MLI Initiatives- Physical Activity

WHO 2020: Physical activity guidelines 2020: comprehensive and inclusive recommendations to activate populations

The new WHO 2020 Guidelines on Physical Activity and Sedentary Behaviour1 provide recommendations on the amount and types of physical activity for various age groups, pregnant and post-partum women, and people living with chronic conditions or disabilities. The 2020 WHO guidelines are built on a much larger evidence base than the 2010 guidelines,2 and include some major developments

1. Evidence for additional health benefits, such as improved cognitive health, health-related quality of life, mental health, and sleep, is reported, over and above what was included in the 2010 WHO guidelines—ie, cancer, cardiorespiratory, metabolic, musculoskeletal, and functional health. This development reflects the maturation of research on physical activity and the growing incorporation of the WHO definition of health as a state of complete physical, mental, and social wellbeing.3

2. The 2020 WHO guidelines, for the first time, on a global level, provide specific recommendations for pregnant and post-partum women and for people living with chronic conditions or disabilities, showing the increasing specificity and relevance of physical activity guidelines to different populations.

3. These guidelines have modified recommendations for how aerobic physical activity should be accumulated—eg, the previous requirement for 10-min minimum duration of continuous activity has been dropped and “some physical activity is better than none"

4. The 2020 WHO guidelines provide general recommendations to reduce sitting time, which accords with growing interest in the health effects of sedentary behaviour.4.

   The launch of the 2020 WHO guidelines follows other major physical activity guidelines, most recently in the USA5 and UK.6 These guidelines provide similar recommendations for the types, intensity, volume, and duration of physical activity for both general and specific populations. Meanwhile, the new Canadian 24-Hour Movement Guidelines for Adults,7 launched in October, 2020, took a different approach by integrating recommendations for sleep, sedentary behaviour, and physical activity of various intensities. Such a 24-h activity spectrum approach, which aims to account for the interconnections across multiple behaviours, has also been applied in guidelines on physical activity, sedentary behaviour, and sleep for children younger than 5 years by WHO8 and countries such as Australia9 and Canada.10 Debate continues about certain aspects of physical activity guideline development. Although some experts consider existing evidence insufficient for supporting quantitative recommendations for sitting time,11 others advocate that guidelines should be developed despite insufficient and low-quality evidence.12 Furthermore, some researchers propose inclusion of the entire 24-h day in integrated movement guidelines,7,12 whereas others raise concerns such as communication challenges and insufficient 24-h compositional evidence.13 Despite some differences, contemporary physical activity guidelines share many commonalities in their defined public health context, an emphasis on participation, and a socially inclusive approach for reaching the entire population. Current physical activity guidelines evolved from decades of evidence generation, syntheses, and updates (figure). Early physical activity guidelines focused on continuous vigorous aerobic exercise mainly for performance improvement14 or cardiac rehabilitation.15 With increasing evidence on the health benefits of moderate-intensity physical activity, such as walking, guidelines evolved to become more public health oriented and the focus shifted from exercise, which is planned and structured, to physical activity, which can be part of daily living.16 In recent decades, evidence that incorporates device-based measures and sophisticated analytical approaches has further characterised the amount of physical activity associated with health benefits—eg, the curvilinear relationship between physical activity and health outcomes, the value of any duration of physical activity, and the benefits of light-intensity physical activity as a replacement for sedentary time.17,18 Such developments have led to the emphasis on doing any physical activity in any duration in the current guidelines.1,5,6 Overall, physical activity guidelines have shifted from exercise training to active living. Guidelines are an important way to bring scientific research to end-users, such as policy makers, health and non-health professionals, and the public. Updates to existing physical activity guidelines should influence priority setting, decision making, and community awareness and behaviour. An emphasis on doing any amount of physical activity, for example, aims to empower inactive individuals to reap benefits of physical activity, even when the recommended target range (ie, 75−150 min per week of vigorous-intensity physical activity or 150−300 min per week of moderate-intensity physical activity) is perceived to be out of reach. This message is particularly relevant during the COVID-19 pandemic, since lockdowns and physical distancing have imposed additional barriers to physical activity.19 Additionally, specific recommendations for subpopulations underline social inclusion by engaging with community members left out by earlier guidelines, such as people living with disabilities. Recommendations to reduce sedentary time could lead to new physical activity promotion strategies, such as encouraging light-intensity physical activity among sedentary workers. Finally, the acknowledgment of the health benefits of incidental physical activity of any duration reinforces the importance of engaging sectors outside of health, such as urban planning, transportation, and architecture, to facilitate short bursts of activities, such as walking or stair climbing. Public health guidelines alone do not lead to progress. To reach the WHO global target of reducing physical inactivity by 15% by 2030,20 guideline development must be supported by long-term political commitment and paired with coordinated and sustained dissemination and communication strategies across sectors.21 WHO encourages governments to consider national social and cultural contexts while adopting the global physical activity guidelines,21 which provide opportunities for governments to incorporate strategies on communication, dissemination, and implementation into national guidelines. Key questions to consider include who to engage, what message to communicate,22 and when, where, and how to deliver messages.23 Furthermore, these guidelines should be used to advocate for long-term resource investment, policy making, and political commitment to reduce physical inactivity. Researchers, practitioners, and advocates need to work with decision makers and all stakeholders and sectors to catalyse change. Tailored guideline summaries and infographics can be disseminated through public health and medical associations to support and empower all practitioners in patient counselling and education. Partnering with non-health sectors, such as transportation, planning, education, and community services, can drive changes in legislation, policies, environments, and practice to facilitate active living.23 Reducing physical inactivity is a mammoth societal challenge. Sustained commitment and investment, effective communication and dissemination, and cross-sectoral coordination and collaboration are all crucial to activate populations.

WHO. WHO 2020 guidelines on physical activity and sedentary behaviour. Geneva: World Health Organization, 2020. https://apps.who.int/iris/ bitstream/handle/10665/336656/9789240015128-eng.pdf (accessed Nov 25, 2020). 2 WHO. Global recommendations on physical activity for health. Geneva: World Health Organization, 2010. 3 WHO. WHO remains firmly committed to the principles set out in the preamble to the Constitution. 2020. https://www.who.int/about/who-we-are/constitution (accessed Oct 6, 2020). 4 Saunders TJ, McIsaac T, Douillette K, et al. Sedentary behaviour and health in adults: an overview of systematic reviews. Appl Physiol Nutr Metabol 2020; 45 (suppl 2): S197–217. 5 US Department of Health and Human Services. Physical activity guidelines for Americans, 2nd edition. Washington, DC: US Department of Health and Human Services, 2018. 6 Department of Health and Social Care. UK Chief Medical Officer’s physical activity guidelines. London: Department of Health and Social Care, 2019. 7 Ross R, Chaput J-P, Giangregorio LM, et al. Canadian 24-hour movement guidelines for adults aged 18–64 years and adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab 2020; 45 (suppl 2): S57−102. 8 Willumsen J, Bull F. Development of WHO guidelines on physical activity, sedentary behavior, and sleep for children less than 5 years of age. J Phys Act Health 2020; 17: 96−100. 9 Okely AD, Ghersi D, Hesketh KD, et al. A collaborative approach to adopting/adapting guidelines—the Australian 24-hour movement guidelines for the early years (birth to 5 years): an integration of physical activity, sedentary behavior, and sleep. BMC Public Health 2017; 17: 869. 10 Tremblay MS, Chaput J-P, Adamo KB, et al. Canadian 24-hour movement guidelines for the early years (0–4 years): an integration of physical activity, sedentary behaviour, and sleep. BMC Public Health 2017; 17: 874. 11 Stamatakis E, Ekelund U, Ding D, Hamer M, Bauman AE, Lee IM. Is the time right for quantitative public health guidelines on sitting? A narrative review of sedentary behaviour research paradigms and findings. Br J Sports Med 2019; 53: 377. 12 Tremblay MS, Rollo S, Saunders TJ. Sedentary Behavior Research Network members support new Canadian 24-Hour Movement Guideline recommendations. J Sport Health Sci 2020; published online Oct 12. https://doi.org/10.1016/j.jshs.2020.09.012. 13 Stamatakis E, Bauman AE. The bold sedentary behavior recommendations in the new Canadian guidelines: are they evidence-based? Response to “Sedentary Behavior Research Network members support new Canadian 24-Hour Movement Guideline recommendations”. J Sport Health Sci 2020; published online Oct 12. https://doi.org/10.1016/j.jshs.2020.09.013. 14 American College of Sports Medicine. American College of Sports Medicine position statement on the recommended quantity and quality of exercise for developing and maintaining fitness in healthy adults. Med Sci Sports 1978; 10: vii−x. 15 Council on Scientific Affairs. Physician-supervised exercise programs in rehabilitation of patients with coronary heart disease. JAMA 1981; 245: 1463−66. 16 Pate RR, Pratt M, Blair SN, et al. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995; 273: 402−07. 17 Ding D, Ramirez Varela A, Bauman AE, et al. Towards better evidence-informed global action: lessons learnt from the Lancet series and recent developments in physical activity and public health. Br J Sports Med 2020; 54: 462−68. 18 Chastin SFM, De Craemer M, De Cocker K, et al. How does light-intensity physical activity associate with adult cardiometabolic health and mortality? Systematic review with meta-analysis of experimental and observational studies. Br J Sports Med 2019; 53: 370−76. 19 Porto LGG, Molina GE, Matsudo VK. Physical activity and the coronavirus pandemic: an urgent time to change the recommendation focus. Ensaios Teóricos em Atividade Física e Saúde 2020; 25: 1−5. 20 WHO. Global action plan on physical activity 2018–2030: more active people for a healthier world. 2018. http://www.who.int/ncds/prevention/ physical-activity/gappa/action-plan (accessed Oct 27, 2020). 21 Bull FC, Saad Al-Ansari S, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020; published online Nov 25. https://doi.org/10.1136/ bjsports-2020-102955.