Chapter 7: Additional Considerations for Some Adults
All Americans should be physically active to improve overall health and
fitness and to prevent many adverse health outcomes. Most Americans should
follow the Guidelines of the child and adolescent, adult, or older adult
chapters, depending upon their age. However, some people have conditions that
raise special issues about recommended types and amounts of physical activity.
This chapter provides guidance on physical activity for healthy women who are
pregnant and for people with disabilities. This chapter also affirms and
illustrates how physical activity is generally appropriate for adults with
chronic conditions by considering three groups of adults:
- Adults with osteoarthritis;
- Adults with type 2 diabetes; and
- Adults who are cancer survivors.
Physical Activity for Women During Pregnancy and the Postpartum
Physical activity during pregnancy benefits a woman's overall
health. For example, moderate-intensity physical activity by healthy women
during pregnancy maintains or increases cardiorespiratory fitness.
Strong scientific evidence shows that the risks of moderate-intensity
activity done by healthy women during pregnancy are very low, and do not
increase risk of low birth weight, preterm delivery, or early pregnancy loss.
Some evidence suggests that physical activity reduces the risk of pregnancy
complications, such as preeclampsia and gestational diabetes, and reduces the
length of labor, but this evidence is not conclusive.
During a normal postpartum period, regular physical activity continues
to benefit a woman's overall health. Studies show that moderate-intensity
physical activity during the period following the birth of a child increases a
woman's cardiorespiratory fitness and improves her mood. Such activity
does not appear to have adverse effects on breast milk volume, breast milk
composition, or infant growth.
Physical activity also helps women achieve and maintain a healthy
weight during the postpartum period, and when combined with caloric
restriction, helps promote weight loss.
Key Guidelines for Women During Pregnancy and the Postpartum
- Healthy women who are not already highly active or doing
vigorous-intensity activity should get at least 150 minutes (2 hours and 30
minutes) of moderate-intensity aerobic activity per week during pregnancy and
the postpartum period. Preferably, this activity should be spread throughout
- Pregnant women who habitually engage in vigorous-intensity aerobic
activity or are highly active can continue physical activity during pregnancy
and the postpartum period, provided that they remain healthy and discuss with
their health-care provider how and when activity should be adjusted over time.
Explaining the Guidelines
Women who are pregnant should be under the care of a health-care
provider with whom they can discuss how to adjust amounts of physical activity
during pregnancy and the postpartum period. Unless a woman has medical reasons
to avoid physical activity during pregnancy, she can begin or continue
moderate-intensity aerobic physical activity during her pregnancy and after the
baby is born.
When beginning physical activity during pregnancy, women should
increase the amount gradually over time. The effects of vigorous-intensity
aerobic activity during pregnancy have not been studied carefully, so there is
no basis for recommending that women should begin vigorous-intensity activity
Women who habitually do vigorous-intensity activity or high amounts of
activity or strength training should continue to be physically active during
pregnancy and after giving birth. They generally do not need to drastically
reduce their activity levels, provided that they remain healthy and discuss
with their health-care provider how to adjust activity levels during this time.
During pregnancy, women should avoid doing exercises involving lying on
their back after the first trimester of pregnancy. They should also avoid doing
activities that increase the risk of falling or abdominal trauma, including
contact or collision sports, such as horseback riding, downhill skiing, soccer,
Physical Activity for People With Disabilities
The benefits of physical activity for people with disabilities have
been studied in diverse groups. These groups include stroke victims, people
with spinal cord injury, multiple sclerosis, Parkinson's disease, muscular
dystrophy, cerebral palsy, traumatic brain injury, limb amputations, mental
illness, intellectual disability, and dementia.
Overall, the evidence shows that regular physical activity provides
important health benefits for people with disabilities. The benefits include
improved cardiovascular and muscle fitness, improved mental health, and better
ability to do tasks of daily life. Sufficient evidence now exists to recommend
that adults with disabilities should get regular physical activity. Physical
activity in children and adolescents with disabilities is considered in
Chapter 3—Active Children and Adolescents.
Key Guidelines for Adults With Disabilities
- Adults with disabilities, who are able to, should get at least 150
minutes per week (2 hours and 30 minutes) of moderate-intensity, or 75 minutes
(1 hour and 15 minutes) per week of vigorous-intensity aerobic activity, or an
equivalent combination of moderate- and vigorous-intensity aerobic activity.
Aerobic activity should be performed in episodes of at least 10 minutes, and
preferably, it should be spread throughout the week.
- Adults with disabilities, who are able to, should also do
muscle-strengthening activities of moderate or high intensity that involve all
major muscle groups on 2 or more days per week as these activities provide
additional health benefits.
- When adults with disabilities are not able to meet the above
Guidelines, they should engage in regular physical activity according to their
abilities and should avoid inactivity.
- Adults with disabilities should consult their health-care providers
about the amounts and types of physical activity that are appropriate for their
Explaining the Guidelines
In consultation with their health-care providers, people with
disabilities should understand how their disabilities affect their ability to
do physical activity. Some may be capable of doing medium to high amounts of
physical activity, and they should essentially follow the Guidelines for
Some people with disabilities are not able to follow the Guidelines for
adults. These people should adapt their physical activity program to match
their abilities, in consultation with their health-care providers. Studies show
that physical activity can be done safely when the program is matched to an
Meeting the Guidelines
People with disabilities are encouraged to get advice from professionals
with experience in physical activity and disability because matching activity
to abilities can require modifying physical activity in many different ways.
Some people with disabilities also need help with their exercise program. For
example, some people may need supervision when performing muscle-strengthening
activities, such as lifting weights.
Physical Activity for People With Chronic Medical Conditions
Adults with chronic conditions should engage in regular physical
activity because it can help promote their quality of life and reduce the risk
of developing new conditions. The type and amount of physical activity should
be determined by a person's abilities and the severity of the chronic
condition. Three examples are provided below to illustrate the benefits of
physical activity for persons with chronic conditions.
For many chronic conditions, physical activity provides therapeutic
benefits and is part of recommended treatment for the condition. However, this
chapter does not discuss therapeutic exercise or rehabilitation.
Key Messages for People With Chronic Medical Conditions
- Adults with chronic conditions obtain important health benefits
from regular physical activity.
- When adults with chronic conditions do activity according to their
abilities, physical activity is safe.
- Adults with chronic conditions should be under the care of
health-care providers. People with chronic conditions and symptoms should
consult their health-care providers about the types and amounts of activity
appropriate for them.
Example 1. Physical Activity for Adults With Osteoarthritis
Osteoarthritis is a common condition in older adults, and people can
live many years with osteoarthritis. People with osteoarthritis are commonly
concerned that physical activity can make their condition worse. Osteoarthritis
can be painful and cause fatigue, making it hard to begin or maintain regular
physical activity. Yet people with this condition should get regular physical
activity to lower their risk of getting other chronic diseases, such as heart
disease or type 2 diabetes, and to help maintain a healthy body weight.
Strong scientific evidence indicates that both aerobic activity and
muscle-strengthening activity provide therapeutic benefits for persons with
osteoarthritis. When done safely, physical activity does not make the disease
or the pain worse. Studies show that adults with osteoarthritis can expect
improvements in pain, physical function, quality of life, and mental health
with regular physical activity.
People with osteoarthritis should match the type and amount of physical
activity to their abilities and the severity of their condition. Most people
can usually do moderate-intensity activity for 150 minutes (2 hours and 30
minutes) a week or more, and may choose to be active 3 to 5 days a week for 30
to 60 minutes per episode. Some people with arthritis can safely do more than
150 minutes of moderate-intensity activity each week and may be able to
tolerate equivalent amounts of vigorous-intensity activity. Health-care
providers typically counsel people with osteoarthritis to do activities that
are low impact, not painful, and have low risk of joint injury. Swimming,
walking, and strength-training are good examples of this type of activity.
Example 2. Physical Activity for Adults With Type 2 Diabetes
Physical activity in adults with type 2 diabetes shows how important it
can be for people with a chronic disease to be active. Physical activity has
important therapeutic effects in people with diabetes, but it is also routinely
recommended to reduce risk of other diseases and help promote a healthy body
For example, strong scientific evidence shows that physical activity
protects against heart disease in people with diabetes. Moderate-intensity
activity for about 150 minutes a week helps to substantially lower the risk of
heart disease. A person who moves toward 300 minutes (5 hours) or more of
moderate-intensity activity a week gets even greater benefit.
Adults with chronic conditions should work with their health-care
providers to adapt physical activity so that it is appropriate for their
condition. For example, people with diabetes must be careful to monitor their
blood glucose and avoid injury to their feet.
Example 3. Physical Activity for Cancer Survivors
With modern treatments, many people with cancer can either be cured or
survive for many years, living long enough to be at risk of other chronic
conditions, such as high blood pressure or type 2 diabetes. Some cancer
survivors are at risk of recurrence of the original cancer. Some have
experienced side effects of the cancer treatment.
Like other adults, cancer survivors should engage in regular physical
activity for its preventive benefits. Physical activity in cancer survivors can
reduce risk of new chronic diseases. Further, studies suggest physically active
adults with breast or colon cancer are less like to die prematurely or have a
recurrence of the cancer. Physical activity may also play a role in reducing
adverse effects of cancer treatment.
Cancer survivors, like other adults with chronic conditions, should
consult their health-care providers to match their physical activity plan to
their abilities and health status.
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