Introducing: Recommendations for Physical Activity

I want to preface this by saying that my perspective on exercise is long term. I want myself, and you, to live a long healthy life. Thus, I won’t be giving advice on how to maximize your training for performance. My target is not athletes, but people who do exercise as a means to live a long healthy life. The recommendations in Sweden are largely based on guidelines from the American College of Sports Medicine. Let’s start off with a rant:

Hello there! Do you know what the recommendations for physical activity is for adults? For elders? For adolescents? You may have heard that 150 minutes of aerobic exercise per week is a milepost good for health, and that you should also do strength training in addition. While these are true they fall woefully short of actually understanding the recommendations. Here is a thing: people don’t understand how important exercise is for health. Yes, everyone knows that it’s important but they DO NOT understand. I know that E = MC2 but let’s be honest: I don’t understand it. It’s the same with exercise for most people, and in large part me.

Then again. A lot of people don’t need to understand exactly why exercise is so good for their health. Maybe they built habits early, have an environment conducive to exercise or just knowing that it’s good, is enough for them. Other people have been to the doctor and heard the words “If you don’t change you will die early” and take it to their heart (literally), they may understand. My goal here isn’t to make you understand, because I’m not 100 percent sure I understand all of it myself. Instead my goal is to learn by offering you my understanding and stance on the recommendations for exercise.

Before we get into that though: One of the largest challenges when it comes to health professionals trying get people moving is habits built at a young age. Old habits die hard, and they usually triumph over common sense. When we are young our bodies are strong. They are adaptable and can take a lot of punishment. And so we don’t see how detrimental a sedentary lifestyle is in the long term. Even when we see our parents crumble under the weight of a sedentary life we will often not make the right connection and wake up.

In addition. The school system usually never really taught us the importance of fitness. We were taught that exercise is going to the gym or doing sports, not that it is vital for our health, which is far mor important than competition. To be clear, I’m sure they told us that it’s important for health, but they didn’t make us understand.

But let’s veer away from the topic of getting people to do PA and habit building, and instead focus on what the recommendations actually are so you, if you feel so inclined, can pass the knowledge (and understanding along). First of all there are four areas of recommendations which we will take a quick look at. “To do every day”, “Aerobic exercise 150 minutes per week”, “Strength/Mobility” and “Things to do less of”. For simplicity we focus on adults in this text.

The recommendations in full can be found here:
http://www.yfa.se/fyss/vad-ar-fyss/

This is a picture I took of myself walking around the local the other day. I also read online that having pictures make articles easier on the eye.

What to do every day

You should walk more. This is independent of physical exercise. I call it ”movement”, and it’s one of the five fundamental pillars of longevity (The pillars in my opinion: Movement, Exercise, Food, Sleep, Meaning) you should consider. Obviously Movement and Exercise both are physical activity, but to me, as concepts, they represent different things and using different terms make it easier for me to talk about them. Walking up stairs, going out with the dog, a promenade in the park or forest, these are all good movement based activities. It’s almost impossible to do too much movement, but you know intuitively that if you walk for 12 hours straight you will be very tired the next day. You also have a life to take care of and can’t dedicate that much time to moving. That said, if you find yourself doing too much of this, you have a lot of free time and I envy you. I walk around 18-19k steps per day and I’m not close to reach an unhealthy limit. Of course this varies if you have certain illnesses or conditions, but most people don’t move nearly enough and can readily do more.

What do at least 150 minutes a week

I have an app that gives me the recommendation to get 150 “heart points” every week. The problem is that it counts taking a walk as exercise and thus I reach 150 points the second day of the week. It’s very important to distinguish between “Movement” and “Aerobic Exercise”. The recommendations by FYSS 2017 is 150 minutes of moderate activity or 75 of intensive. The thing about moderate activity is that you need to reach at least 40 percent of something called your Heart Rate Reserve (HRR) which is ”(Max pulse – Resting Pulse)x0,4+Resting Pulse”. For me that is 110 beats per minute. However, I’d be foolish to think that is enough. When you train aerobic you want your heart to beat at its full stroke volume, which is at about 50 percent of HRR. So for me that would be about 125 beats per minute. If you’re young, that limit may be as high as 140. If your heart’s not beating at it’s full stroke volume, you don’t challenge it. You heart is likely the weakest link in the oxygen transport chain. Making your heart stronger can take a long time, but you also benefit from it if you take a break from exercise for a while. Your central capacity, the heart, takes longer to atrophy than your local capacity, your muscles which can sometimes feel like they’re gone before you even think about it, but also build (relatively) quickly. This is one of the reasons coming back after a while quickly feels invigorating. So you need at least 150 minutes of activity taxing enough to reach 50 percent of your HRR in my opinion. This can be in the form of running, cycling, skiing etc. I suppose if you lift weights enough during a week you may also reach an aerobic state for the required amount of time. To understand it more simply: if you’re not sweating and panting while you do aerobic exercise, you’re probably not getting enough of a challenge. 

Strength/mobility

These are probably the most easy to forget about for most people, because they require more thinking and engagement than going out for a run or sitting on a bicycle. On the flip-side, a lot of people like this and instead forget about Aerobic Exercise. Anyway. Strength is built on a few concepts: individuality, specificity, reversibility, variation and progressive overload (which, in my opinion, sometimes are wrongly separated in Swedish to Progression and Overload). These must be applied to your training which should occur at least 2 times a week. The importance of this, as with Aerobic Exercise, cannot be understated and cannot easily be substituted with other tasks you do in daily life. The two times a week is a minimum for you. If you do less, chances are you aren’t doing nearly enough for your health. It’s difficult for me to say too much about this right now, as I’ve only been doing resistance training for about two years. Yeah, I should have started MUCH earlier. As I previously stated, a young body will compensate for a lack of exercise; I know I am paying the price. That said, it’s never too late to start and these last two years have had an effect on all areas of my life, a positive effect that is. Point is: follow the recommendations.

When it comes to mobility the scientific literature is less clear on the effects long term, but you should be able to move your limbs through full range of motion to live an unhindered and healthy life. A good way to check your ability to move is to look at the movement of the joint at each side. If one has a larger range of motion than the other, chances are you need to do some flexibility exercises. Comparing with others can also work, provided they have a normal range of motion. I think yoga is good for gaining mobility, but I’m no expert (yet).

What to do less of

It sounds easy: be less sedentary. And you’ve heard it before so many times. Here is an important fact: being still too much is an independent risk factor when it comes to early death and sickness. This means that all the exercise you do on your free time has little impact on the negative effects of sitting for too long. You need movement as outlined in the “What to do every day” section of this article. According to WHO physical inactivity is the fourth leading risk factor in early death. The leading causes are High blood pressure, Tobacco use and High blood glucose, two of which can be caused by physical inactivity. Get this: inactivity is higher on the ranking of leading causes of death than being obese (although the two are of course correlated). So for the love of yourself, and those close to you: try to move a few minutes every hour even if you have a desk job. Your family, friends and society will thank you for it later, as will you (thank yourself that is).

Here are the recommendations visualized as a pyramid (picture from Motivation för Motion).

These are just recommendations

You should do more than 150 minutes of aerobic exercise if you want to maximize your health benefits. Of course there is a limit, that once you pass, the risk for injuries increase. This is called Dose-Response between physical activity, health and risk, as outlined in this graph:

I made this beautiful graph myself. We are all lucky I didn’t try to become a graphic designer.

This of course, is a simplification of the truth – because as humans the complete truth is always just out of reach. The curve is different for different sports but to me, as someone who want to advice people on how to exercise, the moderate dose is almost always safe (except for cases of contra-indications, which is another article). In my opinion, if you follow the recommendations to the letter you will reach a moderate amount on the dose response graph. But most people don’t. I didn’t either until recently. It’s so easy to narrow in on one type of exercise, be it strength or aerobic. But ”Lagom is best” as the saying goes.


These are the sources for the information in this article.
FYSS 2017 (2016) – general recommendations read it here for free, but if you want to study physiotherapy you should consider buying it
Motivation för Motion (2014) – general information on exercise
Nya konditionstest på cykel (2011) – effects of exercise on the heart
Physiology of Sports and Exercise (2015) – strength training
ACSM’s Guidelines for Exercise Testing and Prescription (2018) – mobility
WHO: https://www.who.int/topics/risk_factors/en/ – leading risks of early death

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Publicerad av FysioNoa

Jag är fysioterapeut (utbildad vid Karolinska Institutet) som är intresserad av hälsosam träning och forskning.

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