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Moderate Leisure-Time Physical Activity
Who Is Meeting the Public Health Recommendations? A National Cross-sectional Study
Deborah Arriaza Jones, PhD, RD;
Barbara E. Ainsworth, PhD, MPH;
Janet B. Croft, PhD;
Caroline A. Macera, PhD;
Elizabeth E. Lloyd, MS;
Hussain R. Yusuf, MBBS, MPH
Arch Fam Med. 1998;7:285-289.
ABSTRACT
We identified the prevalence of adults who met the 1993 Centers for Disease Control and Prevention and the American College of Sports Medicine moderate physical activity recommendation and the 1996 Surgeon General's Report on Physical Activity and Health energy expenditure guideline for leading a moderately active lifestyle. Participants were 16890 women and 12272 men at least 18 years old who were asked in the 1990 National Health Interview Survey about their leisure-time physical activities. About one third of US adults met either recommendation for moderate activity; 32% met the Centers for Disease Control and Prevention and the American Association of Sports Medicine recommendation and 38% met the surgeon general's guideline. Women, ethnic minorities, adults with lower educational attainment, and older adults were least active. Public health efforts are needed to address the issues related to physical inactivity and to provide organized programs to increase moderate physical activity levels in US adults.
INTRODUCTION
Participating in regular physical activity confers many health benefits, such as reduced risk for coronary artery disease, diabetes mellitus, obesity, some cancers, and various musculoskeletal conditions.1 However, national rates for participation in leisure-time physical activity are consistently low for women, older adults, persons with low educational attainment, and ethnic or racial minorities.2
In 1993 and 1996 the US Public Health Service released recommendations to promote participation in moderate-intensity activities. The 1993 recommendation, developed by an expert panel convened by the Centers for Disease Control and Prevention (CDC) and the American College of Sports Medicine (ACSM) (hereafter, CDC-ACSM), states,"Every U.S. adult should accumulate 30 minutes or more of moderate-intensity activity on most, preferably all, days of the week."3 Moderate-intensity activity was defined as activity performed at an intensity of 3 to 6 metabolic equivalents (METs), calculated as the ratio of the metabolic rate for an activity divided by the resting metabolic rate, equal to about 3.5 mL O2·kg-1·min-1 for a person weighing 60 kg. This would include such activities as gardening, brisk walking, or aerobic dance. The 1996 guideline is part of the US Public Health Service's Surgeon General's Report on Physical Activity and Health (SGR).4 The report defines moderate amounts of physical activity as activity that uses 627.6 kJ/d (150 kcal/d) or 1484 kJ/wk (1000 kcal/wk). Examples of activities meeting this definition are shown in Table 1. Both reports emphasize that adults can meet the moderate-intensity activity recommendation by participating in a variety of activities throughout the day, including sports and conditioning, occupational activity, transportational activity, home repair, and other unstructured activities.
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Table 1. Examples of Moderate Amounts of Physical Activity*
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Few data are available on the prevalence of adults whose pattern of leisure-time activity enables them to meet the recommendations for moderate activity from either the CDC-ACSM or the SGR. We have determined the prevalence and characteristics associated with US adults who meet the CDC-ACSM recommendation and the SGR guideline for moderate leisure-time activity.
PARTICIPANTS AND METHODS
SURVEY DESIGN
We analyzed data from the Health Promotion and Disease Prevention supplement of the 1990 National Health Interview Survey (NHIS).2 The NHIS is a nationwide household survey that uses a complex multistage probability sampling strategy to select respondents from the civilian, noninstitutionalized, adult population.
PARTICIPANTS
A total of 41104 respondents (83.4% response rate) completed the 1990 Health Promotion and Disease Prevention supplement. Data were analyzed for 29162 respondents (16890 women and 12272 men). Respondents were excluded from analysis if they had an activity limitation (18.5%), had an activity restriction in the past 2 weeks (5.7%), had a disability (0.2%), or did not respond to demographic questions including weight or height (1.3%). Because the focus of this analysis was on moderate activity, we excluded the respondents (2.9%) who met the ACSM vigorous-intensity recommendation of at least 20 minutes of activities of more than 6 METs' intensity at least 3 days per week. This small group was already sufficiently active. The sample population was predominantly white (77%), had at least a high school education (81%), was aged from 25 to 64 years (88%), and was within the average classification of body mass index (BMI) (69%). Body mass index was calculated as weight in kilograms divided by height in meters, squared. Sex-specific categories for BMI levels were as follows: underweight, 19.1 or less for women and 20.7 or less for men; overweight, 27.3 or more for women and 27.8 or more for men; and average, the ranges between those values.5
LEISURE-TIME PHYSICAL ACTIVITY
Respondents identified the frequency and duration of their participation in 24 sports and conditioning activities during the past 2 weeks. For each activity, respondents indicated the number of times they performed the activity in the past 2 weeks and the number of minutes per session. Intensity of activity was classified by energy expenditure, expressed as METs. Metabolic equivalent levels were obtained for each leisure-time activity from the Compendium of Physical Activities.6
CDC-ACSM Moderate Activity Recommendation
Identification of respondents who met the CDC-ACSM moderate activity recommendation was based on the frequency, duration, and intensity of activities performed. A cumulative activity score was computed by multiplying the frequency of 17 moderate-intensity activities (those requiring 3-6 METs) performed in the 2-week survey period by the duration of each activity in minutes per session and then adding all activity scores. A frequency of "most days of the week" was defined as 5 times per week. Participants who accumulated at least 300 minutes of moderate activity during at least 10 sessions in the 2-week period (300 min x 10 = 30 min/d) were classified as meeting the CDC-ACSM moderate activity recommendation.
SGR Recommendation
Identification of respondents who met the SGR moderate kilojoule (kilocalorie) guideline was based on body weight and frequency, duration, and intensity of activities performed. A cumulative kilojoule score was computed by multiplying frequency of performance by duration in minutes by intensity in METs by the proportion of body weight more than 60 kg (body weight in kg per 60 kg) for each of the 24 activities and then adding all activity scores. The cumulative kilojoule score was divided by 2 to calculate the weekly kilojoule expenditure or divided by 14 to calculate the daily kilojoule expenditure. Participants who accumulated 4184 kJ/wk (1000 kcal/wk) or averaged 627.6 kJ/d (150 kcal/d) were classified as meeting the SGR moderate recommended energy expenditure during leisure-time physical activity.
STATISTICAL ANALYSIS
Results were weighted to account for the complex sampling design. Descriptive analyses included the distribution of leisure-time physical activity levels by selected characteristics and the prevalence of specific types of activities among persons in the moderate and vigorous activity groups. SUDAAN7 statistical software was used for logistic regression analyses and to compute the 95% confidence intervals around the prevalence estimates. Sex-specific, age-adjusted logistic regression analyses were used to assess the differences in activity among groups defined by race, educational attainment, age, and BMI.
RESULTS
The prevalence of adults meeting the CDC-ACSM and SGR recommendations for moderate activity is shown in Table 2. More adults met the SGR guideline (37.9%) compared with the CDC-ACSM recommendation (32.0%). For both recommendations, men were more active than women; however, larger gender differences were observed for the SGR guideline (47.4% for men vs 29.2% for women) compared with the CDC-ACSM recommendation (34.3% for men vs 29.8% for women). Ethnic differences in participation rates were observed for both recommendations, with more white participants classified as moderately active (CDC-ACSM, 33.0%; SGR, 39.6%) than black participants (CDC-ACSM, 30.1%; SGR, 34.0%) or Hispanics (CDC-ACSM, 25.9%; SGR, 29.7%). The prevalence of adults meeting the CDC-ACSM and SGR recommendations increased with educational attainment (range, 24.6%-44.0%) and decreased with age (range, 42.7%-29.9%). Among the BMI categories, the prevalence of adults meeting the CDC-ACSM recommendation was inconsistent across BMI levels. However, for the SGR guideline, activity levels increased across BMI levels, from 29.7% to 39.4%. The average daily leisure-time energy expenditure among the adults meeting the SGR guideline was 1276 kJ/d (305 kcal/d). Those who did not meet the guideline expended an average of 347.2 kJ/d (83 kcal/d) in leisure-time physical activities.
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Table 2. The National Health Interview Survey, 1990*
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COMMENT
In 1990, 32.0% of US adults in the survey met the CDC-ACSM recommendation and 37.9% of adults met the SGR guideline for moderate physical activity during their leisure time. Despite the different methods used to compute moderate physical activity participation rates for the CDC-ACSM recommendation and for the SGR guideline, the results are similar.4 Whereas it is encouraging that almost one third of US adults engage in moderate activities at least 30 min/d or expend at least 627 kJ/d (150 kcal/d) or 4184 kJ/wk (1000 kcal/wk) in leisure-time activities, more than 60% failed to participate at the recommended levels. These include most women, especially those of low educational attainment, of ethnic minorities, and older than 45 years. Inactive women are vulnerable to osteoporosis, decreased muscular strength and endurance, low physical fitness, and various chronic diseases that are associated with a loss of independence in older age.4 Additionally, increased physical activity reduces the risks for developing chronic coronary heart disease, diabetes mellitus, high blood pressure, and colon cancer by 30% to 50%.4
For both the CDC-ACSM and SGR recommendations, men were more active than women. These observations are consistent with other reports that show men spend more time each day in organized sports and leisure activities.8 This observation may also be related to the omission of household and family care activities on the NHIS survey. Studies using detailed physical activity records show that women spend at least 2 hours per day in household and family care activities compared with about 30 minutes for men.9-10 We speculate that the proportion of women meeting the moderate activity recommendations will increase if household and family care activities are added to future physical activity surveys.11
The disparity in educational status among some minority groups related to leisure-time physical activity levels may be due in part to differential occupational activity. Those with lower educational attainment may have jobs that require a large amount of physical activity. In this case, the category of leisure-time physical activity may be irrelevant for these groups. Future surveys that consider occupational activity may make this educational difference smaller.
More men met the SGR guideline than met the CDC-ACSM recommendation (47.4% vs 34.3%). These differences may be due to the effect of body weight in the SGR calculations. The SGR guideline identifies a moderately active lifestyle as one in which the expenditure in moderate or vigorous physical activity is 627.6 kJ/d (150 kcal/d) or 4184 kJ/wk (1000 kcal/wk). Because this is computed by multiplying duration in minutes by intensity in METs by proportion of body weight more than 60 kg (body weight in kilograms per 60 kg), people who weigh more will expend more kilojoules per unit of time than people who weigh less. Higher body weights among men could account for the greater proportion of men meeting the SGR guideline than the weight-neutral CDC-ACSM recommendations. Since body weights in women are closer to 60 kg, a standard weight used as an estimate of a resting metabolic rate of 4.184 kJ/min (1 kcal/min) or 251.04 kJ/h (60 kcal/h), little difference is observed between the prevalences of women meeting the CDC-ACSM recommendations and those meeting the SGR guideline (29.2% vs 29.8%).
This study has some limitations that may have influenced its results. These limitations, however, are not unique to this physical activity survey. First, respondents were not asked about household, family care, and transportation activities. Most of these activities are moderate intensity, and their omission may have lowered the true estimate of the prevalence of US adults meeting the CDC-ACSM and SGR moderate-activity recommendations. Second, because of the wording of questions in the NHIS, we do not know the actual minutes spent performing the activities daily. We do know, however, the accumulated time spent in activities during 2 weeks. If the respondents reported an accumulation of at least 10 sessions and 300 minutes of moderate activity during the past 2 weeks, we computed their daily activity as 30 min/d, 5 times per week. Third, of the 24 activities in the poll, 17 were moderate intensity (3-6 METs) and 7 were vigorous intensity (>6 METs). It is unknown if additional activities listed in the NHIS would have increased the reported prevalence of US adults who meet the moderate-intensity recommendations. Although the data used in this report were collected in 1990, recent data suggest that the prevalence of US adults who do not participate in any leisure-time physical activity has increased between 1990 and 1994.4 The numbers reported here, therefore, may actually overestimate the prevalence of adults who are meeting either set of recommendations.
Family physicians can help correct this problem by suggesting to their sedentary patients and their family members that they can improve their health by engaging in at least 30 minutes of moderate-intensity activities on most days of the week. Appropriate activities include gardening, brisk walking, and other activities identified in Table 1.
In summary, these data show that about one third of US adults meet the CDC-ACSM and SGR recommendations for moderate physical activity. A larger proportion of men, whites, and more highly educated and younger adults are meeting the physical activity recommendations than women, ethnic minorities, and less-educated and older adults. Additional studies are needed to expand physical-activity surveys to represent moderate activities performed by women and ethnic minorities. Public health efforts are needed to identify strategies to increase moderate activity in adults who fail to meet the current public health moderate physical activity recommendations.
AUTHOR INFORMATION
Accepted for publication June 20, 1997.
We thank John Livengood, MD, MPH, for his insight, and Ms Bridgette Hines and Ms Victoria L. Lombard for their secretarial assistance.
Corresponding author: Deborah Arriaza Jones, PhD, RD, Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, 4770 Buford Hwy (K46), Atlanta, GA 30341-3717 (e-mail: ddj0{at}cdc.gov).
From the Divisions of Nutrition and Physical Activity (Drs Jones and Macera and Ms Lloyd) and Adult and Community Health (Drs Croft and Yusuf), National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Ga; and the Departments of Epidemiology and Biostatistics (Drs Ainsworth and Macera) and Exercise Science (Dr Ainsworth), and the Center for Health Promotion and Disease Prevention (Dr Macera), University of South Carolina School of Public Health, University of South Carolina, Columbia.
REFERENCES
1. Bouchard C, Stevens S, Shephard RJ. Proceedings from the 1992 International Conference on Physical Activity, Fitness, and Health. Champaign, Ill: Human Kinetics; 1994.
2. National Center for Health Statistics. Health Promotion and Disease Prevention: United States, 1990: Vital and Health Statistics. Series 10, No. 185. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1993. Publication PHS 93-1513.
3. 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;273:402-407.
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4. US Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta, Ga: US Dept of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion; 1996.
5. National Center for Health Statistics. Anthropometric Reference Data and Prevalence of Overweight, United States, 1976-1980: Vital and Health Statistics. Series 11, No. 238. Atlanta, Ga: US Dept of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention; 1987. Publication PHS 87-1688.
6. Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc. 1993;25:71-80.
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7. Shah BV, Barnwell BG, Hunt NP, LaVange LM. SUDAAN User's Manual, Release 5.50. Research Triangle Park, NC: Research Triangle Institute; 1991.
8. Crespo CJ, Keteyian SJ, Heath GW, Sempos CT. Leisure-time physical activity among US adults: results from the Third National Health and Nutrition Survey. Arch Intern Med. 1996;156:93-98.
FREE FULL TEXT
9. Ainsworth B, Sternfeld B, Benfield J, Criscoe S. Evaluation of the Health Plan Activity Survey [abstract]. Med Sci Sports Exerc. 1996;28:S35.
10. Richardson M, Leon AS, Jacobs DR, Ainsworth BE, Serfass R. Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire. J Clin Epidemiol. 1994;47:271-281.
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11. Ainsworth BE, Richardson M, Jacobs DR, Leon AS. Gender differences in physical activity. Women Sport Phys Activity J. 1993;2:1-16.
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