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19 Sep 2024

How much exercise is enough – mixed messages?

Exercise

We are told leisure activities like walking the dog or gardening can help decrease stroke risk by as much as 30%.  Without question, some exercise is better than none.  Some activities such as walking are recommended as having universal ‘positives.’ However, many messages give different recommendations, and, at worst, conflicting information. How much exercise is enough?

While most fitness guidelines focus on an ideal amount of physical activity per day for good health, there is a study that indicates that even low levels of physical activity are an improvement over doing nothing at all. The World Health Organization’s 2020 guidelines on physical activity emphasize the message: “some physical activity is better than none.”

“[The study] seems to be in line with other research that’s been published recently that shows that even low levels of physical activity can have tremendous benefits in terms of overall health and affecting mortality,” Dr. Michael Fredericson, Director of the PM&R Sports Medicine and co-director of the Stanford Center on Longevity at Stanford Medicine. He wasn’t affiliated with the research.

In the study, published in March 2022, in BMJ Journal of Neurology, Neurosurgery & Psychiatry, scientists performed a meta-analysis on 15 study articles after reviewing more than 3,000 studies on “leisure-time physical activity,” a catch-all term for any kind of physical activity, no matter the intensity. It encompasses a range of activities from gardening and walking to hiking, biking, and weightlifting.

An inactive or sedentary lifestyle is an established risk factor for many long-term conditions, including obesity, heart disease, type 2 diabetes and stroke. While that is well known, just how much physical activity someone needs to see health benefits isn’t as clear. In fact, the study points out that there isn’t even a consensus about the minimum amount of physical activity to decrease risk of stroke.

So, in a world where only one-in-four US adults meet physical activity guidelines, it’s understandable why researchers would want to know what the effects of doing even the bare minimum amount of exercise are on serious outcomes like stroke.

There is a clear signal from across 15 previously published articles that even minimal amounts of physical activity improved the risk of stroke, independent of age and sex.

Compared to individuals who did no leisure-time physical activity whatsoever, those who did even small amounts reduced their risk of stroke by between roughly 10-30%.

The study also found confirmatory results when looking at specific kinds of stroke outcomes. For ischemic stroke, the most common type of stroke, which is caused by an obstruction in a vessel supplying blood to the brain, individuals who demonstrated low levels of physical activity had a 13% reduction in risk compared to those with none.

Results were similar for haemorrhagic stroke, a less common form of stroke that occurs when a blood vessel bursts and begins to bleed in the brain. In this case, low levels of physical activity resulted in a 16% risk reduction compared to no physical activity.

What to know about physical activity

Part of the difficulty of assessing the health benefits of physical activity is its subjective nature: what is “moderate” for one person could be “intense” for another. So, when the researchers set out to do their review, they found differences in how prior studies categorized levels of exercise.

In total, 15 studies were included, which included more than 750,000 individuals, with an average follow-up time of 10 years.

Five of the studies used three levels to categorize physical activity (“none,” “below target,” and “ideal”); six studies used four (“none,” “low,” “moderate,” and “intense”); and two studies used five levels (“none,” “insufficient,” “low,” “moderate,” and “intense”).

But no matter how many categories the studies used or how they defined low levels of exercise, all showed a benefit compared to “none.”

Of course, high levels of physical activity tended to show more benefit as well. Individuals who had “moderate” levels of physical activity had a reduction in stroke risk of about 33%.

Interestingly, when individuals exercised at the highest level, “intense,” benefits seemed to diminish compared to more moderate exercise. In two of the studies, an “intense level” showed only a 2% improvement compared to doing no exercise at all.

How much exercise should you get?

In 2022/23 in New Zealand 46.5% of adults met physical activity guidelines (meaning they did at least 2.5 hours of activity in the past week, spread out over the week). This is a decline from 51.3% in 2021/22. A higher percentage of men (49.6%) than women (43.7%) met physical activity guidelines in 2022/23.

Even adults with limited physical capabilities, who can only engage in limited amounts of physical activity, can experience its benefits. So, our main message is to encourage exercise. Even small amounts can make a difference for prevention of heart and blood vessel conditions. 

The bottom line

Even small amounts of physical activity can significantly improve your risk of stroke, according to a new study. The more active you are, the better the health effects, but the study indicates that some is better than none.

There is consensus across studies that it is unhealthy to sit for more than half an hour without standing and moving. It is more beneficial to walk even a short distance into another room or walking the length of your indoors area a few times before sitting down again. For people who cannot walk, discuss with a physiotherapist the specific regular upper body movements and stretches, that can make a positive difference.

In 2024 New Zealand The Ministry of Health reviewed and confirmed their 2013 booklet ‘Guidelines on Physical Activity for Older People’ (aged 65 years and older). The fact sheet published in 2024 tells us how much exercise and what types of exercise are recommended for 65+ year olds in New Zealand. The Ministry of Health summary sheet is at www.health.govt.nz, then click on publications, then type in Guidelines on Physical Activity for Older People (aged 65years and over), then click on the Read More button to go to the Summary Sheet.

A summary of the above Ministry of Health Guidelines can be found on The  Selwyn Foundation website at www.selwynfoundation.org.nz/informing/information-about-ageing/walk-this-way    

 

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Published: September 2024

To be reviewed: August 2027