February 2009 Issue
Physical Activity to Promote Cardiovascular Health
By Ellen Coleman, MA, MPH, RD
Today’s Dietitian
Vol. 11 No. 2 P. 8
Suggested CDR Learning Codes: 4040, 4060, 5160; Level 2
Physical inactivity is recognized as a major risk factor for cardiovascular disease (CVD). An impressive body of scientific evidence indicates that regular, moderate-intensity physical activity helps protect against CVD and premature mortality.1-3 Compared with sedentary individuals and those with low aerobic fitness or VO2max, physically active and aerobically fit individuals have a 25% to 50% lower overall risk of developing CVD.1
Regular physical activity also helps prevent unhealthy weight gain, type 2 diabetes, hypertension, thromboembolic stroke, colon and breast cancer, osteoporosis, anxiety, and depression. Greater health benefits and reduced disease risk can be achieved by increasing the amount (intensity, frequency, and/or duration) of physical activity.1-3
In 2007, the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) updated their recommendations on the types and amounts of physical activity healthy adults need to improve and maintain their health. In October 2008, the U.S. government released the first federal Physical Activity Guidelines for Americans. Both sets of guidelines support each other and are based on scientific research that links physical activity to improved health and wellness.
In this article, I’ll review these recommendations and guidelines and show how dietitians can integrate them into counseling strategies for their clients.
Background
In 1995, the Centers for Disease Control and Prevention (CDC) and the ACSM recommended that every American adult accumulate 30 minutes or more of moderate-intensity physical activity on most, but preferably all, days of the week.4 The purpose of the CDC/ACSM recommendation was to provide a clear, concise public health message that would encourage Americans to increase their physical activity.4 The Surgeon General’s Report on physical activity and health was published the following year and supported the same recommendation.5
More than 13 years have passed since the CDC/ACSM recommendation, yet physical inactivity remains a pressing public health issue. Despite the known value of physical activity, in 2006, only 30.9% of Americans engaged in regular leisure-time physical activity (defined as light to moderate activity for 30 or more minutes, five or more times per week, or vigorous activity for 20 or more minutes, three or more times per week).6 Technology and economic incentives tend to discourage activity—gadgets reduce the physical exertion needed to perform activities of daily living, and economics allow sedentary work to pay more than active work.1
Some people have misinterpreted the original CDC/ACSM physical activity recommendation. Many still believe that only vigorous, high-intensity activity will improve health; conversely, others think that the light activities of their daily lives are sufficient to promote health.1 The truth lies in the middle but is somewhat skewed toward the vigorous end of the spectrum.
Physical Activity Recommendations
When the ACSM and the AHA updated the 1995 CDC/ACSM recommendation in 2007, they provided more comprehensive and explicit physical activity recommendations for adults to improve cardiovascular fitness and reduce the risk of chronic disease. The ACSM and the AHA also released similar physical activity recommendations for older adults (aged 65+) with additions and modifications appropriate for that group. Regular physical activity is essential for healthy aging and reduces the risk of chronic disease, premature mortality, functional limitations, and disability in older adults.2
The ACSM and the AHA recommend that all healthy adults (aged 18 to 65) and older adults participate in moderate-intensity aerobic physical activity for a minimum of 30 minutes five days per week or vigorous-intensity aerobic activity for a minimum of 20 minutes three days per week.
The Federal Guidelines recommend that all adults engage in at least 150 minutes of moderate-intensity aerobic physical activity per week or at least 75 minutes of vigorous-intensity physical activity per week.
Both sets of guidelines specify that combinations of moderate- and vigorous-intensity activity can be performed to meet the recommendations. For example, a person can walk briskly for 30 minutes twice per week and then jog for 20 minutes on two other days. Moderate-intensity activity is generally equivalent to a brisk walk and noticeably accelerates heart rate; vigorous-intensity activity is exemplified by jogging and causes rapid breathing and a substantial increase in heart rate. Moderate-intensity bouts of aerobic activity lasting at least 10 minutes can be accumulated toward the goal amount of 30 minutes per day or 150 minutes per week.1-3 (Muscle-strengthening physical activities are discussed later in this article.)
For older adults, both sets of guidelines indicate that moderate-intensity aerobic activity involves a moderate level of effort relative to an individual’s aerobic fitness. On a 10-point scale, on which sitting is 0 and all-out effort is 10, moderate-intensity activity is a 5 or 6 and produces noticeable increases in heart rate and breathing. On the same scale, vigorous-intensity activity is a 7 or 8 and produces large increases in heart rate and breathing. Due to older adults’ diverse fitness levels, for some, a moderate-intensity walk is a slow walk and for others, it is a brisk walk.2,3
Both sets of guidelines indicate that the recommended amount of aerobic activity is in addition to the light-intensity activities of daily living (eg, self-care, cooking, casual walking, shopping) and routine activities lasting less than 10 minutes in duration (eg, walking around the home or office, walking from the parking lot). However, moderate- or vigorous-intensity activities performed as a part of daily life (eg, brisk walking to work, gardening with a shovel, carpentry) performed in bouts of 10 minutes or more can be counted toward the goal amount.1-3
The ACSM/AHA and Federal Guidelines point out that significant health benefits are achieved by going from a sedentary state to the minimum recommended level of physical activity. Both guidelines also emphasize that participating in physical activity above the minimum recommended amounts provides additional health benefits and brings about higher levels of aerobic fitness or VO2max. Many adults should exceed the minimum recommended amounts of physical activity, including those who wish to improve their aerobic fitness or further reduce their risk for CVD and premature mortality.1-3 For more extensive health benefits, the Federal Guidelines recommend that adults engage in 300 minutes of moderate-intensity activity per week or 150 minutes of vigorous-intensity activity per week.3
Older adults should exceed the minimum recommended amounts of physical activity if they have no conditions that preclude higher amounts of physical activity and wish to improve their fitness, improve management of an existing disease (when higher levels of physical activity have greater therapeutic benefits for the disease), or further reduce their risk for chronic diseases and premature mortality.2
Adults will also benefit by engaging in extra weight-bearing and higher impact activities as tolerated (eg, stair climbing or jogging) to promote and maintain skeletal health. To help prevent unhealthy weight gain, some adults will need to exceed the minimum recommended amounts of physical activity and decrease their food intake to achieve energy balance.1-3
Activity Dose
The health benefits associated with physical activity follow a dose-response relationship and are primarily due to the total energy expenditure created by the activity.1,3,7 The total activity dose (or energy expenditure) is, in turn, a function of the intensity, duration, and frequency of the activity. Vigorous-intensity activities carried out for a particular duration and frequency generate greater energy expenditure than moderate-intensity activities of the same duration and frequency.1,3
Metabolic equivalents (METs) are a useful method for estimating energy expenditure during physical activity. METs are also used to scientifically quantify the activity dose. One MET represents a person’s energy expenditure while sitting quietly. For example, walking at 3 miles per hour on a flat, hard surface expends about 3.3 METs and would be classified as moderate-intensity exercise, while jogging on a similar surface at 5 miles per hour expends about 8 METs and is classified as vigorous-intensity exercise. Chart 1 lists the MET values for a variety of physical activities that are light (up to 3 METs), moderate (3 to 6 METs), and vigorous intensity (more than 6 METs).1,3
If a person walks at 3 miles per hour (moderate intensity) for 30 minutes, he or she accumulates 99 MET-minutes of activity (3.3 METs X 30 minutes = 99 MET-minutes). Walking for 30 minutes at 3 miles per hour five days per week accumulates 495 MET-minutes (99 X 5) and meets the minimum moderate-intensity activity recommendations established by the ACSM and the AHA.1
If a person jogs at 5 miles per hour for 20 minutes, he or she accumulates 160 MET-minutes (8 METs X 20 min = 160 MET-minutes). Jogging at 5 miles per hour for 20 minutes three days per week accumulates about 480 MET-minutes (160 X 3) and meets the minimum vigorous-intensity activity recommendations established by the ACSM/AHA and Federal Guidelines.
Using METs as an indicator of activity intensity also allows adults to accumulate credit for the various moderate- or vigorous-intensity activities they perform during the week.1 A person can meet the ACSM/AHA minimum activity recommendations by walking at 3 miles per hour for 30 minutes two days per week (3.3 METs X 60 min = 198 MET-minutes) and jogging at 5 miles per hour for 20 minutes on two other days (8 METs X 40 min = 320 MET-minutes), for a weekly total of about 518 MET-minutes (320 + 198).1,3
The ACSM and the AHA recommend a range of at least 450 to 750 MET-minutes per week for adults who participate in a combination of moderate and vigorous activities. Individuals should start at the lower end of this range when beginning an activity program and progress toward the higher end as they become more fit.1
The Federal Guidelines recommend a range of at least 500 to 1,000 MET-minutes per week for adults. However, the guidelines indicate that physical activity guidelines using MET-minutes are not practical for the general public, since the concept is unfamiliar and difficult to understand. They indicate that either 150 minutes of moderate-intensity activity per week or 75 minutes of vigorous-intensity activity can be regarded as roughly equivalent to 500 MET-minutes per week and meet the minimum federal activity recommendation.
To account for a combination of moderate- and vigorous-intensity activities during the week, the Federal Guidelines specify that one minute of vigorous-intensity activity counts the same as two minutes of moderate-intensity activity.
It is well documented that physical activity of longer duration or higher intensity is associated with additional risk decrements.1 However, the exact shape of the dose-response curve remains unclear and may vary depending on health outcome (eg, CVD, cancer) and the baseline physical activity level of the population being evaluated.1
Recent data indicate that in addition to activity dose, higher levels of aerobic fitness (VO2max) confer greater reductions in risk—for every 1 MET increase in aerobic capacity (VO2max), there was a 17% reduction in mortality for women and a 20% reduction in mortality for men.8,9 (A comprehensive listing of MET values by Ainsworth and colleagues is available at http://prevention.sph.sc.edu/tools/compendium.htm.)
Actual MET values can vary from person to person, depending on a variety of factors (eg, how they perform the activity, skill level, body composition), but the values provided in the compendium are sufficiently accurate for recommending activity.1
Intensity of Activity
The intensity of aerobic activity can be defined in either absolute or relative terms. Absolute intensity is the amount of energy expended per minute of activity. Relative intensity is based on a person’s fitness and is expressed as a percentage of maximal heart rate, heart rate reserve, or oxygen uptake reserve.1-3
Both the ACSM/AHA guidelines and Federal Guidelines for adults define aerobic intensity in absolute terms based on METs. For example, moderate-intensity activities require 3 to 6 METs, and vigorous activities require more than 6 METs.
However, a different definition of aerobic intensity is necessary for older adults due to their lower fitness levels. Performing 3 to 6 MET activities either requires relatively vigorous effort or is impossible for older adults with low fitness levels. Thus, the activity recommendation for older adults defines aerobic intensity as relative to fitness, in the manner of an exercise prescription.2,3
For older adults, the ACSM/AHA and Federal Guidelines recommend an aerobic intensity of 50% to 85% of oxygen uptake reserve (VO2R)—a range that includes both moderate and vigorous activity. If oxygen reserve is measured on a 10-point scale, on which sitting is 0 and all-out effort is 10, then moderate intensity begins at around 5, or 50% VO2R, and the range of vigorous intensity does not quite reach 9, or 90% VO2R.2,3
Recent data indicate that vigorous-intensity activities may have greater benefit for reducing CVD and premature mortality than moderate-intensity physical activity. These benefits are independent of the energy expenditure of the activity.1,10 In a review of the literature, Swain and Franklin consistently found a greater reduction in risk of CVD and more favorable coronary heart disease risk profiles for individuals who engaged in vigorous-intensity activity (6 or more METs) compared with moderate-intensity physical activity.10 Vigorous-intensity activity (at or above 60% aerobic capacity) was associated with greater improvements in diastolic blood pressure, glucose control, and aerobic capacity compared with moderate-intensity exercise. Exercise intensity had no effect on improvements in systolic blood pressure, lipid profile, or body fat loss.
The authors concluded that if the total energy expenditure of activity is held constant, vigorous-intensity activity appears to convey greater cardioprotective benefits than moderate-intensity activity.10
The Federal Guidelines disagree with Swain and Franklin’s findings and state that the total energy expenditure of activity is more important for achieving health benefits than the frequency, intensity, or duration of activity.
Muscular Strength and Endurance
The ACSM/AHA and Federal Guidelines also recommend resistance (strength) training as an integral part of the fitness program. Most exercises to increase aerobic fitness do not improve muscular strength and endurance. Improving muscular strength and endurance allows individuals to perform occupational and leisure tasks with less physiological stress (lower heart rate and blood pressure) and helps promote functional independence throughout the lifespan.1-3,11,12
Additional benefits of resistance training include increases in bone mass and connective tissue strength. Mechanical loading on skeletal tissue by resistance exercise can stimulate an increase in bone formation in young adults and slow bone loss in middle age, thereby reducing the risk of osteoporosis, osteopenia, and bone fracture.1
Recent observational studies have suggested an inverse association between risk of all-cause mortality and components of muscular strength/endurance. Although the specific mechanisms for these associations are unknown, strength training promotes the development and maintenance of metabolically active muscle mass, which is particularly important for enhancing glucose metabolism.1
Resistance training at least twice per week on two or three nonconsecutive days provides a safe, effective method for adults to improve muscular strength and muscular endurance by 25% to 100% or more.13 Most people should complete at least one set of repetitions for eight to 12 exercises that train the major muscle groups: arms, shoulders, chest, abdomen, back, hips, and legs.1,3 A resistance (weight) should be used that results in substantial fatigue after eight to 12 repetitions of each exercise.1,3
Aging causes a progressive loss of muscle mass (sarcopenia) and an associated loss of strength, which can compromise an older person’s ability to perform daily tasks. Resistance training is particularly important for older adults to prevent age-related muscle mass and bone loss and maintain functional capacity.3
For older adults to maximize strength development, a resistance (weight) should be used that allows 10 to 15 repetitions for each exercise. The level of effort for muscle-strengthening activities should be moderate to high. On a 10-point scale, on which no movement is 0 and maximal effort of a muscle group is 10, moderate-intensity effort is a 5 or 6 and high-intensity effort is a 7 or 8. Muscle-strengthening activities include a progressive weight-training program, weight-bearing calisthenics, and similar resistance exercises that use the major muscle groups.3
Flexibility Activity
Flexibility activity is recommended for older adults to maintain joint range of motion necessary for daily activities and physical activity.2,3 Unlike aerobic and resistance exercise, specific health benefits of flexibility exercise are unclear.2,3 It is unknown whether flexibility activities reduce the risk of exercise-related injuries.2,3 Also, few studies have evaluated age-related loss of motion.2
At least one randomized trial has shown flexibility exercises to be beneficial. These exercises are recommended for the management of several common diseases in older adults.2 At least 10 minutes of flexibility activities are recommended based on the time required for a general stretching routine involving major muscle and tendon groups.
Flexibility activities should be done slowly, with a gradual progression to greater ranges of motion. Static stretching involves slowly stretching a muscle to the point of mild discomfort and then holding that position for 10 to 30 seconds. Three to four repetitions of each stretch are recommended. Preferably, flexibility activities are performed on all days that aerobic or muscle-strengthening activities are performed.2
Balance Activity
Community-dwelling older adults who have a substantial risk of falls (eg, history of frequent falls, mobility problems) should perform exercises that maintain or improve balance.2,3 Multicomponent interventions that include regular physical activity are effective for preventing falls in older adults who are at risk.2,3 Physical activity by itself may reduce falls and fall injuries by as much as 35% to 45%.14
Research has focused on balance exercise rather than balance activity such as dancing, so only balance exercise is currently recommended.2 Examples of balance exercise include backward and sideways walking, heel and toe walking, and standing from a sitting position.3 The exercises can increase in difficulty by progressing from holding on to a stable support while doing the exercises to doing them without support. Tai chi exercises may also help prevent falls. To reduce risk of injury from falls, balance exercises should be performed three or more days per week.3
Clearance to Exercise
There is controversy regarding the value of medical screening procedures, such as exercise testing, prior to initiating vigorous exercise programs. The ACSM has previously recommended symptom-limited exercise testing before vigorous exercise (above 60% of VO2max) is undertaken by men older than 45 and women older than 55, those with two or more major cardiac risk factors, persons with any signs or symptoms of coronary artery disease, or those with known cardiac, pulmonary, or metabolic disease.12 However, there is little evidence available to substantiate this recommendation.1
The AHA has indicated that exercise testing is not necessary for everyone beginning a moderate-intensity physical activity program.15 There is a very low rate of cardiovascular complications in asymptomatic persons performing moderate-intensity activity, the predictive value of exercise testing for imminent cardiac events is poor, and mass exercise testing is expensive. There are also uncertainties associated with interpreting abnormal electrocardiographic or cardiac imaging results in persons with a low pretest risk of coronary artery disease. Thus, it is impractical to use exercise testing to prevent serious cardiovascular events in all asymptomatic persons who exercise, especially during activities of moderate intensity.1,15
Asymptomatic individuals who plan to achieve the minimum recommended levels of moderate-intensity activity don’t need to consult with a physician or healthcare provider before starting unless they have specific medical questions.1,3 Symptomatic individuals and those with CVD, diabetes, other active chronic disease, or any medical concern should consult a physician or healthcare provider prior to any significant increase in physical activity, particularly vigorous-intensity activity.1,3,15
Activity Plan for Older Adults
An activity plan identifies recommended levels of physical activity for a specific person and describes how the person intends to meet them. Older adults with chronic conditions should develop an activity plan in consultation with a healthcare provider, so the plan takes into account therapeutic and risk management issues related to chronic conditions.2
The plan should be tailored according to chronic conditions and activity limitations, risk for falls, individual abilities and fitness, strategies for minimizing risks of activity, strategies for increasing activity gradually over time (if the person has not met recommended levels), behavioral strategies for adhering to regular physical activity, and individual preferences.2
Healthy, asymptomatic older adults without chronic conditions should also develop an activity plan (preferably in consultation with a healthcare provider or fitness professional) to take advantage of expertise and resources on physical activity and injury prevention. This recommendation updates the advice to consult a healthcare provider before starting to increase physical activity.2
Promoting Activity in Older Adults
There is substantial evidence that older adults who do less activity than recommended by the ACSM/AHA and Federal Guidelines still achieve some health benefits. Some activity is better than none and more activity is better than less. Such evidence is consistent with the scientific consensus for a continuous dose-response relationship between physical activity and health benefits.2,7
Realistic goals for aerobic activity are usually 30 to 60 minutes of moderate-intensity activity per day. Vigorous activity has a higher risk of injury and lower adherence. Age-related loss of fitness, chronic diseases, and functional limitations are barriers to vigorous activity. However, vigorous activity may be appropriate for selected older adults with sufficient fitness, experience, and motivation.2
The advice to increase physical activity gradually over time is particularly important for older adults. Gradual progression decreases the risk of overuse injury, increases enjoyment of activity, and allows positive reinforcement for small steps forward. Very deconditioned older adults may initially need to exercise below a 5 on a 10-point scale and perform activity in multiple bouts (10 minutes or more) rather than in a single continuous bout. The activity plan needs to be reevaluated when there are changes in health status.2
Conclusion
It is well established that physical activity protects against cardiovascular and other chronic diseases and improves cardiovascular fitness. The ACSM/AHA and Federal Guidelines note that the health benefits associated with physical activity follow a dose-response relationship and are primarily due to the total energy expenditure created by the activity. Both sets of guidelines emphasize that significant health benefits are achieved by going from a sedentary state to the minimum recommended level of physical activity. Furthermore, participating in physical activity above the minimum recommended amounts provides additional health benefits and brings about higher levels of aerobic fitness or VO2max.
The National Heart, Lung, and Blood Institute publication “Your Guide to Physical Activity and Your Heart” provides practical information to help consumers develop and maintain a safe, effective physical activity program. The brochure is also available online.
— Ellen Coleman, MA, MPH, RD, is a nutrition consultant at The Sport Clinic in Riverside, Calif.
Chart 1: MET Values for Light, Moderate, and Vigorous Intensity Activities
Light: < 3 METs
Walking, Jogging, or Running
• Walking slowly around home, store, office = 2*
Household and Occupation
• Sitting: using computer, working at desk, using light hand tools = 1.5
• Standing: performing light work (eg, making bed, washing dishes, ironing, preparing food, working as store clerk) = 2 to 2.5
Leisure Time and Sports
• Arts and crafts, playing cards = 1.5
• Boating: power = 2.5
• Croquet = 2.5
• Darts = 2.5
• Fishing: sitting = 2.5
• Playing most musical instruments = 2 to 2.5
Moderate: 3 to 6 METs
Walking, Jogging, or Running
• Walking 3 mph = 3.3*
• Walking 4 mph = 5*
Household and Occupation
• Carrying and stacking wood = 5.5
• Mowing lawn (walking power mower) = 5.5
• Sweeping floors or carpet, vacuuming, mopping = 3 to 3.5
• Washing windows or car, cleaning garage = 3
Leisure Time and Sports
• Badminton: recreational = 4.5
• Basketball: shooting around = 4.5
• Bicycling: on flat surface, light effort (10 to 12 mph) = 6
• Dancing: ballroom, slow = 3; fast = 4.5
• Fishing from river bank and walking = 4
• Golf: walking, pulling clubs = 4.3
• Sailboating, wind surfing = 3
• Swimming leisurely = 6†
• Table tennis = 4
• Tennis: doubles = 5
• Volleyball: noncompetitive = 3 to 4
Vigorous: > 6 METs
Walking, Jogging, or Running
• Hiking steep grades with 10- to 42-lb pack = 7.5 to 9
• Jogging 5 mph = 8*
• Jogging 6 mph = 10*
• Walking 4.5 mph = 6.3*
• Walking/hiking at/on moderate pace/grade without pack or with light pack = 7
Household and Occupation
• Carrying heavy loads (eg, bricks) = 7.5
• Heavy farming (eg, bailing hay) = 8
• Shoveling, digging ditches = 8.5
• Shoveling sand, coal, etc = 7
Leisure Time and Sports
• Basketball game = 8
• Bicycling: on flat surface, moderate effort (12 to 14 mph) = 8; fast (14 to 16 mph) = 10
• Skiing: cross-country, slow (2.5 mph) = 7; fast (5 to 7.9 mph) = 9
• Soccer: casual = 7; competitive = 10
• Swimming: moderate/hard = 8 to 11†
• Tennis: singles = 8
• Volleyball: competitive at gym or beach = 8
* On flat, hard surface
† MET values can vary substantially from person to person during swimming as a result of different strokes and skill levels.
— Data adapted from Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc. 2000;32(9 Suppl):S498-504.
References
1. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39:1423-1434.
2. Nelson ME, Rejeski WJ, Blair SN, et al. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1435-1445.
3. U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. October 2008. Available at: http://www.health.gov/paguidelines/pdf/paguide.pdf
4. 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.
5. American Heart Association, American Stroke Association. Heart disease and stroke statistics — 2008 update at-a-glance. Available at: http://www.americanheart.org/downloadable/heart/
1200082005246HS_Stats%202008.final.pdf
6. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. Physical activity and health: A report of the Surgeon General. Available at: http://www.cdc.gov/nccdphp/sgr/summary.htm
7. Kesaniemi YK, Danforth E Jr, Jensen MD, et al. Dose-response issues concerning physical activity and health: An evidence-based symposium. Med Sci Sports Exerc. 2001;33(6 Suppl):S351-S358.
8. Gulati M, Pandey DK, Arnsdorf MF, et al. Exercise capacity and the risk of death in women: The St. James Women Take Heart Project. Circulation. 2003;108(13):1554-1559.
9. Myers J, Kaykha A, George S, et al. Fitness versus physical activity patterns in predicting mortality in men. Am J Med. 2004;117(12):912-918.
10. Swain DP, Franklin BA. Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise. Am J Cardiol. 2006;97(1):141-147.
11. American College of Sports Medicine position stand on the recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness and flexibility in healthy adults. Med Sci Sports Exerc. 1998;30(6):975-991.
12. American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription, 7th edition. Philadelphia: Lippincott Williams & Wilkins; 2006.
13. Pollock ML, Franklin BA, Balady GJ, et al. AHA Science Advisory. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association. Circulation. 2000;101:828-833.
14. Robertson MC, Campbell AJ, Gardner MM, Devlin N. Preventing injuries in older people by preventing falls: A meta-analysis of individual-level data. J Am Geriatr Soc. 2002;50(5):905-911.
15. Thompson PD, Buchner D, Piña IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: A statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107:3109-3116.
Learning Objectives
After completing this continuing education exercise, the student will be able to:
1. Identify the guidelines for different age groups in the American College of Sports Medicine/American Heart Association guidelines and the Physical Activity Guidelines for Americans.
2. Define distinct levels of intensity of physical activities.
3. Calculate MET-minutes for accumulation of activity points.
4. List the benefits of strength training in a fitness program.
5. Construct activity plans for a wide range of clients.
Examination
1. Regular, moderate-intensity physical activity helps protect against:
a. cardiovascular disease.
b. premature mortality.
c. type 2 diabetes.
d. a and b
e. a, b, and c
2. The American College of Sports Medicine/American Heart Association guidelines recommend that adults participate in at least:
a. 30 minutes of moderate-intensity aerobic physical activity per day three days per week.
b. 30 minutes of moderate-intensity aerobic physical activity per day five days per week.
c. 75 minutes of moderate-intensity aerobic physical activity per week.
d. 150 minutes of moderate-intensity aerobic physical activity per week.
e. 300 minutes of moderate-intensity aerobic physical activity per week.
3. The Physical Activity Guidelines for Americans recommend that adults participate in at least:
a. 30 minutes of moderate-intensity aerobic physical activity per day three days per week.
b. 30 minutes of moderate-intensity aerobic physical activity per day five days per week.
c. 75 minutes of moderate-intensity aerobic physical activity per week.
d. 150 minutes of moderate-intensity aerobic physical activity per week.
e. 300 minutes of moderate-intensity aerobic physical activity per week.
4. The following statement is false about moderate-intensity activity:
a. It noticeably accelerates heart rate.
b. It rates as a 5 or 6 on a 10-point scale, on which sitting is 0 and all-out effort is 10.
c. It requires more than 6 metabolic equivalents (METs).
d. It requires 3 to 6 METs.
e. Two minutes of moderate-intensity activity counts the same as one minute of vigorous-intensity activity.
5. The following statement is false about vigorous-intensity exercise:
a. It substantially increases heart rate.
b. It rates as a 7 or 8 on a 10-point scale, on which sitting is 0 and all-out effort is 10.
c. It requires more than 6 METs.
d. It requires 3 to 6 METs.
e. One minute of vigorous-intensity activity counts the same as two minutes of moderate-intensity activity.
6. Regular resistance (strength) training:
a. decreases physiological stress during occupational and leisure tasks.
b. reduces the risk of osteoporosis.
c. causes sarcopenia.
d. a, b, and c
e. a and b
7. The following statement about flexibility exercise is false:
a. It is recommended for older adults to maintain joint range of motion.
b. Flexibility activities reduce the risk of exercise-related injuries.
c. It is recommended to help manage several common diseases in older adults.
d. Muscle is stretched to the point of mild discomfort and then held for 10 to 30 seconds.
e. All statements are true.
8. Which of the following is true about physical activity?
a. It must last at least 30 minutes nonstop to count toward the activity goal.
b. It requires medical clearance (including an exercise test).
c. It may reduce falls and fall injuries.
d. Activities of daily living (eg, shopping, cooking) count toward the activity goal.
e. All of the above
9. Your client walks at 4 miles per hour (5 METs) for 30 minutes on two days and bicycles at 12 to 14 miles per hour (8 METs) for 25 minutes on two other days. How many MET-minutes did your client accumulate for the week?
a. 400
b. 500
c. 600
d. 700
e. 800
10. Which of the following is true about physical activity?
a. Some activity is better than none, and more activity is better than less.
b. A combination of moderate- and vigorous-intensity activities during the week count toward the activity goal.
c. The health benefits associated with physical activity follow a dose-response relationship.
d. Health benefits are primarily due to the total energy expenditure created by the activity.
e. All of the above
