Minor the moving body
Week 1:
Tuesday 2-09-2025
Health benefits of physical activity and the effect of sitting on health
Physical activity: Any bodily movement produced by contraction of skeletal muscle
that results in energy expenditure (Caspersen et al 1985). Domains and type, intensity,
duration, frequency.
Dimensions of physical activity-> Occupational/educational, transportation,
household, leisure-time (free time).
Intensity= everything we do when awake:
Sedentary (≤1.5 MET)
Light (>1.5 and <3 MET)
Moderate activities (≥ 3 and <6 MET)-> Health enhancing physical activity
Vigorous activities (≥ 6 MET)-> Health enhancing physical activity (WHO recommends
150 min/wk of MVPA for adults=2% of the waking day, so what about the rest of the
day?....)
Global burden of physical inactivity:
• 35% of the population is not meeting the activity standard, risk of hazard is 28%
and 9% of deaths could have been avoided, that's 5 million global deaths a year.
For smoking this is similar.
• Physical inactivity and mortality are correlated.
• If you move, there's reduced risk of mortality, lower risk of cancer, dementia,
brain health, weight status, falls (older people), physical function (older people),
cardiovascular incidence is also lowered.
• The best bias for public health is activity.
Guidelines on physical activity and sedentary behavior.
What is physical activity?:
Vigorous intensity:
• Jogging or running
• Swimming fast
• Competitive team spots
• Martial arts
Moderate intensity:
• Walking
,• Household chores
• Games and sport
• Riding a bike
Muscle strengthening:
• Carrying heavy
shopping
• Yoga/Pilates/Tai chi
• Lifting weights
• Push-ups/sit-ups
• Heavy gardening
• Every move counts! Recommended range is 150-300 minutes. Risk and harm
increase when above.
• For all adults and older adults: at least 150-300 minutes of moderate intensity
physical activity or at least 75-150 minutes of vigorous intensity physical
activity.
• For additional health benefits: more than 300 minutes of moderate intensity
activity or more than150 vigorous activity.
• Additionally, it's recommended to do muscle strengthening at least 2 days a
week. For older adults, 3 days a week of strengthening and training balance.
• For children at least 60 minutes a day of moderate to vigorous physical
activity. On at least 3 days a week strength activity as well.
• Pregnant women:150 minutes a week of moderate intensity activity. If you did
vigorous exercise before already you can keep doing that. A lot of maternal and
fetal health benefits! (see slide)
• People with chronic conditions and disabilities should also be moving (see
slide). Doing some is better than none! At least 150 to 300 mins of moderate
intensity activity or at least 75 to 150 minutes of vigorous activity. For
additional health benefits: more than 300 minutes of moderate intensity activity
or more than150 vigorous activity and muscle strengthening 2 days a week
• Less than 50% meet physical guidelines.
• Generally, women are more inactive than men and older people are even more
inactive. Overweight people are more inactive and people with lower education
tend to be more inactive as well. Same with people who suffer from disabilities,
they also move less.
Sedentary behavior: Any waking behavior characterized by an energy expenditure ≤1.5
METs while in a sitting, reclining or lying posture ≠ Inactivity
• You can be inactive and be sedentary (teaching for example).
, • 60% of our time is spent being sedentary when you're not working, 30 %
sedentary during household time, and transport is 70% sedentary (83% in
Australia, because it's very car based). Lastly, leisure time is spent 85%
sedentary (lots of screen time).
• Occupational sedentary time: proportion sitting +/- ¾ of work time. Seems to be
increasing.
• Men are generally more sedentary, same with higher educated people.
• Prevalence conclusions: Adults are sedentary ~9 hr/d, sedentary work seems to
be increasing, non-occupational time: leisure time most sedentary.
Sitting and all-cause mortality
• If you're sedentary but are very active (35.5 MET) it doesn't matter that much, but
if you're inactive then it does matter. WHO recommends 7.5 MET so then it does
matter
• Scientific evidence shows more sedentary behavior is related to greater:
All-cause mortality, CVD mortality and incidence, Type 2 diabetes incidence,
Incidence of colon, endometrial, and lung cancer.
WHO sedentary behavior guidelines:
• Limit the time being sedentary and replace that with more physical activity of any
intensity. Ideally replace some sedentary behavior for some light intensity
activity and some MVPA to reduce the sedentary time.
• Mortality lowers when standing longer instead of sitting down. But what counts
as standing? Results are not really trustworthy.
• But prolonged standing can increase the risk of varicose veins and
musculoskeletal problems (i.e. back, neck). Alternating sitting, standing and
physical activity. Do not demonize sitting!
World Health Organisation:Global Action Plan for PhysicalActivity 2018-2030
(GAPPA)-> Target: A 15% relative reduction in the global prevalence of physical
inactivity in adults and in adolescents by 2030.
Eight investments for physical activity:
1. The whole of school programs, 2. Active transport, 3. Active urban design, 4. Health
care, 5. Public education (incl. mass media), 6. Sport & recreation for all, 7. Workplaces
8. Community-wide programs
Conclusions
• A physically active lifestyle can help prevent the development of many health
conditions.
, • WHO recommends adults to do 150 min/week of moderate to vigorous intensity
physical activity.
• Physical inactivity & sedentary behavior are common.
• Actions are needed to reduce the burden of physical inactivity on society.
• Healthy balance between sitting, standing and (light intensity) physical activity.
Thursday 4-09-2025
Lifestyle interventions
For what patient groups would lifestyle medicine be beneficial? -> For everyone it would
be beneficial, but especially for:
• Diseases (e.g.)
• Internal medicine / cardiology:
• Diabetes
• Cardiovascular disease
• Orthopedics:
• Osteoarthritis
• Rehabilitation
• Surgery
• Benigne liver tumor
• Gynaecology
• IVF (pre-pregnancy)
• Pregnancy
Barriers to discuss physical activity: time, financial, motivation, fear of disruption of
patient-doctor relation, lack of knowledge of the options, negative beliefs about
consequences, belief patient is unmotivated, responsibility of general practioner,
financially. (from doctors' perspective)
A lifestyle front office might help break these barriers. And you can also get help in the
community.
The US diabetes prevention program: Randomized controlled trial,
Goal: To prevent or delay the development of type 2 diabetes in persons with impaired
glucose tolerance (IGT). Lifestyle, metformin and placebo group. The first group had to
change their diet and do intensive activity. The Placebo group kind of stayed the same,
metformin group lost a little weight, and the lifestyle group lost the most weight+
physical activity increased significantly. Lifestyle group improves diabetes by 58% and
metformin by 31%, so exercising seems like the best option/healthiest option.
Week 1:
Tuesday 2-09-2025
Health benefits of physical activity and the effect of sitting on health
Physical activity: Any bodily movement produced by contraction of skeletal muscle
that results in energy expenditure (Caspersen et al 1985). Domains and type, intensity,
duration, frequency.
Dimensions of physical activity-> Occupational/educational, transportation,
household, leisure-time (free time).
Intensity= everything we do when awake:
Sedentary (≤1.5 MET)
Light (>1.5 and <3 MET)
Moderate activities (≥ 3 and <6 MET)-> Health enhancing physical activity
Vigorous activities (≥ 6 MET)-> Health enhancing physical activity (WHO recommends
150 min/wk of MVPA for adults=2% of the waking day, so what about the rest of the
day?....)
Global burden of physical inactivity:
• 35% of the population is not meeting the activity standard, risk of hazard is 28%
and 9% of deaths could have been avoided, that's 5 million global deaths a year.
For smoking this is similar.
• Physical inactivity and mortality are correlated.
• If you move, there's reduced risk of mortality, lower risk of cancer, dementia,
brain health, weight status, falls (older people), physical function (older people),
cardiovascular incidence is also lowered.
• The best bias for public health is activity.
Guidelines on physical activity and sedentary behavior.
What is physical activity?:
Vigorous intensity:
• Jogging or running
• Swimming fast
• Competitive team spots
• Martial arts
Moderate intensity:
• Walking
,• Household chores
• Games and sport
• Riding a bike
Muscle strengthening:
• Carrying heavy
shopping
• Yoga/Pilates/Tai chi
• Lifting weights
• Push-ups/sit-ups
• Heavy gardening
• Every move counts! Recommended range is 150-300 minutes. Risk and harm
increase when above.
• For all adults and older adults: at least 150-300 minutes of moderate intensity
physical activity or at least 75-150 minutes of vigorous intensity physical
activity.
• For additional health benefits: more than 300 minutes of moderate intensity
activity or more than150 vigorous activity.
• Additionally, it's recommended to do muscle strengthening at least 2 days a
week. For older adults, 3 days a week of strengthening and training balance.
• For children at least 60 minutes a day of moderate to vigorous physical
activity. On at least 3 days a week strength activity as well.
• Pregnant women:150 minutes a week of moderate intensity activity. If you did
vigorous exercise before already you can keep doing that. A lot of maternal and
fetal health benefits! (see slide)
• People with chronic conditions and disabilities should also be moving (see
slide). Doing some is better than none! At least 150 to 300 mins of moderate
intensity activity or at least 75 to 150 minutes of vigorous activity. For
additional health benefits: more than 300 minutes of moderate intensity activity
or more than150 vigorous activity and muscle strengthening 2 days a week
• Less than 50% meet physical guidelines.
• Generally, women are more inactive than men and older people are even more
inactive. Overweight people are more inactive and people with lower education
tend to be more inactive as well. Same with people who suffer from disabilities,
they also move less.
Sedentary behavior: Any waking behavior characterized by an energy expenditure ≤1.5
METs while in a sitting, reclining or lying posture ≠ Inactivity
• You can be inactive and be sedentary (teaching for example).
, • 60% of our time is spent being sedentary when you're not working, 30 %
sedentary during household time, and transport is 70% sedentary (83% in
Australia, because it's very car based). Lastly, leisure time is spent 85%
sedentary (lots of screen time).
• Occupational sedentary time: proportion sitting +/- ¾ of work time. Seems to be
increasing.
• Men are generally more sedentary, same with higher educated people.
• Prevalence conclusions: Adults are sedentary ~9 hr/d, sedentary work seems to
be increasing, non-occupational time: leisure time most sedentary.
Sitting and all-cause mortality
• If you're sedentary but are very active (35.5 MET) it doesn't matter that much, but
if you're inactive then it does matter. WHO recommends 7.5 MET so then it does
matter
• Scientific evidence shows more sedentary behavior is related to greater:
All-cause mortality, CVD mortality and incidence, Type 2 diabetes incidence,
Incidence of colon, endometrial, and lung cancer.
WHO sedentary behavior guidelines:
• Limit the time being sedentary and replace that with more physical activity of any
intensity. Ideally replace some sedentary behavior for some light intensity
activity and some MVPA to reduce the sedentary time.
• Mortality lowers when standing longer instead of sitting down. But what counts
as standing? Results are not really trustworthy.
• But prolonged standing can increase the risk of varicose veins and
musculoskeletal problems (i.e. back, neck). Alternating sitting, standing and
physical activity. Do not demonize sitting!
World Health Organisation:Global Action Plan for PhysicalActivity 2018-2030
(GAPPA)-> Target: A 15% relative reduction in the global prevalence of physical
inactivity in adults and in adolescents by 2030.
Eight investments for physical activity:
1. The whole of school programs, 2. Active transport, 3. Active urban design, 4. Health
care, 5. Public education (incl. mass media), 6. Sport & recreation for all, 7. Workplaces
8. Community-wide programs
Conclusions
• A physically active lifestyle can help prevent the development of many health
conditions.
, • WHO recommends adults to do 150 min/week of moderate to vigorous intensity
physical activity.
• Physical inactivity & sedentary behavior are common.
• Actions are needed to reduce the burden of physical inactivity on society.
• Healthy balance between sitting, standing and (light intensity) physical activity.
Thursday 4-09-2025
Lifestyle interventions
For what patient groups would lifestyle medicine be beneficial? -> For everyone it would
be beneficial, but especially for:
• Diseases (e.g.)
• Internal medicine / cardiology:
• Diabetes
• Cardiovascular disease
• Orthopedics:
• Osteoarthritis
• Rehabilitation
• Surgery
• Benigne liver tumor
• Gynaecology
• IVF (pre-pregnancy)
• Pregnancy
Barriers to discuss physical activity: time, financial, motivation, fear of disruption of
patient-doctor relation, lack of knowledge of the options, negative beliefs about
consequences, belief patient is unmotivated, responsibility of general practioner,
financially. (from doctors' perspective)
A lifestyle front office might help break these barriers. And you can also get help in the
community.
The US diabetes prevention program: Randomized controlled trial,
Goal: To prevent or delay the development of type 2 diabetes in persons with impaired
glucose tolerance (IGT). Lifestyle, metformin and placebo group. The first group had to
change their diet and do intensive activity. The Placebo group kind of stayed the same,
metformin group lost a little weight, and the lifestyle group lost the most weight+
physical activity increased significantly. Lifestyle group improves diabetes by 58% and
metformin by 31%, so exercising seems like the best option/healthiest option.
