Our physical activity 'dose-response' recommendations for protection against chronic diseases and mortality are correct?
Abstract
It is virtually agreed that physical activity and exercise (PA&E) protect against various non-communicable chronic diseases and mortality. However, the 'dose-response' relationship is not yet clear. It is still under investigation which (modalities, types) and how much (intensity and volume) of PA&E promote the best response. The main recommendations indicate an approximate range of 500 to 1750 MET.min/wk, or 150 to 300 min/wk of moderate effort, or 75 to 150 min/wk of vigorous effort. In this paper we challenge the use of MET or Kcal as a reference for PA&E dose, and we point out that the protective effect of PA&E can be obtained at lower and higher doses than currently has been recommended. However, apparently, we would need to achieve an adequate counterbalance of intensity-volume (CIV). We propose that it is possible to obtain protective effect in different scenarios such as 'high intensity with very low volume' or, at the other end, 'very high volume with very low intensity' since CIV is adequate. Here we highlight important limitations of the main PA&E recommendations regarding dose-response, such that recommendations are paradoxically restrictive and limitless. They are restrictive because consider basically traditional leisure-time PA (e.g., aerobic and cyclic activities), volume is restricted to a given time interval, intensity limited on two categories of effort (moderate and vigorous), and dose <500 MET.min/wk is disregarded as effective in protection. They are limitless because also suggest 'the more PA&E the better!', which does not seem reasonable in the light of scientific evidence. We support our proposal from the accumulated scientific knowledge, and we bring additional elements to feed reflections on this important topic.
References
-Ainsworth, B. E.; Haskell, W. L.; Herrmann S. D.; Meckes, N.; Bassett, D. R. Jr.; Tudor-Locke, C. Compendium of Physical Activities: A Second Update of Codes and MET Values. Med Sci Sports Exerc. Vol. 43. Num. 8. p. 1575-81. 2011.
-Ãlvarez, C.; RamÃrez-Campillo, R.; RamÃrez-Vélez, R.; Izquierdo, M. Effects and prevalence of nonresponders after 12 weeks of high-intensity interval or resistance training in women with insulin resistance: a randomized trial. J Appl Physiol. Vol. 1. Num. 122. p. 985-996. 2017.
-Arem, H.; Moore, S.C.; Patel. A.; Hartge, P.; Berrington de Gonzalez, A.; Visvanathan, K. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship. JAMA Intern Med. Vol. 175. Num. 6. p. 959-67. 2015.
-Blair, S.N.; Kohl, H.W.; Gordon, N.F.; Paffenbarger Jr. R.S. How much physical activity is good for health? Annu Rev Public Health. Vol. 13. p. 99-126.1992.
-Byrne, N.M.; Hills, A. P.; Hunter, G. R.; Weinsier, R.L.; Schutz, Y. Metabolic equivalent: one size does not fit all. J Appl Physiol (1985). Vol. 99. Num. 3. p. 1112-9. 2005.
-Campbell, W.W.; Kraus, W.E.; Powell, K.E.; Haskell, W.L.; Janz, K.F.; Jakicic, J.M. High-Intensity Interval Training for cardiometabolic disease prevention. Med Sci Sports Exerc. Vol. 51. Num. 6. p. 1220-6. 2019.
-Choi, K.W.; Chen, C-Y.; Stein, M.B.; Klimentidis, Y.C.; Wang, M.J.; Koenen, K.C. Major depressive disorder working group of the psychiatric genomics consortium. assessment of bidirectional relationships between physical activity and depression among adults: a 2-sample mendelian randomization study. JAMA Psychiatry. Vol. 1. Num. 76(4). p. E1-E10. 2019.
-Cunha, F.A.; Midgley, A.W.; Montenegro, R.; Oliveira, R.B.; Farinatti, P.T. Metabolic equivalent concept in apparently healthy men: a re-examination of the standard oxygen uptake value of 3.5 mL.kg–1min–1. Appl Physiol Nutr Metab. Vol. 38. Num. 11. p. 1115-9. 2013.
-Dempsey, P.C.; Larsen, R.L.; Dunstan, D.W.; Owen, N.; Kingwell, B.A. Sitting less and moving more: implications for hypertension. Hypertension. Vol. 72. Num. 5. p. 1037-46. 2018.
-Faff, J. Physical activity, physical fitness, and longevity. Biology of Sport. Vol. 21. Num. 1. p. 3-24. 2004.
-Feigenbaum, M.S.; Pollock, M.L. Prescription of resistance training for health and disease. Med Sci Sports Exerc. Vol. 31. Num.1. p. 38-45. 1999.
-Fleck, S. J.; Kraemer, W.J. Fundamentos do treinamento de força muscular. 4ª edição. Porto Alegre. Artmed. 2017.
-Haskell, W.L.; Lee, I.M.; Pate, R.R.; Powell, K.E.; Blair, S.N.; Franklin, B.A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. Vol. 39. Num. 8. p. 1423-34. 2007.
-IPAQ - Guidelines for data processing and analysis of the International Physical Activity Questionnaire - short and long forms. https://sites.google.com/site/theipaq/scoring-protocol 2005.
-Kraus, W.E.; Powell, K.E.; Haskell, W.L.; Janz, K.F.; Campbell, W.W.; Jakicic, J.M. Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease. Med Sci Sports Exerc. Vol. 51. Num. 6. p. 1270-81. 2019.
-Kyu, V.F.; Bachman, L.T.; Alexander, L. T.; Mumford, J. E.; Afshin, A.; Estep, K. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ. Vol. 354. Num. 3857. p. 1-10. 2016.
-Lavie, C.J.; O’Keefe, J.H.; Sallis R.E. Exercise and the heart - the harm of too little and too much. Curr Sports Med Rep. Vol. 14. Num. 2. p. 104-9. 2015.
-Lee, D.C.; Pate R.R.; Lavie, C.J.; Sui, X.; Church, T.S.; Blair, S.N. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. Vol. 64. Num. 5. p. 472-81. 2014.
-Lee, I.M.; Shiroma, E.J.; Lobelo, F.; Puska P.; Blair S.N.; Katzmarzyk, P.T. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. Vol. 21. Num. 380(9838). p. 219-29. 2012.
-Lee, I-M.; Sesso, H.D.; Paffenbarger Jr, R.S. Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk? Circulation. Vol. 29. Num. 102. p. 981-86. 2000.
-Liu, Y.; Lee, D.; Li, Y.; Zhu, W.; Zhang, R.; Sui, X.; e colaboradores. Associations of resistance exercise with cardiovascular disease morbidity and mortality. Med Sci Sports Exerc. Vol. 51. Num. 3. p. 499-508. 2018.
-Löllgen, H.; Böckenhoff A.; Knapp, G. Physical Activity and All-cause Mortality: An Updated Meta-analysis with Different Intensity Categories. Int J Sports Med. Vol. 30. Num. 3. p. 213-24. 2009.
-McDougall, D.; Sale, D. The Physiology of Training for High Performance. Oxford University Press. 1 edition. 440 pages. 2014.
-Morris, J.N. Uses of epidemiology. Br Med J. Vol.13. Num. 4936. p. 395-401.1955.
-Morris, J.N.; Heady, J.A.; Raffle, P.A.B.; Roberts, C.G.; Parks, J.W. Coronary heart-disease and physical activity of work. Lancet. Vol. 265. Num. 6796. p.1053-1057. 1953.
-Morris, J.N.; Raffle, P.A.B. Coronary heart disease in transport workers. A progress report. Br J Ind Med. Vol. 11. Num. 4. p.260-264.1954.
-Paffenbarger, R.S.; Hyde, R.T.; Wing, A.L.; Hsieh. C.C. Physical activity, all-cause mortality, and longevity of college alumni. N Engl J Med. Vol. 6. Num. 314. p. 605-613. 1986.
-Pate, R.R.; Pratt, M.; Blair, S.N.; Haskell, W.L.; Macera, C.A.; Bouchard, C. Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. Vol.1. Num. 273(5). p. 402-407. 1995.
-Perez, A.J. Treinamento Corporal Humano: Fundamentos para a prática de exercÃcios e de esportes. Editora Appris, 1ª ed. 321 páginas. 2018.
-Piercy, K. L.; Troiano, R. P.; Ballard, R. M.; Carlson, S.A.; Fulton, J.E.; Galuska, D. A. The physical activity guidelines for Americans. JAMA. Vol. 320. Num. 19. p. 2020-2028. 2018.
-Powell, K.E.; Paluch, A.E.; Blair. S.N. Physical activity for health: What kind? How much? How intense? On top of what? Annu Rev Public Health. Vol. 32. p. 349-65. 2011.
-Samitz, G.; Egger, M.; Zwahlen, M. Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. Int J Epidemiol. Vol. 40. Num. 5. p. 1382-400. 2011.
-Sattelmair, J.; Pertman, J.; Ding, E.L.; Kohl, H.W.; Haskell, W.; Lee, I-M. Dose-response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation. Vol. 16. p. 789-795. 2011.
-Schnohr, P.; O'Keefe, J.H.; Marott, J.L.; Lange, P.; Jensen, G.B. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. Vol. 10. Num. 65. p. 411-9. 2015.
-Sesso, H.D.; Paffenbarger Jr, R.S.; Lee, I-M. Physical Activity and Coronary Heart Disease in Men. The Harvard Alumni Health Study. Circulation. Vol. 29. Num. 102. p. 975-80. 2000.
-Stamatakis, E.; Johnson, N.A.; Powell, L.; Hamer, M.; Rangul, V.; Holtermann, A. Short and sporadic bouts in the 2018 US physical activity guidelines: is high intensity incidental physical activity the new HIIT? Br. J. Sports Med. Vol. 53. Num. 8. p. 1-3. 2019.
-Stensvold, D.; Viken, H.; Rognmo, Ø.; Skogvoll E.; Steinshamn, S.; Vatten, L.J. A randomised controlled study of the long-term effects of exercise training on mortality in elderly people: study protocol for the Generation 100 study. BMJ Open. Vol. 12. Num. 5(2). p. 1-9. 2015.
-Tanasescu, M.; Leitzmann, M.F.; Rimm, E.B.; Willett, W.C.; Stampfer, M. J.; Hu, F.B. Exercise type and intensity in relation to coronary heart disease in men. JAMA. Vol. 288. Num. 16. p. 1994-2000. 2002.
-Wang, Y.; Lee, D.; Brellenthin, A. G. Sui, X.; Church, T.S.; Lavie, C.J.; Blair, S.N. Association of muscular strength and incidence of type 2 diabetes. Mayo Clinic Proceedings. Vol. 94. Num. 1. p. 643-51. 2019.
-Wen, C.P.; Wu, X. Stressing harms of physical inactivity to promote exercise. Lancet. Vol. 21. Num. 380. p. 192-3. 2012.
-Wen, C.P.; Wai, J.P.; Tsai, M.K.; Chen; C.H. Minimal amount of exercise to prolong life: to walk, to run, or just mix it up? J Am Coll Cardiol. Vol. 5 Num. 64. p. 482-4. 2014.
-Wen, C.P.; Wai, J.P.; Tsai, M.K.; Yang, Y.C.; Cheng, T.Y.; Lee, M.C. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. Vol. 378. Num. 9798. p. 1244-53. 2011.
-Yu, S.; Yarnell, J.W.; Sweetnam, P.M; Murray, L. What level of physical activity protects against premature cardiovascular death? The Caerphilly Study. Heart. Vol. 89. Num.5. p. 502-6. 2003.
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