Health Disclaimer:
These articles are for educative and entertainment purposes only. They are not intended to be a substitute for professional medical advice, diagnosis or treatment. If you have a current injury or are in pain, please seek the advice of your regular health care provider. You are responsible for your own safety and health at all times. Especially, given physical activity is not without risk and can cause harm. By engaging with any content on this website you acknowledge and agree that Eccentric Physio is not liable for any direct, indirect, special, consequential, exemplary, or other damages arising therefrom.

Never disregard professional medical advice or delay seeking medical treatment because of something you have read on or accessed through this web site.

TL;DR - If you are in the 18-64 year old age group you only need to be doing 150 minutes of moderate intensity aerobic activity spread over 5 days a week and 2 days a week of muscle strengthening to meet the World Health Organisation baseline recommendations. Have a read below to find some straightforward advice on how to achieve this.

WHAT IS PHYSICAL ACTIVITY?

Bear with me while we get through some definitions and statistics!

What does physical activity mean? Movement by your muscles. Movement that requires energy. An increasing issue is more people are not partaking in physical activity, instead opting for sedentary activities. Sedentary activities require minimal muscle movement and energy expenditure. Some of this is due to: increased use of passive transport options (cars, buses, trains etc) and lack of access to parks/recreation. Generally the statistics favour men as more physically active than females (1).

Lack of physical activity is a major risk factor for developing a variety of health conditions and is a leading cause of deaths worldwide.

Based on large amounts of research, consistent moderate to vigorous physical activity with specifically prescribed dosages will reduce risk of (2,3):

Heart disease
Stroke
Colon and breast cancer
Depression
Falls
High blood pressure
Diabetes
High BMI (i.e. increased fat storage).
Reduced muscle strength
Reduced bone density
Falling
Reduced cognitive function
Reduced feel good endorphins

What this means is that the right amount of physical activity will REDUCE your risk of a) developing these noncommunicable diseases (NCDs), or b) reduce your chance of developing them. Notice that I keep saying physical activity and not exercise. What many define as exercise is a subcategory under the umbrella of Physical Activity. Physical Activity encompasses all daily movement performed by your muscles that is associated with energy expenditure. However, exercise is the structured intention of improving or maintaining a fundamental part of physical activity. Simply, I have a strength or cardiovascular goal and exercise will help me get there.

Fifa logo (5)

What are other kinds of Physical Activity? Anything that involves your physical movement throughout the day. To name a few: your work commute, your actual work, the chores you do, DIY around the house, sports, playing, dancing, walking etc. Recently FIFA has even labelled soccer as medicine due to the health benefits associated with playing. (4)

So you might have a few questions at this stage. It is clear that reduced physical activity and prolonged sitting increases your risk of mortality. Interestingly, more exercise may not negate the negative effects of excessive sitting (2). We addressed this issue in last week’s article. It is also clear that regular exercise, at the right dosage, is enough to stave off mortality (read death). So how much should you do? Are there age specific recommendations? What kind of exercise should I do? Fortunately the World Health Organisation (WHO) has developed baselines for us to meet. So let’s answer the remaining questions to how you can begin or sustain a physically active lifestyle!

THE WHO GUIDELINES

There are different recommendations for different age groups. We will be focusing on the 18-64 year old age group recommendations for healthy adults! If you are interested in other age groups you can find the reference at the end of this article.

The different age groups are:

0-5 years
5-17 years
18-64 years
65+ years

Specific physical activity recommendations for 18-64 years below (7):

Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
Aerobic activity should be performed in bouts of at least 10 minutes duration.
For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity. According to the new 2020 guidelines, going beyond these recommendations does not “appreciably further decrease the risk of major outcomes”.
Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.
Sedentary activity should be limited across all age groups. At the moment there is insufficient evidence on a specific threshold for sedentary activity. Instead attempt to replace sedentary activity with physical activity options listed below.

FIRST STEP – BEFORE YOU DO ANYTHING!

Have a look through this document. It is called a PAR-Q. It is 7-question questionnaire to establish if it is safe to begin exercise or if you should consult with your GP before starting. Please click this link and answer the questions. Make a responsible decision!

https://www.reps.org.nz/wp-content/uploads/2017/04/REPs-PARQ-Form.pdf

SOME EXERCISE DEFINITIONS TO GET THE LIE OF THE LAND.

This is what we call the dose-response relationship. Basically, how much exercise do I need to do to get the health benefits I need? This is answered with how you manipulate these variables: frequency, duration, intensity, type and total volume. These are the same variables used for social exercise or athletic programs.

Frequency – How often an exercise or physical activity is performed per week.
Duration – How long an exercise or physical activity is performed for (minutes).
Intensity – How hard you work to do the exercise or physical activity. This can be magnitude of effort or the speed/rate you are performing at.
Type – this is what you are doing e.g. cardiovascular, strength, sport, mobility, dancing etc. Volume – The total amount of the above variables you are doing over a week.

WHAT IS MODERATE AND VIGOROUS EXERCISE?

The intensity scale we will be using is relative to your individual capacity, as an individual. I will repeat that because it is arguably the most important sentence in this ENTIRE article. The intensity scale we will be using is relative to your individual capacity, as an INDIVIDUAL! The scale is called the Rate of Perceived Exertion (RPE) 0-10 where 0 = no effort at all and 10 = I literally couldn’t work harder (9–11).

Moderate intensity – 4-6/10 on the RPE scale. In other words you are working at 40-60% of your 100% maximum effort.
Vigorous intensity – 7-8/10 RPE i.e. 70-80% of your 100% maximal effort.

WHERE DO WE START?

Step 1 – Build your duration to meet the above standards in #1. You can achieve this by exercise snacking in #2. Aerobic activities has benefits up to 72 hours afterwards.

Step 2 – Establish consistency with your strengthening activities in #4. Consistency is the most influential variable here.

Step 3 – Once you meet the recommended baselines decide if you want to pursue specific aspects of your health or more performance orientated goals. This is #3 above.

HOW MUCH SHOULD YOU DO?

Aerobic prescription (3-5x/week)

Anything that increases your heart and respiratory rate. What is the easiest way to measure this? Breathlessness. You’re looking for that level of uncomfortable to talk to someone but you’re still able to level. This will mean you are working at 4-6/10 RPE (10,11). Double check the RPE scale earlier in the article if you need a refresher.
Let’s keep this as simple as we can. Whatever physical activity you choose to do try to do at least 150 minutes of 4-6/10 effort. This could be 5x30minute walks. One of those walks could be 3x10 minutes in 1 day.

Activity options (there are many more):

Walking
Running
Jump rope
Rowing
Cycling
Sports
Dancing

Strength prescription (2x/week):

Generally 3x10 is a good prescription for most people starting out.
Choose a movement and do it 2x/week at RPE of 4-6 based on the technique. What this means is if you cannot continue the exercise with good technique due to fatigue then stop. Don’t do 15 reps because you decided 15 reps is the number to get to today. Do 15 reps because you can execute 15 good reps.
If you are new to muscle strengthening don’t worry so much about a structured program. That’s not to say structure isn’t important, especially in the conscious development of habits but for now hang fire. Just focus on figuring out what you enjoy. If you have been exercising for a while and have specific performance goals then structuring your exercise will be more useful.

Movement options:

+ Lunge

+ Squat

+ Stairs

+ Press

+ Pull

+ Carry

+ Balance

At this stage it is vital to note the amount being prescribed above. Nothing written so far has indicated you must go to the gym or exercise daily to get health benefits. You may need to do some consistent work over time if you have specific health goals though. Still don’t have to do it every day! This leads us to our last and arguably most important topic around recreational physical activity. Exercise guilt.

EXERCISE GUILT

This is your classic New Year’s resolution scenario. I am going to sign up to the gym or start running so that I can _______(fill in the blank). You do too much too soon and burnout or get injured. Then the feeling of guilt. This is an unfortunate relationship many have with exercise. Try not to guilt yourself into exercise. Clearly there is a sense of motivation and interest in exercise otherwise you wouldn’t be still be reading, so let’s try looking at this from another angle.
Everyone does NOT need to train like athletes. I repeat! There is no crime here. You do not have to train like an athlete to get health benefits from physical activity (14). Think of it like this. All aspects of life are progressive overload.

Try remembering another time in your life when you were learning a new skill. The process may have gone something like this. First it didn’t take much time doing the new skill to get overwhelmed. You found it was better to do it little and often. As you became more confident maybe you started doing it more often or for longer. Maybe you decided it wasn’t for you and then tried something else. At some point you developed a skill to the level of mastery you were content with. How do we define mastery here? The level which enables YOU to do the task YOU’RE interested in, without having to think about it every moment you are doing it. Sometimes it took years to feel confident performing the skill at this level (read: your job). Exercise is a skill. Exercise is a part of physical activity. Exercise mastery takes time.

In a nutshell, whatever type of physical activity you choose to do may not be the activity you are doing years from now. What is important is that you ultimately stick with an activity that you enjoy enough to do consistently. You will get better over time. Start small, little and often. Enjoy the little mistakes inherent in the process of learning. Don’t rush and exceed your capacity or you will likely make bigger mistakes. Enjoy. More is not better. Better is better. Go to technique failure. Not fatigue failure. What do kids do when they are tired from physical activity? They stop. Unless it is a sport. A lot of the injuries we see in clinic are people who are just doing too much too soon (I’ll let you ponder that point)!

CONCLUSION

Choose something you like to do that gets you breathless. Do this 3-5x/week depending on how hard you work. Choose a few strengthening exercises from above and do 3x10 at a level which feels like 40-60% of your max effort. Do this 2x/week. Rinse. Repeat. Do it consistently. Reap the rewards.

Stay inquisitive and do the basics well,
Ciaran

P.S. A little side note for anyone consuming more information on exercise. Try using these checkpoints for deciding if the information is relevant to you.

Is this talking about my age group?
Is this talking about my activity levels?
Are they talking about things I want to do?
Who is the author? What is their background/history? Does it relate to what they are writing about?
Is the info being explained simply?

References

WHO | Physical Activity [Internet]. WHO. World Health Organization; [cited 2020 Apr 10]. Available from: http://www.who.int/dietphysicalactivity/pa/en/
Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting Time and Mortality from All Causes, Cardiovascular Disease, and Cancer. Medicine & Science in Sports & Exercise. 2009 May;41(5):998–1005.
Thompson PD, Crouse SF, Goodpaster B, Kelley D, Moyna N, Pescatello L. The acute versus the chronic response to exercise. Medicine & Science in Sports & Exercise. 2001 Jun;33(6):S438.
Luo H, Newton RU, Ma’ayah F, Galvão DA, Taaffe DR. Recreational soccer as sport medicine for middle-aged and older adults: a systematic review. BMJ Open Sport Exerc Med [Internet]. 2018 Aug 9 [cited 2020 Apr 12];4(1). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6089298/
FIFA Medical Platform – FIFA Medical Platform [Internet]. [cited 2020 Apr 12]. Available from: https://www.fifamedicalnetwork.com/
Home [Internet]. [cited 2020 Apr 13]. Available from: https://www.who.int
Global recommendations on physical activity for health. Genève: WHO; 2010.
CSEP - PAR-Q Forms [Internet]. [cited 2014 Sep 20]. Available from: http://www.csep.ca/english/view.asp?x=698
Zourdos M, Klemp A, Dolan C, Quiles J, Schau K, Jo E, et al. Novel Resistance Training-Specific RPE Scale Measuring Repetitions in Reserve. The Journal of Strength and Conditioning Research. 2015 Jun 8;30.
Kendrick KR, Baxi SC, Smith RM. Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma. Journal of Emergency Nursing. 2000 Jun;26(3):0216–22.
Borg Rating of Perceived Exertion Scale [Internet]. HealthLink BC. 2016 [cited 2020 Apr 12]. Available from: https://www.healthlinkbc.ca/physical-activity/borg-rating-perceived-exertion-scale
Wilkes L. running zones [Internet]. Podiatry Point. [cited 2020 Apr 13]. Available from: https://podiatrypoint.com.au/news/3-common-mistakes-we-see-in-recreational-runners/attachment/running-zones/
What is Productivity Guilt? (And How Can You Prevent It?) - Scott Young [Internet]. Pocket. [cited 2020 Apr 13]. Available from: https://getpocket.com/explore/item/what-is-productivity-guilt-and-how-can-you-prevent-it
Exercise Has Immediate Benefits: Countering Exercise Myths that Keep Us Unfit [Internet]. [cited 2020 Apr 12]. Available from: https://www.strengthminded.com/exercise-has-immediate-benefits-countering-exercise-myths-that-keep-us-unfit/

Copyright Disclaimer - This article is protected by the Copyright Act 1994. The author controls the copyright of this article. Recognition of the author’s right to be identified as the author will be acknowledged and when relevant the author will be acknowledged as the author. You will obtain the author’s permission before publishing any material from this article. For further information you can reference the Act here: https://www.legislation.govt.nz/act/public/1994/0143/latest/whole.html

Exercise and Physical activity. How to know when you're doing enough (updated for 2020 WHO guidelines).