WHO updates Guidelines on Physical Activity and Sedentary Behaviour

In 2018, the World Health Assembly (WHA) approved a new Global Action Plan on Physical Activity (GAPPA) 2018–2030 and adopted a new voluntary global target to reduce global levels of physical inactivity in adults and adolescents by 15% by 2030. As part of the WHA Resolution (WHA71.6), Member States requested WHO to update the 2010 Global Recommendations on Physical Activity for Health

The updated guidelines focus on children, adolescents, adults, older adults and, for the first time it includes specific recommendations on physical activity for pregnant and postpartum women and people living with chronic conditions or disability. Also for the first time, these WHO guidelines address the health impact of sedentary behaviour. The guidelines were developed in accordance with the processes set out in the WHO Handbook for Guidelines Development and commenced in 2019.

Recommendations for children and adolescents (5–17 years):

Concerning children and adolescents, the Guideline Development Group (GDG) strongly recommend doing at least an average of 60 minutes per day of moderate-to-vigorous intensity physical activity, especially aerobics across the week.

They also suggest Vigorous-intensity aerobic activities, along with muscle and bone-strengthening activities for at least 3 days per week.

The evidence reviewed by GDG indicated that greater time spent in sedentary behaviour is related to adverse health outcomes. The association between sedentary behaviour and adverse health outcomes is generally stronger for television viewing or recreational screen time as the specific exposure variable than for total sedentary time in youth. There was, however, insufficient evidence to set a precise threshold (or 'cut-off') for the amount of sedentary or recreational screen time. The sedentary behaviour recommendation was rated as strong based on low certainty evidence.

Recommendations for adults (18–64 years):

For all adults based on the moderate-quality evidence, GDG strongly recommends to undertake regular physical activity for at least 150 minutes to 300 minutes of moderate-intensity aerobic physical activity throughout the week, or 75 to 150 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity for substantial health benefits. They also recommend adults to do muscle-strengthening activities at a moderate or greater intensity that involve all major muscle groups on 2 or more days a week.

They further added, "Adults may increase moderate-intensity aerobic physical activity to more than 300 minutes per week, or engage in more than 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity, for additional health benefits". unlike previous recommendation this one was conditional.

GDG reviewed the evidence on sedentary behaviour and health outcomes in adults which provided support that all adults should limit the amount of time spent sedentary. They found moderate-certainty evidence on sedentary behaviour with all-cause and CVD(Cardiovascular Disease) mortality which varied by the amount of physical activity. New evidence on the interdependent relationship between sedentary behaviour and physical activity underpinned the additional guidance that recommends increased levels of MVPA (moderate-to-vigorous physical activity) in the context of high levels of sedentary time. However, there was insufficient evidence to specify quantitative thresholds of sedentary behaviour, to determine whether specific health benefits vary by type or domain of sedentary behaviour or to determine the influence of frequency and duration of breaks in sedentary behaviour on health outcomes.

Recommendations for older adults (65 years and above):

For all older adults, based on moderate-quality evidence the GDG strongly recommend to undertake regular physical activity for at least 150 minutes to 300 minutes of moderate-intensity aerobic physical activity throughout the week, or 75 to 150 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity for substantial health benefits. They also recommend older adults to do muscle-strengthening activities at a moderate or greater intensity that involve all major muscle groups on 2 or more days a week.

GDG advised "As part of their weekly physical activity, older adults should do varied multicomponent physical activity that emphasises functional balance and strength training at a moderate or greater intensity on 3 or more days per week to enhance functional capacity and prevent falls"

They also made a conditional recommendation stating "Older adults may increase moderate-intensity aerobic physical activity to more than 300 minutes per week, or engage in more than 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity, for additional health benefits".

GDG made these recommendations based on New high-certainty evidence which demonstrates an inverse dose-response relationship between the volume of aerobic physical activity and risk of physical functional limitations in older adults. They found high certainty evidence that demonstrates that balance and functional exercises reduce the rate of falls. They also found a piece of moderate-certainty evidence that risk of fall-related injury may be reduced with multicomponent physical activity (combinations of balance, strength, endurance, gait and physical function training).

Recommendations for pregnant and postpartum women:

For pregnant and postpartum women GDG strongly recommend doing at least 150 minutes of moderate-intensity aerobic physical activity throughout the week incorporated with a variety of aerobic, muscle-strengthening and gentle stretching activities For women who habitually engaged in a vigorous-intensity aerobic activity or who were physically active before pregnancy They recommend to continue those activities during pregnancy and the postpartum period

These recommendations were based on high-certainty evidence which suggests, physical activity during pregnancy is associated with reduced gestational weight gain and reduced risk of gestational diabetes mellitus in pregnant women with overweight or obesity. Among pregnant women with overweight or obesity, GDG found a low-certainty to moderate-certainty evidence to suggest no increased risk of low birth weight, small for gestational age or large for gestational age babies between women who are physically active and those in standard antenatal care. Similarly, among pregnant women with overweight or obesity, they found no significant difference in the risk of preterm birth between those who were physically active and those in standard antenatal care.

Recommendations for people living with chronic conditions:

For adults with chronic conditions, GDG strongly recommends 150 minutes to 300 minutes of moderate-intensity aerobic physical activity throughout the week, or 75 to 150 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity along with some muscle-strengthening activities that involve all major muscle groups on 2 or more days a week for substantial health benefits.

The GDG stated, "As part of their weekly physical activity, older adults with chronic conditions should do varied multicomponent physical activity that emphasises functional balance and strength training at the moderate or greater intensity on 3 or more days per week to enhance functional capacity and prevent falls".

They also made a conditional recommendation suggesting, "When not contraindicated, adults with chronic conditions may increase moderate-intensity aerobic physical activity to more than 300 minutes per week, or engage in more than 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity, for additional health benefits

GDG made these recommendations after reviewing evidence for the following chronic conditions: cancer, hypertension, type 2 diabetes and HIV. Greater physical activity is related to improved health outcomes in people living with coronary heart disease.

Recommendations for people living with a disability:

After reviewing the following health conditions: multiple sclerosis, spinal cord injury, intellectual disability, Parkinson's disease, stroke, major clinical depression, schizophrenia and attention deficit hyperactivity disorder (ADHD) GDG strongly recommended that adults with disability should do at least 150 minutes to 300 minutes of moderate intensity aerobic physical activity throughout the week, or 75 to 150 minute of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity along with muscle strengthening activities for substantial health benefits; The also suggest older adults with disability to do varied multicomponent physical activity that emphasises functional balance and strength training at moderate or greater intensity on 3 or more days per week to enhance functional capacity and prevent falls. They further made a conditional recommendation stating, "Adults with chronic conditions who are highly sedentary should aim to achieve or exceed the upper levels of recommended moderate-to-vigorous intensity physical activity".

These updated guidelines of 2020 affirm the importance of regular aerobic and muscle-strengthening physical activity and reduction in sedentary behaviours. For all populations, the benefits of doing physical activity and limiting sedentary behaviour outweighed the potential harms. Some physical activity is better than none for those not currently meeting these recommendations, individuals should start with small amounts of physical activity and gradually increase frequency, intensity and duration over time. Countries are encouraged to adopt and disseminate these new global guidelines to key audiences, and use them as the basis for sustained national public education communication campaigns responding to their national context and factors such as culture, ethnic diversity and social norms.

For further information:

https://www.who.int/docs/default-source/physical-activity/call-for-consultation/draft-guideline-on-physical-activity-and-sedentray-behaviour.pdf?sfvrsn=ddf523d5_4