The Physical Activity Guidelines for AmericansKatrina L. Pie.docx

The Physical Activity Guidelines for Americans
Katrina L. Piercy, PhD, RD; Richard P. Troiano, PhD; Rachel
M. Ballard, MD, MPH; Susan A. Carlson, PhD, MPH; Janet E.
Fulton, PhD;
Deborah A. Galuska, PhD, MPH; Stephanie M. George, PhD,
MPH; Richard D. Olson, MD, MPH
IMPORTANCE Approximately 80% of US adults and
adolescents are insufficiently active.
Physical activity fosters normal growth and development and
can make people feel, function,
and sleep better and reduce risk of many chronic diseases.
OBJECTIVE To summarize key guidelines in the Physical
Activity Guidelines for Americans,
2nd edition (PAG).
PROCESS AND EVIDENCE SYNTHESIS The 2018 Physical
Activity Guidelines Advisory
Committee conducted a systematic review of the science
supporting physical activity and
health. The committee addressed 38 questions and 104
subquestions and graded the
evidence based on consistency and quality of the research.
Evidence graded as strong or
moderate was the basis of the key guidelines. The Department
of Health and Human
Services (HHS) based the PAG on the 2018 Physical Activity
Guidelines Advisory Committee
Scientific Report.
RECOMMENDATIONS The PAG provides information and

guidance on the types and
amounts of physical activity to improve a variety of health
outcomes for multiple population
groups. Preschool-aged children (3 through 5 years) should be
physically active throughout
the day to enhance growth and development. Children and
adolescents aged 6 through 17
years should do 60 minutes or more of moderate-to-vigorous
physical activity daily.
Adults should do at least 150 minutes to 300 minutes a week of
moderate-intensity,
or 75 minutes to 150 minutes a week of vigorous-intensity
aerobic physical activity, or an
equivalent combination of moderate- and vigorous-intensity
aerobic activity. They should
also do muscle-strengthening activities on 2 or more days a
week. Older adults should do
multicomponent physical activity that includes balance training
as well as aerobic and
muscle-strengthening activities. Pregnant and postpartum
women should do at least
150 minutes of moderate-intensity aerobic activity a week.
Adults with chronic conditions
or disabilities, who are able, should follow the key guidelines
for adults and do both aerobic
and muscle-strengthening activities. Recommendations
emphasize that moving more and
sitting less will benefit nearly everyone. Individuals performing
the least physical activity
benefit most by even modest increases in moderate-to-vigorous
physical activity. Additional
benefits occur with more physical activity. Both aerobic and
muscle-strengthening physical
activity are beneficial.
CONCLUSIONS AND RELEVANCE The Physical Activity

Guidelines for Americans, 2nd edition,
provides information and guidance on the types and amounts of
physical activity that provide
substantial health benefits. Health professionals and policy
makers should facilitate
awareness of the guidelines and promote the health benefits of
physical activity and support
efforts to implement programs, practices, and policies to
facilitate increased physical activity
and to improve the health of the US population.
JAMA. 2018;320(19):2020-2028. doi:10.1001/jama.2018.14854
Published online November 12, 2018.
Viewpoint page 1971 and
Editorial page 1983
Video
CME Quiz at
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Author Affiliations: Office of Disease
Prevention and Health Promotion,
US Department of Health and Human
Services, Rockville, Maryland (Piercy,
Olson); National Cancer Institute,
National Institutes of Health,
Services, Bethesda, Maryland
(Troiano); Office of Disease
Prevention, National Institutes of
Health, US Department of Health and
Human Services, Bethesda, Maryland
(Ballard, George); National Center for
Chronic Disease Prevention and

Health Promotion, Centers for
Disease Control and Prevention,
Services, Atlanta, Georgia (Carlson,
Fulton, Galuska).
Corresponding Author: Richard P.
Troiano, PhD, Division of Cancer
Control and Population Sciences,
National Cancer Institute, 9609
Medical Center Dr, Room 4E-138,
Bethesda, MD 20892-9762
([email protected]).
Clinical Review & Education
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B eing physically active is one of the most important actions in-
dividuals of all ages can engage in to improve their health.
Inthe United States, an estimated $117 billion in annual health
care costs and about 10% of premature mortality are associated
with
inadequate physical activity (not meeting the existing aerobic
physical
activity guideline).1-3 The evidence reviewed by the Physical
Activity
Guidelines Advisory Committee4 for the newly released
Physical Activ-
ity Guidelines for Americans, 2nd edition5 (PAG) is clear—
physical activ-
ity fosters normal growth and development and can make people
feel
better, function better, sleep better, and reduce the risk of many
chronic
diseases. Health benefits newly identified since the release of
the pre-
vious 2008 Physical Activity Guidelines for Americans6 are
listed in Box 1.
Some health benefits begin
immediately after exercising, and

even short episodes or small
amounts of physical activity are
beneficial. In addition, research
shows that virtually everyone
benefits: men and women of all
races and ethnicities, young chil-
dren to older adults, women who
are pregnant or postpartum,
people living with a chronic condi-
tion or a disability, or people who
want to reduce their risk of disease. The evidence about the
health ben-
efits of regular physical activity is well established (Box 2), and
research
continues to provide insights into what works to increase
physical ac-
tivity, at both the individual and the community level.
The information in the PAG is necessary because of the
importance
of physical activity to the health of people living in the United
States,
whose current inactivity puts them at unnecessary risk for
chronic dis-
eases and conditions. Healthy People 2020 established
objectives for
increasing the level of physical activity among US residents
over the
decade from 2010 to 2020.7 Although the latest federal
monitoring
data shows some improvements in physical activity levels
among US
adults (Figure 1), as of 2016 (adults) and 2015 (adolescents),
only 26%
of men, 19% of women, and 20% of adolescents report

performing suf-
ficient activity. Sufficient physical activity is defined as at least
150 min-
utes of moderate-intensity aerobic physical activity and 2 days
per
week of muscle-strengthening activity for adults and at least 60
min-
utes of moderate-intensity aerobic physical activity and 3 days
per week
of muscle-strengthening activity for youth (Figure 2).8
Although the key guidelines are provided for all people in the
United
States, the primary audience for the PAG is health professionals
and
policy makers. However, the document may also be useful to
individu-
als. The principal concept of the PAG is that regular physical
activity over
months and years can produce long-term health benefits. This
Special
Communication provides an overview of the Physical Activity
Guidelines
for Americans, 2nd edition5 and explains how health
professionals can
help patients increase physical activity and improve health.
Process for Developing the Physical Activity
Guidelines for Americans
The PAG was developed with 2 major steps: a review of the
science
by a federal advisory committee and the development of the
PAG
by the Department of Health and Human Services (HHS) writing
team. In June 2016, 17 academic experts were appointed to the

2018
Physical Activity Guidelines Advisory Committee by former
HHS Sec-
retary Sylvia Mathews Burwell. The committee was charged
with re-
viewing the current science related to physical activity and
health
and providing recommendations to the HHS to inform the
second
edition of the PAG. The members of the committee were asked
to
focus particularly on new results not reflected in the 2008
Physical
Activity Guidelines for Americans.6
At the first public meeting, in July 2016, the committee was
orga-
nized into 9 subcommittees—Aging, Brain Health, Cancer,
Cardiometa-
bolic and Weight Management, Exposure, Individuals With
Chronic
Conditions, Sedentary Behavior, Physical Activity Promotion,
and
Youth—and began discussing which key topics to address. The
Preg-
nancy and Postpartum Work Group was added later. At the
second pub-
lic meeting, in October 2016, after discussing the scope of the
topics
to consider, the committee identified and prioritized 38
literature re-
view questions, including 104 subquestions. Working with a
contrac-
tor, each subcommittee conducted a series of systematic reviews
of
the scientific literature on the selected questions and began

search-
ing for existing meta-analyses and systematic reviews.
At subsequent public meetings, in March, July, and October
2017,
the committee deliberated on the findings from each subcommit-
tee, including the evidence grades and conclusions for each
ques-
tion. The committee agreed on a grading system modified from
the
2015 Dietary Guidelines Advisory Committee.9 Evidence for
each
question and subquestion was graded as strong, moderate, lim-
ited, or not assignable based on the applicability,
generalizability to
the US population of interest, risk of bias or study limitations,
quan-
tity or consistency of results, and magnitude and precision of
ef-
fect. The committee summarized its work in an extensive
scientific
report, the 2018 Physical Activity Guidelines Advisory
Committee
Scientific Report.4 For each question, the report outlined the
methodology used for the literature search, the evidence grades
and conclusion statements, public health importance, and re-
search recommendations. The Scientific Report, which was
submit-
ted to HHS Secretary Alex Azar in February 2018, concluded
the work
of the committee.
A federal writing team with expertise in physical activity and
pub-
lic health who supported the committee during its 21-month ten-
ure used the scientific report, along with public and federal

agency
comments, to draft the second edition of the PAG.5
Key Concepts for the Physical Activity Guidelines
The types and intensity of physical activity are summarized in
Box 3.
Types of Physical Activity
Aerobic Activity
In aerobic activity (also called endurance or cardio activity), the
large
muscles move in a rhythmic manner for a sustained period.
Aero-
bic activity causes the heart rate to increase and breathing to
be-
come more labored.
Aerobic physical activity has 3 components: intensity, fre-
quency, and duration. Intensity describes how hard a person
works
to do the activity. The intensities most often studied are
moderate
(equivalent in effort to brisk walking) and vigorous (equivalent
in ef-
fort to running or jogging). Frequency describes how often a
person
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Activity Guidelines
Physical Activity Guidelines for Americans Special
Communication Clinical Review & Education
jama.com (Reprinted) JAMA November 20, 2018 Volume 320,

Number 19 2021
=jama.2018.14854
does aerobic activity. Duration describes how long a person
does an
activity in any 1 session.
Muscle-Strengthening Activity
Muscle-strengthening activities, which include resistance
training
and weight lifting, cause the body’s muscles to work or hold
against
an applied force or weight. These activities often involve lifting
rela-
tively heavy objects, such as weights, multiple times to
strengthen
various muscle groups. Muscle-strengthening activity can also
in-
volve using elastic bands or body weight for resistance.
Muscle-strengthening activity has 3 components: intensity, fre-
quency, and sets and repetitions. Intensity describes how much
weight or force is used relative to how much a person is able to
lift.
Frequency describes how often a person does muscle-
strengthen-
ing activity. Sets and repetitions describes how many times a
per-
son does the muscle-strengthening activity, like lifting a weight
or

doing a push-up (comparable to duration for aerobic activity).
The effects of muscle-strengthening activity are limited to the
muscles doing the work. It is important to work all the major
muscle
groups of the body—the legs, hips, back, abdomen, chest, shoul-
ders, and arms.
Bone-Strengthening Activity
Bone-streng thening (also called weight-bearing or weight-
loading) activities produce a force on the bones of the body that
pro-
motes bone growth and strength. This force is commonly pro-
duced by impact with the ground. Bone-strengthening activities
can
also be aerobic and muscle-strengthening.
Balance Activities
These kinds of activities can improve the ability to resist forces
within
or outside of the body that cause falls while a person is
stationary
or moving. Strengthening muscles of the back, abdomen, and
legs
also improves balance.
Multicomponent Physical Activity
Multicomponent physical activity programs include a
combination of
balance, muscle-strengthening, and aerobic physical activity. In
ad-
dition, these programs also may include gait, coordination, and
physi-
cal function training. Recreational activities such as dancing,
yoga,
tai chi, gardening, or sports can also be considered

multicomponent
because they often incorporate multiple types of physical
activity.
Physical Activity Intensity
The key guidelines discussed in the next section focus on 2
levels of
intensity—moderate-intensity activity and vigorous-intensity
activ-
ity. The intensity of aerobic activity can be tracked in 2 ways—
absolute intensity and relative intensity. Absolute intensity is
the
amount of energy expended during the activity, without
consider-
ing a person’s cardiorespiratory fitness or aerobic capacity.
Abso-
lute intensity is expressed in metabolic equivalent of task
(MET) units;
1 MET is equivalent to the resting metabolic rate or the energy
expenditure while awake and sitting quietly. Moderate-intensity
ac-
tivities have a MET value of 3 to 5.9 METs; vigorous-intensity
activi-
ties have a MET value of 6 or greater.
Examples of moderate-intensity activities (defined using abso-
lute intensity) include walking briskly at 2.5 to 4.0 mph,
playing vol-
leyball, or raking the yard. Examples of vigorous-intensity
activities
include jogging or running, carrying heavy groceries, or
participat-
ing in a strenuous fitness class. Some activities, such as
swimming
or riding a bicycle, can be either moderate or vigorous intensity,
de-

pending on the effort. Light-intensity physical activity, such as
walk-
ing slowly at 2 mph or less or doing light household chores,
may also
Box 1. New Evidence for Health Benefits of Physical Activity
Improved bone health and weight status for children aged 3
through 5 years
Improved cognitive function for youth aged 6 to 13 years
Reduced risk of cancer at additional sites
Brain health benefits, including improved cognitive function,
reduced
anxiety and depression risk, and improved sleep and quality of
life
Reduced risk of fall-related injuries for older adults
For pregnant women, reduced risk of excessive weight gain,
gestational diabetes, and postpartum depression
For people with various chronic medical conditions, reduced
risk of
all-cause and disease-specific mortality, improved function, and
improved quality of life
Box 2. Health Benefits Associated With Regular Physical
Activity
Children and Adolescents
Improved bone health (ages 3 through 17 years)
Improved weight status (ages 3 through 17 years)

Improved cardiorespiratory and muscular fitness (ages 6
through
17 years)
Improved cardiometabolic health (ages 6 through 17 years)
Improved cognition (ages 6 to 13 years)
Reduced risk of depression (ages 6 to 13 years)
Adults and Older Adults
Lower risk of all-cause mortality
Lower risk of cardiovascular disease mortality
Lower risk of cardiovascular disease (including heart disease
and stroke)
Lower risk of hypertension
Lower risk of type 2 diabetes
Lower risk of adverse blood lipid profile
Lower risk of cancers of the bladder, breast, colon,
endometrium,
esophagus, kidney, lung, and stomach
Improved cognition
Reduced risk of dementia (including Alzheimer disease)
Improved quality of life
Reduced anxiety

Reduced risk of depression
Improved sleep
Slowed or reduced weight gain
Weight loss, particularly when combined with reduced calorie
intake
Prevention of weight regain after initial weight loss
Improved bone health
Improved physical function
Lower risk of falls (older adults)
Lower risk of fall-related injuries (older adults)
Clinical Review & Education Special Communication Physical
Activity Guidelines for Americans
2022 JAMA November 20, 2018 Volume 320, Number 19
(Reprinted) jama.com
=jama.2018.14854
provide some health benefits, especially if a person replaces
sed-
entary behavior with light-intensity activity. However, the

greatest
benefit occurs when sedentary behavior is replaced with
moderate-
to-vigorous physical activity.
In contrast to absolute intensity, relative intensity is the level of
effort required to do an activity compared with a person’s
capacity.
For an activity of a given absolute intensity, relative intensity
will be
higher for a person with lower aerobic capacity than for a
person who
is more fit. Relative intensity can be estimated using a scale of
0 to
10, where sitting is 0 and the highest level of effort possible is
10.
On this scale, moderate-intensity activity is a 5 or 6; vigorous-
intensity activity begins at a level of 7 or 8.
When describing physical activity to an individual (such as a
pa-
tient), the “talk test” is helpful to determine whether an activity
is
moderate or vigorous intensity. Generally, a person doing
moderate-
intensity aerobic activity can talk, but not sing, during the
activity.
A person doing vigorous-intensity activity generally cannot say
more
than a few words without pausing for a breath.
It takes less time to obtain the same benefit from vigorous-
intensity activities than from moderate-intensity activities. For
adults,
a general rule is that 2 minutes of moderate-intensity activity
counts

the same as 1 minute of vigorous-intensity activity. For
example,
30 minutes of moderate-intensity (3-4 METs) activity is roughly
the
same as 15 minutes of vigorous-intensity (6-8 METs) activity.
Either absolute or relative intensity can be used to monitor
prog-
ress in meeting the key guidelines described below. Aerobic
capac-
ity changes with age, peaking in young adulthood.10 Because
older
adults generally have a decreased aerobic capacity compared
with
younger adults, relative intensity is a better guide for older
adults
than absolute intensity. Certain activities, such as some types of
yoga
or tai chi, that are considered light intensity on an absolute
scale may
be perceived as moderate or vigorous intensity for older adults.
Chil-
dren and adults who are inactive or have low fitness levels can
also
use relative intensity to help determine their level of effort.
Progression and Overload
Whether absolute or relative intensity is used to assess level of
effort, for anyone beginning physical activity, walking is
usually a
good first activity because it does not require special skills or
equip-
ment and can generally be done indoors or outside. Over time,
physical activity will get easier as the body adapts to
performing

physical activity that is greater in amount or intensity than
usual.
People should be encouraged to progress to higher levels of
physi-
cal activity as they become more fit. People can work toward
meet-
ing the key guidelines by increasing the amount of time they
per-
form an activity, the intensity of the activity, or the number of
times
a week they are physically active. Small, progressive changes in
activity level and amount help the body adapt to the additional
stresses while minimizing the risk of injury. A health
professional or
physical activity specialist can help tailor physical activity to
meet
the needs and goals of individuals.
The Key Guidelines
Strong evidence demonstrates that regular physical activity has
health benefits for everyone, regardless of age, sex, race,
ethnicity,
or body size. Some benefits occur immediately, such as reduced
feel-
ings of anxiety, reduced blood pressure, and improved sleep,
cog-
nitive function, and insulin sensitivity. Other benefits, such as
Figure 1. Percentage of US Adults 18 Years or Older Who Met
the Aerobic
and Muscle-Strengthening Guidelines, 2008-2016
40
30

20
10
0
%
W
ho
M
et
G
ui
de
lin
es
Women
Men
Year
2008 2009 2010 2011 2012 2013 2014 2015 2016
Source: Centers for Disease Control and Prevention, National
Center for
Health Statistics, National Health Interview Survey (NHIS).
Estimates are
age-adjusted to the 2000 US standard population using 5 age
groups: 18-24
years, 25-34 years, 35-44 years, 45-64 years, and 65 years and
older. Annual

sample sizes ranged from 9188 (2008) to 16 032 (2014) for men
and from
11 955 (2008) to 19 904 (2014) for women. NHIS questions ask
about
frequency and duration of light-intensity to moderate-intensity
and
vigorous-intensity leisure-time physical activities, as well as the
frequency of
muscle-strengthening activities. Meeting the aerobic component
of the 2008
Physical Activity Guidelines for Americans for this population
is defined as
reporting at least 150 minutes of moderate-intensity or 75
minutes of
vigorous-intensity aerobic physical activity per week, or an
equivalent
combination. Meeting the muscle-strengthening component is
defined as
reporting muscle-strengthening activities at least 2 days per
week.
Error bars indicate 95% CIs.
Figure 2. Percentage of US High School Students Who Met the
Aerobic
Physical Activity and Muscle-Strengthening Guidelines, 2011-
2015
40
30
20
10
0

%
W
ho
M
et
G
ui
de
lin
es
Girls
Boys
Year
2011 2013 20142012 2015
Source: Centers for Disease Control and Prevention, Youth Risk
Behavior
Surveillance System. Annual sample sizes ranged from 6599
(2013) to 6950
(2011) for boys and from 6448 (2013) to 7312 (2015) for girls.
Meeting the
aerobic component of the 2008 Physical Activity Guidelines for
Americans for
this population is defined as reporting at least 60 minutes of
“any kind of
physical activity that increases your heart rate and makes you
breathe hard
some of the time” on all days during the 7 days before the

survey. Meeting the
muscle-strengthening component is defined as reporting at least
3 days of
“exercises to strengthen or tone your muscles” during the 7 days
before the
survey. Error bars indicate 95% CIs.
Number 19 2023
=jama.2018.14854
increased cardiorespiratory fitness, increased muscular strength,
de-
creased depressive symptoms, and sustained reduction in blood
pressure, accrue over months or years of physical activity. The
key
guidelines below highlight the amounts and types of physical
activ-
ity recommended for 3 age groups (children and adolescents,
adults,
and older adults), for women who are pregnant or postpartum,
and
for adults with chronic diseases or adults with disabilities. The
PAG
also discusses doing physical activity safely.
The PAG has some new features, reflecting the evolution of re-

search summarized in the 2018 Physical Activity Guidelines
Advi-
sory Committee Scientific Report.4 For example, the PAG
empha-
sizes increasing the amount of moderate-to-vigorous physical
activity
and decreasing sitting time for adults. Most people are not
meeting
the current key guidelines, so shifting from sitting time to being
more
active, ideally by doing moderate- or even vigorous-intensity
physi-
cal activity, would have significant health benefits for many
people
in the United States. Guidance for adults no longer requires
physi-
cal activity to occur in bouts of at least 10 minutes. Also new in
this
edition of the PAG is guidance for children younger than 6
years.
The PAG also identifies numerous benefits of physical activity
for specific populations, which are listed below.
Physical Activity for Preschool-aged Children
Children younger than 6 years undergo periods of rapid growth
and
development. Physical activity can enhance growth and
develop-
ment and teach important movement skills. Parents and care-
givers can have a critical role in supporting and encouraging
young
children to be physically active and in modeling participation in
regu-
lar physical activity (Box 4). Although a quantitative key
guideline

for daily physical activity is not well defined for this age group,
a rea-
sonable target may be 3 hours per day of activity of all
intensities:
light, moderate, or vigorous. This is the average amount of
activity
observed among children of this age11,12 and is consistent with
guide-
lines from Canada,13 the United Kingdom,14 and the Common-
wealth of Australia.15
Physical Activity for School-aged Children and Adolescents
Childhood and adolescence are critical periods for developing
movement skills, learning healthy habits, and establishing a
firm
foundation for lifelong health and well-being. Similar to
younger
children, parents and caregivers can have a crucial supportive
role
to foster positive relationships with physical activity and to
encour-
age and support their children to be active daily. For youth aged
6-17 years, vigorous-intensity, bone-strengthening, and muscle-
strengthening physical activities are important components to
include on 3 or more days a week (Box 4). Unlike adults, youth
typi-
cally do not develop chronic diseases, but risk factors such as
obe-
sity, elevated insulin and blood lipids levels, and elevated blood
pressure can develop in childhood and adolescence. Youth who
are
regularly active have a better chance of a healthy adulthood by
lowering the likelihood that these risk factors will develop, both
now and in the future.
Box 3. Types and Intensity of Physical Activity

Aerobic Activity
An activity in which the body’s large muscles move for a
sustained
amount of time, therefore improving cardiorespiratory fitness.
Aerobic activity is also called endurance or cardio activity.
Examples include brisk walking, running, or bicycling.
Muscle-Strengthening Activity
An activity that increases skeletal muscle strength, power,
endurance, and mass. Examples include weight lifting
or resistance training.
Bone-Strengthening Physical Activity
An activity that produces a force on the bones, which promotes
bone growth and strength. Examples include jumping rope
or running.
Balance Activity
An activity designed to improve individuals’ ability to resist
forces within or outside of the body that cause falls while
a person is stationary or moving. Examples include lunges or
walking backward.
Multicomponent Physical Activity
An activity that includes more than 1 type of physical activity,
such
as aerobic, muscle strengthening, and balance training.
Examples
include some dancing or sports.
Absolute Intensity
Refers to the rate of work being performed and does not
consider
the physiologic capacity of the individual. This is often
expressed

in metabolic equivalent of task (MET) units. Moderate-intensity
physical activities such as walking briskly or raking the yard
have
a MET level of 3 to 5.9 METs.
Relative Intensity
Takes into account or adjusts for a person’s cardiorespiratory
fitness. Someone who is more fit will perceive an exercise to be
easier and thus rate it as of lower relative intensity than
someone
who is less fit.
Box 4. Key Guidelines for Preschool-aged Children
and for School-aged Children and Adolescents
Preschool-aged Children
Preschool-aged children (3 through 5 years) should be
physically
active throughout the day to enhance growth and development.
Adult caregivers of preschool-aged children should encourage
active play that includes a variety of activity types.
School-aged Children and Adolescents
It is important to provide young people opportunities and
encouragement to participate in physical activities that are
appropriate for their age, that are enjoyable, and that offer
variety.
Children and adolescents aged 6 through 17 years should do
60 minutes (1 hour) or more of moderate-to-vigorous physical
activity daily
Aerobic: Most of the 60 minutes or more per day should be
either moderate- or vigorous-intensity aerobic physical activity
and should include vigorous-intensity physical activity on at

least 3 days a week.
Muscle-strengthening: As part of their 60 minutes or more of
daily physical activity, children and adolescents should include
muscle-strengthening physical activity on at least 3 days a
week.
Bone-strengthening: As part of their 60 minutes or more of
daily physical activity, children and adolescents should include
bone-strengthening physical activity on at least 3 days a week.
=jama.2018.14854
Physical Activity for Adults
The link between physical activity and better health is well
estab-
lished in adults. Physical activity has myriad benefits, ranging
from
those occurring after a single bout of physical activity, to long-
term
benefits such as reduced risk of development or progression of a
chronic condition, to improvement of an existing chronic condi-
tion. Most healthy adults do not need to consult a health care
pro-
fessional before beginning physical activity. Starting with low

amounts and gradually increasing the amount of time or
intensity
of physical activity is a good way to build toward meeting the
key
guidelines (Box 5). Bouts, or episodes, of moderate-to-vigorous
physical activity of any duration may be included in the
accumu-
lated total volume of physical activity. Benefits continue to
accu-
mulate with additional physical activity, and both aerobic and
muscle-
strengthening physical activity provide important benefits.
Physical Activity for Older Adults
The benefits of regular physical activity occur throughout life
and
are essential for healthy aging. Adults 65 years and older gain
sub-
stantial health benefits from regular physical activity, even if
they
do not meet the key guidelines. Older adults who are physically
ac-
tive can engage in activities of daily living more easily and
have im-
proved physical function (even if they are frail). They are less
likely
to fall, and if they do fall, the risk of injury is lower. Most older
adults
spend a substantial portion of their day being sedentary, so the
key
guidelines start in a similar fashion as those for adults—move
more
and sit less throughout the day (Box 6). Replacing sitting with
light-
intensity physical activity or, ideally, moderate-intensity
physical ac-

tivity may provide significant benefits. For older adults,
multicom-
ponent physical activity is important. Multicomponent physical
activity combines aerobic, muscle-strengthening, and balance
ex-
ercises. All 3 aspects are important for this population because
older
adults are at an increased risk of falls, and strength and balance
are
needed to prevent falls.
Physical Activity During Pregnancy and During Postpartum
Physical activity during pregnancy benefits a woman’s overall
health
without increasing the risk of adverse pregnancy outcomes, such
as
low birth weight, preterm delivery, or early pregnancy loss.
Ben-
efits include maintenance of, or increases in, cardiorespiratory
fit-
ness, reduced risk of excessive weight gain and gestational
diabe-
tes, and reduced symptoms of postpartum depression. Some
evidence suggests that physical activity may reduce the risk of
preg-
nancy complications such as preeclampsia, reduce the length of
la-
bor and postpartum recovery, and reduce the risk of having a
cesar-
ean delivery. Pregnant women should be under the care of a
health
care practitioner (such as a physician, nursing professional, or
phy-
sician assistant), who can help them to adjust their physical
activity

levels if needed; most women who were active before becoming
pregnant can safety continue their activity level during
pregnancy.
Key guidelines are described in Box 7.
Physical Activity for Adults With a Chronic Health Condition
or a Disability
Regular physical activity is recommended for adults with a
chronic
health condition or a disability and can provide both physical
and
cognitive benefits. For many chronic conditions, physical
activity pro-
vides therapeutic benefits and is part of recommended treatment
for the condition (Box 8). The benefits of physical activity for
people
with disabilities have been studied in diverse groups with
disabili-
ties related to traumatic events or to chronic health conditions.
These
groups include people with previous stroke, spinal cord injury,
mul-
tiple sclerosis, Parkinson disease, muscular dystrophy, cerebral
palsy,
Box 7. Key Guidelines for Women During Pregnancy
and the Postpartum Period
Women should do at least 150 minutes (2 hours and 30 minutes)
of moderate-intensity aerobic activity a week during pregnancy
and the postpartum period. Preferably, aerobic activity should
be
spread throughout the week.
Women who habitually engaged in vigorous-intensity aerobic
activity

or who were physically active before pregnancy can continue
these
activities during pregnancy and the postpartum period.
Women who are pregnant should be under the care of a health
care practitioner who can monitor the progress of the
pregnancy.
Women who are pregnant can consult their health care
practitioner about whether or how to adjust their physical
activity during pregnancy and after the child is born.
Box 5. Key Guidelines for Adults
Adults should move more and sit less throughout the day. Some
physical activity is better than none. Adults who sit less and do
any
amount of moderate-to-vigorous physical activity gain some
health benefits.
For substantial health benefits, adults should do at least 150
minutes
(2 hours and 30 minutes) to 300 minutes (5 hours) a week of
moderate-intensity, or 75 minutes (1 hour and 15 minutes) to
150 minutes (2 hours and 30 minutes) a week of vigorous-
intensity
aerobic physical activity, or an equivalent combination of
moderate-
and vigorous-intensity aerobic activity. Preferably, aerobic
activity
should be spread throughout the week.
Additional health benefits are gained by doing physical activity
beyond the equivalent of 300 minutes (5 hours) of
moderate-intensity physical activity a week.
Adults should also do muscle-strengthening activities of

moderate
or greater intensity that involve all major muscle groups on
2 or more days a week, as these activities provide additional
health benefits.
Box 6. Key Guidelines for Older Adults
The key guidelines for adults also apply to older adults. In
addition,
the following key guidelines are just for older adults:
As part of their weekly physical activity, older adults should do
multicomponent physical activity that includes balance training
as well as aerobic and muscle-strengthening activities.
Older adults should determine their level of effort for physical
activity relative to their level of fitness.
Older adults with chronic conditions should understand
whether and how their conditions affect their ability to do
regular physical activity safely.
When older adults cannot do 150 minutes of moderate-intensity
aerobic activity a week because of chronic conditions,
they should be as physically active as their abilities and
conditions allow.
Number 19 2025

=jama.2018.14854
traumatic brain injury, limb amputations, mental illness,
intellec-
tual disability, and Alzheimer disease and other dementias. If
pos-
sible, those with a chronic condition or disability should try to
meet
the adult key guidelines. However, the type and amount of
physi-
cal activity should be determined by a person’s abilities and the
se-
verity of the chronic condition or disability, which may change
over
time. Health care professionals and physical activity specialists
can
support and guide patients in choosing appropriate types and
amounts of physical activities for their abilities.
Physical Activity and Risk of Injury
Physical activity is safe for almost everyone, and the health
ben-
efits of physical activity outweigh the risks for most people.
Inju-
ries can occur, but individuals can minimize the risk of injury
by wear-
ing protective equipment and gear, choosing safe environments
in
which to be physically active, following rules and policies that
pro-
mote safety, and making sensible choices about when and how
to
be active (Box 9). People who are physically fit have a lower
risk of

injury than people who are not. Therefore, engaging in regular
physi-
cal activity over time can reduce risk of injury. It is also recom-
mended that physical activity be gradually increased over time
through increasing the frequency, duration, or intensity to mini-
mize the risk of injury.
Promoting Physical Activity
In addition to providing specific recommendations for health-
enhancing physical activity, the PAG also addresses evidence-
based strategies to promote and support physical activity. These
strategies include those that focus on individuals or small
groups as
well as programs and policies that can make physical activity
easier
for entire communities. Of particular relevance for health care
pro-
fessionals is evidence that groups led by professionals or peers
can
help improve physical activity levels. These groups usually
incorpo-
rate some form of counseling or guidance from a health profes-
sional or physical activity specialist to help participants set
physical
activity goals, monitor their progress toward these goals, seek
so-
cial support to maintain physical activity, and use self-reward
and
positive self-talk to reinforce progress. They also use structured
prob-
lem solving to prevent relapse to a less active lifestyle. To
reduce staff
burden and costs, groups can also be led by trained peers who
de-
liver the intervention in full or in part and often share similar

char-
acteristics or experiences as group members. Youth, adults, and
older
adults can benefit from individual or group approaches as well
as
community-level programs, practices, and policies to achieve an
ac-
tive lifestyle. The role of health care professionals in
community ap-
proaches is discussed below.
Technology, such as step counters or other wearable devices or
fitness apps, can provide physical activity feedback directly to
the
user. Technology can be used alone or combined with other
strate-
gies, such as goal setting and coaching, to encourage and
maintain
increased physical activity. Technological approaches can also
be
used to provide guidance remotely to individuals through text
mes-
saging, by telephone, or through the internet. Telephone and
inter-
net delivery strategies can offer guidance to individuals from
trained
peers or through interactive voice-response systems.
Discussion
The PAG5 represents a significant evolution from the 2008
Physi-
cal Activity Guidelines for Americans.6 The scientific evidence
for the
health benefits of being physically active has continued to
expand
beyond primary prevention of chronic disease, with new

evidence
of benefits for multiple aspects of brain health, healthy develop-
ment of preschool children, and benefits for persons with
chronic
disease or various disabilities. In addition, new evidence about
the
interrelationship between sedentary behavior and physical activ-
ity has expanded understanding of the importance of being
active
throughout the day.
Box 8. Key Guidelines for Adults With Chronic Health
Conditions
and Adults With Disabilities
Adults with chronic conditions or disabilities, who are able,
should
do at least 150 minutes (2 hours and 30 minutes) to 300 minutes
(5 hours) a week of moderate-intensity, or 75 minutes (1 hour
and
15 minutes) to 150 minutes (2 hours and 30 minutes) a week of
vigorous-intensity aerobic physical activity, or an equivalent
combination of moderate- and vigorous-intensity aerobic
activity.
Preferably, aerobic activity should be spread throughout the
week.
Adults with chronic conditions or disabilities, who are able,
should
also do muscle-strengthening activities of moderate or greater
intensity that involve all major muscle groups on 2 or more days
a week, as these activities provide additional health benefits.
When adults with chronic conditions or disabilities are not able
to
meet the above key guidelines, they should engage in regular

physical activity according to their abilities and should
avoid inactivity.
Adults with chronic conditions or symptoms should be under the
care of a health care practitioner. People with chronic
conditions
can consult a health care professional or physical activity
specialist
about the types and amounts of activity appropriate for their
abilities and chronic conditions.
Box 9. Key Guidelines for Safe Physical Activity
To do physical activity safely and reduce risk of injuries and
other
adverse events, people should
Understand the risks, yet be confident that physical activity can
be safe for almost everyone.
Choose types of physical activity appropriate for their current
fitness level and health goals, because some activities are safer
than others.
Increase physical activity gradually over time to meet key
guidelines or health goals. Inactive people should “start low and
go slow” by starting with lower-intensity activities and
gradually
increasing how often and how long activities are done.
Protect themselves by using appropriate gear and sports
equipment, choosing safe environments, following rules and
policies, and making sensible choices about when, where,
and how to be active.
Be under the care of a health care practitioner if they have

chronic conditions or symptoms. People with chronic conditions
and symptoms can consult a health care professional or physical
activity specialist about the types and amounts of activity
appropriate for them.
=jama.2018.14854
New evidence also shows that obtaining health benefits asso-
ciated with physical activity may be easier than previously
thought.
A single episode of moderate-to-vigorous physical activity can
im-
prove sleep, reduce anxiety symptoms, improve cognition,
reduce
blood pressure, and improve insulin sensitivity on the day the
ac-
tivity is performed. Most of these improvements increase, and
ad-
ditional benefits occur, with the regular performance of
moderate-
to-vigorous physical activity.
A significant change since the 2008 Physical Activity Guide-
lines for Americans6 is that previously, aerobic physical
activity for

adults had to be accumulated in bouts, or sessions, that lasted at
least
10 minutes to count toward meeting the key guidelines. Current
evi-
dence shows that the total volume of moderate-to-vigorous
physi-
cal activity is related to many health benefits; bouts of a
prescribed
duration are not essential. This finding is consistent with the
type
of recommendations made to increase routine daily physical
activ-
ity, such as parking farther away from a destination and
walking, or
taking the stairs rather than the elevator, and will allow health
care
professionals to promote small increases in physical activity
that do
not take 10 minutes. These small changes can contribute to
provid-
ing increases in health-enhancing physical activity.
Sedentary behavior has recently become a topic of consider-
able interest. The PAG addresses the risks of too much sitting
for
adults but does not prescribe a quantitative key guideline for
sit-
ting time or how to break up sitting duration throughout the
day. This
is because recent evidence shows a complex relationship
between
the effects of sitting time and duration of moderate-to-vigorous
physical activity on all-cause and cardiovascular disease
mortality.4
With greater amounts of moderate-to-vigorous physical activity,

the
risk of a given amount of sitting time is reduced. However,
given the
low amount of moderate-to-vigorous physical activity currently
per-
formed by most people in the United States, increasing physical
ac-
tivity and decreasing sitting are both likely to provide benefits.
Physicians and other health care professionals are members of
the key audience for the PAG and are ideally situated to
facilitate
awareness of the PAG and to promote the health benefits of
physi-
cal activity. Many of the target populations of the PAG—
pregnant
women, preschool and school-aged children and adolescents,
older
adults, and persons with chronic diseases or disabilities—have
regu-
lar health care encounters that provide opportunities to inquire
about and promote physical activity. Many tools and resources
are
available to help facilitate physical activity counseling, such as
the
American Academy of Pediatrics’ Bright Futures Guidelines16
and
the Exercise Is Medicine Healthcare Providers’ Action Guide.17
Large
health care systems, including Kaiser Permanente,
Intermountain
Healthcare, and Greenville Health System, have incorporated
moni-
toring physical activity as a vital sign.18-20
Health care professionals can also partner with other sectors to

promote physical activity. The 2016 National Physical Activity
Plan21
identified 9 sectors of society that have a role to play in
promoting
physical activity (Table). For example, health care professionals
can
link patients or clients to physical activity programs within the
Com-
munity, Recreation, Fitness, and Parks sector. Implementing
popu-
lation-level approaches to improve physical activity requires
col-
laboration across these sectors at local, state, and national
levels.
Step It Up! The Surgeon General’s Call to Action to Promote
Walking
and Walkable Communities22 addresses how partnerships can
be
used to promote walking, an easy and common physical activity
that
most people can perform. Although all groups can benefit from
ef-
forts to make physical activity easier, attention to underserved
groups
or those with barriers to physical activity is particularly needed.
The federal government provides a number of resources to sup-
port individuals, organizations, and sectors in promoting
physical ac-
tivity. A list of useful websites is provided in the Appendix of
the PAG5
and at https://health.gov/paguidelines. Communication tools to
sup-

port and disseminate PAG messages are also available at this
website.
Realizing a shared vision of a more physically active and
healthy
United States will require dedication, ingenuity, skill, and
commit-
ment from many partners working across many different sectors.
As clearly demonstrated by the scientific evidence supporting
the
PAG, being physically active is one of the best investments
individu-
als and communities can make in their health and welfare. Now
is
the time to take action and help more individuals in the United
States
attain the numerous benefits of physical activity.
Table. Sectors in the 2016 National Physical Activity Plan
(NPAP)
and Their Potential Role in Supporting Physical Activity
NPAP Sector Role
Business and
industry
Employers can encourage workers to be physically active.
They can provide access to facilities and encourage their use
through outreach activities. Businesses can consider access
to opportunities for active transportation and public transit
when selecting new locations.
Community,
recreation,
fitness, and
parks

This sector plays a leading role in providing access to places
for active recreation, such as playgrounds, hiking and biking
trails, senior centers, sports fields, and swimming pools. This
sector can also provide access to exercise programs and
equipment for a broad range of people, including
underserved populations and people with disabilities.
Education This sector can take a lead role in providing
opportunities for
age-appropriate physical activity in all educational settings.
Opportunities include offering physical education,
after-school sports, and public access to school facilities
during after-school hours, and expanded intramural sports
and campus recreation opportunities.
Faith-based
settings
Faith-based organizations can be important partners in
providing access to places for physical activity and promotion
through outreach activities that can be tailored for diverse
faith-based groups.
Health care Health care professionals can assess, counsel, and
advise
patients on physical activity and how to do it safely. Health
care systems can partner with other sectors to promote
access to community-based physical activity programs.
Mass media Media outlets can provide easy-to-understand
messages
about the health benefits of physical activity as part of
community promotion efforts. Messages can also provide
information about facilities or outlets where individuals can
be active.

Public health Public health departments can monitor community
progress
in providing places and opportunities to be physically active
and track changes in the proportion of the population
meeting the Physical Activity Guidelines for Americans. They
can also take the lead in setting objectives and coordinating
activities among sectors. Public health departments and
organizations can disseminate appropriate messages and
information to the public about physical activity.
Sports This sector can provide organized opportunities for
people to
be active. Youth sports can expose children and adolescents
to a variety of age-appropriate activities that can set the basis
for a lifetime of activity. Sports organizations can also ensure
that sports programs are conducted in a manner that
minimizes risk of injuries.
Transportation,
land use, and
community
design
This sector plays a lead role in designing and implementing
options that provide areas for safe walking, bicycling, and
wheelchair walking. Public transit systems also promote
walking, as people typically walk to and from transit stops.
Community planners and designers can implement design
principles to create communities with activity-friendly routes
to everyday destinations for people of all ages and abilities.
They can also help create or improve access to places for
physical activity, such as parks and other green spaces.

Number 19 2027
https://www.health.gov/paguidelines
=jama.2018.14854
Conclusions
The Physical Activity Guidelines for Americans, 2nd edition,
provides
information and guidance on the types and amounts of physical
ac-
tivity that provide substantial health benefits. Health
professionals and
policy makers should facilitate awareness of the guidelines and
pro-
mote the health benefits of physical activity and support efforts
to
implement programs, practices, and policies to facilitate
increased
physical activity and to improve the health of the US
population.
ARTICLE INFORMATION
Accepted for Publication: September 21, 2018.
Published Online: November 12, 2018.
doi:10.1001/jama.2018.14854

Author Contributions: Dr Piercy had full access to
all of the data in the study and takes responsibility
for the integrity of the data and the accuracy of the
data analysis.
Concept and design: Piercy, Troiano, Ballard,
Fulton, Olson.
Acquisition, analysis, or interpretation of data:
Piercy, Troiano, Carlson, Galuska, George.
Drafting of the manuscript: Piercy, Troiano.
Critical revision of the manuscript for important
intellectual content: All authors.
Obtained funding: Piercy, Troiano, Ballard,
Fulton, Olson.
Administrative, technical, or material support:
Piercy, Troiano, Carlson, George, Olson.
Supervision: Piercy, Troiano, Olson.
Conflict of Interest Disclosures: All authors have
completed and submitted the ICMJE Form for
Disclosure of Potential Conflicts of Interest and
none were reported.
Funder/Sponsor: This study was funded by the US
Department of Health and Human Services (HHS).
Role of the Funder/Sponsor: The HHS is
responsible of all aspects of the development of the
Physical Activity Guidelines for Americans, 2nd
edition (PAG). This includes appointing an advisory
committee, funding contracts for the advisory
committee literature review, and writing the PAG.
HHS had no role in the decision to submit the
manuscript for publication.
Disclaimer: The findings and conclusions in this

report are those of the authors and do not
necessarily represent the official position of the
Centers for Disease Control and Prevention (CDC).
Additional Contributions: We appreciate the
contributions of the fellows who supported the
HHS writing team: Eric T. Hyde, MPH (CDC); Kate
Olscamp, MPH (President’s Council on Sports,
Fitness and Nutrition); Kyle Sprow, MPH (National
Institutes of Health); Julia B. Quam, MSPH, RDN
(Office of Disease Prevention and Health Promotion
[ODPHP]); Alison Vaux-Bjerke, MPH (ODPHP);
and Geoffrey Whitfield (CDC). These individuals
received salaries as fellows but no compensation
related to the PAG. We thank Anne Brown Rodgers
for her editorial support. Ms Rogers was paid
as a contractor for her time.
REFERENCES
1. Carlson SA, Adams EK, Yang Z, Fulton JE.
Percentage of deaths associated with inadequate
physical activity in the United States. Prev Chronic
Dis. 2018;15:E38. doi:10.5888/pcd18.170354
2. Carlson SA, Fulton JE, Pratt M, et al. Inadequate
physical activity and health care expenditures in the
United States. Prog Cardiovasc Dis. 2015;57(4):315-
323. doi:10.1016/j.pcad.2014.08.002
3. Lee IM, Shiroma EJ, Lobelo F, et al. Effect of
physical inactivity on major non-communicable
diseases worldwide: an analysis of burden of
disease and life expectancy. Lancet. 2012;380
(9838):219-229.

4. 2018 Physical Activity Guidelines Advisory
Committee. 2018 Physical Activity Guidelines
Advisory Committee Scientific Report. Washington,
DC: US Dept of Health and Human Services; 2018.
5. US Department of Health and Human Services.
Physical Activity Guidelines for Americans. 2nd ed.
Wasington, DC: US Dept of Health and Human
Services; 2018.
6. US Department of Health and Human Services.
2008 Physical Activity Guidelines for Americans.
Washington, DC: US Dept of Health and Human
Services; 2008.
7. Office of Disease Prevention and Health
Promotion, US Dept of Health and Human Services.
Healthy People 2020: Topics & Objectives—
Physical Activity. HealthyPeople.gov website.
https://www.healthypeople.gov/2020/topics
-objectives/topic/physical-activity. Updated
September 13, 2018. Accessed September 13, 2018.
8. Office of Disease Prevention and Health
Promotion, US Dept of Health and Human Services.
Healthy People 2020: Data Search—Physical
Activity. HealthyPeople.gov website.
https://www.healthypeople.gov/2020/data-search
/search-the-data#topic-area=3504. Updated
September 13, 2018. Accessed September 13, 2018.
9. Dietary Guidelines Advisory Committee;
Scientific Report of the 2015 Dietary Guidelines
Advisory Committee. Advisory Report to the
Secretary of Health and Human Services and the
Secretary of Agriculture. Washington, DC: US Dept

of Agriculture, Agricultural Research Service; 2015.
10. American College of Sports Medicine. ACSM’s
Guidelines for Exercise Testing and Prescription.
7th ed. Baltimore, MD: Lippincott Williams &
Wilkins; 2006.
11. Pate RR, O’Neill JR. Physical activity guidelines
for young children: an emerging consensus. Arch
Pediatr Adolesc Med. 2012;166(12):1095-1096.
doi:10.1001/archpediatrics.2012.1458
12. Institute of Medicine. Early Childhood Obesity
Prevention Policies. Washington, DC: National
Academies Press; 2011.
13. Canadian Society for Exercise Physiology
(CSEP). Canadian 24-hour movement guidelines
for the early years (0-4 years): an integration of
physical activity, sedentary behaviour and sleep.
CSEP website. http://csepguidelines.ca/early-years
-0-4/. 2018. Accessed August 16, 2018.
14. Department of Health, Physical Activity, Health
Improvement and Protection. Start Active, Stay
Active: A Report on Physical Activity for Health From
the Four Home Countries’ Chief Medical Officers.
London, United Kingdom: Dept of Health, Physical
Activity, Health Improvement and Protection; 2011.
15. Commonwealth of Australia. National Physical
Activity Guidelines for Australians: Physical Activity
Recommendations for 0-5 Year Olds. Canberra:
Commonwealth of Australia; 2010.
16. Hagan J, Shaw J, Duncan P. Bright Futures:

Guidelines for Health Supervision of Infants,
Children, and Adolescents. 3rd ed. Elk Grove Village,
IL: American Academy of Pediatrics; 2008.
17. American College of Sports Medicine.
Exercise Is Medicine: Healthcare Providers’ Action
Guide. Indianapolis, IN: American College of Sports
Medicine; 2014.
18. Kaiser Permanente. Exercise as a vital sign.
Kaiser Permanente Center for Total Health website.
https://centerfortotalhealth.org/exercise-vital-sign.
May 18, 2017. Accessed August 6, 2018.
19. Schroder MO. Treating exercise as a vital sign:
why some health providers are asking about
physical activity, and how to join the discussion.
US World News & World Report. https://health
.usnews.com/health-care/articles/2016-11-15
/treating-exercise-as-a-vital-sign. Published
November 15, 2016. Accessed August 6, 2018.
20. Ball TJ, Joy EA, Gren LH, Shaw JM. Concurrent
validity of a self-reported physical activity “vital
sign” questionnaire with adult primary care
patients. Prev Chronic Dis. 2016;13:E16. doi:10.5888
/pcd13.150228
21. National Physical Activity Plan Alliance.
US National Physical Activity Plan. National
Physical Activity Plan Alliance website.
http://physicalactivityplan.org/docs/2016NPAP
_Finalforwebsite.pdf. Published 2016. Accessed
September 25, 2018.
22. US Dept of Health and Human Services.

Step It Up! The Surgeon General’s Call to Action to
Promote Walking and Walkable Communities.
Washington, DC: US Dept of Health and Human
Services, Office of the Surgeon General; 2015.
.14854
https://dx.doi.org/10.5888/pcd18.170354
https://dx.doi.org/10.1016/j.pcad.2014.08.002
https://www.ncbi.nlm.nih.gov/pubmed/22818936
https://www.ncbi.nlm.nih.gov/pubmed/22818936
https://www.healthypeople.gov/2020/topics-
objectives/topic/physical-activity
https://www.healthypeople.gov/2020/topics-
objectives/topic/physical-activity
https://www.healthypeople.gov/2020/data-search/search-the-
data#topic-area=3504
https://www.healthypeople.gov/2020/data-search/search-the-
data#topic-area=3504
https://jama.jamanetwork.com/article.aspx?doi=10.1001/archped
iatrics.2012.1458&utm_campaign=articlePDF%26utm_medium=
articlePDFlink%26utm_source=articlePDF%26utm_content=jam
a.2018.14854
http://csepguidelines.ca/early-years-0-4/
http://csepguidelines.ca/early-years-0-4/
https://centerfortotalhealth.org/exercise-vital-sign

https://health.usnews.com/health-care/articles/2016-11-
15/treating-exercise-as-a-vital-sign
http://physicalactivityplan.org/docs/2016NPAP_Finalforwebsite
.pdf
http://physicalactivityplan.org/docs/2016NPAP_Finalforwebsite
.pdf
=jama.2018.14854
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Week 4: Johns Hopkins Nursing Non-Research Appraisal tool
Submit Assignment
· Submitting a file upload
Purpose
The purpose of this assignment is to provide the graduate
nursing student opportunity to practice reading and critiquing
research articles for application to an evidence-based practice.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the

ability to:
1. Integrate evidence-based practice and research to support
advancement of holistic nursing care in diverse healthcare
settings. (PO 1)
2. Integrate knowledge related to evidence-based practice and
person-centered care to improve healthcare outcomes. (PO 1, 5)
3. Develop knowledge related to research and evidence-based
practice as a basis for designing and critiquing research studies.
(PO 1, 5)
4. Analyze research findings and evidence-based practice to
advanced holistic nursing care initiatives that promote positive
healthcare outcomes. (PO 1, 5)
Due Date: Sunday 11:59 PM MT at the end of WEEK 4, 5, 6
Students are expected to submit assignments by the time they
are due. Assignments submitted after the due date and time will
receive a deduction of 10% of the total points possible for that
assignment for each day the assignment is late. Assignments
will be accepted, with penalty as described, up to a maximum of
three days late, after which point a zero will be recorded for the
assignment. Quizzes and discussions are not considered
assi gnments and are not part of the late assignment policy.
Total Points Possible: 130 points each in weeks 4, 5 & 6
Directions and Assignment Criteria
Students will critique a research article in weeks 4, 5 & 6 (3
total) as follows:
Week 4: Non-research appraisal (Links to an external site.):
Guidelines and Reviews
Each critique will require a two-three page written analysis of
the article. The paper should include:
Introduction
· Article topic/focus
· Author(s)
· Aim of assignment
Critique of Article
The article critique should be a methodological review specific
to type of article (for example, qualitative or quantitative) . The

analysis must be two to three pages and detailed using the text
and resources. The content of the review should also include:
1. Ethical review
2. Analysis of findings
3. Limitations
4. Discussion
5. Application (translation) to practice specialty
6. Future implications
In addition, students must complete the Johns Hopkins Research
Appraisal Tool that is applicable to the type of study design
(qualitative, quantitative or non-research evidence) for the
week. Refer to the rubric for additional requirements.
Preparing the Assignment
Week 4
Non-research appraisal: Guideline or Systematic Review
1. Select a guideline or systematic review article from the Week
4 list.
Article to use: Piercy, L. K., Troiano, P. R., & Ballard, M. R.
(2018). The physical activity guidelines for
Americans. JAMA, 320(19), 2020-2028.
Reference: Jacobs, A. (2016). A medical writer's guide to meta-
analysis. Medical Writing, 25(3), 22-25.
2. Write a two-three (2-3) page critique of the article in a Word
Doc integrating your course readings. Be sure to include a
citation for your article using APA format.
3. Complete the Johns Hopkins Non-research evidence review
document.
4. Submit both through TurnItIn by Sunday 11:59pm MT of
week 4
Format & Presentation Requirements
· APA Format According to 6th edition
· Word Doc per assignment requirements.
· Word Doc Format: Cover page, no abstract, introduction (no
heading per APA), body of the paper/review, reference list,
appendix with Johns Hopkins appraisal doc. For review sections
refer to your readings and the Johns Hopkins Research

Appraisal Tool.
· Article title, author, journal, publication date
· Evidence level and quality
· Analysis of the study methodology (specific to study type,
e.g., qualitative versus quantitative versus non-research)
· Reference list should include the chosen article and other
resources used to construct the review, such as course textbook,
Johns Hopkins Evidence Based Practice: Model and Guidelines,
and How to Read a Paper by Greenhalgh (2014).
ASSIGNMENT CONTENT
Category
Points
%
Description
Introduction
10
8%
Required content for this section includes:
· Introduction to chosen article: Provide introduction to article
topic/focus, authors and specific aim of assignment.
· Succinct overview of assignment focus.
Critique of Article
50
38%
· Methodological review specific to type (non-research versus
research): (use text and resources)
· Ethical review (not always present with guidelines or
systematic reviews)
· Analysis of findings
· Limitations
· Discussion
· Application to practice (translation)
· Future implications
Johns Hopkins Appraisal Tool

50
38%
All sections of the Appraisal Tool are completed for the correct
article review (for example, the non-research tool is used for
guidelines, the qualitative tool is used for qualitative review).
110
84%
Total CONTENT Points= 110 pts
ASSIGNMENT FORMAT
Category
Points
%
Description
APA
15
12%
Requirements:
· Cover (title) page
· Running head
· No abstract
· Introduction (no heading per APA)
· Body of paper and reference page must follow APA guidelines
as found in the 6th edition of the manual. This includes the use
of headings for each section of the paper except for the
introduction where no heading is used.
Syntax, grammar, spelling
5
4%
Rules of grammar, spelling, word usage, and punctuation are
followed and consistent with formal written work as found in
the 6th edition of the APA manual.
20
16%
Total FORMAT Points= 20 pts

130
100%
ASSIGNMENT TOTAL=130 points
Rubric
NR505NP WK4,5,6 Article Critique_SEPT19
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeIntroduction
• Introduction to chosen article
• Succinct overview of assignment focus.
10.0 pts
Excellent
Content includes well-written, succinct, information that
includes: Article topic/focus, authors and specific aim of
assignment.
9.0 pts
V. Good
Content is well-written but omits or is thin in one area.
8.0 pts
Satisfactory
Section content is basic in its explanation of the article
(overview) and the purpose of the assignment but lacks specific
detail and depth.
5.0 pts
Needs Improvement
All content is included but difficult to piece together in its
explanation of the article (overview) and the purpose of the
assignment OR a piece of the content is missing, for example,
overview of assignment focus, yet what is written is well stated.

0.0 pts
Unsatisfactory
Missing OR Section content is vague in its introduction of the
article (overview) and the purpose of the assignment is missing
OR article overview is missing, and purpose of the assignment
is vague.)
10.0 pts
This criterion is linked to a Learning OutcomeCritique of
Article
• Methodological review specific to type (non-research versus
• Ethical review (not always present with guidelines or
systematic reviews)
• Analysis of findings
• Limitations
• Discussion
• Application to practice (translation)
• Future implications
50.0 pts
Excellent
All content is included in the critique with comprehensive
definitions, examples and with in-text citations that support the
article evaluation with depth.
46.0 pts
V. Good
All content is included in the critique. One or two sections may
be included without depth: For example, Definitions, examples
and with in-text citations that support the article evaluation
with depth. Or: All content has explanatory depth of analysis
including definitions, examples and in-text citations supporting
the analysis, however, a content area may be missing (such as
ethical review or limitations)
42.0 pts
Satisfactory

Two or three content areas are missing, or all content areas are
included but there is inconsistent depth/ integration of
definitions, examples and in-text citations that support the
article evaluation with depth
25.0 pts
Needs Improvement
Four or more content areas are missing, or all content areas are
included but there is little to no depth/ integration of
0.0 pts
Unsatisfactory
Critique is vague, without structure, without discernible
integration of definitions, examples, and in-text citations that
support the writing.
50.0 pts
This criterion is linked to a Learning OutcomeJohns Hopkins
Appraisal Tool
50.0 pts
Excellent
46.0 pts
V. Good
Tool is included, is the correct tool, and is missing: A. Non-
Evidence Tool: 1 of the 6 sections B. Evidence Tool: 1 section
missing
42.0 pts
Satisfactory
Evidence Tool 2 or 3 of the 6 sections B. Evidence Tool: 2
sections missing
25.0 pts
Needs Improvement

Tool is included and is missing: A. Non-Evidence Tool 4 or
more of the 6 sections B. Evidence Tool – 3 more sections
missing.
0.0 pts
Unsatisfactory
Tool is missing or the wrong tool is used.
50.0 pts
This criterion is linked to a Learning OutcomeOrganization &
Format
Requirements:
• Cover (title) page
• No abstract
• Introduction
• Body of paper and reference page must follow APA guidelines
15.0 pts
Excellent
All aspects of paper follow APA guidelines (cover, no abstract,
introduction, headings (not on introduction), body of paper and
reference page
14.0 pts
V. Good
1-3 APA errors
12.0 pts
Satisfactory
4-5 APA errors
8.0 pts
Needs Improvement
6-9 APA errors
0.0 pts
Unsatisfactory
10 or greater APA errors

15.0 pts
This criterion is linked to a Learning OutcomeSyntax, grammar,
spelling
5.0 pts
Excellent
There are no grammatical, spelling, word usage or punctuation
errors.
4.0 pts
V. Good
1-3 grammatical, spelling, word usage or punctuation errors.
3.0 pts
Satisfactory
2.0 pts
Needs Improvement
0.0 pts
Unsatisfactory
10 or greater grammatical, spelling, word usage or punctuation
errors.
5.0 pts
Total Points: 130.0
Evidence level and quality rating:
Article title:
Number:
Author(s):

Publication date:
Journal:
Setting:
Sample (composition and size):
Does this evidence address my EBP question?
Yes
No- Do not proceed with appraisal of this evidence
· Clinical Practice Guidelines LEVEL IV
Systematically developed recommendations from nationally
recognized experts based on research evidence or expert
consensus panel
· Consensus or Position Statement LEVEL IV
Systematically developed recommendations, based on research
and nationally recognized expert opinion, that guide members of
a professional organization in decision-making for an issue of
concern
· Are the types of evidence included identified?
· Yes
· No
· Were appropriate stakeholders involved in the development of
recommendations?
· Yes
· No
· Are groups to which recommendations apply and do not apply
clearly stated?
· Yes
· No
· Have potential biases been eliminated?
· Yes
· No
· Does each recommendation have an identified level of
evidence stated?
· Yes
· No
· Are recommendations clear?

· Yes
· No
Findings That Help Answer the EBP Question
Complete the corresponding quality rating section.
Johns Hopkins Nursing Evidence-Based Practice
Appendix F: Non-Research Evidence Appraisal Tool
Johns Hopkins Nursing Evidence-Based Practice
Appendix F
Non-Research Evidence Appraisal
1
· Literature review LEVEL V
Summary of selected published literature including scientific
and nonscientific such as reports of organizational experience
and opinions of experts
· Integrative review LEVEL V
Summary of research evidence and theoretical literature;
analyzes, compares themes, notes gaps in the selected literature
· Is subject matter to be reviewed clearly stated?
· Yes
· No
· Is literature relevant and up-to-date (most sources are within
the past five years or classic)?
· Yes
· No
· Of the literature reviewed, is there a meaningful analysis of
the conclusions across the articles included in the review?

· Yes
· No
· Are gaps in the literature identified?
· Yes
· No
· Are recommendations made for future practice or study?
· Yes
· No
· Expert opinion LEVEL V
Opinion of one or more individuals based on clinical expertise
· Has the individual published or presented on the topic?
· Yes
· No
· Is the author’s opinion based on scientific evidence?
· Yes
· No
· Is the author’s opinion clearly stated?
· Yes
· No
· Are potential biases acknowledged?
· Yes
· No
Organizational Experience
· Quality improvement LEVEL V
Cyclical method to examine workflows, processes, or systems
with a specific organization
· Financial evaluation LEVEL V
Economic evaluation that applies analytic techniques to
identify, measure, and compare the cost and outcomes of two or
more alternative programs or interventions

· Program evaluation LEVEL V
Systematic assessment of the processes and/or outcomes of a
program; can involve both quaNtitative and quaLitative methods
Setting:
Sample Size/Composition:
· Was the aim of the project clearly stated?
· Yes
· No
· Was the method fully described?
· Yes
· No
· Were process or outcome measures identified?
· Yes
· No
· Were results fully described?
· Yes
· No
· Was interpretation clear and appropriate?
· Yes
· No
· Are components of cost/benefit or cost effectiveness analysis
described?
· Yes
· No
· N/A

· Case report LEVEL V
In-depth look at a person or group or another social unit
· Is the purpose of the case report clearly stated?
· Yes
· No
· Is the case report clearly presented?
· Yes
· No
· Are the findings of the case report supported by relevant
theory or research?
· Yes
· No
· Are the recommendations clearly stated and linked to the
findings?
· Yes
· No
Complete the corresponding quality rating.
Community standard, clinician experience, or consumer
preference LEVEL V
· Community standard: Current practice for comparable settings
in the community
· Clinician experience: Knowledge gained through practice
experience
· Consumer preference: Knowledge gained through life
experience
Information Source(s)
Number of Sources
· Source of information has credible experience
· Yes

· No
· N/A
· Opinions are clearly stated
· Yes
· No
· N/A
· Evidence obtained is consistent
· Yes
· No
· N/A
Findings That Help You Answer the EBP Question
Quality Rating for Clinical Practice Guidelines, Consensus, or
Position Statements (Level IV)
A High quality
Material officially sponsored by a professional, public, or
private organization or a government agency; documentation of
a systematic literature search strategy; consistent results with
sufficient numbers of well-designed studies; criteria-based
evaluation of overall scientific strength and quality of included
studies and definitive conclusions; national expertise clearly
evident; developed or revised within the past five years.
B Good quality
Material officially sponsored by a professional, public, or
private organization or a government agency; reasonably
thorough and appropriate systematic literature search strategy;
reasonably consistent results, sufficient numbers of well-
designed studies; evaluation of strengths and limitations of
included studies with fairly definitive conclusions; national
expertise clearly evident; developed or revised within the past
five years.
C Low quality or major flaw
Material not sponsored by an official organization or agency;
undefined, poorly defined, or limited literature search strategy;

no evaluation of strengths and limitations of included studies;
insufficient evidence with inconsistent results; conclusions
cannot be drawn; not revised within the past five years.
Quality Rating for Organizational Experience (Level V)
A High quality
Clear aims and objectives; consistent results across multiple
settings; formal quality improvement or financial evaluation
methods used; definitive conclusions; consistent
recommendations with thorough reference to scientific
evidence.
B Good quality
Clear aims and objectives; formal quality improvement or
financial evaluation methods used; consistent results in a single
setting; reasonably consistent recommendations with some
reference to scientific evidence.
C Low quality or major flaws
Unclear or missing aims and objectives; inconsistent results;
poorly defined quality; improvement/financial analysis method;
recommendations cannot be made.
Quality Rating for Case Report, Integrative Review, Literature
Review, Expert Opinion, Community Standard, Clinician
Experience, Consumer Preference (Level V)
A High quality
Expertise is clearly evident, draws definitive conclusions, and
provides scientific rationale; thought leader in the field.
B Good quality
Expertise appears to be credible, draws fairly definitive
conclusions, and provides logical argument for opinions.
C Low quality or major flaws
Expertise is not discernable or is dubious; conclusions cannot
be drawn.
Week 4: Johns Hopkins Nursing Non-Research Appraisal tool
Submit Assignment

· Submitting a file upload
Purpose
The purpose of this assignment is to provide the graduate
nursing student opportunity to practice reading and critiquing
research articles for application to an evidence-based practice.
Activity Learning Outcomes
Through this assignment, the student will demonstrate the
ability to:
1. Integrate evidence-based practice and research to support
advancement of holistic nursing care in diverse healthcare
settings. (PO 1)
2. Integrate knowledge related to evidence-based practice and
person-centered care to improve healthcare outcomes. (PO 1, 5)
3. Develop knowledge related to research and evidence-based
practice as a basis for designing and critiquing research studies.
(PO 1, 5)
4. Analyze research findings and evidence-based practice to
advanced holistic nursing care initiatives that promote positive
healthcare outcomes. (PO 1, 5)
Due Date: Sunday 11:59 PM MT at the end of WEEK 4, 5, 6
Students are expected to submit assignments by the time they
are due. Assignments submitted after the due date and time will
receive a deduction of 10% of the total points possible for that
assignment for each day the assignment is late. Assignments
will be accepted, with penalty as described, up to a maximum of
three days late, after which point a zero will be recorded for the
assignment. Quizzes and discussions are not considered
assi gnments and are not part of the late assignment policy.
Total Points Possible: 130 points each in weeks 4, 5 & 6
Directions and Assignment Criteria
Students will critique a research article in weeks 4, 5 & 6 (3
total) as follows:
Week 4: Non-research appraisal (Links to an external site.):
Guidelines and Reviews
Each critique will require a two-three page written analysis of
the article. The paper should include:

Introduction
· Article topic/focus
· Author(s)
· Aim of assignment
Critique of Article
The article critique should be a methodological review specific
to type of article (for example, qualitative or quantitative) . The
analysis must be two to three pages and detailed using the text
and resources. The content of the review should also include:
1. Ethical review
2. Analysis of findings
3. Limitations
4. Discussion
5. Application (translation) to practice specialty
6. Future implications
In addition, students must complete the Johns Hopkins Research
Appraisal Tool that is applicable to the type of study design
(qualitative, quantitative or non-research evidence) for the
week. Refer to the rubric for additional requirements.
Preparing the Assignment
Week 4
Non-research appraisal: Guideline or Systematic Review
1. Select a guideline or systematic review article from the Week
4 list.
Article to use: Piercy, L. K., Troiano, P. R., & Ballard, M. R.
(2018). The physical activity guidelines for
Americans. JAMA, 320(19), 2020-2028.
Reference: Jacobs, A. (2016). A medical writer's guide to meta-
analysis. Medical Writing, 25(3), 22-25.
2. Write a two-three (2-3) page critique of the article in a Word
Doc integrating your course readings. Be sure to include a
citation for your article using APA format.
3. Complete the Johns Hopkins Non-research evidence review
document.
4. Submit both through TurnItIn by Sunday 11:59pm MT of
week 4

Format & Presentation Requirements
· APA Format According to 6th edition
· Word Doc per assignment requirements.
· Word Doc Format: Cover page, no abstract, introduction (no
heading per APA), body of the paper/review, reference list,
appendix with Johns Hopkins appraisal doc. For review sections
refer to your readings and the Johns Hopkins Research
Appraisal Tool.
· Article title, author, journal, publication date
· Evidence level and quality
· Analysis of the study methodology (specific to study type,
e.g., qualitative versus quantitative versus non-research)
· Reference list should include the chosen article and other
resources used to construct the review, such as course textbook,
Johns Hopkins Evidence Based Practice: Model and Guidelines,
and How to Read a Paper by Greenhalgh (2014).
ASSIGNMENT CONTENT
Category
Points
%
Description
Introduction
10
8%
· Introduction to chosen article: Provide introduction to article
topic/focus, authors and specific aim of assignment.
· Succinct overview of assignment focus.
Critique of Article
50
38%
· Methodological review specific to type (non-research versus
· Ethical review (not always present with guidelines or

systematic reviews)
· Analysis of findings
· Limitations
· Discussion
· Application to practice (translation)
· Future implications
Johns Hopkins Appraisal Tool
50
38%
110
84%
Total CONTENT Points= 110 pts
ASSIGNMENT FORMAT
Category
Points
%
Description
APA
15
12%
Requirements:
· Cover (title) page
· Running head
· No abstract
· Introduction (no heading per APA)
· Body of paper and reference page must follow APA guidelines
Syntax, grammar, spelling
5
4%

20
16%
Total FORMAT Points= 20 pts
130
100%
ASSIGNMENT TOTAL=130 points
Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning OutcomeIntroduction
• Introduction to chosen article
• Succinct overview of assignment focus.
10.0 pts
Excellent
Content includes well-written, succinct, information that
includes: Article topic/focus, authors and specific aim of
assignment.
9.0 pts
V. Good
Content is well-written but omits or is thin in one area.
8.0 pts
Satisfactory
Section content is basic in its explanation of the article
(overview) and the purpose of the assignment but lacks specific

detail and depth.
5.0 pts
Needs Improvement
All content is included but difficult to piece together in its
explanation of the article (overview) and the purpose of the
assignment OR a piece of the content is missing, for example,
overview of assignment focus, yet what is written is well stated.
0.0 pts
Unsatisfactory
Missing OR Section content is vague in its introduction of the
article (overview) and the purpose of the assignment is missing
OR article overview is missing, and purpose of the assignment
is vague.)
10.0 pts
This criterion is linked to a Learning OutcomeCritique of
Article
• Methodological review specific to type (non-research versus
• Ethical review (not always present with guidelines or
systematic reviews)
• Analysis of findings
• Limitations
• Discussion
• Application to practice (translation)
• Future implications
50.0 pts
Excellent
All content is included in the critique with comprehensive
definitions, examples and with in-text citations that support the
46.0 pts
V. Good
All content is included in the critique. One or two sections may
be included without depth: For example, Definitions, examples

and with in-text citations that support the article evaluation
with depth. Or: All content has explanatory depth of analysis
including definitions, examples and in-text citations supporting
the analysis, however, a content area may be missing (such as
ethical review or limitations)
42.0 pts
Satisfactory
Two or three content areas are missing, or all content areas are
included but there is inconsistent depth/ integration of
article evaluation with depth
25.0 pts
Needs Improvement
Four or more content areas are missing, or all content areas are
included but there is little to no depth/ integration of
0.0 pts
Unsatisfactory
Critique is vague, without structure, without discernible
integration of definitions, examples, and in-text citations that
support the writing.
50.0 pts
This criterion is linked to a Learning OutcomeJohns Hopkins
Appraisal Tool
50.0 pts
Excellent
46.0 pts
V. Good
Evidence Tool: 1 of the 6 sections B. Evidence Tool: 1 section
missing

42.0 pts
Satisfactory
Evidence Tool 2 or 3 of the 6 sections B. Evidence Tool: 2
sections missing
25.0 pts
Needs Improvement
Tool is included and is missing: A. Non-Evidence Tool 4 or
more of the 6 sections B. Evidence Tool – 3 more sections
missing.
0.0 pts
Unsatisfactory
Tool is missing or the wrong tool is used.
50.0 pts
This criterion is linked to a Learning OutcomeOrganization &
Format
Requirements:
• Cover (title) page
• No abstract
• Introduction
• Body of paper and reference page must follow APA guidelines
15.0 pts
Excellent
All aspects of paper follow APA guidelines (cover, no abstract,
introduction, headings (not on introduction), body of paper and
reference page
14.0 pts
V. Good
1-3 APA errors
12.0 pts
Satisfactory
4-5 APA errors

8.0 pts
Needs Improvement
6-9 APA errors
0.0 pts
Unsatisfactory
10 or greater APA errors
15.0 pts
This criterion is linked to a Learning OutcomeSyntax, grammar,
spelling
5.0 pts
Excellent
There are no grammatical, spelling, word usage or punctuation
errors.
4.0 pts
V. Good
3.0 pts
Satisfactory
2.0 pts
Needs Improvement
0.0 pts
Unsatisfactory
10 or greater grammatical, spelling, word usage or punctuation
errors.
5.0 pts
Total Points: 130.0

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