Every Step Counts – Updated WHO Guidelines on Physical Activity and Sedentary Behaviour

[This text has been written by Sarah Koch, postdoctoral researcher at ISGlobal; Carolyn Daher and Mark Nieuwenhuisen, coordinator and director, respectively of the Urban Planning, Environment and Health Initiative at ISGlobal; and Judith Garcia-Aymerich, head of the Non-Communicable Diseases and Environment Programme. It has been published originally on Espai S@alut, a Diputació de Barcelona's newsletter.]

While tremendous efforts are currently being invested in overcoming the COVID-19 pandemic, it is more important than ever to not forget about broader health challenges, many of which are also linked to COVID-impacts. In 2019, the World Health Organization (WHO) listed air pollution and climate change and non-communicable diseases as the top threats to health.

Habitual physical activity is essential in the prevention of non-communicable disease; however, we are globally confronted with a physical inactivity pandemic. A 2018 survey showed that only 66% of adults in Spain met the recommended WHO physical activity guidelines. Among 11 to 18-year-old children and adolescents, only 32% of boys and 17% of girls were estimated to meet the recommended physical activity levels. In a health impact assessment, it was estimated that 1154 deaths per year could be prevented in adult residents in Barcelona adhered to the WHO guidelines.

Habitual physical activity is essential in the prevention of non-communicable disease; however, we are globally confronted with a physical inactivity pandemic

There are many well documented physical health benefits from physical activity including better body weight management, stronger bones, increased muscle mass, and a better-functioning heart-lung systems. Physical activity also contributes to mental health by assisting with stress management by optimizing neurotransmitter and hormone levels, and by strengthening our mental resilience. Physical activity in groups serves as an opportunity to meet others, and improve our feeling of connectedness, an important contributor to social well-being.

As a result of the large potential for physical activity to improve health, the WHO and governments aim to reduce global physical inactivity levels by 15% by 2030. To achieve this ambitious goal, the WHO recently updated its physical activity guidelines including the type, frequency, and duration of physical activities that are optimal to prevent non-communicable disease. The new guidelines represent a shift in the way we think about physical activity, bringing a more holistic view that spans the entire 24-hour day and includes a wider range of activities. This has important implications for policy in many sectors, as it calls for people to be more active during their daily tasks, making every move count. We summarize some of the key elements below.

The WHO recently updated its physical activity guidelines. It represents a shift in the way we think about physical activity, bringing a more holistic view that spans the entire 24-hour day and includes a wider range of activities

The Guidelines

One important novelty is the provision of recommendations for different groups of people:

• Children and adolescents (5-17 years),
• Adults (18-64 years),
• Older adults (> 65 years),
• Pregnant and postpartum women,
• Adults and older adults with chronic conditions: focussing on cancer survivors and people suffering from hypertension, type-2 diabetes and HIV
• Children and adolescents (5-17 years) living with disability
• Adults (18 years and older) living with disability

To maximize the health effects from physical activity, recommendations for four types of activities are provided for each of these groups:

1. Moderate to vigorous intensity physical activity: On a perceived exertion scale of 0 – 10, these activities should be rated a 5 or 6, meaning that they can be sustained for several hours to strengthen cardiovascular endurance. Activities that fall into this category include going for walks, light running, leisure bike rides, easy house- and garden work.
2. Vigorous-intensity aerobic intensity: On a perceived exertion scale of 0-10, these activities should be rated a 5 or higher. Due to the higher intensity, these activities are usually performed for shorter periods of time and include activities such as: faster-paced running or swimming, basketball or tennis games. The purpose of vigorous-intensity physical activity is to strengthen the cardiovascular system and endurance.
3. Muscle-strengthening activities: The purpose of these activities is to increase skeletal muscle strength, power, endurance and muscle mass. Activities that fall into this group include for example traditional resistance training with weights at home or in the gym, or body weight focussed strength exercises such as squats or planks, where the focus is on activating large muscle groups.
4. Sedentary activities: Sedentary time is accumulated when sitting, reclining or lying, and energy expenditure very low. Sedentary activities include desk-based office work, driving a car, or watching television.

A detailed overview of the new physical activity recommendations for different groups in the four physical activity types are provided in the different images embedded on this blog post. Generally, all adults should achieve 150 – 300 minutes of moderate-intensity, or 75-150 minutes of vigorous-intensity physical activity or some equivalent combination of the two every week. Additionally, regular muscle-strengthening activities are recommended for all age groups, while sedentary behaviours should be reduced to a minimum.

For optimal health in children, higher levels of physical activity are recommended compared to adults. Specifically, children should accumulate 60 minutes of daily moderate-vigorous intensity and perform vigorous intensity physical activities on at least three days per week. In older adults, a focus on multicomponent physical activity is recommended; functional balance and strength training at a moderate or greater intensity are emphasized for three times per week to enhance functional capacity and to prevent falls. An example of multicomponent physical activity could be a hike on a nature trail with uneven surfaces and some undulating hills. Having to balance, taking bigger and smaller steps depending on the terrain, walking up- and downhill challenge the cardiovascular, the muscular, and the neuromotor system and enhance one’s cardiovascular endurance, strength and balance.

Generally, all adults should achieve 150 – 300 minutes of moderate-intensity, or 75-150 minutes of vigorous-intensity physical activity or some equivalent combination of the two every week

What Is New?

The guidelines are based on a rigorous revision of the latest scientific evidence, including data that have been collected and analysed using new technology and methodologies such as wearable sensors. The key main messages are:

• Every step counts. In the previous guidelines from 2010, only activities lasting at least 10 minutes were considered meaningful contributions to physical activity levels and health. The new guidelines clearly state that every single step counts. Physical activity of any duration is associated with improved health.
• Some is better than none, and more might be better. Setting a range of recommended physical activity levels rather than a minimal threshold captures the fact that there is a range of physical activity levels that result in maximum health benefits. For people who are not currently meeting the physical activity guidelines, any physical activity, even at levels below the recommended guidelines, will promote health. People meeting and going above the current guidelines are likely to gain extra health benefits, but the benefits may be smaller when compared to people with low physical activity levels. That is, people who are least active will have the most to gain from increasing their physical activity.
• Physical activity is beneficial for everybody. Tailoring physical activity guidelines to pregnant and postpartum women, individuals with chronic diseases and disability, and distinguishing between adults and older adults addresses important gaps in previous health recommendations. These recommendations confirm that daily physical activity for all population groups is feasible and also important for health.
• Minimize sedentary time as much as possible. These are the first guidelines that specifically state that sedentary time should be reduced to a minimum. There is still insufficient scientific knowledge to set time-specific thresholds for daily sedentary time; however, moving more and replacing sedentary time with physical activities of any intensity level is beneficial for health. In practice, this could mean that climbing stairs over taking an elevator or escalators; or choosing to walk while meeting a friend instead of sitting while catching-up are transitions towards reducing sedentary time while increasing physical activity levels.

How to Generate Active Cities?

Physical activity is an important contributor to physical, mental, and social health for all ages and groups. Currently, many adults and even more children and adolescents in Spain and world-wide are not meeting the physical activity guidelines. A collective effort is needed to address this physical inactivity pandemic that is linked to the growing burden of non-communicable diseases including diabetes, cardiovascular and respiratory diseases, and mental health problems. As more and more people choose to live in cities as opposed to the countryside, it is important to account for physical activity in urban planning. To achieve this ambitious goal, multiple approaches need to be leveraged not only from the health system, but other sectors such as mobility and urban planning to make physical activity a practical and attractive choice in a routine way.

National and local policies and initiatives are needed to raise awareness, educate citizens, provide access to facilities, and generate daily opportunities to increase physical activity levels. For example, physical activity challenges such as “bike to work”- weeks where different individuals, companies or neighbourhoods compete against each other to accumulate the most time-spent in physical activity serve as opportunities to introduce individuals to new forms of physical activities, and access to education and information. Bike shares, additional and safe sidewalks and cycling paths, playgrounds, freely accessible open-air gyms, and green- and blue spaces that facilitate physical activity and social contact increase opportunities and motivation to be active for people of all ages and socio-economic backgrounds.

It is important to account for physical activity in urban planning. Multiple approaches need to be leveraged not only from the health system, but other sectors such as mobility and urban planning to make physical activity a practical and attractive choice in a routine way

A particular focus should be put on redistributing public spaces and optimize the built environment to facilitate active transportation. By replacing car rides with active transportation options such as biking or walking, or combinations of active and public transportation increase individual physical activity levels, and also reduce vehicle traffic. The Superblocks in Barcelona, the 15 Minute City Model or completely car-free cities serve as real-life examples and ideas of how public space can be redistributed towards a more active use by residents. Ultimately, fewer vehicles result in lower air pollution emissions. Thus, the transition from passive to active transportation not only increases physical activity levels to prevent non-communicable diseases, it also reduces air pollution emissions, another risk factor to non-communicable diseases.

In summary, because every move counts, governments and citizens are challenged to rethink the way we live and move, creating health one step at a time.

More information

WHO guidelines on physical activity and sedentary behaviour