One leg of the three-legged stool of medical advice is exercise. The other two, watch what you eat, it’s variant, watch between-meal treats, and make sure you get the right amount of sleep. A new study from JAMA Network is reporting that no surprise, we are not making much progress on that exercise leg of the stool. (Other reports from other days point out that the other advice is not doing any better either).
The data is from the health version of the census, the National Health and Nutrition Examination Survey, a series of studies involving questionnaires and examinations performed by the Centers for Disease Control on representative populations throughout the US. The years included in the analysis were from 2007 to 2016. Participants were asked about their past 30 days of moderate and vigorous activity.  They also asked about sedentary activity and the usual demographics. All told they reviewed the responses of 27,343 participants, slightly more female and 66% Caucasian.
- Those participants adhering to the established guidelines  went from 63.2% in 2007 to 65.2% in 2016 — an inconsequential change.
- Some groups did increase their reported adherence to the guidelines, women, non-Hispanic blacks, non-smokers, and those that were overweight but not obese.
- Sedentary behavior, on the other hand, rose from 5.7 hours in 2007 to 6.2 hours in 2016 a statistically significant trend. It had, to be fair, peaked in 2013 at 7.9 hours. And unlike exercise, everyone was more sedentary, no subgroups to worry about here.
- Many participants, 18.8% were able to combine increased sedentary activity and decrease exercise, once again, a statistically significant increase.
They conclude that there has been no significant increase in those of us exercising and a substantial increase in our sedentary ways. The researchers note that only a third of the population was even aware of the guidelines and an even smaller percentage, 1%, felt that they knew the guidelines. The accompanying editorial notes that the survey did not take into account muscle-strengthening activities, presumably jumping to conclusions is not considered muscle strengthening and may under-report the activities of the couch-potato nation.
As with all of these type of reports, it ends with a “call to action.” “Future nationwide efforts may be warranted to promote physical activity and reduce sedentary time in US adults.” Of course, what nationwide efforts is the million-dollar question, isn’t it?
Education doesn’t seem to be working, although you can argue that physicians are not teaching hard enough or patients are resistant to our teaching ways. There are no calls for a sin tax on obesity, nor should there be, as BMI is not a simple issue of “free will.” The outcomes of “gym membership” as an employee wellness benefit are at best mixed.
One last thought, physical activity, engaging in exercise is a habit that we can learn, perhaps we should consider the physical education we provide to our children. According to the CDC,
“although nearly 90% of schools follow national, state, or district physical education standards, very few schools require daily physical education and very few provide the number of minutes recommended by CDC and the Institute of Medicine. Further, many schools allow students to be exempted from physical education requirements.”
3.7% of schools have daily physical education, but it soars to 11.5% if three times a week is sufficient – 90 minutes a week. Of course, that might be a good thing when you noted that only 43% of schools require students to use “appropriate protective gear during physical education.” Why should we be surprised that the nation is increasingly sedentary? While our national standards for physical activity, talk the talk, we do not walk the walk.
 Moderate activity was at least 10 minutes of exercise that raised your heart rate and breathing a bit – to use the analogy of Peloton, you can still hold a conversation. Vigorous activity was at least 10 minutes that raised your heart rate and breathing enough that conversation, when attempted, was short and sweet.
 The guidelines call for 150 minutes of moderate, 75 minutes of vigorous, or some combination of the two weekly.
Source: Trends in Adherence to the Physical Activity Guidelines for Americans for Aerobic Activity and Time Spent on Sedentary Behavior Among US Adults 2007-2016 JAMA Network DOI: 10.1001/jamanetworkopen.2019.7597