Physical activity

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Many children and adults fail to reach the current levels of physical activity recommended by guidelines. Low levels of physical activity and sedentary behaviour are associated with increased all-cause mortality. In contrast, performing more physical activity and more vigorous physical activity are associated with reduced all-cause mortality. For adults and older adults, the guidelines recommend performing >150 minutes of structured, moderate-to-vigorous physical activity (at least walking briskly) every week, as well as strengthening exercises.

CONTENTS

What is physical activity?

Physical activity is any active movement of the body that is produced by muscular contractions and that results in the expenditure of energy (Caspersen et al.). On the basis of this definition, exercise is a sub-category of physical activity, as are various types of occupation, sport, errands and household chores. In contrast, sedentary behaviour is simply an absence of physical activity. Physical activity can be measured in various ways. The most common measurement method is accelerometry. Accelerometers have the benefit of being objective in determining the distance travelled and the duration over which the activity is performed. Sedentary behavior is much more easily defined as the absence of physical activity and this too can be measured using accelerometers. The most commonly-used way to analyze the physical activity into different categories of intensity is on the basis of metabolic equivalent units (METs). One MET is equal to the energy expenditure required to maintain a seated position. Thus, more demanding activities can be related back to how much energy they require in relation to simply maintaining the seated position. The following table shows the key definitions (see Pate et al.):

Definition METs Example
Sedentary behaviour 1.0 METs “Sitting quietly”
Light physical activity <3.0 METs Strolling at 1 – 2 mph, easy swimming, or stretching exercises
Moderate physical activity 3.0 – 6.0 METs Walking briskly at 3 – 4mph, cycling at <10mph, or housework
Vigorous physical activity >6.0 METs Exercise or hard efforts
Moderate-to-vigorous physical activity >3.0 METs As above

Moderate-to-vigorous physical activity is the most important definition to remember. This definition is used most commonly in guideline documents and research into the effects of physical activity and sedentary behavior on health outcomes. Essentially, moderate-to-vigorous physical activity is anything more-than-or-equal-to walking briskly. Many guidelines recommend accumulating >150 minutes of moderate-to-vigorous physical activity every week. For a list of the MET scores of various physical activities, including occupational activities, household chores and common hobbies, see Ainsworth et al.

 


What is the extent of sedentary behaviour in children?

Children are a key focus of physical activity research at present. The following studies have assessed the extent of sedentary behaviour in children from various different populations:

Study Population Time spent in sedentary behaviour
Wang et al. Chinese city children aged 9 – 17 years 521.5 ± 110.0 minutes per day
Kettner et al. Primary school children in south-west Germany 808 ± 97 minutes per day
Verloigne et al. European female children aged 11.6 ± 0.8 years 500 minutes per day
Verloigne et al. European male children aged 11.6 ± 0.8 years 474 minutes per day
Mitchell et al. UK boys aged 12 years 418.0 ± 67.7 minutes per day
Mitchell et al. UK girls aged 12 years 436.0 ± 64.0 minutes per day
Mitchell et al. UK boys aged 14 years 468.0 ± 74.3 minutes per day
Mitchell et al. UK girls aged 14 years 495.6 ± 68.9 minutes per day
Mitchell et al. UK boys aged 16 years 510.4 ± 76.6 minutes per day
Mitchell et al. UK girls aged 16 years 525.4 ± 67.4 minutes per day
Van Cauwenberghe et al. Preschool boys in Australia on weekdays 306 ± 77 minutes per day
Van Cauwenberghe et al. Preschool girls in Australia on weekdays 309 ± 70 minutes per day
Van Cauwenberghe et al. Preschool boys in Australia at weekends 293 ± 23 minutes per day
Van Cauwenberghe et al. Preschool girls in Australia at weekends 300 ± 78 minutes per day
Hesketh et al. Four-year-old British children 283.5 ± 72.2 minutes per day
Nilsson et al. Nine-year old boys in Denmark at weekends 299 ± 87 minutes per day
Nilsson et al. Nine-year old boys in Portugal at weekends 269 ± 89 minutes per day
Nilsson et al. Nine-year old boys in Estonia at weekends 239 ± 94 minutes per day
Nilsson et al. Nine-year old boys in Finland at weekends 289 ± 81 minutes per day
Nilsson et al. Nine-year old boys in Denmark on weekdays 311 ± 78 minutes per day
Nilsson et al. Nine-year old boys in Portugal on weekdays 318 ± 81 minutes per day
Nilsson et al. Nine-year old boys in Estonia on weekdays 277 ± 77 minutes per day
Nilsson et al. Nine-year old boys in Finland on weekdays 298 ± 70 minutes per day
Martínez-Gómez et al. Spanish females aged 13 – 16 years 471.4 ± 84.3 minutes per day
Martínez-Gómez et al. Spanish males aged 13 – 16 years 496.1 ± 80.6 minutes per day
Deforche et al. Normal-weight children aged 6 – 10 years 527 ± 66 minutes per day
Deforche et al. Overweight children aged 6 – 10 years 545 ± 72 minutes per day
Corder et al. British children aged 9 – 10 years 455.3 ± 55.9 minutes per day
Corder et al. British children aged 13 – 14 years 500.7 ± 58.6 minutes per day

Based on the above studies, it seems that children from pre-school to adolescence engage in sedentary behaviour of between 239 – 808 minutes per day. The number of minutes of sedentary behavior seems to be greater in overweight than in normal-weight children and also seems to increase with increasing age. There also appear to be large differences between countries, although the measurement methods could account for some of these differences.


What is the extent of sedentary behaviour in adults?

Although there is much less research interest in studying the extent of sedentary behaviour in adults, the following studies have assessed the extent of sedentary behaviour in adults from varying populations:

Study Population Time spent in sedentary behaviour
Matthews et al. US male adults aged 20 – 29 years 436 minutes per day
Matthews et al. US female adults aged 20 – 29 years 461 minutes per day
Matthews et al. US male adults aged 40 – 49 years 454 minutes per day
Matthews et al. US female adults aged 40 – 49 years 452 minutes per day
Matthews et al. US male adults aged 60 – 69 years 528 minutes per day
Matthews et al. US female adults aged 60 – 69 years 485 minutes per day
Healy et al. US adults aged >20 years 506.4 minutes per day
Hansen et al. Norwegian adult males aged 20 – 85 years 557 minutes per day
Hansen et al. Norwegian adult females aged 20 – 85 years 533 minutes per day
Evenson et al. US adults aged 60 – 69 years 487.8 minutes per day
Evenson et al. US adults aged 70 – 79 years 516.2 minutes per day
Evenson et al. US adults aged >80 years 542.4 minutes per day

Based on the above studies, it seems that adults engage in sedentary behaviour of between 436 – 557 minutes per day. Sedentary behavior may increase with increasing age, although not all studies show a clear trend in this respect.


What is the extent of physical activity in children?

Children are a key focus of physical activity research at present. The following studies have assessed the extent of moderate-to-vigorous physical activity in children from various different populations:

Study Population Time spent in moderate-to-vigorous physical activity
Wang et al. Chinese city children aged 9 – 17 years 28.3 ± 17.7 minutes per day
Kettner et al. Male primary school children in south-west Germany 164 ± 57 minutes per day
Kettner et al. Female primary school children in south-west Germany 106 ± 50 minutes per day
Trost et al. Inner-city elementary schoolchildren in the US 48 minutes per day
Verloigne et al. European female children aged 11.6 ± 0.8 years 32 minutes per day
Verloigne et al. European male children aged 11.6 ± 0.8 years 43 minutes per day
Van Cauwenberghe et al. Preschool boys in Australia on weekdays 32 ± 21 minutes per day
Van Cauwenberghe et al. Preschool girls in Australia on weekdays 27 ± 17 minutes per day
Van Cauwenberghe et al. Preschool boys in Australia at weekends 36 ± 25 minutes per day
Van Cauwenberghe et al. Preschool girls in Australia at weekends 30 ± 21 minutes per day
Comte et al. Canadian youth aged 10 – 15 years on weekdays 55.8 ± 23.0 minutes per day
Comte et al. Canadian youth aged 10 – 15 years at weekends 38.7 ± 26.7 minutes per day
Hesketh et al. Four-year-old British children 69.6 ± 30.7 minutes per day
Nilsson et al. Nine-year old boys in Denmark at weekends 66 ± 45 minutes per day
Nilsson et al. Nine-year old boys in Portugal at weekends 89 ± 47 minutes per day
Nilsson et al. Nine-year old boys in Estonia at weekends 94 ± 61 minutes per day
Nilsson et al. Nine-year old boys in Finland at weekends 87 ± 51 minutes per day
Nilsson et al. Nine-year old boys in Denmark on weekdays 90 ± 45 minutes per day
Nilsson et al. Nine-year old boys in Portugal on weekdays 94 ± 43 minutes per day
Nilsson et al. Nine-year old boys in Estonia on weekdays 104 ± 55 minutes per day
Nilsson et al. Nine-year old boys in Finland on weekdays 121 ± 41 minutes per day
Martínez-Gómez et al. Spanish females aged 13 – 16 years 62.7 ± 19.6 minutes per day
Martínez-Gómez et al. Spanish males aged 13 – 16 years 85.1 ± 29.2 minutes per day
Deforche et al. Normal-weight children aged 6 – 10 years 77 minutes per day
Deforche et al. Overweight children aged 6 – 10 years 57 minutes per day
Decelis et al. Normal-weight Maltese children aged 11 – 12 years 26.4 minutes per day
Decelis et al. Overweight Maltese children aged 11 – 12 years 18.9 minutes per day
Corder et al. British children aged 9 – 10 years 73.9 ± 25.2 minutes per day
Corder et al. British children aged 13 – 14 years 62.0 ± 24.7 minutes per day
Colley et al. Canadian boys aged 6 to 10 years 69.4 ± 29.1 minutes per day
Colley et al. Canadian boys aged 11 to 14 years 59.5 ± 29.4 minutes per day
Colley et al. Canadian boys aged 15 to 19 years 53.1 ± 25.9 minutes per day

Based on the above studies, it seems that children from pre-school to adolescence engage in moderate-to-vigorous physical activity of between 18.9 – 164 minutes per day. The number of minutes of moderate-to-vigorous physical activity seems to be smaller in overweight than in normal-weight children and also seems to reduce with increasing age. There also appear to be large differences between countries, although the measurement methods could account for some of these differences.


What is the extent of physical activity in adults?

Although there is much less research interest in studying the extent of physical activity in adults, the following studies have assessed the extent of moderate-to-vigorous physical activity in adults from various different populations:

Study Population Time spent in moderate-to-vigorous physical activity
Medina et al. Mexican male adults aged 20 – 69 years 48 minutes per day
Medina et al. Mexican female adults aged 20 – 69 years 41 minutes per day
Garriguet and Colley Canadian male adults aged 20 – 39 years 33 minutes per day
Garriguet and Colley Canadian female adults aged 20 – 39 years 24 minutes per day
Garriguet and Colley Canadian male adults aged 40 – 59 years 27 minutes per day
Garriguet and Colley Canadian female adults aged 40 – 59 years 22 minutes per day
Garriguet and Colley Canadian male adults aged 60 – 79 years 17 minutes per day
Garriguet and Colley Canadian male adults aged 60 – 79 years 12 minutes per day
Young et al. Overweight and obese adults in the US aged >25 years 15.8 minutes per day
Troiano et al. US adult males aged 20 – 29 years 39.7 minutes per day
Troiano et al. US adult females aged 20 – 29 years 23.6 minutes per day
Troiano et al. US adult males aged 40 – 49 years 34.7 minutes per day
Troiano et al. US adult females aged 40 – 49 years 19.9 minutes per day
Troiano et al. US adult males aged 60 – 69 years 16.7 minutes per day
Troiano et al. US adult females aged 60 – 69 years 12.4 minutes per day
Dos Anjos et al. Brazilian adult males 99.4 minutes per day
Dos Anjos et al. Brazilian adult females 71.4 minutes per day
Hagströmer et al. Swedish adults with an average age of 45 years 31 minutes per day
Davis et al. Elderly females with an average age of 76 years 16.7 minutes per day
Davis et al. Elderly males with an average age of 76 years 23.8 minutes per day
Davis et al. Young adult females with an average age of 27 years 18.4 minutes per day
Davis et al. Elderly males with an average age of 27 years 40.4 minutes per day
Copeland and Esliger Adults with an average age of 69.7 years 68 minutes per day
Hansen et al. Norwegian adult males aged 20 – 85 years 35 minutes per day
Hansen et al. Norwegian adult females aged 20 – 85 years 33 minutes per day

Based on the above studies, it seems that adults engage in moderate-to-vigorous physical activity of between 12 – 99.4 minutes per day, depending on the population. Overweight and obese adults seem to engage in less physical activity than normal-weight adults. It is unclear whether elderly adults perform markedly less physical activity than young adults.


What is the effect of sedentary behaviour on all-cause mortality?

Some studies have assessed the effects of sedentary behaviour or a lack of physical activity on all-cause mortality, as shown in the table below:

Study Approach Finding
Wanner et al. The researchers assessed the associations between different domains of physical activity and all-cause, cardiovascular disease and cancer mortality. They recruited 17,663 subjects aged 16 – 92 years from two general population health studies conducted in Switzerland and followed-up over an average of 20.2 years. In the follow-up period, there were 3,878 deaths (1,357 from cardiovascular disease and 1,351 from cancer). The researchers found no significant associations between commuting physical activity or work-related physical activity and any measure of mortality. On the other hand, they found that leisure-time physical activity was negatively associated with all-cause mortality in both males (25% reduced risk) and females (18% reduced risk) and sports physical activity was negatively associated with all-cause mortality in males (15 – 24% reduced risk) but not in females.
Lindsted et al. The researchers performed the Adventist Mortality Study which followed 9,484 males who completed a lifestyle questionnaire including details of physical activity in 1960 over an average follow-up period of 26 years. The researchers found that moderate physical activity was associated with reduced all-cause mortality. They noted that while the protective effect of physical activity on all-cause mortality decreased with increasing age, it still remained significant into very old age.
Rakowski and Mor The researchers assessed the association between self-reported physical activity and all-cause mortality among adults aged >70 years in the Longitudinal Study of Aging that included 5,901 subjects. The researchers presented the subjects with four questions, which asked about (1) how much activity they perform compared to peers, (2) whether they have a regular exercise routine, (3) whether they think they get enough exercise, (4) how many days they walk one mile per week. The researchers found that there was a negative association between physical activity and all-cause mortality as assessed by each of the four questions.
Chang-Claude and Frentzel-Beyme The researchers assessed the association between self-reported physical activity of a cohort of 1,904 vegetarian Germans and all-cause mortality. The researchers found that compared to a low level of physical activity, those with a medium or high level of physical activity displayed half the  all-cause mortality. The researchers also noted that body mass index (BMI) was an independent risk factor for all-cause mortality in males but not in females.
Simonsick et al. The researchers assessed the association between self-reported physical activity in physically capable older adults and functional status, incidence of selected chronic conditions, and mortality over 3 and 6 years as part of the Established Populations for Epidemiologic Studies of the Elderly study. The researchers found that a high level of recreational physical activity was associated with a reduced risk of all-cause mortality of around 33% over both 3 and 6 years.
Weyerer The researcher assessed the association between self-reported physical activity and all-cause mortality in a random sample of 1,536 persons aged >15 years in Upper Bavaria over a 5-year follow-up period. The researcher observed that 5.1% of the sample died during the follow-up period. The researcher found that all-cause mortality risk was significantly higher among physically inactive (males: 1.76 times greater risk and females 1.51 times greater risk) in comparison with a self-reported reference group participating in regular physical activity.
Eaton et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in males aged >40 years over an average follow-up period of 21 years as part of the Cohort Analytic Study of 8,463 Israeli government employees. The researchers found that self-reported leisure-time but not work-related physical activity was negatively associated with all-cause mortality.
Ruigómez et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in a Mediterranean elderly population comprising a cohort of 1,219 non-institutionalized males and females aged >65 years in a 5-year follow-up period. During the follow-up period, the researchers observed that 18.4% of the subjects died. The researchers found that a sedentary life-style was associated with a 1.53 times greater risk of dying compared with individuals who reported being more active.
Mensink et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in 3 independent national representative samples in Germany, including 7,689 males and 7,747 females aged 25 – 69 years. The researchers reported that there was a clear negative association only between intense physical activity and all-cause mortality. Specifically, they found that males and females who spent 2 hours per week on sports displayed a 74% and 72% lower risk of all-cause mortality, respectively, than those who were sedentary.
Lissner et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in a population-based sample of 1,405 Swedish women aged 38 – 60 years over a 6-year follow-up period. The researchers reported that in comparison with being inactive, being somewhat active through occupational activity was associated with a 72% lower risk of all-cause mortality and being somewhat active through leisure activity was associated with a 44% lower risk of all-cause mortality.
Kaplan et al. The researchers assessed the association between leisure-time physical activity and all-cause mortality over a 28-year period in 6,131 adults taking part in the Alameda County Study in Northern California. During the follow-up period, the researchers observed that there were 639 deaths from all causes. The researchers found that a 4-point increase on the leisure-time physical activity scale was associated with a 10% reduced risk of death from all causes.
Rosengren et al. The researchers assessed the long-term effect of work-related and leisure time physical activity on all-cause mortality prospectively in a population study of 7,142 males aged 47 – 55 years at baseline over a 20-year follow-up period. The researchers found that males who were more physically active during leisure time had a lower risk of death from all causes. The most active men had a 30% lower relative risk of dying from all causes than the least active men.
Yu et al. The researchers performed a prospective study of 1,975 middle-aged men from Caerphilly, South Wales with an 11 year follow up in order to assess the association between leisure time physical activity and all-cause mortality. The researchers allocated the subjects into quintiles according to the amount of heavy intensity physical activity that they performed. The researchers found that the top quintile (54.4 – 2,142.9 kcals per day) was associated with a 47% reduced risk of all-cause mortality. The researchers observed much weaker associations between less intense physical activity and all-cause mortality.
Kushi et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in 40,417 postmenopausal Iowa women, aged 55 – 69 years in a prospective cohort study over 7 years of follow-up. The researchers found that subjects who reported regular physical activity were at 23% reduced risk of death compared with women who did not. The researchers found that increasing frequency of moderate physical activity was associated with reduced risk of death, with performing physical activity >4 times per week being associated with a 38% reduced risk compared to never performing physical activity.
Morgan and Clarke The researchers assessed 10-year mortality in 1,042 people aged >65 years as part of the Nottingham longitudinal study of activity and ageing. In an initial interview questionnaire, the subjects provided self-reported physical activity levels and these were graded by the researchers as high, intermediate, or low. The researchers controlled for age, health status, and cigarette smoking in their model. The researchers found that for females the risk of dying of all causes was significantly greater in the intermediate and low categories compared to the high category (1.53 and 2.07 times greater). For males, the risk of dying of all causes was significantly greater in the low category compared to the high category (1.59 times greater).
Leon et al. The researchers assessed association between leisure time physical activity all-cause mortality in a prospective study of 12,138 middle-aged men at high risk for coronary heart disease over a 16-year follow-up period. The researchers found that those subjects in the least-active 10% of subjects for leisure time physical activity averaged 4.9 minutes per day of leisure time physical activity. These subjects displayed an age-adjusted mortality rate that was 22% greater than those in the 20 – 40% of subjects for leisure time physical activity, who averaged 22.7 minutes per day of (predominantly) light and moderate physical activity.
Villeneuve et al. The researchers assessed the association between physical activity, physical fitness, and all-cause mortality in a population-based study of 6,246 male and 8,196 female Canadians aged 20 – 69 years who were taking part in the Canada Fitness Survey. The researchers found that males expending >0.5kcal per kg of bodyweight per day displayed an 18% reduced risk of all-cause mortality compared with those expending <0.5kcal per kg per day. They noted that females expending >3.0kcal per kg of bodyweight per day displayed an 29% reduced risk of all-cause mortality compared with those expending <0.5kcal per kg per day.
Bijnen et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in retired Dutch men aged 64 – 84 years from a population-based sample. The researchers divided the subjects into tertiles according to the amount of time that was spent on physical activity, with the reference point being the lowest tertile. The researchers found that the risk of all-cause mortality reduced with increasing physical activity, with the highest tertile being at 30% lower risk than the lowest tertile. The researchers noted that time spent in more intense activities (>4 kcal per kg of bodyweight per hour) was more strongly associated with reduced all-cause mortality than less intense activities.
Stessman et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in a community-based cohort study, the Jerusalem 70-Year-Olds Longitudinal Study mortality, with a 6-year follow-up period. The researchers reported that all-cause mortality was significantly (2.77 times) greater for subjects reporting no regular exercise than for subjects walking for 4 hours per week. This relationship was found to be independent of gender, smoking, economic conditions, and preexisting medical conditions. The researchers observed a dose-response effect such that an increased frequency of physical activity was associated with progressively reduced mortality.
Andersen et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in a prospective study including 13,375 Danish women and 17,265 men, 20 – 93 years of age, with a mean follow-up period of 14.5 years. The researchers found that in comparison with a sedentary group, the all-cause mortality rate in the most physically active age- and gender-matched quartile was 47% lower.
Wannamethee et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in a prospective study of British males from 24 towns. The researchers divided the subjects into four quartiles: inactive/occasionally active, light, moderate, and moderately vigorous/vigorous activity groups. The moderate and moderately-vigorous activity groups had 50% and 35% lower all-cause mortality than the inactive/occasionally active group, respectively. The researchers observed that physical activity improved both cardiovascular and non-cardiovascular mortality.
Konlaan et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in random sample of 7,252 individuals aged 18 – 65 years from the adult population of Stockholm County, Sweden. The researchers found that performing some leisure time activity was associated with a 23% reduction in the risk of all-cause mortality in comparison with not reporting any leisure time physical activity.
Crespo et al. The researchers assessed the association between self-reported physical activity and all-cause mortality in 9,824 Puerto Rican men. The subjects were stratified by quartiles of physical activity. The researchers found that all-cause mortality was lower in quartiles 2, 3 and 4 than in quartile 1 (the lowest level of physical activity) and the risk was lower in these quartiles by 32%, 37% and 45%, respectively.
Gregg et al. The researchers assessed the association between changes in self-reported physical activity and all-cause mortality in a prospective cohort study among 9,518 community-dwelling US white women aged >65 years. The researchers followed-up the subjects up to 12.5 years after baseline. The researchers found that in comparison with continually sedentary women, those who increased physical activity levels between baseline and follow-up had lower risk of all-cause mortality by 48%.
Barengo et al. The researchers assessed the association between changes in self-reported moderate or high leisure-time physical activity, occupational physical activity, and commuting physical activity and all-cause mortality in a prospective study of 15,853 men and 16,824 women aged 30 – 59 years living in eastern and south-western Finland over a follow-up period of 20 years. The researchers found that all-cause mortality was lower in both males and females who were moderately or highly physically active during leisure time. Similarly, the researchers reported that moderate and high levels of occupational physical activity also decreased all-cause mortality by around 21 – 27% in both sexes. However, while commuting physical activity was associated with reduced all-cause mortality in females, it was not similarly associated with reduced all-cause mortality in males.
Myers et al. The researchers assessed the association between self-reported physical activity and exercise capacity and all-cause mortality in 842 males over an average follow-up period of 5.5 ± 2 years. The researchers categorized the level of physical activity into very low, low, moderate and high quartiles. The researchers found that in comparison with the very low quartile, the high quartile displayed a 62% lower risk of all-cause mortality. The researchers found that for each 1000 kcal per week increase in physical activity, there was an all-cause mortality risk reduction of 20%.
Lee and Skerrett The reviewers performed a systematic review in order to explore the dose-response relation between physical activity and all-cause mortality. The reviewers found clear evidence of an inverse linear dose-response relation between volume of physical activity and all-cause mortality rates in both males and females and in younger and older people In comparison with physical activity of <1,000kcal per week (<2.2 MET hours per day), the reviewers found that individuals performing >1,000kcal per week was associated with a 20 – 30% reduction in all-cause mortality. They also noted that greater reductions are noted at higher volumes of activity.
Oguma et al. The reviewers performed a systematic review in order to explore the dose-response relation between physical activity and all-cause mortality in females and males. The reviewers identified a total of 37 prospective cohort studies and one retrospective cohort study. The reviewers found that across all 38 studies, the median reduction in risk was 34% between the most active and the least active females. In males, the median risk reduction was 35%, suggesting that the associations are similar for both sexes. The reviewers found that significantly lower death rates from all-causes were observed incrementally up to at least 2,300 kcal per week (around 5.0 MET hours per day), although risk reductions were observed from as little as 1,000 kcal per week (around 2.2 MET hours per day).
Samitz et al. The reviewers performed a systematic review and meta-analysis to assess the association between different domains of physical activity and all-cause mortality. The reviewers identified 80 studies with 1,338,143 subjects. The reviewers found that in comparison with subjects engaging in the lowest levels of physical activity, subjects with the highest levels of total physical activity levels had a 35% lower incidence of all-cause mortality. And in comparison with subjects performing just 60 minutes per week of vigorous leisure-time activities such as sport, subjects who performed 300 minutes per week had a 39% lower incidence of all-cause mortality. The reviewers noted that the biggest reductions in all-cause mortality arose as a result of vigorous-intensity exercise and sports.

Based on these studies and reviews, it seems that sedentary behaviour is a large risk factor for increased all-cause mortality. Physical activity of any kind seems to reduce the risk of dying of all causes even at low levels. Being among those undertaking the highest levels of moderate physical activity seems to be associated with a reduction in all-cause mortality of around 30 – 40%. Additionally, there are also strong associations with bigger reductions of around 75 – 80% in all-cause mortality in populations who undertake more vigorous physical activity, such as sport.


What do guidelines prescribe regarding physical activity?

The following reviews and guidelines have provided practical recommendations for the prevention and treatment of sedentary behaviour through increasing physical activity:

Study Recommendation
Janssen and LeBlanc The reviewers made recommendations regarding physical activity levels for children and youths aged 5 – 17 years of age. The reviewers propose that this population should engage in an average of >60 minutes per day (i.e. 7 hours per week) of moderate-to-vigorous physical activity. They suggest that after building a base of moderate activity, additional more vigorous intensity activities should be added in order to strengthen muscle and bone on 3 days of the week.
Tremblay et al. The reviewers presented the new Canadian Physical Activity Guidelines for Children (aged 5 –11 years) and Youth (aged 12 – 17 years). They suggest that in order to achieve health benefits, both children and youth should accumulate >60 minutes of moderate-to-vigorous-intensity physical activity every day and that vigorous-intensity activities should be incorporated into this amount >3 days per week. They recommend that activities that strengthen muscle and bone should be performed on >3 days per week. They note that additional amounts of daily physical activity will lead to greater health benefits.
Nelson et al. The reviewers made recommendations regarding physical activity levels for improving and maintaining health in older adults (i.e. adults aged >65 years, and adults aged 50 – 64 years with clinically significant functional limitations affecting their ability to move). The reviewers recommend that older adults should have a plan for obtaining sufficient physical activity that addresses each recommended type of activity, which includes aerobic, muscle-strengthening, and flexibility exercises. For aerobic exercise, they suggest >5 days per week of 30 minutes of moderate intensity or >3 days per week of 20 minutes of vigorous intensity exercise. For muscle-strengthening exercise, they recommend performing 8 – 10 exercises of 1 set of 10 – 15 repetitions involving the major muscle groups. For flexibility, they recommend performing suitable exercises 2 days per week, as well as balance exercises if appropriate.
Tremblay et al. The reviewers presented the new Canadian Physical Activity Guidelines for Older Adults (aged >65 years). They suggest that in order to achieve health benefits and to improve functional capacities, older adults should accumulate >150 minutes of moderate-to-vigorous-intensity physical activity per week, in bouts of >10 minutes. They recommend performing muscle- and bone-strengthening activities that use major muscle groups on >2 days per week and they suggest that those older adults who suffer from poor mobility should perform exercise to help improve balance and prevent falls. They note that additional amounts of daily physical activity will lead to greater health benefits.
Haskell et al. The reviewers made recommendations regarding physical activity levels for improving and maintaining health in all healthy adults aged 18 – 65 years. They recommend that all adults should perform either moderate-intensity physical activity >30 minutes on 5 days per week or vigorous-intensity physical activity for >20 minutes on 3 days per week. They also recommend that strengthening exercises should be performed >2 days per week. The reviewers note that since there seems to be a dose-response relationship between physical activity and health, it is possible for individuals to make further improvements on their personal fitness by performing more exercise, which will in turn lead to bigger reductions in their risk of chronic disease and mortality.
Tremblay et al. The reviewers presented the new Canadian Physical Activity Guidelines for Adults (aged 18 – 64 years). They suggest that in order to achieve health benefits, adults should accumulate >150 minutes of moderate-to-vigorous-intensity physical activity per week, in bouts of >10 minutes. They recommend performing muscle- and bone-strengthening activities that use major muscle groups on >2 days per week. They note that additional amounts of daily physical activity will lead to greater health benefits.

In summary, the guidelines recommend that both children and adults should perform some sort of physical activity >5 days per week as well as 3 days per week of strengthening exercises. For adults and older adults, the guidelines recommend performing >150 minutes of structured, moderate-to-vigorous physical activity (at least walking briskly) either as blocks of 30 minutes of moderate activity or blocks of 20 minutes of vigorous activity.

Conclusions

Based on the above studies and analysis, the following conclusions can be drawn about physical activity and sedentary behaviour:

Area Conclusion
Extent of daily sedentary behaviour in children Children from pre-school to adolescence engage in sedentary behaviour of between 239 – 808 minutes per day. The number of minutes of sedentary behavior seems to be greater in overweight than in normal-weight children and also seems to increase with increasing age. There also appear to be large differences between countries, although the measurement methods could account for some of these differences.
Extent of daily sedentary behaviour in adults Adults engage in sedentary behaviour of between 436 – 528 minutes per day. It is unclear from studies exactly how sedentary behavior changes with age in adults.
Amount of daily physical activity in children Children from pre-school to adolescence engage in moderate-to-vigorous physical activity of between 18.9 – 164 minutes per day. The number of minutes of moderate-to-vigorous physical activity seems to be smaller in overweight than in normal-weight children and also seems to reduce with increasing age. There also appear to be large differences between countries, although the measurement methods could account for some of these differences.
Amount of daily physical activity in adults Adults engage in moderate-to-vigorous physical activity of between 12 – 99.4 minutes per day, depending on the population. Overweight and obese adults seem to engage in less physical activity than normal-weight adults. It is unclear whether elderly adults perform markedly less physical activity than young adults.
Effect of physical activity on all-cause mortality Sedentary behaviour is a large risk factor for increased all-cause mortality. Physical activity of any kind seems to reduce the risk of dying of all causes even at low levels. Being among those undertaking the highest levels of moderate physical activity seems to be associated with a reduction in all-cause mortality of around 30 – 40%. Additionally, there are also strong associations with bigger reductions of around 75 – 80% in all-cause mortality in populations who undertake more vigorous physical activity, such as sport.

In summary, many children and adults fail to reach the current levels of physical activity recommended by guidelines. Low levels of physical activity and sedentary behaviour are associated with increased all-cause mortality. Performing more physical activity and more vigorous physical activity are associated with reduced all-cause mortality. For adults and older adults, the guidelines recommend performing >150 minutes of structured, moderate-to-vigorous physical activity (at least walking briskly) every week as well as strengthening exercises.

References

  1. Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Reports, 100(2), 126.
  2. Pate, R. R., Pratt, M., Blair, S. N., Haskell, W. L., Macera, C. A., Bouchard, C., … & Wilmore, J. H. (1995). Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA, 273(5), 402-407.
  3. Ainsworth, B. E., Haskell, W. L., Whitt, M. C., Irwin, M. L., Swartz, A. M., Strath, S. J., … & Leon, A. S. (2000). Compendium of physical activities: an update of activity codes and MET intensities. Medicine & Science in Sports & Exercise, 32(9; SUPP/1), S498-S504.
  4. Matthews, C. E., Chen, K. Y., Freedson, P. S., Buchowski, M. S., Beech, B. M., Pate, R. R., & Troiano, R. P. (2008). Amount of Time Spent in Sedentary Behaviors in the United States, 2003–2004. American Journal of Epidemiology, 167(7), 875-881.
  5. Healy, G. N., Matthews, C. E., Dunstan, D. W., Winkler, E. A., & Owen, N. (2011). Sedentary time and cardio-metabolic biomarkers in US adults: NHANES 2003–06. European Heart Journal, 32(5), 590-597.
  6. Hansen, B. H., Kolle, E., Dyrstad, S. M., Holme, I., & Anderssen, S. A. (2012). Accelerometer-determined physical activity in adults and older people. Medicine & Science in Sports & Exercise, 44(2), 266-272.
  7. Evenson, K. R., Buchner, D. M., & Morland, K. B. (2012). Objective measurement of physical activity and sedentary behavior among US adults aged 60 years or older. Preventing Chronic Disease, 9.
  8. Wang, C., Chen, P., & Zhuang, J. (2013). A national survey of physical activity and sedentary behavior of Chinese city children and youth using accelerometers. Research Quarterly for Exercise and Sport, 84(sup2), S12-S28.
  9. Kettner, S., Kobel, S., Fischbach, N., Drenowatz, C., Dreyhaupt, J., Wirt, T., … & Steinacker, J. M. (2013). Objectively determined physical activity levels of primary school children in south-west Germany. BMC public health, 13(1), 895.
  10. Trost, S. G., McCoy, T. A., Vander Veur, S. S., Mallya, G., Duffy, M. L., & Foster, G. D. (2013). Physical activity patterns of inner-city elementary schoolchildren. Medicine & Science in Sports & Exercise, 45(3), 470-474.
  11. Verloigne, M., Van Lippevelde, W., Maes, L., Yildirim, M., Chinapaw, M., Manios, Y., … & De Bourdeaudhuij, I. (2012). Levels of physical activity and sedentary time among 10-to 12-year-old boys and girls across 5 European countries using accelerometers: an observational study within the ENERGY-project. International Journal Behavioural Nutrition and Physical Activity, 9(1), 34-41.
  12. Mitchell, J. A., Pate, R. R., Dowda, M., Mattocks, C., Riddoch, C., Ness, A. R., & Blair, S. N. (2012). A prospective study of sedentary behavior in a large cohort of youth. Medicine & Science in Sports & Exercise, 44(6), 1081.
  13. Van Cauwenberghe, E., Jones, R. A., Hinkley, T., Crawford, D., & Okely, A. D. (2012). Patterns of physical activity and sedentary behaviour in preschool children. International Journal Behavioural Nutrition and Physical Activity, 9, 138.
  14. Comte, M., Hobin, E., Majumdar, S. R., Plotnikoff, R. C., Ball, G. D., & McGavock, J. (2013). Patterns of weekday and weekend physical activity in youth in 2 Canadian provinces. Applied Physiology, Nutrition, and Metabolism, 38(2), 115-119.
  15. Hesketh, K. R., McMinn, A. M., Ekelund, U., Sharp, S. J., Collings, P. J., Harvey, N. C., … & van Sluijs, E. M. (2014). Objectively measured physical activity in four-year-old British children: a cross-sectional analysis of activity patterns segmented across the day. International Journal of Behavioral Nutrition and Physical Activity, 11(1), 1.
  16. Nilsson, A., Anderssen, S. A., Andersen, L. B., Froberg, K., Riddoch, C., Sardinha, L. B., & Ekelund, U. (2009). Between‐and within‐day variability in physical activity and inactivity in 9‐and 15‐year‐old European children. Scandinavian Journal of Medicine & Science in Sports, 19(1), 10-18.
  17. Martínez-Gómez, D., Welk, G. J., Calle, M. E., Marcos, A., & Veiga, O. L. (2009). Preliminary evidence of physical activity levels measured by accelerometer in Spanish adolescents; The AFINOS Study. Nutrición Hospitalaria, 24(2).
  18. Deforche, B., De Bourdeaudhuij, I., D’hondt, E., & Cardon, G. (2009). International Journal of Behavioral Nutrition and Physical Activity. International Journal of Behavioral Nutrition and Physical Activity, 6, 25.
  19. Decelis, A., Jago, R., & Fox, K. R. (2012). Objectively assessed physical activity and weight status in Maltese 11–12 year-olds. European Journal of Sport Science, (ahead-of-print), 1-10.
  20. Corder, K., Sharp, S. J., Atkin, A. J., Griffin, S. J., Jones, A. P., Ekelund, U., & van Sluijs, E. M. (2013). Change in objectively measured physical activity during the transition to adolescence. British Journal of Sports Medicine, bjsports-2013.
  21. Colley, R. C., Garriguet, D., Janssen, I., Wong, S. L., Saunders, T. J., Carson, V., & Tremblay, M. S. (2013). The association between accelerometer-measured patterns of sedentary time and health risk in children and youth: results from the Canadian Health Measures Survey. BMC public health, 13(1), 200.
  22. Medina, C., Janssen, I., Campos, I., & Barquera, S. (2013). Physical inactivity prevalence and trends among Mexican adults: results from the National Health and Nutrition Survey (ENSANUT) 2006 and 2012. BMC Public Health, 13(1), 1063.
  23. Garriguet, D., & Colley, R. C. (2012). Daily patterns of physical activity among Canadians. Statistics Canada.
  24. Young, D. R., Jerome, G. J., Chen, C., Laferriere, D., & Vollmer, W. M. (2009). Patterns of Physical Activity Among Overweight and Obese Adults. Preventing Chronic Disease, 6(3).
  25. Troiano, R. P., Berrigan, D., Dodd, K. W., Mâsse, L. C., Tilert, T., & McDowell, M. (2008). Physical activity in the United States measured by accelerometer. Medicine & Science in Sports & Exercise, 40(1), 181.
  26. Dos Anjos, L. A., Barbosa, T. B. C., Wahrlich, V., & de Vasconcellos, M. T. L. (2012). Patterns of physical activity during a typical day for adults in Niterói, Rio de Janeiro State, Brazil: the nutrition, physical activity, and health survey (PNAFS). Cadernos de Saúde Pública, 28(10), 1893-1902.
  27. Hagströmer, M., Oja, P., & Sjöström, M. (2007). Physical activity and inactivity in an adult population assessed by accelerometry. Medicine & Science in Sports & Exercise, 39(9), 1502.
  28. Davis, M. G., & Fox, K. R. (2007). Physical activity patterns assessed by accelerometry in older people. European Journal of Applied Physiology, 100(5), 581-589.
  29. Copeland, J. L., & Esliger, D. W. (2009). Accelerometer assessment of physical activity in active, healthy older adults. Journal of Aging & Physical Activity, 17(1).
  30. Wanner, M., Tarnutzer, S., Martin, B. W., Braun, J., Rohrmann, S., Bopp, M., & Faeh, D. (2014). Impact of different domains of physical activity on cause-specific mortality: A longitudinal study. Preventive Medicine, 62, 89-95.
  31. Lindsted, K. D., Tonstad, S., & Kuzma, J. W. (1991). Self-report of physical activity and patterns of mortality in Seventh-Day Adventist men. Journal of Clinical Epidemiology, 44(4), 355-364.
  32. Rakowski, W., & Mor, V. (1992). The association of physical activity with mortality among older adults in the Longitudinal Study of Aging (1984–1988). Journal of Gerontology, 47(4), M122-M129.
  33. Chang-Claude, J., & Frentzel-Beyme, R. (1993). Dietary and lifestyle determinants of mortality among German vegetarians. International Journal of Epidemiology, 22(2), 228-236.
  34. Simonsick, E. M., Lafferty, M. E., Phillips, C. L., Mendes de Leon, C. F., Kasl, S. V., Seeman, T. E., … & Lemke, J. H. (1993). Risk due to inactivity in physically capable older adults. American Journal of Public Health, 83(10), 1443-1450.
  35. Weyerer, S. (1993). Effects of physical inactivity on all-cause mortality risk in Upper Bavaria. Perceptual and Motor skills, 77(2), 499-505.
  36. Eaton, C. B., Medalie, J. H., Flocke, S. A., Zyzanski, S. J., Yaari, S., & Goldbourt, U. (1995). Self-reported physical activity predicts long-term coronary heart disease and all-cause mortalities. Twenty-one-year follow-up of the Israeli Ischemic Heart Disease Study. Archives of family medicine, 4(4), 323-329.
  37. Ruigómez, A., Alonso, J., & Antó, J. M. (1995). Relationship of health behaviours to five-year mortality in an elderly cohort. Age and Ageing, 24(2), 113-119.
  38. Mensink, G. B., Deketh, M., Mul, M. D., Schuit, A. J., & Hoffmeister, H. (1996). Physical activity and its association with cardiovascular risk factors and mortality. Epidemiology, 7(4), 391-397.
  39. Lissner, L., Bengtsson, C., Björkelund, C., & Wedel, H. (1996). Physical Activity Levels and Changes in Relation to Longevity A Prospective Study of Swedish Women. American Journal of Epidemiology, 143(1), 54-62.
  40. Kaplan, G. A., Strawbridge, W. J., Cohen, R. D., & Hungerford, L. R. (1996). Natural history of leisure-time physical activity and its correlates: associations with mortality from all causes and cardiovascular disease over 28 years. American Journal of Epidemiology, 144(8), 793-797.
  41. Rosengren, A., & Wilhelmsen, L. (1997). Physical activity protects against coronary death and deaths from all causes in middle-aged men: Evidence from a 20-year follow-up of the primary prevention study in Göteborg. Annals of epidemiology, 7(1), 69-75.
  42. Yu, S., Yarnell, J. W. G., Sweetnam, P. M., & Murray, L. (2003). What level of physical activity protects against premature cardiovascular death? The Caerphilly study. Heart, 89(5), 502-506.
  43. Morgan, K., & Clarke, D. (1997). Customary physical activity and survival in later life: a study in Nottingham, UK. Journal of epidemiology and community health, 51(5), 490-493.
  44. Leon, A. S., Myers, M. J., & Connett, J. (1997). Leisure time physical activity and the 16-year risks of mortality from coronary heart disease and all-causes in the Multiple Risk Factor Intervention Trial (MRFIT). International Journal of Sports Medicine, 18(S 3), S208-S215.
  45. Villeneuve, P. J., Morrison, H. I., Craig, C. L., & Schaubel, D. E. (1998). Physical activity, physical fitness, and risk of dying. Epidemiology, 9(6), 626-631.
  46. Bijnen, F. C., Caspersen, C. J., Feskens, E. J., Saris, W. H., Mosterd, W. L., & Kromhout, D. (1998). Physical activity and 10-year mortality from cardiovascular diseases and all causes: the Zutphen Elderly Study. Archives of Internal Medicine, 158(14), 1499-1505.
  47. Stessman, J., Maaravi, Y., Hammerman-Rozenberg, R., & Cohen, A. (2000). The effects of physical activity on mortality in the Jerusalem 70-Year-Olds Longitudinal Study. Journal of the American Geriatrics Society, 48(5), 499-504.
  48. Andersen, L. B., Schnohr, P., Schroll, M., & Hein, H. O. (2000). All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Archives of Internal Medicine, 160(11), 1621.
  49. Wannamethee, S. G., Shaper, A. G., & Walker, M. (1998). Changes in physical activity, mortality, and incidence of coronary heart disease in older men. The Lancet, 351(9116), 1603-1608.
  50. Konlaan, B. B., Theobald, H., & Bygren, L. O. (2002). Leisure time activity as a determinant of survival: a 26-year follow-up of a Swedish cohort. Public Health, 116(4), 227-230.
  51. Crespo, C. J., Palmieri, M. R. G., Perdomo, R. P., Mcgee, D. L., Smit, E., Sempos, C. T., & Sorlie, P. D. (2002). The Relationship of Physical Activity and Body Weight with All-Cause Mortality-Results from The Puerto Rico Heart Health Program. Annals of Epidemiology, 12(8), 543-552.
  52. Gregg, E. W., Cauley, J. A., Stone, K., Thompson, T. J., Bauer, D. C., Cummings, S. R., … & Study of Osteoporotic Fractures Research Group. (2003). Relationship of Changes in Physical Activity and Mortality Among Older Women. JAMA: The Journal of the American Medical Association, 289(18), 2379-2386.
  53. Barengo, N. C., Hu, G., Lakka, T. A., Pekkarinen, H., Nissinen, A., & Tuomilehto, J. (2004). Low physical activity as a predictor for total and cardiovascular disease mortality in middle-aged men and women in Finland. European Heart Journal, 25(24), 2204-2211.
  54. Myers, J., Kaykha, A., George, S., Abella, J., Zaheer, N., Lear, S., … & Froelicher, V. (2004). Fitness versus physical activity patterns in predicting mortality in men. The American journal of medicine, 117(12), 912-918.
  55. Lee, I. M., & Skerrett, P. J. (2001). Physical activity and all-cause mortality: what is the dose-response relation?. Medicine & Science in Sports & Exercise, 33(6; SUPP), S459-S471.
  56. Oguma, Y., Sesso, H. D., Paffenbarger, R. S., & Lee, I. M. (2002). Physical activity and all cause mortality in women: a review of the evidence. British Journal of Sports Medicine, 36(3), 162-172.
  57. Samitz, G., Egger, M., & Zwahlen, M. (2011). Domains of physical activity and all-cause mortality: systematic review and dose–response meta-analysis of cohort studies. International journal of epidemiology, 40(5), 1382-1400.
  58. Janssen, I., & LeBlanc, A. G. (2010). Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International Journal of Behavioral Nutrition and Physical Activity, 7(40), 1-16.
  59. Tremblay, M. S., Warburton, D. E., Janssen, I., Paterson, D. H., Latimer, A. E., Rhodes, R. E., … & Duggan, M. (2011). New Canadian physical activity guidelines. Applied Physiology, Nutrition, and Metabolism, 36(1), 36-46.
  60. Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, P. W., Judge, J. O., King, A. C., … & Castaneda-Sceppa, C. (2007). Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1094.
  61. Haskell, W. L., Lee, I. M., Pate, R. R., Powell, K. E., Blair, S. N., Franklin, B. A., … & Bauman, A. (2007). Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation, 116(9), 1081.