A daily step count of 9,000 to 10,000 may counteract the risk of death and cardiovascular disease in highly sedentary people.

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Increased step count linked to lower risk regardless of time spent sedentary
Increased step count is linked to lower risk regardless of sedentary time.

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In good news for office workers, a new study from the University of Sydney’s Charles Perkins Centre (Australia) has found increasing your step count may counteract the health consequences of too much sedentary time each day.

The study of over 72,000 people, published in the British Journal of Sports Medicine, found every additional step up to around 10,000 steps a day was linked to reduced risk of death (39 per cent) and cardiovascular disease (21 per cent) regardless of how much remaining time was spent sedentary.

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Previous studies have shown an association between greater daily step count and lower levels of death and CVD, and separate studies have linked high levels of sedentary behaviour with increased risks of CVD and death. However, this is the first to measure objectively, via wrist-worn wearables, if daily steps could offset the health risks of high sedentary behaviour.

Lead author and research fellow Dr Matthew Ahmadi said: “This is by no means a get-out-of-jail card for sedentary people for excessive periods. However, it does hold an important public health message that all movement matters and that people can and should try to offset the health consequences of unavoidable sedentary time by upping their daily step count.”

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Senior author Professor Emmanuel Stamatakis, Director of the Mackenzie Wearables Research Hub at the Charles Perkins Centre, said this growing body of physical activity research using device-based measurement provided huge opportunities for public health.

“Step count is a tangible and easily understood measure of physical activity that can help people in the community, and indeed health professionals, accurately monitor physical activity. We hope this evidence will inform the first generation of device-based physical activity and sedentary behaviour guidelines, which should include key recommendations on daily stepping,” said Professor Stamatakis.

How was the study conducted?

Researchers used data on 72,174 individuals (average age 61; 58% female) from the UK Biobank study – a major biomedical database – who had worn an accelerometer device on their wrist for seven days to measure their physical activity. The accelerometer data were used to estimate daily step count and time spent sedentary: sitting or lying down while awake.

The research team then followed the health trajectory of the participants by linking hospitalisation data and death records.

The median daily step count for participants was 6222 steps/day, and 2200 steps/day (the lowest 5 percent of daily steps among all participants) was taken as the comparator for assessing the impact of increasing step count on death and CVD events.

The median time spent sedentary was 10.6 hours/day, so study participants who spent 10.5 hours/day or more sedentary were considered to have high sedentary time, while those who spent less than 10.5 hours/day sedentary were classified as having low sedentary time.

Adjustments were made to eliminate biases, such as excluding participants with poor health who were underweight or had a health event within two years of follow-up. Researchers also took into account factors such as age, sex, ethnicity, education, smoking status, alcohol consumption, diet and parental history of CVD and cancer.

What did they find?

Over an average 6.9 years follow up, 1633 deaths and 6190 CVD events occurred.

After taking into account other potential influences, the authors calculated that the optimal number of steps per day to counteract high sedentary time was between 9000 and 10000 steps/day, which lowered mortality risk by 39 per cent and incident CVD risk by 21 per cent.

In both cases, 50 per cent of the benefit was achieved between 4000 and 4500 steps daily.

Study limitations

This is an observational study, so it can’t establish direct cause and effect. Although the large sample size and long follow-up allowed the risk of bias to be reduced, the authors acknowledge the possibility that other unmeasured factors could affect results. They add that steps and sedentary time were obtained in a single time point, which could also lead to bias.

Nevertheless, they conclude, “Any amount of daily steps above the referent 2200 steps/day was associated with lower mortality and incident CVD risk, for low and high sedentary time. Accruing between 9000 and 10,000 steps a day optimally lowered the risk of mortality and incident CVD among highly sedentary participants.”

Are ChatGPT exercise recommendations just what the doctor ordered?

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Pescatello

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Linda Pescatello from UConn’s College of Agriculture, Health and Natural Resources. CREDIT Jason Sheldon/UConn Photo

According to a new UConn study, ChatGPT’s output provided only 41% of the content expected in a gold-standard exercise recommendation

Since its debut in late 2022, people have experimented with using the AI (artificial intelligence) chat bot ChatGPT for everything from recipe planning to answering trivia to helping with homework. But ChatGPT has been mired in issues concerning its accuracy.

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Regular physical activity is critical for health and disease prevention, yet only 25% of U.S. adults meet national physical activity guidelines. Since the public premiere of ChatGPT, people have been using the tool to generate physical activity plans.

A team composed of researchers from UConn’s College of Agriculture, Health and Natural Resources and Hartford Hospital recently investigated the accuracy of ChatGPT’s exercise recommendations. They published these findings in the Journal of Medical Internet Research Medical Education in a special issue dedicated to ChatGPT and Generative Language Models in Medical Education. The team was led by Amanda Zaleski ’08, ’14, ’18 (CAHNR), a senior scientist in the Department of Preventive Cardiology at Hartford Hospital.

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“It’s a big topic and nobody knows what to do with it,” says Distinguished Professor of Kinesiology Linda Pescatello.

The research team developed a formal grading rubric to score the AI-generated exercise recommendations. The rubric included ten categories that comprise a “gold-standard” exercise recommendation according to the American College of Sports Medicine (ACSM) Guidelines for Exercise Testing and Prescription. Pescatello was already very familiar with these recommendations. She was a member of the 2018 Physical Activity Guidelines Advisory which established them.

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he AI chatbot was then prompted to provide individualized exercise recommendations for all 26 clinical populations for which there exists an evidence base in the ACSM Guidelines. The team then compared AI-generated exercise recommendations to the gold-standard reference and evaluated their comprehensiveness, accuracy, and readability.

The researchers found that ChatGPT’s output provided only 41% of the content expected in a gold-standard exercise recommendation indicating poor comprehensiveness.

The chat bot was able to provide general recommendations, such as getting 150 minutes of exercise per week, but failed to provide guidance on other key elements such as the frequency, intensity, time, and type, also known as the FITT principle of physical activity.

However, of the content provided, ChatGPT output demonstrated high accuracy, around 91%.

The most common source of misinformation was the recommendation to seek medical clearance prior to engaging in any exercise, which is generally not necessary except when a person is having signs and symptoms of disease.

The AI chatbot also failed to account for special considerations such as how the medications a person is taking may interact with a new exercise regime.

In addition, the ChatGPT output was written at the college-level. This is well above the American Medical Association’s recommendation that health-related educational material be written at a level a sixth grader could understand.

The researchers recommend being cautious with following exercise recommendations from ChatGPT, understanding it does not provide a complete physical activity program.

Compounding these findings is another paper by Pescatello’s team led by Shiqi Chen, a master’s student, which analyzed existing mobile apps for exercise recommendations. This work was published in the Journal of Cardiovascular Development and Disease.

They determined that there was no app currently on the market that offered evidence-based exercise recommendations for people with cardiovascular disease risk factors in line with ACSM’s and American Heart Association guidelines.

“We did not find a single app on the market that did that,” Pescatello says.

The 219 apps they studied were highly rated with more than 1,000 reviews, free to download, and not gender specific. A mere 0.5% of the apps were evidence-based. Only 3.7% included a preparticipation screening and less than a third built cardiovascular disease risk profiles.

A majority of the apps (64.8%) focused on body image and/or athletic performance rather than health.

Within this environment of uncertainty and shortcomings, Pescatello has developed her own tool, P3-EX LLC, which offers evidence-based personalized exercise recommendations for those with cardiovascular disease risk factors.

Clinicians can use the tool to generate an exercise recommendation in less than five minutes. This is a critical resource as most doctors do not receive training on generating exercise prescriptions in medical school.

“Our research shows that  we’re touching on something and identifying an unmet clinical need,” Pescatello says.

While the tool is currently only available to clinicians, Pescatello hopes to scale P3-EX so that one day it may be available to the public.

The tool is used in the exercise prescription program at UConn.

“Our mission is to get people to realize the value of exercise and provide that value with tools that can make exercise more accessible and increase adherence,” Pescatello says.

Women get the same exercise benefits as men, but with less effort.

Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men
Smidt Heart Institute Study, published in Journal of the American College of Cardiology, shows women get more heart health benefit from exercise than men

A new study from the Smidt Heart Institute at Cedars-Sinai shows there is a gender gap between women and men when it comes to exercise.

The findings, published in the Journal of the American College of Cardiology (JACC), show that women can exercise less often than men, yet receive greater cardiovascular gains.   

“Women have historically and statistically lagged behind men in engaging in meaningful exercise,” said Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research and co-lead author of the study. “The beauty of this study is learning that women can get more out of each minute of moderate to vigorous activity than men do. It’s an incentivizing notion that we hope women will take to heart.”

Investigators analyzed data from 412,413 U.S. adults utilizing the National Health Interview Survey database. Participants between the time frame of 1997 to 2019—55% of whom were female—provided survey data on leisure-time physical activity. Investigators examined gender-specific outcomes in relation to frequency, duration, intensity and type of physical activity.

“For all adults engaging in any regular physical activity, compared to being inactive, mortality risk was expectedly lower,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute, and senior author of the study. “Intriguingly, though, mortality risk was reduced by 24% in women and 15% in men.”

The research team then studied moderate to vigorous aerobic physical activity, such as brisk walking or cycling, and found that men reached their maximal survival benefit from doing this level of exercise for about five hours per week, whereas women achieved the same degree of survival benefit from exercising just under about 2 ½ hours per week.

Similarly, when it came to muscle-strengthening activity, such as weightlifting or core body exercises, men reached their peak benefit from doing three sessions per week and women gained the same amount of benefit from about one session per week.

Cheng said that women had even greater gains if they engaged in more than 2 ½ hours per week of moderate to vigorous aerobic activity, or in two or more sessions per week of muscle-strengthening activities. The investigators note their findings help to translate a longstanding recognition of sex-specific physiology seen in the exercise lab to a now-expanded view of sex differences in exercise-related clinical outcomes.

With all types of exercise and variables accounted for, Gulati says there’s power in recommendations based on the study’s findings. “Men get a maximal survival benefit when performing 300 minutes of moderate to vigorous activity per week, whereas women get the same benefit from 140 minutes per week,” Gulati said. “Nonetheless, women continue to get further benefit for up to 300 minutes a week.”

Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, says concrete, novel studies like this don’t happen often.

“I am hopeful that this pioneering research will motivate women who are not currently engaged in regular physical activity to understand that they are in a position to gain tremendous benefit for each increment of regular exercise they are able to invest in their longer-term health,” said Albert, professor of Cardiology.

Walking, jogging, yoga and strength training ease depression

Even low intensity activities are beneficial, but the more vigorous the activity, the greater the benefits
Even low-intensity activities are beneficial, but the more vigorous the activity, the greater the benefits.

Walking or jogging, yoga and strength training seem to be the most effective exercises to ease depression, either alone or alongside established treatments such as psychotherapy and drugs, suggests an evidence review published by The BMJ today.

Even low-intensity activities such as walking or yoga are beneficial, but the results suggest that the more vigorous the activity, the greater the benefits are likely to be.

The authors stress that confidence in many of the findings remains low and more high-quality studies are needed, but they say these forms of exercise “could be considered alongside psychotherapy and drugs as core treatments for depression.”

The World Health Organization estimates that more than 300 million people worldwide have depression. Exercise is often recommended alongside psychotherapy and drugs, but treatment guidelines and previous evidence reviews disagree on how to prescribe exercise to treat depression best.

To address this uncertainty, researchers trawled databases looking for randomised trials that compared exercise as a treatment for depression with established treatments (eg, SSRI antidepressants, cognitive behavioural therapy), active controls (eg, usual care, placebo tablet), or untreated controls.



They found 218 relevant trials involving 14,170 participants with depression for analysis. Each trial was assessed for bias and the type, intensity and frequency of each exercise intervention was recorded.

Other potentially influential factors such as participants’ sex, age, baseline levels of depression, existing conditions, and differences between groups were also taken into account.

Compared with active controls, large reductions in depression were found for dance and moderate reductions for walking or jogging, yoga, strength training, mixed aerobic exercises and tai chi or qigong.

Moderate, clinically meaningful effects were also found when exercise was combined with SSRIs or aerobic exercise was combined with psychotherapy, suggesting that exercise could provide added benefit alongside these established treatments.

Although walking or jogging were effective for both men and women, strength training was more effective for women, and yoga or qigong was more effective for men. Yoga was also more effective among older adults, while strength training was more effective among younger people.

And while light physical activity such as walking and yoga still provided clinically meaningful effects, the benefits were greater for vigorous exercise such as running and interval training.

Exercise appeared equally effective for people with and without other health conditions and with different baseline levels of depression. Effects were also similar for individual and group exercise.

The authors acknowledge that the quality of evidence is low and very few trials monitored participants for one year or more. Many patients may also have physical, psychological, or social barriers to participation, they note.

Nevertheless, they suggest a combination of social interaction, mindfulness, and immersion in green spaces that may help explain the positive effects.

“Our findings support the inclusion of exercise as part of clinical practice guidelines for depression, particularly vigorous intensity exercise,” they say. “Health systems may want to provide these treatments as alternatives or adjuvants to other established interventions, while also attenuating risks to physical health associated with depression.”

“Primary care clinicians can now recommend exercise, psychotherapy, or antidepressants as standalone alternatives for adults with mild or moderate depression,” explains Juan Ángel Bellón at the University of Malaga in a linked editorial.

He points out that taking regular exercise can be challenging for people with depression and says studies using real world data are needed to evaluate physical activity programmes for people with depression.

He notes that the European Union has recently committed to promoting exercise across member states and urges health services and local and national administrations to “provide enough resources to make individualised and supervised exercise programmes accessible to the entire population.”

Find out about the benefits of resistance exercise training in treatment of anxiety and depression.

A new study by researchers at University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.
A new study by researchers at the University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.

A new study by researchers at the University of Limerick in Ireland and at Iowa State University has demonstrated the impact resistance exercise training can have in the treatment of anxiety and depressive symptoms.

The new study provides evidence to support the benefits resistance exercise training can have on anxiety and depression and offers an examination of possible underlying mechanisms.

The research, published in the Trends in Molecular Medicine journal, was carried out by Professor Matthew P Herring at the University of Limerick and Professor Jacob D Meyer at Iowa State University.

The researchers said there was “exciting evidence” that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression-like more established therapies while also improving other important aspects of health.

Dr Herring explained: “Anxiety and depressive symptoms and disorders are prevalent and debilitating public health burdens for which successful treatment is limited.

“The healthful benefits of resistance exercise training, or muscle-strengthening exercise involving exerting force against a load repeatedly to generate a training response, are well-established,” said Dr Herring, Associate Professor in the Physical Activity for Health Research Centre, Health Research Institute, and Department of Physical Education and Sport Sciences within the Faculty of Education and Health Sciences in UL.

“However, the potential impact of resistance exercise training in the treatment of anxiety and depressive symptoms and disorders remains relatively understudied. Moreover, the plausible psychobiological mechanisms that help us better understand how and why resistance exercise training may improve these mental health outcomes are poorly understood.”

The researchers argue that, while the available studies in this area are focused on relatively small sample sizes, there is sufficient evidence from previous and ongoing research at UL and the National Institute of Health-funded research with Dr Meyer and colleagues at Iowa State University to suggest that resistance exercise training does improve anxiety and depressive symptoms and disorders – though disorders themselves are scarcely studied.

“There is a critical need for confirmatory, definitive trials that adequately address limitations, including small sample sizes, but the limited evidence available to us provides initial support for the beneficial effects of resistance exercise training on these mental health outcomes, including increased insulin-like growth factor 1, cerebrovascular adaptations, and potential neural adaptations influenced by controlled breathing inherent to resistance exercise,” Dr Herring explained.

“We are tremendously excited to have what we expect to be a highly cited snapshot of the promising available literature that supports resistance exercise training in improving anxiety and depression. 

“Notwithstanding the limitations of the limited number of studies to date, there is exciting evidence, particularly from our previous and ongoing research of the available studies, that suggests that resistance exercise training may be an accessible alternative therapy to improve anxiety and depression.

“A more exciting aspect is that there is substantial promise in investigating the unknown mechanisms that may underlie these benefits to move us closer to maximizing benefits and to optimising the prescription of resistance exercise via precision medicine approaches,” Dr Herring added.

Professor Meyer, a co-author on the study, said: “The current research provides a foundation for testing if resistance training can be a key behavioural treatment approach for depression and anxiety.

“As resistance training likely works through both shared and distinct mechanisms to achieve its positive mood effects compared to aerobic exercise, it has the potential to be used in conjunction with aerobic exercise or as a standalone therapy for these debilitating conditions.

“Our research will use the platform established by current research as a springboard to comprehensively evaluate these potential benefits of resistance exercise in clinical populations while also identifying who would be the most likely to benefit from resistance exercise.”