Key changes include new schools/jobs, marriage, pregnancy, parenting, retirement

Clinicians should engage patients in conversations about exercise and physical activity, especially during major life events and transitions, the American Heart Association (AHA) said in a new scientific statement.

“Some life events and transitions are associated with reductions in physical activity and, potentially, increases in sedentary behavior,” wrote Abbi Lane-Cordova, PhD, of the University of South Carolina in Columbia and co-authors, in Circulation.

“The aim of this scientific statement is to first provide an overview of the evidence suggesting changes in physical activity and sedentary behavior across life events and transitions,” they wrote. “A second aim is to provide guidance for health care professionals or public health workers to identify changes and promote physical activity during life events and transitions.”

“Certain life events and transitions may mark the beginning and end of different phases of a person’s life, and these life changes may lead to periods of less physical activity and more sedentary lifestyle behaviors,” Lane-Cordova said in an AHA news release. “This is a particularly important topic right now because, in addition to life’s other major events, the Covid-19 pandemic is another disruption of everyone’s daily routines and activity levels,” she added.

Physical activity is inversely associated with cardiovascular mortality and is recommended to prevent and treat other chronic conditions in the 2018 Physical Activity Guidelines for Americans. Sedentary behavior has emerged as a distinct cardiovascular risk factor.

The AHA recommends most adults participate in at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination. Children ages 6 to 17 should get at least 60 minutes of moderate-to vigorous-intensity physical activity every day. According to the CDC’s Healthy People 2020 initiative, only 20% of adolescents and 24% of adults routinely achieve recommended levels.

Accumulating evidence suggests that physical activity levels may change significantly in response to commonly experienced life events, Lane-Cordova and co-authors observed.

“Life events and transitions are often characterized by some disruption or change in routines or resources,” they wrote. “According to the “critical windows” theory, establishing good physical activity and sedentary behavior habits during life events and transitions could shape lifelong levels of these behaviors.”

“There are several important life transitions associated with declines in physical activity, including entry to school (elementary, middle, high school, and college), entry to the labor market, marriage or civil union, pregnancy, parenting, retirement, and entry to long-term care facilities,” noted Kara Whitaker, PhD, MPH, of the University of Iowa in Iowa City, in an AHA commentary.

Some subgroups may have greater need for physical activity support during major life events, including people with lower education, who live alone, who have less access to safe outdoor spaces, Black Americans, sexual or gender minority groups, and women during pregnancy and postpartum, Whitaker added.

“While the evidence examining sedentary behavior and life transitions is less robust, preliminary data indicates that school-level transitions, entry or exist from the labor market, pregnancy, and major illness and injury are associated with increases in sedentary behavior,” she wrote.

The new AHA statement frames lifespan transitions and physical activity in a socioecological model, including individual, social, environmental, and policy factors in a comprehensive framework.

Factors influencing physical activity for children include gender, age, motor coordination, time outside, physical activity preferences, body image, physical education, and involvement in school sports, the AHA authors noted. For adults, factors include health, self-efficacy, perceived benefits of physical activity, enjoyment, and lower stress levels.

After a life change has been identified, quantifying and promoting physical activity are important next steps, the authors emphasized. “Routine physical activity assessment may support activity through self-monitoring, awareness, and tailored physical activity recommendations,” Lane-Cordova and co-authors wrote.

“Organizational-level strategies include assessing activity levels when a patient checks in, when vital signs are collected, or as part of the rooming process,” they suggested, adding that integrating physical activity assessment in conjunction with screening for life transition and events into the electronic health record when vital signs are collected may be an effective approach.

“For most situations in clinical or community settings, incorporating a brief two-question tool at each encounter can determine compliance with the current aerobic 2018 Physical Activity Guidelines,” the authors added, noting that the two-question “physical activity as a vital sign” approach asks “on average, how many days per week do you engage in moderate to strenuous exercise (like a brisk walk)?” and “on average, how many minutes do you engage in exercise at this level?”

Wearables like pedometers and accelerometers also can provide objective information, Lane-Cordova and colleagues indicated. “Steps per day have been shown to be the most valid and reliable metric available from wearables,” they stated.

“An increase of 1,000 steps per day can lead to health benefits,” the authors noted. “Focusing on gradual and realistic increases in step count can be a powerful strategy for many individuals.”

Patient interactions should begin with “compassion and empathy as first-line treatment for life transitions and events,” Lane-Cordova and co-authors advised. “Just as health care professionals would encourage the continuation of routines to control chronic conditions during these transitions, they can include specific encouragement for regular physical activity.”

Strategies for discussing physical activity with patients going through a life event are included in the AHA statement. In addition, the AHA suggests American College of Sports Medicine’s Exercise is Medicine initiative as a resource for physical activity, coding and billing tips, and exercise prescription pads. The 2018 Federal Physical Activity Guidelines for Americans Advisory Committee Scientific Report also contains stringently reviewed physical activity promotion strategies for various settings and populations.

Organizational and public health level efforts may induce a larger effect through wider reach, since they address social support and cultural norms, the authors noted. “Future research needs include a better characterization of physical activity and sedentary behavior across life events and transitions in higher-risk subgroups,” they added.

  1. Clinicians should engage patients in conversations about exercise and physical activity, especially during major life events and transitions, the American Heart Association said in a new scientific statement.

  2. Life transitions associated with declines in physical activity include entry to school or the labor market, marriage or civil union, pregnancy, parenting, retirement, and entry to long-term care facilities.

Paul Smyth, MD, Contributing Writer, BreakingMED™

Lane-Cordova reported support from the American Heart Association and NIH/NIGMS.

Whitaker is supported by the National Heart Lung and Blood Institute.

Cat ID: 914

Topic ID: 74,914,494,730,914,192,48,772,151,925