How many steps/day are enough? For adults.

Physical activity guidelines from around the world are typically expressed in terms of frequency, duration, and intensity parameters. Objective monitoring using pedometers and accelerometers offers a new opportunity to measure and communicate physical activity in terms of steps/day. Various step-based versions or translations of physical activity guidelines are emerging, reflecting public interest in such guidance. However, there appears to be a wide discrepancy in the exact values that are being communicated. It makes sense that step-based recommendations should be harmonious with existing evidence-based public health guidelines that recognize that "some physical activity is better than none" while maintaining a focus on time spent in moderate-to-vigorous physical activity (MVPA). Thus, the purpose of this review was to update our existing knowledge of "How many steps/day are enough?", and to inform step-based recommendations consistent with current physical activity guidelines. Normative data indicate that healthy adults typically take between 4,000 and 18,000 steps/day, and that 10,000 steps/day is reasonable for this population, although there are notable "low active populations." Interventions demonstrate incremental increases on the order of 2,000-2,500 steps/day. The results of seven different controlled studies demonstrate that there is a strong relationship between cadence and intensity. Further, despite some inter-individual variation, 100 steps/minute represents a reasonable floor value indicative of moderate intensity walking. Multiplying this cadence by 30 minutes (i.e., typical of a daily recommendation) produces a minimum of 3,000 steps that is best used as a heuristic (i.e., guiding) value, but these steps must be taken over and above habitual activity levels to be a true expression of free-living steps/day that also includes recommendations for minimal amounts of time in MVPA. Computed steps/day translations of time in MVPA that also include estimates of habitual activity levels equate to 7,100 to 11,000 steps/day. A direct estimate of minimal amounts of MVPA accumulated in the course of objectively monitored free-living behaviour is 7,000-8,000 steps/day. A scale that spans a wide range of incremental increases in steps/day and is congruent with public health recognition that "some physical activity is better than none," yet still incorporates step-based translations of recommended amounts of time in MVPA may be useful in research and practice. The full range of users (researchers to practitioners to the general public) of objective monitoring instruments that provide step-based outputs require good reference data and evidence-based recommendations to be able to design effective health messages congruent with public health physical activity guidelines, guide behaviour change, and ultimately measure, track, and interpret steps/day.

How many steps/day are enough? For older adults and special populations.

Older adults and special populations (living with disability and/or chronic illness that may limit mobility and/or physical endurance) can benefit from practicing a more physically active lifestyle, typically by increasing ambulatory activity. Step counting devices (accelerometers and pedometers) offer an opportunity to monitor daily ambulatory activity; however, an appropriate translation of public health guidelines in terms of steps/day is unknown. Therefore this review was conducted to translate public health recommendations in terms of steps/day. Normative data indicates that 1) healthy older adults average 2,000-9,000 steps/day, and 2) special populations average 1,200-8,800 steps/day. Pedometer-based interventions in older adults and special populations elicit a weighted increase of approximately 775 steps/day (or an effect size of 0.26) and 2,215 steps/day (or an effect size of 0.67), respectively. There is no evidence to inform a moderate intensity cadence (i.e., steps/minute) in older adults at this time. However, using the adult cadence of 100 steps/minute to demark the lower end of an absolutely-defined moderate intensity (i.e., 3 METs), and multiplying this by 30 minutes produces a reasonable heuristic (i.e., guiding) value of 3,000 steps. However, this cadence may be unattainable in some frail/diseased populations. Regardless, to truly translate public health guidelines, these steps should be taken over and above activities performed in the course of daily living, be of at least moderate intensity accumulated in minimally 10 minute bouts, and add up to at least 150 minutes over the week. Considering a daily background of 5,000 steps/day (which may actually be too high for some older adults and/or special populations), a computed translation approximates 8,000 steps on days that include a target of achieving 30 minutes of moderate-to-vigorous physical activity (MVPA), and approximately 7,100 steps/day if averaged over a week. Measured directly and including these background activities, the evidence suggests that 30 minutes of daily MVPA accumulated in addition to habitual daily activities in healthy older adults is equivalent to taking approximately 7,000-10,000 steps/day. Those living with disability and/or chronic illness (that limits mobility and or/physical endurance) display lower levels of background daily activity, and this will affect whole-day estimates of recommended physical activity.

[Effects of the government's healthy living program on metabolic markers and physical capacity in Chilean women]. / Efectos del programa gubernamental vida sana en marcadores metabólicos y capacidad física en mujeres Chilenas.

OBJECTIVE: To determine the effects of the government's healthy living plan on metabolic markers and physical capacity in sedentary women from Villa Alemana, Chile. MATERIALS AND METHODS: 63 women who participated in the study (41.2±11.2 years) underwent 12 months of multi- and interdisciplinary intervention (doctor, nutritionist, psychologist and physical education teacher) of 180 minutes of physical activity per week. Mean and standard deviation were used for statistical analysis, while the t-test of related samples was used to determine the effects of the program. The level of significance was estimated with a value of p<0.05. RESULTS: There was a decrease in total cholesterol (p=0.003) and LDL cholesterol (p=0.048), improvement in the 6-minute test (p=0.000) and number of squats in thirty seconds (p=0.000) with a positive effect on delta recovery heart rate (p=0.001). CONCLUSIONS: The government's strategy resulted in a decrease of cardiovascular risk due to improved metabolic markers and women's physical capacity.

OBJETIVO: Determinar los efectos del plan gubernamental vida sana en marcadores metabólicos plasmáticos y capacidad física en mujeres sedentarias de Villa Alemana. MÉTODOS: Participaron 63 mujeres (41,2 ± 11,2 años) que fueron sometidas a 12 meses de intervención multi e inter-disciplinaria (médico, nutricionista, psicólogo(a) y profesor de educación física) (180 minutos de ejercicio por semana). En el análisis estadístico descriptivo se utilizaron la media y desviación estándar, la prueba T de muestras relacionadas se usó para determinar los efectos del programa, el nivel de significancia se estimó con un valor p<0,05. RESULTADOS: Se apreció una disminución en el colesterol total (p=0,003) y colesterol LDL (p=0,048), mejora en el test de 6 minutos (p=0,000) y número de sentadillas en treinta segundos (p=0,000) con un efecto positivo en el delta de recuperación de la frecuencia cardíaca (p=0,001). CONCLUSIÓN: La estrategia gubernamental produjo una disminución en el riesgo cardiovascular debido a una mejora en los marcadores metabólicos y capacidad física de las mujeres.

Efectos del programa gubernamental vida sana en marcadores metabólicos y capacidad física en mujeres Chilenas / Effects of the government's healthy living program on metabolic markers and physical capacity in Chilean women

RESUMEN Objetivo Determinar los efectos del plan gubernamental vida sana en marcadores metabólicos plasmáticos y capacidad física en mujeres sedentarias de Villa Alemana. Métodos Participaron 63 mujeres (41,2 ± 11,2 años) que fueron sometidas a 12 meses de intervención multi e inter-disciplinaria (médico, nutricionista, psicólogo(a) y profesor de educación física) (180 minutos de ejercicio por semana). En el análisis estadístico descriptivo se utilizaron la media y desviación estándar, la prueba T de muestras relacionadas se usó para determinar los efectos del programa, el nivel de significancia se estimó con un valor p<0,05. Resultados Se apreció una disminución en el colesterol total (p=0,003) y colesterol LDL (p=0,048), mejora en el test de 6 minutos (p=0,000) y número de sentadillas en treinta segundos (p=0,000) con un efecto positivo en el delta de recuperación de la frecuencia cardíaca (p=0,001). Conclusión La estrategia gubernamental produjo una disminución en el riesgo cardiovascular debido a una mejora en los marcadores metabólicos y capacidad física de las mujeres.(AU)

ABSTRACT Objective To determine the effects of the government's healthy living plan on metabolic markers and physical capacity in sedentary women from Villa Alemana, Chile. Materials and Methods 63 women who participated in the study (41.2±11.2 years) underwent 12 months of multi- and interdisciplinary intervention (doctor, nutritionist, psychologist and physical education teacher) of 180 minutes of physical activity per week. Mean and standard deviation were used for statistical analysis, while the t-test of related samples was used to determine the effects of the program. The level of significance was estimated with a value of p<0.05. Results There was a decrease in total cholesterol (p=0.003) and LDL cholesterol (p=0.048), improvement in the 6-minute test (p=0.000) and number of squats in thirty seconds (p=0.000) with a positive effect on delta recovery heart rate (p=0.001). Conclusions The government's strategy resulted in a decrease of cardiovascular risk due to improved metabolic markers and women's physical capacity.(AU)

Dislipidemias e a promoção da atividade física: uma revisão na perspectiva de mensagens de inclusão / Dislipidemia and physical activity: a review inclusive message perspective

As alterações no metabolismo dos lipídeos são uma das conseqüências negativas mais importantes do sedentarismo. O propósito deste artigo é rever os estudos mais significantes que analisaram a relação entre atividade/inatividade física no perfil lipídico. Considerando a ineficácia das intervenções anteriores que procuraram usar atividade física na prevenção e tratamento, especial atenção foi dedicada à informação científica que levou em conta práticas modernas, particularmente as que permitam uma maior aderência, essencial em programas de saúde pública. A revisão presente aborda as causas e os efeitos deletérios do sedentarismo na mobilização de lipídeos, o papel da atividade física moderada e acumulada, a eficácia de propostas de estilo de vida ativo, comparação de efeitos entre programas de condicionamento (fitness) com os estilo de vida (atividade física), as recomendações preventivas e terapêuticas, assim como recentes aspectos da relação entre dislipidemias e declínio na função cognitiva. Os estudos aqui sumarizados apontam que programas de atividade física são fundamentais na prevenção e no tratamento das dislipidemias, sendo que as evidências científicas do impacto positivo dos protocolos inclusivos de atividade física, que enfatizam as vantagens da intensidade moderada e da forma acumulada, podem em muito beneficiar a adesão e manutenção de pessoas em padrões regulares de atividade.

Changes in lipides metabolism has been one of the utmost negative consequences of sedentariness. The purpose of this paper was to review the most significant studies that have analyzed the relationship of physical activity/inactivity and lipids profiling. Considering the ineffective impact of former interventions in promoting physical activity as prevention or treatment tool, special attention was dedicated to the scientific information that took into account modern practices, particularly the ones which permitted a higher long term adherence, essential for public health programs. Present review comprised the harmful effects of sedentarism, the role of moderate physical activity, the role of accumulation approach, the effectiveness of active life style, comparing fitness to active living programs, the recommendations for prevention and treatment; and recent issues on the relationship between dislipidemias and declining in cognitive function. Summary of the review articles confirms that physical activity programs are fundamental in dislipidemia prevention and treatment. Scientific evidences showed the positive impact of inclusive physical activity protocols, particularly when emphasizing the advantages of moderate intensity and accumulated mode, increasing adherence and sustained physical activity.

Padrão da prescrição de atividade física realizada por médicos ortopedistas brasileiros / Pattern of physical activity prescription realized by brazilian orthopedic surgeons

Objetivo: avaliar a prescrição de atividade física realizada por ortopedistas brasileiros. Metodologia: 521 ortopedistas responderam um questionário sobre prescrição de atividade física. Os parâmetros prescritos de freqüência, duração e intensidade considerados corretos foram: realizar pelo menos 30 minutos contínuos ou acumulados de atividade moderada na maioria dos dias da semana. Utilizada análise estatística descritiva. Resultados: 86,4% prescrevem atividade física para a maioria dos pacientes, sendo caminhada (97,5%) e natação/hidroginástica (96,5%) as mais prescritas. Cerca de 60% prescrevem musculação, atividades cotidianas e corrida/jogging. Caminhada apresentou os maiores índices de acerto da freqüência (18,9%), duração (62,4%) e intensidade (44,1%). As porcentagens de acerto desses parâmetros para todas as atividades prescritas foram: 8,8%, 40,3% e 35,3%. A prescrição de atividades cotidianas foi a mais vaga, com pelo menos 50% sem a definição de freqüência e duração, 40% sem intensidade definida. A maioria prescreve verbalmente e poucos usam receituário. Musculação é mais prescrita para reabilitação. Caminhada e atividades cotidianas são prescritas principalmente para prevenção de doenças. Conclusões: o ortopedista brasileiro prescreve atividade física para a maioria dos pacientes como prevenção e tratamento de doenças, geralmente de forma verbal (diminuindo sua eficácia) e pouco condizentes com a recomendação atual para promoção da saúde.

Objective: to evaluate physical activity prescription performed by Brazilian orthopedic. Methodology: 521 orthopedic answered a questionnaire on physical activity prescription. The prescribed parameter of frequency, duration, and intensity of physical activity considered appropriate was: at least 30 continuous or accumulated minutes of moderate activity accomplished on most days of the week. Descriptive statistical analysis was applied to it. Results: 86.4% of the orthopedists prescribe physical activity for the majority of the patients. Walking (97.5%) and swimming/water aerobics (96.5%) are the most prescribed activities. Nearly 60% of them prescribe weight lifting, daily activities, and jogging. Walking had the highest rate of appropriateness on frequency (18.9%), duration (62.4%) and intensity (44.1%). Whereas for all prescribed activities the rate of appropriateness o those parameters were 8.8%, 40.3% and 35.3%. Daily activities had the most imprecise prescription, at least 50% did not define frequency and duration, and 40% lacked defined intensity. Most physicians prescribe verbally, and few of them use dispensatories. Weight lifting is mostly prescribed for rehabilitation, while walking and daily activities are mainly prescribed for prevention of diseases. Conclusions: the Brazilian orthopedic prescribes physical activity for the majority of patients as prevention and treatment of diseases, usually through a verbal mean (which lessens its efficacy) and not consistent with the current recommendation for health promotion.

Efeito de um programa de atividade física na aptidäo f1sica e na auto-percepçäo da aptidäo física em mulheres acima de 50 anos de idade / Effect of a physical fitness of women over 50 years-old

O objeto desse estudo foi verificar o efeito de um programa de atividade física na aptidäo física e na auto-percepçäo da aptidäo física em mulheres acima de 50 anos. Participaram do programa de 22 semanas, 2 vezes/semana, 1h/aula, 35 mulheres divididas em:experimental (GE), n=20,50 a 75 anos; e controle (GC), n= 15,50 a 83 anos. Foram analisadas as variáveis: adiposidade, índice de massa corporal IMC), força dos membros superiores e inferiores (MMII), flexibilidade do tronco, mobilidade (VA); agilidade e a endurance cardiorrespiratória(ECR). A auto-percepçäo (AP) foi avaliada de forma quantitativa: nota de 0(pior) a 10(melhor); e qualitativa: pior, igual ou melhor que seus pares. Análises estatísticas utilizadas: "teste t de student" e delta percentual na aptidäo física pré e pós programa; coeficiente de correlaçäo linear de Pearson para AP quantitativo e qui-quadrado e kappa para AP qualitativo com p menor que 0,05. Os resultados mostraram incremento significativo no GE nas variáveis VA, força dos MMII e agilidade, e manutençäo das demais variáveis da aptidäo física. Houve modelaçäo das variáveis e alta na AP quantitativa com a aptidäo física mensurada nas variáveis adiposidade, IMC, VA, agilidade e ECR. Na AP qualitativa houve concordância significativa na adiposidade do GE. Portanto podemos concluir que: a)a prática de atividade física teve bom efeito na manutençäo e/ou incremento das variáveis da aptidäo física; b)a AP quantitativa teve melhor relaçäo com o nível de aptidäo física do que AP qualitativa; c)sugere-se realizaçäo de novos estudos para consolidar a importância da AP, já que esta vem se apresentando como ótimo preditor do nível de aptidäo física em indivíduos mais velhos.(au)