The ABC of Physical Activity for Health: A consensus statement from the British Association of Sport and Exercise Sciences

Figures & data

Table I. Evidence for a causal relationship between physical activity and reduced risk of chronic diseases, according to Hill's (1965) criteria for causality.

Disease or condition	Criteria
	Strength of association*	Consistency	Temporal sequence	Biological plausibility	Experimental evidence	Dose–response
Cardiovascular disease	✓✓✓	✓✓✓	✓✓✓	✓✓✓	✓✓✓	✓✓✓
Type 2 diabetes	✓✓✓	✓✓✓	✓✓✓	✓✓✓	✓✓✓	✓✓✓
Overweight and obesity	✓✓✓	✓✓	✓	✓✓✓	✓	✓
Post-menopausal breast cancer	✓✓	✓✓	✓✓	✓		✓
Colon cancer	✓	✓✓	✓✓	✓		✓
Psychological well-being	✓	✓		✓		✓
Clinical depression	✓✓	✓	✓			✓
Cognitive impairment	✓	✓✓	✓
Prostate cancer^#	✓	✓	✓
Anxiety disorders
✓ = moderate evidence. ✓✓ = strong evidence. ✓✓✓ = very strong evidence. *‘Very strong’ strength of association refers to a two-fold increase in risk associated with inactivity after adjustment for confounding variables. ^#Evidence refers to the incidence of advanced prostate cancer observed in large cohort studies.

Figure 1. Intensity of physical activity and risk of cardiovascular disease in men and women. In each of these prospective cohort studies, the reference group is sedentary or inactive, and vigorous activity required ≥6 METs. The most conservative multivariate relative risk is cited. HA is the 15-year Harvard Alumni Health Study of 13,485 men (Lee & Paffenbarger, 2000); HP is the 12-year Health Professionals' Follow-Up Study of 44,452 men (Tanasescu, Leitzmann, Rimm, & Hu, 2003); HUNT is the 16-year Hunt Study, Norway, of 27,143 men and 28,929 women (Wisloff et al., 2006); JACC is the 10-year Japanese Collaborative Cohort Study of 31,023 men and 42,242 women (Noda et al., 2005); FT is the 17-year Finnish Twin Cohort of 7925 men (Kujala, Kaprio, Sarna, & Koskenvuo, 1998); NHS is the 8-year Nurses' Health Study of 70,102 women (Hu et al., 1999); WHIOS is the 3-year Women's Health Initiative Observational Study of 73,743 post-menopausal women (Manson et al., 2002); and WHS is the 5-year Women's Health Study of 39,372 women (Lee, Rexrode, Cook, Manson, & Buring, 2001).

Table II. Perception of effort for various physical activities in men aged 20–29 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (10.1)	Below average (11.5)	Average (12.5)	Above average (13.8)	Well above average (15.4)
Vacuuming or mopping (3.5)	Light	Light	Light	Light	Light
Brisk walking (3.8)	Light	Light	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Light	Light	Light	Light
Mowing lawn with power mower (4.5)	Moderate	Light	Light	Light	Light
Tennis, doubles (6)	Moderate	Moderate	Moderate	Moderate	Light
Badminton, competitive (7)	Hard	Hard	Moderate	Moderate	Moderate
Circuit training or jogging at 5 mph (8)	Hard	Hard	Hard	Moderate	Moderate
Cycling at 14.0–15.9 mph (10)	Maximal	Very hard	Hard	Hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Maximal	Very hard
*Fitness levels from 2606 men, courtesy of The Cooper Institute, Dallas, TX: well below average is 10th percentile, below average is 30th percentile, average is 50th percentile, above average is 70th percentile, and well above average is 90th percentile. METs are metabolic equivalents, where one MET is equivalent to the energy expended at rest. MET costs from Ainsworth and colleagues' (1993, 2000) compendia. Perceived effort estimated by equating RPE scores with exercise intensity: “very light” on the 6–20 RPE scale is equivalent to <20% of aerobic capacity, “light” is 20–39%, “moderate” is 40–59%, “hard” is 60–84%, “very hard” is (≥85%, and maximal is around 100% of aerobic capacity (American College of Sports Medicine, 1998). For example, brisk walking (a 3.8-MET activity) is perceived as “moderate” in an individual with a 9.2-MET capacity (3.8/9.2 = 41% of aerobic capacity). “Hard” is equivalent to “vigorous”. “Impossible” indicates that the activity is more demanding than the individual's aerobic capacity and is therefore unsustainable.

Table III. Perception of effort for various physical activities in men aged 30–39 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (9.6)	Below average (11.0)	Average (12.1)	Above average (13.4)	Well above average (15)
Vacuuming or mopping (3.5)	Light	Light	Light	Light	Light
Brisk walking (3.8)	Moderate	Light	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Light	Light	Light	Light
Mowing lawn with power mower (4.5)	Moderate	Moderate	Light	Light	Light
Tennis, doubles (6)	Hard	Moderate	Moderate	Moderate	Moderate
Badminton, competitive (7)	Hard	Hard	Moderate	Moderate	Moderate
Circuit training or jogging at 5 mph (8)	Hard	Hard	Hard	Hard	Moderate
Cycling at 14.0–15.9 mph (10)	Impossible	Very hard	Hard	Hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Very hard
*Fitness levels from 13,158 men, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table IV. Perception of effort for various physical activities in men aged 40–49 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (9.1)	Below average (10.5)	Average (11.5)	Above average (12.6)	Well above average (14.6)
Vacuuming or mopping (3.5)	Light	Light	Light	Light	Light
Brisk walking (3.8)	Moderate	Light	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Light	Light	Light	Light
Mowing lawn with power mower (4.5)	Moderate	Moderate	Light	Light	Light
Tennis, doubles (6)	Hard	Moderate	Moderate	Moderate	Moderate
Badminton, competitive (7)	Hard	Hard	Hard	Moderate	Moderate
Circuit training or jogging at 5 mph (8)	Very hard	Hard	Hard	Hard	Moderate
Cycling at 14.0–15.9 mph (10)	Impossible	Very hard	Very hard	Hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Very hard
*Fitness levels from 16,534 men, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table V. Perception of effort for various physical activities in men aged 50–59 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (8.1)	Below average (9.5)	Average (10.5)	Above average (11.7)	Well above average (13.4)
Vacuuming or mopping (3.5)	Moderate	Light	Light	Light	Light
Brisk walking (3.8)	Moderate	Moderate	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Moderate	Light	Light	Light
Mowing lawn with power mower (4.5)	Moderate	Moderate	Moderate	Light	Light
Tennis, doubles (6)	Hard	Hard	Moderate	Moderate	Moderate
Badminton, competitive (7)	Very hard	Hard	Hard	Hard	Moderate
Circuit training or jogging at 5 mph (8)	Maximal	Hard	Hard	Hard	Moderate-to-hard
Cycling at 14.0-15.9 mph (10)	Impossible	Impossible	Very hard	Very hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Maximal
*Fitness levels from 9102 men, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table VI. Perception of effort for various physical activities in men aged 60–69 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (6.9)	Below average (8.4)	Average (9.4)	Above average (10.5)	Well above average (12.3)
Vacuuming or mopping (3.5)	Moderate	Moderate	Light	Light	Light
Brisk walking (3.8)	Moderate	Moderate	Moderate	Light	Light
Cycling at <10 mph (4)	Moderate	Moderate	Moderate	Light	Light
Mowing lawn with power mower (4.5)	Hard	Moderate	Moderate	Moderate	Light
Tennis, doubles (6)	Very hard	Hard	Hard	Moderate	Moderate
Badminton, competitive (7)	Impossible	Hard	Hard	Hard	Moderate
Circuit training or jogging at 5 mph (8)	Impossible	Very hard	Very hard	Hard	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Impossible	Very hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Impossible
*Fitness levels from 2682 men, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table VII. Perception of effort for various physical activities in men aged 70–79 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (5.9)	Below average (7.4)	Average (8.4)	Above average (9.4)	Well above average (11.3)
Vacuuming or mopping (3.5)	Moderate	Moderate	Moderate	Light	Light
Brisk walking (3.8)	Hard	Moderate	Moderate	Moderate	Light
Cycling at <10 mph (4)	Hard	Moderate	Moderate	Moderate	Light
Mowing lawn with power mower (4.5)	Hard	Hard	Moderate	Moderate	Moderate
Tennis, doubles (6)	Maximal	Hard	Hard	Hard	Moderate
Badminton, competitive (7)	Impossible	Maximal	Hard	Hard	Hard
Circuit training or jogging at 5 mph (8)	Impossible	Impossible	Maximal	Very hard	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Impossible	Impossible	Very hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Impossible
*Fitness levels from 467 men, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table VIII. Perception of effort for various physical activities in women aged 20–29 years of different aerobic fitness levels.

	Aerobic fitness levels (METs)*
Activity (MET costs)	Well below average (8.0)	Below average (9.5)	Average (10.8)	Above average (12.1)	Well above average (14.3)
Vacuuming or mopping (3.5)	Moderate	Light	Light	Light	Light
Brisk walking (3.8)	Moderate	Moderate	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Moderate	Light	Light	Light
Mowing lawn with power mower (4.5)	Moderate	Moderate	Moderate	Light	Light
Tennis, doubles (6)	Hard	Hard	Moderate	Moderate	Moderate
Badminton, competitive (7)	Very hard	Hard	Hard	Moderate	Moderate
Circuit training or jogging at 5 mph (8)	Maximal	Hard	Hard	Hard	Moderate
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Very hard	Hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Very hard
*Fitness levels from 1350 women, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table IX. Perception of effort for various physical activities in women aged 30–39 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (7.3)	Below average (9.0)	Average (10.0)	Above average (11.3)	Well above average (13.3)
Vacuuming or mopping (3.5)	Moderate	Light	Light	Light	Light
Brisk walking (3.8)	Moderate	Moderate	Light	Light	Light
Cycling at <10 mph (4)	Moderate	Moderate	Moderate	Light	Light
Mowing lawn with power mower (4.5)	Hard	Moderate	Moderate	Moderate	Light
Tennis, doubles (6)	Hard	Hard	Hard	Moderate	Moderate
Badminton, competitive (7)	Very hard	Hard	Hard	Hard	Moderate
Circuit training or jogging at 5 mph (8)	Impossible	Very hard	Hard	Hard	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Maximal	Very hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Maximal
*Fitness levels from 4394 women, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table X. Perception of effort for various physical activities in women aged 40–49 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (6.7)	Below average (8.1)	Average (9.3)	Above average (10.5)	Well above average (12.5)
Vacuuming or mopping (3.5)	Moderate	Moderate	Light	Light	Light
Brisk walking (3.8)	Moderate	Moderate	Moderate	Light	Light
Cycling at <10 mph (4)	Hard	Moderate	Moderate	Light	Light
Mowing lawn with power mower (4.5)	Hard	Moderate	Moderate	Moderate	Light
Tennis, doubles (6)	Very hard	Hard	Hard	Moderate	Moderate
Badminton, competitive (7)	Impossible	Very hard	Hard	Hard	Moderate
Circuit training or jogging at 5 mph (8)	Impossible	Impossible	Very hard	Hard	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Impossible	Very hard	Hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Impossible
*Fitness levels from 4834 women, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table XI. Perception of effort for various physical activities in women aged 50–59 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (6.0)	Below average (7.3)	Average (8.3)	Above average (9.2)	Well above average (11.0)
Vacuuming or mopping (3.5)	Moderate	Moderate	Moderate	Light	Light
Brisk walking (3.8)	Hard	Moderate	Moderate	Moderate	Light
Cycling at <10 mph (4)	Hard	Moderate	Moderate	Moderate	Light
Mowing lawn with power mower (4.5)	Hard	Hard	Moderate	Moderate	Moderate
Tennis, doubles (6)	Maximal	Hard	Hard	Hard	Moderate
Badminton, competitive (7)	Impossible	Maximal	Hard	Hard	Hard
Circuit training or jogging at 5 mph (8)	Impossible	Impossible	Maximal	Very hard	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Impossible	Impossible	Very hard
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Impossible
*Fitness levels from 3103 women, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table XII. Perception of effort for various physical activities in women aged 60–69 years of different aerobic fitness levels.

Activity (MET costs)	Aerobic fitness levels (METs)*
	Well below average (5.3)	Below average (6.4)	Average (7.3)	Above average (8.3)	Well above average (9.8)
Vacuuming or mopping (3.5)	Hard	Moderate	Moderate	Moderate	Light
Brisk walking (3.8)	Hard	Moderate	Moderate	Moderate	Light
Cycling at <10 mph (4)	Hard	Hard	Moderate	Moderate	Moderate
Mowing lawn with power mower (4.5)	Very hard	Hard	Hard	Moderate	Moderate
Tennis, doubles (6)	Impossible	Very hard	Hard	Hard	Hard
Badminton, competitive (7)	Impossible	Impossible	Maximal	Hard	Hard
Circuit training or jogging at 5 mph (8)	Impossible	Impossible	Impossible	Maximal	Hard
Cycling at 14.0–15.9 mph (10)	Impossible	Impossible	Impossible	Impossible	Maximal
Running at 8 mph (13.5)	Impossible	Impossible	Impossible	Impossible	Impossible
*Fitness levels from 1088 women, courtesy of The Cooper Institute, Dallas, TX. See footnote to Table II.

Table XIII. Classification of overweight and obesity by body mass index (BMI), waist circumference, and associated disease risks in Caucasians.

		Disease risk relative to normal weight and waist circumference*
		Waist circumference
	BMI	Men ≤ 102 cm	Men > 102 cm
Classification	(kg · m^−2)	Women ≤ 88 cm	Women > 88 cm
Underweight	<18.5	–	–
Normal	18.5–24.9	–	–
Overweight^#	25.0–29.9	Increased	High
Obese I	30.0–34.9	High	Very high
Obese II	35.0–39.9	Very high	Very high
Extreme obese	≥40	Extremely high	Extremely high
*Disease risk for type 2 diabetes, hypertension, and cardiovascular disease. ^#Increased waist circumference can also be a marker for increased risk even in persons of normal weight. From Expert Panel on the Identification, Evaluation, and Treatment of Overweight in Adults (1998).

Table XIV. Classification of overweight and obesity by body mass index (BMI), waist circumference, and associated disease risks in Asians*.

		Risk of co-morbidities
		Waist circumference
		Men <90 cm	Men >90 cm
Classification	BMI (kg · m^−2)	Women <80 cm	Women >80 cm
Underweight	<18.5	Low^#	Average
Normal	18.2–22.9	Average	Increased
Overweight	≥23
At risk	23–24.9	Increased	Moderate
Obese I	25–29.9	Moderate	Severe
Obese II	≥30	Severe	Very severe
*Waist girth thresholds for obesity have been identified for specific ethnic groups, including Chinese men (≥90 cm), Chinese women (≥80 cm), Japanese men (≥85 cm), and Japanese women (≥90 cm) (Alberti, Zimmet, & Shaw, 2005). ^#The risk of type 2 diabetes, hypertension, and cardiovascular disease is low in underweight individuals, but the risk of other clinical problems is increased. From World Health Organization (2000).

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