It’s trendy in some circles to bash government guidelines related to exercise and nutrition. After all, if obesity rates are rising and the physical fitness levels of the population are declining with each generation, the guidelines must be bad…right?
There’s an obvious flaw in this line of thinking: public health guidelines and recommendations don’t determine health and fitness outcomes. The best recommendations in the world wouldn’t improve health outcomes if no one followed them. So, that begs the question: how many people actually meet government exercise guidelines? Dietary guidelines are a topic for another day.
A recent meta-analysis by Garcia-Hermoso and colleagues sought to evaluate the proportion of individuals adhering to government guidelines for aerobic and muscle-strengthening activities (1). To be included in the meta-analysis, a study needed to examine individuals who were at least 5 years old, and assess adherence to guidelines for both aerobic exercise and muscle-strengthening activities via either questionnaires or accelerometry. Ultimately, 21 studies met these inclusion criteria, evaluating 3,390,001 individuals from 32 countries.
Adherence rates varied country-to-country, from a high of 53.4% in Iceland, to a low of 0.5% in Romania (6). However, the pooled average was 17.3% (Figure 1). Sub-analyses found that men were a bit more likely to adhere to both guidelines (aerobic and strength exercise) than women, older adults were a bit less likely to adhere to both guidelines than younger, adherence was nonlinearly related to BMI status, and adherence was positively associated with education level (Figure 2).
Moving beyond this meta-analysis and going one step deeper, other research has evaluated adherence to aerobic exercise guidelines and muscle strengthening guidelines independently. A 2018 study of 1.9 million adults from 168 countries found that 72.5% of adults met aerobic exercise guidelines (2), while a 2020 review with data on over a million adults from six countries found that about 22.5% of adults met guidelines related to muscle-strengthening activities (3, 4). So, in total, about 17.3% of people do enough aerobic and muscle strengthening exercise, about 5.2% of people do enough muscle strengthening exercise but not enough aerobic exercise, about 55.2% of people do enough aerobic exercise but not enough muscle strengthening exercise, leaving about 22.3% of people not doing enough muscle strengthening exercise or aerobic exercise (Figure 3). Keep in mind that these estimates of people meeting aerobic exercise guidelines, muscle strengthening exercise guidelines, and both sets of guidelines come from different studies covering different countries, so these are imprecise estimates. However, I do think the general takeaway is accurate: people are far more likely to meet aerobic exercise guidelines than muscle strengthening guidelines, and maybe 20-25% of people don’t do enough of either type of exercise.
The reasons people fail to meet exercise guidelines are multifactorial – time constraints, low self-efficacy, lack of access to safe locations to exercise, and even just lack of desire to exercise. As fitness professionals and fitness enthusiasts, we should focus on ways to make all forms of exercise more enjoyable and accessible for people who aren’t currently exercising enough. If you’re helping someone increase their physical activity levels, a great first step is to have a supportive conversation about their largest barriers to exercise, and feasible ways to circumvent those barriers. Most MASS readers are concerned with getting as strong or jacked as possible, but for someone who currently does no resistance training, just 10-15 minutes of bodyweight training, 2-3 times per week, can be a huge step in the right direction. But, to circle back to the framing device used at the start of this research brief: it’s hard to say that government exercise guidelines are responsible for declining physical fitness, because more than 80% of people don’t actually meet government exercise guidelines. For reference, you can find the basic version of the CDC’s exercise guidelines here, and you can find the full version here.
Note: This article was published in partnership with MASS Research Review. Full versions of Research Spotlight breakdowns are originally published in MASS Research Review. Subscribe to MASS to get a monthly publication with breakdowns of recent exercise and nutrition studies.
References
- Garcia-Hermoso A, López-Gil JF, Ramírez-Vélez R, Alonso-Martínez AM, Izquierdo M, Ezzatvar Y. Adherence to aerobic and muscle-strengthening activities guidelines: a systematic review and meta-analysis of 3.3 million participants across 32 countries. Br J Sports Med. 2022 Nov 23:bjsports-2022-106189. doi: 10.1136/bjsports-2022-106189. Epub ahead of print. PMID: 36418149.
- Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants. Lancet Glob Health. 2018 Oct;6(10):e1077-e1086. doi: 10.1016/S2214-109X(18)30357-7. Epub 2018 Sep 4. Erratum in: Lancet Glob Health. 2019 Jan;7(1):e36. PMID: 30193830.
- Nuzzo JL. Sex Difference in Participation in Muscle-Strengthening Activities. J Lifestyle Med. 2020 Jul 31;10(2):110-115. doi: 10.15280/jlm.2020.10.2.110. PMID: 32995338; PMCID: PMC7502892.
- The study cited in 3 listed multiple studies for some countries, published in different years and using different exercise guidelines. I averaged adherence rates from the most recent large study from each country using the “standard” guideline of ≥2 sessions per week (to avoid issues associated with double-counting, or nonrepresentative estimates resulting from the use of non-standard guidelines).
- Europe and the Anglosphere were overrepresented in citations 1 and 3. Adherence to exercise guidelines may be considerably different elsewhere in the world.
- It’s not entirely clear if the included studies examined country-by-country adherence to the WHO guidelines (at least 150 minutes of moderate-to-vigorous aerobic exercise per week, including at least 2 sessions of muscle-strengthening activities targeting most major muscle groups per week), or adherence to the guidelines of individual countries. However, that’s not an overly important distinction, because most countries’ individual guidelines are either very similar to the WHO guidelines, or are identical to the WHO guidelines.
