Functional Morphology and Kinesiology Editorial Physical Activity for Health—An Overview and an Update of the Physical Activity Guidelines of the Italian Ministry of Health

Abstract

Physical activity for health is the topic chosen for the third editorial of this newly launched journal. The aim of this editorial is to illustrate and comment on the physical activity guidelines of the Italian Ministry of Health.

Full text

Journal of
Functional Morphology
and Kinesiology
Editorial
Physical Activity for Health—An Overview and an
Update of the Physical Activity Guidelines of the
Italian Ministry of Health
Giuseppe Musumeci
Department of Biomedical and Biotechnological Sciences, Human Anatomy and Histology Section,
School of Medicine, University of Catania, Via S. Sofia 87, 95123 Catania, Italy; g.musumeci@unict.it;
Tel.: +39-095-378-2043; Fax: +39-095-378-2034
Academic Editor: Moataz Eltoukhy
Received: 23 May 2016; Accepted: 17 June 2016; Published: 23 June 2016
Abstract:
Physical activity for health is the topic chosen for the third editorial of this newly launched
journal. The aim of this editorial is to illustrate and comment on the physical activity guidelines of
the Italian Ministry of Health.
Keywords: physical activity; health; pregnant women; children; old people; diseases
1. Introduction
The expression mens sana in corpore sano, which means “a healthy mind in an healthy body”,
stems from a sentence written by Decimo Giunio Giovenale. In the Western world, the phrase is
widely used in sporting and educational contexts to express the concept that physical exercise is an
important or essential part of mental and psychological well-being. The Latin poet, in the first century
A.D., criticizes men who strive to obtain wealth and fame, an activity that in his view is ephemeral
and harmful. Thus, Giovenale thought that only two qualities for which it was worth invoking the gods
existed: the health of the mind and the health of the body (Orandum est ut sit mens sana in corpore sano)
.
Today, the phrase, popular in sports clubs since the beginning of the last century, has taken on quite
a different meaning, influenced by today
'
s conventional wisdom: keeping your body in a good
shape also maintains the brain’s health. It has been demonstrated that physical activity prevents
neurodegenerative diseases, such as Alzheimer’s disease and other disorders [
1
]. Moving daily has
positive effects on people’s physical and mental health: exercise is medicine. The human body was not
meant for inactivity. Movement is inherently required, and regular physical activity, even if moderate,
helps to improve all aspects of quality of life. In contrast, poor physical activity is implicated in the
onset of some of the most common disorders and diseases: type 2 diabetes, cardiovascular disease
(heart attack, myocardial infarction, stroke, and heart failure), and tumors [2,3].
2. The Numbers
Italy currently has no national health monitoring or surveillance system for physical activity.
The country has adopted national recommendations, using cut-off points for adults reaching
recommended physical activity levels as defined by the United States Centers for Disease Control and
Prevention (CDC) and the American College of Sports Medicine (ACSM) [
4
]. In Italy, 30% of adults
between 18 and 69 years, in everyday life, perform less physical activity than recommended and can
be defined as sedentary. In particular, the risk of physical inactivity increases with age, and is higher
among people with low educational attainment and economic difficulties. The situation is better in
the regions of Northern Italy, but worse in the southern regions, as previously described in national
data for the years 2010–2013 from the survey by the Italian Ministry of Health’s Behavioral Risk Factor
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J. Funct. Morphol. Kinesiol. 2016,1, 269–275 270
Surveillance System (Progressi delle Aziende Sanitarie per la Salute in Italia (PASSI) [
4
]. According to
ISTAT (Italian National Institute of Statistics), in 2010 in Italy, 38% of people older than three years
said they did not practice physical activity, in daily life, in sports, or in other forms. According to the
“Okkio alla salute project”, only 1 child out of 10 performed physical activity appropriately for their age
and about 1 out of 4 children (26%), at the time of detection, stated that they had not engaged in any
physical activity the day before the survey [
5
]. As in other European countries, physical activity of
the population in Italy has declined in parallel with the great changes of work and organization of
the urban environment. On the one hand, there is the development of automation in domestic work
and the social downgrading of manual labor, with the dominance of motorized transport and the
reduction of space and safety for pedestrians and cyclists. Together with these latter factors, the free
space allowed for children’s games and for team and individual sports has decreased. These activities
now have allotted places whose accessibility is limited; they have a cost, not just monetary, often
not affordable for most people. Moreover, the value that is socially assigned to physical activity and
other factors, such as parental models and the influence attributed to physical activity in the school
curriculum, play a role. Today, in Italian schools, there are only two hours a week of physical activity
for the young students, and this is done too often without sufficiently qualified instructors [
6
,
7
]. These
obstacles make a programmed activity with exercise and training movements difficult.
3. The Benefits of Physical Activity
Daily moving has positive effects on the physical and mental health of any person. Plenty of
studies [1–3,8–11] confirms its beneficial effects and discloses that physical activity
‚improves glucose tolerance and reduces the risk of type 2 diabetes;
‚
prevents hypercholesterolemia and hypertension and reduces the levels of blood pressure
and cholesterol;
‚
decreases the risk of developing heart disease and several cancers, such as those of the colon
and breast;
‚
reduces the risk of premature death, especially that caused by heart attacks and other
heart diseases;
‚
prevents and reduces the risk of osteoporosis and fractures, as well as musculoskeletal disorders
(e.g., back pain);
‚prevents and reduces the risk of osteoarthritis and other rheumatic diseases;
‚reduces the symptoms of anxiety, stress, physical limitations, fatigue, and depression;
‚
prevents, especially among children and young people, risky behaviors such as the use of tobacco,
alcohol, unhealthy diets, and bullying and promotes psychological well-being by developing
self-esteem, making the management of anxiety and stressful situations easier; and
‚produces an energy expenditure and decreases the risk of obesity.
4. Which Physical Activity?
When anybody talks about physical activity, it is not an uncommon mistake to confuse it with sport.
However, the World Health Organization (WHO) defines physical activity as any body movement
produced by skeletal muscles that requires energy expenditure. This definition covers therefore not
only sports, but also the work of those performing manual work and normal movements of daily living,
such as walking, cycling, dancing, playing, gardening, and housework [
11
–
14
] (Figure 1). For physical
activity, therefore, it is not necessary to find time to specifically dedicate to physical activity. You can
find opportunities to engage in physical movement at all times of the day in normal daily activities.
This is a plea to do a bit of exercise. A bit of activity is better than none. The benefits begin as soon as
you start to become more active.

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J. Funct. Morphol. Kinesiol. 2016, 1, 269-275 271
Figure 1. Infographic of physical activity guidelines during our normal life in one week, suggested
by the World Health Organization (WHO), to prevent the onset of diseases related to a sedentary
lifestyle. This graphic represents the pyramid of physical activity recommendations. At the base are
the suggestions for everyday activities, and at the top are activities to perform rarely.
5. How to Move?
There is no definite level of physical activity that is valid for any person, nor is it easy to measure
the amount of movement made. Nevertheless, in 2010, the WHO [12] has tried to give clear
indications that apply to all, establishing a minimum amount of physical activity for three age groups:
Children (5–17 years): at least 60 min a day of moderate-vigorous activity, including strength
exercises, consisting of, e.g., games requiring movement or sports activities, at least three times a
week.
Adults (18–64 years): at least 150 min per week of moderate activity or 75 min of vigorous
activity, with exercises strengthening major muscle groups, carried out at least twice a week.
Seniors (65 years and above): the indications are the same as adults, taking care to also carry out
activities geared to balance in order to prevent falls. Whoever is unable to follow the
recommendations in full should do physical activity at least three times a week and adopt an
appropriately active lifestyle.
In any case, it was shown that there is no clear threshold below which physical activity is not
beneficial to health. A transition from a sedentary lifestyle to a level of activity even lower than the
levels indicated by the guidelines is therefore very important. It is also important to make a personal
commitment to change the context in which we live in order to support the changes needed to make
it easier to adopt a healthy and active lifestyle in our own cities, whether studying or working [11–
14].
Figure 1.
Infographic of physical activity guidelines during our normal life in one week, suggested
by the World Health Organization (WHO), to prevent the onset of diseases related to a sedentary
lifestyle. This graphic represents the pyramid of physical activity recommendations. At the base are
the suggestions for everyday activities, and at the top are activities to perform rarely.
5. How to Move?
There is no definite level of physical activity that is valid for any person, nor is it easy to measure
the amount of movement made. Nevertheless, in 2010, the WHO [
12
] has tried to give clear indications
that apply to all, establishing a minimum amount of physical activity for three age groups:
Children (5–17 years): at least 60 min a day of moderate-vigorous activity, including strength
exercises, consisting of, e.g., games requiring movement or sports activities, at least three times a week.
Adults (18–64 years): at least 150 min per week of moderate activity or 75 min of vigorous activity,
with exercises strengthening major muscle groups, carried out at least twice a week.
Seniors (65 years and above): the indications are the same as adults, taking care to also carry out
activities geared to balance in order to prevent falls. Whoever is unable to follow the recommendations
in full should do physical activity at least three times a week and adopt an appropriately active lifestyle.
In any case, it was shown that there is no clear threshold below which physical activity is not
beneficial to health. A transition from a sedentary lifestyle to a level of activity even lower than the
levels indicated by the guidelines is therefore very important. It is also important to make a personal
commitment to change the context in which we live in order to support the changes needed to make it
easier to adopt a healthy and active lifestyle in our own cities, whether studying or working [11–14].
6. Children
For children and young people, participation in games and other physical activities, both at school
and during free time, is essential for healthy bones and joints and muscular system development,
psychological and social well-being, the control of body weight, and the proper functioning of the

J. Funct. Morphol. Kinesiol. 2016,1, 269–275 272
cardiovascular and respiratory systems. In addition, sport and physical activity can help prevent the
onset of behavior unfavorable to health, such as the habit of smoking and alcohol and drug use. The
WHO recommends at least 60 min a day of moderate-vigorous activity [12].
To better promote the welfare of children in Italy, the HEPA (a European network for the
promotion of health-enhancing physical activity) (Table 1), in agreement with the Ministry of Education,
Universities and Research, the Italian Olympic Committee (CONI), and the Presidency of the Council
of Ministers, established a promotion program to promote physical education in primary school in
Italy in 2013. The aims of the intervention were to motivate young children to be more physically
active, ensure 2 h per week of physical education, review the governance model for PE in schools to
ensure greater synergy and coordination between the project coordinators, and ensure that all primary
schools in Italy were engaged in the program on some level [13].
Table 1.
Objectives and principles of the HEPA (European network for the promotion of
health-enhancing physical activity).
Objectives Principles
Promote a better understanding of health-enhancing physical
activity and give a stronger voice to physical activity
promotion in health policy and in other relevant sectors in
Europe, including support for workforce development.
Focus on population-based approaches for the promotion of
health-enhancing physical activity using the best available
scientific evidence.
Develop, support, and disseminate effective strategies and
multi-sectoral approaches in the promotion of
health-enhancing physical activity.
Emphasis on the importance of monitoring and evaluation;
encouragement of the development of standardized
measurement methods and systematic research.
Foster the preservation and creation of social and physical
environments as well as values and lifestyles supportive of
health-enhancing physical activity.
Encouragement of the ongoing exchange, dissemination, and
sharing of experience and knowledge.
Together with other relevant institutions and organizations,
improve coordination in physical activity promotion across
sectors and administrative structures.
Support of cooperation, partnerships, and collaboration with
other related sectors, networks, and approaches.
7. Pregnant Women
Physical activity during pregnancy is far from being contraindicated. If carried out observing
several precautions, it can be beneficial for the mother and the child. In fact, it increases the ability
to transport oxygen in the blood and nutrients that the fetus needs. In addition, exercise increases
the efficiency of the cardiovascular and respiratory systems, improves blood flow in the legs, thus
reducing swelling, and reduces the episodes of pain, cramps, and fatigue. Regular movement, as well,
limits the increase in body weight, decreasing the risk of gestational diabetes. However, it must not be
overdone. For healthy women, 30–40 min a day of physical activity at low intensity are enough, i.e.
walking, swimming, or gymnastics. After the eighth month of pregnancy, however, you must take
caution, performing exercises to improve breathing and relaxation only [15].
8. Elderly People
Even for elderly people, exercise is particularly useful. Daily movement retards aging, prevents
osteoporosis, and helps to prevent disability, depression, and mental impairment. It prevents the risk
of accidental falls by improving balance and coordination.
According to the WHO, 150 min per week of moderate activity are enough, and activities geared to
improving equilibrium to prevent falls are preferred [
16
–
19
]. For the majority of the aging population,
the goals are not related to athletic performance, but rather to daily living activities. Flexibility
programs can increase the functional range of motion and reduce the risk of injury. Joint flexibility
may decrease with age, affecting normal daily function; elderly adults could maintain their fitness by
improving flexibility through stretching exercises [9].

J. Funct. Morphol. Kinesiol. 2016,1, 269–275 273
9. People Who Have no Time
Not everyone can devote part of the day to physical activity. However, this does not mean that it
is not possible to carry out the right amount of movement. One should simply stay active at every
opportunity [9]. For example, one can do the following:
‚go to work or to school on foot or by bicycle;
‚when using public transportation, get off one stop earlier and finish on foot;
‚
do not take the car to make short trips, and, when you use it, park a little farther from
the destination;
‚take the stairs instead of the elevator;
‚walk the dog;
‚do gardening or housework;
‚go dancing;
‚train at home listening to music (or a home exercise program); and
‚play with children, possibly outdoors or through activities that require physical movement.
10. People Who Have Diseases
People who have diseases such as diabetes, sarcopenia of cirrhosis, hypertension, and obesity
can benefit greatly from regular physical activity [
19
]. Moreover, people suffering from other diseases,
such as cardiovascular ones, can benefit from the regular practice of physical activity, much like a
pharmacological treatment that, if done properly, aids in the management of the disease. Often, the
practice of physical activity is at least as effective as drugs in not only the prevention, but also the
treatment of several diseases such as heart failure, diabetes, and depression. The manner and timing
should always be agreed with the appropriate physician.
11. Conclusions
Exercise can be beneficial both physically and psychologically. Regular exercise has great
importance in maintaining good health, balance, and posture; indeed, inactivity is a risk factor
for several chronic diseases. Moreover, physical activity is a good way to socialize and an excellent
anti-stress agent—not to mention the aesthetic benefits for our body. Physical activity also helps to
reduce constipation. It is useful and highly recommended by the WHO, ACSM, HEPA, and the Italian
Ministry of Health’s Physical Activity Guidelines to do physical activity at least three times a week
for about one to two hours of training, in effect taking at least 10,000 steps a day, as suggested by
the American Heart Association [
20
]. Moreover, in order to have a healthy lifestyle, we must also
know how to handle the other 22 remaining hours of the day in a healthy way: for example, having
a healthy and good nutrition, avoiding medication, sleeping well, moving as much as possible, and
having restful sleep. For improved physical performance, using an activity tracker for monitoring
is recommended to ensure your daily activities meet your individual needs. Activity trackers can
constantly monitor steps taken, sleep patterns, and heart rate [
21
]. The nutritional aspects associated
with physical activity are fundamental in daily life [
22
–
26
] to help improve our body despite an active
and stressful day. As Patrick Holford said in his book “the health begins at the table”.
The exercise regimen must be mild to moderate and mostly “adapted” personalized, or
“tailor-made” since the level of exercise will be dependent on the tolerability of the individual, because
the body of each individual responds in a different way. For this reason, each trainer should elaborate
and personalize a trainee’s diet and training program in accordance with the trainee’s skill level;
moreover, novices should be monitored by a specialized trainer. No do-it-yourself training should be
allowed, because physical activity, when done poorly, can do much more harm than sedentary life.
As stated by the American College of Sports Medicine, physical activity should be your prescription
for health, as non-pharmacologic treatment, since exercise is medicine.

J. Funct. Morphol. Kinesiol. 2016,1, 269–275 274
Acknowledgments:
A special thank goes to our editorial advisors, eminent scientists in these fields whose
experience and important suggestions guided us in this great enterprise, our excellent editorial board members,
whose depth of experience cover a very broad spectrum of morphology and kinesiology; the assistant editors
that, day after day, thanks to their valuable contributions, made this journal possible; and the peer reviewers.
On behalf of the editorial board, we appreciate the voluntary contribution that each peer reviewer has given to
maintaining high journalistic standards and ensuring rapid publication. I sincerely thank them in advance for
offering their precious time for the participation in the review process.
Conflicts of Interest: The author declares no conflict of interest.
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2016 by the author; licensee MDPI, Basel, Switzerland. This article is an open access
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