Information Centre - Research and Evidence

This page contains summaries of key physical activity research. Additional physical activity research can be found in population/setting sections on the left hand side menu. It is divided into the following sections:

General physical activity & health

Physical activity recommendations

Physical activity, energy expenditure, weight change & Body Mass Index (BMI)

Physical activity and disability

Physical activity & nutrition

Physical activity & smoking

Physical activity & the environment

Physical activity measurement & evaluation

Pedometers & accelerometers

Physical activity interventions

Exercise

Fitness

Click on each section to access research summaries.

General physical activity & health

The relationship between delivery agents' physical activity level and the likelihood of implementing a physical activity program

Estabrook, P., Bradshaw, M., Fox, E., Berg, J. and Dzewaltowski, D.A. (2004). The relationship between delivery agents' physical activity level and the likelihood of implementing a physical activity program. American Journal of Health Promotion, 18(5), 350-353.

Ninety-one state health promotion agents (94.5% women) from across Kansas participated in a study to determine the relationship between their personal physical activity characteristics and their implementation of a community physical activity programme. Agents' conducted a 10-minute telephone interview and were then observed to determine if they implemented a community walking programme. The primary measures were: 1) physical activity; 2) physical activity self-efficacy; 3) behavioural value of physical activity; and 4) programme adoption. Fifty-five percent of the agents met the CDC/ACSM recommended physical activity levels (30 min mod intensity activity on most days of the week), 35% were insufficiently active, and 10% were inactive. Agents who met the CDC/ACSM recommendations were more likely to adopt the programme for their counties (69%) than were insufficiently active agents (41%) and those who were inactive (11%).

Longitudinal physical activity and sedentary behavior trends

Gordon-Larsen, P., Nelson, M. C. and Popkin, B. M. (2004). Longitudinal physical activity and sedentary behavior trends. American Journal of Preventive Medicine, 27(4), 277-283.

This paper looks at the trend of low levels of physical activity and high levels of inactivity stretching from adolescence to adulthood.  The study examines trends in achieving five or more sessions of moderate to vigorous activity per week and less than 14 hours of television and video viewing/computer games usage across the transition period from adolescence to young adulthood.  It was found that of those adolescents who achieve favourable amounts of physical activity and weekly screen time, few continued these healthful behaviours.  More individuals failed to maintain these favourable amounts of physical activity and screen time into adulthood. This study identifies that physical activity declines with age.  The vast majority of adolescents do not achieve five or more bouts of physical activity per week, and continue to fail to achieve this amount of activity into adulthood. The transition period from adolescence into young adulthood is an important time to promote physical activity and reduce television and video viewing and computer and video game use.  It is also an important time to encourage those who are already active to maintain adequate amounts of physical activity.  Among adolescents, a very small proportion of the population is active and maintains an active lifestyle into adulthood.  The report also includes some cultural differences that may need addressing.

Considerations for physical activity research: Variations on a theme

Ham, S., Macera, C., Jones, D., Ainsworth, B. and Turcyn, K. (2004). Considerations for physical activity research: Variations on a theme. Journal of Physical Activity and Health, 1, 98-113.

There are a number of physical activity questionnaires available to researchers and the purpose of this study was to identify among demographic groups the differences in prevalence estimates that may occur as a result of differences in survey design characteristics, including question wording, placement and examples of activities.  The authors compared responses to similar instruments administered to large samples of adults in 1999 (n=9,7745), 2000 (n = 32,374) and 1999-2000 (n=7,529). Questions assessed participation in non-occupational activity at moderate and vigorous intensity. The prevalence of physical activity varied by 10% across 3 surveys and higher prevalence was seen with the use of examples to measure multiple domains of activity.  When examining the effect of question order on prevalence estimates asking moderate activity questions first was intended to cognitively separate the moderate from vigorous intensity activities asked in the survey and reduce double reporting. Results demonstrate that some people may not be able to distinguish between the two, so a full explanation is needed. Walking questions were found in cognitive testing to confuse people when they were asked after the moderate questions that included walking as an example. Measuring multiple domains of physical activity is important for assessing health related physical activity and the results suggest that physical activity measurement varies with question and survey design characteristics. Researchers need to understand that minor changes in questionnaire design can change the interpretation among socio-economic groups and lead to unintended results from physical activity surveys.

The relationship between working memory capacity and physical activity rates in young adults

Lambourne, K. (2006). The relationship between working memory capacity and physical activity rates in young adults. Journal of Sports Science and Medicine, 5(1): 149 – 153.

This cross-sectional study examined the relationship between physical activity and cognitive function in younger adults aged 19-30. The study participants consisted of 42 male and female college students who were divided into groups based on self-reported physical activity level. The participants in one group (n = 23) met the physical activity requirements specified by the Center for Disease Control and Prevention (CDC) (moderate-intensity physical activities for at least 30 minutes on 5 or more days of the week), and participants in the other group (n = 19) did not, and therefore acted as the control. A reading span task was used to assess the participant’s working memory capacity. Analysis of variance results demonstrated that exercise was associated with enhanced memory. Differences in working memory capacity as a function of gender and department were not statistically significant, nor were any interactions between these variables. The findings from this study lends support to the hypothesis that exercise is related to working memory capacity in younger adults, as well as older adults.

Physical activity from childhood to adulthood: A 21-year tracking study

Telama, R., Yang, X., Viikari, J., Välimäki, I., Wanne, O. and Raitakari, O.  (2005).  Physical activity from childhood to adulthood: A 21-year tracking study.  American Journal of Preventive Medicine, 28(3), 267-273.

The aim of this study was to investigate stability of physical activity from childhood and adolescence to adulthood in multiple age cohorts.  Furthermore the study aimed to examine how well adult physical activity can be predicted by various physical activity variables measured in childhood and adolescence.  The study started in 1980 when cohorts of different aged girls and boys were sampled and measured for the first time.  The measurements were repeated in 1983, 1986, 1989, 1992 and 2001.  Physical activity was measured by means of short self report questionnaire which was given individually in connection with a medical examination.  On the basis of a questionnaire a physical activity index (PAI) was calculated. On average, the results indicated that the tracking correlation was lower in females than males.  Persistent physical activity, defined as a score in the most active third of the PAI in 2 or 3 consecutive measurements, increased the odds that an individual would be an active adult.  It was concluded that a high level of physical activity at ages 9 to 18, especially when continuous, was a significant predictor of a high level of physical activity in adulthood.  It is therefore considered that physical activity in school-aged children is important  as it appears to influence levels of physical activity in adulthood, and through this the  public health of the general population. 

Tracking of physical activity from childhood to adulthood

Trudeau, F., Laurencelle, L. and Shephard, R. J. (2004). Tracking of physical activity from childhood to adulthood. Medicine and Science in Sport and Exercise, 36(11), 1937-1943.

This paper looks at how physical activity during childhood tracks into adulthood.  It is widely accepted that if an individual has chosen to be physically active during childhood or adolescence it is more likely that they will continue to be active into adulthood.  The paper looks at 2 cohorts of children studied between 1970 and 1977.  This initial phase compared the two cohorts, based upon their entry into two schools.  In 1996-1998 subsets of both cohorts were recalled for measurements of physical activity and fitness.  This study aimed to identify any association between the weekly time spent in physical activity at ages 10-12 years and 35 years.  Also it explores the influence of an experimental enhancement of primary school physical education upon any observed associations.  Thirdly the paper examines the potential influence of parental physical activity on the physical activity of their offspring when the latter had become adults of a similar age. The findings suggest that there is a positive impact of early compulsory physical education upon adult physical activity levels.  However, there is little evidence of an overall association between time spent on other physical activities during childhood and physical activity as an adult.

The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review

Wang, C., Collet, J. and Lau, J. (2004). The effect of Tai Chi on health outcomes in patients with chronic conditions: A systematic review. Archives of Internal Medicine, 164, 493-501.

A recent review of previously published studies suggests that Tai Chi appears to have beneficial effects for people with chronic health conditions. The researchers analysed 47 studies identified by a search of English and Chinese databases of medical literature, reporting on the effects of Tai Chi in people with various chronic health conditions. Overall, these studies reported that long-term tai chi practice had favourable effects on the promotion of balance control, flexibility and cardiovascular fitness and reduced the risk of falls in elders. The researchers also found that benefits were reported by the authors of these studies in cardiovascular and respiratory function in healthy subjects and in patients who had undergone coronary artery bypass surgery, as well as in patients with heart failure, hypertension, acute myocardial infarction, arthritis and multiple sclerosis. In addition, benefit was also found for balance, strength and flexibility in older subjects; falls in frail elderly subjects and pain, stress and anxiety in healthy subjects.

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Physical activity recommendations

Pedometer indices for weekly physical activity recommendations in postmenopausal women

Jordan, A. N., Jurca, G. M., Tudor-Locke, C., Church, T. S. & Blair, S. N. (2005). Pedometer indices for weekly physical activity recommendations in postmenopausal women. Medicine & Science in Sports & Exercise, 37(9), 1627-1632.

This study aimed to quantify pedometer-determined steps per day associated with 50, 100, and 150% of the current public health recommendation for weekly physical activity in sedentary postmenopausal women. The subjects  were a sample of 111 women from the Dose Response to Exercise in Women (DREW) study. The women were randomly assigned into one of three exercise groups expending 4, 8, or 12 kcal per kilogram per week (KKW). Participants exercised alternately on a treadmill and recumbent cycle ergometer for a 6-month training period. Only treadmill sessions done at zero gradient at slow to moderate speeds were used in this analysis. Intensity was controlled at a heart rate (HR) equivalent to 50% of peak VO2. Participants wore pedometers at baseline and throughout the study to assess their free-living physical activity. The results showed that baseline averages were <5400 steps per day for the 4, 8, and 12 KKW groups. During the 6 months of exercise training, free-living step counts remained <5400 steps per day and did not significantly differ from baseline for each group. Results indicate that initially sedentary postmenopausal women can meet 50% (4 KKW), 100% (8 KKW), and 150% (12 KKW) of the current public health recommendation of weekly physical activity through planned moderate-intensity walking, accumulating an average of about 2800 (50%), 5500 (100%), and 6500 steps (150%) per week.

Comparison of walking recommendations in previously inactive women

Hultquist, C. N., Albright, C and Thompson, D. L. (2005).  Comparison of walking recommendations in previously inactive women.  Medicine and Science in Sports and Exercise, 37, 676-683

This study aimed to compare the number of steps accumulated by women who were instructed to walk 10 000 steps per day with other women who were told to take a brisk 30 minute walk on most, preferably all days of the week.  The total number of daily steps were compared for 58 sedentary women who were randomly assigned to either the 10 000 steps group or the 30 minutes brisk walk group.  Subjects wore a sealed pedometer for 2 weeks for a base line physical activity assessment.  Those individuals who took less than 7000 steps per day were randomly assigned to a group for the four week intervention.  All subjects wore a sealed pedometer, and additionally the 10 000 step group wore a second pedometer for viewing their daily steps.  At baseline there were no differences between groups, but during the intervention there was a significant difference between groups in daily steps taken.  The group who were given the target of walking 10 000 steps each day took significantly more steps than the women who took a brisk walk each day.  In conclusion the study reported that women walk more when they are told to take 10 000 steps per day compared with other women who were instructed to take a 30 minute brisk walk.  However, on the days when women did take a 30 minute brisk walk, their average step count was near 10 000 steps.

Does participation in recommended levels of vigorous-intensity physical activity decrease participation in moderate-intensity physical activity?

McCormack, G. and Giles-Corti, B. (2004). Does participation in recommended levels of vigorous-intensity physical activity decrease participation in moderate-intensity physical activity? Journal of Physical Activity and Health, 1, 45-55.

It is unknown if participation in recommended levels of vigorous-intensity physical activity influences the likelihood of participating in recommended levels of moderate-intensity physical activity. Face to face interviews were conducted on 1803 healthy adults, 18-59 years old from the top and lower quintiles of socio-economic status. Data used in the analysis included television watching, vigorous-intensity activity, moderate-intensity activity and walking for recreation and transport. Logistic regression was used to determine whether participation in recommended levels of vigorous-intensity predicted participation in recommended levels of other physical activity and television watching.  When controlling for age, gender, education and social advantage, participating in ³ 90 min/week vigorous-intensity activity was not found to be associated with walking for transport (³ 150 min/week) but was found to be significantly associated with recommended levels of recreational walking (³ 150 min/week). Participation in recommended levels of vigorous-intensity activity was associated with a reduced likelihood of watching television more than 10 hours per week.  There appears to be no compensatory response in moderate-intensity activity in those who participate in vigorous –intensity activity. Since there is no negative influence and given the added health benefits associated with vigorous-intensity physical activity  concurrent promotion of both moderate and vigorous-intensity activity is warranted.

Adults participation in recommended levels of physical activity - United States, 2001 and 2003

Sapkota, S., Bowles, H. R., Ham, S. A. & Kohl H. W. (2006). Adult participation in recommended levels of physical activity—United States, 2001 and 2003. Journal of the American Medical Association, 295(1): 27-29.

The US Division of Nutrition and Physical Activity, US National Center for Chronic Disease Prevention and Health Promotion (CDC) and the American College of Sports Medicine (ACSM) recommend that adults engage in at least 30 minutes of moderate-intensity physical activity on most days, preferably all days, to have a beneficial effect on their health. Two Healthy People 2010 objectives are to increase the proportion of adults who engage in regular moderate or vigorous activity to at least 50% and to decrease the proportion of adults who engage in no leisure-time physical activity to 20%. CDC analyzed data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys for 2001 and 2003 to examine differences from 2001 to 2003 in overall U.S. and state- and territory-specific prevalence estimates of adult participation in the minimum recommended level of physical activity and physical inactivity among adults during lifestyle activities. Since 2001, BRFSS has used six survey questions about physical activity in three domains (household work, transportation, and discretionary/leisure time) to quantify its frequency, duration, and intensity. Respondents are asked to provide information on overall frequency and duration of time spent in bouts of 10 minutes or more of physical activity of moderate intensity and vigorous intensity during a usual week. The findings indicated that more than half of U.S. adults continue not to participate in physical activity at a level recommended as beneficial to health. From 2001 to 2003, the age-adjusted prevalence of adults participating in physical activity at the minimum recommended level remained similar (45.3% in 2001 and 45.9% in 2003). Concerted public health efforts at federal, state, and local levels are needed to improve participation in physical activity.

Healthy People 2010 Physical activity guidelines and psychological symptoms: Evidence form a large nationwide database

Taylor, M., Pietrobon, R., Pan, D., Huff, M. and Higgins, L. (2004). Healthy People 2010 Physical activity guidelines and psychological symptoms: Evidence form a large nationwide database. Journal of Physical Activity and Health, 1, 114-130.

Physical inactivity is a risk factor for poor mental health so the authors looked at the association between mental health and physical activity levels according to the ‘Healthy People 2010’ (US) guidelines.  The primary predictor variable was physical activity and the primary outcome measure was frequency of mental distress in 41,914 participants selected from the 2001 Behavioural Risk Factor Surveillance system.  Compared with those meeting the physical activity guidelines sedentary participants were 1.31 times more likely to experience 14 or more days of mental distress during the past 30 days, 1.34 times more likely to experience anxiety symptoms and 1.22 times more likely to experience depressive symptoms. The results suggest that being sedentary is associated with more aversive psychological symptoms. Future research should continue to elucidate the psychological outcomes of leading public health physical activity recommendations as well as quantify the physical activity stimulus necessary to promote optimal mental health.

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Physical activity, energy expenditure, weight change & Body Mass Index (BMI)

Physical activity and change in body mass index from adolescence to mid-adultshood in the 1958 British cohort

Parsons, T. J., Manor, O. & Power, C. (2006). Physical activity and change in body mass index from adolescence to mid-adulthood in the 1958 British cohort. International Journal of Epidemiology, 35(1): 197-204.

This longitudinal study examined whether frequency of adolescent physical activity affected subsequent body mass index (BMI) through to mid-adulthood. The British birth cohort of all births in 1 week in March 1958, includes information on physical activity frequency and BMI between ages 11–45 years. The researchers examined relationships between activity in adolescence and trajectories of BMI between 16 years and 45 years using multi-level models. The results showed that physical activity at 11 years had no effect on the BMI trajectories, in males or females. Females who were more active at 16 years gained BMI more slowly than others between the ages of 16–45 years, whereas the most active males gained BMI faster than others. This effect in males was not evident on the BMI trajectory from 23 to 45 years. Consistent with these analyses, change in activity were associated with changes in BMI in females, e.g. females active at 16 and 42 years gained less BMI than inactive females. Results for males were found to be inconsistent over the time periods examined.  The study shows that physical activity may lessen the gains in BMI from adolescence onwards, but relationships vary with age, and in later adolescence show opposite effects for males and females. Decreasing activity between adolescence and mid-adulthood in males, and inactivity in both life stages in females may increase BMI gain.

Physical activity and body composition after menopause

Sternfeld, B., Bhat, A. K., Wang, H., Sharp, T. & Quesenberry, C. P. (2005).Menopause, Physical Activity, and Body Composition/Fat Distribution in Midlife Women. Medicine and Science in Sports and Exercise, 37(7):1195-1202.

Women's midlife weight gain is more a function of age than it is of a change in menopausal status, according to this study. However, it was found that physical activity is a modifiable factor that influences both fat mass and lean mass body composition. A total of 248 white (39.7) and Chinese (60.3%) women between the ages of 47 to 57 years were followed annually with questionnaires and clinical examinations. Participants kept a log book to record their physical activity, which was measured for 7 consecutive days with an accelerometer. Total activity and minutes per day of moderate-intensity and vigorous-intensity activity were determined using a pre-set number of counts per minute. For white women, decreased percent body fat and smaller waist circumference were significantly associated with higher levels of physical activity, especially vigorous-intensity activity. The Chinese women did not experience statistically significant changes. 34% spent less than 60 minutes a day in moderate intensity activity, compared to 23% of the white women. A higher percentage also performed no vigorous activity (38%) compared with 22% of the white women. Both groups experienced lower lean mass after menopause, and the Chinese women experienced increased body fat. The authors stated that the age-related increases in weight, coupled with menopause-related decreases in lean mass, create a ‘critical need’ to find interventions for midlife women, and physical activity is an effective approach.

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Physical activity and disability

Correlates of physical activity for adults with disability

Boslaugh, A. E. & Andresen, E. M. (2006). Correlates of physical activity for adults with disability. Preventing Chronic Disease, 3(3).

This cross sectional study was designed to determine factors that influence the physical activity level of adults with a disability as identified in a large representative sample of U.S. adults. Data were taken from the District of Columbia and the 12 states that administered the Quality of Life and Caregiving Module of the 2001 Behavioral Risk Factor Surveillance System. Adults with a disability (n = 4038) were defined as those who required special equipment because of a health problem or who required the assistance of another person either for their personal care or routine needs. Adequate physical activity was defined as meeting the Centers for Disease Control and Prevention and American College of Sports Medicine recommendation of at least 30 minutes of moderate activity per day at least 5 days per week. Unadjusted and adjusted odds ratios were computed for demographic, health status, health care access, and health behaviour variables. Results showed that only a quarter of the study population met the recommendation for moderate activity level. African American race, age of 50 years or older, annual income of $50,000 or higher, and being in good, fair, or poor health were all significantly related to activity level; sex, education level, health care access, and years of disability were not. Adults with a disability were found not to be meeting the recommendations for physical activity. Some correlates of physical activity found in general populations were also found to be related to activity level for people with disability (age, general health, race), whereas others (sex, education level) were not. These factors should be considered when planning physical activity interventions for people with a disability. 

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Physical activity & nutrition

Changes in cognitive measures in a randomized controlled trial of a health promotion program for couples targeting diet and physical activity

Burke, V., Giangiulio, N., Gilliam, H.F., Beilin, L.J. and Houghston, S. (2004). Changes in cognitive measures in a randomized controlled trial of a health promotion program for couples targeting diet and physical activity. American Journal of Health Promotion, 18(4), 300-311.

Seventy-eight couples participated in a 4-month health promotion programme consisting of six printed modules focusing on diet and physical activity. To be eligible for the study, couples had to have lived together for two years or less. Couples were randomly assigned to one of three groups: interactive group, mail group, or control group. The interactive group received three modules by mail and the other three at interactive group sessions. The mail group completed an initial group session to explain the programme, followed by delivery of all six modules by mail. The programme was based on the Social Cognitive Theory, the Health Belief Model, the Theory of Reasoned Action, and incorporated decisional balance. Measurements for all three groups were obtained at baseline, post-intervention and one year after beginning the programme. Perceived importance of barriers to dietary change decreased in both the mail and interactive groups and dietary self-efficacy increased in the interactive group. Similar trends for physical activity were not statistically significant. Overall, changes in cognitive variables were greater in the interactive group, although the mail group showed some improvements. Change in cognitive variables was associated with improvements in diet, physical activity and cardiovascular risk factors. Changes in cognitive variables were more predictive of change in behaviour than changes in knowledge.

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Physical activity & smoking

Acute effects of self-paced walking on urges to smoke during temporary smoking abstinence

Taylor, A. H., Katomeri, M. and Ussher, M.  (2005).  Acute effects of self-paced walking on urges to smoke during temporary smoking abstinence.  Psychopharmacology, On-line.
 
The purpose of this study was to examine the effects of a 1 mile self-paced walk on different measures of urges to smoke following temporary smoking abstinence.  A within subjects counterbalanced design was used.  Following  15 hours of smoking abstinence the subjects either exercised or sat passively on separate days.  The exercise was undertaken on a treadmill and consisted of a 2 minute warm up followed by a 1 mile walk .  Participants were instructed to walk briskly as if to catch a bus, but no to the point of breathlessness.  Participants then did a 2 minute cool down.  A strength of desire to smoke questionnaire was administered at 5 points. The results suggest that smokers who take a moderate-intensity self-paced one mile walk when they crave a cigarette can temporarily lessen their desire to smoke compared with individuals who don’t walk.  The group who participated in self-paced walk waited an average of 83.7 minutes before their next cigarette, compared with non-walkers who waited approximately 26.6 minutes.  The authors concluded that a self-paced walk, at low intensity, lasting approximately 15-20 minutes can have a rapid and measurable positive affect on urges to smoke, lasting at least 20 minutes, during temporary smoking abstinence.

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Physical activity & the environment

Associations of perceived social and physical environmental supports for physical activity and walking behaviors

Addy, C. L., Wilson, D. K., Kirtland, K. A., Ainsworth, B. E., Sharpe, P. A. and Kimsey C. D. (2004). Associations of perceived social and physical environmental supports for physical activity and walking behaviors. American Journal of Public Health, 94(3): 440-443.

Approximately 1,200 adults participated in a telephone interview to evaluate how perceptions of social and physical environmental supports contribute to predicting physical activity and walking behaviour.  Results showed that younger age, better street lighting, trust of neighbours, and use of private recreation facilities, parks, playgrounds, sports fields, schools and worship facilities were associated with increased physical activity. Younger age, more education, having physically active neighbours, having sidewalks in the neighbourhood, and using a mall for walking were associated with increased walking behaviours. 

Changing the environment to promote health-enhancing physical activity

Foster, C. and Hillsdon, M. (2004).  Changing the environment to promote health-enhancing physical activity.  Journal of Sport Sciences, 22(8): 755-769.

Theories and models are available that demonstrate the possible influences that the environment can exert on health-enhancing physical activity, but little is known about the effectiveness of environmental interventions.  This paper reviews the evidence base of the potential ability of the environment to increase health-enhancing physical activity.  It addresses 2 key questions:

1. Does the environment influence health-enhancing physical activity?
2. What is the scientific evidence base for the effectiveness of changing the environment to promote health-enhancing physical activity?

Environmental change studies showed a small increase on health-enhancing physical activity behaviour, although the relative impact was not evaluated.  The paper found a number of before and after studies which found a weak effect of simple environmental change to promote stair climbing while travelling or shopping. The paper identifies that despite a lack of effectiveness data, current national policy has embraced the environment as an option for promoting health-enhancing physical activity, especially active travel.  However, the authors recommend that appropriate evaluation methods should be used to assess the efficacy and effectiveness of existing or planned initiatives.  

Green exercise in the UK countryside: Effects on health and psychological well-being, and implications for policy and planning

Pretty, J., Peacock, J., Hine, R., Sellens, M., South, N. and Griffin, M. (2007) Green exercise in the UK countryside: Effects on health and psychological well-being, and implications for policy and planning. Journal of Environment Planning and Management. 50(2): 211-231

Evidence has shown that access to the natural environment can help to promote good health. Ten green case studies were selected from each region in the UK which included walking, cycling, fishing, horse-riding, and conservation activities.  The 263 participants recruited into the study completed a composite questionnaire which was split into two sections. The 1st section contained questions to determine the physical and mental health of the participant during the sampling phase. Section 2 which was completed before and after taking part in the activity was designed to determine any changes in the subjects psychological health brought on by participating in green exercise. Despite the subjects in this study already being generally active and healthy it was found that participation in green activities had a significant improved on individuals self-esteem and total mood disturbance. There was no difference found between the type of activity and effect on self esteem and mood thus all the activities regardless of type, intensity or duration had a positive effect on mental health. Authors conclude that green activity has  important implications for public and environmental health.

Association of environmental factors to meeting physical activity recommendations in two South Carolina Counties

Sharpe, P. Granner, M. Hutto, B. and Ainsworth, B. (2004). Association of environmental factors to meeting physical activity recommendations in two South Carolina Counties. American Journal of Health Promotion, 18(3), 251-257.

Over 1900 adults from  2 counties in South Carolina were contacted in a random-digit-dialled telephone survey to assess the associations between adults' perceptions of environmental and policy supports and self-reported physical activity (PA).  After adjusting for age, gender, race, and  education, environmental factors associated with meeting PA  recommendations included neighbourhood sidewalk condition, worksite sports teams, presence of mapped walking/jogging or bicycle routes, number of known walking/jogging routes, number of known bicycling  routes, number of days/month using tracks, trails, paths, or mapped  routes, and number of days/month using public parks or outdoor recreation areas.

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Physical activity measurement & evaluation

Monitoring physical activity: Uses and measurement issues with automated counters

Granner, M. and Sharpe, P. (2004). Monitoring physical activity: Uses and measurement issues with automated counters. Journal of Physical Activity and Health, 1: 131-141.

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Pedometers & accelerometers

10, 000 steps Rockhampton: Evaluation of a whole community approach to improving population levels of physical activity

Brown, W. J., Mummery, K., Eakin, E. G. & Schofield, G. M. (2006). 10,000 steps Rockhampton: Evaluation of a whole community approach to improving population levels of physical activity. Journal of Physical Activity and Health, 3(1).

This evaluation aimed to describe the effectiveness of a multi-strategy physical activity (PA) intervention in Rockhampton, Australia, from self-reported data from random community samples, which were collected prior to and following intervention. Social marketing, healthcare provider, and environmental strategies were concurrently implemented with a central coordinating theme of “10,000 Steps Rockhampton.” The results showed evidence of significant project reach and awareness. The downward trend in PA seen in the comparison community (48.3% to 41.9% of the population classified as active) was not evident in Rockhampton. Womenwere the “early adopters” in this project; with an increase of 5% in the percent categorised as active (compared with decreases among women in the comparison community and among men in both communities). High levels of project awareness, combined with modest increases in activity levels in women, show the initial effects of the project. Longer term interventions, focusing on sustainable individual, social, and environmental change strategies are needed to maintain and improve these result.

A Preliminary study on the impact of a pedometer-based intervention on daily steps

Costeau, K.A. (2004). A Preliminary study on the impact of a pedometer-based intervention on daily steps. American Journal of Health Promotion, 18(3), 217-220.

Thirty-seven college employees participated in an 8-week, pedometer-based lifestyle physical activity intervention. At baseline, participants rated their level of physical activity answering the one-item Perceptions of Physical Activity Survey (PPA) and the 12-item Physical Activity Survey (PAS). The PAS assesses levels of PA during the past 7 days. During the intervention participants were encouraged to increase steps/day depending on baseline levels. Individuals with over 10,000 steps per day at baseline were told to maintain their current level of PA, those with 8,000 to 10,000 steps per day to increase steps by 5% every 2 weeks, and those with fewer than 8,000 steps per day to increase steps by 10% every 2 weeks. Results indicate that average steps per day increased by 23%, from 8,565 to 10,538. The 10% group increased steps by 39.9%, the 5% groups increased by 24.9%, and the maintainers increased by 5.0%. Obese and overweight participants increased steps by 34.3% and 24.0%, respectively. PPA scores also increased from 2.57 at baseline (mid-point between perceptions of being low active and moderately active) to close to 3.00 at the end of the intervention (moderately active).

Changes in physical activity influenced by using a pedometer

Glazener, H., DeVoe, D., Nelson, T. and Gotshall, R. (2004). Changes in physical activity influenced by using a pedometer. Journal of Human Movement Studies, 46(6), 473-482.

This paper explores the effect that pedometers may have on physical activity levels.  A group of women aged 35-65 were studied and the number of steps they took per day was measured using a pedometer.  The  aim of the investigation was to establish whether participants in an experimental group, who were given a specific number of steps per day as a target to aim for, would increase their daily physical activity as compared to participants in a control group who were left to set their own goals and not given a specific target.  From the two week baseline to the two week intervention period, there was a significant increase in the step counts within the experimental group compared to the control group.  The linear trend was significant for the experimental group, which displayed a steady increase in average steps per day, and in comparison, no linear trend was displayed in the control group.  The study demonstrates the potential to increase daily physical activity in individuals when given pedometers and an individualised, specific target to work towards.

Comparison of walking recommendations in previously inactive women

Hultquist, C. N., Albright, C and Thompson, D. L. (2005).  Comparison of walking recommendations in previously inactive women.  Medicine and Science in Sports and Exercise, 37, 676-683

This study aimed to compare the number of steps accumulated by women who were instructed to walk 10 000 steps per day with other women who were told to take a brisk 30 minute walk on most, preferably all days of the week.  The total number of daily steps were compared for 58 sedentary women who were randomly assigned to either the 10 000 steps group or the 30 minutes brisk walk group.  Subjects wore a sealed pedometer for 2 weeks for a base line physical activity assessment.  Those individuals who took less than 7000 steps per day were randomly assigned to a group for the four week intervention.  All subjects wore a sealed pedometer, and additionally the 10 000 step group wore a second pedometer for viewing their daily steps.  At baseline there were no differences between groups, but during the intervention there was a significant difference between groups in daily steps taken.  The group who were given the target of walking 10 000 steps each day took significantly more steps than the women who took a brisk walk each day.  In conclusion the study reported that women walk more when they are told to take 10 000 steps per day compared with other women who were instructed to take a 30 minute brisk walk.  However, on the days when women did take a 30 minute brisk walk, their average step count was near 10 000 steps.

Pedometer indices for weekly physical activity recommendations in postmenopausal women

Jordan, A. N., Jurca, G. M., Tudor-Locke, C., Church, T. S. & Blair, S. N. (2005). Pedometer indices for weekly physical activity recommendations in postmenopausal women. Medicine & Science in Sports & Exercise, 37(9), 1627-1632.

This study aimed to quantify pedometer-determined steps per day associated with 50, 100, and 150% of the current public health recommendation for weekly physical activity in sedentary postmenopausal women. The subjects  were a sample of 111 women from the Dose Response to Exercise in Women (DREW) study. The women were randomly assigned into one of three exercise groups expending 4, 8, or 12 kcal per kilogram per week (KKW). Participants exercised alternately on a treadmill and recumbent cycle ergometer for a 6-month training period. Only treadmill sessions done at zero gradient at slow to moderate speeds were used in this analysis. Intensity was controlled at a heart rate (HR) equivalent to 50% of peak VO2. Participants wore pedometers at baseline and throughout the study to assess their free-living physical activity. The results showed that baseline averages were <5400 steps per day for the 4, 8, and 12 KKW groups. During the 6 months of exercise training, free-living step counts remained <5400 steps per day and did not significantly differ from baseline for each group. Results indicate that initially sedentary postmenopausal women can meet 50% (4 KKW), 100% (8 KKW), and 150% (12 KKW) of the current public health recommendation of weekly physical activity through planned moderate-intensity walking, accumulating an average of about 2800 (50%), 5500 (100%), and 6500 steps (150%) per week.

Evaluation of quality commercial pedometers

Tudor-Locke , C., Sissona, S. B., Lee, S. M., Craig, C. L., Plotnikoff, R. C. and Bauman, A. (2006).  Evaluation of quality of commercial pedometers. Canadian Journal of Public Health, SUPP 1:S10-5, S10-6.

The purpose of this study was to (i) evaluate the quality of promotional pedometers widely distributed through cereal boxes at the time of the Canadian ‘On the Move’ campaign; and (ii) establish a battery of testing protocols to provide direction for future consensus on industry standards for pedometer quality. Fifteen Kelloggs Special K step counters and 9 Yamax pedometers were tested with 9 participants according to the following protocol; (1) 20 step test, (2) treadmill at 80m per min and motor vehicle controlled conditions, and (3) 24 hour free-living conditions against an accelerometer criterion. 53% percent of the Special K pedometers passed the 20 step test compared to 100% pf the Yamax pedometers. The Special K pedometer detected 6 fold more non-steps compared to the Yamax during the motor vehicle condition and in the free-living condition. Mean absolute percent error relative to the ActiGraph was 44.9±34.5% for the Special K pedometer versus 19.5±21.2% for the Yamax. In conclusion the paper states that the Special K pedometers are unacceptably inaccurate. The paper suggests that research-grade pedometers should be (1) manufactured to a sensitivity threshold, (2) detect ±1 step error on the 20 step test, (3)detect ±1% error most of the time during  treadmill walking at 80m per minute as well as (4) detect steps/day within 10% of the ActiGraph at least 60% of the time or be within 10% of the Yamax under free-living conditions.

How many days of pedometer monitoring predict weekly physical activity in adults?

Tudor-Locke, C., Burkett, L., Reis, J. P., Ainsworth, B. E., Macera, C. A. and Wilson, D. K. (2004). How many days of pedometer monitoring predict weekly physical activity in adults? Preventive Medicine, 40(3): 293-298.

Pedometers are increasingly being used for both measurement of physical activity and also motivation, although objective monitoring using these instruments is still in its infancy.  The validity of pedometers has been confirmed in a handful of previous studies but protocols and standard assessment is still being considered and developed.  This study aimed to establish the number of days needed to estimate mean pedometer-determined steps per day in a field setting. In conclusion the study found that although there was a statistical difference between days, there is little practical difference.  The main difference appeared to be limited to a Sunday which was the weakest predictor of steps walked.  Although a single day of collection is not acceptable, any 3 days can provide a sufficient estimate of steps walked.

How many steps/day are enough?: Preliminary pedometer indices for public health

Tudor-Locke, C. and Bassett, D. (2004). How many steps/day are enough?: Preliminary pedometer indices for public health. Sports Medicine, 34(1): 1-8.

The use of pedometers for tracking physical activity has been increasing, with the popular recommendation of accumulating 10,000 steps/day.  This review of past studies provides the rationale and evidence for general pedometer indices for public health research and physical activity recommendations.  The authors determined that making incremental increases in physical activity (increasing by a minimum of 2500 steps/day) above usual daily activity could lead to improved health outcomes.  The following indices were proposed to classify pedometer guidelines in healthy adults: 

• < 5000 steps/day is typical of a sedentary lifestyle
• 5000-7499 steps/day is representative of usual daily activity and may be considered “low active”
• 7500-9999 steps/day might be considered “somewhat active”
• ³ 10,000 steps/day used to classify individuals as “active” 
• Individuals taking > 12,500 steps/day would be classified as “highly active.”

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Physical activity interventions

Ready to Be Physically Active? The effects of a course preparing low-income multi-ethnic women to be more physically active

Collins R., Lee, R., Albright, C., and King, A. (2004). Ready to Be Physically Active? The effects of a course preparing low-income multi-ethnic women to be more physically active. Health Education and Behaviour, 31(1): 47-64.

Eighty-two low-income, multi-ethnic women (75% Latina) were recruited to participate in both phases of the Increasing Motivation for Physical Activity (IMPACT) project. The IMPACT project consists of two phases 1) prepare the participants to become more active and 2) 10-month home-based physical activity intervention. The paper describes phase 1, which consisted of eight, 1-hour, weekly skills-building classes adapted from those developed for Project Active by the Cooper Institute for Aerobics Research. The curriculum was designed to move participants from the contemplation stage of the Transtheoretical Model to the preparation and early action stages. After phase 1, physical activity knowledge, total social support for physical activity, social support from friends for physical activity, and number of minutes walking for exercise significantly increased. Changes in social support from friends were significantly correlated with minutes walking. Of the women who were in either precontemplation, contemplation, preparation, or relapse stages prior to taking the course, 48% shifted forward one or more stages after the course.

Exercise behaviour change in 40 to 65-year old women:  The SWEAT study (Sedentary Women Exercise Adherence Trial)

Cox, K., Gorely, P., Puddey, I, Burke, V. and Beilin, (2003). Exercise behaviour change in 40 to 65-year old women:  The SWEAT study
(Sedentary Women Exercise Adherence Trial). British Journal of Health Psychology, 8, 477-495.

One hundred and fifteen sedentary  women, aged 40-65 years, took part in an 18-month intervention designed to examine the effects of a stage-based intervention on exercise behaviour change.  Participants were assigned to either a center-based program or a home-based program and within these to either vigorous or moderate exercise for the first six months. For the remaining 12 months, both groups were home-based and received supportive telephone calls every six weeks.  Written materials based on the anticipated stage of change for each phase of the program
were distributed to participants in both groups.  Only 11% of those completing the project remained sedentary.  There was no difference between the exercise intervention groups in terms of the patterns of change; therefore the intervention was effective regardless of the setting or intensity.  

Minimal-contact physical activity interventions in women: A pilot study

DuVall, C., Dinger, M.K., Taylor, L. and Bemben, D. (2004). Minimal-contact physical activity interventions in women: A pilot study. American Journal of Health Behaviour, 28(3): 280-286.

Fifty sedentary or irregularly active women were recruited to participate in an 8-week minimal contact physical activity intervention. The women were randomly assigned to one of three interventions: pedometer only (PED), pedometer/behaviour modification (COMBO) and standard care (SC). Women wore an accelerometer at baseline and post intervention to objectively measure physical activity. The PED group wore a pedometer and recorded their physical activity on step log sheets, which they mailed to the researchers each week. Starting with the third week each participant was encouraged to increase her steps/day by 20%, with the total adjusted every 2 weeks. The COMBO group consisted of the pedometer intervention plus behaviour modification strategies. Each week members of the group received educational and skill-building materials by mail, which they completed and sent to the researchers. The SC group received educational materials designed to promote health and wellness through physical activity, stress management, and breast cancer. This group received three educational brochures over the course of the 8-week intervention. Results show that all groups significantly increased their physical activity levels from baseline to post intervention, with no significant difference in physical activity between intervention groups.

Adherence within and between lifestyle physical activity groups in project PRIME

Heesch, K. (2004). Adherence within and between lifestyle physical activity groups in project PRIME. Journal of Physical Activity and Health, 1: 29-44.

Interventions have been shown to increase physical activity behaviour although the increases  have not been large. Small to moderate changes can result from participants having insufficient adherence to the intervention protocol to produce an intervention effect and should therefore be tracked. The study examined changes in adherence over 6  months in a lifestyle physical activity intervention. Participants were 244 sedentary adults who took part in project PRIME (Physically Ready for Invigorating Movement Everyday). Adherence was measured separately for a group based intervention (PRIME-G) and a telephone mail based control (PRIME-C). Completion of homework, self monitoring of physical activity, attendance at class (PRIME-G only) and completion of monthly telephone calls (PRIME-C only) were used as markers of adherence. The probability of attending class, completing the telephone calls and completing the homework decreased significantly over 6 months.  Participants in PRIME-G were more likely than those in PRIME-C to complete the homework throughout the activity.  The findings suggest that individuals are less willing to adhere to a telephone protocol over 6 months and most are not willing to self monitor physical activity for more than a few days a month. In addition, the results suggest that adherence to the protocol in the first month is a significant predictor of adherence in the remaining months. Extra effort should be made to encourage adherence early in the intervention or a different intervention should be offered to those who do not adhere early in the intervention period.

The Agita Sao Paulo program as a model for using physical activity to promote health

Matsudo, S. M., Matsudo, V. R., Araujo, T. L., Andrade, D. R., Andrade, E. L., de Oliveria, L. C., and Braggion, G. F. The Agita Sao Paulo program as a model for using physical activity to promote health. Pan American Journal of Public Health, 14(4): 265-272.

The Agita Sao Paulo programme is a multi-level intervention designed to promote physical activity among the 37 million residents of the state of Sao Paulo, Brazil. The verb ‘agita’ means to move the body, but also suggests changing the way of thinking to become a more active citizen. The programme was launched in 1996 and promotes the CDC/ACSM recommendation of 30 minutes of physical activity per day. The direct cost of the Agita Sao Paulo programme is US $152,000 per year, which equals an investment of less than US $0.01 per inhabitant per year. Agita Sao Paulo’s success can be attributed to its simplicity, messages that pertain to members of all social groups, broad use of partnerships, and programme support from governmental and non-governmental organizations. In 2002, a survey discovered that of those who were familiar with the program, 54% were physically active, compared to 32% among those not familiar with the programme. Similar programmes have been adopted in Latin America and have led to the establishment of the Physical Activity Network of the Americas with strong support from the CDC and PAHO (Pan American Health Organization).

A brief intervention to increase physical activity in sedentary women

Purath, J., Miller, A.M., McCabe, G., and Wilbur, J. (2004). A brief intervention to increase physical activity in sedentary women. Canadian Journal of Nursing Research, 36(1): 77-91.

One-hundred twenty women participated in a brief counseling intervention designed to increase physical activity. Women were recruited at an employee wellness screening and randomized to either an intervention or control group. Intervention participants received a brief intervention based on the Patient-Centered Assessment and Counseling for Exercise (PACE) protocol, which uses the Stages of Change from the Transtheoretical Model. After their initial screening participants took part in a stage-based discussion lasting 3-5 minutes. Two weeks later, a nurse practitioner telephoned the participant to inquire about her progress. Pre and post measures included Stages of Change, Paffenbarger physical activity questions, and PACE walking questions. At the six week follow-up, participants showed significant improvements in Stage of Change, blocks walked per day, vigorous and moderate weekend activity, minutes walked for exercise and total minutes walked per week. Minutes walked per week increased from 87.7 to 209.5, minutes walked per week for exercise increased from 18.6 to 91.6 and self-reported number of blocks walked increased from 7.7 to 12.9.

Inactivity, exercise, and visceral fat. STRIDE: a randomised, controlled study of exercise intensity and amount.

Slentz, C. A., Aiken, L. B., Houmard, J. A., Bales, C. W., Johnson, J. L., Tanner, C. J., Duscha, B. D. and Kraus, W. E. (2005). Inactivity, exercise, and visceral fat. STRRIDE: a randomised, controlled study of exercise intensity and amount. Journal of Applied Physiology, 99(4): 1613-1618.

This study looked at 175 men and women who were all overweight and led sedentary lives and were all beginning to show signs of lipid problems. Subjects were randomly allocated to one of four groups, each group carried out different levels of activity/inactivity:

a. No exercise at all.
b. Low dose moderate intensity activity (walking 12 miles per week)
c. Low dose vigorous intensity activity (12 miles jogging per week)
d. High dose vigorous intensity activity (20 miles jogging each week)

All 175 people were told not to alter their diets. The aim of the study was to examine what impact exercise alone might have. The trial lasted six months for the inactive group and eight months for the other three groups (group d were given a two-month start to get them fit enough to do the trial). All activity was supervised and Computed Tomography (CT) was used at the beginning and end of the trial to determine the extent and distribution of fat change. No significant difference in visceral fat levels was found in groups b & c. The researchers concluded that mild exercise helps stop the increase in visceral fat levels, but does not reduce them. In contrast, the inactive group experienced increases in visceral fat levels. The study also found that the more people exercised, and the higher their intensity, the faster they lost their excess visceral fat. The most active group saw visceral fat levels drop by 6.9% in six months and subcutaneous fat levels dropped by 7%. According to researchers, exercise can significantly reduce visceral fat. The greater the intensity of the exercise, the more visceral fat will be lost.

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Exercise

Genetic response to exercise

Kritchevsky, S. B., Nicklas, B. J., Visser, M., Simonsick, E. M., Newman, A. B., Harris, T. B., Lange, E. M., Penninx, B. M, Goodpaster, B. H., Satterfield, S., Colbert, L. A., Rubin, S. M. & Pahor, M. (2005). Angiotensin-Converting Enzyme Insertion/Deletion Genotype, Exercise, and Physical Decline. Journal of the American Medical Association, 294(6): 691-698.

New research suggests why some older adults who exercise have better physical function than others. Researchers found that an enzyme involved in blood pressure regulation may influence how the body responds to exercise. The study is the first to show that a gene that controls levels of angiotensin converting enzyme (ACE) in the body may be associated with physical function in older adults. The researchers found that older exercisers who inherited a gene combination associated with the lowest ACE production were 45 percent more likely to develop difficulties with climbing stairs or walking a quarter-mile than exercisers with gene combinations associated with higher levels of ACE. The study involved 3,075 well-functioning, community-dwelling adults aged 70 to 79 years. Participants were enrolled in 1997 and 1998. The current data are from 2,966 participants who were followed for up to 4.1 years. About a third ( 31.3 percent ) of the group was active, burning more than 1,000 calories a week in exercise; the others were inactive. The researchers found that the exercisers were significantly less likely (33 percent) to report mobility problems than the non-exercisers.

Consistency of the talk test for exercise prescription

Persinger, R., Foster, C., Gibson, M., Fater, D. C. W. and Porcari, J. P. (2004). Consistency of the talk test for exercise prescription. Medicine and Science in Sport and Exercise, 36(9): 1632-1636.

This study aimed to evaluate the consistency of the talk test as a method of exercise prescription.  The talk test is a method for monitoring exercise intensity and is aimed at making exercise prescription more simple.  The guideline suggests that if the exercise intensity allows  the person to ‘just respond to conversation’, then the exercise intensity may be ‘just about right’.  Over the past few years the validity of this guideline has been systematically evaluated.  The ability to converse during exercise has consistently been shown to produce exercise intensities consistent with the parameters suggested in clinical guidelines for exercise training.  Therefore it appears to be a valuable although quite simple tool for exercise prescription. Participants’ responses whilst undertaking different modes of exercise were compared.  The results support the talk test.  Using the talk test whilst exercising on either a treadmill or a cycle, speech first became difficult at an exercise intensity almost exactly equivalent to ventilatory threshold.  When speech was not comfortable, exercise intensity was consistently above the ventilatory threshold.  The results of this study demonstrate that the simple monitoring device of asking whether speech is comfortable provides exercise intensities that are within well accepted guidelines for exercise prescription.  Additionally, as the results are comparable between different modes of exercise it seems reasonable that the talk test is highly consistent.  This technique may therefore be a clinically useful tool for clinicians faced with the challenge of providing exercise training guidelines for their patients.

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Fitness

Associations of self-related fitness and different types of leisure time physical activity with predicted aerobic fitness in 5979 Finnish adults

Borodulin, K., Lakka, T., Laatikainen, T., Laukkanen, R., Kinnunen, H. and Jousilahti, P. (2004). Associations of self-related fitness and different types of leisure time physical activity with predicted aerobic fitness in 5979 Finnish adults. Journal of Physical Activity and Health, 1, 142-153.

The aim of this study was to investigate the recently established Polar Fitness Test (PFT) as a method to predict maximal oxygen uptake (VO2 max is a measure of aerobic fitness) to assess the distribution of predicted VO2 max by gender and age and to compare predictions to self reported physical activity and self rated fitness level in a large Finnish population.  The population was 5979 men and women aged 25-74 years.  Subjects completed a questionnaire assessing self rated fitness level and total, commuting, conditioning and non conditioning physical activity.  The PFT was performed with a trained nurse present and is based on resting heart rate, heart rate variability, gender, age, height, weight and self reported physical activity. It takes about 12 minutes to complete and has been deemed reliable and valid. The mean predicted VO2 max was 38.1 and 35.1 ml/kg/min in healthy men and women respectively. Predicted VO2 max declined with age in both genders whilst individuals with cardiovascular disease had lower VO2 max predictions. Self rated fitness level and conditioning and commuting leisure time physical activity were independently associated with predicted VO2 max while no correlation between non-conditioning leisure time physical activity and predicted aerobic fitness was found.  The results show that PFT was a feasible method to predict aerobic fitness in a large population and was associated with self reported fitness and levels of physical activity. Studies to investigate the associations between predicted VO2 max and cardiovascular and metabolic risk factors such as overweight, glucose and lipid metabolism abnormalities and blood pressure are needed.

Chart to measure women's fitness levels, USA

Gulati, M., Black, H.R., Shaw, L.J., Arnsdorf, M.F., Bairey Merz, C.N., Lauer, M.S., Marwick, T.H., Pandey, D. K., Wicklund, R.H. & Thisted, R.A. The Prognostic Value of a Nomogram for Exercise Capacity in Women. New England Journal of Medicine, 353(5): 468-475.

Researchers have developed a special chart, which aims to gauge what a woman's fitness level should be at any given age, therefore also predicting her risk of death. The chart - called a nomogram - was developed by doctors at the Northwestern Memorial Hospital in Chicago. The participant's exercise capacity is measured using a treadmill test and their fitness level is then determined using the nomogram. According to the researchers, women whose exercise capacity is less than 85% of their age-predicted levels, have twice the risk of death, compared to those who reach at least 85%. To develop the chart, over 10,000 women underwent a recognised treadmill test designed to determine a person's stress levels.