Guidelines for
promoting
physical activity
to adults
Movement = Health
Me korikori ka ora
A Resource for
Health Professionals
For further information on SPARC and its initiatives go to www.sparc.org.nz or contact us on
+ 64 4 472 8058 or [email protected]
Copyright SPARC 2005
First published July 2005
ISBN 1-877356-38-7
Design by MJF Communications, Wellington
Printed and bound by Astra Print Limited, Wellington
Contents
About this booklet
2
Physical activity in New Zealand
4
Promoting physical activity
6
Promoting the four guidelines
8
Encourage physical activity - it’s FUN and it’s FREE!
10
For older people - it’s never too late to start.
11
Overcoming barriers to physical activity
13
Strategies to help overcome barriers to physical activity
14
Linking in with other initiatives
17
The link between physical activity, nutrition and keeping a healthy weight
18
The five dimensions of physical activity
21
Physical activity and intensity levels
23
Physical activity and chronic health conditions
26
Physical activity and Green Prescriptions (GRx)
29
MOVEMENT = HEALTH
About this booklet
This booklet is produced by SPARC and is designed to assist health promoters
and other health professionals involved in promoting physical activity to adults.
It offers:
• the New Zealand Guidelines for Physical Activity as a practical and costeffective way of promoting physical activity
• evidence-based information relating to physical activity.
ABOUT SPARC
SPARC’s role is to promote, encourage and support physical activity and sport
in New Zealand. In undertaking that role, SPARC seeks to adopt a wholeof-Government approach that emphasises collaborative and coordinated
strategies across sectors.
As an investment agency, SPARC provides support to a wide range of
organisations that make sport and physical activity happen. This includes 17
regional sports trusts who promote sport and physical activity to people of all
ages and abilities in the community.
SPARC aims to create links and partnerships with heath agencies and to
promote physical activity initiatives, as well as research and development,
across the sector.
The launch in June 2004 of the Ministry of Health’s Healthy Eating - Healthy
Action, Oranga Kai - Oranga Pumau Implementation Plan for 2004-2010 has
provided an opportunity for SPARC to work closely with the health sector. The
Plan’s objectives are based on the Ottawa Charter and the four pathways of
He Korowai Oranga are woven through the document.
SPARC’s Active Communities investment is all about increasing participation
in physical activity at a local and regional level, by investing in initiatives which
are coordinated by territorial authorities. SPARC is committed to supporting
collaboration of stakeholders, including those from the health sector, to
develop regional and district physical activity strategies appropriate to the
needs of the community.
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A RESOURCE FOR HEALTH PROFESSIONALS
There is the potential for District Health Boards and Primary Health
Organisations to align their District Annual Plans and Health Promotion Plans
with other stakeholders’ plans to ensure a collaborative approach.
Tama tu tama ora, tama noho tama mate.
The person who is active will live long and live well,
but the person who only sits will not.
3
MOVEMENT = HEALTH
Physical activity in New
Zealand
Over the last 100 years enormous social, environmental, technological and
lifestyle changes have led to a drastic reduction in the amount of physical
activity undertaken by humans - to the point where inactivity is damaging
health.
Research by the Ministry of Health1 has found that:
• physical inactivity is associated with 8% of all deaths in New Zealand and is
estimated to account for over 2600 deaths per year
• a 10% increase in participation in physical activity could result in 600 fewer
deaths per year
• physical inactivity is an independent risk factor for a range of noncommunicable diseases, such as:
-
cardiovascular diseases
-
type 2 diabetes
-
obesity
-
cancers, including colon and breast cancer
-
osteoporosis
• physical activity can improve mental health and wellbeing; improve
symptoms in those with chronic obstructive respiratory disease (CORD),
osteoarthritis, obesity and diabetes; and reduce falls in older people
• the direct costs of obesity to New Zealand have been estimated at over
$100 million per year2
• a 10% increase in physical activity could save $55 million through reduced
health expenditure, additional years of life and decreased incapacity3
• physical inactivity is second only to smoking as a modifiable risk factor for
poor health
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• increasing physical activity can contribute significantly to reducing risk of
mortality and morbidity in the New Zealand population
• physical activity is today’s ‘best buy’ in health. It is one of the lowest cost
interventions available - almost anyone can go for a walk at no cost.4
Evidence shows that one-third of adults in New Zealand are not physically
active at levels sufficient to benefit their health.5
Being fitter and stronger ensures people
are more independent.
Healthy Eating - Healthy Action. Oranga Kai - Oranga Pumau: A Background, Ministry of
Health, 2003.
1
The healthcare costs of obesity in New Zealand, Swinburn B, Ashton T, Gillespie J, et al,
International Journal of Obesity 21, 1997.
2
NZ Food - NZ People: Key Results of the 1997 National Nutrition Survey, Russell, Parnell,
Wilson et al, Ministry of Health, 1999.
3
Physical Activity Toolkit; DHB Toolkits, Ministry of Health website: www.newhealth.govt.nz/
toolkits
4
5
Push Play Facts, Sport and Recreation New Zealand, 2002, website: www.sparc.org.nz
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MOVEMENT = HEALTH
Promoting physical activity
Research by the Ministry of Health shows that regular physical activity reduces
the risk of developing, or dying from, many serious diseases, becoming
disabled and being injured.1 The challenge for health promotion is to develop
ways to activate populations so that regular physical activity becomes an
accepted lifetime habit.
1n 2001, the Hillary Commission developed the New Zealand Guidelines for
Physical Activity for adults. Based on the Australian physical activity guidelines
and on other substantive research, these guidelines offer considerable health
benefits to those who follow them. The New Zealand Guidelines can form a
useful part of a healthy lifestyle programme involving physical activity, healthy
eating and maintaining a healthy weight. Moreover they are easily integrated
into most lifestyles at little or no cost.
THE NEW ZEALAND GUIDELINES FOR PHYSICAL ACTIVITY
1. View movement as an opportunity, not an inconvenience.
2. Be active every day in as many ways as possible.
3. Put together at least 30 minutes of moderate-intensity physical activity on
most if not all days of the week.
4. If possible, add some vigorous exercise for extra health and fitness.
Definitions relating to physical activity
Physical activity is any bodily movement produced by skeletal muscles that
results in energy expenditure (eg, walking, gardening, playing sports, workrelated activity).
Exercise is a planned physical activity for recreation, leisure or fitness with
a specific objective such as improving fitness, performance, health or social
interaction.2
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Physical fitness is a state rather than a behaviour. It is a multidimensional
indicator of capacities such as cardiovascular endurance, muscular strength or
mobility, which in varying degrees are a result of genetics, age and physical
activity levels.
Evidence shows that at least 30 minutes
of moderate-intensity physical activity
on most, if not all, days of the week can
benefit health.
3
1
Healthy Eating - Healthy Action. Oranga Kai - Oranga Pumau: A Background. Op cit.
2
From Physical Activity Toolkit; DHB Toolkits. Op cit.
3
Physical Activity and health - A report of the US Surgeon General, US Department of
Health and Human Services, Atlanta GA, 1996.
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MOVEMENT = HEALTH
Promoting the four
guidelines
•
Explain that for maximum benefit all guidelines need to be followed, and
should be supported by a healthy eating pattern.
•
Refer anyone with a chronic health condition or compromised fitness to a
doctor before they start any physical activity. For physical activity in older
people refer to page 11.
1. View movement as an opportunity, not an inconvenience.
Changing attitudes toward movement is a good first step in promoting
physical activity. Encourage groups/clients/individuals to perceive movement
as an opportunity to increase their level of activity and benefit their
health, rather than as a nuisance and something to be avoided.
2. Be active every day in as many ways as possible.
Recent research shows that even the most inactive people can gain health
benefits if they become just slightly more active. Encourage people to make
small increases in activity throughout the day, for example taking the stairs
instead of the lift; walking rather than driving to the shops - or parking further
away; adding on an extra chore when doing housework; hanging out the
washing instead of using the dryer; fetching the mail/a book/a drink of water
oneself instead of getting the kids to do it.
3. Put together at least 30 minutes of moderate-intensity
physical activity on most if not all days of the week.
Moderate-intensity physical activity is activity which makes a person breathe a
little harder than normal.
This might include such activities as brisk walking, cycling, gathering kai
moana, kapa haka, gardening, kilikiti, siva - any activities that are energetic but
not vigorous.
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At least 30 minutes of moderate-intensity physical activity on most days can
produce health benefits such as improvements in glucose metabolism, blood
pressure, cholesterol and body weight.1 These benefits occur soon after
beginning a physically active lifestyle and apply to men and women of all
ages and ethnicities. In terms of cancer prevention, the more activity a person
undertakes, the lower the risk of cancer.2 Some people may prefer to do
shorter sessions of 10 or 15 minutes (‘snacktivity’) to reach their 30-minute
goal. Encourage them to choose activities they enjoy.
4. If possible, add some vigorous exercise for extra health
and fitness.
Vigorous exercise means physical activities that make a person breathe a lot
harder than normal (‘huff and puff’). It includes such activities as active sports
(eg, rugby, netball), aerobics, jogging, vigorous waka ama, oe vaka, power
walking uphill.
In addition to 30 minutes a day of moderate-intensity physical activity,
encourage people to add some vigorous exercise. This achieves greater health
benefits including extra protection against heart disease, and improvement in
fitness and sports performance. For best results this type of activity should be
done for a minimum of 20 minutes on 3-4 days a week. Start people off slowly
at a low level, building up gradually over a number of weeks.
ANY activity is better than none, and
MORE activity is better than a little.
1
The World Health Report: Reducing Risks, Promoting Healthy Life. WHO, 2002.
Exercise Management, Concepts and Professional Practice. Mackinnon, Ritchie et al,
Human Kinetics, Australia, 2002.
2
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MOVEMENT = HEALTH
Encourage physical activity:
it’s FUN and it’s FREE!
• Make physical activity FUN! All activities have the potential for being fun
and rewarding. Encourage people to choose activities they enjoy. If time is
an issue, give them ideas for adding fun and movement into their lifestyles,
eg, mopping the floors to music; racing the lift when using the stairs;
dancing/bending/flexing when hanging out the clothes. Motivate people
to try new activities - this can be lots of fun especially if done with friends,
whanau or workmates.
• It costs next to nothing! Many activities are free - walking, dancing,
playing games with the children, mowing the lawn. Encourage people to
take advantage of New Zealand’s diverse opportunities for cheap or free
activities - bushwalks, swimming, hill climbing, cycling, team sports, fishing,
tramping, hunting.
• Get creative with incidental activities! Encourage people to maximise
ovement in their everyday activities, eg, meeting a friend for a walk rather
than for a cup of tea; washing the windows today instead of putting it off
till next week; walking the kids to school instead of seeing them off at the
front door. Knowing that health benefits can be gained from increasing
one’s daily movement can make even the most routine activity seem more
attractive!
• Enjoy the natural environment. It’s fun to get out and about in the natural
environment under one’s own steam. Walking or cycling in the fresh air,
through parks, trails and reserves, at the beach or in the countryside offers
enjoyment and satisfaction.
• Rewards! Remind people of the rewards they receive from becoming more
physically active, eg, the range of health benefits, the feeling of personal
achievement, improved confidence, increased energy, and a greater sense
of control over their lives. Encourage them to reward themselves once in
a while, eg, call in a babysitter and step out with a friend; go dancing or
fishing - or indulge in a massage or mirimiri after rowing, enjoy a healthy
café lunch with a walking group; or buy a new pair of jeans after losing
some weight.
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A RESOURCE FOR HEALTH PROFESSIONALS
For older people - it’s never
too late to start
Let older people know that, whatever their age and however inactive they are,
health benefits will begin shortly after they become regularly active. Advise
them to check with their doctor before starting regular physical activity.
When promoting the recommended 30 minutes of moderate physical
activity, be aware that the term ‘moderate’ is relative to the fitness of the
individual at the time. In healthy older adults, moderate activity might
include brisk walking, golf, table tennis, climbing stairs, gardening, kapa
haka, siva, ballroom dancing, jazzercise, cycling; - for others it may be
walking at a relatively slow pace to the shops.1
For inactive or frail older people, 30 minutes of continuous physical activity
may be unattainable, but evidence shows that a ‘snacktivity’ approach to
achieving the 30-minute goal will also confer health gains. Some may never
reach the 30-minute goal, but point out that even the smallest amounts of
activity will bring significant benefits. The greatest gains are when sedentary
older adults become ‘a little more active a little more often’. Small bouts of five
minutes is a start, such as walking to the letterbox or going to make a cup of
tea.2
It is also important to encourage balance exercises in older people to help
prevent falls, eg, tai chi, aqua - aerobics and exercise classes.
For older people, including frail older people, being active in daily life can:
• maintain and/or increase muscle strength and flexibility
• improve balance and coordination
• reduce the incidence and severity of injury from falls
• reduce stress and anxiety, reduce the risk of depression and enhance a
sense of wellbeing, mood and self-esteem
• reduce the risk of suffering from cardiovascular diseases, cancer, diabetes
and osteoporosis
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MOVEMENT = HEALTH
• enhance sleep quality
• lead to new friendships due to widening social networks3
• enhance independent living.
For health promoters working with older people, check out the Otago
Exercise Programme. This home-based programme is designed specifically to
prevent falls in older people. For details about this programme in your region,
phone 0800 THINKSAFE (0800 844 657). Alternatively, visit the website:
www.acc.co.nz – click on How do I prevent injury? then click on Home
safety, then select Fall prevention in older adults.
“I am 74 years old and find the exercise
that I am doing is keeping me fit and
healthy.”
4
1
Silver Surfers? The Benefits of an Active Older Life. www.sportex.net
2
Ibid.
3
Ibid.
4
Respondent’s comment: Survey of Green Prescriptions Patients, July 2004.
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A RESOURCE FOR HEALTH PROFESSIONALS
Overcoming barriers to
physical activity
A fully inclusive society is one in which people of all abilities have the
opportunity to participate. In terms of physical activity it is important that
barriers to participation and achievement are identified and removed so that
everyone has access to opportunities for participating and achieving.
Based on surveys and research in New Zealand, the Ministry of Health1 has
identified the following barriers to physical activity:
1. lack of time
2. other responsibilities (family, job, particularly for women)
3. lack of knowledge about facilities and opportunities to be active
4. feelings of inadequacy (eg, negative perception of body image)
5. fear of failure
6. language (new immigrants)
7. injury or disability
8. no one to be physically active with
9. no motivation
10. poor health.
Strategies that may help people to overcome these barriers are set out on the
following page.
Physical activity can add years to your life,
and life to your years!
1
Physical Activity Toolkit, DHB Toolkits. Op cit.
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MOVEMENT = HEALTH
Strategies to help overcome
barriers to physical activity
Identified barriers to
physical activity
Strategies to help overcome
barriers
• Lack of time
• Encourage people to choose
activities that they are familiar
with and can easily integrate into
their lifestyles, such as walking not
driving; housework; using the stairs;
walking the dog; playing with the
children
• Other responsibilities (family,
job etc)
• Fear of failure
• Language (new immigrants)
• No one to be physically
active with
• No motivation
• Lack of knowledge about
facilities and opportunities to
be active
• No one to be physically
active with
• No motivation
14
• Inform people of facilities and
opportunities within their localities
• Encourage them to integrate activity
into their daily lives as an alternative
to gyms, clubs etc
• Link up like-minded people so that
they can explore facilities together,
plan together and support each
other
A RESOURCE FOR HEALTH PROFESSIONALS
Identified barriers to
physical activity
Strategies to help overcome
barriers
• Feelings of inadequacy (body
beautiful image)
• Plan special activities to increase
confidence and meet specific needs,
eg, small non-threatening group
sessions; setting achievable goals etc
• Fear of failure
• Language (new immigrants)
• Injury or disability
• Poor health
• No motivation
• Set up buddy systems for support
and motivation
• Link in with agencies that support
those with special needs, eg,
Arthritis NZ, Heart Foundation
Cardiac Clubs etc
• Encourage those with chronic health
conditions to see their GP. This may
result in the person being given a
Green Prescription (refer to page 29)
• For all barriers
• Help people set achievable goals,
both short and long term
• Encourage commitment to regular
daily activity by providing ongoing
support and contact
15
MOVEMENT = HEALTH
In some cases, overcoming barriers may be as easy as learning what other
organisations or groups in the region are doing - for example, local councils
may provide walkways with wheelchair access; aquatic centres may provide
swimming programmes for women only, or for people with specific needs;
local neighbourhoods may have started walking school buses, or walk groups.
Inclusive physical recreation, activity and sport means meeting the unique
needs and preferences of all individuals in the community. The Halberg
Trust Sport Opportunity Programme is committed to ensuring people with
a disability can take part in inclusive sport and active leisure within their
community. See www.halberg.co.nz for a list of Sport Opportunity Advisors.
For further information about inclusive physical activity, refer to the No
Exceptions Strategy and Implementation Plan distributed by SPARC in June
2005. This document is linked to the New Zealand Disability Strategy (2001)
and is intended to guide the strategies and actions of all agencies involved
in the provision of physical recreation and sport opportunities for disabled
people.
“People who exercise regularly actually
get more pleasure out of the little things
in life: their friendships, their careers,
their meals, their hobbies, even the
smiles of passersby!”
1
1
Run for your life, David Servan-Schreiber, Psychotherapy Networker, July/August, 2004.
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Linking in with other
initiatives
The Guidelines for Physical Activity are supported by a number of organisations
concerned with improving health/hauora/wellbeing through physical activity.
Linking in with these organisations helps to keep costs down, maximise
resources and prevent duplication.
It makes good sense to contact:
• health promotion teams at your Regional Public Health Unit and/or Primary
Health Organisation (PHO) to explore ways of supporting and linking in
with local initiatives
• your local regional sports trust (RST) to find out about facilities, clubs and
initiatives happening in your region: phone 0800 ACTIVE (0800 228 483).
RSTs also have access to the many physical activity leaflets produced by
SPARC
• SPARC Green Prescriptions resource order form can be downloaded from
www.sparc.org.nz
• health agencies such as the National Heart Foundation (www.nhf.org.nz),
Te Hotu Manawa Maori (www.tehotumanawa.org.nz), the Cancer Society
(0800 800 426; wwwcancersoc.org.nz), Arthritis NZ (www.arthritis.org.nz),
Agencies for Nutrition Action (www.ana.org.nz) and Diabetes NZ (0800
342 238; www.diabetes.org.nz) for resources, advice and information on
physical activity, healthy eating and maintaining a healthy body weight
• your local government body: town and city councils have a number of
recreational facilities and programmes catering for a range of activities.
“I have met a group of people who face
similar problems and we have a lot of fun
and chat after our exercises.”
1
1
Respondent’s comment: Survey of Green Prescriptions Patients, July 2004.
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MOVEMENT = HEALTH
The link between physical
activity, nutrition and
keeping a healthy weight
New Zealand, along with many other countries, is in the throes of an obesity
epidemic. More than 1000 people die each year from obesity-related health
problems. From 1989 to 1997 there was a 55% increase in the prevalence of
obesity. In 1997, overweight (35%) and obesity (17%) affected more than
half of New Zealand adults.1
Obesity is a condition in which the fat stores (adiposity) are excessive for an
individual’s height, weight, gender and race to an extent that it produces
adverse health outcomes. Obesity develops over time when a person’s energy
intake (food and beverages) is regularly greater than energy expenditure
(physical activity),2 resulting in the storage of excess energy (fat or adipose
tissue).
Committing to regular physical activity and choosing healthier foods can help
address the energy imbalance that leads to overweight and obesity.
An optimal approach is to promote the four guidelines for physical activity
in conjunction with good nutrition. Remind people that health benefits
- including keeping a healthy weight - are maximised when physical activity is
supported by a healthy eating plan. Encourage people to view healthy eating
as a positive experience - an opportunity to explore and enjoy a range of
nutritious foods, and a chance to limit consumption of fatty/salty/sugary foods
and drinks.
The New Zealand Food and Nutrition Guidelines for Healthy Adults3 offer
practical recommendations for those wishing to adopt a healthy eating plan.
These include:
1. Maintain a healthy body weight by eating well and by daily physical
activity.*
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A RESOURCE FOR HEALTH PROFESSIONALS
2. Eat well by including a variety of nutritious foods from each of the
four major food groups each day.
• Eat plenty of vegetables and fruits.
• Eat plenty of breads and cereals, preferably wholegrain.
• Have milk and milk products in your diet, preferably reduced or lowfat options.
• Include lean meat, poultry, seafood, eggs or alternatives.
3. Prepare foods or choose pre-prepared foods, drinks and snacks:
• with minimal added fat, especially saturated fat
• that are low in salt; if using salt, choose iodised salt
• with little added sugar; limit your intake of high-sugar foods.
4. Drink plenty of liquids each day, especially water.
5. If choosing to drink alcohol, limit your intake.
6. Purchase, prepare, cook and store food to ensure food safety.
Further information on healthy food choices can be found in the
health education resources on the Ministry of Health website
(www.healthed.govt.nz).
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MOVEMENT = HEALTH
Note:
For those who find weight loss difficult to achieve or maintain, emphasise
the benefits of physical activity - let them know that fatter active people have
better health outcomes than skinny sedentary people.
“Me mohio te tangata ki te ata kai, me te
kori tinana hei hoa!”
4
It’s about knowing how much to eat, plus exercise.
NZ Food: NZ People - Key Results of the 1997 National Nutrition Survey, Russell, Parnell,
Wilson et al, Ministry of Health, 1999.
1
2
Health Eating - Healthy Action. Oranga Kai - Oranga Pumau: A Background. Op cit.
Food and Nutrition Guidelines for Healthy Adults: A Background Paper, Ministry of Health,
October 2003. (www.moh.govt.nz)
3
Oranga Kai, Healthy Eating for Maori, Code 1440. Comment by Jacqui Te Kani, President,
Maori Women’s Welfare League, Ministry of Health, 2004.
4
* 30 minutes of moderate-intensity physical activity on most if not all days of the week and if
possible add some vigorous exercise for extra health and fitness.
20
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The five dimensions of
physical activity
1
Note: Most of the information in this section and the following section,
Physical activity and intensity levels, is relevant to health promoters and others
who are skilled in planning and implementing physical activity programmes
and interventions.
When developing programmes to increase physical activity the following
elements need to be taken into account:
• the health and fitness level of the individual
• the five dimensions or components of physical activity. These include the
FITT components...
-
Frequency - how often should the activity be done?
-
Intensity - how much effort is appropriate?
-
Time (duration) - what length of time should each activity take?
-
Type - what type of activity is appropriate, eg, aerobic,* weight
bearing?
… and the social context in which the activity takes place.
The diagram on the next page shows these five dimensions and associated
variables which need to be considered when planning interventions.
* Aerobic activity is activity which gives the heart and lungs a continuous
workout. It involves any extended activity that makes a person breathe hard
while using the large muscle groups (eg, legs and arms) at a regular, even
pace. Aerobic activities help make the heart stronger and more efficient.
1
Physical Activity Toolkit; DHB Toolkits. Op cit.
21
MOVEMENT = HEALTH
Figure 1: The five dimensions of physical activity
TIME
• dependent on age and
intensity
• generally an accumulation
of 150 mins moderateintensity activity per week
• ‘snacktivity’ of 10 mins, 3
times per day
FREQUENCY
SOCIAL CONTEXT
• spreading physical activity
over 5 days per week is
best
• sport and recreation
• paid/unpaid work
• transport - requires safe
environment
• incidental - eg,
housework, gardening
TYPE
Physical
Activity
• activity should be lifelong
for continued benefit
INTENSITY
• depends on health/risk
factors
• moderate activity,
achievable for most
• aerobic/resistance/weight
bearing
• increased benefit with
vigorous activity
• a balance of aerobic and
strength is best
• light activity is better than
no activity
Source: Adapted from Physical Activity Toolkit; DHB Toolkits, Ministry of Health website:
www.newhealth.govt.nz/toolkits
Keep a pair of comfortable walking shoes
or sneakers in the car or office.
22
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Physical activity and intensity
levels
Intensity levels can be measured in a number of ways.
One relatively simple method is the talk test method. A person who is
active at a light intensity level (eg, walking slowly, pruning, doing very light
gardening, bicycling with very little effort, lightly treading water) should be
able to sing while doing the activity. One who is active at a moderate intensity
level should be able to carry on a conversation comfortably. If a person
becomes winded or too out of breath to carry on a conversation, the activity
can be considered vigorous.1
Some people use the Borg Rating of Perceived Exertion (RPE) to determine
their physical activity intensity. Perceived exertion is how hard a person feels
their body is working and is based on their physical experiences during activity,
such as increases in heart rate, breathing, sweating and muscle fatigue. Visit
www.cdc.gov/nccdphp/dnpa/physical/measuring/perceived_exertion.htm for
more information on RPE or do a Google search on Borg Rating of Perceived
Exertion Scale.
The Metabolic Equivalent (MET) measurements is another way of measuring
intensity levels and may be useful to health promoters and others skilled in
planning and implementing physical activity interventions. One MET is defined
as the energy expenditure for sitting quietly. A 2-MET activity therefore
requires two times the metabolic energy expenditure of sitting quietly.
Moderate-intensity physical activity refers to any activity equivalent to 3-6
METs (or that burns 15 to 30 kilojoules [KJ] per minute). Vigorous-intensity
physical activity refers to any activity of more than 6 METs (or that burns
more than 30 kJ per minute).
If planning a physical activity intervention based on the MET intensities, the
health and fitness of the client plus frequency and duration rates for the
activity will need to be factored into the intervention.
Centers for Disease Control and Prevention website: www.cdc.gov/nccdphp/dnpa/physical/
measuring/talk_test.htm
1
23
MOVEMENT = HEALTH
A range of activities and their approximate intensity levels is set out below.
Figure 2: Activities and intensity levels by METs
Moderate-intensity activity
Vigorous-intensity activity
3-6 METs (15-30 kJ/min)
More than 6 METs (more than 30 kJ/min)
• Walking briskly (4.5-7 kph) on flat terrain
• Aerobic walking (8 kph or more)
• Walking with crutches
• Walking briskly uphill, jogging or
running
• Rollerskating at leisurely pace
• Bicycling, flat terrain (approx 8-14 kph)
• Stationary bicycling using moderate effort
• Water aerobics
• Yoga
• Gymnastics
• Dancing
• Golf
• Swimming (recreational)
• Rowing at less than 6 kph
• Skateboarding
• Gardening
• Yard work: raking leaves, planting trees,
bagging leaves, hoeing etc
• Mowing lawn with motorised mower
• Housework: scrubbing floor/bathtub; hanging
out washing; sweeping; washing windows;
packing/unpacking boxes etc
• Roller skating at brisk pace
• Bicycling more than 16 kph, or uphill
• Stationary bicycling using vigorous
effort
• Step or dance aerobics; water jogging
• Calisthenics: push-ups; pull-ups etc
• Vigorous skipping, rowing machine etc
• Energetic dancing
• Tennis singles, wheelchair tennis
• Swimming: steady, paced laps
• Rowing at more than 6.5 kph
• Sports: squash, wheelchair basketball; volleyball; rugby/soccer game, water polo; netball
game etc
• Heavy yard work: digging ditches; felling
trees; splitting logs; rapid shovelling of earth/
sand
etc
• Actively playing with children
• Mowing lawn with hand mower
• Bathing and dressing an adult
• Heavy housework: moving/pushing heavy
• Home repair: cleaning gutters, sanding floor,
removing carpet or tiles; carpentry
24
furniture (34 kg or more); shovelling coal;
carrying items (11 kg or more) upstairs etc
• Playing vigorously with children
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Moderate-intensity activity
Vigorous-intensity activity
3-6 METs (15-30 kJ/min)
More than 6 METs (more than 30 kJ/min)
• Washing and waxing car by hand
• Jogging while pushing a pushchair
• Workplace jobs: waiting tables; cleaning;
• Heavy home repair: hard physical labour,
picking fruit/vegetables; digging; building;
labouring; bathing and dressing adults etc
hand sawing hard wood; carrying loads of 23
kg or more
• Workplace jobs: couriers constantly running
upstairs with loads; other work requiring
much pushing, pulling, carrying, firefighting,
forestry work, coal mining, loading trucks etc.
Source: Adapted from: Promoting physical activity: A Guide for Community Action. Human
Kinetics,1999, US Department of Health and Human Services, Centers for Disease Control and
Prevention, Division of Nutrition and Physical Activity.
Doing lots of extra little activities throughout the day CAN make a difference.
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MOVEMENT = HEALTH
Physical activity and chronic
health conditions
To recap, the New Zealand Guidelines for Physical Activity are set out below:
1. View movement as an opportunity, not an inconvenience.
2. Be active every day in as many ways as possible.
3. Put together at least 30 minutes of moderate-intensity physical activity on
most if not all days of the week.
4. If possible, add some vigorous exercise for extra health and fitness.
For some people with health conditions some of these guidelines may not be
appropriate. It is strongly recommended that people with health conditions
or injuries first consult with their GP and a qualified exercise specialist before
increasing their physical activity.
The section that follows, based on recent research by the Ministry of Health,1
outlines the recommended activities to reduce the risk of, or improve
outcomes for, a number of chronic health conditions and life stages.
1
Healthy Eating - Healthy Action. Oranga Kai - Oranga Pumau: A Background. Op cit.
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Alzheimer’s disease: regular, moderate aerobic activity is associated with
a reduction in the risk of developing Alzheimer’s disease.
Anxiety: any activity that is acceptable, appropriate and self-chosen can
reduce anxiety, especially if maintained over the long term.
Asthma: there is some evidence that physical fitness is associated with a
reduced risk of adult-onset asthma. Activity for the prevention of adultonset asthma should be moderate to vigorous intensity.
Cancer: regular activity reduces the risk of some cancers - for example,
aerobic activity reduces the risk of colon and breast cancer, while 45-60
minutes of moderate to vigorous activity appears to protect against
colorectal cancer, and there is some evidence that physical activity has a
preventive effect for cancer of the endometrium and prostate.
CORD (chronic obstructive respiratory disease): regular aerobic activity
may result in improvements in ventilation, oxygen consumption and
dyspnoea in people with CORD. Strength or resistance training may also be
useful to reduce muscle fatigue.
Coronary heart disease: aerobic activity is important for the prevention
and control of coronary heart disease. A close relationship exists, with
increasing benefits obtained through increasing intensity. Activity should
be performed regularly.
CVA (cerebrovascular accident or stroke): aerobic activity (particularly
vigorous activity) in middle-aged and older adults is associated with a
reduced risk of stroke. The risk decreases with increasing intensity of
aerobic activity, so some vigorous activity is recommended.
Depression: regular aerobic activity of light or moderate intensity can
improve mood in those with major depressive disorders and reduce the risk
of depression in others.
Diabetes: regular moderate-intensity physical activity reduces the risk of
developing type 2 diabetes, especially in those at high risk.
Hypertension: aerobic activity can reduce blood pressure in the short
term, and in the long term if activity level is maintained.
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MOVEMENT = HEALTH
Longevity: a lifelong commitment to a high level of physical activity in
terms of duration and frequency, and to a lesser degree intensity, can
improve disability-free years of life and life expectancy.
Obesity: regular, moderate-intensity physical activity aids in the
prevention, maintenance and treatment of obesity.
Osteoarthritis: both resistance and selected aerobic activities can improve
symptoms and functions if activities are maintained.
Osteoporosis: moderate and vigorous activity in asymptomatic adults
helps preserve bone density and reduce fracture risk. Modified physical
activity is recommended in those with osteoporosis to improve posture and
muscle strength, and to maintain bone mass.
Pregnancy: moderate intensity physical activity is important for foetal
wellbeing.
Stress: any leisure-time activity that is enjoyable may reduce subjective
stress.
It doesn’t have to be hard to be good
for you.
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Physical activity and Green
Prescriptions (GRx)
Some people, especially those with chronic health conditions or injuries,
may need to see their GP before beginning a physically active lifestyle. They
may, after medical assessment, be given a Green Prescription or GRx. Green
Prescriptions are based on a partnership between primary healthcare providers,
regional sports trusts and SPARC and offer a coordinated approach to
increasing physical activity levels.
GPs and practice nurses can offer Green Prescriptions to patients who are
inactive and/or who would benefit from increased physical activity. This
includes people with conditions such as hypertension, obesity, diabetes,
osteoporosis, anxiety or depression. Before receiving a GRx the medical
condition must be stabilised.
A patient with a Green Prescription is referred by the medical centre to the
local regional sports trust. Professional staff at the regional sports trust can
then ‘usher’ patients into regular appropriate physical activities, provide
personal encouragement, monitor compliance and give feedback to the
referring GP and practice nurse. Patients can also access regional sports trusts
by phoning 0800 ACTIVE (0800 228 483).
“GRx encouraged me to enter Round
the Bays - it gave me a goal to go for.”
“If it wasn’t for their (RST) support I
would still be a couch potato; now my
weekends are a lot more enjoyable
than before I started.”
1
1
Respondents’ comments: Survey of Green Prescriptions Patients, July 2004.
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MOVEMENT = HEALTH
Notes
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Notes
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MOVEMENT = HEALTH
Notes
32
Level 4, 78 Victoria St
PO Box 2251 Wellington
Ph: 04 472 8058
Fax: 04 471 0813
www.sparc.org.nz