May 23, 2008
The Honorable Michael O. Leavitt
Secretary of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Dear Secretary Leavitt,
On behalf of the entire 2008 Physical Activity Guidelines Advisory Committee, we are
very pleased to submit the Physical Activity Guidelines Advisory Committee Report,
2008.
You charged our committee to “…review existing scientific literature to identify where
there is sufficient evidence to develop a comprehensive set of specific physical activity
recommendations.” The Committee's report documents scientific background and
rationale for the 2008 edition of the Physical Activity Guidelines for Americans. The
Committee also identified areas where further scientific research is needed.
The Committee’s review and deliberations clearly demonstrated that sedentary behavior
confers substantial health risks throughout the lifespan. The health benefits of being
habitually physically active appear to apply to all people regardless of age, sex,
race/ethnicity, socioeconomic status, and to many people with physical or cognitive
disabilities. The amount and intensity of physical activity needed to achieve many health
benefits is well within the capacity of most Americans .and can be performed safely. This
report provides the scientific basis for these conclusions and the development of federal
physical activity guidelines.
For the entire Committee, we want to thank you for the opportunity to support your
Prevention Priority. Over the past twelve months, the Committee members and
consultants worked exceptionally long and hard to conduct the extensive scientific review
that made this report possible. Despite this task being added to their usual busy schedules,
they met tight deadlines, provided insight and education to one another, and unselfishly
worked to develop a consensus report. Thus, we wish to thank you for assembling a
committee of outstanding professionals who are not only knowledgeable and highly
productive but also most pleasant in character.
U.S. Public Health Service
It is important to emphasize that this report could not have been completed without the
outstanding support of all the HHS staff who assisted us throughout the entire process.
We are very grateful for their substantial assistance in developing an extensive electronic
searchable literature database for use by the Committee and for their excellent logistical
and management support in all aspects of the Committee's work. Special recognition
goes to RADM Penelope Slade Royall and CAPT Richard Troiano of the Office of
Disease Prevention and Health Promotion for their tireless dedication in the coordination,
and ultimate completion, of this project. This report greatly benefits from the expert
editing provided by Anne Brown Rodgers, who helped us present information that is
useful and readable, and from the careful work of Reba Norman, who ensured the
completeness and accuracy of the report’s extensive reference lists.
Our review documents very strong scientific evidence that physically active people have
higher levels of health-related fitness, a lower risk of developing a number of disabling
medical conditions, and lower rates of various chronic diseases than people who are
inactive. Given Americans' low rates of participation in physical activity and high
prevalence of chronic diseases and associated disabilities, this report is particularly
timely. It provides the necessary foundation for HHS to proceed to develop Physical
Activity Guidelines for Americans, 2008 and related policy statements. Strong federal
guidelines, policies, and programs regarding physical activity should be an essential
component of any comprehensive disease prevention and health promotion strategy for
Americans. Committee members are committed to the broad dissemination of this report
and the ensuing guidelines. Please do not hesitate to contact us or any of the Committee
members if we can be of further service.
Sincerely,
[Signed May 23, 2008]
William L. Haskell, Ph.D
Chair, 2008 Physical Activity Guidelines Advisory Committee
Prevention Research Center, School of Medicine, Stanford University
[Signed May 23, 2008]
Miriam E. Nelson, Ph.D.
Vice-Chair, 2008 Physical Activity Guidelines Advisory Committee
John Hancock Center for Physical Activity and Nutrition
Friedman School of Nutrition Science and Policy, Tufts University

Contents
Physical Activity Guidelines Advisory Committee Members....................Front Matter-1
Part A: Executive Summary..............................................................................................A-1
The Physical Activity Guidelines Advisory Committee..............................................A-1
Report Contents..............................................................................................................A-2
Review of the Science on Physical Activity and Health..............................................A-2
Research Recommendations........................................................................................A-10
Part B: Introduction...........................................................................................................B-1
Setting the Stage for Physical Activity Guidelines for Americans.............................B-1
The Physical Activity Guidelines Advisory Committee..............................................B-2
A Systematic Review of the Evidence on Physical Activity and Health....................B-3
Contents and Organization of the Physical Activity Guidelines Advisory
Committee Report..........................................................................................................B-5
Part C: Key Terms.............................................................................................................C-1
Physical Activity and Exercise......................................................................................C-1
Physical Fitness...............................................................................................................C-4
Health..............................................................................................................................C-6
Study Design and Measurement...................................................................................C-6
Publication Types...........................................................................................................C-7
Reference List.................................................................................................................C-8
Part D: Background...........................................................................................................D-1
Introduction....................................................................................................................D-1
Some Issues Regarding Dose Response........................................................................D-1
Recent Trends in Physical Activity in the United States............................................D-9
Development of Physical Activity Guidelines in the United States..........................D-17
Reference List...............................................................................................................D-28
Part E: Integration and Summary of the Science...........................................................E-1
Introduction....................................................................................................................E-1
Summarizing the Evidence............................................................................................E-1
Integrating the Evidence: Questions and Answers About the Health
Benefits of Physical Activity........................................................................................E-22
Reference List...............................................................................................................E-35
Part F: Scientific Literature Search Methodology..........................................................F-1
Background.....................................................................................................................F-1
Conceptual Framework.................................................................................................F-1
Physical Activity Guidelines Advisory Committee Report v
Contents
Research Questions........................................................................................................F-1
Operational Plan............................................................................................................F-3
Literature Review...........................................................................................................F-4
Part G. Section 1: All-Cause Mortality.........................................................................G1-1
Introduction.................................................................................................................G1-1
Review of the Science..................................................................................................G1-1
Overview of Questions Addressed.........................................................................................G1-1
Data Sources and Process Used to Answer Questions...........................................................G1-1
Question 1: Is There an Association Between Physical Activity and All-Cause
Mortality? If So, What Is the Magnitude of This Association?..............................................G1-2
Question 2: What Is the Minimum Amount of Physical Activity Associated With
Significantly Lower Risk of All-Cause Mortality?................................................................G1-5
Question 3: Is There a Dose-Response Relation Between Physical Activity and All-
Cause Mortality?..................................................................................................................G1-14
Question 4: What Is the Shape of the Dose-Response Relation Between Physical
Activity and All-Cause Mortality?.......................................................................................G1-17
Question 5: Is the Relation Between Physical Activity and All-Cause Mortality
Independent of Adiposity?...................................................................................................G1-20
Overall Summary and Conclusions.........................................................................G1-21
Reference List............................................................................................................G1-23
Part G. Section 2: Cardiorespiratory Health................................................................G2-1
Introduction.................................................................................................................G2-1
Review of the Science..................................................................................................G2-1
Overview of Questions Addressed.........................................................................................G2-1
Data Sources and Process Used To Answer Questions..........................................................G2-2
Special Considerations and Limitations.................................................................................G2-3
Question 1: What Is the Relationship Between Physical Activity and
Cardiovascular Morbidity and Mortality?..............................................................................G2-4
Question 2: What Are the Dose-Response Relations Between Physical Activity and
Cardiovascular Morbidity and Mortality?............................................................................G2-12
Question 3: What Is the Relationship Between Physical Activity and
Cerebrovascular Disease and Stroke?..................................................................................G2-15
Question 4: What Is the Relationship Between Physical Activity and Peripheral
Arterial Disease?..................................................................................................................G2-17
Question 5: What Is the Relationship Between Physical Activity and Hypertension?........G2-19
Question 6. What Is the Relationship Between Physical Activity and Atherogenic
Dyslipidemia?.......................................................................................................................G2-21
Question 7: What Is the Relationship Between Physical Activity and Vascular
Health?..................................................................................................................................G2-23
Question 8: What Is the Relationship Between Physical Activity and
Cardiorespiratory Fitness?....................................................................................................G2-28
Overall Summary and Conclusions.........................................................................G2-39
Physical Activity Guidelines Advisory Committee Report vi
Contents
Research Needs..........................................................................................................G2-40
Reference List............................................................................................................G2-41
Part G. Section 3: Metabolic Health..............................................................................G3-1
Introduction.................................................................................................................G3-1
Review of the Science..................................................................................................G3-2
Overview of Questions Asked................................................................................................G3-2
Data Sources and Process Used To Answer Questions..........................................................G3-2
Question 1. Does Physical Activity Have a Role in Preventing or Treating
Metabolic Syndrome?.............................................................................................................G3-3
Question 2. Does Physical Activity Have a Role in Preventing and Treating Type 2
Diabetes?................................................................................................................................G3-9
Question 3. Does Physical Activity Have a Role in Reducing Macrovascular Risks
in Type 2 Diabetes?..............................................................................................................G3-15
Question 4. Does Physical Activity Have Benefits for Type 1 Diabetes?............................G3-20
Question 5. Does Physical Activity Have a Role in Preventing and Treating
Diabetic Microvascular Complications?..............................................................................G3-22
Question 6: Do Physical Activity and Exercise Have a Role In Preventing
Gestational Diabetes?...........................................................................................................G3-28
Overall Summary and Conclusions.........................................................................G3-29
Research Needs..........................................................................................................G3-29
Reference List............................................................................................................G3-30
Part G. Section 4: Energy Balance................................................................................G4-1
Introduction.................................................................................................................G4-1
Review of the Science..................................................................................................G4-1
Overview of Questions Addressed.........................................................................................G4-1
Data Sources and Process Used to Answer Questions...........................................................G4-1
Caveats...................................................................................................................................G4-2
Question 1: How Much Physical Activity Is Needed for Weight Stability and
Weight Loss?..........................................................................................................................G4-2
Question 2. How Much Physical Activity Is Needed to Prevent Weight Regain in
Previously Overweight Individuals?......................................................................................G4-8
Question 3. What Is the Effect of Physical Activity on Body Composition
Parameters (e.g., Waist Circumference, Intra-Abdominal Fat, Abdominal
Adiposity, Total Body Fat) That Are Specifically Related to Metabolic Disorders?...........G4-10
Question 4: What Effects Do Sex and Age Have on the Role of Physical Activity in
Energy Balance?...................................................................................................................G4-13
Question 5: How Do the Physical Activity Requirements for Weight Maintenance
Differ Across Racial/Ethnic and Socioeconomic Groups?...................................................G4-15
Overall Summary and Conclusions.........................................................................G4-19
Physical Activity, Weight Stability, and Weight Loss.........................................................G4-19
Physical Activity and Weight Regain...................................................................................G4-20
Physical Activity and Body Composition Parameters..........................................................G4-20
Physical Activity Guidelines Advisory Committee Report vii
Contents
The Effect of Sex and Age on Physical Activity and Energy Balance.................................G4-21
Physical Activity Requirements Across Race/Ethnicity and Socioeconomic Groups.........G4-21
Research Needs..........................................................................................................G4-21
Physical Activity, Weight Stability, and Weight Loss.........................................................G4-21
Physical Activity and Weight Regain...................................................................................G4-22
Physical Activity and Body Composition Parameters..........................................................G4-22
The Effect of Sex and Age on Physical Activity and Energy Balance.................................G4-22
Physical Activity Requirements Across Race/Ethnicity and Socioeconomic Groups.........G4-22
Reference List............................................................................................................G4-23
Part G. Section 5: Musculoskeletal Health...................................................................G5-1
Introduction.................................................................................................................G5-1
Review of the Science..................................................................................................G5-2
Overview of Questions Addressed.........................................................................................G5-2
Data Sources and Process Used to Answer Questions...........................................................G5-2
Question 1. Does Physical Activity Reduce the Incidence of Osteoporotic
Fractures?...............................................................................................................................G5-3
Question 2. Does Physical Activity Reduce Risk of Osteoporosis by Increasing, or
Slowing the Decline in, Bone Mineral Density or Bone Mineral Content?.........................G5-11
Question 3. Does Physical Activity Reduce or Increase the Incidence of
Osteoarthritis?......................................................................................................................G5-17
Question 4. Is Physical Activity Harmful or Beneficial for Adults With
Osteoarthritis or Other Rheumatic Conditions?...................................................................G5-24
Question 5. Does Physical Activity Increase or Preserve Muscle Mass Throughout
the Lifespan? Does Physical Activity Improve Skeletal Muscle Quality, Defined as
Changes in Intrinsic and Extrinsic Measures of Force-Generating Capacity, Such as
Strength or Power?...............................................................................................................G5-31
Overall Summary......................................................................................................G5-38
Reference List............................................................................................................G5-38
Part G. Section 6: Functional Health............................................................................G6-1
Introduction.................................................................................................................G6-1
Conceptual Model and Terminology......................................................................................G6-1
Functional Health in Middle-Aged and Older Adults............................................................G6-2
The Importance of Reducing Disability and Falls in Older Adults........................................G6-3
Review of the Science..................................................................................................G6-3
Overview of Questions Addressed.........................................................................................G6-3
Data Sources and Process Used To Answer Questions..........................................................G6-4
Question 1: In Middle-Aged and Older Adults Who Do Not Have Severe
Functional or Role Limitations, Does Regular Physical Activity Prevent or Delay
the Onset of Substantial Functional Limitations and/or Role Limitations?...........................G6-4
Physical Activity Guidelines Advisory Committee Report viii