How much do you have to exercise to be healthy? What is the minimum duration per week, is there a maximum? Some of us may have missed it: November 2020’s World Health Organisation (WHO) Physical Activity Guidelines. They contain the answer to our question.
Before we proceed any further, please talk to your doctor or medical practitioner most familiar with your medical history before implementing any changes in diet, exercise or lifestyle, especially if you are under treatment. Where we reference studies, these are shared at bottom of page.
For a few years now many of us have aimed towards exercising at the recommended 150 minutes moderate (or 75 mins vigorous) intensity exercise per week. Health can be earned at 5 days per week, 30 minutes of: housework, chasing the kids, the cats etc. Alternatively, chase the sunrise in your favourite running shoes (aka 'vigorous intensity' activity) for 3 mornings per week at 25 minutes per session and you are hitting the target. Spread the exercise over 5 or 6 days a week, even better.
In 2020, the WHO updated their guidelines to state: “Adults aged 18–64 years should do at least 150–300 minutes of moderate-intensity aerobic physical activity; or at least 75–150 minutes of vigorous-intensity aerobic physical activity; or an equivalent combination of moderate- and vigorous-intensity activity throughout the week”
Hey, that’s double! Seemingly many scientists have said for years that '150 minutes moderate' should be the minimum NOT the target but this message appears to have been diluted as some thought it would be better to advise the public 'what might be achievable' as opposed to 'what the reality is'. We prefer reality.
This change in message acknowledges that there is a range of physical activity that provides health benefits and, no surprises, more is better than less. Up to a point. What is perhaps less known is that the bulk of health benefits from aerobic exercise are gained in the lower end of training volume. Yes, those who regularly exercise for lower durations gain the most benefit. Those who exercise for longer still accrue valuable benefits but the benefits taper off. (see the graph in page 35 of the WHO Guidelines, link below) But that doesn't mean we should aim for the minimum, right?!
So what does that mean for those already hitting or exceeding the recommendations? First of all, well done for meeting the recommendations! Distance runners, cyclists, endurance athletes are certainly Fit (with a capital F!) but are they healthier than those who get 150 minutes of vigorous exercise? The answer appears to be No, not always.
Long duration exercise or over-training can lead to increased levels of inflammation or risk of injury. There is some evidence from marathoners that heart damage occurs towards the end of the race, although whether this leads to immediate post-run risk of heart attack is not evident. Everyone, even 'the fit', are subject to heart disease if diets are poor, the protection afforded by exercise only helps to a certain extent. Our nutritionist Felicia has personal experience with marathon runners who love their wine and steak and yet still have cardiovascular disease leading to stroke and heart attack.
To reuse a much loved quote 'You can’t outrun a bad diet!'
Many variables cloud and confound the picture. For some endurance athletes the amount of time spent training may detract from social activities with family or friends, social well-being is a key factor of health. Conversely, they may make new friendships because of the activity. For others, vital weight bearing (strength) exercise may be deprioritised or missed. The WHO’s position on this is:
“Adults aged 18–64 years… should also do muscle-strengthening activities at moderate or greater intensity that involve all major muscle groups on 2 or more days a week, as these provide additional health benefits.”
On a personal level, once in a while I increase my training to complete a couple of very leisurely paced half-marathons. However, I also notice that I am less inclined to dedicate time and energy on essential strength and mobility exercises. This serves as a self-reminder that I need to focus on more ‘easy running’ and ensure that I use the local Fitness (calisthenics) Corner. I need to make plans and execute.
We also need to understand why people exercise. There is a difference between “I exercise for health and longevity” versus "I want to run a marathon” versus “I want to be as strong as possible”. Some simply want to get out into nature, to run or just to hike. Other mighht prefer the efforts that a 'ruck' - hiking with a loaded backpack - provides.
Prospective marathon runners or those giving their all to lift their personal best – go ahead, that is great – enjoy what you enjoy! Massive respect for ultra-runners, weightlifters and those that push themselves to excel in their given field. Does the extra distance, the additional 10 kgs on the bar or setting a personal best improve long-term health outcomes, not necessarily. Is there an argument to spend time on other types of exercises with other health benefits? For long-term health I believe Yes. I switched out a weekly running session (moving from a 7 day to 11 day training cycle) to practice tai chi. The tai chi has helped me on numerous levels, with my balance and proprioception.
Final Thoughts
A significant percentage (about 1 in 3) of Singapore society is not exercising enough at all. It can be really difficult to start and maintain exercise plans. Just a little regular exercise will help this group substantially in their long-term health outcomes.
If you are already exercising for health and longevity check the balance of your training. From personal experience I know that I favour running and cardio versus weight bearing exercise. If I were to change my running programme to max out at 150, not 300, minutes vigorous activity per week I know that I would be getting all the health benefits. I could then use the rest of my available exercise time (life is busy!) to complete more weight bearing exercises, try other sports or activities that develop me in different ways. That is surely a win!
For most people, improving health is about finding motivation and prioritising self-care with an ultimate goal of taking action. If you want to take effective and targeted steps that fit into your unique lifestyle, The Whole Health Practice is here to help.
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Stay Healthy,
Alastair
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Related Studies
Martinez-Gomez D, Luo M, Huang Y, et al. Physical Activity and All-Cause Mortality by Age in 4 Multinational Megacohorts. JAMA Netw Open. 2024;7(11):e2446802. doi:10.1001/jamanetworkopen.2024.46802
Lang JJ, Prince SA, Merucci K, Cadenas-Sanchez C, Chaput JP, Fraser BJ, Manyanga T, McGrath R, Ortega FB, Singh B, Tomkinson GR. Cardiorespiratory fitness is a strong and consistent predictor of morbidity and mortality among adults: an overview of meta-analyses representing over 20.9 million observations from 199 unique cohort studies. Br J Sports Med. 2024 May 2;58(10):556-566. doi: 10.1136/bjsports-2023-107849. PMID: 38599681; PMCID: PMC11103301.
Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, McDermott MM, Swift DL, Webel AR, Lane A; on behalf the American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Clinical Cardiology; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention; and Council on Peripheral Vascular Disease. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation. 2024 Jan 16;149(3):e217-e231. doi: 10.1161/CIR.0000000000001189. Epub 2023 Dec 7. PMID: 38059362.
Kokkinos P, Faselis C, Samuel IBH, Pittaras A, Doumas M, Murphy R, Heimall MS, Sui X, Zhang J, Myers J. Cardiorespiratory Fitness and Mortality Risk Across the Spectra of Age, Race, and Sex. J Am Coll Cardiol. 2022 Aug 9;80(6):598-609. doi: 10.1016/j.jacc.2022.05.031. PMID: 35926933.
Bull FC, Al-Ansari SS, Biddle S, Borodulin K, Buman MP, Cardon G, Carty C, Chaput JP, Chastin S, Chou R, Dempsey PC, DiPietro L, Ekelund U, Firth J, Friedenreich CM, Garcia L, Gichu M, Jago R, Katzmarzyk PT, Lambert E, Leitzmann M, Milton K, Ortega FB, Ranasinghe C, Stamatakis E, Tiedemann A, Troiano RP, van der Ploeg HP, Wari V, Willumsen JF. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020 Dec;54(24):1451-1462. doi: 10.1136/bjsports-2020-102955. PMID: 33239350; PMCID: PMC7719906.
Yang YJ. An Overview of Current Physical Activity Recommendations in Primary Care. Korean J Fam Med. 2019 May;40(3):135-142. doi: 10.4082/kjfm.19.0038. Epub 2019 May 20. PMID: 31122003; PMCID: PMC6536904.
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