Study suggests 5X increase of current exercise recommendations

[Brett Black]

WHO guidelines on hours of exercise needed to stay healthy are way off, Queensland study finds

By Allyson Horn

 

People need to do five times the exercise recommended by the World Health Organisation (WHO) to stay healthy, a Queensland study has found.

Researchers from the University of Queensland studied the link between physical activity and chronic health conditions including breast and bowel cancer, diabetes, heart disease and stroke.

They found exercise levels recommended by the WHO needed to be much higher to increase resistance.

 

Researcher Dr Lennert Veerman said the WHO recommended physical activity of 10 metabolic equivalent (MET) hours a week.

"So that's the equivalent of about 1.75 hours of running or two, three hours of walking briskly [a week]," he said.

"But the study found health gains accumulated up to the levels of 50 to 70 MET hours a week.

"That's the equivalent of 15-20 hours of brisk walking or 6-8 hours of running [a week].

[continues...]"

http://www.abc.net.au/news/2016-08-10/australians-need-to-do-five-times-the-exercise-who-recommend/7711562

---

 

Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013

BMJ 2016; 354 doi: http://dx.doi.org/10.1136/bmj.i3857 (Published 09 August 2016) Cite this as: BMJ 2016;354:i3857

 

Hmwe H Kyu, acting assistant professor1, Victoria F Bachman, medical student2, Lily T Alexander, post bachelor fellow1, John Everett Mumford, post bachelor fellow1, Ashkan Afshin, acting assistant professor1, Kara Estep, project officer II1, J Lennert Veerman, senior lecturer3, Kristen Delwiche, medical student4, Marissa L Iannarone, project officer1, Madeline L Moyer, systematic reviewer1, Kelly Cercy, data analyst1, Theo Vos, professor1, Christopher J L Murray, professor1, Mohammad H Forouzanfar, assistant professor1

 

Abstract

 

Objective To quantify the dose-response associations between total physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events.

 

 

Design Systematic review and Bayesian dose-response meta-analysis.

 

Data sources PubMed and Embase from 1980 to 27 February 2016, and references from relevant systematic reviews. Data from the Study on Global AGEing and Adult Health conducted in China, Ghana, India, Mexico, Russia, and South Africa from 2007 to 2010 and the US National Health and Nutrition Examination Surveys from 1999 to 2011 were used to map domain specific physical activity (reported in included studies) to total activity.

 

Eligibility criteria for selecting studies Prospective cohort studies examining the associations between physical activity (any domain) and at least one of the five diseases studied.

 

Results 174 articles were identified: 35 for breast cancer, 19 for colon cancer, 55 for diabetes, 43 for ischemic heart disease, and 26 for ischemic stroke (some articles included multiple outcomes). Although higher levels of total physical activity were significantly associated with lower risk for all outcomes, major gains occurred at lower levels of activity (up to 3000-4000 metabolic equivalent (MET) minutes/week). For example, individuals with a total activity level of 600 MET minutes/week (the minimum recommended level) had a 2% lower risk of diabetes compared with those reporting no physical activity. An increase from 600 to 3600 MET minutes/week reduced the risk by an additional 19%. The same amount of increase yielded much smaller returns at higher levels of activity: an increase of total activity from 9000 to 12 000 MET minutes/week reduced the risk of diabetes by only 0.6%. Compared with insufficiently active individuals (total activity <600 MET minutes/week), the risk reduction for those in the highly active category (≥8000 MET minutes/week) was 14% (relative risk 0.863, 95% uncertainty interval 0.829 to 0.900) for breast cancer; 21% (0.789, 0.735 to 0.850) for colon cancer; 28% (0.722, 0.678 to 0.768) for diabetes; 25% (0.754, 0.704 to 0.809) for ischemic heart disease; and 26% (0.736, 0.659 to 0.811) for ischemic stroke.

 

Conclusions People who achieve total physical activity levels several times higher than the current recommended minimum level have a significant reduction in the risk of the five diseases studied. More studies with detailed quantification of total physical activity will help to find more precise relative risk estimates for different levels of activity.

http://www.bmj.com/content/354/bmj.i3857

[TomBAvoider]

I don't know about this. The Copenhagen joggers study, and others, seem to imply there is a U shaped benefit for all-cause mortality when it comes to exercise - at least jogging - and the optimum identified was at a fairly low number, something like 145 minutes a week of slow/moderate jogging no more than 3 times a week. Now, it's possible that this U shape only applies to "vigorous" exercise, which jogging is considered as, so if you get your 4000 MET through walking and the like you're OK. It is also possible that getting 4000 MET is good for lowering the rates of diseases identified, but nonetheless results in worse all-cause mortality in line with the U curve from the Copenhagen study. Or, maybe the U shape is illusory due to low numbers in the Copenhagen study and problems with other studies that agree.

[mikeccolella]

I luv to experiment and it's an ongoing thing with me and I find QOL like better sleep, level of life satisfaction, sense of vitality is best with at least 3 hours or more of brisk walking and or its equivalent met wise and throwing in some intensity several times a week. I personally am active doing brisk walking like activities at least three hours a day. I also do about 2 hours of light strolling activities on top of that at least. The medscape post shows benefits for a lot of moderate exercise

 

http://www.medscape.com/viewarticle/842901#vp_2

 

Looks like the pop press is already on to this. http://www.today.com/health/how-much-exercise-do-you-need-prevent-heart-disease-cancer-t101665

[Dean Pomerleau]

Great finds guys!

 

I (obviously) subscribe to the "low-intensity, high-volume" exercise camp, and so was heartened to see this from Dr. Arem, the author of the study discussed here (PMID:25844730) that found 3-5x the daily recommendation of exercise to be beneficial relative to meeting the bare minimum, and no adverse effects on mortality up to 10x the WHO recommendation.

 

Arem said these results suggest it's the volume of activity that makes a difference on mortality rather than the intensity.

 

So much for HIIT... Speaking of intensity of training, this was an interesting graph from Arem et al (PMID: 25844730)

 

 

It appears that any amount of either moderate or vigorous physical activity resulted in about a 20% drop in mortality risk, after accounting for a bunch of potential confounders. Additional vigorous activity didn't seem to reduce mortality risk any further, while additional moderate physical activity dropped mortality risk about almost another 10%.

 

This suggest that slow and steady wins the race.

 

--Dean

[mikeccolella]

I know it's anecdote but really the very longest lived and healthiest oldsters I have known throughout my life were not joggers or high intensity types. They were strollers, puttering around a lot and just being busy gardening, cleaning, projects etc.

[Gordo]

My theory is that most of the mortality associations/relative risk with regard to exercise type and duration is related to blood glucose control.  The average American eats all day long, and therefore would benefit from exercising all day long too, but this is not an optimal or efficient strategy for longevity.

 

"Those with glucose above 85 mg/dL are at increased risk of heart attack.34 This was shown in a study of nearly 2,000 men where fasting blood glucose levels were measured over a 22-year period. The startling results showed that men with fasting glucose over 85 (mg/dL) had a 40% increased risk of death from cardiovascular disease.

The researchers who conducted this study stated “fasting blood glucose values in the upper normal range appears to be an important independent predictor of cardiovascular death in nondiabetic apparently healthy middle-aged men.”34

34. Bjornholt JV, Erikssen G, Aaser E, et al. Fasting blood glucose: an underestimated risk factor for cardiovascular death. Results from a 22-year follow-up of healthy nondiabetic men. Diabetes Care. 1999 Jan;22(1):45-9.

[Dean Pomerleau]

Gordo,

 

First off, I'm all for keeping both fasting a postprandial glucose low. The 1999 study you cite [1], is a pretty dramatic result in support of these goals - a 40% observed increase in CVD-related mortality for men with fasting blood glucose (FBG) > 85 mg/dl. One thing to look at though is the confidence interval of the risk. From the abstract of [1] below:

 

[After statistical adjustments - DP] the relative risk of cardiovascular death for men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8).

 

That's a pretty wide confidence interval, particularly for a study with 2000 people, almost stretching to the point of no elevated risk.

 

A much more recent (2014) meta-analysis [2], which looked at 26 studies including data from 280K+ individuals (vs. 2000 in [1]), found a much less dramatic risk of CVD (and all-cause) mortality associated with elevated FBG. For people with FBG in the 110-125 range (defined as "pre-diabetes"), the CVD-mortality risk was 19% higher (all-cause 12% higher) compared to people with "normal" fasting glucose. But when the pre-diabetes range was widened to include FBG of 100-125 mg/dl, the elevated risk of CVD or all-cause mortality was no longer even statistically significant (RR 1.16, 95% CI 0.94-1.42). Notice once again a very wide confidence interval.

 

One thing to consider is that all but one of the 26 studies included in the meta-analysis of [2] were more recent than study [1]. One explanation for the discrepancy between [1] and [2] (besides the wide error bars in both) may therefore be that we've gotten better at managing both diabetes (e.g. using metformin) and cardiovascular disease (e.g. using statins) since 1999 when [1] was published.

 

But there are other possible explanation that are more insidious, and might support a greater concern for mildly elevated FBG, as your study [1] suggests.

 

One of the criteria for a study's inclusion in the meta-analysis was that it had to define normoglycaemia "as FPB < 100 or < 110 mg/dl, and/or a normal glucose tolerance test". So right there they are allowing people to be considered "normal" at FBG levels far higher than the level that [1] found to be problematic (anything > 85 mg/dl). That seems like a pretty big potential discrepancy and shortcoming of [2] if we really think it takes an FBG < 85 mg/dl to avoid elevated CVD risk. 

 

Second, the meta-analysis included studies with a follow-up durations ranging from 5 to 19 years, with a mean of about 8-9 years, which is quite a bit less than the 22 year follow-up in [1]. Perhaps the negative CVD effects of modestly elevated FBG take longer to manifest. There is some evidence of the importance of follow-up duration in the data from [2]. When they divided their 26 studies into those with ≤10 years of follow-up vs. >10 years of follow-up, there was a bump up in the risk of CVD mortality for FBG > 110 in the longer studies (HR 1.16 → 1.26), but for the definition of pre-diabetes as FBG > 100, the HR was still not significant even in studies with >10 year follow-up (HR 1.10, 95% CI 0.97-1.24).

 

So it appears there is substantial uncertainty about just how detrimental mildly elevated fasting blood glucose is for cardiovascular disease risk. 

 

--Dean

 

------------

[1] Diabetes Care. 1999 Jan;22(1):45-9.

 

Fasting blood glucose: an underestimated risk factor for cardiovascular death.

Results from a 22-year follow-up of healthy nondiabetic men.

 

Bjørnholt JV(1), Erikssen G, Aaser E, Sandvik L, Nitter-Hauge S, Jervell J,

Erikssen J, Thaulow E.

 

Author information: 

(1)Medical Department, Rikshospitalet, Oslo, Norway.

 

Comment in

    Diabetes Care. 1999 Aug;22(8):1385-7.

    Diabetes Care. 1999 Dec;22(12):2104.

 

OBJECTIVE: Because of the available conflicting epidemiological data, we

investigated the possible impact of fasting blood glucose as a risk factor for

cardiovascular death in nondiabetic men. This study reports the results from a

22-year prospective study on fasting blood glucose as a predictor of

cardiovascular death.

RESEARCH DESIGN AND METHODS: Of the 1,998 apparently healthy nondiabetic men

(aged 40-59 years), a total of 1,973 with fasting blood glucose < 110 mg/dl were 

included in the study in which also a number of conventional risk factors were

measured at baseline.

RESULTS: After 22 years of follow-up, 483 men had died, 53% from cardiovascular

diseases. After dividing men into quartiles of fasting blood glucose level, it

was found that men in the highest glucose quartile (fasting blood glucose > 85

mg/dl) had a significantly higher mortality rate from cardiovascular diseases

compared with those in the three lowest quartiles. Even after adjusting for age, 

smoking habits, serum lipids, blood pressure, forced expiratory volume in 1 s,

and physical fitness (Cox model), the relative risk of cardiovascular death for

men with fasting blood glucose > 85 mg/dl remained 1.4 (95% CI 1.04-1.8).

Noncardiovascular deaths were unrelated to fasting blood glucose level.

CONCLUSIONS: Fasting blood glucose values in the upper normal range appears to be

an important independent predictor of cardiovascular death in nondiabetic

apparently healthy middle-aged men.

 

 

PMID: 10333902

 

-------------------

[2] Ann Med. 2014 Dec;46(8):684-92. doi: 10.3109/07853890.2014.955051. Epub 2014 Sep 

18.

 

Associations of prediabetes with all-cause and cardiovascular mortality: a

meta-analysis.

 

Huang Y(1), Cai X, Chen P, Mai W, Tang H, Huang Y, Hu Y.

 

Author information: 

(1)Clinical Medicine Research Institute, the Affiliated Hospital at Shunde,

Southern Medical University , Foshan , PR China.

 

BACKGROUND: Reports on the association of prediabetes with all-cause mortality

and cardiovascular mortality are inconsistent. Objective. To evaluate the risk of

all-cause and cardiovascular mortality in association with impaired fasting

glucose (IFG) and impaired glucose tolerance (IGT).

METHODS: Prospective cohort studies with data on prediabetes and mortality were

included. The relative risks (RRs) of all-cause and cardiovascular mortality were

calculated and reported with 95% confidence intervals (95% CIs).

RESULTS: Twenty-six studies were included. The risks of all-cause and

cardiovascular mortality were increased in participants with prediabetes defined 

as IFG of 110-125 mg/dL (IFG 110) (RR 1.12, 95% CI 1.05-1.20; and RR 1.19, 95% CI

1.05-1.35, respectively), IGT (RR 1.33, 95% CI 1.24-1.42; RR 1.23, 95% CI

1.11-1.36, respectively), or combined IFG 110 and/or IGT (RR 1.21, 95% CI

1.11-1.32; RR 1.21, 95% CI 1.07-1.36, respectively), but not when IFG was defined

as 100-125 mg/dL (RR 1.07, 95% CI 0.92-1.26; and RR 1.16, 95% CI 0.94-1.42,

respectively).

CONCLUSIONS: Prediabetes, defined as IFG 110, IGT, or combined IFG 110 and/or

IGT, was associated with increased all-cause and cardiovascular mortality.

 

DOI: 10.3109/07853890.2014.955051 

PMID: 25230915

 

[drewab]

Popular dietician Jeff Novick had an interesting response to this study - see below.

 

 

 

 

A few comments

 

Typically, when the recommendations for *exercise* are given, they are given as a minimum of 30 minutes of moderate exercise a day.  That is for exercise/activity that is on top of baseline activity and not a recommendation for "all" activity.  

 

The above study calculated the issue differently.  

 

They included all types of physicals activity, including very low levels of minimum basic baseline activity (like leisure, work, household, etc), that would not have met the criteria of moderate activity as defined by me and all the other health organization listed in my Exercise Guidelines thread. For an activity to be moderate, it needs to be about 4-6 METs.

 

In this study, "Baseline activity, as currently defined, includes all sedentary and light activities (<3 METs)"

 

A simple leisurely stroll is 2 MET, so strolling for 60 minutes per day is 120 MET minutes, x 5 days is 600 MET minutes per week, which they are saying is the minimum goal and are using as the baseline comparison group.   This would not meet the minimum I discuss. 

 

So, the comparison is not a fair one of oranges to oranges.  

 

Now, that does not make baseline activity worthless as several previous meta-analyses do show an association between 150 min/week of leisure time activity and a significant reduction in disease. 

 

http://circ.ahajournals.org/content/early/2011/08/01/CIRCULATIONAHA.110.010710

 

So, the current study is still a bit misleading because it's using an extremely low level of total physical activity (600 MET/Minutes) and including low intensity activity in that total as the control/comparison and not being clear on this. 

 

The 150 min/week recommendation is still relevant as long as people are aware it's above and beyond their normal light physical activity and activities of daily living.

 

Many years ago, I wrote an article about this issue of exercise, vs activity.   In it, I asked the question, which was more important, the hour you spend in the gym doing formal exercise, or just being active all day and getting >/= 10K steps a day.   My answer, was both.   We need to get the equivalent of at least 30-60 minutes of moderate exercise, at least 5 days a week and we also have to lead an active lifestyle.  

 

https://www.pritikin.com/eperspective/0409/exercise_print.htm

 

Perhaps I will add some comments to my exercise thread to clarify this issue, and these distinctions,  some more. 

 

In Health

Jeff

 

[AlPater]

[i thought that the below pdf-availed paper puts exercise values in perspective relative to covariates.]

 

Dose-dependent association between muscle-strengthening activities and all-cause mortality: Prospective cohort study among a national sample of adults in the USA.

Dankel SJ, Loenneke JP, Loprinzi PD.

Arch Cardiovasc Dis. 2016 Aug 31. pii: S1875-2136(16)30121-8. doi: 10.1016/j.acvd.2016.04.005. [Epub ahead of print]

PMID: 27591819

http://www.ncbi.nlm.nih.gov/pubmed/?term=27591819

 

Abstract

 

BACKGROUND: We have a limited understanding of the association between
behavioural participation in muscle-strengthening activities (MSA) and all-cause
mortality.
AIM: To determine the effect of MSA on all-cause mortality, and examine a
potential dose-response relationship between the frequency with which MSA are
performed and the incidence of all-cause mortality.
METHODS: Individuals (8772 adults aged≥20years) from the 2003-2006 National
Health and Nutritional Examination Survey were evaluated for baseline
characteristics, then followed for an average of 6.7years. MSA were assessed at
baseline as the number of self-reported sessions completed within the past
30days. Analyses were performed in 2015.
RESULTS: Only 18.6% of individuals met MSA guidelines (2-3 MSA sessions/week) at
baseline, while those performing any form of MSA had a 23% reduced risk of
all-cause mortality (hazard ratio (HR): 0.77; 95% confidence interval: 0.60-0.98;
P=0.04). Additionally, we created a five-category variable to determine whether a
dose-response relationship existed between MSA and premature mortality; only
individuals performing 8-14 sessions over a 30-day period (current MSA
guidelines) had a reduced risk of all-cause mortality (HR: 0.70; P=0.02). Results
were similar for CVD-specific mortality.
CONCLUSION: The national recommendations that 2-3 MSA sessions be performed per
week appear to be most effective at reducing the risk of premature all-cause
mortality; however, despite these recommendations, the majority of the adult
population in the USA still fails to perform any MSA. Future studies should
determine strategies for increasing adherence to these established guidelines.

 

Only 18.6% of individuals met MSA guidelines (2-3 MSA sessions/week) at baseline, while those performing any form of MSA had a 23% reduced risk of all-cause mortality (hazard ratio (HR): 0.77; 95% confidence interval: 0.60-0.98; P=0.04). Additionally, we created a five-category variable to determine whether a dose-response relationship existed between MSA and premature mortality; only individuals performing 8-14 sessions over a 30-day period (current MSA guidelines) had a reduced risk of all-cause mortality (HR: 0.70; P=0.02). Results were similar for CVD-specific mortality.   

 

    Table 2.     Weighted Cox proportional hazard model examining the association between engagement in muscular strengthening activities and all-cause mortality, 2003–2006 NHANES (n = 8772).
=====================================

   Variable    Total mortality HR (95% CI)    P
=====================================
    MSA in past 30 days: Yes versus No    0.77 (0.60–0.98)    0.04
    Covariates        
    Age, 1-year increase    1.08 (1.07–1.09)    <0.001
    Female versus male    0.62 (0.52–0.75)    <0.001
    Other versus Non-Hispanic white    1.08 (0.91–1.29)    0.34
    Some college education versus less    0.82 (0.69–0.97)    0.02
    Stands or walks about a lot during the day, but does not have to carry or lift things often versus Sits during the day and does not walk very much    0.50 (0.40–0.63)    <0.001
    Lifts light loads or climbs stairs or hills often versus Sits during the day and does not walk about very much    0.38 (0.27–0.54)    <0.001
    Does heavy work or carries heavy loads versus Sits during the day and does not walk about very much    0.50 (0.25–0.99)    0.04
    Cotinine, 50ng/mL increase    1.04 (1.02–1.07)    0.001
    C-reactive protein, 1mg/dL increase    1.08 (1.02–1.15)    0.004
    Overweight/obese versus Not    0.70 (0.59–0.83)    <0.001
    Comorbidities, one comorbidity increase    1.30 (1.22–1.38)    <0.001
=====================================

    CI: confidence interval; HR: hazard ratio; MSA: muscle-strengthening activities; NHANES: National Health and Nutritional Examination Survey.