- If you are very unfit or you have or think you may have any health conditions that may have any impact on undertaking increased levels of physical activity/exercise be sensible and discuss with your doctor first.
- If you don't know that you are already have a good level of cardiorespiratory fitness be cautious and stay safe by slowly building up your physical activity/exercise from lower levels of activity/exercise to higher ones over the course of a at least a month but may be significantly longer (departing on your age and starting condition), making sure you feel comfortable as you gradually increase the frequency, duration and the intensity of physical activity/exercise over time.
- Do not incorporate vigorous intensity physical exertion into your physical exercise/activity until you have a reasonable level of fitness.
- Vigorous intensity physical exertion is associated with a increased risk of heart attack compared with less vigorous intensity physical exertion but individual risk of adverse events is reduced in fit individuals.
- See the following link to research about the increased risk of heart attack following heavy physical exertion.
- Middle aged and older adults are recommended to take part in at least 12 weeks of moderate intensity exercise before introducing any vigorous intensity exercise
- Do not pursue or seek to incorporate a High Intensity Interval Training (HIIT) into your physical exercise/activity until you have a reasonable level of fitness.
- "The physiotherapist Adam Meakins advises people in general to avoid high-intensity workouts if they are new to exercise. “The risk with a novice going in and doing HIIT exercises is that you can end up pulling something in your muscular-skeletal system a lot more easily than you would if you were an experienced exerciser whose body has adapted resilience to explosive forces.” That said, he welcomes anything that will get people moving. “There are always risks associated with any exercise … the biggest risk factor is not doing any exercise at all.”" See the following link to the article where this statement is made.
- See the following link to the research abstract about the increases in injuries related to high-intensity workout programs.
- For a long video discussion that explores the various forms of HIIT in detail and compares it to other forms of physical exercise/activity see the following link:
Key overall principles
- Any physical activity/exercise is better than none.
- For a concise article that considers this principle in more detail see the following link:
- More physical activity/exercise is better than less.
- Although of course this will inevitably be balanced against time available and effort versus potential return considerations.
- For an article and then a video about step counting and benefits see the following links:
- https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765
- https://youtu.be/Saj8QfoH3HI
- For research that quantifies physical activity/exercise in terms of daily step count see the following link:
- Different types of physical activity/exercise (cardiorespiratory versus resistance) yield distinct favourable outcomes.
Every day physical activity
- Keep moving, minimise sedentary behaviour but don't forget to find time to relax and keep stress under control.
- Brisk pace walking has a lower risk of mortality from all-causes compared to slow pace walking. For details see the following research article link:
- If you are able, climb stairs / steps whenever you get the opportunity.
- For an excellent "long read" article that expands on the above, provides a historical context and contextualises what follows see the following link:
Exercise guidance on the types and amounts of exercise - For physically able adults aged 18 to 64 years old
Cardiorespiratory
- A minimum of 150 mins per week of Moderate Intensity physical activity (UK public health physical activity guidelines).
- OR a minimum of 75 mins per week Vigorous Intensity physical activity (1 min Vigorous Intensity = 2 mins Moderate Intensity. Low end Vigorous Intensity physical activity consumes about twice the energy of low end Moderate Intensity physical activity).
- This is the minimum required to build / maintain significant cardiorespiratory health benefits.
- Although anything is better than nothing. See the article link that follows:
- However a recent systematic review and meta-analysis of running specific research has suggested that as little as 50 mins running per week as little as once a week confers all-cause mortality benefits with no evidence that mortality benefits increase with greater amounts of running (running is Vigorous Intensity exercise so this would equate to 100 mins per week of Moderate Intensity physical activity. See the link that follows to the research paper abstract:
- USA public health physical activity guidelines advise at least 150 to 300 Moderate Intensity physical activity minutes or 75 to 150 of Vigorous Intensity physical activity minutes.
- The American Cancer Society Guidline for Diet and Physical Activity for cancer prevention say achieving or exceeding the upper limit of 300 min is optimal.
- Public health guidance is generally targeted at having the widest population health impact and tends to be set at levels deemed to be achievable by the majority. This does not mean that it is necessarily optimal at an individual level.
- Above 150 mins per week and up to approximately 600 mins per week of Moderate Intensity physical activity.
- OR 75 mins and up to 300 mins per week of Vigorous Intensity physical activity (1 min Vigorous Intensity = 2 mins Moderate Intensity).
- Significant further cardiorespiratory health benefits are built / maintained.
- Beyond about 600 mins per week of Moderate Intensity physical activity minimal further cardiorespiratory health benefits are believed to be derived (see the charts and links below under the NOTES: section).
- OR beyond about 300 mins per week of Vigorous Intensity physical activity (1 min Vigorous Intensity = 2 mins Moderate Intensity).
- Although see the information above about recent running research.
- Vigorous cardiorespiratory focused physical physical activity is not very high intensity and it is not working at your maximum intensity.
- Moderate Intensity cardiorespiratory focused physical activity has half the time value of a Vigorous Intensity cardiorespiratory focused physical activity but both can count towards the weekly total. So you can mix Moderate and Vigorous Intensity physical activity to get to the total you want.
- Some Garmin devices automatically measure Moderate/Vigorous Intensity physical activity/exercise and term the metric "Intensity Minutes" although bouts have to be of a minimum of 10 min to be recorded within the metric.
- Vigorous Intensity physical activity provides significantly lower risk of all-cause and cause-specific mortality compared to individuals who undertake physical activity at Moderate Intensity or lesser Intensity levels.
- See the following links for examples of research which support the above statement:
- Risk reduction for all-cause mortality per unit of time increase is largest for vigorous exercise.
- See the following link for an example of research which supports the above statement:
- For maximum cardiorespiratory benefits incorporating physical activity for 15 to 25 mins at the top end of the Vigorous Intensity exercise zone is considered optimal.
- Cardiorespiratory health benefits increase with increasing cardiorespiratory fitness levels.
- Very high levels of cardiorespiratory fitness appear to have no cardiorespiratory health dis-benefits.
- To build / maintain very high levels of cardiorespiratory fitness very large volumes of exercise are required.
- There is a diminishing return in terms of improvement in cardiorespiratory health benefits at the higher levels of cardiorespiratory fitness.
- See the charts and links further down this page in the NOTES: section.
Strength / resistance
- Full body strength/resistance training on, ideally non consecutive days, 1 to 3 days per week of approximately 30 – 60 min/week is considered optimal for health benefits.
- Non-linear dose–response meta-analysis of the associations between muscle-strengthening activities and all-cause mortality, cardiovascular disease (CVD), total cancer and diabetes. Muscle-strengthening activities were modelled with restricted cubic splines in a random-effects dose–response model. The black line indicates the spline model and dashed lines represent 95% confidence intervals. RR, relative risk. Source:
- To build / maintain muscle mass for general strength, metabolic optimisation and health benefits.
- See the journal article link that follows for information about the cardiorespiratory health benefits derived from strength training:
- See the link below to a clear and concise article below that describes strength / resistance training and the benefits associated with it:
- Resistance exercise training may be effective for inducing improvements in cardio metabolic health outcomes in healthy adults and those with an adverse cardio metabolic risk profile.
- Medium-term and long-term resistance exercise training reduced systolic blood pressure (−4.02 (95% CI −5.92 to −2.11) mm Hg, p<0.0001 and −5.08 (−10.04 to –0.13) mm Hg, p=0.04, respectively) and diastolic blood pressure (−1.73 (−2.88 to –0.57) mm Hg, p=0.003 and −4.93 (−8.58 to –1.28) mm Hg, p=0.008, respectively) versus control. Medium-term resistance exercise training elicited reductions in fasted insulin and insulin resistance (−0.59 (−0.97 to –0.21) µU/mL, p=0.002 and −1.22 (−2.29 to –0.15) µU/mL, p=0.02, respectively). The effects were greater in those with elevated cardiometabolic risk or disease compared with younger healthy adults. The quality of evidence was low or very low for all outcomes. There was limited evidence of adverse events. Short-term (≤6 weeks), medium-term (7–23 weeks) and long-term (≥24 weeks). Source:
- Certain types of cardiorespiratory focused exercise if done at Vigorous Intensity can reduce / remove the need to do strength/resistance training.
- Muscle strength can be considered a key across lifetime health indicator.
- An general assessment of overall muscle strength can be quickly and easily assessed by measuring maximal handgrip strength (HGS) using a handgrip dynamometer.
- Handgrip dynamometers are low cost (less than £25) and readily available to purchase.
- Every 5kg decrease in HGS was associated with 16% greater risk for all-cause mortality at a median 4-year follow-up in 142,861 adults aged 35–70 years. See the following link to the research:
- See the measurement method, key data comparison charts and research link further down this page at the bottom of the NOTES: section for further details.
Balance and flexibility
- Full body balance and flexibility exercises.
- To build / maintain balance, flexibility and therefore optimal mobility.
- It is probably optimal to add these exercises to the beginning or end of a cardiorespiratory or strength/resistance training session.
UK public health advice summary
What is too much and how to determine it (training loads)?
- To maximise health outcomes and / or performance and minimise risks, such as, injury, illness or fatigue an understanding of what is too much and how to determine what is too much is sensible to know. See the following link to an article that provides a good overview and explains the concept of training loads:
NOTES:
- For a concise article which explains Hazard Ratios with a real world example see the following link:
- For a video that explains Hazard Ratios see the following link:
1. Research about moderate to vigorous physical activity volume, bouts and impact on mortality:
"Distribution of hazard ratios provided in the Table by total duration of moderate‐to‐vigorous physical activity (MVPA) for jointly classified quartiles of total minutes and tertiles of relative contribution of bouted minutes."
Source:
Moderate‐to‐Vigorous Physical Activity and All‐Cause Mortality: Do Bouts Matter?
Pedro F. Saint‐Maurice et al.
Journal American Heart Association 2018
https://www.ahajournals.org/doi/10.1161/JAHA.117.007678
2. Research about cardiorespiratory fitness level and cardiorespiratory health benefits:
"Cardiorespiratory Fitness and Mortality in the FIT Project. Fig (A) Graded improvement in survival is shown across the increasingly high-fitness groups in patients ≥30 years of age. Fig (B) Multivariate-adjusted estimated survival as a function of METs. Graphic assessments reveal no upper threshold of survival among even the most highly fit individuals. FIT = Henry Ford Exercise Testing Project; METS = metabolic equivalents."
Source:
No Evidence of an Upper Threshold for Mortality Benefit at High Levels of Cardiorespiratory Fitness
David I. Feldman, et al.
Journal of the American College of Cardiology
http://www.onlinejacc.org/content/65/6/629
3. Research about beneficial associations of low and large doses of leisure time physical activity and mortality:
Source:
Beneficial associations of low and large doses of leisure time physical activity with all-cause, cardiovascular disease and cancer mortality: a national cohort study of 88,140 US adults
Min Zhao, et al.
British Journal of Sports Medicine 2019
https://bjsm.bmj.com/content/early/2019/02/26/bjsports-2018-099254
4. Research about cardiorespiratory fitness level and cardiorespiratory health benefits:
4a. "Patient Survival by Performance Group. Log-rank P < .001 for all groups, except elite vs high performers (log-rank P = .002)."
4b. "Risk-Adjusted All-Cause Mortality Adjusted hazard ratios (HRs) for all-cause mortality compared with low performers in all patients. Error bars indicate 95% CIs."
- For a video that explains the above charts and more see the following link:
4c. "Classification of Cardiorespiratory Fitness by Age and Sex". For the above 2 graphs.
Source:
Association of Cardiorespiratory Fitness With Long-term Mortality Among Adults Undergoing Exercise Treadmill Testing
Kyle Mandsager, et al.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2707428
5. Successful 10 second one legged stance performance predicts survival in middle aged and older individuals
- Kaplan-Meier survival curves of participants aged 51–75 years old divided by ability (YES) and inability (NO) to complete the 10s one-legged stance test.
- Measurement method
- Participants stood on a flat platform. Static balance was assessed as the ability to complete 10s in one leg stance (OLS), either left or right foot. Participants were barefoot and were instructed to place the dorsal part of the non- support foot on the back of the opposite lower leg, as naturally as possible (see picture). Additionally, participants were asked to keep their elbows extended, the arms naturally placed close to their body and instructed to fix their gaze on an eye level point at a 2m distance. Once the participant assumed the correct position, a count of 10s was started and up to three attempts were allowed. A very simple criterion was applied, ability to complete 10s OLS on either foot, keeping the correct initial position and without any other support and participants were accordingly classified as ability (YES) or inability (NO) to complete the 10s OLS test. Source:
6a. Handgrip Strength Percentiles by Gender, Ethnicity, and Hand Dominance in Americans
- Measurement method
- Participants were instructed to stand with their feet hip width apart and hold the dynamometer away from their body and in line with the forearm, at thigh level so that the dynamometer did not touch the body (unless physically unable). An emphasis was made on squeezing the handle of the dynamometer hard and quickly. A practice trial at sub-maximal effort was performed by participants to determine if the dynamometer was properly fitted to their hand size and to confirm understanding of the Handgrip Strength (HGS) protocol. Each person squeezed the dynamometer with maximal effort, exhaling while squeezing, and then released the muscle contractions. Participants reported their hand dominance and the decision to begin HGS testing on the dominant or non-dominant hand was randomized. Each hand was tested 3 times, alternating hands between trials, with 60 seconds of rest between measures on the same hand. The highest recorded HGS value on either hand was included in the analyses.
- Handgrip strength value tables
- Absolute and Body Mass Index Normalized Handgrip Strength Percentiles by Gender, Ethnicity, and Hand Dominance in Americans. Source:
6b. Cross-cohort centile curves for grip strength
- Centiles shown 10th, 25th, 50th, 75th and 90th. ADNFS Allied Dunbar National Fitness Survey, ALSPAC Avon Longitudinal Study of Parents and Children, ELSA English Longitudinal Study of Ageing, HAS Hertfordshire Ageing Study, HCS Hertfordshire Cohort Study, LBC1921 and LBC1936 Lothian Birth Cohorts of 1921 and 1936, N85 Newcastle 85 + Study, NSHD Medical Research Council National Survey of Health and Development, SWS Southampton Women’s Survey, SWSmp mothers and their partners from the SWS, T-07 West of Scotland Twenty-07 Study, UKHLS Understanding Society: the UK Household Panel Study. Source:
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