This lecture was delivered as part of eleventh MDRF–UAB International Seminar on Prevention and control of non-communicable diseases organized by Madras Diabetes Research Foundation (MDRF), Chennai, India in association with Florida International University(FIU), University Of Alabama at Birmingham (UAB), & University Of Minnesota, Supported by National Institutes of Health (NIH), USA February 13-17, 2013.

1. Current Recommendations for
Physical Activity in India
at MDRF, Chennai, Feb 2013
Dr. Nayanjeet Chaudhury, MD, MPH
Certified Personal Trainer (ACSM)
Certified Aerobics Trainer (Reebok)
Director for M&E and
Health Services Delivery(NCDs),
Population Services International
New Delhi

2. Available Guidelines
Age group WHO Guidelines Physical activity guidelines for Asian
indians (conensus statement)
Duration Intensity Duration Intensity
0-5 Years None None None None
5-17 years
old
60 min daily Moderate to
vigorous intensity
60 min / day Moderate to
vigorous intensity
18-64 years
old
150 min per
week / 70 min
week
Moderate /
vigorous /
combination of
both
60 min / day Moderate intensity
65 years and
above
150 min per
week / 70 min
week
Moderate /
vigorous /
combination of
both
60 min / day Moderate intensity

3. Physical Activity guidelines of few countries
Age
group
WHO Guidelines Physical activity
guidelines-UK
Canadian Society for
Exercise Physiology
Department of Health
& Aging-Australia
CDC Guidelines on
physical activity
Physical activity
guidelines for
Aasian indians
Duration Intensity Duration Intensity Duration Intensity Duration Intensity Duration Intensity Duration Intensity
0-5
Years
None None Every day Floor
based
play
Every day Floor based
play for
toddlers
Pre-
schoolers
180 min
spread
throughout
the day
Every day Floor based
play for
toddlers
Pre-
schoolers
180 min
spread
throughout
the day
60 min gymnasti
cs or
push-
ups,
at least 3
days per
week
None None
5-17
years
old
60 min
daily
Moderate
to
vigorous
intensity
60 min
daily
Moderate
to
vigorous
intensity
60
minutes /
Day
Moderate to
vigorous
intensity
60 min/
day
Moderate to
vigorous
intensity
60 min /
day
Moderate
to
vigorous
intensity
18-64
years
old
150 min
per week
/ 70 min
week
Moderate
/ vigorous
/
combinati
on of both
150 min
per week
/ 70 min
week
Moderate
/ vigorous
/
combinati
on of both
150
minutes /
week
Moderate to
vigorous
intensity
60 min/
day
Moderate to
vigorous
intensity
150
minutes/
week
75
minutes/
week
Moderat
e
intensity
vigorous
intensity
60 min /
day
Moderate
intensity
65
years
and
above
150 min
per week
/ 70 min
week
Moderate
/ vigorous
/
combinati
on of both
150 min
per week
/ 70 min
week
Moderate
/ vigorous
/
combinati
on of both
150
minutes /
week
Moderate to
vigorous
intensity
30 min/
day
moderate
intensity
60 min /
day
Moderate
intensity

4. Definition of Terms – WHO guidelines
• Moderate-intensity physical activity.
“On an absolute scale, activity that is performed at 3.0–5.9 times the intensity of
rest. On a scale relative to an individual’s personal capacity, moderate-intensity
physical activity is usually a 5 or 6 on a scale of 0–10”
• Vigorous-intensity physical activity.
“On an absolute scale, activity that is performed at 6.0 or more times the intensity of
rest for adults and typically 7.0 or more times for children and youth. On a scale
relative to an individual’s personal capacity, vigorous intensity physical activity is
usually a 7 or 8 on a scale of 0–10”
• Duration: “The length of time in which an activity or exercise is performed.
Duration is generally expressed in minutes”
• Frequency: “The number of times an exercise or activity is performed. Frequency
is generally expressed in sessions, episodes, or bouts per week”
• Intensity: “Intensity refers to the rate at which the activity is being performed or
the magnitude of the effort required to perform an activity or exercise”

5. Definitions of Physical Activity Intensity –
Consensus Physical Activity Guidelines for Asian Indians
• Low-intensity: “activity elicits a slight increase in breathing
rate and is relative to a given person”
• Moderate-intensity: “activity elicits a moderate, noticeable
increase in depth and rate of breathing, while still allowing
comfortable talking and is relative for a given person”
• Vigorous-intensity: “activity elicits a noticeable increase in
depth and rate of breathing, will not be able to allow more
than a few words without pausing for a breath”

6. Key highlights for healthy adults:
Consensus statement
• Physical inactivity should be avoided as far as possible.
• Pre-participation medical consultation for those with chronic diseases
• A total of 60 min of physical activity is recommended every day including
aerobic, work-related activity and muscle-strengthening activity.
– Minimum 30 min of moderate-intensity aerobic activity (e.g., brisk walking, jogging, hiking,
gardening, bicycling etc.),
– 15 min of work-related activity (e.g., carrying heavy loads, climbing stairs etc.) and
– 15 min of muscle-strengthening exercises (at least 3-4 times a week)
• Total duration could be accumulated in 10-15 min periods of activity 2-3 times a
day.
• Additional benefits if adults increase moderate-intensity aerobic activity to 300
min/week, or engage in 150 min/week of vigorous-intensity aerobic activity, or
an equivalent combination of moderate- and vigorous-intensity activity.
• Brisk walking (walking at an intensity wherein an individual finds speaking
difficult but not impossible) is the preferred initial mode of exercise
• Inactive people should start slow and gradually increase physical activity.

7. Children and Adolescents
• Daily minimum of 1 hour and up to several
hours of at least moderate-intensity aerobic
physical activity.
• Activity may mostly comprise sports activities
and active transport, over and above habitual
physical activity.
• TV viewing, computer work (sedentary) should
be restricted to less than 2 hrs per day

8. Children and AdolescentsType Frequency Duration
Moderate- or vigorous-
intensity aerobic physical
activity (such as running,
hopping, skipping, jumping
rope, swimming, dancing,
and bicycling)
At least 3 days a week
(Preferably daily),
60+ min per day
Muscle-strengthening
physical activity (playing on
playground equipment,
climbing trees, tug-of-war,
weight lifting or working
with resistance bands)
3 days a week 20-30 min
Bone-strengthening
physical activity (such as
running, jumping,
basketball, tennis)
3 days a week 20-30 min

9. Activities for Children and Adolescents Age Group : Examples from American Guidelines
Activity Children Adolescents
Moderate–
intensity
aerobic
• Active recreation, such as hiking,
skateboarding, rollerblading • Bicycle
riding • Brisk walking
• Active recreation, such as canoeing, hiking,
skateboarding, • Brisk walking • Bicycle (stationary or
road bike) • Housework /yard work, such as sweeping
or pushing a lawn mower • Games that require
catching and throwing, such as baseball and softball
Vigorous–
intensity
• Active games involving running and
chasing, such as tag • Bicycle riding •
Jumping rope • Martial arts, such as
karate • Running • Sports such as
soccer, hockey, basketball, swimming,
tennis • Cross-country skiing
• Active games involving running and chasing,
aerobic such as flag football • Bicycle riding • Jumping rope •
Martial arts, such as karate • Running • Sports such as
soccer, ice or field hockey, basketball, swimming,
tennis • Vigorous dancing • Cross-country skiing
Muscle-
strengthening
• Games such as tug-of-war • Modified
push-ups (with knees on the floor) •
Resistance exercises using body weight
or resistance bands • Rope or tree
climbing • Sit-ups (curl-ups or
crunches) • Swinging on playground
equipment/bars
• Games such as tug-of-war • Push-ups and pull-ups •
Resistance exercises with exercise bands, weight
machines, hand-held weights • Climbing wall • Sit-ups
(curl-ups or crunches)
Bone-
strengthening
• Games such as hopscotch • Hopping,
skipping, jumping • Jumping rope •
Running • Sports such as gymnastics,
basketball, volleyball, tennis
• Hopping, skipping, jumping • Jumping rope •
Running • Sports such as gymnastics, basketball,
volleyball, tennis
Source:http://www.health.gov/paguidelines/pdf/paguide.pdf

10. Examples of activities for Older Adults
• Aerobic
• Walking
• Dancing
• Swimming
• Jogging
• Aerobic exercise
classes
• Bicycle riding (stationary
or on a path)
• Some activities of
gardening, Tennis
• Muscle-
Strengthening
• Exercises using exercise
bands, weight machines,
hand-held weights
• Calisthenic exercises (body
weight provides resistance
to movement)
• Digging, lifting, and carrying
as part of gardening
• Carrying groceries
• Some yoga exercises
Source:http://www.health.gov/paguidelines/pdf/paguide.pdf

11. Other categories.
• Pregnancy; Usually exercise is as safe as in other
healthy adults, but needs obstetrician’s
consultation. Pelvic floor strengthening may be
critical to post pregnancy health of uterus.
• Elderly adults: Special recommendation for
resistance training.
• Patients with CHD, hypertension: minimum 120
hours of aerobic activity recommended.
• Diabetes: Same as for healthy adults.
• Obesity & overweight: Minimum 60 minutes of
activity most of the time.

12. References
• WHO | Global Recommendations on Physical activity for Health
www.who.int/dietphysicalactivity/...recommendations/en
• Canadian Physical Activity Guidelines and Canadian Sedentary Behaviour Guidelines
http://www.csep.ca/english/view.asp?x=804
• UK physical activity guidelines : Department of Health – Publications.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuida
nce/DH_127931
• Australian Government. Department of Health and Ageing - Physical Activity Guidelines.
http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-
phys-act-guidelines
• Centre for Disease Control and Prevention. Physical Activity for Everyone: Guidelines:
Children | DNPAO | CDC
http://www.cdc.gov/physicalactivity/everyone/guidelines/index.html
• Anoop Misra, Priyanka Nigam, Andrew P. Hills, Davinder S. Chadha, Vineeta Sharma, K.K.
Deepak, Naval K. Vikram, Shashank Joshi, Ashish Chauhan, Kumud Khanna, Rekha Sharma,
Kanchan Mittal, Santosh Jain Passi, Veenu Seth, Seema Puri, Ratna Devi, A.P. Dubey, and
Sunita Gupta, for the Physical Activity Consensus Group. Diabetes Technology & Therapeutics.
January 2012, 14(1): 83-98. doi:10.1089/dia.2011.0111.