Author + information
- Chi Pang Wen, MD, DrPH∗ ( and )
- Xifeng Wu, MD, PhD
- ↵∗National Health Research Institute, No. 35, Keyan Road, Zhunan Town, Miaoli County 350, Taiwan
A journey of one thousand miles starts with your single step.
—Lao-tzu, Chinese philosopher, 600 BC (1)
We would like to thank Dr. Murakami and colleagues for their interest in our paper (2). We applaud the National Institute of Health and Nutrition of Japan for promoting exercise with an innovative approach, particularly for motivating the inactive couch potatoes. The benefits of exercising <30 min a day have not been promoted in the exercise guidelines of most countries. By firing the first salvo, the Japanese have called attention to a miracle medicine that requires minimal effort. With the conviction that “some is good, but more is better,” the “+10 min” concept is a smart way to set the theme. The emphasis is not just a 10-min exercise by itself but stresses the “+” sign with an incremental effort on top of one’s overall activity. As long as you have not met the recommended level, adding an additional 10 min of exercise is critical (Table 1).
With limited time to spend, most of us want to do only what is absolutely necessary. The search for the minimum amount to harvest health benefits has become increasingly popular. In the committee report of the “2008 Physical Activity Guidelines for Americans” (3), a meta-analysis of 12 cohort studies found positive benefits, not just at 150 min or more of exercise a week, but also with 90 min or less a week of exercise, including 60 min a week, or “+10,” as part of the extrapolated conclusion. Nevertheless, the committee report fell short of identifying a specific minimal level for lack of evidence.
There are some limitations for “+10” (Table 1). First and foremost, its health benefits have not been documented. If the critical threshold is attainable only at 15 min of exercise per day, as proven by Wen et al. (4) in the Lancet, 10-min exercise may miss the 3-year life extension benefits expected. Second, while “+10” is a great motivator to initiate exercise, it lacks the magic of sustaining power. After all, it is persistent daily exercise that counts. As “+ 10” is simple to attain for a number of days, it may be too simple and boring to do daily for years. Third, socialization is an important way to make exercise fun and sustainable, but “+10” will be mostly done alone. Asking people to come may take longer than 10 min. Fourth, while “+10” is easy to get started, much of the first 10 min is spent warming up, without enough time for aerobic health effects to sink in, nor for exercisers to enjoy feeling the “high” from the release of endorphins.
As no public health guidelines issued by any government have incorporated the minimum threshold so far, such as 15 min of walking, the Japanese are lucky to hear the good news of “short walks work wonders” and to take advantage of it ahead of others. Whether “+15” is better than “+10” or whether it is scientifically proven is really academic, as it is a no-brainer to expect a miracle, once one starts to move “+10” regularly. As Chinese philosopher Lao-tzu said, “A journey of a thousand miles starts with your single step,” (1) a 10-min dedicated brisk walk is worth every bit of the 1,000 steps it requires. Proof of these benefits will be experienced by the Japanese, who grabbed the low lying fruit of 10 min of exercise and declined to wait for the full 30-min prize, as if they knew “a bird in hand is worth two in the bush”.
- American College of Cardiology Foundation
- ↵BrainyQuote. Lao-tzu quotes. Available at: http://www.brainyquote.com/quotes/quotes/l/laotzu137141.html. Accessed January 20, 2015.
- Wen C.P.,
- Wai J.P.,
- Tsai M.K.,
- Chen C.H.
- ↵U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans: Be Active, Healthy, and Happy! Washington, DC. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report 2008. Available at: http://www.health.gov/paguidelines/Report/pdf/CommitteeReport.pdf. Accessed January 27, 2015.