90 kg etc), and the type of
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5 activity performed. An example of the APS is provided in Table 1. The complete APS is presented as supplemental material.
Table. 1: The activity point system (APS). Activities of daily living in alphabetical order. The points indicated are based on ten minutes' duration of each activity, with the exception of stair climbing which refers to one minute. Shaded fields: Not suitable for respective BMI group.
ACTIVITIES OF DAILY LIVING
Bicycling
BMI I 25.0 – 29.9 > 90 ≤ 90 kg kg
BMI II 30.0 – 39.9 ≤ 120 > 120 kg kg
BMI III ≥ 40 ≤ 150 > 150 kg kg
5
6
7
8
9
10
7
9
10
12
13
15
2
2
3
3
4
4
Gardening, lawn work
5
6
7
8
9
11
Housekeeping - light effort
2
3
4
5
6
7
Housekeeping - general (e.g. sweeping, vacuuming)
4
5
6
7
8
9
Shopping
2
3
4
5
5
6
1
2
3
4
5
6
2
4
5
6
7
8
(< 10 mph, e.g. to work)
Climbing stairs (up, down)
Desk work (e.g. writing, reading, computer)
(e.g. cooking, washing, ironing)
(walking, non-grocery)
Walking, strolling (< 2 mph)
Walking (2.5 mph, e.g. to work)
In an exercise program for overweight and obese patients, 100 to 300 activity points should be collected weekly according to the individual’s goals. On the basis of accepted recommendations for the promotion and maintenance of health, the optimum accumulation is between 200 to 300 activity points per week. [1-3,5,6] Since the total weekly amount of energy expended and the amount expended at higher intensities is also of prime importance in the prevention and treatment of health risks
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6 during exercise [2,7-10], it is beneficial to accumulate more activity points and/or at higher intensities if safely possible. The activity points are based on the equations published by Ainsworth et al. [11,12] in the Compendium of Physical Activities. The energy expenditure for 60 daily and sports-related activities is calculated as follows:
energy expenditure (kcal/min) = factor x body weight (kg) x (number of min/60 min)
where the “factor” denotes exercise intensity as MET intensities and is a multiple of one metabolic equivalent, i.e. an oxygen intake of 3.5 ml·min-1·kg-1. This we did for three BMI classes including overweight, obese class I and II, and obese class III catgories. As body weight varies substantially within one BMI class, each class was subdivided into two weight groups to account for the added energy cost of moving more body weight. To make things practical, the energy requirements were based on 10 minutes’ duration of each activity, with the exception of stair climbing which was limited to one minute. As we felt that overweight and obese people should not have to think in terms of calories which relate to dieting and therefore to an area fraught with failure, and again to make the system easy to handle, the calories were divided by 10 to yield ‘activity points’. Patients are thus encouraged to collect activity (and "health") points rather than estimate calories expended. If desired, the calories expended in various activities can easily be obtained by multiplying the activity points bei 10 or they can be calculated using the equation presented for computing energy expenditure from the activity intensity, duration, and the individual’s body mass. The Activity Point System can be personalized by inputting the corresponding table into a computer for each patient and printing it out. However, the points
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7 provided for the two weight groups within each BMI class, e.g. ≤ 90 kg and > 90 kg, are of sufficient accuracy to account for the energy expended by most patients. As shown in Figure 1, an additional table with weekdays, e.g. in form of a personal booklet can be used to provide patients with an easy way to make a note of the daily activity points collected. As a rule patients should only keep book of activities in addition to routine activities of daily living and light intensity, such as self care, casual walking, or less than 10 minutes of duration such as walking to the parking lot. A blank personal booklet is presented as supplemental material. Insert Figure 1 about here In discussing the need for physical activity with overweight and obese adults, health care providers can refer to the book, Promoting Physical Activity: A Guide for Community Action, published by the U.S. Department of Health and Human Services [3] and to the article, Self-Efficacy, Decision Making and the Stages of Change: An Integrative Model of Physical Exercise, by Marcus et al. [4] These resources are practical guides for identifying strategies to increase physical activity.
SUMMARY An Activity Point System is presented which assists health care providers and health professionals with a way to prescribe exercise in a semi-quantitative manner and to motivate their patients to begin an exercise program. Activity points are specific to one’s body weight, BMI, and activity intensity for ten-minute bouts of activity performed. With a goal of accumulating 100-300 activity points per week, the APS provides a simple yet quantitatively accurate way to prescribe exercise for overweight and obese adults.
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8
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9
Competing interests statement and copyright statement:
Competing interests: None
Copyright statement The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence on a worldwide basis to the BMJ Publishing Group Ltd and its Licensees to permit this article (if accepted) to be published in British Journal of Sports Medicine editions and any other BMJPGL products to exploit all subsidiary rights, as set out in our licence (http://bjsm.bmj.com/misc/ifora/licenceform.shtml)
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10
References
1
U.S. Department of Health and Human Services (Ed.): Physical Activity and
Health. A Report of the Surgeon General. McLean, VA: International Medical Publishing, 1996. 2
Physical Activity Guidelines Advisory Committee Report 2008.
www.health.gov/PAGuidelines/committeereport.aspx, June 2008. 3
U.S. Department of Health and Human Services, Public Health Service,
Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition and Physical Activity. Promoting physical activity: a guide for community action. Champaign IL: Human Kinetics 1999. 4
Marcus BH, Eaton CA, Rossi JS et al. Self-efficacy, decision-making and the
stages of change: An integrative model of physical exercise. J Appl Soc Psych 1994;24:489-508. 5
Haskell WL, Lee I-Min, Pate RR et al. Physical Activity and public health:
Updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1423-1434. 6
Nelson ME, Rejeski WJ, Blair SN et al. Physical activity and public health in
older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc 2007;39:1435-1445. 7
Paffenbarger RS, Hyde RT, Wing AL, et al. Physical activity, all-cause
mortality, and longevity of college alumni. N Engl J Med 1986;314:605-613. 8
Blair SN. Physical activity, physical fitness and health. Res Q Exerc Sport
1993;64:365-376.
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11 9
Blair SN, Brodney S. Effects of physical inactivity and obesity on morbidity and
mortality: current evidence and research issues. Med Sci Sports Exerc 1999;31(11 Suppl):S646-662 10
Hu FB, Sigal RJ, Rich-Edwards JW, et al. Walking compared with vigorous
physical activity and risk of type 2 diabetes in women: a prospective study. JAMA 1999;282:1433-1439. 11
Ainsworth BE, Haskell WL, Leon AS, et al. Compendium of physical activities:
classification of energy costs of human physical activities. Med Sci Sports Exerc 1993;25:71-80. 12
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of physical activities:
an update of activity codes and MET intensities. Med Sci Sports Exerc 2000;32:498516.
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12
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13 List of Figures Figure 1. Example of a personal booklet that can be used to provide patients with an easy way to make a note of the daily activity points collected with the Activity Point System (APS). In the upper section, patients record the activity performed in the first column, an abbreviation for the activity (first letter of the activity) recorded in the second column, and the number of points assigned according to their BMI and body weight level for each multiple of a 10 minute activity bout recorded in the remaining columns. On the right side of the form, patients record the week dates for the activity period and comments regarding their activity during the week. In the bottom section, patients record the abbreviation for the activity performed in the columns labeled (A for Activity) and record the associated points earned for the duration of the activity in the columns labeled (P for Points). The daily total points are computed by summing all activity points completed each day and recording them in the column labeled daily total. The total weekly activity points are computed by summing the daily activity points and recording them in the box labeled activity points, weekly total. The patient’s goal is to accumulate between 100 and 300 activity points per week.
Activity points (P) for 20 30 40 50 min min min min
10 min
Week Program
60 min
of
Date: from ____________ to ____________ Comments:
Day
A
P
A
P
A
P
A
P
A
P
A
P
A
P
A
P
A
P
Monday Tuesday Wednesday Thursday Friday Saturday Sunday Activity points, weekly total
Daily total
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Abbr .
Activity (A)
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Tab. 2: The activity point system (APS). Sports-related physical activities in alphabetical order. The points indicated are based on ten minutes' duration of each activity. Shaded fields: Not suitable for respective BMI group. PHYSICAL ACTIVITIES, SPORTS
BMI I 25.0 – 29.9 ≤ 90 > 90 kg kg
BMI II 30.0 – 39.9 ≤ 120 > 120 kg kg
BMI III ≥ 40 ≤ 150 > 150 kg kg
Aerobics
8
10
11
14
15
17
Badminton
6
7
8
9
10
11
Basketball
8
10
11
13
14
16
Beach Volleyball
10
13
14
17
18
22
Bicycling (stationary)
4
5
6
7
8
9
9
11
12
15
16
18
16
20
22
27
29
34
5
6
7
8
9
11
9
11
12
15
16
18
13
16
18
21
23
26
Bicycling, BMX or mountain
11
14
15
18
19
22
Billiards
2
3
4
5
6
7
Bowling
3
4
5
6
7
8
Canoeing, Paddling
5
6
7
8
9
10
10
13
14
17
18
22
Dancing
6
7
8
9
10
12
Darts
2
3
4
5
6
7
Field Hockey
10
13
14
17
18
22
(50 W - light effort)
Bicycling (stationary) (150 W - moderate effort)
Bicycling (stationary) (250 W - vigorous effort)
Bicycling (10 mph - light effort)
Bicycling (12.5 mph - moderate effort)
Bicycling (15 mph - vigorous effort)
(leisure)
Circuit training (aerobic, resistance)
1
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Tab. 2 continued: The activity point system (APS). PHYSICAL ACTIVITIES, SPORTS
BMI I 25.0 – 29.9 > 90 ≤ 90 kg kg
BMI II 30.0 – 39.9 ≤ 120 > 120 kg kg
BMI III ≥ 40 ≤ 150 > 150 kg kg
Fishing
3
4
5
6
7
8
Frisbee playing
3
4
5
6
7
8
Golf
6
7
8
9
10
12
Handball
16
20
22
26
28
33
Health Club Exercise
7
9
10
11
12
15
Hiking, climbing hills
9
11
12
15
16
19
Hiking, cross country
8
10
11
13
14
16
Horseback riding
5
6
7
8
9
11
Ice Hockey
10
13
14
17
18
22
Ice Skating
9
11
12
15
16
19
Judo
13
16
18
21
23
27
Karate
13
16
18
21
23
27
Orienteering
12
15
16
19
21
24
Roller skating
16
20
22
27
29
34
Rowing, ergometer
4
5
6
7
8
9
11
14
15
18
19
23
18
23
25
30
32
38
3
4
5
6
7
8
(with 0 - 9 lb load)
(leisure)
(50 W - light effort)
Rowing, ergometer (150 W - fairly vigorous effort)
Rowing, ergometer (250 W, very vigorous effort)
Rowing (3 mph - light effort)
2
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Tab. 2 continued: The activity point system (APS).
PHYSICAL ACTIVITIES, SPORTS
Rowing
BMI I 25.0 – 29.9 > 90 ≤ 90 kg kg
BMI II 30.0 – 39.9 ≤ 120 > 120 kg kg
BMI III ≥ 40 ≤ 150 > 150 kg kg
9
11
12
15
16
19
16
20
22
26
28
33
10
13
14
17
18
22
16
20
22
27
29
34
21
26
29
34
37
44
3
4
5
6
7
8
Skiing, downhill
9
11
12
15
16
19
Skiing, cross-country
9
11
12
15
16
19
10
13
14
17
18
22
12
15
16
19
21
24
Soccer
9
11
12
15
16
19
Squash
16
20
22
26
28
33
Stretching
2
3
4
5
6
7
Swimming, backstroke
9
11
12
15
16
19
Swimming, breaststroke
13
16
18
21
23
27
Swimming, crawl
9
11
12
15
16
19
(5 mph - moderate effort)
Rowing (6.8 mph - vigorous effort)
Running (5 mph)
Running (7.5 mph)
Running (10 mph)
Sailing (leisure)
(2.5 mph - light effort)
Skiing, cross-country (4.5 mph - moderate effort)
Skiing, cross-country (7 mph - vigorous effort)
(calisthenics)
3
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Tab. 2 continued: The activity point system (APS).
PHYSICAL ACTIVITIES, SPORTS
BMI I 25.0 – 29.9 > 90 ≤ 90 kg kg
BMI II 30.0 – 39.9 ≤ 120 > 120 kg kg
BMI III ≥ 40 ≤ 150 > 150 kg kg
Swimming, butterfly
14
18
20
23
25
30
Table tennis, ping pong
5
6
7
8
9
11
Tai chi
5
6
7
8
9
10
Tennis, doubles
7
9
10
13
14
16
Tennis, singles
9
11
12
15
16
19
Volleyball
3
4
5
6
7
8
Walking
4
5
6
7
8
9
6
8
9
10
11
13
10
13
14
17
18
22
Water calisthenics
5
6
7
8
9
10
Water skiing
8
10
11
13
14
16
Weight lifting
8
10
11
13
14
16
3
4
5
6
7
8
(3 mph)
Walking (4 mph)
Walking (5 mph)
(free weights)
Wind surfing (leisure)
4
Walking (4 mph) Bicycling to work, shop Aerobics
Activity points (P) for 20 30 40 50 min min min min
10 min
Week 5 Program
60 min
W
8
16
24
32
40
48
B
6
12
18
24
30
36
A
10
20
30
40
50
60
of
Date: from 07/18/2006 to 07/24/2006 Comments: I tried Aerobics for the first time. – Like it! Rain on Saturday…
A
P
A
P
A
P
Monday
B
6
B
6
W
24
36
Tuesday
B
6
A
50
B
6
62
Wednesday
B
6
B
6
Thursday
W
32
Friday
B
6
Saturday Sunday
A
P
A
P
A
P
A
P
A
P
A
P
Daily total
Day
12 32
B
6
B
12
B
12
36 0
W
40
40
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Abbr .
Activity (A)
218 Activity points, weekly total
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