See discussions, stats, and author profiles for this publication at: http://www.researchgate.net/publication/49841000New Canadian Physical Activity GuidelinesARTICLEinAPPLIED PHYSIOLOGY NUTRITION AND METABOLISM FEBRUARY 2011Impact Factor: 2.23 DOI: 10.1139/H11-009 Source: PubMedCITATIONS167DOWNLOADS1,946VIEWS53212 AUTHORS, INCLUDING:Darren WarburtonUniversity of British Columbia - Vancouver225 PUBLICATIONS 4,608 CITATIONS SEE PROFILEIan JanssenQueen's University280 PUBLICATIONS 14,317 CITATIONS SEE PROFILEDonald H. PatersonThe University of Western Ontario280 PUBLICATIONS 5,163 CITATIONS SEE PROFILEAudrey HicksMcMaster University116 PUBLICATIONS 3,192 CITATIONS SEE PROFILEAvailable from: Ian JanssenRetrieved on: 27 July 2015REVIEW / SYNTHE`SENew Canadian Physical Activity GuidelinesMark S. Tremblay, Darren E.R. Warburton, Ian Janssen, Donald H. Paterson,Amy E. Latimer, Ryan E. Rhodes, Michelle E. Kho, Audrey Hicks,Allana G. LeBlanc, Lori Zehr, Kelly Murumets, and Mary DugganAbstract: The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stake-holders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian PhysicalActivity Guidelines for Children (aged 511 years), Youth (aged 1217 years), Adults (aged 1864 years), and OlderAdults (aged 65 years). The new guidelines include a preamble to provide context and specific guidelines for each agegroup. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation(AGREE) II instrument, which is the internationalstandard for clinicalpracticeguideline development. Thus, the guide-lines have gone through a rigorous and transparent developmentalprocess; we based the recommendations herein on evi-dence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultationprocess with hundreds of stakeholders and key informants, both domestic and international.Since 2006, the products ofour efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectivelyguided this work. The process that Canadian researchers undertook to update the national physical activityguidelines rep-resents the most current synthesis, interpretation,and applicationof the scientific evidence to date.Key words: physical activity, recommendations,guidelines, measurement, children and youth, adults, older adults.Resume: La Societecanadienne de physiologie de lexercice (SCPE) en collaboration avec ParticipACTION et des partiesprenantes et avec lappui de lAgence de santepublique du Canada (ASPC) a elaborede nouvelles Directives canadiennesen matie`re dactivitephysique a`lintention des enfants (ages de 5 a`11 ans), des jeunes (ages de 12 a`17 ans), des adultes(ages de 18 a`64 ans) et des a nes (ages de 65 ans et plus). Les nouvelles directives sont composees dun preambule si-tuant le contexte et de directives specifiques a`chaque tranche dage. Lelaboration comple`te des directives a respectelaGrille II devaluation de la qualitedes recommandations pour la pratique clinique (AGREE), un outil reconnu internationa-lement pour lelaboration des lignes directricesen pratique clinique. Lelaboration des directives resulte dun processus ri-goureux et transparent. Les recommandations presentees dans cet articlesont basees sur les donnees probantes releveesdans trois analyses documentaires systematiques, et les directives finales ont beneficiedes fruits dune vaste consultationen ligne et en personne aupre`s de centaines dintervenants concernes et de sources de premier plan, sur la sce`ne nationaleet internationale.Depuis 2006, les resultats de nos efforts se retrouvent entre autres dans 21 articles(dont 5 analyses docu-mentaires systematiques) sanctionnes par des pairs. La demarche entreprise par les chercheurs canadiens pour la mise a`jour des directives en matie`re dactivitephysique a abouti a`la synthe`se, linterpretation et lapplicationdes donnees pro-bantes les plus recentes a`ce jour.Received 24 January 2011. Accepted 24 January 2011. Published on the NRC Research Press Web site at apnm.nrc.ca on 15 February2011.M.S. Tremblay1and A.G. LeBlanc. Healthy Active Living and Obesity Research Group, CHEO Research Institute, DepartmentofPediatrics, University of Ottawa, 401 Smyth Road, Ottawa, ON K1H 8L1, Canada.D.E. Warburton. ExperimentalMedicine Program, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4,Canada.I. Janssen and A.E. Latimer. School of Kinesiology and Health Studies and Department of Community Health and Epidemiology,Queens University, Kingston, ON K7L 3N6, Canada.D.H. Paterson. School of Kinesiology, University of Western Ontario, London ON N6G 2M3, Canada.R.E. Rhodes. Behavioural Medicine Laboratory, Faculty of Education, University of Victoria, Victoria, BC V8P 5C2, Canada.M.E. Kho. Department of Physical Medicine and Rehabilitation,Johns Hopkins University, Baltimore, MD 21287, USA.A. Hicks. Canadian Society for Exercise Physiology, McMaster University, Hamilton, ON L8S 4K1, Canada.L. Zehr. Student Development, Camosun College, Victoria, BC V9E 2C1, Canada.K. Murumets. ParticipACTION, 2 Bloor Street E., Suite 1804, Toronto, ON M4W 1A8, Canada.M. Duggan. Canadian Society for Exercise Physiology, #370, 18 Louisa Street, Ottawa, ON K1R 6Y6, Canada.La version francaise traduite de ce document est disponible a`Appl. Physiol. Nutr. Metab. 36(1) : 4758.1Corresponding author (e-mail:mtremblay@cheo.on.ca).36Appl. Physiol. Nutr. Metab. 36: 3646 (2011) doi:10.1139/H11-009 Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.Mots-cles : activitephysique, recommandations,directives, mesures, enfants et jeunes, adultes, a nes._______________________________________________________________________________________IntroductionOver thepast several decades, thephysical activityandfitness of Canadians has decreased, whereas overweightobesityandmanyoftheirassociatedcomorbiditieshavein-creased (Colley et al. 2011a, 2011b; Shields et al. 2010;Tremblayet al. 2010b). Engaginginregularphysical activ-ityiswidelyacceptedasaneffectivepreventativemeasurefor avarietyof healthrisksacrossall age, gender, ethnic,and socioeconomic subgroups (Janssen 2007; Janssen andLeBlanc2010; MartinGinis and Hicks 2007; Paterson etal.2007; Paterson and Warburton 2010; Physical ActivityGuidelines Advisory Committee 2008; Timmons et al.2007;YoungandKatzmarzyk2007;Warburtonetal. 2007,2010; World Health Organization (WHO) 2010). Since1995, theCanadianSocietyfor ExercisePhysiology (CSEP)and the Public Health Agency of Canada (PHAC) haveworked togetheron thedevelopmentof theCanadianPhysi-cal ActivityGuidelinestopromotehealthyactivelivinginthe Canadian population. The first guidelines were presentedintheformof guides that servedtotranslatetheguide-linesintoaformat toencourageandassist Canadianstobemoreactive. ThisbeganwiththepublicationofaCanadianphysical activity guide for adults (aged 2055 years) in 1998(Health Canada and the Canadian Society for Exercise Phys-iology 1998), for older adults (aged >55 years) in 1999(Health Canada and the Canadian Society for Exercise Phys-iology1999), forchildren(aged69years)in2002(HealthCanadaandtheCanadianSocietyfor Exercise Physiology2002b), andfor youth(aged1014years) in2002(HealthCanadaandtheCanadianSocietyfor Exercise Physiology2002a). Theseguides havebeen PHACs most requestedre-source (Tremblay et al. 2007b).This paper briefly outlines the guideline developmentprocessforthe2011CanadianPhysical ActivityGuidelinesfor Children(aged511years), Youth(aged1217years),Adults (aged 1864 years), and Older Adults (aged65years). TheseguidelineswerereleasedinJanuary2011by CSEP and replace the previous guidelines. PHAC has en-dorsed these new guidelines and ParticipACTION hasplayedakeyroleintheirpromotionand dissemination.Thenew guidelineswereinformedbyarigorous andtransparentprocess, andrecommendations arebasedonsystematicre-viewsofthescientificevidence. Adetailedreport outliningthefull guidelinemethodological development processandrelatedmaterials canbe accessedthroughthe CSEPWebsiteat http://www.csep.ca/english/view.asp?x=804. Thepur-poseofthispaper istoprovideasummaryof thisprocessand to present the guidelines themselves.BackgroundTheprocess tocreatethe newCanadianPhysicalActivityGuidelinesstartedwithaday-longthinktankinHalifaxin2006. Thethinktankbrought together expertsinthefieldsofexercisephysiology, thepsychosocialaspectsofphysicalactivity, socialmarketing, epidemiology, andphysicalactiv-ity guideline development. They highlighted some keyknowledge gaps in the old Canadian Physical ActivityGuidelines and proposed the creation of the official PhysicalActivityMeasurement andGuidelinesproject (PAMG) andtheappointment of anofficial steeringcommitteetoguidetheproject. In2007, thePAMGSteeringCommittee, withleadership from CSEP, commissioned a series of 12 compre-hensive narrative reviews focusedonthe current evidenceonphysical activityandhealth. Fundingfor thisworkwasprovidedbyPHAC. Thesefoundationpapers weretohelpinformnewtheCanadianPhysical ActivityGuidelinesandwere published jointlyinAppliedPhysiology,Nutrition, andMetabolism(APNM) andthe CanadianJournal of PublicHealth(CJPH)(BrawleyandLatimer2007; Cameronet al.2007; Esliger andTremblay2007; Janssen2007; Katzmar-zykandTremblay2007; MartinGinisandHicks2007; Pa-terson etal. 2007; Sharrattand Hearst 2007; Timmonset al.2007; Tremblay et al. 2007a, 2007b, 2007c; Warburton et al.2007; Young and Katzmarzyk2007).In 2008, in an effort to increase the methodological rigourof theprocess to one consistentwith clinicalpracticeguide-linedevelopment, 5systematicreviewswerecommissionedto further informthe development of the newCanadianPhysical ActivityGuidelines. Thisledtoa2.5-dayconfer-ence where international representatives, content experts,stakeholders, andanindependent international panel (Kesa-niemi et al. 2010)debated, discussed, andcametoconsen-sus on the strength of the available evidence, importantgaps in the literature, the steps needed to harmonize with in-ternational efforts, andwhethertheexistingCanadianPhys-ical ActivityGuidelines shouldbemodified. Concurrently,2researchmethodologyconsultantswereengagedtoadvisethePAMGSteeringCommitteeonbest practicesfordevel-opingtheguidelinesandconductingthesystematicreviewsneededtodeveloprobust, evidence-informedclinical prac-tice guidelines.Based on adviceprovided, the PAMG Steer-ing Committee chose the Appraisal of Guidelines forResearch Evaluation (AGREE) II instrument as a frameworktoguidetheproject (Brouwerset al. 2010a, 2010b, 2010c).AGREE II is the internationally accepted standard for guide-line development that guides and assesses scientific rigorandtransparencythroughout theprocess. The3mainsys-tematicreviewsexaminedtherelationshipbetweenphysicalactivityandhealthinschool-agedchildrenandyouth(aged517years) (JanssenandLeBlanc2010), adults(aged1864years) (Warburtonet al. 2010), andolder adults (aged65years)(PatersonandWarburton2010). Twoadditionalsystematic reviews examined approaches for constructingthemessagesaccompanyingtheCanadianPhysical ActivityGuidelines(Latimer et al. 2010) andmediatorsof physicalactivitybehaviour change (Rhodes and Pfaeffli 2010). A pa-per explaining the process behind the systematic reviewsandthePAMGproject upuntil that point (Tremblayet al.2010a) and an independent expert consensus and reviewpaper (Kesaniemiet al.2010) can be found in the same ser-ies, for a total of 7 peer-reviewedpapers.Tremblay et al. 37Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.Materials and methodsGuideline developmentFigure 1 outlines the process used to develop the newCanadianPhysical ActivityGuidelines. Detailsontheproc-esstoguidethefoundationpapers(Tremblayet al. 2007b),the systematic reviews (Tremblay et al. 2010a), and theAGREE II instrument (Brouwers et al. 2010a, 2010b,2010c) can be found elsewhere.Thetarget populations andguidelinedevelopment ques-tions were as follows:Children (aged 511 years) and youth (aged 1217 years) What is the relationship between physical activity and7healthindicators (cholesterol, depression, injury, bonemineral density, high blood pressure, overweight andobesity, and the metabolic syndrome) in school-aged chil-dren and youth? How much (volume) physical activity is needed for mini-mal andoptimal healthbenefits inschool-agedchildrenand youth (i.e., does this increase in a dose-responsemanner)? Whattypesofactivityareneededtoproducehealthben-efits? What is the appropriatephysical activityintensity? Dotheeffects of physical activityonhealthinschool-aged children and youth vary by sex and (or) age?Adults (aged 1864 years) What is the relationship between physical activity and8 health indicators (prematureall-causemortality,cardio-vascular disease, stroke, hypertension, colon cancer,breast cancer, type 2 diabetes, and osteoporosis) in adults? Does this relationship increase in a dose-response manner(and if so, what is the nature of the curve)? Does current evidence support the existing Canadian Phy-sical Activity Guidelines?Older adults (aged 65 years) What is the relationship between physical activity andfunctional independence(i.e., functional limitations, dis-ability, or loss of independence) andcognitive functionin older adults? What arethetypes, volumes, andintensitiesofphysicalactivityrelatedto higher functional status? Is there a dose-response of total activity or physical activ-ity intensity related to the outcomes?Evidence basePlease see the following 3 systematic reviews for detailedinformationontheevidencebaseinformingtheguidelines:(1) school-aged children and youth (aged 517 years)(JanssenandLeBlanc2010); (2)adults(aged1864years)(Warburton et al. 2010); and (3) older adults (aged65 years) (Paterson and Warburton 2010).Consensus meetingIn September 2010, a 2.5-day consensus meeting con-vened the PAMGSteering Committee, systematic reviewauthors, contentexperts, healthcareprofessionals, andpart-nerorganizationstodraft therecommendationsforthenewCanadianPhysical ActivityGuidelines. The guideline rec-ommendations wereinformedbyevidencefromthe3sys-tematic reviews. Participants also received backgroundmaterials includingtheexpert consensus paper (Kesaniemiet al. 2010) and other resources fromrecently developedphysical activity guidelines by WHO(WHO2010), theUnitedStates(Physical ActivityGuidelinesAdvisoryCom-mittee2008), Australia(Okelyet al. 2008), andtheUnitedKingdom(Bull et al. 2010)toassist withwordingandfor-mat harmonization. The resulting product for each age groupwasapreambletoexplaintheguidelines, followedbytheguidelines themselves. Thedraft guidelines werethensenttostakeholders, includingnational andinternational contentexperts, government and nongovernmental organizations,healthcareprofessionals, teachers, andcaregiversforcom-ment and input. The final scientific Canadian Physical Activ-ity Guidelines for all age groups are presented in this paper.Stakeholder involvementThroughouttheguidelinedevelopment process, therewassubstantial stakeholder involvement, including scientists,guidelinedevelopers, andpotentialguidelineusers.Thesci-entific stakeholders were engagedthroughthe peer-reviewprocess of all the background papers and systematic reviews.The PAMG Steering Committee liaised regularly with repre-sentativesinvolvedinthedevelopment of physical activityguidelinesintheUnitedStates, theUnitedKingdom, Aus-tralia, andWHO(CanadianSocietyforExercisePhysiologyandthePublicHealthAgencyofCanada2009;Okelyetal.2008; Physical Activity Guidelines Advisory Committee2008; WHO 2010). Based on the evidence and recommenda-tions presented in the systematic reviews and the draftguidelinespreparedat theSeptember2010consensusmeet-ing, feedback was also sought through a wide range ofstakeholders interestedinphysical activityandhealthpro-motionbybothCSEPandPHAC. This included nationalandinternational content experts, healthprofessionals, gov-ernment andnongovernmental organizations, teachers, andcaregivers. StakeholderswerealsoencouragedtosharetheCSEPsurveywiththeir peersandcolleaguestofurtherex-pand the consultationbase.The consultation was completed through a series of onlineandin-personconsultations. TheCSEPonlinesurveycon-sistedof14questionsabout thewordingandagreement forthe proposed Canadian Physical Activity Guidelines andtheir associated preamble for children, youth, adults, andolder adults. Writtencomments wereinvitedandrespond-entsweretoldthat theywouldreceiveupdatedandrefinedguidelines when the survey process was completed. Over550stakeholdersrespondedthroughtheonlineconsultationprocess. The results of this online consultation were re-viewed by the CSEPPAMG Steering Committee andPHAC. Overall, the majority of respondents completelyagreed or agreed with the proposed preamble and guide-linefor all agegroups(90.2%, 88.7%and89.7%for chil-dren and youth, adults, and older adults, respectively).Becausewerecruitedrespondentsusingasnowballproc-ess,wewereunabletocalculatearesponserateforouron-line survey. A summary of the results can be found at http://www.csep.ca/english/view.asp?x=879.38 Appl. Physiol. Nutr. Metab. Vol. 36, 2011Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.Fig. 1. Summary of the timelineand key events in the developmentof the new Canadian Physical Activity (PA) Guidelines. AGREE,Appraisal of Guidelines for Research Evaluation;APNM, Applied Physiology, Metabolism, and Nutrition; CPG, Clinical Practice Guide-lines; CSEP, Canadian Society for Exercise Physiology; IJBNPA, InternationalJournal of BehavioralNutrition and Physical Activity.# Canadian Society for Exercise Physiology.Tremblay et al. 39Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.While the online surveys were beingcompleted, PHACheld8in-personconsultations acrossCanada. Thesemeet-ingsweredesignedsothatstakeholdersandscientistscoulddiscuss anddebate the proposedguidelines. Followingthein-person consultations, a subsequent online process wascompleted to ask stakeholders, government departments,educators,and healthand fitness leadersaboutconcernsandquestionstheyhadregardingthenewguidelines, aswell asanysuggestionstheymayhavetodisseminatethem. Over800peoplerespondedtothissurvey. Thelargemajorityofrespondents felt comfortable withthe process usedtode-velop the new Canadian Physical Activity Guidelines,thoughmanyhighlightedtheneedtofurthertranslatethesescientificguidelinesintosimplemessagesfordisseminationandutilizationbythepublic. Thefull andsummaryreportsof this consultationare available through PHAC.Finalization of guidelinesInNovember 2010, the PAMGSteeringCommittee re-convened to address the concerns and comments raisedthroughall ofthestakeholder consultationsandrevisedtheguidelines accordingly.ResultsThenewCanadianPhysicalActivityGuidelinesforChil-dren(aged511years), Youth(aged1217years), Adults(aged1864years), andOlderAdults(aged65years)arepresented below.Children (aged 511 years) and youth (aged 1217 years)PreambleThese guidelines are relevant to all apparently healthychildren (aged 511 years) and youth (aged 1217 years), ir-respective of gender, race, ethnicity, or socioeconomic statusofthefamily.Childrenandyouthareencouragedtopartici-pateinavarietyofphysicalactivitiesthatsupporttheirnat-ural developmentand that are enjoyableand safe.Childrenandyouthshouldbephysicallyactivedailyaspartofplay,games,sports,transportation, recreation, physi-cal education, orplannedexerciseinthecontext offamily,school, andcommunity(e.g., volunteer, employment) activ-ities. This should be achieved above and beyond the incidentalphysical activities accumulated in the course of daily living.Followingthesephysical activityguidelinescanimprovecholesterol levels, bloodpressure, bodycomposition, bonedensity, cardiorespiratory and musculoskeletal fitness, andaspects of mental health. Thepotential benefits far exceedthe potentialrisks associated with physical activity.These guidelines may be appropriate for children andyouthwithadisabilityormedical condition; however, theyshouldconsultahealthprofessionaltounderstandthetypesand amounts of physical activityappropriatefor them.Forthosewhoarephysicallyinactive, doingamountsbe-lowtherecommendedlevelscanprovidesomehealthbene-fits. For thesechildrenandyouth, it isappropriatetostartwithsmalleramountsofphysical activityandgraduallyin-creaseduration, frequency,andintensityasasteppingstoneto meetingthe guidelines.For guidance ondecreasingsedentarybehaviour, pleaserefer tothe CanadianSedentaryBehaviour Guidelines forChildrenandYouth(availableonlinefromhttp://www.csep.ca/english/view.asp?x=881) (Tremblay et al. 2011).GuidelinesForhealthbenefits, children(aged511years)andyouth(aged1217years) shouldaccumulate at least 60minofmoderate-tovigorous-intensityphysical activitydaily. Thisshould include Vigorous-intensity activitiesat least 3 days per week. Activities that strengthen muscle and bone at least 3 daysper week.More daily physical activity provides greater health benefits.Adults (aged 1864 years)PreambleThese guidelines are relevant to all apparently healthyadults aged 1864 years, irrespective of gender, race, ethnic-ity, orsocioeconomicstatus. Adultsareencouragedtopar-ticipateinavarietyofphysical activitiesthat areenjoyableand safe.Adults canmeet these guidelines throughplannedexer-cise sessions, transportation, recreation, sports, or occupa-tional demands, inthecontext of family, work, volunteer,andcommunity activities. This should be achievedaboveandbeyondtheincidentalphysicalactivitiesaccumulatedinthe course of daily living.Followingtheseguidelinescanreducetheriskofprema-turedeath, coronaryheart disease, stroke, hypertension, co-loncancer, breastcancer, type2diabetes, andosteoporosis,and improve fitness, body composition, and indicators ofmental health. The potential benefits far exceed the potentialrisks associated with physical activity.These guidelines maybe appropriate for those whoarepregnant, have a disability, or have a medical condition;however, they should consult a healthprofessional to under-standthetypesandamountsofphysicalactivityappropriatefor them.Forthosewhoarephysicallyinactive, doingamountsbe-lowtherecommendedlevelscanprovidesomehealthbene-fits. For theseadults, it isappropriatetostart withsmalleramounts of physical activity and gradually increase duration,frequency, andintensityasasteppingstonetomeetingtheguidelines.Guidelines To achieve health benefits, adults aged 1864 yearsshould accumulate at least 150 min of moderate- tovigorous-intensityaerobicphysical activityper week, inbouts of 10 min or more. It is also beneficial to add muscle- and bone-strengtheningactivities that usemajor musclegroups, at least 2daysperweek. More physical activityprovides greater health benefits.Older adults (aged 65 years)PreambleThese guidelines are relevant to all apparently healthy40 Appl. Physiol. Nutr. Metab. Vol. 36, 2011Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.adultsaged65yearsandolder, irrespectiveofgender, race,ethnicity, orsocioeconomicstatus. Olderadultsareencour-aged to participatein a varietyof physicalactivities that areenjoyableand safe.Older adults canmeet these guidelines throughplannedexercisesessions, transportation, recreation, sports, oroccu-pational demandsinthecontext offamily, work, volunteer,andcommunity activities. This should be achievedaboveandbeyondtheincidentalphysicalactivitiesaccumulatedinthe course of daily living.Followingtheseguidelinescanreducetheriskofchronicdisease and premature death, maintain functional independenceandmobility, aswellasimprovefitness, bodycomposition,bone health, cognitive function, and indicators of mentalhealth. Thepotential benefitsfar exceedthepotential risksassociatedwithphysical activity.Theseguidelinesmay be appropriatefor older adultswithfrailty, a disability, or medical condition; however, theyshouldconsultahealthprofessionaltounderstandthetypesand amounts of physical activity appropriate for them based ontheir exercise capacity and specific health risks or limitations.For those who are physically inactive, doing amounts belowthe recommended levels can provide some health benefits. Forthese adults, it is appropriate to start with smaller amounts ofphysical activityandgraduallyincreaseduration, frequency,and intensity as a stepping stone to meeting the guidelines.Guidelines Toachievehealthbenefits andimprovefunctional abil-ities, adults aged65years andolder shouldaccumulateatleast150minofmoderate-tovigorous-intensityaero-bic physical activity per week, in bouts of 10 min ormore. It is also beneficial to add muscle- and bone-strengtheningactivities that usemajor musclegroups, at least 2daysperweek. Thosewithpoormobilityshouldperformphysical activ-ities to enhancebalance and prevent falls. More physical activityprovides greater health benefits.DiscussionThis paper presents the newCanadianPhysical ActivityGuidelinesforChildren(aged511years),Youth(aged1217 years), Adults (aged 1864 years), and Older Adults (aged65 years). These guidelines were developed through a robustand rigorous process, are based on the best possible scientificevidence, and involved extensive input from stakeholders.Changes from previous guidelinesChildren and youthInclusion of all school-aged children and youthThe new guidelines apply to a wider age group for the pe-diatricpopulation. Whereasthepreviousguidelinesfocusedonchildren(aged69years)(HealthCanadaandtheCana-dian Society for Exercise Physiology 2002b) and youth(aged1014years)(HealthCanadaandtheCanadianSoci-etyforExercisePhysiology2002a), thenewguidelinesap-plytoallschool-agedchildren(aged511years)andyouth(aged1217years). Thechangeinagegroupsalsoreflectstheavailabilityofthebestevidence, whichisoftenfocusedintheschool setting. Thenewguidelines, therefore, fill thevoidintheprevious guidelines for 5-year-olds and15- to17-year-olds.Recommendation for 60 min of moderate- to vigorous-intensityphysical activityper dayThebest availableevidenceshowsaclear dose-responserelationshipbetweenthevolumeof moderate- tovigorous-intensity physical activity and increased health benefits(JanssenandLeBlanc2010). Most of theincreasedhealthbenefits occur within the initial 60 min of moderate- tovigorous-intensity physical activity per day. Whereas theprevious guidelines recommended that children andyouthshould increase time currently spent on physical activity,starting with 30 min more per day and progressing over5monthsto90minmoreperday,datafromthesystematicreviewdidnot support this recommendation (JanssenandLeBlanc2010). Therefore,thenewguidelineshavechangedtoreflect thenewevidence. Theevidenceisalsoclearthatphysicalactivityinexcessofthe60-minutes-per-dayguide-lineisassociatedwithfurtherhealthbenefits,andthisisre-flectedin the new guidelines.Thesenew guidelinesarealsoharmonizedwiththe newUnitedStates andWHOguide-lines (Physical Activity Guidelines Advisory Committee2008; WHO2010). The newguidelines clarify that the60minisinclusiveof therecommendedvigorous-intensityphysical activityandbone-andmuscle-strengtheningactiv-ities.Finally,becauseofanabsenceofsupporting evidence,reference to bouts of any particular length has been removedfrom the new guidelines.Emerging recommendations for sedentary behavioursThefinal substantivechangefrompreviousguidelinesistheomissionof recommendations for time spent engaginginsedentarybehaviours, inparticular screen-timeactivitiessuch as watching television, computer use, and playingvideogames. Worktoprovideevidence-informedCanadianguidelines specifically for sedentarybehaviour for school-agedchildrenandyouth(aged517years) wascompletedconcurrentlywith, andfollowingasimilar process to, thatwhich the Canadian Physical Activity Guidelines haveundergone. Asisterdocument focusingonsedentarybehav-iour has beendevelopedseparately(available online fromhttp://www.csep.ca/english/view.asp?x=881) (Tremblay etal. 2011).AdultsRevised age range (18 to 64 years)The new adult guidelines cover a larger age range.Whereas the previous guidelines focused on adults aged 2055 years, the new guidelines include those aged 1864 years.This changewas madetoreflectthebestavailableevidence(Warburton et al. 2010) and to ensure guidelines for thecompleteagerangeofadults. Furthermore, thisrecommen-dation harmonizes with guideline recommendations withother countries and organizations.Tremblay et al. 41Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.Recommendation for 150 min of moderate- to vigorous-intensity aerobic physical activityper weekEvidencedemonstratesclearlythedose-responserelation-shipbetweenincreasedphysical activityandhealthbenefits(Physical Activity Guidelines Advisory Committee 2008;Warburtonet al. 2010; WHO2010), but it isunclearaboutthebestfrequencyof physicalactivity(i.e.,whetherthis ac-tivityneedstobedonedaily, oreveryotherdayformaxi-mumeffect). Although previous guidelines recommended60minutes of physical activityeverydaytostayhealthyand improveyour health (Health Canada and theCanadianSocietyfor ExercisePhysiology1998), thewordingof theguidelines has been updated to reflect more precisely the ag-gregatedevidence. Thesenewguidelineshavetheinherentadvantage of allowing each individual to customize theirweekly routine to their schedule while adhering to theguidelines. Theguidelinesalsostatethatadditionalphysicalactivity is associated with increased health benefits. Thenew guidelines also clarify that the muscle- and bone-strengtheningactivitiesshouldbeinadditiontotherecom-mended 150 min per week.Since the earlierguidelines (Health Canada and the Cana-dianSocietyforExercisePhysiology1998), therehasbeensubstantial evidence showing that shorter duration but higherintensityactivityisassociatedwithhealthbenefits. Thisiscapturedinthewordingof thenewguidelinesandwill befurther profiledinthe messagingdelivered tothe generalpublic.FlexibilityrecommendationsSpecificguidelinesforflexibilityactivitieswereremovedasthereiscurrentlylimitedevidencetosubstantiatesuchaclearrecommendation. Suchactivitiesandexercisesarenotdiscouraged, but should not replace the physical activity rec-ommendedinthe newguidelines. Further investigationinthis area is warranted.Emerging recommendations for sedentary behavioursThefinal substantivechangefrompreviousguidelinesistheomissionof recommendations for time spent engaginginsedentarybehaviours, inparticular screen-timeactivitiessuch as watching television, computer use, and playingvideogames. Worktoprovideevidence-informedCanadianguidelines specifically for sedentary behaviour for adults(aged 1864 years) is a priority for the CSEP.Older adultsRevision of age range (aged 65 years)The new guidelines for older adults include people 65 yearsof age to reflect the best available evidence, whereas previousguidelines focused on 55 years of age. This age grouping pro-vides a complete age continuum for the new guidelines, and isconsistent with that used by the WHO (WHO 2010).Recommendation for 150 min of moderate- to vigorous-intensity aerobic physical activityper weekAs with the adult guidelines, evidence clearly demon-strates the dose-response relationship between increasedphysical activityandhealthbenefits(PatersonandWarbur-ton2010;PhysicalActivityGuidelinesAdvisory Committee2008; WHO2010), but it isunclear thebest frequencyofphysical activity (e.g., if this activity needs to be done daily,oreveryotherdayformaximumeffect). Althoughpreviousguidelines recommended 60 minutes of physical activityeverydaytostayhealthyandimproveyourhealth(HealthCanadaandtheCanadianSocietyfor Exercise Physiology1999), thewordingoftheguidelineswasupdatedtoreflectmorepreciselytheaggregatedevidence. Thisnewguidelinehas the inherent advantage of allowingeachindividual tocustomizetheir weeklyroutinetotheir schedulewhilead-heringtotheguidelines. Theguidelinesalsostatethataddi-tional physical activityis associatedwithincreasedhealthbenefits. As withthe adult guidelines, the newguidelinesclarify that the muscle and bone strengthening activitiesshould be in addition to the recommened 150 min per week.Since the earlier guidelines (Health Canada and theCanadian Society for Exercise Physiology 1999), therehas beensubstantial evidence showingthat shorter dura-tionbut higher-intensityactivityisassociatedwithhealthbenefits, andoutcomesrelatedtofunctional independence.Thisiscapturedinthewordingofthenewguidelinesandis further profiledinthemessagingdeliveredtothegen-eral public.Flexibility recommendationsSpecificguidelinesforflexibilityactivitieshavebeenre-movedas there is limitedevidence tosubstantiate sucharecommendation. Suchactivitiesandexercises arenot dis-couraged, but shouldnot replacethephysical activityrec-ommendedinthe newguidelines. Further investigationinthis area is warranted.Consultation feedbackThrough the extensive consultation process, many re-spondents expressed concern over the perception that thenewCanadianPhysical ActivityGuidelines arelower thanthe previous ones. Respondents indicated that some maymisinterpret thenewguidelines asCanadians requirelessactivitythan previously thought, which may causesome toquestionthecredibilityofthenewguidelines. Weofferthefollowingresponses tothese concerns: the newguidelinesareevidence-based, arerealisticandachievable, arewidelyendorsedbyexpertgroups, andareconsistentwithotherju-risdictions. More specifically, the newCanadian PhysicalActivity Guidelines are evidence-based: based on systematic reviews of the best availableevidence followingarigorous andtransparent scientificprocess, areconsistent withtheover-archingmessageofthepre-vious Canadian Physical Activity Guidelines, which isthat,in general,more is better, and thenew guidelinesshould be viewed as a minimaltarget, and thepreviousguidelinesarenot exactlywhat manythinkthey are (e.g., the common perception is that the previousguidelines for children were 90 min of moderate- tovigorous-intensityphysical activityper day, but infactthey were a progression from 0 to 90 min a day, resultingin60minof moderatephysical activityand30minofvigorous physical activityper dayandacommensuratedecreaseof 90 min of sedentary behaviour per day);42 Appl. Physiol. Nutr. Metab. Vol. 36, 2011Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.are realisticand achievable: usingtheprevious guidelines for childrenandyouthaspresentedintheabovelist, wehavenosurveillancedatainCanadatoassessprogressivechangesinphysical ac-tivitybehavioursamongCanadiansevenifwedid, itisunlikelythat asingleCanadianchildwouldmeet thisguidelinewhenassessedwithobjectivemeasures(Colleyet al. 2011b), whichwouldmakesuchaguidelineques-tionablein value, and havingguidelinesthatareunattainabletothevastmajor-ity of the population risks disenfranchising those whowould benefit the most froman increase in physicalactivitythenewguidelinesarebeingmetbyonly7%of Canadian children and youth (Colley et al. 2011b);areendorsedbyexpertgroupsandareconsistentwithotherjurisdictions: the majority of stakeholder respondents completelyagreed or agreed with the proposed preamble andguidelinefor all agegroups(90.2%, 88.7%, and89.7%for childrenandyouth, adults, andolder adults, respec-tively), areconsistentandharmonizedwithotherrecent physicalactivityguidelines based on the same evidence,and areacceptedby the CanadianCardiovascularHarmoniza-tion of NationalGuidelines Endeavour (C-CHANGE).Furthermore, until thedeclineinthefitnessofCanadians(Shieldset al. 2010; Tremblayet al. 2010b) subsides, it islikelythat anevensmalleramount ofphysical activitywillproduce health benefits in future research studies, so the evi-dence compiled through future systematic reviews will natu-rally lead to a progressive reduction in physical activityguidelines based on the most recent evidence.Dissemination and implementationTheworktoinformthedevelopment of theseguidelineshasbeenpublishedinthepeer-reviewedliterature(BrawleyandLatimer2007; Cameronet al. 2007; EsligerandTrem-blay2007; Janssen2007; JanssenandLeBlanc2010; Katz-marzykandTremblay2007; Kesaniemietal.2010;Latimeret al. 2010; MartinGinis andHicks 2007; Patersonet al.2007; Paterson and Warburton 2010; Rhodes and Pfaeffli2010; Sharratt and Hearst 2007; Timmons et al. 2007; Trem-blayet al. 2007a, 2007b, 2007c, 2010a; Warburtonet al.2007, 2010; Young and Katzmarzyk 2007). Further, themethodological process, systematic reviews, andfinal rec-ommendations have been and will be shared at scientificmeetingsandconferencesandarepostedontheCSEPWebsite (availablefrom www.csep.ca).These newguidelines are endorsed, promoted, anddis-seminatedbytheCSEP, ParticipACTION, PHAC, FederalProvincialTerritorial partners, stakeholder groups, andcommittedindividuals. This process is guidedbyaset ofcontent anddisseminationrecommendationsput forthbyacommittee of experts, including the guideline authors, healthcommunicationand marketingexperts,and healthbehaviourchange researchers. The steps to develop these recommenda-tions paralleledtherigorous process usedfor thedevelop-ment of the Canadian Physical Activity Guidelinesthemselves. Theprocesstoinformanddevelopthemessag-ingrecommendations for thenewguidelines canbefoundelsewhere(Latimer et al. 2010; Rhodes andPfaeffli 2010;www.csep.ca).Updating the guidelinesUpdatingthenewguidelinesinthefuturewill beimpor-tant andnecessarytoensurethat theguidelinesremaintruetothemostcurrent science. Duetotheimmenseamountofworkrequiredtoupdateeachsystematicreviewandtheim-plications of new guidelines on public practice,it is difficulttoupdatetheguidelinesfor all agegroupssimultaneously.Therefore, thePAMGSteeringCommittee has proposedacyclical update of the guidelines. This will allow eachguideline to be updatedin a timelyfashion. However, if im-portant evidence emerges inthe interimbetweenupdates,leaderswill worktoincludeit inatimelyfashionandthetimelinefor updates may change.SurveillanceThereareavarietyof mechanismsthat will beusedforsurveillance of adherence tothe newguidelines. The pri-marysurveysthatwillbeusedandtheiraffiliatedorganiza-tion are as follows: CanadianHealthMeasures Survey (CHMS; StatisticsCa-nada: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=5071&lang=en&db=imdb&adm=8&dis=2) Canadian Community Health Survey (CCHS; StatisticsCanada: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2) National Longitudinal Survey of Children and Youth (NLSCY;Statistics Canada: http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=4450&lang=en&db=imdb&adm=8&dis=2) Physical Activity Levels Among Youth (CANPLAY;CanadianFitnessandLifestyleResearchInstitute: http://www.cflri.ca/eng/programs/canplay) Physical ActivityMonitor (PAM; CanadianFitness andLifestyleResearchInstitute: http://www.cflri.ca/eng/statistics/surveys/pam2005.php) Health Behavior in School-aged Children Survey (HBSC;PHACandQueensUniversity: http://www.hc-sc.gc.ca/fn-an/surveill/nutrition/child-enfant/index-eng.php)For recent, specific examples of surveillanceactivitiesseeColleyet al. (2011a, 2011b), ActiveHealthyKidsCanadaReport Cards (Active Healthy Kids Canada 2005, 2006,2007, 2008, 2009, 2010), and the Canadian Fitness and Life-style Research Institutes CANPLAYresults (Craig et al.2010).Future researchAreasforfutureresearchhavebeenidentifiedwithinthesystematic reviews that informed the guidelines develop-ment, as well as through the stakeholder consultations.Many of these areas are specific to their respective agegroups; however, 4 important gap areas exist for all agegroups. Thefirst is todevelopphysical activityguidelinesfor special populations(i.e., diseasedor disabled); thesec-ondistheabsenceofguidelinesfortimespent engaginginsedentary behaviour (e.g., sitting or watching television).Tremblay et al. 43Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.Thethirdgaparearelatedtophysical activityisrelatedtothemessagingstrategiesusedtodisseminatethenewguide-linestothegeneral public. Tailoredmessaging, gain-framemessages, andself-efficacychangemessages holdpromisefor the future (Latimer et al. 2010), but the general nullfindingsof manybehavioural interventionsareof atimelyconcern and should be a focus for improvements in physicalactivity(RhodesandPfaeffli 2010). Finally, acrossall agegroups, systematic data are required on adverse effectsrelatedtothe recommendedlevels of physical activityre-ported herein.Sedentarybehaviourshave importanthealthconsequencesindependent ofmoderate- tovigorous-intensityphysical ac-tivity levels (Tremblay et al. 2010c). However, there arecurrentlynoevidence-basedsedentarybehaviourguidelines,not onlyinCanada, but intheworld. Thisisevident withtheabsenceofanyrecommendationsfortimespent engag-inginsedentarybehaviours inthenewCanadianPhysicalActivityGuidelines. Thiswasdonepurposefullyandnot todiminish the importance of limiting sedentary behaviours.Thisabsenceonlyhighlightstheneedforworktobecom-pletedinthisarea.For school-aged childrenand youth,sed-entary guidelines have been developed through a processcompletedinparallel withthe CanadianPhysical ActivityGuidelinesdescribedhere(availablefromhttp://www.csep.ca/english/view.asp?x=881) (Tremblay et al. 2011).Moreresearchisneededonstructured, population-basedsamples looking at direct and standardized measures ofphysical activityandage-specifichealthoutcomes. Consid-eration needs tobe takenwhenaccounting for covariatessuch as age, gender, socioeconomicstatus, and ethnicity.Children and youthThe first, and arguably the most important limitation asso-ciated with the guidelines for children and youth is the com-plete absence of guidelines for children under the age of5years. Todate, nosystematic evidence-based guidelinesexist for this age group, not only in Canada, but in theworld.The authors of the systematic review (Janssen andLeBlanc2010) highlightedmanylimitations inthecurrentevidence. First, the review itself was limited by methodolog-ical shortfalls of thecurrent evidence. Agreat deal of theavailableevidencein young peoplewas based on self-reportdatathroughquestionnaires. Self-report datanot onlyintro-ducesavarietyofbiasesbut alsointroduceshighheteroge-neity across studies, making it difficult to conduct largescale meta-analyses. Inaddition, the authors were limitedbythenatureofchild-focusedresearch: childrenandyouthhave difficulty recalling physical activity habits; parentshave a great deal of control over their childrens daily activ-ities; andmost oftenresearchersstudypredictorsof healthoutcomes(e.g., bloodpressure, obesity)andcannot relyonmorbidityor mortalityoutcomes. Theuseof morerobust,direct measures in future research is recommended.Thereare several recommendations for futurework in thepediatric population. Most notably, there is a need for ahigher quality of randomized controlled trials in this agegroup (i.e., larger and more diverse sample sizes, directmeasuresofphysicalactivity, intention-to-treat analyses,re-portingofadverseevents). Theselargerstudiesshouldthenbe able to address the impact various sociodemographicvar-iables. Furthermore, futureresearchshouldfocusonstand-ardizingmethodsfordatacollectionandanalysisandworktowardsimplementingdirect (i.e., accelerometers)andindi-rect (i.e., questionnaires for context) measures of physicalactivity. Standardizedmethodsforassessingphysical activ-ity will also allow researchers to look specifically at differentintensities of activity andthe associated benefits and(or)risks.AdultsAgreat deal of workhas examinedtherelationshipbe-tween physical activity and morbiditymortality in adults(Warburton et al. 2007, 2010). The authors of the systematicreview (Warburton et al. 2010) noted that the biggest limita-tioninthecurrent researchisthevarietyofwaysinwhichdata are analyzed. For example, early research analyses gen-erally controlled for fewconfounders (i.e., only for age),whereas current research often controls for many factors(i.e., age, sex, race, socioeconomic status, etc.). There arealsodiscrepanciesinmeasurement methods. Highheteroge-neitymakesitdifficulttoconductmeta-analyseswithinthisreview. Future work should standardize methods for measur-ing andassessing levelsof physicalactivityand its relation-ship to various health outcomes.There is alsoa clear needfor guidelines that meet theuniqueneedsofpersonslivingwithchronicconditions, in-cludingthepreventionandlong-termmaintenanceof unfav-ourable body composition. Finally, future research shouldfocusontherelationshipbetweenenhancingflexibilityandskeletal fitness andcomorbidities across thelifespan. Thiswork should be completed in large, diverse, internationaltrials,whichcan examine subgroup differencesto determineif different guidelinesarewarranted(i.e., for different age,sex, or ethnic subgroups).Older adultsFutureresearchrequiresbetter assessment anddefinitionofthephysical activitynature, type, intensity, andvolume,and what physical activity variables relate to specificoutcomes with a dose-response analysis. For example, islight-intensityactivity, as well as moderate- andvigorous-intensity activity, associated with better cognitive outcomes?Is vigorous activityrequiredfor certainphysiological out-comes that predispose to prevention of certain diseaseprocesses?Whichofintensityorvolumeofphysical activ-ityiscritical tothedose-responseforvariousoutcomes?Additionally, whereas prospective cohort studies exam-ined the relationship of physical activity with long-term out-comes, or theeffectsof life-longactivity, for older adults,themoreimmediateeffectsconsequent tophysical activityinterventions(i.e., exerciseprograms) over afewweekstomonths and their short-termoutcomes are important. Theconcept it is not too late to start appears to apply, asshort-termexercise training can greatly improve functionandmaintainfunctional independence; however, thereis aneed for longer-termfollow-up of these initiatives to ob-servehowincreasedphysicalactivityismaintained, andthelonger-termoutcomes relatedtodisabilityand(or) loss ofindependence. Exercisetrainingprogramshavebeenratherstandardized in terms of their nature, components, type,44 Appl. Physiol. Nutr. Metab. Vol. 36, 2011Published by NRC Research PressAppl. Physiol. Nutr. Metab. Downloaded from www.nrcresearchpress.com by Queens University on 07/27/12For personal use only.intensity,andvolume,andmanyhavebeenmulticomponentinterventions; there is needfor future worktoisolate themost beneficial components(e.g., strengthoraerobic; needfor flexibilityor balancecomponents).ConclusionsThispaper providesabrief overviewof theprocessthathas beenfollowed to developnew Canadian PhysicalActiv-ityGuidelinesforChildren(aged511years), Youth(aged1217years), Adults(aged1864years), andOlderAdults(aged 65 years). These guidelines have been developedthroughpartnershipswithmanyorganizationstopresentthebest evidenceontherelationshipbetweenphysical activityandvarioushealthoutcomes.ThePAMG SteeringCommit-teehas ensuredthat theprocess todeveloptheguidelineshas been rigorous, transparent, and thoroughly documented.AcknowledgementsThe authors wishtoacknowledge the CanadianSocietyfor Exercise Physiology (CSEP) for leading the developmentof the new physical activityguidelines;ParticipACTION forbeing a lead partner in their development and dissemination;andthePublicHealthAgencyof Canada(PHAC) for pro-vidingsupport totheguidelinedevelopment process. CSEPandPHACfundedtheseguidelines. Theviewsofthefund-ingagencieshadnoinfluenceonthecontent orrecommen-dations includedinthis document. We wouldalsolike toacknowledge the in-kind fundingsupport providedbytheleadauthorsandtheirrespectivelaboratoriesinthegenera-tion of the systematic reviews. Special thanks to Drs. AnteroKesaniemi, StevenBlair, ChrisRiddoch, BruceReeder, andThorkild Srensen for serving as the independent reviewpanel. We acknowledge Dr. Andrea Triccos contributionsas themethodologicalconsultantforthesystematicreviews.Thequalityoftheguidelinesisaresultofthecontributionsandcommitment ofall authorsofthefoundational, system-aticreviewandprocess papers andreports, participants atthe2009ConsensusmeetinginKananaskis, participantsinfinal guideline development meetings, participants inmes-sagingmeetings, stakeholders, partners andparticipants inthe online CSEPconsultations, participants in the PHACstakeholder consultation meetings, and the PHAConlineconsultations. CSEPwishestoextendspecialthankstoPro-fessorMarcel Nadeau, retiredfromtheUniversite deSher-brooke, fortranslatingthereviewsfromEnglishtoFrench.MichelleKhoisfundedbyaFellowshipAwardandBisbyPrize from the Canadian Institutes of Health Research.ReferencesActive Healthy Kids Canada. 2005. 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