Author + information
- Haruka Murakami, PhD,
- Julien Tripette, PhD∗ (, )
- Ryoko Kawakami, MSc and
- Motohiko Miyachi, PhD
- ↵∗National Institute of Health and Nutrition, Department of Health Promotion and Nutrition, 1-23-1 Toyama, Shinjuku, Tokyo 162-8636, Japan
We read with interest the papers by Lee et al. (1) and Wen et al. (2), both of which advocated for the health benefits of low doses of exercise, even performed at moderate intensity. The American College of Sports Medicine currently recommends completing the equivalent of 30 min of moderate-to-vigorous physical activity (MVPA) per day in bouts of at least 10 min. On the other hand, on the basis of the results of their exercise dose–response analyses, Lee et al. (1) and Wen et al. (2) both argue that an exercise prescription of 5 min of running or 15 min of walking per day can positively influence cardiovascular mortality. The idea is to encourage people to engage in physical activity (PA), even if they cannot allocate the recommended daily 30 min.
On the basis of scientific evidence provided by the (Japanese) National Institute of Health and Nutrition, the Ministry of Health, Labour and Welfare established and published the Japanese recommendations for PA (or “ActiveGuide”) in March 2013 (3). This document advises Japanese adults (i.e., 18 to 64 years of age) to perform 60 min of MVPA per day without any consideration of the duration of the bouts. In contrast to the reports of both Lee et al. (1) and Wen et al. (2), these recommendations include not only structured bouts of running or walking, but also incorporate PA resulting from housework, commuting, or shopping that are over 3 metabolic equivalents (METs). Most importantly, the main message disseminated to the Japanese population is “+10,” representing “+10 min of MVPA per day.” To our knowledge, the implementation of such PA recommendations in a governmental health promotion policy is a world first. It allows the involvement of people who have already achieved the targeted 60 min per day and encourages the most sedentary individuals to become progressively more active, thus targeting sedentary and more active people with the same simple message.
The Japanese “+10” recommendation mainly results from the 2 following complementary reports. The first is a PA dose–response meta-analysis completed in March 2011 (4). Data was extracted from 26 cohort studies that investigated the relation between the amounts of PA (summed from at least 2 PA domains) and mortality divided by the relative risk for some noncommunicable diseases (including cardiovascular diseases, cancer, dementia, and joint or musculoskeletal diseases). We found that an increment of 1 MET-h/week, which is equivalent to 2 to 3 min of MVPA per day, results in a 0.8% reduction of the average relative risk (RR) (see Table 14 in reference ). The second is Japan’s National Health and Nutrition Survey, completed in 2010, in which the data collected from a sample of 7,876 people indicated that 61% of the Japanese population would be willing to perform an additional 10 min per day of PA (5).
Taken together, the results from the meta-analysis and data of the National Health and Nutrition Survey provide room for an approximately 3.2% reduction of the RR (2 to 3 min × 4 ≈ 10 min, so 0.8% × 4 ≈ 3.2%), which is promising from a public health perspective.
To summarize, we demonstrated that a low dose of >3 METs activities, which can be performed in the course of daily life, that is, not only structured sessions of running or walking, can positively influence the RR for noncommunicable diseases and mortality. In accordance with the scientific evidences described by Lee et al. (1) and Wen et al. (2), the Japanese “+10” experience presented here may inspire other public health agencies, encouraging them to consider an efficient but engaging low-dose PA message that fits the characteristics and needs of their populations. We will be able to validate the effectiveness of such a policy by comparing PA between 2013 and 2023 using annual objective assessments PA in National Health and Nutrition Surveys.
Please note: The establishment of “ActiveGuide” was supported by the Health Labor Sciences Research Grant program (H22-Junkankitou [Seishu]-Shitei-021 to Motohiko Miyachi). The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Lee D.C.,
- Pate R.R.,
- Lavie C.J.,
- Sui X.,
- Church T.S.,
- Blair S.N.
- Wen C.P.,
- Wai J.P.,
- Tsai M.K.,
- Chen C.H.
- ↵Ministry of Health, Labour and Welfare. ActiveGuide: Japanese Official Physical Activity Guidelines for Health Promotion. Brochure in English. March 2013. Available at: http://www0.nih.go.jp/eiken/info/pdf/active2013-e.pdf. Accessed October 30, 2014.
- ↵Ministry of Health, Labour and Welfare. [Japanese Physical Activity References for Health Promotion 2013]. Report in Japanese. March 2011. See pp. 36–7. Available at: http://www.mhlw.go.jp/stf/houdou/2r9852000002xple-att/2r9852000002xpqt.pdf. Accessed October 30, 2014.
- ↵Ministry of Health, Labour and Welfare. [The National Health and Nutrition Survey, Japan 2010]. Report in Japanese. See p. 129. Available at: http://www.mhlw.go.jp/bunya/kenkou/eiyou/dl/h22-houkoku-01.pdf. Accessed October 30, 2014.