Reviewed by Brunilda Nazario, MD on December 10, 2018

Dec. 10, 2018 -- Ten years ago, Indira Levine weighed 336 pounds, had never exercised a day in her life, and was very sedentary.

“I had to take my inhaler with me everywhere I went. If I went up a flight of steps, I was out of breath. I would come home, cook dinner, sit down, and watch TV. That was it. I didn’t have any idea what else to do,” she says. “The environment I grew up in -- nobody worked out, nobody ran 5Ks. That wasn’t something I ever saw, and I didn’t know how to be more active.”

She says those around her were concerned, and before she died, her mother had a heart-to-heart with Levine about her habits. “My mom, before she passed away, said, ‘Do whatever you have to do to get the weight off and be more active. You are too young to be this heavy,’” Levine says.

The U.S. Department of Health and Human Services (HHS) is hoping more Americans can heed the advice of Levine’s mother and put physical activity into their lives. The agency released the second edition of the “Physical Activity Guidelines for Americans” in mid-November and says the stakes for our personal health are high. But are people are really taking this to heart?

Levine did. After her mother’s advice, she decided she wanted to make changes after moving to Florida, where she was inspired by the warm weather and the area’s active, outdoor lifestyle. But she wasn’t sure where or how to start. So she began working with a personal trainer.

“I learned that sometimes you have to ask for help. If you don’t know how to do it and you realize after a couple of tries it’s not working, you have to reach out,” says Levine, a television news photographer.

Even with that help, her journey took time. But in 9 years, she has transformed her body and her life. Levine lost 140 pounds, built up a lot of muscle, and in the process discovered a love of exercise.

“It is hard. I am the first one to say it is a process to learn how to be active. But don’t give up. If I can do it, everyone can do it,” Levine says.

The New Guidelines

This is only the second time HHS has released these types of physical activity recommendations. The original set was issued in 2008, but federal officials say scientific data published since then call for several updates.

“We want to emphasize what’s new in two key areas. One is it’s clear there is new evidence for even more benefits of being physically active. And secondly, there are some changes that we hope will make it easier for people to become more physically active,” says Richard Troiano, PhD, program director at the National Cancer Institute in Bethesda, MD. He was part of the team that wrote the guidelines based on a review of the latest scientific and medical research by a committee of academic experts. The team made the changes because, he says, “the science is there to support it.”

The new guidelines are focused on health, not weight loss. While following the guidelines may help you lose weight, a true weight loss plan might require more intense exercise. Consult a doctor if you’re unsure.

Here are the guidelines to stay healthy:

  • Move more and sit less. Officials say new evidence shows a strong relationship between more inactive behavior and higher odds of death for any reason, cardiovascular disease death, heart disease, and type 2 diabetes.
  • Adults should do at least 150 minutes (2 hours and 30 minutes) to 300 minutes (5 hours) a week of moderate aerobic physical activity; or 75 minutes (1 hour and 15 minutes) to 150 minutes (2 hours and 30 minutes) a week of vigorous aerobic physical activity; or an equal combination of both. It’s best if aerobic activity is spread throughout the week.
  • Older adults should combine aerobic, muscle-strengthening, and balance activities when possible. And if chronic conditions make moderate exercise challenging, be as physically active as you safely can.
  • Children (ages 6 through 17) need 60 minutes of moderate to vigorous physical activity a day.

Previous guidelines that said only 10-minute bouts of physical activity counted have also been removed. All activity now counts -- whenever and however you get it.

“Now we have consumer devices that allow you to look at minute-by-minute physical activity, and we were able to see, you don’t necessarily need an episode of 10 minutes to get benefits,” Troiano says. “What really is important is the total amount of physical activity you accumulate during the day and the week.”

For the first time, the guidelines also extend to children between the ages of 3 and 5, and suggest they should be active throughout the day to enhance their growth and development. Troiano says active children are less likely to become overweight or obese, and starting physical activity young can embed important healthy habits for life.

“One of the big changes over the past 10 years since the first guidelines were issued is how many competing activities there are for little kids. You see a lot of young children holding screens, and 15 years ago we didn’t see that. They may have been in front of the TV, but they didn’t have personal screens,” Troiano says. “So it’s even more important to emphasize the need for children to be active. The message is really for parents to provide opportunities for them to be moving throughout the day.”

The agency says that since its first recommendations, it’s learned a lot more about how exercise improves your health including:

  • Immediate benefits, from just one bout of activity, including lower anxiety and blood pressure, better sleep, and improved insulin sensitivity.
  • Long-term benefits, including improved brain health, lower odds of eight types of cancer (previously two), less chance of fall-related injuries in older adults, and lower risk of too much weight gain
  • Help with managing chronic health conditions
  • Less pain for those with osteoarthritis
  • Hypertension and type 2 diabetes get worse more slowly.
  • Fewer symptoms of anxiety and depression
  • Improved thinking for those with dementia, multiple sclerosis, ADHD, and Parkinson’s disease

Stopping Sedentary Behavior

The new guidelines don’t recommend a specific limit on daily sedentary behavior or thoughts on how to break up sedentary behavior through the day. They simply encourage replacing sedentary behavior with physical activity to counter the risks.

But historically, few people have followed the guidelines. HHS says currently, just 26% of men, 19% of women, and 20% of teens report meeting these goals. The agency says this is troubling since the risks and costs of inactivity are so clear. Lack of physical activity is linked to nearly $117 billion in annual health care costs and 10% of all premature deaths.

What Are the Barriers?

One could be the intensity of the recommended activity, which may seem daunting to people who don’t exercise much. The guidelines focus on moderate to vigorous activities. Moderate-intensity activities are ones that allow you to talk while doing them -- but not sing -- like walking 3 mph. Running so hard you can’t carry on a conversation is considered vigorous. Troiano says the guidelines are written this way because science mostly focuses on the benefits of moderate and vigorous activities, but he says if that is a struggle, just do what you can.

“The science on light-intensity activity is still evolving, but people who replace sitting with light activity may see benefits,” he says. “Those who will gain the greatest benefit for doing some activity are the people who currently do the least. So you don’t need to go from 0 to 150 minutes a week. If you go from 30 minutes a week to 60 minutes a week, that isn’t a big overall change, but it can have a big impact on reducing the adverse impacts of inactivity.”

Bradley J. Cardinal, PhD., a kinesiology professor at Oregon State University and president of the National Academy of Kinesiology, has published more than 200 peer-reviewed research articles and written several books about physical activity and health.  

He says it’s important to try to remove barriers, too, because physical activity can be seen as a privilege for some who financially, logistically, geographically, or physically can’t or don’t want to do it. But he says even in the most challenging cases, you can probably find ways to build in some activity. You don’t have to join a fancy gym or buy expensive gear. Pace while you are on the phone. Choose parking spaces, bus stops, or subway stops a little farther from your destination so you walk more. Decide to take the stairs at least a few flights before catching the elevator. 

“We know the human body needs physical activity for our long-term survival and health. We are really designed to move,” Cardinal says. “Some of it is just trying to figure out how you can put activity in your day.”

A personal test

How hard is it to make exercise a daily part of your life? Cardinal decided to put his own research to the test. On Oct. 1, 2009, he committed to doing a minimum of 1 hour of aerobic exercise every day. Nine years later, he’s kept that promise -- only missing one day when he ended up in the emergency room for a viral illness. But he made up the time he missed that day by working out a bit more later in the week.

He says he’s learned it can almost always be done -- even when life gets busy, you get sick, or you travel a lot. He says he’s walked high-speed laps in airports, drawing the attention of Transportation Security Administration  agents who questioned him about what he was doing. He’s climbed hotel stairwells when it was raining too hard outside to do anything else, routinely jogs in place while waiting for photocopies, and says he has discovered he can find a way to build activity into just about any moment of the day, no matter where he is.

“If I’m clothes shopping with my wife, I’ll do squats while I wait for her. I’ve actually had people join me in the past doing that,” Cardinal says. “I try to figure out how can I be physically active in any moment. I’m very intentional about it, and I find myself happier when I do it.”

Gina Harney, a certified personal trainer, group fitness and yoga instructor, and founder of the popular health lifestyle site, The Fitnessista, says don’t worry if you have to start small.

“At first it can seem overwhelming because you are changing something about your normal day-to-day routine, which can be daunting. So maybe start just once a week. And then do twice a week,” says Harney, who also writes about fitness for WebMD. “If you try to do too much when you start, you’ll get burned out or overwhelmed, and then you’re not motivated to continue. So set realistic goals.”

Harney says it can be manageable to start with 10-minute bouts of activity like taking a walk at lunch, climbing a few stairs, or doing an exercise video on YouTube. She says that over time, you can make it last longer, make it more intense, and do it more often.

“Look at this as something to empower you rather than intimidate you,” she says. “Consistency adds up, so even just a little every day will add up over time. It doesn’t have to be a huge, drastic change. It can be something small that you build on.”

As for Levine, she now works at a gym, helping others start their journeys to physical activity in Capitol Heights, MD. She says no matter what you think your barrier is, reach out for help.

“This is not a rich area, and a lot of time we hear stories that people can’t afford to train, so we are constantly working with people. We have six or seven children who come daily with their parents because we don’t want lack of child care to be someone’s excuse,” she says. “It is hard. I am the first one to say it is a process to learn to be active. So I want to do what I can to help people.”

Levine recommends finding a workout buddy to hold you accountable and make it more fun. And if money is a challenge, you can ask gyms if they’ll barter, or you can talk with a trainer to see if you and several friends can split a session.

And last year, she completed a Spartan race -- a 5-mile, timed, military-style obstacle course that involves running through mud and the woods, climbing walls, and lifting 50-pound buckets of rocks -- and she ran the men’s course to really challenge herself.

“At the end of that, I jumped over this 6-foot fire pit and I remember thinking, ‘I can’t believe I did this.’ I was bawling. Because 10 years ago, I couldn’t even walk fast, much less carry anything. That was the moment when I thought, ‘Mom, I know you are proud.’ I did this. I was really proud, too,” Levine says.

For more information about the latest Physical Activity Guidelines for Americans visit

Show Sources

Bradley J. Cardinal, PhD, Oregon State University, Corvallis.

Gina Harney, The Fitnessista, Tucson, AZ.

Indira Levine, Les Talk, More Training, Capitol Heights, MD.

Richard Troiano, PhD, National Cancer Institute, Bethesda, MD.

American Journal of Health Promotion: “Prospective analysis of stage-of-exercise movement following mail-delivered, self-instructional exercise packets.”

Journal of American College Health: “Differences in university students’ motivation between a required and an elective physical activity education policy.”

Preventive Medicine: “Built environment and changes in blood pressure in middle aged and older adults.”

JAMA: “The Physical Activity Guidelines for Americans.”, Physical Activity: “Move Your Way” campaign materials.

Physical Guidelines for Americans, 2nd edition, Executive Summary.

CDC: “Physical Activity Basics.”

U.S. Department of Health and Human Services: “HHS Releases Physical Activity Guidelines for Americans, 2nd edition,” Nov.12, 2018.


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