More intensity with less time: two studies could change the recommendations of physical exercise as preventive medicine

What if your GP told you in office that doing two two-minute bouts of intense physical exercise Monday through Friday could reduce your risk of cardiovascular disease by 40%?

What if you, who have cardiovascular risk factors such as diabetes or hypertension, were assured by your cardiologist that with four two-minute bursts of vigorous exercise daily you could reduce your mortality risk by 27%?

Different studies, some of them carried out and published by Spanish researchers, had already shown in recent years that intense physical exercise has greater benefits for cardiovascular health.

Now, two investigations, published together in the October issue of the

with data from more than 70,000 adults from the UK Biobank, have the potential to "mark a before and after" in physical exercise recommendations. as a preventive medicine measure, according to Dr. Fernando de la Guía, coordinator of the Sports Cardiology working group of the Spanish Society of Cardiology and head of Cardiology at the Glorieta Dénia Polyclinic (Alicante).

"The phrase 'sport is the best medicine' becomes more evident than ever with these studies," adds the cardiologist, who highlights the importance of these investigations due to a differential factor: previous studies published in this regard used self-reports to determine the level of of physical activity, "which is not at all necessary to limit duration and intensity."

The two investigations published in the

, however, used accelerometers to accurately and objectively measure the movement and intensity of physical activity performed by the participants.

“Questionnaire-based studies have suggested that 60 to 70 minutes a week of vigorous activity could reduce mortality risk by 30%.

The recent study by Dr. Matthew N. Ahmadi suggests that a minimum dose of 20 minutes per week of 'real' vigorous physical activity provides similar levels of lower mortality risk.

That is to say, an approximate equivalence of 3:1 of the activity time measured by questionnaires and accelerometers”, argues De la Guía.

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Great benefits with short periods of intense physical activity

The research led by Dr. Ahmadi, from the University of Sydney, followed nearly 72,000 adults (56% women and mean age 62.5 years) for seven years without cardiovascular disease or cancer.

Through the data obtained with this follow-up, they have discovered that just 15 minutes of vigorous physical activity a week could reduce mortality from all causes and the risk of cancer by 15%.

Extending that time by another five minutes, up to 20 a week, could reduce the risk of heart disease by 40%.

“The minimum dose of vigorous physical exercise for health benefits was approximately 15-20 minutes per week, but we have found additional health benefits up to approximately 50-60 minutes per week, where the sweet spot would be. , with a 36% lower risk of death from any cause”, explains the author of the research to EL PAÍS.

It has not been the only great discovery of the investigation.

According to data obtained from accelerometers, these health benefits could accrue through short bouts of intense physical activity lasting up to two minutes.

“One of the most unique results of our study was that vigorous physical activity did not need to be accumulated over long periods of time to obtain health benefits.

Therefore, any physical activity a person engages in provides the opportunity for vigorous physical activity, if they can perform the activity at a faster pace or at a higher intensity for short periods of time.

This can be particularly important for people who don't have the time or don't want to go to a gym or do traditional exercise,” says Dr. Ahmadi.

“It is that even in those people with poor physical condition who have cardiovascular risk factors (diabetes, hypertension, obesity, etc.), doing this vigorous exercise in short bursts of time of up to two minutes and four times a day reduces mortality by a 27%”, says Dr. Fernando de la Guía with enthusiasm, who wonders which pill or medicine that is part of the pharmacy arsenal of the cardiology clinic can provide these results.

"Now there's no excuse that I don't have time, because piling up small amounts of vigorous exercise throughout the day throughout the week can be done by anyone," he adds.

Prioritize intensity without forgetting quantity

The second investigation points in the same direction after following more than 80,000 adults for almost seven years (58% women and 62 years on average).

After analyzing the accelerometer data, the researchers found that the total volume of physical activity was strongly associated with a decreased risk of cardiovascular disease.

Also that the greater the part of the total volume of physical activity that was obtained from moderate or intense exercise, the greater the reduction in cardiovascular risk.

“We found that when overall levels of physical activity were doubled, there was no significant effect on cardiovascular disease rates when the proportion of moderate to vigorous physical activity was maintained at 10% of the total.

However, the risk of cardiovascular disease was reduced by 23% and 40% when the proportion of moderate to vigorous physical activity increased to represent 20% and 40% of the total, respectively," replies by email. The study's lead author, Dr. Paddy C. Dempsey, a researcher at the British Universities of Leicester and Cambridge.

Despite these data, however, Dempsey prefers not to speak of a "paradigm shift" in the recommendations for physical exercise for health.

“One could interpret the results as a counterargument of 'quality versus quantity' for improving cardiovascular disease health.

For some this can be useful, especially if they do not have time.

However, it would be wrong for me to say that “loudness doesn't matter”, since intensity and volume are intrinsically related.

Instead of facing quality and quantity, I would be more in favor of talking about different options or ways to achieve benefits through physical exercise, so that each person can choose or gravitate towards an approach that works best for them, ”he reasons. the scientist.

In the same sense, Dr. Fernando de la Guía, who agrees with Dempsey, agrees that what is recommended is the correct association of both factors, intensity and volume, being clear at all times that it is not the same to take a walk at a slow pace, with a low cadence, than doing it with a more energetic rhythm.

"These two studies confirm that every movement counts and that little exercise is better than none to improve our health, but we also now know that the intensity of this physical activity plays a significant role, even above the total volume of exercise," he concludes. .

How the intensity of physical activity is measured

How do I know if the exercise I am doing is light, moderate or intense?

As explained by Dr. Fernando de la Guía, the intensity of physical activity is measured in METs, which is the metabolic rate or oxygen consumption per minute for an adult at rest.

1 MET is equivalent to 3.5 ml O2/kg/min. 

Up to 3 METs of oxygen consumption per minute we would talk about light activity.

Domestic activities or activities that involve sitting or resting most of the time would be found in this range.

For example, watching television while lying down, sitting down working on the computer or reading, or standing up ironing or getting dressed.

Also walking on flat terrain and without printing any speed at our pace.

Between 3 and 6 METs we would already be talking about moderate physical activities.

This step would also include certain domestic activities that involve more movement (sweeping, vacuuming, scrubbing the floor), as well as going up or down the stairs to the house, carrying light objects or light physical activities (table tennis, golf) or other practiced with moderate intensity (dancing, hiking, soccer, basketball or tennis at moderate levels).

From 6 METs an activity is considered intense or vigorous.

This would include loading and unloading work that involves large volumes, high-intensity farm or garden work, running up or down stairs, or any physical activity (running, aerobics, swimming, skiing, climbing, or playing soccer, basketball, or basketball). any other sport) practiced intensely. 

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