February 2019 Issue

Focus on Fitness: Small Increases in Activity
Can Boost Heart Health

By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 21, No. 2, P. 50

New federal guidelines encourage all forms of movement.

Professional medical organizations and health care providers typically emphasize the amount of exercise recommended by national guidelines—at least 150 minutes of aerobic exercise and two strength training sessions weekly. But this amount may be daunting to inactive individuals, leading them to forego exercising because they feel they'll never be able to meet these recommendations.

In honor of American Heart Month, I'll discuss how the latest federal guidelines take a new approach to exercising and physical activity.

Almost 80% of American adults don't meet exercise guidelines, increasing their risk of developing chronic diseases (including heart disease) considered preventable with regular physical activity. Getting Americans to exercise more is critical to improving both heart health and overall health. Breaking down the guideline-recommended 150 minutes into daily sessions of approximately 30 minutes helps motivate some individuals, but others still may be intimidated.

Is exercising for less than this amount beneficial for the heart? Is there a minimum amount of exercise that will keep the heart healthy?

Newly updated guidelines released in November 2018 by the US Department of Health and Human Services has changed its messaging. They now state that "something is better than nothing" and recommend that Americans "move more and sit less." The department's second edition of "Physical Activity Guidelines for Americans" is based on a comprehensive review of scientific studies published since the 2008 guideline.1 Although the recommended amounts and intensity of physical activity for adults have remained the same, the 2018 recommendations also emphasize the substantial benefits that can be achieved by sedentary adults who start moving more—even for just a few minutes at a time.

According to the scientific review conducted by the Health and Human Services Physical Activity Advisory Committee, recently published strong evidence demonstrates that there are immediate benefits to even short bouts of exercise, including decreased blood pressure, reduced anxiety, and improved sleep, especially for those who previously have been inactive. Adding some light-intensity physical activity daily and reducing sedentary behavior decreases CVD incidence and mortality.

Although the guidelines note there's no threshold that must be exceeded for heart benefits to begin to occur, they do strongly encourage inactive individuals to gradually increase physical activity to add some moderate-intensity exercise if possible because more health benefits occur as the amount of physical activity increases. For those with chronic conditions, injuries, or other movement limitations, the updated guidelines recommend that they be as physically active as possible, adjusting activity type and intensity based on overall fitness level, abilities, and safety.

The updated guidelines also note the distinction between "exercise" and "physical activity." Physical activity is any type of movement using the skeletal muscles that requires energy. Exercise is planned, structured, repetitive, and intentional movement intended to improve or maintain fitness. Therefore, exercise is a type of physical activity, but not all physical activity is "exercise."

Because many individuals are intimidated by exercise in a gym setting, as part of a sports activity, or in the context of home fitness equipment, using the phrase "physical activity" may motivate sedentary individuals to move more. A large analysis of 22 studies including more than 320,000 adults found that as little as one hour of walking or household/yard work like gardening per week decreased risk of heart attack and stroke.2

This change in messaging was made with the hope that more sedentary individuals, especially those intimidated by the concept of exercise, will change their lifestyle to become more physically active. Therefore, your clients don't have to "exercise" to become more physically active and derive heart health benefits. Simply decreasing the amount of daily time spent sitting and increasing time spent moving in some way will be beneficial.

The location of daily activity also may improve cardiovascular function. Recent studies have investigated the effects of nature walks, specifically "forest bathing," or Shinrin-yoku, a Japanese concept that involves experiencing the atmosphere of a peaceful wooded area. Scandinavian countries also have the concept of friluftsliv, which translates to "open-air living" and endorses the value of spending time outdoors in nature for mental and physical well-being.

Clinical studies have shown that a forest environment can decrease levels of stress hormones, blood pressure, and heart rate, thereby inducing relaxation.3,4 A 2017 systematic review and meta-analysis of 20 studies that included 732 participants found that both systolic and diastolic blood pressure of individuals walking or sitting in a forest setting was significantly lower than those in a nonforest environment.3

Other research suggests that living near or spending time in green vegetated areas—not just forests—promotes physical activity, improves mental health, and reduces the risk of CVD.4 Because stress influences health, any activity that reduces stress benefits the heart, so performing light physical activity such as walking or simply enjoying some time in nature can contribute to a healthy heart.

Advice for Inactive Clients
• Encourage clients to become more active rather than to "exercise." For example, adding a short lunchtime walk at work or dancing when hearing a favorite song can add up to several minutes of physical activity weekly.

• Explain the difference between exercising for increased fitness and becoming more physically active for heart health. Clients may equate exercise with muscled, fit people at a gym and be intimidated. Daily physical activities such as doing housework, gardening, and walking the dog count.

• Encourage outdoor activities, including walking in local parks or on wooded trails, gardening, and golfing. Suggest they track blood pressure over time after increasing outdoor nature activities.

• Suggest chair exercises and/or water activities for clients with movement limitations.

• Encourage gradual increases in activity intensity as clients become more active. For example, increase walking speed and distance or join a beginner exercise class.

• Suggest active volunteer opportunities for retired clients and others with spare time. For example, clients can walk dogs at animal shelters, work at museums and nonprofit organizations as a walking tour guide, or perform litter clean-up for local environmental organizations.

Hopefully, the new messages of "move more, sit less" and "anything is better than nothing" in national physical activity guidelines will get more sedentary Americans moving to improve heart health.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Lancaster, Pennsylvania, area.

1. US Department of Health and Human Services. Physical activity guidelines for Americans, 2nd edition. https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf. Published 2018.

2. Simon HB. Exercise and health: dose and response, considering both ends of the curve. Am J Med. 2015;128(11):1171-1177.

3. Ideno Y, Hayashi K, Abe Y, et al. Blood pressure-lowering effect of Shinrin-yoku (forest bathing): a systematic review and meta-analysis. BMC Complement Altern Med. 2017;17(1):409.

4. James P, Banay RF, Hart JE, Laden F. A review of the health benefits of greenness. Curr Epidemiol Rep. 2015;2(2):131-142.