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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

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

38%

Required content for this section includes:
· 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

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

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

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.

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
Required content for this section includes:
• 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
Required content for this section includes:
• 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

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 definitions, examples and in-text citations that support the article evaluation with depth.

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
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).

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
Tool is included, is the correct tool, and is missing: A. Non-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 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.

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
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.

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
4-5 grammatical, spelling, word usage or punctuation errors.

2.0 pts

Needs Improvement
6-9 grammatical, spelling, word usage or punctuation errors.

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

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

· 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?

· Are groups to which recommendations apply and do not apply clearly stated?

· Have potential biases been eliminated?

· Does each recommendation have an identified level of evidence stated?

· Are recommendations clear?

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

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

Findings That Help Answer the EBP Question

· 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?
· Is literature relevant and up-to-date (most sources are within the past five years or classic)?
· Of the literature reviewed, is there a meaningful analysis of the conclusions across the articles included in the review?
· Are gaps in the literature identified?
· Are recommendations made for future practice or study?
			Complete the corresponding quality rating section.

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

Findings That Help Answer the EBP Question

Complete the corresponding quality rating section.

· Expert opinion LEVEL V

Opinion of one or more individuals based on clinical expertise

· Has the individual published or presented on the topic?

· Is the author’s opinion based on scientific evidence?

· Is the author’s opinion clearly stated?

· Are potential biases acknowledged?

Setting:

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

Findings That Help Answer the EBP Question

Complete the corresponding quality rating section.

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
Sample Size/Composition:
· Was the aim of the project clearly stated?
· Was the method fully described?
· Were process or outcome measures identified?
· Were results fully described?
· Was interpretation clear and appropriate?
· Are components of cost/benefit or cost effectiveness analysis described?				· N/A

· Yes

· No

· Yes

· No

· Yes

· No

· Yes

· No

Findings That Help Answer the EBP Question

· 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?

· Is the case report clearly presented?

· Are the findings of the case report supported by relevant theory or research?

· Are the recommendations clearly stated and linked to the findings?

Complete the corresponding quality rating.

· Yes

· No

· N/A

· Yes

· No

· N/A

· Yes

· No

· N/A

Complete the corresponding quality rating section.

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
· Opinions are clearly stated
· Evidence obtained is consistent
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; , 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

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

1. Ethical review

2. Analysis of findings

3. Limitations

4. Discussion

5. Application (translation) to practice specialty

6. Future implications

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.

· 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)

ASSIGNMENT CONTENT

Category

Points

Description

Introduction

Critique of Article

38%

Johns Hopkins Appraisal Tool

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

12%

Syntax, grammar, spelling

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.

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
Required content for this section includes:
• 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

0.0 pts

10.0 pts

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

42.0 pts

25.0 pts

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

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
Tool is included, is the correct tool, and is missing: A. Non-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

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

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
4-5 grammatical, spelling, word usage or punctuation errors.

2.0 pts

Needs Improvement
6-9 grammatical, spelling, word usage or punctuation errors.

0.0 pts

Unsatisfactory
10 or greater grammatical, spelling, word usage or punctuation errors.

5.0 pts

Total Points: 130.0

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
jamanetwork.com/learning

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,
US Department of Health and Human
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,
US Department of Health and Human
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
(troianor@mail.nih.gov).

Clinical Review & Education

JAMA | Special Communication

2020 (Reprinted) jama.com

https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.14854&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.16998&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.16070&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

https://jamanetwork.com/learning/video-player/10.1001/jama.2018.16371/?utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

https://jama.jamanetwork.com/learning/article-quiz/10.1001/jama.2018.14854/?utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

mailto:troianor@mail.nih.gov

http://www.jama.com/?utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

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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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)

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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

%
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

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.

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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.

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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.

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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.

Clinical Review & Education Special Communication Physical Activity Guidelines for Americans

2026 JAMA November 20, 2018 Volume 320, Number 19 (Reprinted) jama.com

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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.

Physical Activity Guidelines for Americans Special Communication Clinical Review & Education

jama.com (Reprinted) JAMA November 20, 2018 Volume 320, Number 19 2027

https://www.health.gov/paguidelines

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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.

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Clinical Review & Education Special Communication Physical Activity Guidelines for Americans

2028 JAMA November 20, 2018 Volume 320, Number 19 (Reprinted) jama.com

https://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.2018.14854&utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

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https://dx.doi.org/10.1016/j.pcad.2014.08.002

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http://csepguidelines.ca/early-years-0-4/

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http://www.jama.com/?utm_campaign=articlePDF%26utm_medium=articlePDFlink%26utm_source=articlePDF%26utm_content=jama.2018.14854

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