Abstract
Primary care physicians should encourage their patients to engage in adequate physical activity. Current recommendations for physical activity in adults are as follows: at least 150–300 minutes per week of moderate-intensity, 75–150 minutes per week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate- and vigorous-intensity aerobic activity. Adults should also perform muscle-strengthening activities of moderate intensity or higher that involve all major muscle groups for 2 or more days per week. The elderly should perform additional balance training and fall prevention exercises more than 3 times a week. Children and adolescents should perform at least 1 hour of moderate-to-vigorous physical activity daily, which includes vigorous aerobic activity at least 3 days per week. As part of their 60 minutes or more of daily physical activity, resistance training and bone strengthening exercise should be done at least 3 days per week. According to new evidence, one bout of any exercises can be shorter than 10 minutes. Previously, physical activities were recommended for more than 10 minutes. For patients with diabetes, it is advisable to perform resistance exercise or short-distance running before aerobic exercise to prevent hypoglycemia. New evidence shows that dynamic resistance training is safe and effective in patients with hypertension provided the load is not too heavy. Exercise reduces pain and improves quality of life and physical function in patients with osteoarthritis,. Therefore, the treatment guidelines for osteoarthritis have been changed recently from not recommending exercise to highly recommending it.
-
Keywords: Exercise; Guideline; Diabetes Mellitus; Hypertension; Osteoarthritis
INTRODUCTION
Research about the effects of exercise and physical activity on health began in the 1950s with cardiovascular disease. The positive effects of exercise has been verified in a variety of additional research areas including cancer, cerebrovascular disease, mental illness, and musculoskeletal disorders. Therefore, exercise and physical activity are an important topic in clinical practice, and ever increasing in the modern age where lifestyle-relate and chronic diseases have become more important than infectious and acute diseases.
It was suggested that exercise should be vigorous to have a positive effect on health, because it was believed that extensive exercise causes physiological changes such as improvement of cardiopulmonary endurance which is beneficial. However, many studies concluded that even without intensive exercise, there were health benefits as long as there was enough of physical activity. With that, moderate exercise was recommended to promote health after the mid 1990s. Moderate exercise produces enough health benefits without a high risk of injury. Exercise amount is defined by the equation intensity×frequency×duration and as it increases as does its positive impact on health, as long as it is not overdone.
It is also known that physical activity that can encompass standard daily activities are beneficial to health. In recent years, physical activity, which is a broader term than exercise, tends to be defined by its impact on health.
This article summarizes the recent advances in sports medicine and exercise-related research.
EFFECT OF PHYSICAL ACTIVITY ON HEALTH
Physical activity reduces mortality, prevents various cancers, musculoskeletal and cerebrovascular diseases, improves metabolism, and is beneficial for mental health.
There is a great deal of research showing that mortality declines when physical activity increases or body fitness improves. The Shanghai women study showed that general daily physical activity, without intentional exercise, is also beneficial to health [
1].
Physical activity decreases the incidence of colorectal cancer, breast cancer, bladder cancer, endometrial cancer, esophageal cancer, kidney cancer, lung cancer, and stomach cancer. Physical activity also has a positive effect on rehabilitation of cancer patients.
Studies on the prevention and treatment of cardiovascular diseases using exercise have been ongoing for many years. Physical activity controls hypertension, diabetes, and dyslipidemia, thereby preventing cerebrovascular disease. It also improves obesity and insulin resistance, otherwise known as metabolic syndrome.
Positive effects of physical activity on the musculoskeletal system have been demonstrated as they prevent osteoporosis, reduce fractures, and improve the function of patients with rheumatoid and degenerative arthritis. Physical activity is also important in reducing musculoskeletal pain and aiding the rehabilitation of injured patients. Exercise therapy plays a major role in back pain, shoulder impingement syndrome, myopathy syndrome, fibromyalgia syndrome, plantar fasciitis, and ankle sprains.
The effect of exercise on mental health have been proven in depression, anxiety, stress, sleep, dementia, and psychological well-being. Physical activity lowers the risk of depression and improves depressive symptoms, regardless of whether they are diagnosed with depression. It reduces symptoms of anxiety regardless on whether the episode is acute or chronic. Improvement in sleep quality after exercise can be attributed to reduced length of time it takes to go to sleep, reduced awakening, increased deep sleep, and reduced daytime sleepiness. Improvement in cognitive function, memory, concentration, and learning ability were also demonstrated.
Conversely, intensive physical activity pressure on the cardiopulmonary and musculoskeletal systems negatively. Undiagnosed ischemic heart disease can cause a myocardial infarction triggered by exercise. However, it can be prevented by appropriate physical activity, and the overall risk of a heart attack from exercise is relatively low compared its public health benefit.
PHYSICAL ACTIVITY RECOMMENDATIONS AND STATUS IN KOREA
1. Guidelines for Physical Activity
The department of health and human services of the United States has published guidelines for physical activity for Americans in 2018. It is the modified from one from the 2008 US Physical Activity Guidelines and the World Health Organization (WHO) Physical Activity Guidelines in 2010 [
2]. The Ministry of Health and Welfare of Korea issued guidelines of physical activity for Koreans in 2013. The Korean and US guidelines are similar, and the revised guidelines have the same basic principles, although some guidelines have been revised and supplemented.
In all the physical activity guidelines, adults are encouraged to practice moderate aerobic physical activity for at least 150 minutes per week, or alternatively 75 minutes of high intensity exercise. High intensity exercise means vigorous intensity exercise. In this article, both words have been used as the same meaning. We can assume 1 minute of high intensity activity is equal to 2 minutes of moderate intensity activity. When combining high and moderate intensity activities, the guidelines of 150 minutes or more per week should be based on moderate intensity activity. For example, if you have 50 minutes of high intensity activity per week (100 minutes as moderate intensity) and 60 minutes of moderate intensity activity, it will be calculated as 160 minutes of moderate physical activity.
The latest US guidelines state that the moderate aerobic physical activity should be at least 150–300 minutes. This suggests that it is a minimum goal to increase to 300 minutes as much as possible, rather than just 150 minutes per week. It also stated that more than 300 minutes of moderate physical activity is linked to more health benefits.
Moderate physical intensity refers to the exercise intensity corresponding to 3 to 5.9 metabolic equivalents (METs), while high intensity refers to 6 METs and more. One MET is an oxygen uptake of 3.5 mL/kg/min when an adult is resting and corresponds to an energy consumption of 1 kcal/kg per hour. Moderate (3 to 5.9 METs) and high intensity (over 6 METs) physical activities are broad, but the high intensity is roughly double the intensity of moderate intensity.
During light-intensity activities most people are able to sing, during moderate-intensity they can talk but not sing, and during vigorous activities, even talking is difficult.
In the past, physical activity for more than 10 minutes at a time was recommended because evidence was based on the research that studied physical activities for longer than 10 minutes. But it is now known that exercising for as little as 10 minutes is effective, so exercise duration is no longer emphasized [
3].
Since sparse exercise, defined as between 1–2 times per week, increases the risk of injury, it is recommended to exercise three or more days a week, for as many days as possible. Particularly, some papers showed that chronic disease patients should perform exercises for more than 3 days a week. Because increased insulin sensitivity by acute bout of exercise dissipate in 48–72 hours [
4].
Many data sets define the intensity of exercise by the type of physical activity. The most extensive and accurate list is the compendium of physical activities from the University of South Carolina [
5]. Intensities of daily activities, such as gardening, house chores, as well as sports activities, are clearly defined.
It is inappropriate to express intensity of exercise by the amount of sweat. Sweating ability varies from person to person and is affected by temperature and humidity. To be more precise, the intensity can be expressed as heart rate or maximum oxygen uptake, but this is too complicated to use in practice.
Muscle strengthening exercises or resistance exercises reduce the risk of injury, and help maintain weight. It is better to space muscle strengthening exercises to 2 to 3 times a week by each muscle groups rather than on consecutive days. This is because micro-tears in muscle fibers caused by muscle strengthening exercises need time to recover. Moreover, if exercise is performed frequently, the risk of injury may increase.
Muscle strengthening exercises include dumbbells, weight-lifting, push-ups, sit-ups, knee-flexion and extension, and moving objects. Most of the exercises using instruments at a gym are muscle strengthening exercises.
A typical method of determining the appropriate weight for an individual is as follows:
First, there is a way to express the load as a percentage of the maximum weight, or 1 repetition maximum (RM). Approximately 60%–70% of 1 RM (moderate to hard intensity) is for novice to intermediate exercisers to improve their strength. At 80% or higher of 1 RM (hard to very hard intensity) is when experienced strength trainers to improve strength. With 40%–50% of 1 RM (very light to light intensity), older persons and sedentary people initially beginning to exercise can start to improve strength.
The second is a method that estimates appropriate starting weight by what can be lifted. It is used largely because it is easy to measure. Generally, the weight recommended for resistance exercise is the one that can be lifted 8 to 15 times at a time.
Muscle strength is usually increased by the weighted exercise with eight repetitions, while muscular endurance is improved by the one 15 repetitions. Therefore, at the beginning, using a weight that can be lifted only 8 times at a time is recommended. If the designated weight can be lifted 15 times at a time, then it can be increased.
The easiest way is to breathe while doing muscle strengthening exercises is slowly without a pause while lifting a weight for 3 seconds, resting for 1 second, then lowering it for 3 seconds. This is repeated 8–15 times, which is called a set. It is appropriate to perform three sets of muscle strengthening exercise.
Guidelines recommend the elderly or 65 years of age or older should do same physical activities as adults. Especially for the elderly, prevention of falls is important, so balance, leg strength, and flexibility should be improved.
Physical activities for fall prevention should be performed more than 3 times a week, which can include the following: standing on one leg, moving the upper body while standing on one leg, standing or moving on a heel, standing with closed eyes, and standing on a soft, bumpy, or inclined floor. Physical activity should be modified according to the physical fitness and situation to prevent injury.
Children and adolescents should perform 60 minutes or more of physical activity daily which includes aerobic, muscle and bone strengthening activities.
Most of the 60 minutes or more per day should be either moderateor vigorous-intensity aerobic physical activity and should include vigorous-intensity physical activity for at least 3 days a week. They should also include muscle and bone-strengthening physical activity on at least 3 days a week. Jumping, hopping, skipping, and dancing are activities that are good examples of these.
Warming up and cooling down should be done pre- and post-exercise period. These are physical activities with an intensity of about 50% of the originally planned exercise and may include stretching [
6]. For example, you can walk and stretch before and after jogging.
Although the evidence of warming up for prevention of injuries is weak, it is recommended to be carried out to prevent musculoskeletal injuries and heart attacks. Cooling down is also recommended to promote recovery from minute injuries and to prevent dizziness after exercise.
Physical activity should also be performed for chronic patients because regular physical activity is very important for general health maintenance and prevention of cerebrovascular disease. Primary care physicians should encourage the patients with chronic diseases to perform physical activity, educate them on how to exercise safely in accordance with their physical strength, and give them precautions for exercise [
7].
Table 1 summarizes the recommendations of primary care physicians recommend physical activity for the patients based on the WHO, US, and Korea Physical Activity Guidelines.
2. Status of Physical Activity in the Korean Population
According to the Korea National Health and Nutrition Examination Survey about 50% of Korean adults met the guidelines for aerobic physical activity. Unfortunately this percentage has been decreasing yearly from 2014 to 2017 (
Figure 1) [
8]. About 20% of Korean adults who met the guidelines of muscle strengthening physical activity (
Figure 2) [
8]. Muscle strengthening activities should be encouraged more, especially for women.
Korean adults who met the physical activity guidelines in 2014 were 15.6% of the total population, comprising of 22% of total men, 9.4% of total women (
Figure 3) [
8]. As age increased, fewer physical activities were performed. In the United States, about 26% of men, 19% of women, and 20% of adolescents met the guidelines in 2016 [
9].
Exercise is one of the main treatment methods for some musculoskeletal disorders [
10]. Chronic pain leads to muscle atrophy and joint contracture, fatigue and even depression, which exercise can then alleviate.
Muscle strengthening exercises and flexibility and balance training are the cornerstones for the treatment of musculoskeletal diseases.
Muscle strengthening exercise is recommended to be performed 2–3 times a week. It is necessary to leave more than one day of rest in between to relax and strengthen muscles.
Stretching is required for whole body muscles. Larger muscles such as the calves, thighs, hamstrings, lumbosacral spine, and anterior shoulder muscles particularly should be stretched to be flexible. For those with back pain, it is essential to stretch the muscles behind the waist and femur. Range of motion exercises are helpful for the arthritic joints.
A sense of balance prevents injuries caused by falls. Although balance improves to some extent with muscle strengthening or stretching exercises, it is preferable to have active balance training.
Exercise therapy is effective in the treatment of some musculoskeletal problems such as shoulder instability and/or impingement syndrome, myofascial pain syndromes (upper trapezius, sternocleidomastoid muscle, levator scapulae, and other such muscles), adhesive capsulitis, tennis and golf elbows, osteoarthritis, patellofemoral pain syndrome, and chronic low back pain.
In order to treat musculoskeletal pain of the shoulder, exercises for shoulder stability and rotator cuff strengthening are important. Muscle strengthening and stretching of the wrist are needed for tennis and/or golf elbow. To prevent and treat knee osteoarthritis, walking, cycling and swimming are recommended. Aerobic exercise and muscle strengthening training around the joints are needed for the treatment of osteoarthritis. Weight reduction of 5% of total body weight improves osteoarthritis if the patient is overweight. Overall, exercise reduces musculoskeletal pain and improve function, quality of life as well as mental health.
Exercise is not recommended for acute lower back pain although it is effective for chronic lower back pain (LBP). Core stabilization exercises are recommended for chronic LBP. Aerobic exercise is also good for chronic LBP.
Exercise should be modified according to the individual’s response. For example, if the patient feels pain during the musculoskeletal exercise, it is recommended to hold the exercise. If the patient feels pain next day as well, the amount of exercise should be reduced 50%. From there, they can gradually increase the amount.
PRECAUTIONS WHEN EXERCISING
Exercise should be done safely and effectively. Primary care physicians should have four basic principles in mind for the recommendation of physical activities.
First, exercise should not impair or damage patients’ health. Second, exercise should be effective; it should improve illnesses and promote health. Third, overloading is needed since it is effective when the patient applies a load greater than what is usually experienced in normal routine. Fourth, slow progression is needed. Depending on the patient’s fitness level, the patient should increase their load from low to high, gradually.
Exercise prescription should include five elements of exercise: type, intensity, duration, frequency, and speed of movement. Primary care physicians should inform the patient of the risks and provide them with precautions for that particular exercise.
1. Exercise-Induced Heart Attack or Musculoskeletal Injuries
People with chronic diseases who have cardiovascular risk factors may not have any problems even if they are active. However, since there may be a component of underlying cerebrovascular disease, it is recommended to determine if the patients have any abnormal symptoms or signs before they start their activity. If they are planning for higher intensity physical activity, a more thorough check-up is needed. If the risk of cardiovascular disease is high, it is important to exclude the possibility of ischemic heart disease. Recent myocardial infarction, unstable angina, acute heart failure, and complete heart block are contraindications to exercise.
Patients with chronic diseases or disability can have health benefits even with low intensity activities. Physical activity should be modified on an individual basis. Patients who have not exercised before should begin with mild activity for less than 10 minutes. Activity time is increased gradually, and if there are no problems, the number of days of activity per week are increased. It is safe to increase exercise intensity after an increase in exercise time. If periodic physical activity is temporarily suspended due to illness or injury, it is safe to start again with lower activity intensity and gradually increase it to previous activity levels.
A heart attack may occur when the patients exercise violently due to undiagnosed arteriosclerosis. However, the risk of a heart attack due to exercise is relatively small compared to the risk reduction of myocardial infarction by exercise. The sudden death risk of an active person is about 30% of inactive people.
If the patient is a novice who undergoes sudden, strenuous exercise, overuse syndromes such as sprains, tendinopathies, shin splints, fasciitis, bursitis, and stress fractures may occur. In order to prevent overuse syndromes, it is necessary to use adequate footwear with arch support, obtain proper nutrition and hydration, perform adequate warming up, gradually increase exercise time and intensity, have a good posture during exercise, and engage in cross training [
11]. Cross training alternates the type of exercises engaged, which reduces boredom and prevents overuse syndrome.
Once a patient is injured or sprained, resting of the joints and muscles are recommended. For example, if a knee problem occurs with jogging or aerobics, free style swimming or aquatic exercise may be applied to rest the injured knee.
Overtraining syndrome refers to myalgia, chronic fatigue, and overuse syndrome caused by excessive exercise. When the exercise ability is reduced, reduction of the amount of exercise or rest is recommended to rule out overtraining syndrome.
2. General Exercise Precautions
When exercising outdoors, patients should be mindful about temperature, humidity, and air pollution. Generally, exercising for more than 30 minutes at 27℃–29℃ and above 70% relative humidity is harmful to the body and is a contraindication to exercise, especially for heart disease patients. In hot weather it is better to exercise early in the morning or evening or indoors.
When pollen-sensitive asthmatic patients exercise outdoors, preventive measures are needed, such as bronchodilator inhalation. In cold weather, asthma is easily induced by exercise because of dry air, thus, indoor activities are recommended.
When prescribing exercise, the primary care physician needs to identify the patients’ current medication and respond appropriately. For example, if a patient is taking nitroglycerin, intervals as needed between medication and exercise because exercising immediately after taking nitroglycerin may cause hypotension. Insulin-dependent patients with diabetes should reduce the amount of insulin to prevent hypoglycemia, and administration should be on the abdomen instead of extremities to prevent quick absorption. Beta blockers may slow the heart rate; therefore, the primary care physician should not use heart rate as an index of exercise intensity in these patients. Subjective exercise intensity is a more appropriate and realistic indicator. Beta blockers may also reduce exercise capacity by reducing cardiac contractility. Potassium sparing diuretics may cause hyperkalemia, while other diuretics may cause potassium deficiency, resulting in arrhythmias during exercise. It should also be noted that anticholinergic drugs such as antispasmodics and antihistamines may inhibit sweating and can easily increase body temperature.
3. Precautions in Chronic Diseases
1) Diabetes mellitus
To date, there is no consensus on whether pre-exercise health screening should be performed for patients with diabetes. Patients with diabetes who are asymptomatic and inactive may not be required to undergo screening if they perform low or moderate intensity exercise; if the intensity is equivalent to brisk walking or less, screening is not necessary. However, if they are going to engage in more intense activity than usual, if they are at high risk for cardiovascular disease (high blood pressure, smoking, family history, and other such factors) and if they are suspected to have other exercise-related health problems, pre-exercise screening is needed [
12].
Patients with diabetes are also encouraged to exercise per standard guidelines but with additional emphasis on exercising more than three days a week. Rest for more than 2 days is avoided due to the temporary positive effect of exercise on insulin sensitivity.
Exercise-induced hypoglycemia should be considered as insulin sensitivity increases for about 24–48 hours after active exercise. Hypoglycemia can occur due to exercise particularly when insulin secretagogues or insulin injections are used. Fortunately, there are many types of diabetes medications that rarely cause hypoglycemia. To determine effect of exercise on blood glucose, measurements of blood glucose before and after exercise are recommended. If the patient has a high risk of hypoglycemia, reduction of pre-exercise medication dose or having a pre-exercise meal is required. If the pre-exercise blood glucose is less than 90 mL/dL, carbohydrate intake is necessary. Insulindependent patients with diabetes should reduce their insulin dose to prevent development of exercise-induced hypoglycemia and should consume carbohydrates once hypoglycemic symptoms occur. In addition, on the day of exercise, injection into the arms and the legs which muscles that are mostly exercising should be avoided, injection into the abdomen is recommended to prevent too rapid insulin absorption.
In order to prevent hypoglycemia, it is advisable to perform resistance exercises or short-distance running before aerobic exercise. This is because strenuous activity can signal counter-regulatory hormones which can prevent a decrease in the blood glucose.
Exercise-induced nocturnal hypoglycemia should also be noted. Blood glucose levels can be reduced up to 48 hours after exercise. This can be prevented by a reduction in evening insulin dose, incorporating midnight snacks, and engaging in continuous glucose monitoring.
Exercise-induced hyperglycemia is also possible, especially when high pre-exercise blood glucose is elevated. It can be caused by high intensity exercise such as short-distance running, strong aerobic exercise, and heavy weight-lifting exercises. If patients are going to perform these exercises, insulin dose control and interval training (alternating between high intensity and moderate intensity exercises) are recommended.
If uncontrolled blood pressure, severe autonomic or peripheral neuropathy, history of diabetic foot disease, and/or unstable proliferative retinopathy are present, it is advisable to avoid high intensity exercise and to perform moderate and lower intensity exercise.
If autonomic neuropathy is present, sudden vertical positional changes should be avoided to prevent orthostatic hypotension. Adequate hydration is required for prevention of dehydration and hyperthermia. Because of the possibility of diabetic foot ulcers, the patient should have well-fitting shoes and conduct a careful inspection for wounds before and after their workout.
If there is severe non-proliferative retinopathy or unstable proliferative retinopathy, high intensity aerobic exercise and resistance exercise should be avoided. In particular, jumping, exercises with a lowered head, and breath holding exercises should be avoided. Breath holding during isometric exercise that does not change in distance can increase intraocular pressure via the Valsalva effect.
Unlike the previous guidelines, there is no limitation of exercise when albuminuria or kidney disease is present. Physical activity can be performed even during dialysis.
High-intensity exercise should be avoided if there is concern of ketoacidosis. However, if there is no ketoacidosis and the patient’s overall systemic condition is good, it is not necessary to delay exercise even if hyperglycemia is present. Unlike previous guidelines, hyperglycemia itself is not a contraindication to exercise. High-intensity exercise is safe when pre-exercise blood glucose is less than 250 mg/dL [
13]. In addition, if type 1 diabetes patients do not get insulin injections for a long time, hyperglycemia may occur, so it is desirable to prohibit vigorous activities.
2) Hypertension
The importance of physical activity has become even greater as the levels designating of hypertension have decreased. In the case of systolic blood pressure 130–140 mm Hg, lifestyle modification is recommended before taking medication. Physical activity lowers blood pressure by 5–8 mm Hg. Regardless of exercise intensity, duration, or type, blood pressure lowering effects are demonstrated.
Previously resistance exercises were prohibited in hypertensive patients because it was hypothesized to cause a Valsalva effect and decrease blood circulation, which then would result in a compensatory elevation in heart rate and subsequent elevation in blood pressure. However, this has been disproven by many studies and ultimately have shown that there are blood pressure lowering effects in the long term. As a result, patients with hypertension are now encouraged to perform resistance exercises. Dynamic resistance exercise is safe and effective in hypertension if the load is not too heavy [
14]. Generally, the weight that can be lifted 8 times or more is not a problem. While isometric exercise is safe and effective, there is not enough evidence to support it, so it cannot be formally recommended.
However, hypertensive patients may have problems if the weight is too heavy, thus should be encouraged to exercise with proper weights and to avoid breath holding.
3) Osteoarthritis
In patients with osteoarthritis, exercise reduces pain, improves quality of life, and improves physical function. Therefore, the guidelines have been changed from not recommending exercise to highly recommending it. Recommendations for non-pharmacological treatment include weight loss (5% decrease in total body weight when overweight), aerobic physical activity, range of motion exercises, resistance exercises, and proper footwear [
15].
For patients with hip and knee osteoarthritis, it is recommended to engage in low-impact exercises with low weight-bearing. Additionally, swimming and stationary bicycle exercises are preferable. However, it is important to consider that the breast-stroke can be a challenge for patients with knee osteoarthritis, because it requires wide knee flexion. If knee pain occurs, it is advised to swim using free style, back stroke or participate in an aquatic sport. Even when riding a stationary bicycle, knee pain worsen due to continuous knee flexion. Raising the saddle height of the stationary bicycle to straighten the leg may relieve knee pain. Knee flexion and extension exercises in addition to cycling would be helpful in decreasing knee loads. For example, a semi-squat exercise is effective.
Muscle strengthening exercises around the knee, especially the quadriceps, are essential in treating lower extremity osteoarthritis and also in alleviating patellofemoral pain syndrome.
CONCLUSION
Exercise or physical activity should be done at least moderately. Adult physical activity guidelines are for moderate intensity aerobic physical activity for 150–300 minutes per week and muscle strengthening exercise 2–3 times a week. The elderly have the same physical activity guidelines as adults, but additionally need balance training to prevent falls. Children and adolescents need at least one hour of physical activity each day, including high intensity aerobic activity, resistance training, and bone strengthening exercises for at least three days per week. Previously, physical activities for more than 10 minutes were recommended, but now shorter activities are being encouraged because evidence demonstrates that shorter activities are also effective. However, since the aerobic physical activity of Korean people is decreasing, various efforts are needed to promote physical activity.
Living a sedentary lifestyle is also an independent risk factor for disease, and even a little physical activity has a positive impact on our health.
The risk of injuries or negative outcomes from physical activities should be identified and eliminated by pre-participation testing, for patients who are at risk. It is also necessary to provide exercise instructions and exercise precautions to prevent injuries.
In reality, it is not easy to carry out detailed exercise counseling during busy outpatient clinic hours. However, during primary care appointments, physicians have an opportunity to assess and encourage physical activity for their patients. It is necessary to caution patients with hypertension, diabetes and osteoarthritis on appropriate physical activity.
Notes
Figure. 1.Proportion of Korean adults who met the aerobic physical activity guidelines, 2014–2017. From Korea Center for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey reports [Internet]. Cheongju: Korea Center for Disease Control and Prevention [cited 2019 May 4]. Available from:
https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.[
8]
Figure. 2.Proportion of Korean adults who met the muscle-strengthening activity guidelines, 2005–2017. From Korea Center for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey reports [Internet]. Cheongju: Korea Center for Disease Control and Prevention [cited 2019 May 4]. Available from:
https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.[
8]
Figure. 3.Proportion of Korean adults who met the aerobic and musclestrengthening guidelines, 2014. From Korea Center for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey reports [Internet]. Cheongju: Korea Center for Disease Control and Prevention [cited 2019 May 4]. Available from:
https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7.[
8]
Table 1.Recommendations for physical activities for the patients in primary care
|
Recommendations |
|
1. |
Primary care physicians should frequently check on the amount of physical activity performed by the patients and encourage physical activities. |
|
2. |
Educate patients to perform the following physical activities: |
|
1) |
Move as much as possible and avoid sedentary activities. |
|
2) |
For substantial health benefits, adults should perform at least 150–300 min/wk of moderate-intensity, 75–150 min/wk of vigorous-intensity, 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 engaging in physical activity beyond the equivalent of 300 minutes (5 hours) of moderate-intensity physical activity per week. |
|
3) |
Adults should also perform muscle-strengthening exercises 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. |
|
4) |
Guidelines for the elderly (aged 65 years or older) are as follows: |
|
|
(1) |
The key guidelines for adults also apply to the elderly patients depending on their condition. |
|
|
(2) |
Balance training and fall prevention exercises should be performed more than 3 times a week |
|
|
(3) |
Older adults should determine their level of effort for physical activity relative to their level of fitness. |
|
5) |
Guidelines for children and adolescents |
|
|
Patients should perform 60 minutes or more of moderate-to-vigorous physical activity daily with the following distribution: |
|
|
(1) |
Aerobic: Most of the daily activity should be either moderate-or vigorous-intensity aerobic physical activity and should also include vigorous-intensity physical activity on at least 3 d/wk. |
|
|
(2) |
Muscle-strengthening: Children and adolescents should include muscle-strengthening physical activity as part of their 60 minutes or more of daily activity on at least 3 days a week. |
|
|
(3) |
Bone-strengthening: Children and adolescents should include bone-strengthening physical activity on at least 3 days a week. |
|
3. |
Warming up and cooling down exercises are recommended in the pre- and post-exercise period, respectively. |
|
4. |
If patients have chronic diseases, they must engage in physical activity, as outlined above; however, the following considerations should be kept in mind: |
|
1) |
Regular physical activity is crucial to maintaining health and preventing cardiovascular disease complications. |
|
2) |
Patients must consult their physician and work out safely according to their fitness level. |
References
- 1. Matthews CE, Jurj AL, Shu XO, Li HL, Yang G, Li Q, et al. Influence of exercise, walking, cycling, and overall nonexercise physical activity on mortality in Chinese women. Am J Epidemiol 2007;165:1343-50.
- 2. World Health Organization. Global recommendations on physical activity for health [Internet]. Geneva: World Health Organization; 2010 [cited 2019 Apr 29]. Available from: http://whqlibdoc.who.int/publications/2010/9789241599979_eng.pdf
- 3. 2018 Physical Activity Guidelines Advisory Committee. 2018 Physical Activity Guidelines Advisory Committee scientific report [Internet]. Rockville (MD): U.S. Department of Health and Human Services; 2018 [cited 2019 Apr 29]. Available from: https://health.gov/paguidelines/second-edition/report/
- 4. King DS, Baldus PJ, Sharp RL, Kesl LD, Feltmeyer TL, Riddle MS. Time course for exercise-induced alterations in insulin action and glucose tolerance in middle-aged people. J Appl Physiol (1985) 1995;78:17-22.
- 5. Ainsworth BE, Haskell WL, Herrmann SD, Meckes N, Bassett DR Jr, Tudor-Locke C, et al. 2011 Compendium of physical activities: a second update of codes and MET values. Med Sci Sports Exerc 2011;43:1575-81.
- 6. Horia-Daniel I, Georges J. Comparison of two warm-up models for obese and normal-weight adults performing supramaximal cycling exercise. Biol Sport 2018;35:93-8.
- 7. Yang YJ. Physical activity. In: Korean Academy of Family Medicine Family medicine. 4th ed. Seoul: IJPNC; 2013. p. 232-41.
- 8. Korea Center for Disease Control and Prevention. Korean National Health and Nutrition Examination Survey reports [Internet]. Cheongju, Korea Center for Disease Control and Prevention. [cited 2019 May 4]. Available from: https://knhanes.cdc.go.kr/knhanes/sub04/sub04_03.do?classType=7
- 9. Piercy KL, Troiano RP, Ballard RM, Carlson SA, Fulton JE, Galuska DA, et al. The Physical Activity Guidelines for Americans. JAMA 2018;320:2020-8.
- 10. Yang YJ. Exercise therapy for musculoskeletal pain. Korean J Fam Pract 2014;4:186-93.
- 11. Brukner P, Khan K. Clinical sports medicine. 4th ed. Sydney: McGrow Hill; 2012.
- 12. Colberg SR. Key points from the updated guidelines on exercise and diabetes. Front Endocrinol (Lausanne) 2017;8:33.
- 13. Colberg SR, Sigal RJ, Yardley JE, Riddell MC, Dunstan DW, Dempsey PC, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care 2016;39:2065-79.
- 14. Pescatello LS, MacDonald HV, Lamberti L, Johnson BT. Exercise for hypertension: a prescription update integrating existing recommendations with emerging research. Curr Hypertens Rep 2015;17:87.
- 15. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. Arthritis Rheum 2000;43:1905-15.
Figure & Data
Citations
Citations to this article as recorded by
- The Relationship Between Physical Activity Profiles and Cardiovascular Disease Risk Factors: Results of a Cross-Sectional Survey of Active Duty U.S. Service Members
Jimmy Dawood, James D Mancuso, Kasi Chu, Martin Ottolini, Anwar E Ahmed
Military Medicine.2025; 190(3-4): e657. CrossRef - Muscle Mass Index Decline as a Predictor of Lung Function Reduction in the General Population
Joon Young Choi, Chin Kook Rhee, Sang Hyuk Kim, Yong Suk Jo
Journal of Cachexia, Sarcopenia and Muscle.2025;[Epub] CrossRef - Lifestyle interventions for dementia risk reduction: A review on the role of physical activity and diet in Western and Asian Countries
Amelia Nur Vidyanti, Fitri Rahmawati, Rifki Habibi Rahman, Astuti Prodjohardjono, Abdul Gofir
The Journal of Prevention of Alzheimer's Disease.2025; 12(2): 100028. CrossRef - Unraveling Temporal Dynamics of Employees’ Musculoskeletal Health: The Role of Initial Success in Workplace Physical Activity Interventions
Alexander Nath, Sophia Schimmelpfennig, Udo Konradt
Occupational Health Science.2025;[Epub] CrossRef - Effects of Physical and Mind-body Exercise on Sleep Quality in Individuals With Diabetes Mellitus: A Systematic Review and Meta‐analysis
Yohanes Andy Rias, Renny Wulan Apriliyasari, Made Satya Nugraha Gautama, Faizul Hasan, Margareta Teli, Hsiao-Yean Chiu, Ratsiri Thato
Journal of Preventive Medicine and Public Health.2025; 58(1): 1. CrossRef - Aerobic Exercise and Metformin: A Dual Approach to Enhancing Glycemic Maintenance in Type 2 Diabetes Mellitus
Zahra Eslami, Gholamreza Roshandel, Seyed Javad Mirghani
Chonnam Medical Journal.2025; 61(1): 9. CrossRef - Nanotechnology and Artificial Intelligence in Dyslipidemia Management—Cardiovascular Disease: Advances, Challenges, and Future Perspectives
Ewelina Młynarska, Kinga Bojdo, Hanna Frankenstein, Natalia Kustosik, Weronika Mstowska, Aleksandra Przybylak, Jacek Rysz, Beata Franczyk
Journal of Clinical Medicine.2025; 14(3): 887. CrossRef - Development and Pilot Testing of a Mobile App–Based Chatbot for the Self-management of Physical Activity for Older Adults
Sooyeon Park, Su Jung Lee
CIN: Computers, Informatics, Nursing.2025;[Epub] CrossRef - The influence of sex on activity in voluntary wheel running, forced treadmill running, and open field testing in mice
Adam J. Janowski, Giovanni Berardi, Kazuhiro Hayashi, Ashley N. Plumb, Joe B. Lesnak, Tahsin Khataei, Ben Martin, Christopher J. Benson, Kathleen A. Sluka
Physiological Reports.2025;[Epub] CrossRef - Resveratrol and Physical Activity: A Successful Combination for the Maintenance of Health and Wellbeing?
Mario Ruggiero, Maria Letizia Motti, Rosaria Meccariello, Filomena Mazzeo
Nutrients.2025; 17(5): 837. CrossRef - The impact of acute bike desk usage before encoding and during early consolidation on memory task performance in university students and use case evaluation in an educational setting
Ahmed Mohsen Abbas El-Hagrasy, Rachel Anna Marshall, Thuraiya Hilal Said Al-Rawahi, Sally Doherty, Nitya Kumar, Declan Gaynor, Emiliano Cè
PLOS ONE.2025; 20(3): e0319658. CrossRef - Exploring the inclusion of children with disabilities in physical activities: benefits, barriers, and facilitators
Margaret Bukola Fatudimu, Yusuff Tunde Gbonjubola, Leader Francis
Adesh University Journal of Medical Sciences & Research.2025; 6: 5. CrossRef - CD36 polymorphism, sugary drinks, and sedentarism are associated with hypertriglyceridemic waist phenotype
Dayanara Navarro-Rios, Arturo Panduro, Sonia Roman, Omar Ramos-Lopez
International Journal for Vitamin and Nutrition Research.2024; 94(1): 37. CrossRef - An Examination of Coping Strategies that Moderated the Effects of COVID-19-Related Stress on Anxiety Among Older Adults in Aotearoa/NZ
Navneet Kaur, Christine Stephens
Journal of Aging and Health.2024; 36(7-8): 436. CrossRef - Deciphering the mechanisms, biochemistry, physiology, and social habits in the process of aging
Folake Olubukola Asejeje, Olalekan Bukunmi Ogunro
Archives of Gerontology and Geriatrics Plus.2024; 1(1): 100003. CrossRef - Lowering blood pressure by exercise: investigating the effect of sweating
Rastegar Hoseini, Rasha Raed Hamid
Blood Pressure Monitoring.2024;[Epub] CrossRef - Risk Factors of Hypertension in Low- and Middle-income Countries: A Prompt Portray
Rahnuma Ahmad, Susmita Sinha, Kona Chowdhury, Mainul Haque
Advances in Human Biology.2024;[Epub] CrossRef - Association between Thyroid Function and Insulin Resistance Indices in Korean Adolescents: Findings from the 2014–2015 Korea National Health and Nutrition Examination Survey
Eunji Mun, Hye Ah Lee, Jung Eun Choi, Rosie Lee, Kyung Hee Kim, Hyesook Park, Hae Soon Kim
Children.2024; 11(3): 370. CrossRef - Patterns of Physical Activity of Adolescents With ADHD in the School Context: A Cross-Sectional Study for Clinical Practice
Raquel Prat, Anna Puig-Ribera, Mireia Pagerols, Gemma Español-Martín, Cristina Rivas, Aurea Autet, Pere Tàpies, Ana C. Martín, Miquel Casas, Rosa Bosch
Journal of Attention Disorders.2024; 28(8): 1210. CrossRef - Impact of a daily legume‐based meal on blood and anthropometric parameters in a group of omnivorous adults: A pilot study
Helena Ferreira, Marta Vasconcelos, Ana M. Gil, Joana Silveira, Paulo Alves, Sandra Martins, Marco Assunção, João Tiago Guimarães, Elisabete Pinto
Nutrition Bulletin.2024; 49(2): 235. CrossRef - Association Between Shift Work and Clean Room Environment on Self-reported Premenstrual Symptoms and Menstrual Pain in Taiwan
Su-Ying Tsai
Safety and Health at Work.2024; 15(3): 278. CrossRef - Combined effects of sugar-sweetened beverage consumption, screen-based sedentary behavior, and sleep duration on South Korean adolescent obesity: a cross-sectional study
Jin Suk Ra, Do Thi Thu Huyen
Child Health Nursing Research.2024; 30(2): 77. CrossRef - The Role of Physical Activity in Adjunctive Nursing Management of Neuro-Degenerative Diseases among Older Adults: A Systematic Review of Interventional Studies
Majed Awad Alanazi
Life.2024; 14(5): 597. CrossRef - Towards Optimal Cardiovascular Health: A Comprehensive Review of Preventive Strategies
Philip Branigan, Y. V Duong, Ammar Y Abdulfattah, Jacob Sabu, Mary Mallappallil, Sabu John
Cureus.2024;[Epub] CrossRef - Effects of additional physical exercise on the nutritional status and disease progression during the low-protein diet in Chronic Kidney Disease Patients: a systematic review and meta-analysis
Jing Wang, Xiaofen Xiao, Hui Zhang, Dan Wu, Feifei Luo, Juling Yu
European Journal of Clinical Nutrition.2024; 78(9): 737. CrossRef - Health Effects of Tai Chi Qigong Practices and Its Reflections on Nursing Practices
Müjde Kerkez, Canan Birimoglu Okuyan, Behice Erci
Holistic Nursing Practice.2024; 38(5): 267. CrossRef - Association between various physical activity domains and overall cancer risk, National Health and Nutrition Examination Survey (NHANES) 2007–2018
Yanxue Lian, Pincheng Luo, Nestor Asiamah
PLOS ONE.2024; 19(7): e0308099. CrossRef - A Scoping Review of Firefighters' Health Behaviors and Chronic Diseases
Trevin E. Glasgow, James B. Burch, Chrisa Arcan, Jean M. Reading, Maddy Theal, John W. Cyrus, Bernard F. Fuemmeler
American Journal of Health Behavior.2024; 48(3): 746. CrossRef - Physical Activity Assessment of Physicians in Primary Healthcare Centers in Makkah, Saudi Arabia
Alaa G Alolayan, Salman Alsubhi
Cureus.2024;[Epub] CrossRef - Healthy lifestyle factors and male perpetration of intimate partner violence: a cross-sectional study in Mwanza, Tanzania
Anna E. Jacob, Gerry Mshana, Neema Mosha, Ramadhan Hashim, Simon Sichalwe, Donati Malibwa, Saidi Kapiga, Philip Ayieko, Heidi Stöckl
Global Health Action.2024;[Epub] CrossRef - Relationship between smoking experience and risk of suicide mortality in South Korean adults: A nationwide population-based retrospective cohort study
Hyo Jin Park, Byoungduck Han, Bongseong Kim, Kyungdo Han, Seohwan Kim, Hyunjoo Kim, Kyoungjoon Youn, Hyun Jin Park, Yong-kyun Roh, Youn Seon Choi, Ga Eun Nam, Seon Mee Kim
Journal of Affective Disorders.2024; 367: 67. CrossRef - Influence of Kinesiophobia on muscle endurance in patients with chronic low back pain- A case-control study
Praveen Kumar, Arthur de Sá Ferreira, Leandro Alberto Calazans Nogueira, Watson Arulsingh, Mr. Sharad Patil
F1000Research.2024; 13: 1016. CrossRef - The association between tooth brushing during lunchtime and obesity in South Korean adolescents
Yoonjin Cho, Heejae Shin, Seunghoon Lee, Jinhyun Kim, Jaeyong Shin, Hyunkyu Kim
Scientific Reports.2024;[Epub] CrossRef - Perceptions Experiences and Challenges of Physical Activity among Firefighters with Coronary Heart Disease Risk Factors in the City of Cape Town Fire and Rescue Services
Ghaleelullah Achmat, Makhaya Malema, Charlene Erasmus, Jill Kanaley, Lloyd Leach
The Open Public Health Journal.2024;[Epub] CrossRef - The Tendency to Use Substances/Drugs and its Association with Interpersonal Dependence in Iranian Medical Students
Mohammadrasoul Khalkhali, Mahnoosh Tavakkoli fard, Seyed Yasin Mousavi, Amirreza Ariannezhad, Hassan Farrahi
Addiction and Health.2024; 16(3): 188. CrossRef - Portion Size Norms of Discretionary Foods and Eating Settings: A Repeated Cross-Sectional Study
Qingzhou Liu, Margaret Allman-Farinelli, Anna Rangan
Nutrients.2024; 16(21): 3670. CrossRef - Epidemiological Profile of Spine Cases in a Tertiary Care Hospital
Jan Melburgo Chiu, Hansel Gould Cocjin, Gladys Tan, Ma. Ella Muriel Valdevieso
Philippine Journal of Orthopaedics.2024; 39(2): 44. CrossRef - Effectiveness of low-load resistance training with blood flow restriction vs. conventional high-intensity resistance training in older people diagnosed with sarcopenia: a randomized controlled trial
Mei Zhang, Yuanyuan Song, Jiaye Zhu, Peiyuan Ding, Nan Chen
Scientific Reports.2024;[Epub] CrossRef - Identifying data gaps in early childhood physical activity evidence
Jessica Wimberly, Aleah Nguyen, Erica Memoli, Matt Kasman, Bill Heerman, Russell Pate, Evan Sommer, Adam Sedlak, Lydia Reader, Ross A. Hammond, Shari Barkin
Frontiers in Pediatrics.2024;[Epub] CrossRef - Prevalence of physical inactivity and associated factors among adults in Eastern African countries: a systematic review and meta-analysis protocol
Habtamu Wagnew Abuhay, Nebiyu Mekonnen Derseh, Tracy L Kolbe-Alexander, Prajwal Gyawali, Melaku Kindie Yenit
BMJ Open.2024; 14(11): e084073. CrossRef - Adaptation Of The Exercise Maintenance Motivation Scale To Turkish Culture
Mehmet Öztaş, Abdullah Kilci, Ali Erdoğan, Erkan Faruk Şirin
Turkish Journal of Sport and Exercise.2024; 26(3): 428. CrossRef - The interplay of factors in metabolic syndrome: understanding its roots and complexity
Md. Sharifull Islam, Ping Wei, Md Suzauddula, Ishatur Nime, Farahnaaz Feroz, Mrityunjoy Acharjee, Fan Pan
Molecular Medicine.2024;[Epub] CrossRef - Adaptation of The Personality Traits Scale of E-Sports Players to Turkish Culture
Mehmet Öztaş, Ali Erdoğan
International Journal of Sport, Exercise & Training Sciences.2024; 10(4): 299. CrossRef - Association between S-phenylmercapturic Acid Related to Environmental Benzene Exposure and Diabetes: 8th Korea National Health and Nutrition Examination Survey (2020~2021)
Sang Shin PYO
Korean Journal of Clinical Laboratory Science.2024; 56(4): 349. CrossRef - Irisin pathways in hearts of Type 1 diabetic adult male rats following 6 weeks of moderate and high-volume aerobic exercise on a treadmill
Humeyra Celik, Ali Doğan Dursun, Yakup Tatar, Goktug Omercioglu, Metin Bastug
Sport Sciences for Health.2023; 19(2): 597. CrossRef - Effect of treadmill walking for anxiety, depression, and social well-being in women with diabetes type 2: A randomized controlled trial
Sonill S. Maharaj, Jibril M. Nuhu
Health Care for Women International.2023; 44(6): 734. CrossRef - Risk of Rapid Lung Function Decline in Young Adults With Chronic Obstructive Pulmonary Disease: A Community-Based Prospective Cohort Study
Sang Hyuk Kim, Hyun Lee, Hyonsoo Joo, Hayoung Choi, Yun Su Sim, Chin Kook Rhee, Yong Bum Park, Youlim Kim, Kwang Ha Yoo
Journal of Korean Medical Science.2023;[Epub] CrossRef - Psychometric properties of the Barriers Self-Efficacy Scale for Physical Activity–Korean
Jung-Suk Kim, Chun-Ja Kim, Elizabeth A. Schlenk
Archives of Psychiatric Nursing.2023; 43: 29. CrossRef - National trends in physical activity among adolescents in South Korea before and during the COVID‐19 pandemic, 2009−2021
Rosie Kwon, Min Ji Koo, Seung Won Lee, Yong Sung Choi, Youn Ho Shin, Jung U. Shin, Ai Koyanagi, Louis Jacob, Lee Smith, Sang Youl Rhee, Hyug‐Gi Kim, Chanyang Min, Seong Ho Cho, Abdullah Özgür Yeniova, So Young Kim, Jinseok Lee, Seung Geun Yeo, Jae Il Shin
Journal of Medical Virology.2023;[Epub] CrossRef - Association between Asthma and Oral Health Symptoms in Adolescents
Ka-Yun Sim, Yun-Seo Jang, Na-Young Yoon, Eun-Cheol Park
International Journal of Environmental Research and Public Health.2023; 20(4): 2921. CrossRef - Analysis of Daily Activity Pattern to Estimate the Physical Activity Level and Energy Expenditure of Elite and Non-Elite Athletes
Ekta Kapri, Subrata Dey, Manju Mehta, Nilima Deshpande, Erika Zemková
Applied Sciences.2023; 13(5): 2763. CrossRef - Metabolically Healthy Obesity: Are Interventions Useful?
Bryan J. Mathis, Kiyoji Tanaka, Yuji Hiramatsu
Current Obesity Reports.2023; 12(1): 36. CrossRef - A qualitative study of patients’ and carers’ perspectives on factors influencing access to hypertension care and compliance with treatment in Nigeria
Blessing O. Ukoha-Kalu, Maxwell O. Adibe, Chinwe V. Ukwe
Journal of Hypertension.2023;[Epub] CrossRef - Physical Inactivity, Sedentary Behavior and Quality of Life in the Chilean Population: ENCAVI Results, 2015–2016
Carlos Gonzalez-Torres, Tuillang Yuing, Francisco Berral-de la Rosa, Pablo A. Lizana
Healthcare.2023; 11(7): 1020. CrossRef - Musculoskeletal Injury Prevalence, Pain Perception, and Physical Activity Level Among Brazilian Strength and Cross-Training Practitioners
Olga Thainá Mendes de Carvalho, Bruna Augusta Alves da Silva, Victor Gonçalves Corrêa Neto, Jason B. Winchester, Silvio Rodrigues Marques Neto, Andressa Silva, Alexsandro Oliveira, Fábio Feitosa, Jefferson da Silva Novaes, Estêvão Rios Monteiro
Perceptual and Motor Skills.2023; 130(5): 2106. CrossRef - The impact of COVID-19 on students’ anxiety and its clarification: a systematic review
Jiarun Wu, Garry Kuan, Hu Lou, Xiaoyu Hu, Mohamad Najmi Masri, Abdulwali Sabo, Yee Cheng Kueh
Frontiers in Psychology.2023;[Epub] CrossRef - Level and associated factors with physical activity among Indian public school teachers
Parveen Jangra, Parveen Kumar, Kuldeep Nara
Health, sport, rehabilitation.2023; 9(3): 6. CrossRef - Longitudinal associations of physical activity with inflammatory markers in US adults with and without type 1 diabetes
Leigh Ann Richardson, Arpita Basu, Lung-Chang Chien, Amy C. Alman, Janet K. Snell-Bergeon
Diabetes Research and Clinical Practice.2023; 206: 110978. CrossRef - Resistant hypertension: consensus document from the Korean society of hypertension
Sungha Park, Jinho Shin, Sang Hyun Ihm, Kwang-il Kim, Hack-Lyoung Kim, Hyeon Chang Kim, Eun Mi Lee, Jang Hoon Lee, Shin Young Ahn, Eun Joo Cho, Ju Han Kim, Hee-Taik Kang, Hae-Young Lee, Sunki Lee, Woohyeun Kim, Jong-Moo Park
Clinical Hypertension.2023;[Epub] CrossRef - Personalized Physical Activity Programs for the Management of Knee Osteoarthritis in Individuals with Obesity: A Patient-Centered Approach
Hassan Zmerly, Chiara Milanese, Marwan El Ghoch, Leila Itani, Hana Tannir, Dima Kreidieh, Volkan Yumuk, Massimo Pellegrini
Diseases.2023; 11(4): 182. CrossRef - Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations
Pranam Pandit, Siddhant P Murkey, Akash Agarwal, Arpita Jaiswal, Suyash Agrawal
Cureus.2023;[Epub] CrossRef - Evaluation of an Online Physical and Mental Wellbeing Program for UST-CRS Students: A Feasibility Study
Catherine Joy T. Escuadra, Jordan Barbra P. Nav, Arlene Chiong C. Maya, Neil Zachary M. Aningalan, Beatriz Joy E. Borhillo, Llana Eunice R. Duya, Marco Celso S. Francisco III, Katrina Angela G. Jarobel, Darlene Sofia A. Lim, Jan Mikaela B. Ramos, Julia Va
Philippine Journal of Physical Therapy.2023; 3(1): 12. CrossRef - Assessment of the Impact of the COVID-19 Pandemic on the Pro-Health Behavior of Poles
Karolina Hoffmann, Anna Paczkowska, Aleksandra Bońka, Michał Michalak, Wiesław Bryl, Dorota Kopciuch, Tomasz Zaprutko, Piotr Ratajczak, Elżbieta Nowakowska, Krzysztof Kus
International Journal of Environmental Research and Public Health.2022; 19(3): 1299. CrossRef - Gender Differences in Body Composition in Pre-Frail Older Adults With Diabetes Mellitus
Reshma Aziz Merchant, John Tshon Yit Soong, John E. Morley
Frontiers in Endocrinology.2022;[Epub] CrossRef - Importance of Healthy Habits During the COVID-19 Pandemic: Perspective and Suggestions
Marcos Roberto Tovani-Palone, Nicola Comini, Andrea Giacalone, Thomas Franchi
Electronic Journal of General Medicine.2022; 19(3): em369. CrossRef - Physical Activity for Health and Fitness: Past, Present and Future
Gaurav Kapoor, Priya Chauhan, Gurjant Singh, Nitesh Malhotra, Aksh Chahal
Journal of Lifestyle Medicine.2022; 12(1): 9. CrossRef - Exposure to ambient air pollution and osteoarthritis; an animal study
Abyadul Fitriyah, Denis Andreevich Nikolenko, Walid Kamal Abdelbasset, Marwah Suliman Maashi, Abduladheem Turki Jalil, Ghulam Yasin, Mohammed Mustafa Abdulkadhm, G.U. Samieva, Holya A. Lafta, Azher M. Abed, Larissa Souza Amaral, Yasser Fakri Mustafa
Chemosphere.2022; 301: 134698. CrossRef - Myostatin Levels and the Risk of Myopenia and Rheumatoid Cachexia in Women with Rheumatoid Arthritis
Fabiola Gonzalez-Ponce, Jorge Ivan Gamez-Nava, Eli Efrain Gomez-Ramirez, Melissa Ramirez-Villafaña, Heriberto Jacobo-Cuevas, Norma Alejandra Rodriguez-Jimenez, Eva Maria Olivas-Flores, Yussef Esparza-Guerrero, Alejandro Martelli-García, Aline Priscilla Sa
Journal of Immunology Research.2022; 2022: 1. CrossRef - Physical activity, sedentary behaviors, and breakfast eating as factors influencing BMI in Saudi students, aged 10 to 15 years
Mohamed Ahmed Said, Mohammed Shaab Alibrahim
Annals of Medicine.2022; 54(1): 1459. CrossRef - Physical activity does not impact mediolateral margin of stability across a range of postural-perturbing conditions in young adults
Patrick G. Monaghan, Sarah A. Brinkerhoff, Jaimie A. Roper
Gait & Posture.2022; 96: 236. CrossRef - Marked Corridor 20 Meters Brief Walking Aerobic Exercise Improves the Quality of Life and Functional Capability of Stroke Survivor Outpatients in Tertiary Hospitals in Osogbo, Nigeria
Israel Arogundade Ojo, Olufunmilola Leah Dominic, Wale Johnson Adeyemi
Journal of The Korean Society of Physical Medicine.2022; 17(2): 41. CrossRef - Insufficient Level of Physical Activity and Its Effect on Health Costs in Low- and Middle-Income Countries
Wei Liu, Abbas Dostdar-Rozbahani, Fahime Tadayon-Zadeh, Mohsen Akbarpour-Beni, Mohammad Pourkiani, Fatemeh Sadat-Razavi, Vahid Barfi, Valiollah Shahedi
Frontiers in Public Health.2022;[Epub] CrossRef - Current Status of Physical Activity in South Korea
Yoo Bin Seo, Yun Hwan Oh, Yun Jun Yang
Korean Journal of Family Medicine.2022; 43(4): 209. CrossRef - Time-dependent Effects of Moderate- and High-intensity Exercises on
Myocardial Transcriptomics
Shunchang Li, Jiacheng Ma, Xiaoli Pang, Yu Liang, Xiaole Li, Manda Wang, Jinghan Yuan, Yanrong Pan, Yu Fu, Ismail Laher
International Journal of Sports Medicine.2022; 43(14): 1214. CrossRef - Motives for Following Sports Events among Physical Education Students from Bosnia and Hercegovina and Slovenia
Blaz Jereb, Maja Dolenc, Tanja Kajtna
Sustainability.2022; 14(17): 10992. CrossRef - Association between sedentary behavior and depression among South Korean adolescents
Jinhyun Kim, Hyunkyu Kim, Sung-In Jang, Eun-Cheol Park
BMC Psychiatry.2022;[Epub] CrossRef - Joint association of smoking and physical activity with mortality in elderly hypertensive patients: A Chinese population-based cohort study in 2007–2018
Yating Yang, Huilin Xu, Xiaoqin Liu, Jiong Li, Zeyan Liew, Xing Liu, Chen Huang, Jingjing Zhu, Jinling Zhang, Linli Chen, Yuantao Hao, Guoyou Qin, Yongfu Yu
Frontiers in Public Health.2022;[Epub] CrossRef - Association of Glycosylated Hemoglobin Level and Cancer-Related Mortality in Patients without Diabetes
Tae Kyung Yoo, Mi Yeon Lee, Sul A. Lee, Eun Sun Cheong, Mi Hae Seo, Ki Chul Sung
Journal of Clinical Medicine.2022; 11(19): 5933. CrossRef - Summary and application of the WHO 2020 physical activity guidelines for patients with essential hypertension in primary care
Apichai Wattanapisit, Chirk Jenn Ng, Chaisiri Angkurawaranon, Sanhapan Wattanapisit, Sirawee Chaovalit, Mark Stoutenberg
Heliyon.2022; 8(10): e11259. CrossRef - Remote, Whole-Body Interval Training Improves Muscular Endurance and Cardiac Autonomic Control in Young Adults
Patricia Concepción García-Suárez, Ermilo Canton-Martínez, Iván Rentería, Barbara Moura Antunes, Juan Pablo Machado-Parra, Jorge Alberto Aburto-Corona, Luis Mario Gómez-Miranda, Alberto Jiménez-Maldonado
International Journal of Environmental Research and Public Health.2022; 19(21): 13897. CrossRef - Familial Hypercholesterolemia and Its Current Diagnostics and Treatment Possibilities: A Literature Analysis
Kristina Zubielienė, Gintarė Valterytė, Neda Jonaitienė, Diana Žaliaduonytė, Vytautas Zabiela
Medicina.2022; 58(11): 1665. CrossRef - Short-course antidepressant therapy reduces discontinuation syndrome while maintaining treatment efficacy in patients with refractory functional dyspepsia: A randomized controlled trial
Qian-Qian Wang, Li Cheng, Bi-Yu Wu, Ping Xu, Hong-Yi Qiu, Bo Wang, Xiu-Juan Yan, Sheng-Liang Chen
Frontiers in Psychiatry.2022;[Epub] CrossRef - The Difference in the Prevalence of Metabolic Syndrome According to Meeting Guidelines for Aerobic Physical Activity and Muscle-Strengthening Exercise: A Cross-Sectional Study Performed Using the Korea National Health and Nutrition Examination Survey, 201
Du Ho Kwon, Young Gyu Cho, Hyun Ah Park, Ho Seok Koo
Nutrients.2022; 14(24): 5391. CrossRef - Physical Activity and Mental Health in Undergraduate Students
Gabriel Rodríguez-Romo, Jorge Acebes-Sánchez, Sonia García-Merino, María Garrido-Muñoz, Cecilia Blanco-García, Ignacio Diez-Vega
International Journal of Environmental Research and Public Health.2022; 20(1): 195. CrossRef - The effectiveness of folk physical activity and food education programme on body mass, nutrition knowledge and consumption behaviour among overweight primary school children in Southern Thailand
Firdaos Saemoh, Musara Jeadeng, Dusanee Suwankhong, Chamnan Chinnasee, Ali Md Nadzalan
Pedagogy of Physical Culture and Sports.2022; 26(6): 391. CrossRef - Health promotion: the essence of primary healthcare
Sung Sunwoo
Journal of the Korean Medical Association.2022; 65(12): 772. CrossRef - Protein and physical activity in older persons
Suey S.Y. Yeung, Ruth S.M. Chan, Jean Woo
Current Opinion in Clinical Nutrition & Metabolic Care.2021; 24(1): 42. CrossRef - Awareness of Warning Symptoms of Heart Disease and Stroke: Results of a Follow-up Study of the Chinese Canadian Cardiovascular Health Project
Calvin Lee, Chi-Ming Chow, Andrew T. Yan, Gordon W. Moe, Jack V. Tu, Joseph Y. Chu
CJC Open.2021; 3(6): 741. CrossRef - Prevalence of Hypertension and Associated Risk Factors Among Women in a Rural Community in Bangladesh: A Cross-Sectional Study
Anika Boitchia, Shabnam Naher, Sabbir Pervez, Moyazzem Hossainc
Millennium Journal of Humanities and Social Sciences.2021; : 1. CrossRef - Exercise Strategies to Prevent Hypoglycemia in Patients with Diabetes
Ah Reum Jung, Hyunah Kim, Hun-Sung Kim, Churlmin Kim, Whan-Seok Choi
Korean Journal of Family Medicine.2021; 42(2): 91. CrossRef - Association between insulin resistance and lung function trajectory over 4 years in South Korea: community-based prospective cohort
Sang Hyuk Kim, Hyun Sam Kim, Hyang Ki Min, Sung Woo Lee
BMC Pulmonary Medicine.2021;[Epub] CrossRef - Regulation data for the horizontal jump of children and adolescents
Rossana Gomez-Campos, Ruben Vidal-Espinoza, Luis Felipe Castelli Correia de Campos, Cynthia Lee Andruske, Jose Sulla-Torres, Camilo Urra-Albornoz, Wilbert Cossio-Bolaños, Fernando Alvear-Vasquez, Jorge Mendez-Cornejo, Marco Cossio-Bolaños
European Journal of Translational Myology.2021;[Epub] CrossRef - Estimating excess post-exercise oxygen consumption using multiple linear regression in healthy Korean adults: a pilot study
Won-Sang Jung, Hun-Young Park, Sung-Woo Kim, Jisu Kim, Hyejung Hwang, Kiwon Lim
Physical Activity and Nutrition.2021; 25(1): 35. CrossRef - Changes in adipose tissue and biochemical parameters after aerobic exercise in overweight and obese women
Meltem SERTBAŞ, Serkan ELARSLAN, Emre ŞENOCAK
Journal of Surgery and Medicine.2021; 5(3): 294. CrossRef - Overview of Physical Activity Counseling in Primary Care
Apichai Wattanapisit, Sanhapan Wattanapisit, Sunton Wongsiri
Korean Journal of Family Medicine.2021; 42(4): 260. CrossRef - Can Resistance Exercise Be a Tool for Healthy Aging in Post-Menopausal Women with Type 1 Diabetes?
Zeinab Momeni, Jessica E. Logan, Ronald J. Sigal, Jane E. Yardley
International Journal of Environmental Research and Public Health.2021; 18(16): 8716. CrossRef - Physical activity levels, lifestyle behaviour and musculoskeletal health profiles among seated video gamers during COVID-19
Nicholas Harding, Habib Noorbhai
BMJ Open Sport & Exercise Medicine.2021; 7(3): e001194. CrossRef - Low Physical Activity Levels Are Linked to Early Hypertension Risk in College-Going Young Adults
Kalyana Chakravarthy Bairapareddy, Mariam Mhd Salem Kamcheh, Ranim Jihad Itani, Mirna Mohamed, Heba Ayman Eid Abdellatif Zahran, Gopala Krishna Alaparthi, May Tamim, Parameshwar Anche, Baskaran Chandrashekaran
Healthcare.2021; 9(10): 1258. CrossRef - Dysregulated Inflammation During Obesity: Driving Disease Severity in Influenza Virus and SARS-CoV-2 Infections
Katina D. Hulme, Ellesandra C. Noye, Kirsty R. Short, Larisa I. Labzin
Frontiers in Immunology.2021;[Epub] CrossRef - Adherence to the Mediterranean Diet and Its Association with the Level of Physical Activity in Fitness Center Users: Croatian-Based Study
Dinko Martinovic, Daria Tokic, Lovre Martinovic, Marko Kumric, Marino Vilovic, Doris Rusic, Josip Vrdoljak, Ivan Males, Tina Ticinovic Kurir, Slaven Lupi-Ferandin, Josko Bozic
Nutrients.2021; 13(11): 4038. CrossRef - Relationship of Fat Mass Index and Fat Free Mass Index With Body Mass Index and Association With Function, Cognition and Sarcopenia in Pre-Frail Older Adults
Reshma Aziz Merchant, Santhosh Seetharaman, Lydia Au, Michael Wai Kit Wong, Beatrix Ling Ling Wong, Li Feng Tan, Matthew Zhixuan Chen, Shu Ee Ng, John Tshon Yit Soong, Richard Jor Yeong Hui, Sing Cheer Kwek, John E. Morley
Frontiers in Endocrinology.2021;[Epub] CrossRef - THE IMPORTANCE OF CARDIORESPIRATORY FITNESS AND PHYSICAL ACTIVITY AMONG ADULTHOOD STAGES—REVIEW
Dan Alexandru SZABO
Studia Universitatis Babeş-Bolyai Educatio Artis Gymnasticae.2021; : 85. CrossRef - Association between a family history of diabetes and carotid artery atherosclerosis in Korean adults
Sun Young Shim, Ga Bin Lee, Jee-Seon Shim, Sun Jae Jung, Hyeon Chang Kim
Epidemiology and Health.2021; 43: e2021049. CrossRef - Dual use of electronic and conventional cigarettes is associated with higher cardiovascular risk factors in Korean men
Choon-Young Kim, Yu-Jin Paek, Hong Gwan Seo, Yoo Seock Cheong, Cheol Min Lee, Sang Min Park, Da Won Park, Kiheon Lee
Scientific Reports.2020;[Epub] CrossRef - A Proposal of Physical Performance Tests Adapted as Home Workout Options during the COVID-19 Pandemic
Danúbia da Cunha de Sá-Caputo, Redha Taiar, Adérito Seixas, Borja Sanudo, Anelise Sonza, Mario Bernardo-Filho
Applied Sciences.2020; 10(14): 4755. CrossRef - Collateral Health Issues Derived from the Covid-19 Pandemic
Borja Muniz-Pardos, Jonathan Shurlock, Andre Debruyne, Juergen M. Steinacker, Mats Börjesson, Bernd Wolfarth, James L. J. Bilzon, Herbert Löllgen, Anca Ionescu, Petra Zupet, Michiko Dohi, Jeroen Swart, Victoriya Badtieva, Irina Zelenkova, Maurizio Casasco
Sports Medicine - Open.2020;[Epub] CrossRef - Anti-fracture Efficacy of Monthly Risedronate Compared with That of Weekly Risedronate in Postmenopausal Korean Women with Osteoporosis: A Nationwide Cohort Study
Yong Ho Cho, Kyung Hyun Bae, Dong Ryul Lee, Jungun Lee
Korean Journal of Family Medicine.2020; 41(5): 339. CrossRef - Severity, Progress, and Related Factors of Mood Disorders in Patients with Coronary Artery Disease: A Retrospective Study
Changbae Lee, Sang Cheol Lee, Yeon Seob Shin, Sangwoo Park, Ki Bum Won, Soe Hee Ann, Eun Jae Ko
Healthcare.2020; 8(4): 568. CrossRef - Hypertension in Saudi Arabia: Assessing Life Style and Attitudes
Bushra Elbashir, Msab Al-dkheel, Hamad Aldakheel, Naif Aruwished, Nasser Alodayani
International Journal of Translational Medical Research and Public Health.2020; 4: 23. CrossRef
