ACSM/AHA Updates Physical Activity Recommendations, Including Guidelines for Older Adults

Michael O'Riordan

August 8, 2007 — More than ten years after they were first published, the American College of Sports Medicine (ACSM) and the American Heart Association (AHA) have updated their recommendations regarding physical activity for adults [1]. The new guidelines, which also include modified recommendations for older adults, are intended to update and clarify the 1995 recommendations on the types and amount of exercise needed by healthy adults to improve and maintain health.
"I think if you look back during the last ten years or so, there have been some misconceptions about exercise, especially as it relates to health and the specific benefits to the heart," Dr Jennifer Mieres (New York University School of Medicine, NY), a spokesperson for the AHA, told heartwire. "The new guidelines give a very good definition of what constitutes physical activity, as well as the benefits that this exercise can bring about. The guidelines also give a much better roadmap in terms of fitting exercise into our daily lives."
The new recommendations for adults, as well as those aged 65 years of age and older, are published in the August 1, 2007 online issue of Circulation.
More Data, as Well as a Little Bit of Confusion
In the published report, the ACSM/AHA writing group, led by Dr William Haskell (Stanford University School of Medicine, CA), points out that despite the previous ACSM physical-activity recommendations, which were supported by the AHA at that time, physical inactivity remains a pressing public-health concern. In 2005, for example, nearly 25% of adults aged 18 to 65 years old reported no leisure-time activity, and less than half of US adults met the 1995 ACSM physical activity guidelines.
In addition, the 1995 recommendations have been misinterpreted, the group notes, with some people continuing to believe that only vigorous-intensity activity will improve health, whereas others believe that light activities, such as performing chores around the house or doing arts and crafts, are sufficient to maintain health. With this in mind, the new recommendations are intended to provide a more "comprehensive and explicit public-health recommendation" for US adults based on the available evidence.
To promote and maintain health, the ACSM/AHA writing group recommends that "all healthy adults aged 18 to 65 years need moderate-intensity aerobic physical activity for a minimum of 30 minutes on five days each week or vigorous-intensity aerobic activity for a minimum of 20 minutes on three days each week." Combining these exercises is also acceptable, with people allowed to meet the recommendations by walking briskly or performing an activity that noticeably accelerates the heart rate for 30 minutes twice during the week and then jogging for 20 minutes, or performing any activity that causes rapid breathing and a substantial increase in heart rate on two other days.
In addition to clarifying the frequency of moderate-intensity exercise and incorporating vigorous-intensity exercise into the recommendations, the new guidelines specify that moderate- and vigorous-intensity exercises are complementary to daily living and that even more exercise than the recommended amount provides additional health benefits. Muscle-strengthening activities have also been included in the updated recommendations. Although the 1995 recommendations mentioned the importance of muscular strength and endurance, they stopped short of making explicit recommendations.
The ACSM/AHA also states that combining shorts bouts of activity — 10 minutes or more — can be combined to meet the 30-minute daily goal. "The new guidelines tell us that these short bouts of exercise are OK," said Mieres. "We see a lot of busy patients who have no idea how to incorporate physical activity into their crazy-busy lives. Letting them break up their activities, instead of wrapping their heads around a full 30 minutes, gives them a chance to feel that daily exercise is possible."
Speaking with heartwire, Mieres said she sees the new recommendations as a step in the right direction toward meeting the goals of Healthy People 2010 because they provide a prescription for exercise and incentives to help people achieve these goals. We are now just three years away from 2010, she said, and there are large segments of the population not fulfilling the outlined goals.
Older Adults Also Taken Into Consideration
In addition to publishing the guidelines for adults, the ACSM/AHA also issued recommendations on the types and amounts of physical activity needed to improve and maintain health in those 65 years of age and older [2]. The recommendations, written by lead author Dr Miriam Nelson (Tufts University, Boston, MA), for older adults are similar to the recommendations for the general public, but take into account the older adult's aerobic fitness and promote activities that maintain or increase flexibility and improve balance.
"In addition to strength training and aerobic exercise, other types of physical activity must be taken into consideration," said Mieres. "Stretching exercises to improve flexibility, as well as those that work on balance, especially for individuals at risk for falls and fracture, must also be considered."
Like the general recommendations, the physical-activity guidelines for older adults highlight the benefits of greater amounts of physical activity. Because older adults often have comorbid disease, such as arthritis, osteoporosis, or chronic cardiovascular conditions, the ACSM/AHA guidelines recommend integrating preventive and therapeutic activities. In addition, doctors should emphasize to their older patients the importance of reducing sedentary behavior, increasing moderate activity, putting less emphasis on attaining high levels of activity, and taking a gradual stepwise approach.
Circulation. Published online August 1, 2007.