Physical Activity Guidelines for Americans, 2nd edition (2018) — Comprehensive Study Notes (Markdown)
Message from the Secretary
Regular physical activity is one of the most important actions for health; benefits arise from moving more and sitting less, across all ages, sexes, races, ethnicities, and fitness levels.
Individuals with chronic disease or disability benefit from regular physical activity; pregnancy in women also benefits.
Benefits can start with small amounts and occur immediately after activity.
Current situation (as of the 2nd edition): about 117 million American adults have one or more preventable chronic diseases; seven of the ten most common chronic diseases are influenced positively by activity.
Nearly 80% of adults do not meet key aerobic and muscle-strengthening guidelines; about half meet aerobic guidelines alone.
Inactivity costs: about $117 billion in annual health care costs and ~10% of premature mortality.
The 2018 Guidelines (2nd edition) are grounded in current evidence and the 2018 Advisory Committee Scientific Report; they aim to guide activity amounts and types to maintain/improve health and reduce chronic disease risk.
The Guidelines are a tool for health professionals and policymakers to design programs, policies, and community interventions to promote activity in places where people live, learn, work, and play.
Achieving population-level improvements requires comprehensive, coordinated strategies across sectors; everyone has a role to play in moving the nation toward more activity.
Call to action: if we all move more and sit less, we will create a healthier Nation and enable healthier, more active lives for all.
Signed: Alex M. Azar II, Secretary, U.S. Department of Health and Human Services
Summary of the Physical Activity Guidelines for Americans, 2nd Edition
Being physically active is among the most important actions to improve health; health benefits begin immediately after exercise.
The Guidelines cover people aged 3 years and older and reflect new evidence on brain health, more cancer sites, fall-related injuries, sleep and mood benefits, and multicomponent activity for older adults.
Key new aspects include: brain health benefits, immediate and longer-term wellness benefits, more guidance for older adults and those with chronic conditions, risks of sedentary behavior, preschool guidelines, elimination of the 10-minute bout requirement, and tested population-level strategies.
The Guidelines complement the Dietary Guidelines for Americans (USDA/HHS collaboration) and promote healthy activity and eating as a package for reducing chronic disease risk.
Emphasis on translating professional guidance into consumer messages via Move Your Way campaign; resources exist for professionals and the public to promote activity.
The Guidelines promote evidence-based, community-level interventions to make being active the easy choice across settings.
Roadmap to the Physical Activity Guidelines for Americans
Chapter 1: Introducing the Guidelines – development background and rationale.
Chapter 2: Physical Activity and Health – health benefits, dose–response, and the overall health impact of activity.
Chapter 3: Active Children and Adolescents – guidance for ages 3–17 (including those with disabilities).
Chapter 4: Active Adults – guidance for ages 18–64.
Chapter 5: Active Older Adults – guidance for 65+; includes multicomponent activity with balance.
Chapter 6: Additional Considerations for Some Adults – pregnancy/postpartum, chronic conditions, and disabilities.
Chapter 7: Active and Safe – safety guidance for practicing activity and reducing injuries.
Chapter 8: Taking Action: Increasing Physical Activity Levels of Americans – strategies for individuals, communities, and sectors; steps to implement.
Glossary and Appendices with definitions and resources (e.g., METs, intensity, bouts, and steps).
Chapter 1. Introducing the Physical Activity Guidelines for Americans
Physical activity benefits span health, growth, sleep, and quality of life; benefits accrue even from small amounts.
Evidence shows benefits across ages, races, sexes, and health statuses, including pregnancy and disability.
New edition (2018) expands guidance for ages 3+, adds brain health, fall prevention, and cognitive benefits; discusses sedentary behavior and its interaction with activity.
Rationale and development: started in 2016 with external 2018 Advisory Committee; systematic reviews fed into the Scientific Report; public and agency input considered.
The Move Your Way campaign translates the Guidelines for professionals and the public; resources available at the Move Your Way site.
Key figures ( Figures 1-1, 1-2 in the text) show trends in aerobic and muscle-strengthening guideline attainment among adults and youth (data examples from NHIS and YRBS).
Chapter 2. Physical Activity and Health
All Americans should engage in regular physical activity to improve health and prevent adverse outcomes; benefits seen in healthy people and those at risk or with chronic conditions.
Benefits can occur immediately or after a single episode; some benefits begin with as little as 60 minutes per week.
Substantial health benefits for adults occur with approximately 150 minutes of moderate-intensity aerobic activity per week (or 75 minutes of vigorous activity) or an equivalent combination; benefits continue to accrue with more activity.
Both aerobic and muscle-strengthening activities are beneficial; health benefits exist across all races/ethnicities and at all life stages, including chronic conditions or disabilities.
Health benefits generally outweigh the risk of adverse events for most people.
Major research conclusions include: regular moderate-to-vigorous activity reduces risk for multiple diseases; more activity yields more benefits; benefits extend to brain health, sleep, and quality of life; activity improves physical function and may improve cognitive function; benefits occur in youth and older adults alike.
Absolute vs. Relative Intensity; Levels of Aerobic Activity (Inactive, Insufficiently Active, Active, Highly Active) defined for adults; definitions use METs and energy expenditure.
Sedentary Behavior: characterized by low energy expenditure (≤ 1.5 METs) while sitting or reclining; strong relationships exist between sedentary time and all-cause mortality and cardiovascular mortality; replacing sedentary time with light-to-moderate activity yields health benefits; no fixed target for interruptions was defined due to interaction with overall activity level.
Bouts: originally, guidelines required MVPA in bouts of 10 minutes or more; 2018 Advisory Committee concluded that bouts of any length contribute to the health benefits of accumulated MVPA; short bursts (even a few flights of stairs) count toward total MVPA.
Progression toward targets: gradual increases in activity to meet guidelines; risk of injury increases with large increases in overload; progression should be gradual and individualized.
Physical Activity Behaviors: Intensity, Bouts, and Steps – METs, MET-minutes, and steps used as measurement tools; Appendix 1 provides more details on MET-minutes.
Guiding concept: Overload, Progression, and Specificity – benefits depend on applying appropriate stress to body systems; benefits are specific to the body systems used.
Chapter 3. Active Children and Adolescents
Preschool-aged children (3–5) should be physically active throughout the day to support growth/development; caregivers should encourage a variety of active play types.
School-aged children and adolescents (6–17) should accumulate at least 60 minutes per day of MVPA; the majority should be aerobic, with vigorous activity on at least 3 days/week; include muscle-strengthening on ≥3 days/week; include bone-strengthening activities on ≥3 days/week.
Activity types can be mixed; bone-strengthening activities are important during pre-/puberty years for peak bone mass development.
Intensity and notions of absolute vs. relative intensity: for youth, both scales can be used; intensity definitions apply in context of growth and development; vigorous activity is emphasized for fitness gains.
Typical activity patterns of children: intermittent activity with short bursts; any episode counts toward the daily MVPA target.
Special considerations for children with disabilities; emphasize inclusive opportunities and tailored activity guidance.
Real-life examples illustrate how preschoolers, school-aged children, and adolescents can meet guidelines via a mix of aerobic, muscle-strengthening, and bone-strengthening activities; examples show plans for different ages and capabilities.
Chapter 4. Active Adults
Adults should move more and sit less; any amount of physical activity yields some health benefits; substantial benefits require 150–300 minutes/week of moderate-intensity aerobic activity, or 75–150 minutes/week of vigorous activity, or an equivalent combination; ideally spread through the week.
Additional health benefits come from exceeding 300 minutes of moderate-intensity activity weekly.
Muscle-strengthening activities involving all major muscle groups on 2+ days/week provide additional health benefits.
If time is limited, substituting some vigorous-intensity activity for moderate-intensity activity is a time-efficient option (the 2-to-1 rule: 2 minutes moderate ≈ 1 minute vigorous).
Other health benefits: reduced anxiety and depression, improved sleep and quality of life; increased cardiorespiratory and muscular fitness; better weight management; improved functional ability for daily activities.
Key guidelines apply to adults aged 18–64, with cross-references to Chapter 6 for women during pregnancy, and for adults with chronic conditions or disabilities.
Aerobic activity is defined by its intensity, frequency, and duration; total volume (minutes per week) is the primary driver of benefits; all aerobic time counts toward the guidelines if performed at ≥ moderate intensity.
Relative and absolute intensity concepts explained; for older adults, relative intensity is often more appropriate due to lower baseline fitness.
Chapter 5. Active Older Adults
The adult guidelines apply to older adults, with added emphasis on multicomponent activity (aerobic + muscle-strengthening + balance).
Older adults should determine effort relative to fitness and health status; adjust activity to conditions and capabilities; when unable to meet 150 minutes, stay as active as possible.
Multicomponent activity including balance training reduces fall risk; regular activity preserves physical function and independence; higher cardiorespiratory fitness reduces age-related functional limitations.
Example activities: walking, dancing, swimming, water aerobics, cycling, strength training with bands/weights, balance activities like tandem standing, and flexibility work.
Dose and intensity: aim for 150–300 minutes of moderate activity per week; 75–150 minutes of vigorous activity is also acceptable; combine with muscle-strengthening on ≥2 days/week; multicomponent programs are especially beneficial for frailty and post-hip fracture rehabilitation.
For older adults with chronic conditions, adjust intensity and progression, seek health care guidance, and emphasize safe practice and gradual progression.
Real-life examples illustrate how Barbara (active 65) and Rumi (79, with osteoarthritis) meet guidelines through multicomponent programs and progressive activity.
Chapter 6. Additional Considerations for Some Adults
Focuses on pregnancy/postpartum, adults with chronic conditions, and adults with disabilities.
Women during pregnancy: at least 150 minutes of moderate-intensity aerobic activity per week; safe to continue vigorous activity if previously active under medical guidance; avoid lying on the back after the first trimester and high-risk activities.
Postpartum period: continued activity supports fitness and mood; potential weight-management benefits when combined with caloric balance.
For adults with chronic conditions or disabilities: at least 150–300 minutes/week of MVPA, plus muscle-strengthening on ≥2 days/week; adapt activities to abilities; avoid inactivity; regular care by a health professional is advised.
Examples of condition-specific guidance include osteoarthritis, type 2 diabetes, hypertension, cancer survivorship, and other disabilities; emphasize multicomponent activity and safety.
Each condition may require different monitoring (e.g., blood glucose in diabetes; footwear considerations in diabetes; blood pressure management in hypertension).
Chapter 7. Active and Safe
The health benefits of activity far outweigh risk of injury for most people; injuries are more likely with greater overload or when activity is unsafe.
Key safety guidance: understand risks but remain confident activity is safe; choose activities aligned with current fitness/goals; increase activity gradually; use proper gear, safe environments, and good policies; seek health care advice if chronic conditions are present.
Safer activities tend to be moderate intensity, low impact, with low risk of collision; walking, gardening, cycling (transport), dancing, swimming, and certain low-impact activities have the lowest injury rates.
Overuse and injury risk can be reduced by variety and progression; prior injuries require careful progression and prevent re-injury.
Warm-up and cool-down are beneficial; warm-ups prepare heart rate and breathing; cool-down allows gradual recovery; time spent warming up/cooling down can count toward aerobic guidelines if at least moderate intensity.
Protective gear and proper equipment reduce injury risk; safe environments and adherence to rules/policies are important.
Planning for environmental factors: safe environments, weather considerations, air quality (AQI), and visibility; select times/locations to minimize risk.
Advice from health care providers: generally, healthy individuals can self-monitor activity; those with symptoms or chronic conditions should consult professionals when adjusting activity, particularly for vigorous activity.
Chapter 8. Taking Action: Increasing Physical Activity Levels of Americans
Action requires strategies at individual, community, and societal levels; evidence-based strategies have been identified to increase activity.
For Individuals/Small Groups: behavior-change theories guide interventions; strategies include goal setting, self-monitoring, social support, problem solving, and tailored counseling.
Appendix 2 provides federal resources to support implementation (e.g., Move Your Way, Surgeon General’s Call to Action, Community Guide).
For Communities: five proven strategies with high reach and potential for lasting change:
Point-of-Decision Prompts (e.g., stairs signage)
School Policies and Practices to increase activity before/during/after school
Access to Indoor/Outdoor Recreation Facilities
Community-Wide Campaigns to promote activity via multi-channel messaging
Community Design to improve walkability and bikeability (built environment changes)
Everyone Has a Role: individuals, families, communities, and sectors share responsibility to promote activity.
Practical guidance for individuals to set personal goals, identify meaningful benefits, and choose activities aligned with lifestyle and safety.
For Families/Caregivers: support youth with age-appropriate activity opportunities; promote safe participation and skill development; encourage lifelong activity habits.
For Sectors of Society: nine sectors include business, recreation/parks, education, faith-based settings, health care, media, public health, sports, transportation and community design.
The National Physical Activity Plan Alliance identifies nine sectors with roles in promoting activity; examples of sector-specific actions and collaboration strategies are provided.
Real-Life Examples (Case Studies): Jim (75) uses a pedometer to increase walking; a community example demonstrates a town coalition implementing a 10-year action plan across sectors with goals like safer crossings and park improvements.
Appendices and Glossary
Appendix 1. Physical Activity Behaviors: Intensity, Bouts, and Steps: details on MET-minutes and METs; how to assess intensity (absolute vs relative) and bout duration; step-based approaches.
Appendix 2. Federal Physical Activity Resources: a compendium of government resources (CDC, NIH, NIA, EPA, DOT, USPSTF, etc.) and programs (Go4Life, We Can!, Million Hearts, The Community Guide, etc.).
Glossary: definitions of key terms including Absolute intensity, Relative intensity, MET, MVPA, Multicomponent physical activity, Adverse event, Overload, Progression, Specificity, and more.
The Guidelines provide repeated definitions across chapters to support practical application and translation into consumer messages.
Key Guidelines by Population
Preschool-Aged Children (3–5): physically active throughout the day; adult caregivers encourage diverse active play.
Children and Adolescents (6–17): 60 minutes/day MVPA; aerobic majority; vigorous activity on ≥3 days/week; muscle-strengthening on ≥3 days/week; bone-strengthening on ≥3 days/week.
Adults (18–64): move more, sit less; 150–300 minutes/week of moderate-intensity aerobic activity or 75–150 minutes/week of vigorous-intensity aerobic activity, or an equivalent mix; aerobic activity spread over the week; 2+ days/week of muscle-strengthening.
Older Adults (65+): same adult guidelines plus multicomponent activity including balance; assess effort relative to fitness; adapt for chronic conditions; stay as active as abilities allow; if 150 minutes are not feasible, remain as active as possible.
Women During Pregnancy and Postpartum: at least 150 minutes/week of moderate-intensity aerobic activity; can continue vigorous activity if previously active, under medical supervision; avoid certain positions and high-risk activities after pregnancy.
Adults with Chronic Health Conditions/Disabilities: 150–300 minutes/week MVPA plus 2+ days/week of strengthening; adapt activities to abilities; stay under care of health professionals; avoid inactivity; benefits persist with activity.
Mathematical Notes and Formulas (LaTeX)
MET concept and MET-minutes:
1 MET = energy expenditure at rest; activity energy expenditure scales with METs.
Example MET-minute calculation:
A 4 MET activity for 30 minutes yields (which equals 2.0 MET-hours).
Typical weekly targets (adult):
Moderate-intensity: per week; Vigorous-intensity: per week; or an equivalent combination.
2-to-1 rule (substitution between intensities): to meet the same MVPA dose.
Targets for adults with high activity: more than of moderate-intensity activity per week; or equivalent volume of MVPA.
Sedentary behavior definition: waking behavior with energy expenditure ≤ while sitting, reclining, or lying.
Conceptual Frameworks to Remember
Overload, Progression, Specificity:
Overload: apply greater stress than normal to elicit adaptation.
Progression: gradually increase overload to continue gains with minimized risk.
Specificity: benefits depend on the body systems being stressed (e.g., walking benefits lower body/cardio systems).
Bouts: any duration of MVPA counts toward total; total MVPA is the key determinant of health benefits.
Multicomponent Activity: combining aerobic, resistance, and balance training yields the greatest benefits for older adults and falls risk reduction.
Relative vs Absolute Intensity: absolute intensity uses METs (e.g., 3.0–5.9 METs is moderate); relative intensity is adjusted to fitness (e.g., % VO2 max or heart rate reserve) and is especially useful for older adults.
Important Takeaways for Exam Preparation
Always frame activity in terms of weekly targets, not just daily bouts:
Adults: 150–300 minutes of MVPA per week + 2+ days of muscle strengthening; more gives greater benefits.
Children 6–17: 60 minutes/day MVPA with additional muscle- and bone-strengthening on multiple days.
Do not overlook the role of reducing sedentary time; benefits increase as you replace sedentary time with light-to-moderate activity.
Understand safety: most adults can safely start with light-to-moderate activity; gradually increase; seek guidance with chronic conditions or during pregnancy.
Real-world translation: use steps, walking, and simple activities as entry points; employ “Move Your Way” ideas to communicate to the public.
The guidelines emphasize a lifespan approach: content covers infants through older adults with examples, scenarios, and program suggestions.
Message from the Secretary
Regular physical activity is recognized as one of the most crucial actions for maintaining and improving health, with benefits stemming from moving more and sitting less, applicable across all ages, sexes, races, ethnicities, and fitness levels. This includes individuals with chronic diseases or disabilities, as well as pregnant women, all of whom can derive significant advantages from consistent physical activity. Importantly, health benefits can begin with even small amounts of activity and are often immediate.
As of the 2nd edition of these guidelines, approximately 117 million American adults suffer from one or more preventable chronic diseases, and regular physical activity positively influences seven of the ten most common chronic diseases. Despite its importance, nearly 80% of adults do not meet the key aerobic and muscle-strengthening guidelines, with about half meeting only the aerobic guidelines. This inactivity carries substantial costs, estimated at about in annual health care expenses and contributing to approximately 10% of premature mortality.
The 2018 Guidelines (2nd edition) are built upon current scientific evidence and the 2018 Advisory Committee Scientific Report. Their primary objective is to provide guidance on the amounts and types of physical activity necessary to maintain/improve health and reduce the risk of chronic diseases. These Guidelines serve as a vital tool for health professionals and policymakers, enabling them to design and implement effective programs, policies, and community interventions to promote physical activity in diverse settings where people live, learn, work, and play.
Achieving widespread population-level improvements in physical activity requires comprehensive, coordinated strategies implemented across various sectors, underscoring that everyone has a role in fostering a more active nation. The Secretary, Alex M. Azar II, issues a call to action: by collectively moving more and sitting less, the nation can become healthier, enabling more active lives for all.
Summary of the Physical Activity Guidelines for Americans, 2nd Edition
Being physically active is among the most important actions individuals can take to improve their health, with immediate health benefits observed after exercise. The Guidelines apply to people aged 3 years and older, incorporating new evidence on crucial areas such as brain health, a wider range of cancer sites, fall-related injuries, improvements in sleep and mood, and the importance of multicomponent activity specifically for older adults.
Key new aspects introduced in this edition include: enhanced understanding of brain health benefits, a focus on immediate and longer-term wellness benefits, more tailored guidance for older adults and individuals with chronic conditions, a discussion on the risks associated with sedentary behavior, specific guidelines for preschool-aged children, the elimination of the previous 10-minute bout requirement, and the inclusion of tested population-level strategies.
These Physical Activity Guidelines complement the Dietary Guidelines for Americans—a collaboration between USDA and HHS—by promoting a holistic approach to healthy activity and eating as a combined strategy to reduce chronic disease risk. Furthermore, there is a strong emphasis on translating professional guidance into accessible consumer messages through the "Move Your Way" campaign, with comprehensive resources available for both health professionals and the general public to encourage physical activity. The Guidelines advocate for evidence-based, community-level interventions designed to make being active the easy and accessible choice in all environments.
Roadmap to the Physical Activity Guidelines for Americans
This edition of the Physical Activity Guidelines is structured into several chapters to systematically cover various aspects of physical activity and health. Chapter 1, "Introducing the Guidelines," provides background information on their development and rationale. Chapter 2, "Physical Activity and Health," delves into the extensive health benefits, the dose–response relationship, and the overall health impact of physical activity. Subsequent chapters offer specific guidance for different age groups and populations: Chapter 3 focuses on "Active Children and Adolescents" (ages 3–17, including those with disabilities); Chapter 4 addresses "Active Adults" (ages 18–64); and Chapter 5 is dedicated to "Active Older Adults" (ages 65+, emphasizing multicomponent activity with balance). Chapter 6, "Additional Considerations for Some Adults," covers specific populations such as pregnant/postpartum women and adults with chronic conditions or disabilities. Chapter 7, "Active and Safe," provides essential safety guidance for engaging in physical activity and minimizing injury risks. Finally, Chapter 8, "Taking Action: Increasing Physical Activity Levels of Americans," outlines strategies for individuals, communities, and various sectors, along with steps for implementation. The document also includes a Glossary and Appendices for definitions and resources, such as METs, intensity levels, activity bouts, and step counts.
Chapter 1. Introducing the Physical Activity Guidelines for Americans
Physical activity offers a wide array of benefits encompassing overall health, growth, improved sleep, and enhanced quality of life, with notable advantages emerging even from small amounts of activity. Evidence consistently demonstrates these benefits across all ages, races, and sexes, as well as for individuals with various health statuses, including during pregnancy and for those with disabilities. The latest 2018 edition expands its guidance to include ages 3 and above, incorporating new insights into brain health, fall prevention, and cognitive benefits. It also extensively discusses sedentary behavior and its complex interaction with physical activity.
The rationale and development process for these Guidelines commenced in 2016, involving an external 2018 Advisory Committee. This committee utilized systematic reviews to inform its Scientific Report, which then integrated public and agency input. The "Move Your Way" campaign plays a crucial role in translating these Guidelines into practical advice for both professionals and the public, with comprehensive resources readily available on the Move Your Way website. Key figures within the text (Figures 1-1, 1-2) illustrate trends in the attainment of aerobic and muscle-strengthening guidelines among adults and youth, drawing on data examples from the National Health Interview Survey (NHIS) and the Youth Risk Behavior Survey (YRBS).
Chapter 2. Physical Activity and Health
It is recommended that all Americans engage in regular physical activity to enhance health and prevent adverse outcomes. Benefits are observed not only in healthy individuals but also in those at risk or living with chronic conditions. These benefits can manifest immediately or after a single session of activity, with some advantages beginning with as little as 60 minutes of physical activity per week. For adults, substantial health benefits are achieved with approximately 150 minutes of moderate-intensity aerobic activity per week, or 75 minutes of vigorous activity, or an equivalent combination, with further benefits accruing with increased activity. Both aerobic and muscle-strengthening activities are crucial, and health benefits are consistent across all races/ethnicities and at every life stage, including for individuals with chronic conditions or disabilities. Generally, the health benefits of physical activity significantly outweigh the risk of adverse events for most people.
Major research conclusions highlight that regular moderate-to-vigorous physical activity reduces the risk for numerous diseases, and greater activity yields more extensive benefits. These benefits extend to improved brain health, sleep quality, and overall quality of life. Physical activity also enhances physical function and may improve cognitive function, with benefits observed equally in youth and older adults. The Guidelines define levels of aerobic activity for adults—Inactive, Insufficiently Active, Active, Highly Active—using concepts of Absolute vs. Relative Intensity, with definitions based on METs and energy expenditure. Appendix 1 provides more details on MET-minutes, a key measurement tool.
Sedentary Behavior is characterized by low energy expenditure () while sitting or reclining. Strong epidemiological relationships demonstrate a link between prolonged sedentary time and increased risks for all-cause and cardiovascular mortality. Replacing sedentary time with light-to-moderate physical activity leads to measurable health benefits. However, due to its interaction with overall activity level, no fixed target for interruptions to sedentary time was defined. Regarding Bouts, while previous guidelines suggested activity in segments of 10 minutes or more, the 2018 Advisory Committee concluded that bouts of any length contribute to the overall health benefits of accumulated moderate-to-vigorous physical activity (MVPA). Even short bursts, such as climbing a few flights of stairs, count toward total MVPA. Progression toward recommended activity targets should be gradual, as large increases in activity overload can elevate the risk of injury; therefore, progression should be individualized. Measurement tools for Physical Activity Behaviors, including Intensity, Bouts, and Steps, involve METs, MET-minutes, and steps. The guiding concepts of Overload, Progression, and Specificity emphasize that benefits depend on applying appropriate stress to body systems and are specific to the systems being used.
Chapter 3. Active Children and Adolescents
Preschool-aged children, specifically those aged 3–5, should engage in physical activity throughout the day to support their healthy growth and development. Caregivers are encouraged to promote and facilitate various types of active play. School-aged children and adolescents, aged 6–17, are advised to accumulate at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. The majority of this activity should be aerobic, with vigorous-intensity activity included on at least three days per week. Additionally, muscle-strengthening activities should be incorporated on three or more days per week, and bone-strengthening activities are also recommended on three or more days per week.
Different types of activities can be mixed to meet these guidelines. Bone-strengthening activities are particularly vital during the pre-pubertal and pubertal years for optimal development of peak bone mass. Intensity, considering both absolute and relative scales, can be applied to youth, with definitions adapted to their growth and developmental stage; vigorous activity is particularly emphasized for its role in fitness gains. Children's typical activity patterns often involve intermittent bursts of activity, and any episode of MVPA, regardless of length, contributes to the daily target.
Special considerations are provided for children with disabilities, with an emphasis on fostering inclusive opportunities and tailoring activity guidance to their specific needs. Real-life examples are included to illustrate how preschoolers, school-aged children, and adolescents can effectively meet the guidelines through a diverse mix of aerobic, muscle-strengthening, and bone-strengthening activities, showing plans adaptable to different ages and capabilities.
Chapter 4. Active Adults
Adults are encouraged to increase physical activity and reduce sedentary time, as even small amounts of physical activity offer health benefits. Substantial health benefits are achieved with 150–300 minutes per week of moderate-intensity aerobic activity, or 75–150 minutes per week of vigorous-intensity activity, or an equivalent combination, ideally distributed throughout the week. Exceeding 300 minutes of moderate-intensity activity weekly provides additional health benefits. Furthermore, muscle-strengthening activities engaging all major muscle groups on two or more days per week contribute significantly to overall health.
For individuals with limited time, substituting some vigorous-intensity activity for moderate-intensity activity is an efficient option, following the 2-to-1 rule, where is approximately equivalent to in terms of health benefits. Other health benefits include reduced anxiety and depression, improved sleep and quality of life, increased cardiorespiratory and muscular fitness, better weight management, and enhanced functional ability for daily tasks.
These key guidelines apply to adults aged 18–64, with specific cross-references to Chapter 6 for women during pregnancy and for adults with chronic conditions or disabilities. Aerobic activity is defined by its intensity, frequency, and duration, with total volume (minutes per week) being the primary driver of benefits; all aerobic time counts toward the guidelines if performed at a moderate intensity or higher. Both relative and absolute intensity concepts are explained, with relative intensity often being more appropriate for older adults due to their potentially lower baseline fitness levels.
Chapter 5. Active Older Adults
The general adult physical activity guidelines also apply to older adults (aged 65+), but with an added emphasis on multicomponent activity. This includes a combination of aerobic, muscle-strengthening, and balance training. Older adults should gauge their effort relative to their individual fitness and health status, adjusting their activity levels to suit their specific conditions and capabilities. If meeting the 150-minute recommendation is challenging, they are encouraged to remain as active as their abilities allow.
Multicomponent activities that incorporate balance training are particularly effective in reducing the risk of falls. Regular physical activity helps preserve physical function and supports independence, while higher cardiorespiratory fitness can mitigate age-related functional limitations. Examples of suitable activities include walking, dancing, swimming, water aerobics, cycling, strength training with resistance bands or weights, balance exercises like tandem standing, and various flexibility routines. The recommended dose and intensity for older adults are 150–300 minutes of moderate-intensity activity per week, or 75–150 minutes of vigorous activity, combined with muscle-strengthening on at least two days per week. Multicomponent programs are especially beneficial for addressing frailty and aiding in post-hip fracture rehabilitation.
For older adults with chronic conditions, it is crucial to adjust the intensity and progression of activity. Seeking guidance from a health care professional is advised, with a strong emphasis on safe practice and gradual increases in activity. Real-life examples, such as Barbara, an active 65-year-old, and Rumi, a 79-year-old with osteoarthritis, illustrate how individuals can meet these guidelines through tailored multicomponent programs and progressive activity plans.
Chapter 6. Additional Considerations for Some Adults
This chapter provides specific guidance for women during pregnancy and the postpartum period, as well as for adults living with chronic conditions and those with disabilities. For pregnant women, a minimum of 150 minutes of moderate-intensity aerobic activity per week is recommended. If previously active and under medical guidance, it is generally safe to continue vigorous activity. However, it is important to avoid lying on the back after the first trimester and to steer clear of high-risk activities. During the postpartum period, continued activity supports fitness and mood, and when combined with caloric balance, can aid in weight management.
Adults with chronic conditions or disabilities are advised to engage in at least 150–300 minutes per week of moderate-to-vigorous physical activity (MVPA), in addition to muscle-strengthening activities on two or more days per week. Activities should be adapted to individual abilities, and avoiding inactivity is crucial. Regular care from a health professional is strongly advised to ensure safety and effectiveness. The Guidelines offer condition-specific guidance, covering examples such as osteoarthritis, type 2 diabetes, hypertension, cancer survivorship, and various other disabilities, emphasizing the importance of multicomponent activity and safety. Each condition may necessitate different monitoring strategies; for instance, blood glucose monitoring for diabetes, footwear considerations for diabetes, and blood pressure management for hypertension.
Chapter 7. Active and Safe
For most individuals, the health benefits derived from physical activity significantly outweigh the risk of injury. However, injuries are more likely to occur with excessive overload or when activities are performed unsafely. Key safety guidance includes understanding potential risks while remaining confident that activity is generally safe, choosing activities aligned with one's current fitness level and goals, and gradually increasing activity intensity and duration. It is also important to use proper gear, engage in activities in safe environments, adhere to good policies, and seek health care advice if chronic conditions are present.
Safer activities generally involve moderate intensity, low impact, and a low risk of collision. Activities like walking, gardening, cycling for transport, dancing, swimming, and certain other low-impact exercises typically have the lowest injury rates. The risk of overuse injuries can be minimized through activity variety and gradual progression; individuals with prior injuries should be particularly careful with progression to prevent re-injury. Warming up and cooling down are beneficial practices; warm-ups prepare the heart rate and breathing for activity, while cool-downs allow for gradual recovery. Time spent warming up or cooling down can contribute to aerobic guidelines if performed at least at moderate intensity.
Using protective gear and appropriate equipment helps reduce injury risk, and engaging in activities within safe environments while adhering to rules and policies is essential. When planning for environmental factors, it is critical to consider safe surroundings, weather conditions, air quality (using the AQI), and visibility, selecting times and locations that minimize risk. Regarding advice from health care providers, generally healthy individuals can self-monitor their activity levels. However, those experiencing symptoms or living with chronic conditions should consult professionals when adjusting their activity, particularly before undertaking vigorous activities.
Chapter 8. Taking Action: Increasing Physical Activity Levels of Americans
Effective action to increase physical activity levels requires comprehensive strategies implemented at individual, community, and societal levels, with several evidence-based approaches identified. For Individuals and Small Groups, behavior-change theories guide interventions. Key strategies include goal setting, self-monitoring of activity, fostering social support, developing problem-solving skills, and receiving tailored counseling. Appendix 2 provides federal resources, such as the "Move Your Way" campaign, the Surgeon General’s Call to Action, and the Community Guide, to support these implementation efforts.
At the Community Level, five proven strategies, known for their high reach and potential for sustainable change, include: Point-of-Decision Prompts (e.g., signage encouraging stair use), School Policies and Practices designed to boost activity before, during, and after school, ensuring Access to Indoor/Outdoor Recreation Facilities, launching Community-Wide Campaigns to promote activity through multi-channel messaging, and implementing Community Design improvements to enhance walkability and bikeability through changes in the built environment.
Promoting physical activity is a shared responsibility, implying that Everyone Has a Role, including individuals, families, communities, and various sectors of society. Practical guidance for individuals involves setting personal goals, identifying meaningful benefits, and selecting activities that align with their lifestyle and ensure safety. For Families and Caregivers, supporting youth with age-appropriate activity opportunities, promoting safe participation, facilitating skill development, and encouraging lifelong activity habits are vital roles. The National Physical Activity Plan Alliance identifies nine key Sectors of Society that have roles in promoting activity: business, recreation/parks, education, faith-based settings, health care, media, public health, sports, and transportation and community design. This chapter provides examples of sector-specific actions and effective collaboration strategies. Real-life examples (Case Studies) illustrate these efforts, such as Jim (75), who uses a pedometer to increase walking, and a community example demonstrating a town coalition implementing a 10-year action plan across sectors with goals like safer crossings and park improvements.
Appendices and Glossary
The appendices and glossary provide essential supporting information for the Physical Activity Guidelines. Appendix 1, titled "Physical Activity Behaviors: Intensity, Bouts, and Steps," offers detailed explanations of MET-minutes and METs, clarifying how to assess activity intensity (both absolute vs. relative) and bout duration, and discusses step-based approaches. Appendix 2, "Federal Physical Activity Resources," compiles a comprehensive list of government resources from agencies such as the CDC, NIH, NIA, EPA, DOT, and USPSTF, along with relevant programs like Go4Life, We Can!, Million Hearts, and The Community Guide. The Glossary provides clear definitions of key terms, including Absolute intensity, Relative intensity, MET, MVPA (moderate-to-vigorous physical activity), Multicomponent physical activity, Adverse event, Overload, Progression, and Specificity. The Guidelines strategically repeat definitions across various chapters to enhance practical application and facilitate their translation into consumer-friendly messages.
Key Guidelines by Population
Preschool-Aged Children (3–5)
These children should be physically active throughout the day, and adult caregivers play a crucial role in encouraging a diverse range of active play to support their growth and development.
Children and Adolescents (6–17)
Children and adolescents in this age group are recommended to accumulate at least 60 minutes of moderate-to-vigorous physical activity (MVPA) daily. The majority of this activity should be aerobic, with vigorous-intensity activity included on at least three days per week. Additionally, muscle-strengthening activities are advised on three or more days per week, as are bone-strengthening activities, also on three or more days per week.
Adults (18–64)
Adults are encouraged to move more and reduce sedentary time. The core recommendation is 150–300 minutes per week of moderate-intensity aerobic activity, or 75–150 minutes per week of vigorous-intensity aerobic activity, or an equivalent combination. This aerobic activity should be spread throughout the week, and adults should also engage in muscle-strengthening activities involving all major muscle groups on two or more days per week.
Older Adults (65+)
Older adults should follow the same general adult guidelines, with an added emphasis on multicomponent activity that includes balance training to reduce fall risk. They should assess their effort relative to their individual fitness and health status, adapting activities to their conditions and capabilities. If meeting the 150-minute target is not feasible, they are encouraged to remain as active as their abilities allow.
Women During Pregnancy and Postpartum
Women during pregnancy and the postpartum period should aim for at least 150 minutes per week of moderate-intensity aerobic activity. If previously active, continuing vigorous activity may be safe under medical supervision. It is important to avoid certain positions after pregnancy and high-risk activities during pregnancy.
Adults with Chronic Health Conditions/Disabilities
These adults are advised to engage in 150–300 minutes per week of moderate-to-vigorous physical activity (MVPA), in addition to muscle-strengthening activities on two or more days per week. Activities should be adapted to individual abilities, and avoiding inactivity is strongly recommended. Regular care by health professionals is advised, and the benefits of activity persist even with these conditions.
Mathematical Notes and Formulas (LaTeX)
MET concept and MET-minutes
One MET (Metabolic Equivalent of Task) represents the energy expenditure at rest, with activity energy expenditure scaling proportionally with METs.
Example MET-minute calculation
An activity rated at 4 METs performed for 30 minutes yields a total of which is equivalent to 2.0 MET-hours.
Typical weekly targets (adult)
For adults, typical weekly targets include 150 minutes (which is ) of moderate-intensity activity, or 75 minutes () of vigorous-intensity activity, or an equivalent combination.
2-to-1 rule (substitution between intensities)
The 2-to-1 rule indicates that 2 \text{ min moderate} \text{ \approx } 1 \text{ min vigorous} activity to achieve the same dose of moderate-to-vigorous physical activity (MVPA) benefits.
Targets for adults with high activity
Adults who engage in high levels of activity aim for more than of moderate-intensity activity per week, or an equivalent volume of MVPA.
Sedentary behavior definition
Sedentary behavior is defined as any waking activity characterized by an energy expenditure of while an individual is sitting, reclining, or lying down.
Conceptual Frameworks to Remember
Overload, Progression, Specificity
Overload refers to the principle of applying greater stress than normal to the body to elicit adaptation and improvement.
Progression involves gradually increasing this overload to ensure continued gains while minimizing the risk of injury.
Specificity indicates that the benefits achieved are particular to the body systems being stressed; for instance, walking primarily benefits the lower body and cardiovascular systems.
Bouts
Any duration of moderate-to-vigorous physical activity (MVPA), regardless of its length, counts towards the total activity accumulated. The total volume of MVPA is considered the key determinant of overall health benefits.
Multicomponent Activity
For older adults, combining aerobic, resistance, and balance training into a multicomponent activity program yields the greatest benefits, particularly for improving physical function and reducing the risk of falls.
Relative vs Absolute Intensity
Absolute intensity is measured using METs, where, for example, 3.0–5.9 METs typically denotes moderate intensity. Relative intensity, however, is adjusted to an individual's fitness level, often expressed as a percentage of or heart rate reserve, and is particularly useful for guiding activity levels in older adults.
Important Takeaways for Exam Preparation
When preparing for exams, it is crucial to always frame physical activity recommendations in terms of weekly targets, rather than relying solely on daily bouts. For adults, this means aiming for 150–300 minutes of moderate-to-vigorous physical activity (MVPA) per week, supplemented by two or more days of muscle strengthening activities, with greater benefits observed at higher activity levels. For children aged 6–17, the guideline is 60 minutes per day of MVPA, accompanied by additional muscle- and bone-strengthening activities on multiple days.
It is also very important not to overlook the significance of reducing sedentary time; health benefits demonstrably increase when sedentary periods are replaced with light-to-moderate physical activity. Understanding safety is another key aspect: most healthy adults can generally begin with light-to-moderate activity and gradually increase intensity and duration. However, individuals with chronic conditions or those who are pregnant should seek professional guidance before adjusting their activity levels. Finally, understanding the real-world application of these guidelines is essential, utilizing familiar activities such as walking and simple movements as entry points, and employing concepts from the "Move Your Way" campaign to effectively communicate these messages to the public. The guidelines consistently emphasize a lifespan approach, covering recommendations for all ages from infants through older adults, supported by examples, scenarios, and program suggestions.
Message from the Secretary
Regular physical activity is one of the most important actions for health.
Benefits apply across all ages, sexes, races, ethnicities, and fitness levels.
Individuals with chronic disease, disability, or pregnancy also benefit.
Benefits start with small amounts and occur immediately.
Current situation (as of 2nd edition):
About 117 million American adults have one or more preventable chronic diseases.
Seven of the ten most common chronic diseases are positively influenced by activity.
Nearly 80% of adults do not meet key aerobic and muscle-strengthening guidelines.
Approximately half meet aerobic guidelines alone.
Inactivity costs: about billion in annual health care costs and about 10% of premature mortality.
The 2018 Guidelines (2nd edition):
Grounded in current evidence and the 2018 Advisory Committee Scientific Report.
Aim to guide activity amounts and types to maintain/improve health and reduce chronic disease risk.
Serve as a tool for health professionals and policymakers to design programs, policies, and community interventions.
Achieving population-level improvements requires comprehensive, coordinated strategies across sectors; everyone has a role.
Call to action: moving more and sitting less creates a healthier Nation.
Signed: Alex M. Azar II, Secretary, U.S. Department of Health and Human Services.
Summary of the Physical Activity Guidelines for Americans, 2nd Edition
Being physically active is among the most important actions to improve health; benefits begin immediately.
The Guidelines cover people aged 3 years and older.
Reflect new evidence on brain health, more cancer sites, fall-related injuries, sleep and mood benefits, and multicomponent activity for older adults.
Key new aspects include:
Brain health benefits.
Immediate and longer-term wellness benefits.
More guidance for older adults and those with chronic conditions.
Risks of sedentary behavior.
Preschool guidelines.
Elimination of the 10-minute bout requirement.
Tested population-level strategies.
The Guidelines complement the Dietary Guidelines for Americans (USDA/HHS collaboration) for reducing chronic disease risk.
Emphasis on translating professional guidance into consumer messages via Move Your Way campaign.
Resources exist for professionals and the public.
Promote evidence-based, community-level interventions to make being active the easy choice.
Roadmap to the Physical Activity Guidelines for Americans
Chapter 1: Introducing the Guidelines – development background and rationale.
Chapter 2: Physical Activity and Health – health benefits, dose–response, overall health impact.
Chapter 3: Active Children and Adolescents – guidance for ages 3–17 (including those with disabilities).
Chapter 4: Active Adults – guidance for ages 18–64.
Chapter 5: Active Older Adults – guidance for 65+; includes multicomponent activity with balance.
Chapter 6: Additional Considerations for Some Adults – pregnancy/postpartum, chronic conditions, disabilities.
Chapter 7: Active and Safe – safety guidance for practicing activity and reducing injuries.
Chapter 8: Taking Action: Increasing Physical Activity Levels of Americans – strategies for individuals, communities, and sectors; steps to implement.
Glossary and Appendices with definitions and resources (e.g., METs, intensity, bouts, and steps).
Chapter 1. Introducing the Physical Activity Guidelines for Americans
Physical activity benefits span health, growth, sleep, and quality of life; benefits accrue even from small amounts.
Evidence shows benefits across ages, races, sexes, and health statuses, including pregnancy and disability.
New edition (2018) expands guidance:
For ages 3+.
Adds brain health, fall prevention, and cognitive benefits.
Discusses sedentary behavior and its interaction with activity.
Rationale and development:
Started in 2016 with external 2018 Advisory Committee.
Systematic reviews fed into Scientific Report; public and agency input considered.
The Move Your Way campaign translates the Guidelines for professionals and the public; resources available.
Key figures (Figures 1-1, 1-2) show trends in aerobic and muscle-strengthening guideline attainment among adults and youth (data examples from NHIS and YRBS).
Chapter 2. Physical Activity and Health
All Americans should engage in regular physical activity to improve health and prevent adverse outcomes.
Benefits seen in healthy people and those at risk or with chronic conditions.
Benefits can occur immediately or after a single episode; some begin with as little as 60 minutes per week.
Substantial health benefits for adults:
Approximately 150 minutes of moderate-intensity aerobic activity per week (or 75 minutes of vigorous activity) or an equivalent combination.
Benefits continue to accrue with more activity.
Both aerobic and muscle-strengthening activities are beneficial.
Health benefits exist across all races/ethnicities and at all life stages, including chronic conditions or disabilities.
Health benefits generally outweigh the risk of adverse events for most people.
Major research conclusions:
Regular moderate-to-vigorous activity reduces risk for multiple diseases; more activity yields more benefits.
Benefits extend to brain health, sleep, and quality of life.
Activity improves physical function and may improve cognitive function.
Benefits occur in youth and older adults alike.
Absolute vs. Relative Intensity; Levels of Aerobic Activity (Inactive, Insufficiently Active, Active, Highly Active) defined for adults using METs and energy expenditure.
Sedentary Behavior:
Characterized by low energy expenditure () while sitting or reclining.
Strong relationships exist between sedentary time and all-cause mortality and cardiovascular mortality.
Replacing sedentary time with light-to-moderate activity yields health benefits.
No fixed target for interruptions defined due to interaction with overall activity level.
Bouts:
Originally, guidelines required MVPA in bouts of 10 minutes or more.
2018 Advisory Committee concluded that bouts of any length contribute to health benefits.
Short bursts (even a few flights of stairs) count toward total MVPA.
Progression toward targets: gradual increases in activity; risk of injury increases with large overloads; progression should be gradual and individualized.
Physical Activity Behaviors: Intensity, Bouts, and Steps – METs, MET-minutes, and steps used as measurement tools; Appendix 1 provides more details.
Guiding concept: Overload, Progression, and Specificity – benefits depend on applying appropriate stress to body systems; benefits are specific to the body systems used.
Chapter 3. Active Children and Adolescents
Preschool-aged children (3–5):
Should be physically active throughout the day to support growth/development.
Caregivers should encourage a variety of active play types.
School-aged children and adolescents (6–17):
Accumulate at least 60 minutes per day of MVPA.
Majority should be aerobic, with vigorous activity on at least 3 days/week.
Include muscle-strengthening on days/week.
Include bone-strengthening activities on days/week.
Activity types can be mixed; bone-strengthening activities are important during pre-/puberty years for peak bone mass.
Intensity and notions of absolute vs. relative intensity: for youth, both scales can be used; vigorous activity emphasized for fitness gains.
Typical activity patterns of children: intermittent activity with short bursts; any episode counts toward daily MVPA target.
Special considerations for children with disabilities; emphasize inclusive opportunities and tailored activity guidance.
Real-life examples illustrate how preschoolers, school-aged children, and adolescents can meet guidelines.
Chapter 4. Active Adults
Adults should move more and sit less; any amount of physical activity yields some health benefits.
Substantial benefits require:
150–300 minutes/week of moderate-intensity aerobic activity, or 75–150 minutes/week of vigorous activity, or an equivalent combination; ideally spread through the week.
Additional health benefits come from exceeding 300 minutes of moderate-intensity activity weekly.
Muscle-strengthening activities involving all major muscle groups on 2+ days/week provide additional health benefits.
If time is limited, substituting some vigorous-intensity activity for moderate-intensity activity is efficient (the 2-to-1 rule: 2 \text{ minutes moderate \approx} 1 \text{ minute vigorous}).
Other health benefits: reduced anxiety and depression, improved sleep and quality of life; increased cardiorespiratory and muscular fitness; better weight management; improved functional ability.
Key guidelines apply to adults aged 18–64, with cross-references to Chapter 6 for pregnancy, chronic conditions, disabilities.
Aerobic activity defined by intensity, frequency, duration; total volume (minutes per week) is primary driver of benefits; all aerobic time at moderate intensity counts.
Relative and absolute intensity concepts explained; relative intensity often more appropriate for older adults.
Chapter 5. Active Older Adults
The adult guidelines apply to older adults, with added emphasis on multicomponent activity (aerobic + muscle-strengthening + balance).
Older adults should determine effort relative to fitness and health status; adjust activity to conditions; when unable to meet 150 minutes, stay as active as possible.
Multicomponent activity including balance training reduces fall risk; regular activity preserves physical function and independence.
Example activities: walking, dancing, swimming, water aerobics, cycling, strength training with bands/weights, balance activities, flexibility work.
Dose and intensity: aim for 150–300 minutes of moderate activity per week; 75–150 minutes of vigorous also acceptable; combine with muscle-strengthening on days/week.
Multicomponent programs are especially beneficial for frailty and post-hip fracture rehabilitation.
For older adults with chronic conditions, adjust intensity and progression, seek health care guidance, emphasize safe practice and gradual progression.
Real-life examples illustrate how individuals meet guidelines through multicomponent programs.
Chapter 6. Additional Considerations for Some Adults
Focuses on pregnancy/postpartum, adults with chronic conditions, and adults with disabilities.
Women during pregnancy:
At least 150 minutes of moderate-intensity aerobic activity per week.
Safe to continue vigorous activity if previously active under medical guidance.
Avoid lying on the back after the first trimester and high-risk activities.
Postpartum period: continued activity supports fitness and mood; potential weight-management benefits with caloric balance.
For adults with chronic conditions or disabilities:
At least 150–300 minutes/week of MVPA, plus muscle-strengthening on days/week.
Adapt activities to abilities; avoid inactivity; regular care by a health professional is advised.
Examples of condition-specific guidance include osteoarthritis, type 2 diabetes, hypertension, cancer survivorship, and other disabilities.
Emphasize multicomponent activity and safety.
Each condition may require different monitoring (e.g., blood glucose, footwear, blood pressure).
Chapter 7. Active and Safe
Health benefits of activity far outweigh risk of injury for most people; injuries more likely with greater overload or unsafe activity.
Key safety guidance:
Understand risks but remain confident activity is safe; choose activities aligned with fitness/goals.
Increase activity gradually; use proper gear, safe environments, good policies; seek health care advice if chronic conditions are present.
Safer activities tend to be moderate intensity, low impact, with low risk of collision (e.g., walking, gardening, cycling, dancing, swimming).
Overuse and injury risk reduced by variety and progression; prior injuries require careful progression.
Warm-up and cool-down are beneficial; time spent warming up/cooling down can count toward aerobic guidelines if at least moderate intensity.
Protective gear and proper equipment reduce injury risk; safe environments and adherence to rules are important.
Planning for environmental factors: safe environments, weather, air quality (AQI), visibility; select times/locations to minimize risk.
Advice from health care providers: generally, healthy individuals can self-monitor; those with symptoms or chronic conditions should consult professionals when adjusting activity, particularly vigorous activity.
Chapter 8. Taking Action: Increasing Physical Activity Levels of Americans
Action requires strategies at individual, community, and societal levels; evidence-based strategies identified.
For Individuals/Small Groups: behavior-change theories guide interventions.
Strategies include goal setting, self-monitoring, social support, problem solving, tailored counseling.
Appendix 2 provides federal resources (e.g., Move Your Way, Surgeon General’s Call to Action, Community Guide).
For Communities: five proven strategies with high reach and potential for lasting change:
Point-of-Decision Prompts (e.g., stairs signage).
School Policies and Practices to increase activity.
Access to Indoor/Outdoor Recreation Facilities.
Community-Wide Campaigns to promote activity.
Community Design to improve walkability and bikeability.
Everyone Has a Role: individuals, families, communities, and sectors share responsibility.
Practical guidance for individuals to set personal goals, identify benefits, and choose activities.
For Families/Caregivers: support youth with age-appropriate activity, promote safe participation, encourage lifelong habits.
For Sectors of Society: nine sectors (business, recreation/parks, education, faith-based, health care, media, public health, sports, transportation/community design) have roles.
The National Physical Activity Plan Alliance identifies these sectors.
Examples of sector-specific actions and collaboration strategies provided.
Real-Life Examples (Case Studies): Jim (75) uses a pedometer; a community coalition implements a 10-year action plan.
Appendices and Glossary
Appendix 1. Physical Activity Behaviors: Intensity, Bouts, and Steps: details on MET-minutes and METs; how to assess intensity (absolute vs relative) and bout duration; step-based approaches.
Appendix 2. Federal Physical Activity Resources: compendium of government resources (CDC, NIH, NIA, EPA, DOT, USPSTF, etc.) and programs (Go4Life, We Can!, Million Hearts, The Community Guide, etc.).
Glossary: definitions of key terms including Absolute intensity, Relative intensity, MET, MVPA, Multicomponent physical activity, Adverse event, Overload, Progression, Specificity, and more.
Guidelines provide repeated definitions across chapters for practical application.
Key Guidelines by Population
Preschool-Aged Children (3–5): physically active throughout the day; adult caregivers encourage diverse active play.
Children and Adolescents (6–17): 60 minutes/day MVPA; aerobic majority; vigorous activity on days/week; muscle-strengthening on days/week; bone-strengthening on days/week.
Adults (18–64): move more, sit less; 150–300 minutes/week of moderate-intensity aerobic activity or 75–150 minutes/week of vigorous-intensity aerobic activity, or an equivalent mix; aerobic activity spread over the week; 2+ days/week of muscle-strengthening.
Older Adults (65+): same adult guidelines plus multicomponent activity including balance; assess effort relative to fitness; adapt for chronic conditions; stay as active as abilities allow.
Women During Pregnancy and Postpartum: at least 150 minutes/week of moderate-intensity aerobic activity; can continue vigorous activity if previously active, under medical supervision; avoid certain positions and high-risk activities.
Adults with Chronic Health Conditions/Disabilities: 150–300 minutes/week MVPA plus 2+ days/week of strengthening; adapt activities to abilities; stay under care of health professionals; avoid inactivity.
Mathematical Notes and Formulas (LaTeX)
MET concept and MET-minutes:
1 MET = energy expenditure at rest; activity energy expenditure scales with METs.
Example MET-minute calculation:
A 4 MET activity for 30 minutes yields (which equals 2.0 MET-hours).
Typical weekly targets (adult):
Moderate-intensity: per week; Vigorous-intensity: per week; or an equivalent combination.
2-to-1 rule (substitution between intensities): to meet the same MVPA dose.
Targets for adults with high activity: more than of moderate-intensity activity per week; or equivalent volume of MVPA.
Sedentary behavior definition: waking behavior with energy expenditure while sitting, reclining, or lying.
Conceptual Frameworks to Remember
Overload, Progression, Specificity:
Overload: apply greater stress than normal to elicit adaptation.
Progression: gradually increase overload to continue gains with minimized risk.
Specificity: benefits depend on the body systems being stressed.
Bouts: any duration of MVPA counts toward total; total MVPA is the key determinant of health benefits.
Multicomponent Activity: combining aerobic, resistance, and balance training yields greatest benefits for older adults and falls risk reduction.
Relative vs Absolute Intensity: absolute intensity uses METs (e.g., 3.0–5.9 METs is moderate); relative intensity adjusted to fitness and useful for older adults.
Important Takeaways for Exam Preparation
Always frame activity in terms of weekly targets, not just daily bouts:
Adults: 150–300 minutes of MVPA per week + 2+ days of muscle strengthening; more gives greater benefits.
Children 6–17: 60 minutes/day MVPA with additional muscle- and bone-strengthening on multiple days.
Do not overlook the role of reducing sedentary time; benefits increase as you replace sedentary time with light-to-moderate activity.
Understand safety: most adults can safely start with light-to-moderate activity; gradually increase; seek guidance with chronic conditions or during pregnancy.
Real-world translation: use steps, walking, and simple activities as entry points; employ “Move Your Way” ideas.
The guidelines emphasize a lifespan approach: content covers infants through older adults with examples, scenarios, and program suggestions.