Where do we start when creating fitness goals? What is going to be most beneficial for me versus someone else? Should I lift weights, run, swim or something else? In general, we want to expose ourselves to activities that will improve various components of health and performance including aerobic capacity, endurance, strength, and power. The most important component of a good training program is consistency, one that is sustainable and progressively challenges you over the long term. If you or your coach writes up the “perfect program”, but you literally don’t do it then that program is useless. Have a goal, create a plan and be consistent over a long period of time. 

So, where to start?

An actionable starting point for physical fitness is to create specific goals you want to achieve. The Physical Activity Guidelines for Americans from 2018 recommend for adults to do at least 150 minutes of moderate intensity aerobic activity per week (or 75 minutes of vigorous intensity aerobic activity per week) AND moderate intensity muscle strengthening activities involving all major muscle groups at least 2 days per week(1). This general framework exposes us to a balanced workout plan that can improve our conditioning/endurance and muscle strength as well as promote a healthy lifestyle facilitating weight loss, and decreasing risks of cardiovascular disease, hypertension, type II diabetes, reducing fall risk in older adults and improving our mental health(1,2). It has also been shown that physical inactivity can lead to more degenerative changes of the thoracic, lumbar and overall thoracolumbar spine including long term disc degeneration compared to more physically active individuals(3).

The study by Zhao et al (2020) investigated the 2018 Physical Activity Guidelines and its relation to all-cause mortality. What they found was the following: 

• For those meeting BOTH recommended aerobic and strengthening guidelines, they found a 40% risk reduction in all-cause mortality(4)

• For those meeting the recommended aerobic guideline only, they found a 29% risk reduction in all-cause mortality(4)

• For those meeting the recommended strengthening guideline only, they found an 11% risk reduction in all-cause mortality(4)

They did not discuss the specific workouts, but as long as individuals hit the recommended guidelines they found a reduction in all-cause mortality with the greatest effect hitting both the aerobic and strengthening guidelines. 

So the guidelines seem to have some positive effect, but how are we doing achieving these goals? From the same paper, of the 479,856 US adults included, only 15.9% fully met both the aerobic and strengthening guidelines(4). It is beneficial to be achieving these Recommended Physical Activity Guidelines, yet we are doing an awful job of actually putting them into action.

What can we do to make these guidelines more actionable? Well, just being aware of them is a good starting point. From a rehab professional’s perspective, we must be promoting physical activity with the human beings we encounter. It can be as simple as integrating upper body work into a program for someone following an ACL surgery or promoting a walking program for someone following a rotator cuff repair. Even something as simple as a higher daily step count has been significantly associated with lower all-cause, cardiovascular disease and cancer mortality rates(5). 

From a gym-goer’s perspective, you have to set goals and find an entry point to achieve those goals. With general health in mind, the 2018 Physical Activity Guidelines are a good framework to have a balance of aerobic/endurance work and strengthening work. Utilizing the 150 minutes of aerobic work/week and 2x/week of strengthening you can plan and organize your workouts based around your weekly schedule. Having something in writing will always help make it actionable!

In more specialized populations such as a powerlifter, field sport athlete or marathoner the Guidelines may not always be ideal depending on the time of the year. As competition approaches then our training will become biased towards maximizing performance which will not necessarily meet the 2018 Physical Activity Guidelines. For example, as a powerlifter nears competition they will be doing a lot of heavy squatting, benching and deadlifting and not much aerobic work. In contrast, a marathoner will be doing a lot of longer runs and aerobic work and probably not as much strengthening. At some point throughout a year of training it is important for all human beings to get some dosage of what they may not get exposed to in their sport/competition. And for those who are just working out to stay healthy then having an actionable plan and a framework to guide the process is a good place to start!

References: 

1. Piercy KL et al. The Physical Activity Guidelines for Americans. JAMA 2018;320(19): 2020-2028. Doi: 10.1001/jama.2018.14854

2. Erickson KI et al. Physical Activity, Cognition, and Brain Outcomes: A Review of the 2018 Physical Activity Guidelines. Med Sci Sports Exerc. 2019; 51 (6): 1242-1251.

3. Maurer E et al. Long-term effect of physical inactivity on thoracic and lumbar disc degeneration-an MRI-based analysis of 385 individuals from the general population. The Spine Journal 2020 (000) 1-11. Doi: 10.1016/j.spinee2020.04.016

4. Zhao M, Veeranki SP, Magnussen CG, &Ma Xi B. Recommended physical activity and all cause and cause specific mortality in US adults: prospective cohort study. BMJ 2020;370:m2031|doi: 10.1136/bmj.m2031

5. Saint-Maurice PF et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA 2020; 323(12):1151-1160. Doi: 10.1001/jama.2020.1382