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Canada's Guide for Healthy Physical Activity:

Deveopment and Rationale

All ribe reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without prior written permission of the Canadian Society for Exercise Physiology.

A project oftheCanadian Society for Exercise Physiology

in partnership withFitness and Active Living Unit, Health Canada

Development of the Guide:Overview of the Process

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Overview of the Development of the Guide

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Biological Outcomes

Roy Shephard Ph. D.Claude Bouchard Ph.D.

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Physical Activity and Health• Sedentary living may contribute to the initiation and progression of a variety of health problems

and may also slow the normal process of recovery. In contrast, regular physical activity isincreasingly recognized as a measure decreasing the risk of these health disturbances.

• Sedentary living is associated with a high incidence of coronary heart disease. There is anapproximate doubling in the risk of coronary heart disease when individuals with a low level ofphysical activity are compared to those who are active.

• Regular physical activity is inversely related to resting blood pressure and to the risk ofdeveloping hypertension.

• Regular physical activity may reduce the risk of developing adult-onset diabetes.

• Regular physical activity is impomnt for the prevention of weight gain and plays a major rolewith respect to long-term success in weight reduction.

• Regular physical activity seems to offer some protection against the risk of cerebrovasculardiseases.

• Regular physical activity may protect against colon cancer.• Regular physical activity has the potential to postpone or prevent certain musculo-skeletal

disorders such as low back pain and osteoporosis.

• Regular physical activity has potential to influence favorably structures, functions andprocesses, which determine functional capabilities, contributing to continued independence inold age.

Regular physical activity has a favorable influence on mood state,

Recommendations• Even a moderate increase over your current level of physical activity will improve yo ur

health. Indeed, the largest health benefits accrue on moving from the lowest to the nexthighest level of physical activity.

• An optimum plan will see you unde@ng aerobic exercise on most days of the week. 'Meamount of 6= you must spend for substantial benefit depends on the intensity of the activity.With light activity, such as walking at a moderate speed, you should aim for 60 minutesper day, but this can drop to 20-30 minutes if you choose more vigorous activity such asjogging or a game of squash. You can accumulate this activity in several segments over theday: for example, three 20 minute periods of walking in a day.

• You should also aim to exercise the main muscle groups of the body systematically at leasttwice per week. Find a load that is near the maximum you can accomp@h for each musclegroup, and then make 8-10 contractions at about a half of this load.

• You should also take the main joints of the body gently through their full range of motion onmost days. This is a good preliminary to a bout of exercise.

• Remember that you don't have to visit a gym or a squash court to get exercise that canimprove your health. Walking to the subway station, mowing the lawn with a hand mower,climbing up stairs in the office, and do it yourself activities around the home are all helpful.It is also possible to strengthen the muscles by pushing against the floor or the back of yourchair when you are in an airplane, a long car journey, or sitting at an office desk.

• The intensity of aerobic exercise for strengthening the heart and increasing your enduranceof moderate activity should be such as to make you conscious of your breathing, to sensesweating and ft heart pounding. The intensity of exercise should be increased progressivelyas your condition improves. However, an exercise session should leave you no more

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thanpleasantly @d for the rest of the day. With a progressive programme, good gains may beseen within 2-3 months.

• Aerobic exercise will not strengthen the muscles, these require resistance exercise - eitheragainst an external load (Weight-lifting or carrying groceries) or against body weight (forexample, push-ups). Again a progressive programme will yield substantial increases ofstrength over 2-3 months, but the building of larger muscles will take longer.

• To get rid of @Ius fat and to reduce cholesterol levels, the key is the amount of exerciseperformed each week- To produce a substantial change, you need to add the equivalent of1820 @ of walldng to your weekly routine, without a compensating increase in food intake.You should not anticipate seeing benefits quickly - substantial fat loss may take 6 - 1 2months.

Practical TipsGetting StartedTry to see ways you can build moderate activity into your daily schedule.

The barriers that people see to exercising are lack of time and lack of facilities. Tum isrequired to travel to a distant g@ but if you walk to the subway or the corner store, thismay be just as quick as getting your car out of the basement garage and finding parkingspace at the other end. Equally, it is often q@r to use the stairs than to wait for an elevator.

Begin slowly, but try to do a little more each day and each week. Do not make the mistake oftrying to accomplish feats that were possible twenty years earlier on the rmt day you beginyour exercise regmien.

Exercise eventually becomes a pleasant and eagerly anticipated part of the day. However, if youhave not exercised for a long d=, expect a little fatigue and some minor aches and pains for afew days. As you persist, you will find that you can accomplish the activity and reap therewards.

Safety and clearance. Light progressive exercise is very safe - in fact, those who exercise havea better chance of living to age 80 than those who don't Most people under the age of fifty cbnot need special medical clearance if they are merely planning to take a little more exercisethan they did the previous we& If you have some known disease, consult your physician, andif you are uncertain whether you need to do this, the PAR-Q questionnaire will help you todecide.

If you find exercise is causing symptoms other than moderate tiredness and shortness ofbreath during the activity, then you should discuss this with your physician. Do not allowpride or competition to push you to do more than your body tells you that you canaccomplish.

You will reduce the chance of sprains and @s if you wear shoes with a good cushioned soleand good ankle support and you avoid jogging or doing aerobic dance on hard surfaces such asconcrete sidewalks or studios with tile-on-concrete floors.

BibliographyBiering-Serensen, F., Bendix, T., Jorgensen, K., Manniche, C., Nielsen, H. (1994). Physical

activity, fitness and back pain. In C. Bouchard, R.J. Shephard, T Stephens (Eds.). Physicalactivity, fitness and health: International proceedings and consensus statement. Champaign, IL:Human Kinetics.

Bouchard, C., Depres, J-P., Tremblay, A. (1993). Exercise and obesity. Obesity Res, 1, 133­147.

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Bouchard, C., Shephard R.l. & Stephens T. (1994) The Consensus Statement. In C. Bouchard,R.l. Shephard, & T. Stephens (Eds.), Physical activity, fitness, and health: Internationalproceedings and consensus statement. Champaign, IL: Human Kinetics.

Chazan, B.I., Balodimos, M.C., Ryan, 1.R., & Marble, A. (1970). Twenty-five to forty-fiveyears of diabetes with and without vascular complications. Diabetologia, 6, 565-569.

Donchin, M., Woolf, 0., Kaplan, L., Floman, Y. 1990. Secondary prevention of low-back pain.A clinical trial. Spine. 15, 1317-1320.

Fagard, R.H., Tipton, C.M. (1994). Physical activity, fitness and hypertension. In C. Bouchard,R.l. Shephard, T Stephens (Eds.). Physical activity, fitness and health: Internationalproceedings and consensus statement. Champaign, IL: Human Kinetics.

Giacca, A., Qing Shi, Z., Marliss, E.B., Zinman, B., & Vranic, M. (1994). Physical activity,fitness, and Type I Diabetes. In C. Bouchard, R.l. Shephard, & T. Stephens (Eds.), Physicalactivity, fitness, and health: International proceedings and consensus statement. Champaign, IL:Human Kinetics.

Gudat, D., Berger, M., & Lefebvre, P.l. (1994). In C. Bouchard, R.l. Shephard, & T. Stephens(Eds.), Physical activity, fitness, and health: International proceedings and consensusstatement. Champaign, IL: Human Kinetics.

Hagberg, 1.M. (1990). Exercise, fitness and hypertension. In C. Bouchard, R.l Shephard, T.Stephens, 1.R. Sutton, B.C. McPherson (Eds.) 1990. Exercise, Fitness and Health.Champaign, IL: Human Kinetics.

Heinrich, C.H., Going, S.B., Parmenter, R.W., Perry, C.D., Boyden, T.W., & Lohman, T.G.(1990). Bone mineral content of cyclically menstruating female resistant and endurance trainedathletes. Medical Science Sports and Exercise, 22, 558-563.Helmrich, S.P., Ragland, D.R.,Leung, R.W., & Paffenbarger, R.W. (1991). Physical activity and reduced occurrence of non­insulin dependent diabetes mellitus. New England Journal ofMedicine, 325, 147-152.

Kellett, K.M., Kellett, D.A., Nordholm, L.A. 1991. Effects of an exercise program on sick leavedue to back pain. Phys. Ther. 71, 283-293.

Kriska, A.M., LaPorte, R.E., Patrick, S.L., Kuller, L.H., & Orchard, T.l. (1991). Theassociation of physical activity and diabetic complications in individuals with insulin-dependentdiabetes mellitus: The epidemiology of diabetes complications study - VII. Journal ofClinicalEpidemiology, 44, 1207-1214.

LaPorte, R.E., Dorman, 1.S., Tajima, N., Cruickshanks, K.l., Orchard, T.l., Cavender, D.E.,Becker, D.l., & Drash, A.L. (1986). Pittsburgh insulin dependent diabetes mellitus morbidityand mortality study: Physical activity and diabetic complications. Pediatrics, 78, 1027-1033.

Lee,I-M. (1994). Physical activity, fitness, and cancer. In C. Bouchard, R.l. Shephard, & T.Stephens (Eds.), Physical activity, fitness, and health: International proceedings and consensusstatement. Champaign, IL: Human Kinetics.

Lee, I-Min, & Paffenbarger, R.S. (1994). Physical activity and its relation to cancer risk: Aprospective study of college alumni. Medicine and Science in Sports and Exercise, 26 (7), 831­837.

Linsted, K.D., Tonstad, S., Kuzuma, 1.W. (1991). Self -report of physical activity and patternsof mortality in Seventh-Day Adventist men. J. Clin. Epidemiol. 44, 355-364.

Manson 1.E., Rimm, E.B., Stampler, M.l., Colditz, G.A., Willet, W.C., Krolewski, A.S.,Rosner, B., Hennekens, C.H., Speizer, & F.E. (1991). Physical activity and incidence of non­insulin dependent diabetes mellitus in women. Lancet, 338, 774-778.

O'Connor, G.T., Buring, 1.E., Yusuf, S et al. (1989). An overview of randomized trials ofrehabilitation with exercise after myocardial infarction. Circulation, 80, 234-244.

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Paffenbarger, R.S., Jr., Hyde, M.A., Wing, A.L., et al.(l994). Some interrelations of physicalactivity, physiological fitness, health, and longevity. In C. Bouchard, R.J. Shephard, TStephens (Eds.). Physical activity, fitness and health: International proceedings and consensusstatement. Champaign, IL: Human Kinetics.

Rejeski, W.J., Brawley, L.R., Shumaker, S.A. (1996). Physical activity and health-relted qualityof life. Exercises and Sport Science Reviews, 24,71-108.

Shaper, A.G., Wannamethee, G. (1991). Physical activity and ischaemic heart disease in middle­aged British men. Br. Heart J. 66, 384-394.

Smith, E.L. & Gilligan C. (1988). Osteoporosis, bone mineral, and exercise. In Physical activityand aging, American Academy ofPhysical Education papers No. 22 (pp. 1-5). Champaign,IL.: Human Kinetics.

Sternfeld, B. (1992). Cancer and the protective effect of physical activity: The epidemiologicalevidence. Medical and Science in Sports and Exercise, 24 (II), 1195-1209.

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Brawley & Gauvin

Psychological Outcomesand

Social Psychological Principles

Lawrence R. Brawley, Ph.D.Lise Gauvin, Ph.D.

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IntroductionThe purpose of this section is twofold. The first goal is to enumerate those social psychologicaloutcomes of physical activity that have been widely documented in the scientific literature and thatshould be communicated to the target audience ofCanada's Guide for Healthy Physical Activity.The second purpose is to outline selected social psychological principles that have been shown inthe scientific literature to contribute to the reach and selected objectives or outcomes of a mass­media communication strategy. The structure of the document is somewhat unusual in that theinformation and ideas are presented mainly via bullet points rather than through a narrative expose.Our intent was to highlight the information and principles in the most succinct way possible. As aprelude to the main portions of the text we will reiterate the goal of the Canadian Guide to HealthyPhysical Activity, outline what psychological and behavioral parameters we believe can bepositively influenced through the dissemination of the Guide and offer suggestions for evaluatingthe impact of the Guide on these parameters.

The information presented is based on the described purpose of theGuide:To provide inactive Canadian adults (i.e., 25 to 55 years) with a Guide for HealthyPhysical Activity that recommends how to take initial steps towards experiencinghealth benefits by becoming more physically active.

Target Audience for the GuideBecause the Guide will function mostly as a form of targeted advertisement, its primary objective isto initiate some form of physical activity-related behavior, not necessarily limited to but includingdirect activity participation attempts. For the target audiences we have identified above, numerousbehavioral objectives may be realized. However, there are also objectives that could be unrealisticexpectations for the Guide. We will comment on both realistic and unrealistic expectations.

Realistic OutcomesGiven the above-mentioned goal, we believe that the Guide can potentially have an impact on theknowledge, selected psychosocial parameters and selected behaviors of the target group (i.e.,apparently healthy Canadian adults aged 25 to 55 years). These potential outcomes are:

• knowledge of physical health outcomes of various doses of physical activity

• knowledge of what vigourous-, moderate- and low-intensity physical activity means

• knowledge of the psychological benefits of physical activity

• knowledge that physical inactivity is one of the recognized risk factors of cardiovasculardisease

• knowledge of other health risks associated with physical inactivity

• knowledge and recognition that beginniing and maintaining a more active lifestyle requires theinitaition of first steps as outlined in the Guide

• knowldege about who to consult and where to go if one whants to do more than just take thefirst steps towad an active lifesltye

• more positive attitude-related affect for personally performing a wide variety of preferredtypes and doses of physical activity

• more positive attitude-related affect for personally developing a more active lifestyle thatwould include physical activities ranging from low to moderate to vigorous

• intensity increased self-efficacy or perceived behavioral control for those behaviors thatinvolve taking first steps

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• increased self-efficacy or perceived behavioral control for those behaviors that constitutefirst steps towards becoming more active

• creation or strengthening of an intention to take first steps towards becoming physicallyactive and towards maintain a more active lifestyle

• trying a new enjoyable physical activity.

Given these outcomes, it should be clearly stated that the Guide will result in some of the followinghighly desirable outcomes that are associated with long-term involvement in physical activity:

• marked improvements societal norms for regular involvement in physical activity

• marked short-term changes in the health status of the population• marked short-term improvements in involvement in regular physical activity in the population

• immediate changes in self-presentational outcomes (e.g., weight loss, firming up) in personsusing the Guide

• marked long-term changes in level of psychological well-being in those persons that followthe advice in the Guide.

Rather the Guide should be viewed as one initial strategy in a comprehensive approach to increasethe knowledge, beliefs, attitudes, perceived competence, intentions/goals and behaviors of healthyCanadian adults for regular physical activity. While not central to its focus, the Guide may serve toreinforce the behaviors of Canadians who are already maintaining an active lifestyle.

Benefits of Acute PhysicalThere is consensus that a single bout of vigorous physical activity (around 70% of HRR for about30 minutes) in regularly active persons results in

• small decreases in state anxiety• moderate decreases in transient depression• large increases in feelings of revitalization• moderate increases in feelings of tranquility• small to moderate increases in global positive affect.

A smaller amount of data show that a single bout moderate physical activity (around 50% of HRRfor about 30 minutes) in regularly active persons results in

• small decreases in state anxiety• moderate increases in feeling of revitalization/energy

• improved feelings of global positive affect

• moderate increases in tranquility.

Very little is known about the outcomes of single sessions of low-intensity physical activity andabout the minimum duration required to achieve these positive psychological outcomes.

Limited data show the following moderating influences:

• In regularly active persons, people feeling worst before physical activity usually accrue greaterimprovements following physical activity than those who were feeling comparatively better.

• Those persons who are feeling better during of performance for the physical activity accruegreater psychological benefits from physical activity than those who feel comparatively worstduring the performance of the physical activity.

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• The social environment within which the physical activity unfolds may positively serve toincrease the psychological outcomes of performing the physical activity.

Benefits of Chronic Physical ActivityThere is consensus that regular involvement in moderate to vigorous physical activity results inimprovements in psychological well-being (PWB) reflected by

• small decreases in trait anxiety

• small to moderate decreases in depression• improved self-efficacy for performing physical activity and for adhering to regular physical

activity

• improved self-esteem• decreased feeling of global fatigue at the end of the day• promoted sleep, improved sleep quality, and reduced daytime sleepiness

The data also show that.these positive psychological outcomes are strongest when

• participation has been maintained for more than 4 months• changes in objectively measured fitness levels may not be required to achieve the above-

• mentioned benefits• these effects are similar for both young and old (i.e., over 56 years)

• there are no apparent gender effects

Furthermore, data from participants (young to middle aged [40-45 yrs] or older adults [60-80+yrs) in physical activity training studies, randomized clinical trials, and observational studies thathave involved physiological demands of low to moderate level aerobic physical activity (i.e., 45%to 85% peak heart rate) for a period> 1.5 months but < 3 years show that physical activity bothsupervised and free living (i.e. leisure time, sport, active living) is associated with• improvements in various aspects of health-related quality of life (HRQL) regardless of age,

activity status, or health of the participants (e.g., sedentary healthy and frail elderly)

• more pronounced, and positive effects on selected aspects of HRQL for participantsexperiencing various chronic diseases (e.g. arthritis)

• less pronounced, but positive effects for the already healthy

But these associations are

• not dependent upon changes in fitness as typically assessed (e.g., changes in V02 Max areonly modestly or weakly correlated with changes in HRQL)

• stronger and more often detected with corresponding changes in performance based measuresof physical function (e.g., performance battery of activities of daily living [ADLS] or exercisetolerance, e.g. 6 minute walk)

Given the limited amount of data available on initially sedentary persons, little is known about thegeneralizability of these findings for the target audience of the Guide. Therefore, in presenting thisinformation, it should be made clear that the positive psychological outcomes will be gleanedthrough the process of maintaining a more physically active lifestyles as opposed to initiating firststeps towards becoming more physically active.

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Social Psychological Research Principles in DesignIn this section, we will enumerate principles for designing the Guide. The viability of theseprinciples are supported by scientific research in either social psychology or exercise science. Ourenumeration will be accompanied by appropriate examples of how to render the principles concretein the context of the Guide. In constructing the Guide, the following principles should be adheredto:• Very specific physical activity behaviors should be identified and referred to as often as

possible. Avoid making reference to some generic type of physical activity.

Research shows that people make decisions in ten-ns of specific physical activity behaviors (i.e.swimming, walking, jogging, weight training) as opposed to fitness or health in general.Therefore, in educating Guide consumers about different doses of physical activity, providenumerous and specific examples of different doses of physical activity.

• Emphasize the positive 12ersonal consequences of physical activity by having people activelyconsider which positive outcomes of physical activity they would like to achieve forthemselves.

Research shows that people will be impelled to engage in an activity only to the extent that theybelieve that the behavior will have some tangible benefits for themselves. In other words, theymay think that physical activity is a good thing in general but they can not visualize what theypersonally would get out of physical activity. Therefore, the Guide should be constructed in sucha way as to incite people to identify positive outcomes of physical activity that have meaning forthem, and then to identify what behaviors. are required to achieve these outcomes. Given thepurposes of the Guide and its underlying health focus, we believe that much work should bedevoted to illustrating dose response relationships. In other words, several specific examples ofeach of the different doses of physical activity should be provided and be accompanied by anillustration of their positive health outcomes.

• Emphasize how to minimize negative personal consequences of physical activity.

Initiating a new health behavior and particularly physical activity behavior is effortful andassociated with selected negative consequences. In constructing the Guide, these negative personalconsequences should be acknowledged and illustrated. The Guide should also include specificsuggestions as to how to overcome these negative personal consequences. Some of the mostsalient negative personal consequences of physical activity include scheduling time, dealing withmuscle aches and pains, coping with physical exertion, and changing one's habits.• Emphasize negative outcomes of not exercising.

While the Guide should be formulated in such a way as to emphasize the positive outcomes of amore physically active lifestyle, information about the negative health outcomes of being sedentaryshould be include. In this regard, information about the relative risk of being sedentary incomparison to being a smoker and having high serum cholesterol would be would serve animportant educational function.

• Create social pressure to become physically active.

From a theoretical point of view (i.e., based upon attitude-action models - theory of plannedbehavior), the use of important other people as a source of influence on the target groups is anotherconsideration for the Guide. Those target individuals who believe that they should comply withwhat important others would like them to do regarding exercise, will have stronger intentions toexercise. Thus, key individuals/groups such as medical doctors, spouse, or family may bementioned in the exercise recommendations for the Guide in such a way as to cue initiate exerciserstoward taking a first step. While not at all target individuals are influenced by these normative

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beliefs about others, there are specific situations/groups on which this information will have animpact (e.g., exercise science research shows that the spouse may be influential for individualswhose goal is to use exercise to remediate disease. There is also some evidence of these beliefsbeing more important for the elderly).

• Emphasize that gaining perceived control over starting-up behaviors for physical activity IS

relatively easy.

A great deal of research on self-efficacy has demonstrated that increased confidence in onesabilities to do exercise, overcome barriers to exercise, and schedule and plan exercise will influenceintentions and encourage physical activity-related behavior. Thus, messages in the Guide shouldbe aimed at emphasizing how easy/quickly the first steps to exercise can be mastered and thatsuccess at these initial steps comes rapidly (e.g., most people who haven't exercised find thisactivity to be a good first step on the road to successful maintenance of physical activity).• Provide the most basic and detailed information about how to do the activity.

The Guide should include a wide variety of specific, but easy to do types of activities and exercisedoses. As well, specific instructions on these activities and first steps toward action should beprovided. Behavioral goals that are realistic and easily accomplished should be stressed withrespect to activities, doses and first steps.

• Provide immediate opportunity to act on the Guide

To encourage behavior that immediately stems from the influence of the Guide, initial opportunitiesto act should be suggested. these actions could be aimed at different target sub-groups within theoverall target of apparently healthy, but sedentary individuals who have positive attitudes aboutstarting physical activity. For example, for those who have never done much consistent physicalactivity, steps such as observing an introductory fitness class, or inquiring into communityresources available for the desired physical activity would 'be the first step. For those restartingexercise, trying a new easy-to-do activity that they enjoy may be a reasonable step or adjusting theexercise dose to easier levels may be important. The important feature that should accompany the"how to" aspects of the messages is the opportunity to act immediately in order to encourage initialcommitment. For example, if there were a "I-8oo-FITNESS" number to call for immediate advice,the Guide would want its consumer to act on this first.

• Make reference to appropriate resource people/groups where additional information may beobtained.

Given that the Guide is designed to have people take the first steps towards becoming morephysically active, it is important to have information in the Guide as to appropriate resourcespersons (e.g., physical educators, Certified Fitness Appraisers, physicians). Consensus may haveto be achieved as to who constitute appropriate resource persons for dissemination of the Guide.we believe that this issue should be addressed by CSEP representatives as well as Fitness Canadarepresentatives and any other governing bodies in the area of physical activity.

Implications for Guide ConstructionThe theoretical bases that form the foundation for recommendations for developing the Guide comefrom the Theories of Planned Behavior/Reasoned Action (Attitude-Action models), self-efficacytheory (social cognitions influencing behavior). The recommendations for the mode of delivery forthe Guide come from the Elaboration-Likelihood Model of Social Persuasion (attitude-change) andfrom perspectives drawn from social marketing research. In particular, we have relied onrecommendations made by social psychologists, cognitive behavioral modification experts, andsocial scientists in exercise/health psychology in making the foregoing and following suggestions.

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Key Delivery Steps.Use the central rather than peripheral route to persuasion in constructing and delivering the Guide'smessages (cL Elaboration Likelihood Model). social persuasion to engage in initial Guide-relatedaction steps is more likely to occur when people (like the Guide's target groups) are motivated tothoughtfully consider and cognitively elaborate on the Guide's messages. For the messages in theGuide to be accepted and considered throughtfully, they must be simple yet strong arguments forinitiating steps towards or first steps in physical activities valued by the target audience. Theattitude change encouraged by this approach is generally stronger with audiences that makephysical activity attractive (e.g., environmental cues, attractive others, catchy phrases, "pumped"bodies). Below we list the target subgroups (cf. Donovan & Owen, 1994) thought to beresponsive to the message and mode of delivery.

Target groups to which Recommendations Apply

Inactive but moderately positive attitude toward physical activity

* Primary behavioral expectancies from exl20sure to the Guide

trying a first step that may be preliminary exerciseobserving exercise salient to them and appropriate for their current level of fitnessperceiving and trying facets of active living as exercise that will add up to lAMArecommendations (cf. Pate et aI., 1995) and recommendations offered by Bouchard &Shephard for the Guide.

Moderately active (infrequent) and moderately positive attitude toward physical activity

* PrimaEy behavioral objectives

increase dosage and frequency to make more systematic during the week add active livingforms of exercise (i.e. moderate intensity: heavier yard work, snow shovelling, bicycling,walking to the store)try alternate forms of their vigorous level of activity that are easyself-monitoring via a diary to check on being systematic

Moderately active but neutral to moderately negative toward primary physical activity

Primary behavioral objectives

attempt a variety of more pleasurable activities that may require less time or are easier toschedulemake attempts to substitute or add in active-living bouts of exercise (see lAMArecommendations)make attempts to learn management of time and log best liked efforts at exercise for arecord of self-monitoring

Both the quite active and the inactive and highly negative groups of people are not target groups forthe Guide.

Other Steps for DeliveryThis section briefly outlines what steps might be followed after initial distribution of the Guide.We recognize that financial and resource constraints may preclude these suggestions from beingimplemented.

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Use the two-step flow of communication

A mass media message is delivered by the Guide. However, other facilitating steps may encouragethe sedentary to take action. The basic process involved in the flow of infon-nation involved themass-media message being delivered to community opinion leaders, preferably those recognizedand accepted by the target group (Step 1). The second step in the process involves opinion leadersdelivering the message to the target audience in ways that promote face to face interaction (Step 2 ­see below for examples).

Translating into Practice

Attitude-change campaigns:

STEP I of the 2-st.12 flow of communications MEDIA TO OPINION LEADErs

use characteristics of source audience, message and behavior (media approach)

STEP 2 of the 2-stell flow of communication EW OPIMON I,EADERS TO TINDI

interpersonal influence examples would involve:i) general practitioners in the communityii) guest speakers in work settingsiii) advertised group discussionsiv) information desks at shopping centresv) telephone advice servicesvi) clinics (free at first)

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Synthesis of Substantive Content for the Guide:Based on the Scientific Review Process

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Consolidated Scientific Review

Physical activity is important for physical and psychological health and well-being.

Physical and psychological health benefits can be obtained from a wide spectrum of activitiesranging from walking, household chores and physically demanding occupations to deliberateexercise and sport participation.

In general, benefits are greater with more activity.

The minimum needed duration of activity per day for optimal health benefits depends on itsintensity:

• "Moderate intensity activity" refers to being active at 50%. of maximum intensity such activitiesas brisk walking, yard work, shoveling snow pursued for at least 30 and preferably 60 minutesper day, on most days, accumulated over 1-3 sessions per day.

• "Vigorous intensity activity" refers to being active at 7080% of maximum intensity - suchactivities as jogging, fast swimming, skating, cross-country skiing or cycling, various sports ­pursued for at least 20 minutes per day, on most days, preferably in a single session.

The physical and psychological benefits of physical activity may be acute/short-term (for example,an immediate and temporary improvement of mood state following a single session of physicalactivity) or chronic/long-term (for example, a reduction in heart disease risk that develops overseveral months of regular physical activity).

Following a single session of physical activity, there can be immediate and temporary physicalbenefits (e.g.; reduction of blood pressure, improved sugar and fat metabolism) together withenhanced psychological status (e.g., increased feelings of energy and calmness, and a reduction ofnegative feeling states such as anxiety and symptoms of depression).

There are persistent gains in physical and psychological health with regular moderate tovigorous physical activity. These changes seem to occur independent of age, gender and initialhealth status. The most consistent changes are:

• Psychological GainsRegular physical activity is related to:

• lower levels of trait anxiety.

• lower levels of depressive symptoms.

• higher levels of self-efficacy for performing physical activity and for adhering toregular physical activity.

• higher levels of improved self-esteem.

• lower feelings of global fatigue at the end of the day.

• improved sleep qual.ity, and reduced daytime sleepiness.

• improvements in various aspects of health-related quality of life (HRQL) regardless ofage, or initial health and physical activity status.

Note: changes in objectively measured fi.tness levels may not be required to achieve theabove-mentioned benefits.

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• Physical Gains

• Sedentary living/physical inactivity may contribute to the initiation and progression of avariety of health problems and may also slow the normal process of recovery from illnessand surgery. In contrast, regular physical activity is increasingly recognized as a measuredecreasing the risk of these health disturbances.

• Sedentary living is associated with a high incidence of coronary heart disease. The risk ofcoronary heart disease is reduced when individuals with a low level of physical activitybecome more active (being halved by vigorous activity). llremature mortality will also bereduced.

• Regular moderate and prolonged physical activity is inversely related to resting bloodpressure and reduces the risk of developing hypertension; it may also help in the control ofexisting moderate hypertension.

• Regular physical activity may reduce the risk of developing adult onset

• diabetes and is also important to the daily management of the disease,• Regular physical activity is important for the prevention of weight gain and the maintenance

of healthy weights, and also plays a major role with respect to long-term success in weightreduction. .

• Regular physical activity seems to offer some protection against the risk of cerebrovasculardiseases.

• Regular physical activity may help to protect against colon cancer.• Regular physical activity has the potential to postpone or prevent certain musculo-skeletal

disorders and delay the advent of osteoporosis,

• Regular physical activity may also help in coping with arthritis.• Regular physical activity has potential to influence favourably structures, functions and

processes, which determine functional capabilities, contributing to continued independencein old age.

If you are now doing little physical activity, even a moderate increase over the current level willimprove your health. You will gain the largest increase in health benefits upon moving from thelowest to a moderate level of physical activity.

You know you are adequately active to achieve optimal health benefits when:1) you have reached the target of moderate or vigorous activity recommended on most days; and2) your activity program is integrated into your daily life and includes a variety of aerobic,

strength and flexibility items.

Your target is to undertake aerobic (continuous) activity on most days of the week (preferablydairy) at least 30 and preferably 60 minutes of moderate activity or at: least 20 minutes of vigorousactivity.

An optimum plan will see you undertaking aerobi.c physical activity on most days of the week(preferably daily). The amount of time you must spend for optimum health benefit depends on theintensity of the activity. with moderate activity, such as brisk walking, you should aim to progressto 30 and preferably 60 minutes per day, but your target can be 20-30 minutes if you choose morevigorous activity such as jogging, swimming, cycling, dancing or sports such as a game ofsquash. For moderate activity, you can accumulate this over several sessions during the day: forexample, three 1.020 minute periods of brisk walking in a day.

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You should also aim to exercise the main muscle groups of the body systematically againstresistance at ]-east twice a week. Find a load or resistance that is near the maximum you canaccomplish for each muscle group, then make B-1ocontractions initially at about half of this load,and over subsequent sessions progress gradually to a higher intensity. Allow 48 hours betweensessions.• If you are currently sedentary your best approach is to begin with light to moderate

activity.• You can begin with short sessions (5 10 minutes) of physical activity and gradually build

up to the desired level of activity.• Regular activity is important to both benefits and to safety and injury prevention.• After a brief aerobic warm-up you should also take the main joints of the body gently

through their full range of motion on most days. This is a good preliminary to a bout ofphysical activity.

• Remember that you don't have to visit a gym or a squash court to get physical activity thatcan improve your health. Walking to the subway station, or the village, mowing the lawnwith a hand mower, climbing up the stairs at the office, and do-it-yourself activities aroundthe home are all helpful components of your activity needs. It is also possible to strengthenthe muscles by pushing against the floor or the back of your chair when you are sitting at anoffice desk, in an airplane, or on a long car journey.

• There is no one best activity or way to be active. The most important factors are that theactivity be enoyable and that it fit into your daily life.

• Moderate intensity activity should be such as to make you conscious of your breathing, tosense sweating and the heart beating. The intensity can be increased gradually andprogressively as your fitness level improves to a vigorous level that is perceived assomewhat hard. However, a session of physical activity should leave you no more thanpleasantly tired for a few hours and relaxed for the rest of the day.

Note: Activities such as brisk walking may be moderate for some and vigorous forothers, depending on their physical activity/fitness level and age.

• Resistance exercise is needed to strengthen the muscles either against an external load(weight lifting or carrying groceries) or against body weight (for example, push-ups). Aprogressive programme will. yield substantial increases of strength over 2-3 months, butan increase of muscle mass will take longer and require greater resistance.

Practical TipsGetting started: The major barriers that people see to being active are lack of time, energy andmotivation. rime is required to travel to a distant gym, but if you walk to the subway, the village orthe comer store, this may be just as quick as getting your car out of your garage and findingparking space at the other end. Equally, it is often quicker to use the stairs than to wait for anelevator. Being active can also provide pleasant opportunities to socialize and spend time withfamily and friends. Try to see ways you can build moderate activity into your daily schedule.

You may find at the beginning that being active utilizes some of your energy. However, beingregularly active over time will actually build up your energy reserve so that you will have moreenergy, not less, as a result of being active.

Begin slowly, but try to do a little more each day and each week. Be patient and listen to yourbody. Do not make the mistake of trying to accomplish feats that were possible twenty yearsearlier on the first day you begin to becomq more active.

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Physical activity eventually becomes a pleasant and eagerly anticipated part of the day. However,if you have not been active for a long time, expect a little fatigue and some minor aches and painsfor a few days. As you persist, you will find that you can accomplish the activity and reap therewards.

Safety and clearance: Light progressive physical activity is very safe in fact, those who are activehave a better chance of living to age 80 than those who are not. Most people under the age of fiftydo not need special medical clearance if they are merely planning to undertake a little moremoderate intensity physical activity than they did in the previous week. If you have some knowndisease, consult your physician, and if you are uncertain whether you need to do this, the PhysicalActivity Readiness Questionnaire (PAR-Q) will help you decide.

if you find that your activity is causing symptoms other than moderate tiredness and shortness ofbreath during the physical activity, then you should stop the activity and discuss this wi.th yourphysician. Do not allow pride or competition to push you to do more than your body tells you thatyou can accomplish.

You will reduce the chance of sprains and strains if you wear shoes with a good cushioned soleand good ankle support, and you should avoid jogging or doing aerobic dance on hard surfacessuch as concrete sidewalks or studios with tile-on-concrete floors.

Reduce your physical activity if the weather is hot, and remember to drink adequate amounts ofwater. Try to be active either in an indoor area such as a shopping mall, or in the cool of eveningand early morning.

in winter, move indoors if there is a severe wind-chill, or the conditions are icy.

Most populations with special needs (e.g., pregnant women, persons with a disability) canundertake moderate physical activity safely and achieve the same benefits as described above.

l-or pregnant women, moderate physical acti.vity should be continued, and will help a normaldelivery. However, do not undertake very prolonged physi.cal activity on a hot- day nor beactive for longer than 60 minutes at a time during the first trimester - this may reduce thefood supply to the fetus.

The benefits and principles outlined above apply equally to persons utilizing wheelchairs,crutches and walkers; soreness of the wrists may be a warning for the wheelchair user tomoderate physical. activity until symptoms have passed. Extreme environmental temperaturescan also provoke excessive rises of blood pressure in some people with paraplegia.

Those with hearing and visual impairments can also follow the general principles outlined I

although if commuting becomes an important part of the daily physical activity plan for suchindividuals, particular care is needed to avoid traffic accidents.

Considerations affecting those with other special needs will be discussed in a separate document.

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