Physical activity

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Physical activity is not just exercise. It includes other activities that involve movement; for example cleaning, working, active transport etc. TaipeiMetro-Cleaner.JPG
Physical activity is not just exercise. It includes other activities that involve movement; for example cleaning, working, active transport etc.

Physical activity is defined as any voluntary bodily movement produced by skeletal muscles that requires energy expenditure. [1] Physical activity encompasses all activities, at any intensity, performed during any time of day or night. [2] It includes both exercise and incidental activity integrated into daily routine. This integrated activity may not be planned, structured, repetitive or purposeful for the improvement of fitness, and may include activities such as walking to the local shop, cleaning, working, active transport etc. Lack of physical activity is associated with a range of negative health outcomes, whereas increased physical activity can improve physical and mental health, as well as cognitive and cardiovascular health. [3] There are at least eight investments that work to increase population-level physical activity, including whole-of-school programmes, active transport, active urban design, healthcare, public education and mass media, sport for all, workplaces and community-wide programmes. [4] [5] Physical activity increases energy expenditure and is a key regulator in controlling body weight (see Summermatter cycle for more). [6]

Contents

Terminology misconception

"Exercise" and "physical activity" are frequently used interchangeably and generally refer to physical activity performed during leisure time with the primary purpose of improving or maintaining physical fitness, physical performance, or health. However, physical activity is not exactly the same concept as exercise. Exercise is defined as a subcategory of physical activity that is planned, structured, repetitive, and purposeful in the sense that the improvement or maintenance of one or more components of physical fitness is the objective. [1] Conversely, physical activity includes exercise but may also be unplanned, unstructured, random and non-purposeful carried out for a multitude of reasons.

Intensity of physical activities on a continuum from sedentary behavior to vigorous physical activity. Intensity and Energy Expenditure.png
Intensity of physical activities on a continuum from sedentary behavior to vigorous physical activity.

A 2021 study shows that people who start successful physical activity programmes maintain much of it for at least three months. [7]

Intensity

Physical activity can be at any intensity, from a simple twitch of a muscle to an all-out sprint. In practice, physical activity can be viewed as a continuum from sedentary behavior to vigorous intensity activity. Intensities are broadly categorized according to energy expenditure using a standard measure of intensity, metabolic equivalents (METs). The broad categories are sedentary behavior, light activity, moderate activity and vigorous activity.

Example activities at each intensity

The following table documents some examples of physical activities at each intensity level. Depending on the individual and the activity involved, activities may overlap intensity categories or change categories completely.

IntensityExample Activities
Sedentary BehaviorSitting, lying
StandingStanding still
Light Physical Activity (LPA)Slow walking, shuffling around the house
Moderate Physical Activity (MPA)Brisk walking, jogging, light swimming, stair climbing
Vigorous Physical Activity (VPA)Fast running, fast cycling, sprinting

Physical activity as prevention and therapy

Physical activity is a cornerstone of public health and prevention of non-communicable disease. Physical inactivity has been found to cause a wide range of non-communicable diseases, including coronary heart disease, stroke, diabetes mellitus and depression [8] . An analysis of the healthcare costs of non-communicable diseases and mental illess attributable to physical inactivity for 2020–30 found that 500 million new cases of disease will occur globally between 2020 and 2030 if physical activity remains at today’s levels. This corresponds to more than US$300 billion in treatment costs [9]

Many studies have demonstrated the potential beneficial effects of physical activity on the prevention and therapy of many disorders as Obesity [10] [11] and Irritable bowel syndrome [12] [13] Physical activity has been shown to reduce anxiety as a condition (individual physical exercise, without continuity), anxiety as a personality trait (continuous performance, "exercise" of certain physical activities), psycho-physiological signs of anxiety - blood pressure and heart rate (moderate physical activity can lead to a decrease in the intensity of short-term physiological reactivity and encourage recovery from short-term physiological stressors (Biddle et al., 2000)). For people with a severe depressive episode and anxiety disorder, long and short walks proved to be the most effective; for people with substance abuse disorders, bipolar disorder and frequent psychotic decompensation, "strenuous" gymnastics and riding proved to be the most effective.[ medical citation needed ] Reducing workplace-base sitting has been shown to address sedentary behaviour in workplace. However, there are few interventions that are cost-effective in reducing occupational sitting time. [14] A study estimated the annual value of nature-based PA conducted in England in 2019 in terms of avoided healthcare and societal costs of six non-communicable diseases (ischaemic heart disease, ischaemic stroke, type 2 diabetes, colon cancer, breast cancer and major depressive disorder) at £108.7million [15] .

Physical activities during leisure and clusters of different forms of meaningfulness

Model over the field of physical activity in terms of clusters of movement cultures with different forms of meaningfulness. From: Lundvall & Schantz 2013. Model of the field of physical activity.pdf
Model over the field of physical activity in terms of clusters of movement cultures with different forms of meaningfulness. From: Lundvall & Schantz 2013.

Different forms of physical activity in leisure time can be divided into different clusters of activities that have a common denominator in the form of type of meaningfulness, se model to the right (Lundvall & Schantz 2013). [16]

These separate forms of meaningfulness consist of (i) competition and championship, (ii) nature encounters, (iii) aesthetic-expressive, (iv) fitness gymnastics and play, (v) everyday exercise and (vi) five different basic forms of physical training (aerobic, anaerobic, strength, flexibility and coordination training).

How these different clusters have been treated over time from 1813 to today in a context of teacher training for physical education in the Swedish school system has been described by the Swedish professors in human movement science Suzanne Lundvall & Peter Schantz (2013). [17]

Recommendations for physical activity (including sleep and sedentary behavior)

Global recommendations

The World Health Organization recommend the following: [1]

Adults aged 18–64

1. Adults aged 18–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

2. Aerobic activity should be performed in bouts of at least 10 minutes duration.

3. For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.

4. Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

Adults aged 65+

1. Adults aged 65 years and above should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.

2. Aerobic activity should be performed in bouts of at least 10 minutes duration.

3. For additional health benefits, adults aged 65 years and above should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate-and vigorous-intensity activity.

4. Adults of this age group, with poor mobility, should perform physical activity to enhance balance and prevent falls on 3 or more days per week.

5. Muscle-strengthening activities should be done involving major muscle groups, on 2 or more days a week.

6. When adults of this age group cannot do the recommended amounts of physical activity due to health conditions, they should be as physically active as their abilities and conditions allow.

Children and Adolescents aged 5–17

1. Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.

2. Amounts of physical activity greater than 60 minutes provide additional health benefits.

Country-level recommendations

Australia, [18] New Zealand, [19] the United Kingdom, [20] Canada [21] and the United States [22] are among the countries that have issued physical activity recommendations.

Predictors of physical activity levels

The amount of physical activity conducted by a population—and by extension the proportion of that population reaching guidelines or other specified thresholds—is dictated by a number of factors including demographics (e.g., age, sex, ethnicity), population health status, cultural aspects, and the state of the environment itself (e.g. infrastructure that affords physical activity). Demographic groups can also intersect, increasing risk to individuals who are both female and socially disadvantaged for example. [23]

Studies have shown that as availability of natural environments (e.g., parks, woodlands, inland waters, coasts) increases, more leisure-time physical activity such as walking and cycling are reported. [24] Meteorological conditions have been found to predict physical activity differently in different types of environment. For example, in a large population-based study in England, higher air temperatures and lower wind speeds were associated with increased physical activity. [25]

Globally, in 2016, according to a pooled analysis of 298 population-based surveys, around 81% of students aged 11–17 years were insufficiently physically active. [26] The region with the highest prevalence of insufficient activity in 2016 was high-income Asia Pacific. [26]

As a health indicator

Insufficient physical activity among adults (2016) Insufficient physical activity.png
Insufficient physical activity among adults (2016)

Physical activity, qualified in the form of a physical activity vital sign (PAVS) metric, has been proposed as a screening tool in primary care diagnostics. [27] It has been suggested to correspond with BMI [28] and chronic disease, when coupled with demographic information [27] as well as a tool for identifying patients who do not meet certain physical activity guidelines. [29] Generally, this metric is evaluated by a self-reported medical questionnaire, which can significantly affect the validity and applicability of a PAVS in clinical treatment determination. [27] [29]

See also

Related Research Articles

<span class="mw-page-title-main">Exercise</span> Physical activity that improves health

Exercise is physical activity that enhances or maintains fitness and overall health. It is performed for various reasons, including weight loss or maintenance, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic skills, improve health, or simply for enjoyment. Many individuals choose to exercise outdoors where they can congregate in groups, socialize, and improve well-being as well as mental health.

<span class="mw-page-title-main">Aerobic exercise</span> Low to high intensity physical exercise

Aerobic exercise is physical exercise of low to high intensity that depends primarily on the aerobic energy-generating process. "Aerobic" is defined as "relating to, involving, or requiring oxygen", and refers to the use of oxygen to meet energy demands during exercise via aerobic metabolism adequately. Aerobic exercise is performed by repeating sequences of light-to-moderate intensity activities for extended periods of time. Examples of cardiovascular or aerobic exercise are medium- to long-distance running or jogging, swimming, cycling, stair climbing and walking.

<span class="mw-page-title-main">Lifestyle disease</span> Diseases linked with the way people live their life

Lifestyle diseases can be defined as the diseases linked to the manner in which a person lives their life. These diseases are non-communicable, and can be caused by lack of physical activity, unhealthy eating, alcohol, substance use disorders and smoking tobacco, which can lead to heart disease, stroke, obesity, type II diabetes and lung cancer. The diseases that appear to increase in frequency as countries become more industrialized and people live longer include Alzheimer's disease, arthritis, atherosclerosis, asthma, cancer, chronic liver disease or cirrhosis, chronic obstructive pulmonary disease, colitis, irritable bowel syndrome, type 2 diabetes, heart disease, hypertension, metabolic syndrome, chronic kidney failure, osteoporosis, PCOD, stroke, depression, obesity and vascular dementia.

<span class="mw-page-title-main">Physical fitness</span> State of health and well-being

Physical fitness is a state of health and well-being and, more specifically, the ability to perform aspects of sports, occupations, and daily activities. Physical fitness is generally achieved through proper nutrition, moderate-vigorous physical exercise, and sufficient rest along with a formal recovery plan.

<span class="mw-page-title-main">Endurance</span> Ability of an organism to exert itself and remain active for a long period of time

Endurance is the ability of an organism to exert itself and remain active for a long period of time, as well as its ability to resist, withstand, recover from and have immunity to trauma, wounds, or fatigue.

<span class="mw-page-title-main">High-intensity interval training</span> Exercise strategy

High-intensity interval training (HIIT) is a training protocol alternating short periods of intense or explosive anaerobic exercise with brief recovery periods until the point of exhaustion. HIIT involves exercises performed in repeated quick bursts at maximum or near maximal effort with periods of rest or low activity between bouts. The very high level of intensity, the interval duration, and number of bouts distinguish it from aerobic (cardiovascular) activity, because the body significantly recruits anaerobic energy systems. The method thereby relies on "the anaerobic energy releasing system almost maximally".

<span class="mw-page-title-main">Sedentary lifestyle</span> Type of lifestyle involving little or no physical activity

Sedentary lifestyle is a lifestyle type, in which one is physically inactive and does little or no physical movement and/or exercise. A person living a sedentary lifestyle is often sitting or lying down while engaged in an activity like socializing, watching TV, playing video games, reading or using a mobile phone or computer for much of the day. A sedentary lifestyle contributes to poor health quality, diseases as well as many preventable causes of death.

The metabolic equivalent of task (MET) is the objective measure of the ratio of the rate at which a person expends energy, relative to the mass of that person, while performing some specific physical activity compared to a reference, currently set by convention at an absolute 3.5 mL of oxygen per kg per minute, which is the energy expended when sitting quietly by a reference individual, chosen to be roughly representative of the general population, and thereby suited to epidemiological surveys. A Compendium of Physical Activities is available online, which provides MET values for hundreds of activities.

Aerobic conditioning is a process whereby the heart and lungs are trained to pump blood more efficiently, allowing more oxygen to be delivered to muscles and organs. The skeletal muscles also become aerobically conditioned, as regular aerobic exercise produces a shift in muscle fibres from more type II into more type I (slow-twitch/oxidative). Type I muscle fibres have far more mitochondria than type II, making type I fibres the producers of adenosine triphosphate (ATP) primarily through oxidative phosphorylation rather than anaerobic glycolysis. Some neuromuscular diseases recommend regular aerobic exercise in order for the skeletal muscles to become aerobically conditioned, providing relief of symptoms or slowing the course of the disease, for example metabolic myopathies and Duchenne muscular dystrophy.

<span class="mw-page-title-main">Active living</span> Physically active way of life

Active living is a lifestyle that integrates physical activity into everyday routines, such as walking to the store or biking to work. Active living is not a formalized exercise program or routine, but instead means to incorporate physical activity, which is defined as any form of movement, into everyday life. Active living brings together urban planners, architects, transportation engineers, public health professionals, activists and other professionals to build places that encourage active living and physical activity. One example includes efforts to build sidewalks, crosswalks, pedestrian crossing signals, and other ways for children to walk safely to and from school, as seen in the Safe Routes to School program. Recreational opportunities close to the home or workplace, walking trails, and bike lanes for transportation also contribute to a more active lifestyle. Active living includes any physical activity or recreation activity and contributes to a healthier lifestyle. Furthermore, active living addresses health concerns, such as obesity and chronic disease, by helping people have a physically active lifestyle. Communities that support active living gain health benefits, economic advantages, and improved quality of life.

Physical fitness is maintained by a range of physical activities. Physical activity is defined by the World Health Organization as "any bodily movement produced by skeletal muscles that requires energy expenditure." Human factors and social influences are important in starting and maintaining such activities. Social environments can influence motivation and persistence, through pressures towards social conformity.

Interval training is a type of training exercise that involves a series of high-intensity workouts interspersed with rest or break periods. The high-intensity periods are typically at or close to anaerobic exercise, while the recovery periods involve activity of lower intensity. Varying the intensity of effort exercises the heart muscle, providing a cardiovascular workout, improving aerobic capacity and permitting the person to exercise for longer and/or at more intense levels.

<span class="mw-page-title-main">Exercise trends</span> General trends of people doing exercise

Worldwide there has been a large shift towards less physically demanding work and a more sedentary lifestyle. This has been accompanied by increasing use of mechanized transportation, automobile dependency, a greater prevalence of labor saving technology in the home, and less active recreational pursuits. At least 31% of the world's population does not get sufficient physical exercise. This is true in almost all developed and developing countries, and among children. Some experts refer to sitting as "the new smoking" because of its negative effects on overall health.

Exercise prescription commonly refers to the specific plan of fitness-related activities that are designed for a specified purpose, which is often developed by a fitness or rehabilitation, or Exercise medicine specialist for the client or patient. Due to the specific and unique needs and interests of the client/patient, the goal of exercise prescription should focus on motivation and customization, thus making achieving goals more likely to become successful. Exercise prescription should take into account the patient's medical history, and a pre-examination of a patient's physical fitness to make sure a person has the capacity to perform the exercises.

Physical Activity Guidelines for Americans are National Physical Activity Guidelines first published by the United States Department of Health and Human Services (HHS) in 2008. These guidelines provided physical activity recommendations for people aged six years and older, including those with many chronic health conditions and disabilities. The science-based Guidelines recommend a total amount of physical activity per week to achieve a range of health benefits. In 2018, HHS released an update to the first set of guidelines. This 2018 edition provides guidelines for people aged three years and older and summarizes the new knowledge gained from studies that were conducted since the first edition was released in 2008.

<span class="mw-page-title-main">Lack of physical education</span> Inadequate provision and effectiveness of physical education in schools

Lack of physical education is the inadequacy of the provision and effectiveness of exercise and physical activity within modern education.

<span class="mw-page-title-main">Cardiovascular fitness</span> Heart-related component of physical fitness

Cardiovascular fitness refers to a health-related component of physical fitness that is brought about by sustained physical activity. A person's ability to deliver oxygen to the working muscles is affected by many physiological parameters, including heart rate, stroke volume, cardiac output, and maximal oxygen consumption.

<span class="mw-page-title-main">Peter Schantz</span>

Peter Gösta Schantz, born on April 28, 1954, in Stockholm, Sweden, graduated as a doctor in medical sciences at the Karolinska Institute in Stockholm in 1986, became a professor in human movement sciences at Mid-Sweden University in Östersund, Jämtland, in 2008, and professor in human biology, including the multidisciplinary field of movement, health and environment, at the Swedish School of Sport and Health Sciences, GIH, in Stockholm, Sweden, in 2013.

<span class="mw-page-title-main">Neurobiological effects of physical exercise</span> Neural, cognitive, and behavioral effects of physical exercise

The neurobiological effects of physical exercise involve possible interrelated effects on brain structure, brain function, and cognition. Research in humans has demonstrated that consistent aerobic exercise may induce improvements in certain cognitive functions, neuroplasticity and behavioral plasticity; some of these long-term effects may include increased neuron growth, increased neurological activity, improved stress coping, enhanced cognitive control of behavior, improved declarative, spatial, and working memory, and structural and functional improvements in brain structures and pathways associated with cognitive control and memory. The effects of exercise on cognition may affect academic performance in children and college students, improve adult productivity, preserve cognitive function in old age, preventing or treating certain neurological disorders, and improving overall quality of life.

The benefits of physical activity range widely. Most types of physical activity improve health and well-being.

References

  1. 1 2 3 Global Recommendations on Physical Activity for Health, 2009. World Health Organization. Geneva, Switzerland. Accessed 13/07/2018. Available at: http://www.who.int/ncds/prevention/physical-activity/en/
  2. ↑ Pedišić, Ž. (2014). Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research—the focus should shiftep, sedentary behaviour, standing and activity. Kinesiology, 46 (1), 135-146. Retrieved from https://hrcak.srce.hr/123743
  3. ↑ Ione Avila-Palencia (2018). "The effects of transport mode use on self-perceived health, mental health, and social contact measures: A cross-sectional and longitudinal study". Environment International. 120: 199–206. doi:10.1016/j.envint.2018.08.002. hdl: 10044/1/62973 . PMID   30098553. S2CID   51965322.
  4. ↑ Fenech, Amanda; Chockalingam, N.; Formosa, C.; Gatt, A. (1 January 2021). "Longitudinal effects of evidence-based physical education in Maltese children". Child and Adolescent Obesity. 4 (1): 98–116. doi: 10.1080/2574254X.2021.1915041 . S2CID   237846270.
  5. ↑ Milton, Karen; Cavill, Nick; Chalkley, Anna; Foster, Charlie; Gomersall, Sjaan; Hagstromer, Maria; Kelly, Paul; Kolbe-Alexander, Tracy; Mair, Jacqueline; McLaughlin, Matthew; Nobles, James (2021-05-12). "Eight Investments That Work for Physical Activity". Journal of Physical Activity and Health. -1 (aop): 625–630. doi: 10.1123/jpah.2021-0112 . hdl: 1983/8805dde9-3053-4103-aa70-314da5fd30cc . ISSN   1543-5474. PMID   33984836.
  6. ↑ S, Summermatter; C, Handschin (November 2012). "PGC-1α and Exercise in the Control of Body Weight". International Journal of Obesity. 36 (11): 1428–35. doi: 10.1038/ijo.2012.12 . PMID   22290535. S2CID   26821676.
  7. ↑ Madigan, Claire (June 2021). "Effectiveness of interventions to maintain physical activity behavior (device-measured): Systematic review and meta-analysis of randomized controlled trials". Obesity Reviews. 22 (10): e13304. doi:10.1111/obr.13304. PMID   34129276. S2CID   235437649.
  8. ↑ Peters, Ruth; EE, Nicole; Peters, Jean; Beckett, Nigel; Booth, Andrew; Rockwood, Kenneth; Anstey, Kaarin J (2019-10-01). "Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction". Therapeutic Advances in Chronic Disease. 10: 1–14. doi:10.1177/2040622319880392. PMC   6794648 . PMID   31662837.
  9. ↑ Costa Santos, Andreia; Willumsen, Juana; Meheus, Filip; Ilbawi, Andre; Bull, Fiona C (2022-12-05). "The cost of inaction on physical inactivity to public health-care systems: a population-attributable fraction analysis". The Lancet Global Health. 11 (1): E32–E39. doi:10.1016/S2214-109X(22)00464-8. PMC   9748301 . PMID   36480931.
  10. ↑ Chin SH, Kahathuduwa CN, Binks M. Physical activity and obesity: what we know and what we need to know. Obes Rev. 2016 Dec;17(12):1226-1244. doi: 10.1111/obr.12460.
  11. ↑ Wareham NJ, van Sluijs EM, Ekelund U. Physical activity and obesity prevention: a review of the current evidence. Proc Nutr Soc. 2005 May;64(2):229-47. doi: 10.1079/pns200542
  12. ↑ Johannesson E, Simrén M, Strid H, Bajor A, Sadik R. Physical activity improves symptoms in irritable bowel syndrome: a randomized controlled trial. Am J Gastroenterol. 2011 May;106(5):915-22. doi: 10.1038/ajg.2010.480. Epub 2011 Jan 4. PMID 21206488.
  13. ↑ Costantino A, Pessarelli T, Vecchiato M, Vecchi M, Basilisco G, Ermolao A. A practical guide to the proper prescription of physical activity in patients with irritable bowel syndrome. Dig Liver Dis. 2022 Nov;54(11):1600-1604. doi: 10.1016/j.dld.2022.08.034. Epub 2022 Sep 21. PMID 36153192.
  14. ↑ Akhavan Rad, Sanaz; Kiwanuka, Frank; Korpelainen, Raija; Torkki, Paulus (2022-06-30). "Evidence base of economic evaluations of workplace-based interventions reducing occupational sitting time: an integrative review". BMJ Open. 12 (6): e060139. doi:10.1136/bmjopen-2021-060139. ISSN   2044-6055. PMC   9247688 . PMID   35772822.
  15. ↑ Grellier, James; White, Mathew P; de Bell, Sian; Brousse, Oscar; Elliott, Lewis R; Fleming, Lora E; Heaviside, Clare; Simpson, Charles; Taylor, Tim; Wheeler, Benedict W; Lovell, Rebecca (2024-04-19). "Valuing the health benefits of nature-based recreational physical activity in England". Environ Int. 187: 108667. doi: 10.1016/j.envint.2024.108667 .
  16. ↑ [(7) https://www.researchgate.net/publication/273319321_Physical_Activities_and_Their_Relation_to_Physical_Education_A_200-Year_Perspective_and_Future_Challenges Title/Lundvall, S. & Schantz, P. 2013. Physical Activities and Their Relation to Physical Education: A 200-Year Perspective and Future Challenges. The Global Journal of Health and Physical Education Pedagogy 2(1):1-16]
  17. ↑ [(7) https://www.researchgate.net/publication/273319321_Physical_Activities_and_Their_Relation_to_Physical_Education_A_200-Year_Perspective_and_Future_Challenges Title/Lundvall, S. & Schantz, P. 2013. Physical Activities and Their Relation to Physical Education: A 200-Year Perspective and Future Challenges. The Global Journal of Health and Physical Education Pedagogy 2(1):1-16]
  18. ↑ "Australia's Physical Activity and Sedentary Behaviour Guidelines". The Department of Health Australia. Retrieved 2018-07-13.
  19. ↑ "Physical Activity". Ministry of Health. Retrieved 2018-07-13.
  20. ↑ "UK physical activity guidelines". Gov.uk. Retrieved 2018-07-13.
  21. ↑ "CSEP | SCPE". csepguidelines.ca. Retrieved 2021-09-19.
  22. ↑ "Physical Activity Guidelines for Americans 2nd Edition". Office of Disease Prevention and Health Promotion. Retrieved 2020-12-04.
  23. ↑ Hopkins, Ellyse (2023-11-10). The 'double jeopardy' of practice: Changing relationships between physical activity and young women from disadvantaged areas (thesis thesis). Cardiff Metropolitan University. doi:10.25401/cardiffmet.24534943.v1.
  24. ↑ Elliott, Lewis; White, Mathew; Taylor, Adrian; Herbert, Stephen (2015). "Energy expenditure on recreational visits to different natural environments". Social Science and Medicine. 139: 53–60. doi: 10.1016/j.socscimed.2015.06.038 . hdl: 10871/19949 . PMID   26151390.
  25. ↑ Elliott, Lewis; White, Mathew; Sarran, Christopher; Grellier, James; Garrett, Jo; Scoccimarro, Enrico; Smalley, Alexander; Fleming, Lora (2019). "The effects of meteorological conditions and daylight on nature-based recreational physical activity in England" (PDF). Urban Forestry & Urban Greening. 42: 39–50. doi: 10.1016/j.ufug.2019.05.005 .
  26. 1 2 Guthold, Regina; Stevens, Gretchen A.; Riley, Leanne M.; Bull, Fiona C. (2019-11-21). "Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1·6 million participants". The Lancet Child & Adolescent Health. 4 (1): 23–35. doi:10.1016/S2352-4642(19)30323-2. ISSN   2352-4642. PMC   6919336 . PMID   31761562.
  27. 1 2 3 Lin, C.Y.; Gentile, N.L.; Bale, L.; Rice, M.; Lee, S.; Ray, L.S.; Ciol, M.A. (2022). "Implementation of a Physical Activity Vital Sign in Primary Care: Associations Between Physical Activity, Demographic Characteristics, and Chronic Disease Burden". Preventing Chronic Disease. 19 (E33): E33. doi: 10.5888/pcd19.210457 . PMID   35749145. S2CID   249965817.
  28. ↑ Greenwood, J.L.J.; Joy, E.A.; Stanford, J.B. (2010). "The Physical Activity Vital Sign: A Primary Care Tool to Guide Counseling for Obesity". Journal of Physical Activity and Health. 7 (5): 571–576. doi:10.1123/jpah.7.5.571. PMID   20864751.
  29. 1 2 Ball, T.J.; Joy, E.A.; Gren, L.H.; Shaw, J.M. (2016). "Concurrent Validity of a Self-Reported Physical Activity "Vital Sign" Questionnaire With Adult Primary Care Patients". Preventing Chronic Disease. 13: E16. doi:10.5888/pcd13.150228. PMC   4747440 . PMID   26851335.
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