Current Recommendations for Physical Activity in India

at MDRF, Chennai, Feb 2013

Dr. Nayanjeet Chaudhury, MD, MPH Certified Personal Trainer (ACSM)

Certified Aerobics Trainer (Reebok)

Director for M&E and Health Services Delivery(NCDs),

Population Services International New Delhi

Available Guidelines

Age group WHO Guidelines Physical activity guidelines for Asian

indians (conensus statement)

Duration Intensity Duration Intensity

0-5 Years None None None None

5-17 years

old

60 min daily Moderate to

vigorous intensity

60 min / day Moderate to

vigorous intensity

18-64 years

old

150 min per

week / 70 min

week

Moderate /

vigorous /

combination of

both

60 min / day Moderate intensity

65 years and

above

150 min per

week / 70 min

week

Moderate /

vigorous /

combination of

both

60 min / day Moderate intensity

Physical Activity guidelines of few countries Age

group

WHO Guidelines Physical activity

guidelines-UK

Canadian Society for

Exercise Physiology

Department of Health

& Aging-Australia

CDC Guidelines on

physical activity

Physical activity

guidelines for

Aasian indians

Duration Intensity Duration Intensity Duration Intensity Duration Intensity Duration Intensity Duration Intensity

0-5

Years

None None Every day Floor

based

play

Every day Floor based

play for

toddlers

Pre-

schoolers

180 min

spread

throughout

the day

Every day Floor based

play for

toddlers

Pre-

schoolers

180 min

spread

throughout

the day

60 min gymnasti

cs or

push-

ups,

at least 3

days per

week

None None

5-17

years

old

60 min

daily

Moderate

to

vigorous

intensity

60 min

daily

Moderate

to

vigorous

intensity

60

minutes /

Day

Moderate to

vigorous

intensity

60 min/

day

Moderate to

vigorous

intensity

60 min /

day

Moderate

to

vigorous

intensity

18-64

years

old

150 min

per week

/ 70 min

week

Moderate

/ vigorous

/

combinati

on of both

150 min

per week

/ 70 min

week

Moderate

/ vigorous

/

combinati

on of both

150

minutes /

week

Moderate to

vigorous

intensity

60 min/

day

Moderate to

vigorous

intensity

150

minutes/

week

75

minutes/

week

Moderat

e

intensity

vigorous

intensity

60 min /

day

Moderate

intensity

65

years

and

above

150 min

per week

/ 70 min

week

Moderate

/ vigorous

/

combinati

on of both

150 min

per week

/ 70 min

week

Moderate

/ vigorous

/

combinati

on of both

150

minutes /

week

Moderate to

vigorous

intensity

30 min/

day

moderate

intensity

60 min /

day

Moderate

intensity

Definition of Terms – WHO guidelines

• Moderate-intensity physical activity.

“On an absolute scale, activity that is performed at 3.0–5.9 times the intensity of rest. On a scale relative to an individual’s personal capacity, moderate-intensity physical activity is usually a 5 or 6 on a scale of 0–10”

• Vigorous-intensity physical activity. “On an absolute scale, activity that is performed at 6.0 or more times the intensity of

rest for adults and typically 7.0 or more times for children and youth. On a scale relative to an individual’s personal capacity, vigorous intensity physical activity is usually a 7 or 8 on a scale of 0–10”

• Duration: “The length of time in which an activity or exercise is performed. Duration is generally expressed in minutes”

• Frequency: “The number of times an exercise or activity is performed. Frequency is generally expressed in sessions, episodes, or bouts per week”

• Intensity: “Intensity refers to the rate at which the activity is being performed or the magnitude of the effort required to perform an activity or exercise”

Definitions of Physical Activity Intensity – Consensus Physical Activity Guidelines for Asian Indians

• Low-intensity: “activity elicits a slight increase in breathing rate and is relative to a given person”

• Moderate-intensity: “activity elicits a moderate, noticeable increase in depth and rate of breathing, while still allowing comfortable talking and is relative for a given person”

• Vigorous-intensity: “activity elicits a noticeable increase in depth and rate of breathing, will not be able to allow more than a few words without pausing for a breath”

Key highlights for healthy adults: Consensus statement

• Physical inactivity should be avoided as far as possible.

• Pre-participation medical consultation for those with chronic diseases

• A total of 60 min of physical activity is recommended every day including aerobic, work-related activity and muscle-strengthening activity. – Minimum 30 min of moderate-intensity aerobic activity (e.g., brisk walking, jogging, hiking,

gardening, bicycling etc.),

– 15 min of work-related activity (e.g., carrying heavy loads, climbing stairs etc.) and

– 15 min of muscle-strengthening exercises (at least 3-4 times a week)

• Total duration could be accumulated in 10-15 min periods of activity 2-3 times a day.

• Additional benefits if adults increase moderate-intensity aerobic activity to 300 min/week, or engage in 150 min/week of vigorous-intensity aerobic activity, or an equivalent combination of moderate- and vigorous-intensity activity.

• Brisk walking (walking at an intensity wherein an individual finds speaking difficult but not impossible) is the preferred initial mode of exercise

• Inactive people should start slow and gradually increase physical activity.

Children and Adolescents

• Daily minimum of 1 hour and up to several hours of at least moderate-intensity aerobic physical activity.

• Activity may mostly comprise sports activities and active transport, over and above habitual physical activity.

• TV viewing, computer work (sedentary) should be restricted to less than 2 hrs per day

Children and Adolescents Type Frequency Duration

Moderate- or vigorous-intensity aerobic physical activity (such as running, hopping, skipping, jumping rope, swimming, dancing, and bicycling)

At least 3 days a week (Preferably daily),

60+ min per day

Muscle-strengthening physical activity (playing on playground equipment, climbing trees, tug-of-war, weight lifting or working with resistance bands)

3 days a week

20-30 min

Bone-strengthening physical activity (such as running, jumping, basketball, tennis)

3 days a week 20-30 min

Activities for Children and Adolescents Age Group : Examples from American Guidelines

Activity Children Adolescents

Moderate–

intensity

aerobic

• Active recreation, such as hiking,

skateboarding, rollerblading • Bicycle

riding • Brisk walking

• Active recreation, such as canoeing, hiking,

skateboarding, • Brisk walking • Bicycle (stationary or

road bike) • Housework /yard work, such as sweeping

or pushing a lawn mower • Games that require

catching and throwing, such as baseball and softball

Vigorous–

intensity

• Active games involving running and

chasing, such as tag • Bicycle riding •

Jumping rope • Martial arts, such as

karate • Running • Sports such as

soccer, hockey, basketball, swimming,

tennis • Cross-country skiing

• Active games involving running and chasing,

aerobic such as flag football • Bicycle riding • Jumping rope •

Martial arts, such as karate • Running • Sports such as

soccer, ice or field hockey, basketball, swimming,

tennis • Vigorous dancing • Cross-country skiing

Muscle-

strengthening

• Games such as tug-of-war • Modified

push-ups (with knees on the floor) •

Resistance exercises using body weight

or resistance bands • Rope or tree

climbing • Sit-ups (curl-ups or

crunches) • Swinging on playground

equipment/bars

• Games such as tug-of-war • Push-ups and pull-ups •

Resistance exercises with exercise bands, weight

machines, hand-held weights • Climbing wall • Sit-ups

(curl-ups or crunches)

Bone-

strengthening

• Games such as hopscotch • Hopping,

skipping, jumping • Jumping rope •

Running • Sports such as gymnastics,

basketball, volleyball, tennis

• Hopping, skipping, jumping • Jumping rope •

Running • Sports such as gymnastics, basketball,

volleyball, tennis Source:http://www.health.gov/paguidelines/pdf/paguide.pdf

Examples of activities for Older Adults

• Aerobic • Walking

• Dancing

• Swimming

• Jogging

• Aerobic exercise classes

• Bicycle riding (stationary or on a path)

• Some activities of gardening, Tennis

• Muscle-Strengthening • Exercises using exercise

bands, weight machines, hand-held weights

• Calisthenic exercises (body weight provides resistance to movement)

• Digging, lifting, and carrying as part of gardening

• Carrying groceries

• Some yoga exercises

Source:http://www.health.gov/paguidelines/pdf/paguide.pdf

Other categories. • Pregnancy; Usually exercise is as safe as in other

healthy adults, but needs obstetrician’s consultation. Pelvic floor strengthening may be critical to post pregnancy health of uterus.

• Elderly adults: Special recommendation for resistance training.

• Patients with CHD, hypertension: minimum 120 hours of aerobic activity recommended.

• Diabetes: Same as for healthy adults.

• Obesity & overweight: Minimum 60 minutes of activity most of the time.

References

• WHO | Global Recommendations on Physical activity for Health www.who.int/dietphysicalactivity/...recommendations/en

• Canadian Physical Activity Guidelines and Canadian Sedentary Behaviour Guidelines http://www.csep.ca/english/view.asp?x=804

• UK physical activity guidelines : Department of Health – Publications. http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_127931

• Australian Government. Department of Health and Ageing - Physical Activity Guidelines. http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

• Centre for Disease Control and Prevention. Physical Activity for Everyone: Guidelines: Children | DNPAO | CDC http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html

• Anoop Misra, Priyanka Nigam, Andrew P. Hills, Davinder S. Chadha, Vineeta Sharma, K.K. Deepak, Naval K. Vikram, Shashank Joshi, Ashish Chauhan, Kumud Khanna, Rekha Sharma, Kanchan Mittal, Santosh Jain Passi, Veenu Seth, Seema Puri, Ratna Devi, A.P. Dubey, and Sunita Gupta, for the Physical Activity Consensus Group. Diabetes Technology & Therapeutics. January 2012, 14(1): 83-98. doi:10.1089/dia.2011.0111.