As new physical activity recommendations and guidelines have spread globally since 1996,

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1 DOI: /jkma pissn: eissn: Original Article Physical activity recommendations and guidelines based on a new paradigm Kwang Wook Koh, MD 1,2* 1 Department of Preventive Medicine, Kosin University College of Medicine, Busan, 2 Korean Exercise Instruction Association, Seoul, Korea * Corresponding author: Kwang Wook Koh, kwkoh@kosin.ac.kr Received July 23, 2010 Accepted October 1, 2010 Abstract As new physical activity recommendations and guidelines have spread globally since 1996, scrutiny of the evolution of national physical activity recommendations and guidelines for application to the Korean medical field iare needed. Retrieving literatures and electric database confined to aerobic activity of adult. Most findings were based on the results of epidemiological and behavioral studies of physical activity and health. Most national physical activity recommendations and guidelines have aphysical activity for healthparadigm instead of an exercise for fitness paradigm. Most stressed the health benefits of accumulation of moderate intensity of a wide variety of physical activity and the importance of the total amount rather than the specific frequency, intensity, time, or type of physical activity. Some used scientific health behavior theories. Researchbased applications of evidence based physical activity policy to Korean medical practice are suggested. Korean medical field could have initiatives in comprehensive physical activity policy in Korean health promotion if actively adopting the new physical activity for health paradigm. Keywords: Physical activity; Public policy; Moderate intensity c Korean Medical Association This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 1139

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3 Physical activity recommendations and guidelines based on a new paradigm Table 1. Representative physical activity recommendation or guide for public health Year Name of recommendation or guide Major contents 1978 American College of Sports Medicine...perform an endurance-type activity for 15 to 60 minutes, 3 to 5 days per week, Position Statement[15] at 60% to 90% of heart rate reserve or 50% to 85% of maximal oxygen uptake 1993 American College of Sports Medicine Every American adult should accumulate 30 minutes of moderate-intensity and Centers for Disease Control physical activity on most, preferably all, days of the week recommendation[18] 1996 U.S. Surgeon General Report on...physical activity need not be strenuous to achieve health benefits... Physical Activity and Health[17] 1998 Canada's Physical Activity Guide[19]...(Aerobic physical activity) time needed depends on effort National physical activity guidelines for...put together at least 30 minutes of moderate intensity physical activity on Australians[20] most, preferably all, days. If you can, also enjoy some regular, vigorous activity for extra health and fitness Report from the Chief Medical Adults should achieve a total of at least 30 minutes of at least moderate intensity Officer (UK)[21] physical activity a day, on 5 or more days a week 2006 Exercise and physical activity reference For physical activity, the reference was set as 23 METshour/week. for health promotion 2006 (Japan)[22] The reference and its range for exercise were set as 4 METshour/week and 2-10 METshour/week, respectively 2008 Pacific physical activity guidelines for 1....Do regular physical activity and reduce sedentary activities. 2. Be active every adults (WHO/WPRO)[23] day in as many ways as you can, your way. 3. Do at least 30 minutes of moderate -intensity physical activity on five or more days each week. 4. If you can, enjoy some regular vigorous-intensity activity for extra health and fitness benefits physical activity guidelines for All adults should avoid inactivity. Some physical activity is better than none... For Americans summary[24] substantial health benefits, adults should do at least 150 minutes a week of moderate-intensity, or 75 minutes a week of vigorous-intensity aerobic physical activity, or an equivalent combination... Aerobic activity should be performed in episodes of at least 10 minutes, and preferably, it should be spread throughout the week. For additional and more extensive health benefits, adults should increase their aerobic physical activity to 300 minutes a week of moderate intensity, or 150 minutes a week of vigorous intensity aerobic physical activity, or an equivalent combination... Additional health benefits are gained by engaging in physical activity beyond this amount

4 Koh KW Table 2. Examples of moderate amount of physical activity Less vigorous activity needs more time Washing and waxing a car for minutes Washing windows or floors for minutes Playing volleyball for 45 minutes Playing touch football for minutes Gardening for minutes Wheeling self in wheelchair for minutes Walking 1 3/4 miles in 35 minutes (20 min/mile) Basketball (shooting baskets) for 30 minutes Bicycling 5 miles in 30 minutes Dancing fast (social) for 30 minutes Pushing a stroller 1 1/2 miles in 30 minutes Walking 2 miles in 30 minutes (15 min/mile) Water aerobics for 30 minutes Swimming laps for 20 minutes Wheelchair basketball for 20 minutes Basketball (playing a game) for minutes Bicycling 4 miles in 15 minutes Jumping rope for 15 minutes Running 1 1/2 miles in 15 minutes (10 min/mile) Stairwalking for 15 minutes More vigorous activity needs less time From U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Presidents Council on Physical Fitness. Physical activity and health: a report of the surgeon general. Sudbury, MA: Jones and Bartlett Publishers; 1996 [6]. Table 3. National physical activity guidelines for Australian adults Guide 1 Think of movement as an opportunity, not an inconvenience. Guide 2 Be active every day in as many ways as you can. Guide 3 Put together at least 30 minutes of moderate intensity physical activity on most, preferably all, days. Guide 4 If you can, also enjoy some rehular, vigorous activity for extra health and fitness. From Department of Health and Ageing of Australian Government. National physical activity guidelines for Australians. Canberra: Department of Health and Ageing of Australian Government; 1999 [8]. 1142

5 Physical activity recommendations and guidelines based on a new paradigm Very light effort Strolling Dusting Time needed depends on effort Light effort Moderate effort Vigorous effort Maximum 60 minutes minutes minutes effort Light walking Volleyball Easy gardening Stretching Brisk walking Biking Raking leaves Swimming Dancing Water aerobics Aerobics Jogging Hockey Basketball Fast swimming Fast dancing Range nddede to stay healthy Figure 1. Dose-response concept between physical activity time needed and effort (From Public Health Agency of Canada. Canadian physical activity guide to health active living [Internet]. Ottawa: Public Health Agency of Canada; [cited 2010 Jan 2]. Available from: back1e.html [23]). Exercise Moderate or highintensity exercise brisk walking, jogging, tennis, swimming... Low-intensity exercise stretching... Physical activity Nonexercise activity Moderate or high-intensity nonexercise activity walking, cleaning floors, gardening, car washing, walking up and down stairs, playing with children... Low-intensity nonexercise activity standing, cooking, doing laundry. playing piano.. Sprinting Racing (3METs or more) Moderate or high-intensity Figure 2. Classification of exercise and physical activity, and their intensity from recommended physical activity and exercise of Japan (From National Institute of Health and Nutrition. Exercise and Physical Activity Reference for Health Promotion 2006 (EPAR 2006): physical activity, exercise, and physical fitness. Tokyo: Ministry of Health, Labour and Welfare of Japan; 2006 [19]). Low-intensity 1143

6 Koh KW Table 4. Classification of total weekly amounts of aerobic physical activity into four categories Levels of Range of moderate- Summary of physical activity intensity minutes a week overall health benefit Comment Inactive No activity beyond baseline None Being inactive is unhealthy. Low Activity beyond baseline but Some Low levels of activity are clearly preferable to an fewer than 150 minutes a week to an inactive lifestyle. Medium 150 minutes to 300 Substantial Activitu at the high end of this range has additional minutes a week and more extensive health benefits than activith at the low end. High More than 300 minutes Additional Current science does not allow researchers to a week identify an upper limit of activity above which there are no additional health benetits. From U.S. Department of Health and Hu-man Services. Physical Activity Guidelines Advisory Committee report. Washington, DC: US Department of Health and Human Services; 2008 [16]. REFERENCES 11. Fletcher GF, Blair SN, Blumenthal J, Caspersen C, Chaitman B, Epstein S, Falls H, Froelicher ES, Froelicher VF, Pina IL. Statement on exercise: benefits and recommendations for physical activity programs for all Americans: a statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart association. Circulation 1992; 86: Jeong YH, Seo MK, Lee JT, Jeong HS, Koh SJ, Chae SM, Kim 1144

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8 Koh KW activity and fitness. Washington, DC: U.S. Department of Health and Human Services; 2009 [cited 2010 Jan 6]. Available from: Objectives/TopicArea.aspx?id=39&TopicArea=Physical+Activi ty+and+fitness. 30. U.S. Department of Health and Human Services. Be active your way: a guide for adults based on the 2008 physical activity guidelines for Americans Washington, DC: U.S. Department of Health and Human Services; Ministry of Health, Labour and Welfare of Japan. Exercise and physical activity guide for health promotion Tokyo: Ministry of Health, Labour and Welfare of Japan; Peer Reviewers Commentary 1146