Canada Unveils New Physical Activity Guidelines

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Some exciting news today – Canada’s new Physical Activity Guidelines have been officially released!  The guidelines have received a tremendous amount of media attention of late and, disappointingly, much that has been written about the guidelines in the media has been misleading or simply incorrect.  So I thought it would be good to look at the new guidelines and how they differ from the old ones. They’re not perfect, and I know that some people will argue that physical activity guidelines are unnecessary (I disagree), but I think it’s important that people have a general understand of what the guidelines are, and what they are not.

First off, some disclosure:  I am a member of the Canadian Society for Exercise Physiology (the group that created the guidelines), and have sat on committees in the past for ParticipACTION (who were also involved with the guidelines process).  Several of my current and former colleagues, including my PhD Supervisor, have been directly involved in the guidelines process.  So feel free to take my opinion with a grain of salt.  That being said, I didn’t actually have anything to do with the guidelines, and this post (as with all of our posts) are my own thoughts and opinions, and don’t represent the views of anyone else. Now back to the guidelines.

Why did we need new guidelines?

A number of reasons.  The old guidelines were first published in 1998 (guidelines for adults were released in 1998, older adults in 1999, children and youth in 2002), and were based on evidence from 1996 and earlier.  So the most important reason is that there is simply a lot more information now, and as a result some of the recommendations are no longer supported by the best available evidence.

Here are some of the other reasons which I’ve adapted from the CSEP website:

1. An explosion of new research, making the old guidelines out of date.  This is important for obvious reasons – there is no sense promoting a behaviour if there is no evidence linking it to health (e.g. stretching, which was in the old guidelines, but not in the new ones).

2. The old guidelines were vague, and new evidence allows more specific recommendations. Anyone who, like me, has spent hours on the Public Health Agency of Canada website trying to figure out the old guidelines, will appreciate the new clarity.  This is also helpeful for population surveillance work – vague guidelines make it difficult to classify someone as “active” or “inactive”.  For example, the old guidelines for children suggested that kids “INCREASE time CURRENTLY spent on physical ativity, starting with 30 minutes MORE per day” (emphasis theirs).  So the old guidelines were not, as many people think, that kids should do 90 minutes of physical activity per day – they were simply that kids should increase their physical activity levels by 30 minutes per day.  Since that is almost impossible to assess at the population level (you would need both pre-and post measurements, among other things…), surveillance studies of the Canadian population classified kids as “active” if they were getting 90 or more minutes of PA per day.  Which then made everyone think that the guideline was itself 90 minutes per day.  All of this to say that the vagueness of the old guidelines caused a lot of confusion.

3. The old guidelines did not cover all ages.  For example, 15-19 year-olds were left out of both child and adult guidelines in the past, placing them in guideline limbo.  That’s a pretty big problem.  While we still don’t have pre-school guidelines (although I think they’re in the pipeline), everyone else is now covered.

4. The guideline development process is now far more robust.  Previous guidelines were assembled using “Expert Opinion”… which also happens to be the lowest quality evidence, since it can introduce opportunities for bias (e.g. if one expert really thinks that stretching is important, then there is a good chance that stretching will make it into the guidelines, whether or not it is supported by the evidence).   The current Canadian guidelines have been created using the most robust and exhaustive process for any guidelines anywhere in the world (in fact, the new WHO guidelines, as well as those in other countries, are based on the evidence assembled for the creation of the Canadian guidelines).  This is important, because we physical activity folk are pushing for physicians and other healthcare workers to prescribe physical activity, just as they would any other evidence-based treatment.  But for healthcare professionals to feel comfortable with the guidelines, they need to be evidence-based.  And now they are.

What are the new guidelines?

From the CSEP website:

Kids 5-11:

For health benefits, children aged 5-11 years should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily. This should include:

  • Vigorous-intensity activities at least 3 days per week.
  • Activities that strengthen muscle and bone at least 3 days per week.

More daily physical activity provides greater health benefits.

Youth 12-17:

For health benefits, youth aged 12-17 should accumulate at least 60 minutes of moderate-to-vigorous physical activity daily.  This should include:

  • Vigorous-intensity activities at least 3 days per week.
  • Activities that strengthen muscle and bone at least 3 days per week.

More daily physical activity provides greater health benefits.

Adults Aged 18-64:

To achieve health benefits, adults aged 18-64 years should accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.

It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week.

More physical activity provides greater health benefits.

Adults 65+:

To achieve health benefits and improve functional abilities, adults aged 65 years and older should accumulate at least 150 minutes of moderate- to vigorous-intensity aerobic physical activity per week, in bouts of 10 minutes or more.

It is also beneficial to add muscle and bone strengthening activities using major muscle groups, at least 2 days per week.

Those with poor mobility should perform physical activities to enhance balance and prevent falls.

More physical activity provides greater health benefits.

Why are the experts telling us to exercise less?

There has been a lot of confusion around the fact that the minimum guidelines are lower in certain situations than they were in the old guidelines.  For example this article from the Sun media chain titled Canadians so lazy, experts lower targets.  The way it’s been presented, you can’t help but get upset at these ivory-tower experts who are telling our kids to exercise less.  Or, as celebrity trainer Paul Plakas put it in one interview “That’s the wrong message. We have to set the standards high”

But the guidelines don’t tell people to exercise less, in fact the guideline for each age-group includes the statement “More physical activity provides greater health benefits”.  These guidelines are based on the minimum amount of daily activity that is associated with health benefits.  More is clearly better.  But an arbitrary guideline that is chosen simply to “set the standards high” is obviously of no value to health care practitioners whatsoever.  When I go to get a physical next week, I expect that my blood pressure will be compared to an evidence-based guideline, rather than an arbitrary one that is simply there to set a “high standard”, or one whose goal is to demonstrate that Canadians take blood pressure more seriously than the rest of the world.  Physical activity guidelines should be no different.

Also, as I mentioned above, the guidelines are not lower than in the past.  Or at least not uniformly so.  In some situations the new guidelines are higher than in the past, and in other situations they are lower.  More than anything they are just different, and much simpler.  For example, the below image is from the old adult physical activity guidelines:
As you can see, the old guidelines for adults differed depending on how intense your exercise was.  So the old guidelines were 60 minutes of activity per day for adults, but only if that activity was light.  If the activity was moderate, then the guidelines said that benefits could be achieved with lower amounts of activity, and if the activity was vigorous, then they needed just 20-30 minutes per day.  All this to say that it’s hard to argue that the old guidelines were a higher standard than the new ones, unless you’re willing to also admit that they were a lower standard than the new ones – it all depends on which examples you pick.  More than anything, they are different, and they are now evidence based.

Final Thoughts

So those are the guidelines themselves, and some of the ways that they differ from the old ones (CSEP also outlines the key differences on their website).  I should point out that just because these are the guidelines, it doesn’t mean that they need to be promoted to the public using exactly these terms.  In other words, I don’t think that a 30 second commercial that says “Adults should exercise 150 minutes per week” is going to be a terribly useful public-health campaign.

If the topic is how we should message the guidelines, then I like Yoni Freedhoff’s suggestion: Some is good.  More is better.  Everything counts. While that statement is not entirely evidence-based (e.g. does everything truly count, or does it have to be in bouts of 10 minutes or more?), I think it summarizes the take-home message of the guidelines quite nicely.  But regardless of the messaging we need evidence-based guidelines for at least 2 reasons:

1.  To provide healthcare workers with evidence-based information on the amount of physical activity associated with important health benefits

2.  To allow population surveillance studies (such as the recent Canadian Health Measures Survey) to determine whether Canadians are accumulating enough physical activity to maintain proper health.

I know that some people will argue that we don’t need evidence-based guidelines, and I don’t expect to convince them otherwise with this post.  But I fail to see how we are better served as researchers or as a population by not knowing the amount of physical activity associated with good health, which is essentially what they are arguing for.  I realize that some have argued that we need to address the built-environment and a number of other important societal factors in order to see physical activity levels increase, and I agree with that wholeheartedly.  But I think that’s an entirely separate issue.  The guideline itself (e.g. people should accumulate X amount of physical activity per day) should be based on the best available evidence, just as our other guidelines for things like BMI, waist circumerence, and metabolic syndrome are.  The steps taken to help the population meet those guidelines is a completely different issue.  I’m curious to hear what everyone else thinks in the comments.

For more info on the guidelines, you can check out the detailed info at the Canadian Society for Exercise Physiology website, which includes more in-depth info on the guidelines themselves, and the process used to create them.  You can also check out my previous post on the exhaustive evidence review process used to inform the guidelines.

Travis

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