Exercise and Physical Activity Guide for Health Promotion 2006
～ To Prevent Lifestyle-related Diseases ～<Exercise Guide 2006>

Prepared in August, 2006
By the Office for Lifestyle-Related Diseases Control,
General Affairs Division, Health Service Bureau,
Ministry of Health, Labour and Welfare of Japan

Translated in November, 2007
by Dr. Izumi Tabata(Director of Health Promotion and Exercise Program
National Institute of Health and Nutrition, Japan),with assistance of Miki Miyoshi(Center for Collaboration and Partnership,
National Institute of Health and Nutrition, Japan)

This English report was prepared under the Health and Labour Sciences Research Grants ofDr. Izumi Tabata for the research on exercise and physical activity guidelines, awarded from the
Ministry of Health, Labour and Welfare, Japan.

〔CONTENTS〕
Purpose for the Guide
Chapter 1. Theoretical Concept
1. Physical activity and exercise
2. The quantity of physical activity for health promotion(1) Goal for physical activity and exercise(2) Relationship between the quantity of physical activity and the risk of developing
lifestyle-related diseases
3. Physical fitness(1) Physical fitness for health promotion(2) Need of exercise suitable for one’s physical fitness
Chapter 2. Practice Section
1. Assessment of the current quantity of physical activity
2. Assessment of the current physical fitness(1) Assessment of endurance(2) Assessment of muscle strength
3. Setting the goal for the quantity of physical activity(1) Concept of goal setting(2) Exercises suitable for one’s physical fitness(3) Specific examples
4. To achieve the goal
(1) Advices for achieving the goal
(2) Advices for achieving the goal, according to one’s current stage
5. Notes on practicing exercise(1) Notes for a safe exercise(2) Warm-up and cool-down exercise
Appendix 1 Table for METs and Ex of each physical activity
Appendix 2 Case examples of approaches to increase the quality of physical activity, according
to one’s lifestyle.
Appendix 3 An example of press release2

Purpose of formulating the Guide

3

Purpose of the Guide○ Recently, the control of lifestyle-related diseases has been a significant issue in Japan. Basedon the results of various studies that have been published, the reference values for thequantity of physical activity, exercise and physical fitness were set in the “Exercise andPhysical Activity Reference for Health Promotion 2006: Physical Activity, Exercise, andPhysical Fitness” (EPAR2006).
○ Based on the EPAR2006, the preparation committee formulated the “Exercise and Physical
Activity Guide for Health Promotion 2006”, in order to introduce safe and effective physicalactivity and exercise widely among the general population. This guide specifically describes;
1) the methods to assess one’s current quantity of physical activity, exercise and physicalfitness, based on which the goals will be set; 2) how to select and plan exercise considering
one’s physical characteristics and condition, so as to achieve the goals.
○ The subjects of this exercise guide are healthy adults. Yet, it must be noted that there areindividual differences in physical fitness, and thus the appropriate intensity of exercise would
vary by each individual. It is therefore crucial even for a healthy adult to fully understand thisguide, before starting an exercise with higher intensity than walking. If one suffers from achronic illness, s/he should consult his/her doctor to ensure the safe exercise program.
○ In order to prevent lifestyle-related diseases, it is necessary to undertake a regular physicalactivity continuously. For which, it is recommended that one could start with increasing thephysical activity moderately in one’s daily life. For example, walking to school/office andhousework are the kinds of activity in which many people can readily incorporate in their daily
lives.
○ In addition to increasing the quantity of physical activity, it is important to assess one’s dietand resting for prevention of lifestyle-related diseases. Let’s take a balanced diet and avoid
excessive energy intake, with referring to the Japanese Food Guide Spinning Top.

4

Chap ter 1. T heor etic al C once pt

51. Physical activity and exercise
In this exercise guide, physical activity, exercise and nonexercise activity (NEA) are defined
as follows:c Physical activity
All bodily movement that accompanies energy expenditure above resting energy expenditure.
d Exercise
A kind of physical activity that are practiced intentionally for maintaining and improving
one’s physical fitness.
e NEA (nonexercise activity)
A kind of physical activity that are not classified as exercise. This category includes theoccupational activities.

Fig. 1. Classification of exercise and physical activity, and their intensities

brisk walking, jogging,
tennis, swimming…

Moderate or high-intensity
nonexercise activity (NEA)

walking, cleaning the floors, gardening,
car washing, walking up and down
stairs, playing with children…

(3METs or more)
Moderate or high-Moderate or highintensity exercise

Physical activity
Nonexercise activity (NEA)

intensity

Exercise

Low-intensity
exercisestretching…

standing, cooking, doing laundry,
playing piano…

6

Low-intensity

Low-intensity nonexercise
activity (NEA)

As the unit to express the intensity and quantity of physical activity, “METs” and “METs·hour(called as “Ekusasaizu (Ex))” is used, respectively.

c MET (unit of intensity)
MET (metabolic equivalent) is an index for intensity of physical activity, calculated as energy
expenditure (oxygen uptake, mL/kg/min) during a specific physical activity divided bysitting/resting energy expenditure. With defining MET of sitting/resting as 1, for example, that ofnormal walking is 3.
d “Ekusasaizu (Ex)” (=METs·hour) (unit of quantity)
METs·hour is a unit to express the quantity of physical activity, calculated by multiplying theintensity of physical activity (METs) by the duration of the activity (hour). The higher intensity
the physical activity, the shorter the time needed to achieve 1 Ex.
<Examples>
Physical activity with 3 METs for one hour: 3 METs × 1 hour = 3 Ex (METs·hour)
Physical activity with 6 METs for 30 minutes : 6 METs × ½ hour = 3 Ex (METs·hour)7[Reference] Energy expenditure equivalent to “1 Ex” of physical activity
Energy expenditure equivalent to 1 Ex of physical activity would vary according to one’s
body weight. Specifically, it can be calculated using the following formula. The weightdependent energy expenditure calculated by this formula is compiled in the table below. Now,
let’s check the energy expenditure that corresponds to your own goal of physical activity.
Simple conversion formula: energy expenditure (kcal) = 1.05 × Ex (METs·hour) × body weight (kg)(Table) Energy expenditure equivalent to “1 Ex” of physical activity, according to body weight
Body weight
40 kg
50 kg
60 kg
70 kg
80 kg
90 kg
Energy expenditure

42 kcal

53 kcal

63 kcal

74 kcal

84 kcal95 kcal* Total energy expenditure including sitting/resting energy expenditure.

[Reference] Why “calorie (kcal)” is not used to express the quantity of physical activity?
While “calorie (kcal)” is generally used to express energy expenditure, it is quite difficult toquantify physical activity and exercise using “calorie (kcal)”, due to its variability by one’s bodyweight. For example, when two individuals, one weighing 40 kg and the other weighing 80 kg,
undertake the same physical activity, the energy expenditure of the heavier person is twice that of
the one weighing 40 kg. Thus, in order to indicate the quantity of physical activity and exercise
necessary for prevention of lifestyle-related diseases independent of one’s body weight, thisexercise guide adopts the units of “METs” and Ex.

8

2. The quantity of physical activity for health promotion(1) Goal for physical activity and exercise
Let’s target 23 Ex (METs·hour) per week by physical activity, of which 4 Ex by active exercise!

The goal of quantity of physical activity for health promotion was set at 23 Ex or more per
week by active physical activity (including both exercise and NEA), of which 4 Ex or more by
active exercise.
Based on the results of a systematic review of domestic and foreign literature on theassociation between physical activity/exercise and lifestyle-related diseases, this goal was set bycalculating the mean of quantity of physical activity and exercise necessary for prevention oflifestyle-related diseases.
The “active physical activity” is defined as those with intensity of 3 METs or more. The METof sitting/resting is 1, and the physical activity with less than 3 METs are not included in this goal.
Fig. 2. Active physical activity equivalent to 1 Ex
Activephysical activity equivalent to 1 Ex
１ｴｸｻｻｲｽﾞに相当する活発な身体活動
Exercise

NEA運動

Intensity
強度
強度

生活活動

3
METs
３メッツ
３メッツ
Light weight lifting:Volleyball: 20 min
軽い筋力トレーニング
バレーボール：２０分
20 min：２０分

Walking:
20 min
歩行：２０分

4 METs４メッツ

Brisk walking:速歩：１５分

Golf: 15 min
ゴルフ：１５分

Bicycling:
15 min
自転車：１５分

15 minPlaying with child:
子供と遊ぶ：１５分
15 min6 METs
６メッツ

Aerobics: 10 min
エアロビクス：１０分
Jogging: 10 min
軽いジョギング：１０分

Walking up anddown the stairs: 10 min
階段昇降：１０分

8 METs
８メッツ
Carrying
heavy load: 7~8 min
重い荷物を運ぶ：７～８分

Swimming:
7~8 min
Running: 7~8 min
ランニング：７～８分
水泳：７～８分

9(2) Relationship between the quantity of physical activity and the risk for developing
lifestyle-related diseases
Active physical activity would activate physical function by increasing energy expenditure,
which would promote the metabolism of carbohydrates and lipids, possibly leading to reduced
visceral fat. Consequently, lifestyle-related diseases can be prevented through improvement ofblood glucose level, dyslipidemia and blood pressure.
It has been reported that the increased energy expenditure and improved physical fitness, bothof which are by exercise, also have preventive effect on lifestyle-related diseases.
In this guide, the quantity of physical activity and exercise with which one could reduce therisk of developing lifestyle-related diseases is indicated as the goals, based on the results ofstudies on the effects of physical activity and exercise on development of lifestyle-relateddiseases.
However, the goals shown here should be revised regularly in the future, based on the reviewof the latest evidence.

10

[Reference]
The quantity of exercise necessary to reduce visceral fat⎯ for those with metabolic syndrome or prodromal one ⎯The goals for the quantity of physical activity to prevent lifestyle-related diseases have alreadybeen explained in [(1) goals for quantity of physical activity]. This section explains the quantityof exercise necessary for people with “metabolic syndrome (visceral fat syndrome)” or
prodromal one to reduce visceral fat and also to improve the symptoms related to metabolic
syndrome.
(A) Need of reducing visceral fat
The individuals who have metabolic syndrome are characterized by visceral fat obesity(abdominal circumference: ≥ 85 cm for male, ≥ 90 cm for female); in addition, the syndrome iscomplicated with at least two of the following three components: elevated blood glucose, lipid
abnormality and elevated blood pressure. Those with prodromal metabolic syndrome have one of
the above three components in addition to visceral fat obesity.
It is said that those with metabolic syndrome or prodromal one would have high risk ofdeveloping myocardial infarction or stroke by having multiple risks.
Metabolic syndrome can be caused by an unfavorable lifestyle, including lack of physicalactivity and overeating. By increasing the quantity of exercise and improving one’s diet, visceralfat can be reduced and the symptoms of metabolic syndrome can be improved, by which it isexpected that the risks of developing myocardial infarction and stroke will decrease.
(B) Combined effects of increased exercise and improved diet
Reduction in abdominal circumference, an index of visceral fat accumulation, by 1 cmcorresponds to the reduction in body weight by about 1 kg (mostly composed of fat). In order toreduce weight by 1 kg, it is necessary to expend about 7,000 kcal, which is the sum of increase inenergy expenditure by exercise and decrease in energy intake by improved diet. For example, inorder to reduce in abdominal circumference by 1 cm within one month, one must expend about
230 kcal per day by increased exercise and improved diet.
Generally speaking, a combined approach of diet and exercise can be more effective, rather
than a single approach by exercise alone, to reduce one’s body weight as well as visceral fat. It istherefore possible to reduce one’s visceral fat more by improving his/her diet, with referring theJapanese Food Guide Spinning Top, in addition to increasing the quantity of exercise.
(C) Quantity of exercise required to reduce visceral fat
The goal of quantity of exercise for health promotion was set at 4 Ex per week. According to
the studies that examined the association between the quantity of exercise and visceral fat, about
10 Ex/week or more of exercise is required to ensure the reduction in visceral fat. For example, if
30 minutes’ brisk walking is done 5 times a week, it corresponds to 10 Ex.
Without changing the dietary intakes, s/he can lose about 1-2% of visceral fat within amonth, by increasing the quantity of exercise by 10 Ex per week.

113. Physical fitness(1) Physical fitness for health promotion
Physical fitness encompasses multiple elements related to the capacity of physical activity;
endurance, muscle strength, balancing capacity and flexibility.
Of which, this exercise guide focuses on “endurance” and “muscle strength”, because theassociation with prevention of lifestyle-related diseases has been well-established and also
because it is possible for the general population to practice and self-evaluate it.
Studies have shown that the one with higher endurance and muscle strength would havelower risk of developing lifestyle-related diseases. It is therefore expected that lifestyle-relateddiseases can be prevented by improving these elements of physical fitness through exercise.

(2) Need of exercise suitable for one’s physical fitness
It is important that one selects the types of exercise suitable for his/her current physicalfitness. By which, s/he can practice it safely and effectively and also expect the positive
psychological effect including having exhilaration and relieving anxiety.
If you follow the exercise program with low intensity for your physical fitness, you may notachieve the expected effect. On the contrary, if you follow the one with extremely high intensity
for your physical fitness, you may get injured or suffer from extreme muscle pain on thefollowing day, which could make you quit the program without attaining the expected effect.
Besides, it is important to determine whether to adopt an exercise focusing on endurance (e.g.
jogging, running), or the one focusing on muscle strength (e.g. weight lifting), or a combinationof these two types of exercise. Based on which, one should practice the program together withwarm-up and cool-down including stretching before and after the routine exercise, to achieve
his/her goal.
12

S/he could plan safer and more effective exercise program, by consulting the specialists on
exercise such as the Health Fitness Programmer.

13

Chap ter 2. P ract ical Sec tion

14

Flowchart from assessment to practice
1. Assessment of the current
quantity of physical activity
Let’s check the current quantity of physical activity, using the “Check sheet
to assess the quantity of physical activity” (Page 16)

2. Assessment of physicalfitness
Let’s check if your physical fitness (endurance, muscle strength) matches
the goal set for your gender and age (Page 17)

3. Setting the goal for thequantity of physical activity(1) How much quantity of physical activity to be increased?
Based on the goal for the quantity of physical activity (*) and the current
quantity of physical activity assessed in 1., determine how muchquantity of physical activity and exercise you should increase (Page 20).
* 23 Ex per week by active physical activity, of which 4 Ex by active exercise(2) What type of exercise to be undertaken?
Based on the current physical fitness assessed in 2., select the types of
exercise you will undertake (Page 21).

4. Practice(1) To achieve the goal
To achieve the goal set in 3. , let’s increase the NEA in your daily lifeand practice exercise suitable for your current stage (Page 30).
(2) For safe exercise
Be cautious to avoid an accident during exercise (Page 36).

15

1. Assessment of the current quantity of physical activity
Let’s assess your current quantity of physical activity.
Compared with the goal for physical activity (23 Ex) and that for exercise (4 Ex), let’s checkyour current quantity by using the following check sheet.
Check sheet to assess the quantity of physical activity
activities

Exercise

NEA

Total

Mon.

Ex

Ex

Ex

Tues.

Ex

Ex

Ex

Wed.

Ex

Ex

Ex

Thurs.

Ex

Ex

Ex

Fri.

Ex

Ex

Ex

Sat.

Ex

Ex

Ex

Sun.

Ex

Ex

Ex

Total

Ex

Ex

Ex

Examples of exercise corresponding to 1 Ex
Activities
Bowling, volleyball, frisbee, weight lifting (light or moderate effort)
Brisk walking, Radio calisthenics, Golf (using power cart), table tennis,
badminton, aquabics, Tai Chi
Light jogging, weight lifting(vigorous effort), jazzercise, aerobics,
basketball, swimming (leisurely), soccer, tennis, skiing, skating
Running, swimming, judo, karate

Time (minutes)
20
15
10
7-8

Examples of NEA corresponding to 1 Ex
Activities
Time (minutes)
Walking, Sweeping floor, loading/unloading a car, child care, car washing
20
Brisk walking, bicycling, nursing, gardening,
15
Walk/run - playing with child(ren) or animals, moderate
Mowing lawn, walk, power mower;
10
Moving furniture; Climbing the stairs; Shoveling snow by hand
Carrying heavy loads
7-8* Refer to “Appendix 1” for other exercise and physical activity: Tables for METs and Ex of each physical activity (p.33).
* When there are multiple values for a single activity, the one that is considered to appear more frequently is listed(c.f., taking the value for leisure activity over that for competitive sport).

16

2. Assessment of the current physical fitness
Let’s assess your current physical fitness to plan the exercise program suitable for yourphysical fitness. There are several methods to assess one’s physical fitness, of which we focus
on the simple methods to assess endurance and muscle strength by oneself. If you wish tomeasure your physical fitness more accurately, you could take several tests at the facilities
where the specialists on exercise such as the Health Fitness Programmer are available.

(1) Assessment of endurance
Here, the methods typically used to assess endurance are shown as below;
c Walk for 3 minutes at a rate which you feel somewhat hard and measure the distance.
d Let’s assess your endurance by comparing the distance (c) with the values in Table 1.
e If the distance (c) exceeds the value for your gender and age group in Table 1, yourcurrent endurance almost reaches the goal for preventing lifestyle-related diseases.
f If the distance (c) is less than the value of Table 1, your endurance has not reached thegoal.
* If you have any chronic illness, consult your doctor ensure the safe testing.
* Do not do this test when you have strong knee/back pain.
* Avoid testing on a very hot/cold day.

Table 1. Reference walking distance according to gender and age group
Males

Females

Sex/AgeWalking distance (m)for 3 minutes
Walking speed(m/minute)
Walking distance (m)for 3 minutes
Walking speed(m/minute)

20s

30s

40s

50s

60s

375

360

360

345

345

125

120

120

115

115

345

345

330

315

300

115

115

110

105

100

17

References
1. Nakagaichi M, Tanaka T. Development of a 12-min treadmill walk test at a self-selected pace
for the evaluation of cardiorespiratory fitness in adult men. Appl Human Sci 1998; 17(6):2818
2. Astrand PO, Rodahl K. Chapter 14. Applied sports physiology. in: Textbook of work
physiology: physiological bases of exercise, 3rd ed. McGraw-Hill, New York. 1986, pp64682
3. Ministry of Health, Labour and Welfare of Japan. Exercise and Physical Activity Reference for
Health Promotion 2006.

18

(2) Assessment of muscle strength
Muscle strength, especially of the legs, is affected by aging; hence this guide focuses on
muscle strength of the legs.
c Sit on a chair and stand up (as shown below) 10 times and measure the required time using
a stopwatch.
(1) Straighten your back andsit on a chair.
(2) Cross your arms in frontof your chest.

(3) Stand up until your knees
become completely straight.
(4) Return quickly to the original
sitting position [(1) to (4)completes a single cycle].

* Use a sturdy and stable chair.
* Do this test bare-footed or with low-heeled shoes.
* Do not hold your breath during this test.
* Do not do this test when you have strong knee/back pain.

.
d Let’s assess your muscle strength by comparing the time (c) with the values in Table 2.
Please note that the motion can not be counted as one cycle, if your buttocks do not touch theseat when you sit down or if the knees are not completely straight when you stand up.
e If the time (c) falls on “average” or “fast” for your gender and age group in Table 2, yourcurrent muscle strength almost reaches the goal for preventing lifestyle-related diseases.
f If the time (c) falls on “slow” in Table 2, your muscle strength does not reach the goal.
Table 2. Reference time (seconds) according to gender and age group
Fast

Males
Average

Slow

20-39

-6

7-9

40-49

-7

50-59
60-69

Age (years)

Fast

Females
Average

Slow

10-

-7

8-9

10-

8-10

11-

-7

8-10

11-

-7

8-12

13-

-7

8-12

13-

-8

9-13

14-

-8

9-16

17-

(Data are provided by Prof. Fukunaga, Laboratory of Sports Biomechanics, Faculty of Sport Sciences, Waseda University)19

3. Setting the goal for the quantity of physical activity(1) Concept of goal setting
Detail methods are presented here to set a goal for the quantity of physical activity for healthpromotion. Let’s think about the goal based on the current quantity of physical activity.
Let’s enjoy walking anytime and anywhere: 10,000 steps per day (70,000 steps per week)!
Let’s work up a good sweat by exercise suitable for you: total 60 minutes per week!

If 23 Ex per week of physical activity, the target Ex set for health promotion, are converted to
the number of steps, it corresponds to approximately 8,000 to 10,000 steps per day (56,000 to
70,000 steps per week). Likewise, 4 Ex per week of exercise corresponds to about 60 minutesof brisk walking or about 35 minutes of playing tennis per week.
(A) Setting the goal for the quantity of physical activity
Let’s examine the current quantity of physical activity, by comparing with the goal. If yourcurrent quantity of physical activity has not reached the goal, you should try to achieve it firstby increasing the time of walking or bicycling in your daily life. Let’s start measuring thenumber of steps using a pedometer, as it is as easy as weighing yourself on a scale.
If the quantity of your physical activity has already reached the goal, you should maintainthe current quantity and improve physical fitness by exercise based on the results of physicalfitness test.
(B) Setting the goal for the quantity of exercise
Let’s examine the current quantity of exercise. It is important to set the goal of the quantity of
exercise in accordance with one’s current exercise habit and physical fitness.

20

If you have no habit of exercise, you should start with the exercise of 2 Ex per week, andwhen you get used to exercise, you should set the goal as 4 Ex by increasing the quantity of
exercise little by little.
If the current quantity of exercise exceeds 4 Ex per week, increase the quantity of exercise
with setting the goal as 10 Ex.
It will be effective to do exercise by which one could increase your physical fitness safely
and effectively to the goal, based on the results of physical fitness test. With referring to “(2)Exercises suitable for your physical fitness (see below)”, let’s exercise to achieve the goal.

(2) Exercises suitable for one’s physical fitness
As mentioned in the previous section, it is effective to undertake exercise suitable for yourcurrent physical fitness. Focusing on endurance and muscle strength, this section explains thetypes of exercise to increase them.
(A) To increase endurance
Q 1. What kinds of exercise would increase endurance?
A1. Exercises suitable to increase endurance are: brisk walking, jogging, bicycling, aerobics,
aquatic exercises, swimming, ball games and dancing. For the person who starts exercise forthe first time, brisk walking is recommended. Fig. 3 shows an ideal form for brisk walking.
Fig. 3. Ideal form for brisk walking
Look at far point,and 視線は遠くに
pull your chin
あごは引く

Relax
the shoulders
肩の力を抜くStraighten
the back
背筋を伸ばすWalk with
胸を張るchest out

Swing your arms
腕は前後にback and forth
大きく振る

Extendyour leg
脚を伸ばすTake
as large a
歩幅は出来るだけ
stride広くとるas possibleLandwith theかかとから着地
heels first21

Q2. How much exercise to be done?
A2. Exercise to increase your endurance doesn’t have to be very hard. You could increase
your endurance safely by moderate exercise. For example, moderate brisk walking can be
explained as below:• Walking at a speed slightly faster than usual.
• You may feel slightly out of breath, but can still keep a smile on your face.
• You can continue for some time, but may feel anxious to continue for a long time.
• You start to sweat in about 5 minutes.
• After about 10 minutes’ walking, you feel a slight muscle pain in your calf.
If you exercise for the first time, your should start with the speed that you feel very easy, andyou could gradually increase the speed to the moderate level.
Let’s target the quantity of exercise at 4 Ex per week, as is recommended in the EPAR2006(B) To increase muscle strength
Q1 What kinds of exercise would enhance muscle strength?
A1. Let’s start muscle resistance training that uses your body weight as a load, which you caneasily do at home. Of course, you can also start with resistance training using a machine
under the guidance of a specialist on exercise.
The following figures show the examples of resistance training that you can do at home.
Every action should be done with a correct posture, slowly without a rebound, and withbeing conscious of the muscles that are being trained.

22

○ Examples of resistance training at homec Squatting (strengthening the front side of femoral muscle and the major psoas muscle)
1) Stand with the feet at shoulder-width apart and the toes turned outward.
Straighten the back and extend both arms forward.
2) Bend the knees in 3 seconds, with keeping the same direction as the toes,
like sitting on a chair and maintain this posture for one second.
3) Return to the original posture within the next 3 seconds.
* Make sure that the knees do not come ahead of the toes.
* Do not bend down your head.

d Hip extension (strengthening the back side of femoral muscle and buttocks)
1) With straightening the back and fixing the waist unmoved, put force tothe lower buttocks.
2) Raise a foot backward from the heel in 3 seconds, and maintain the
posture for one second.
3) Return the foot to its original position within the next 3 seconds.
* Make sure that the upper body does not lean forward.
* Raise the foot without bending backward.
* Do not put your weight on the chair.

e Push-ups (strengthening the chest and arm muscles)
1) Bend the knees a little and rest on the floor. Stretch both arms
vertically to the floor (with the elbows slightly bent).
2) Place your hands slightly wider than shoulder-width apart. Turnthe fingers slightly inward.
3) Bend the elbows slowly and maintain this posture for one second.
4) Return slowly to the original posture (do not bend backward).

23

Q2 How much exercise to be done?
A2. The goal for the quantity of resistance training should be set based on the results ofassessment of muscle strength shown in page 19.
• “Slow” → c to e (Page 23) should be done 10 times × 1 set, 5 to 7 times a week.
• “Average” → The c to e (Page 23) should be done 10 times × 2 sets, 5 to 7 times a week.
• “Fast” → The c to e (Page 23)should be done 10 times × 3 sets, 5 to 7 times a week.
* If you are not confident with your muscle strength, the maximum number of sets should be
limited to 2.

Q3. How to increase one’s muscle strength in his/her daily life?
A3. In the daily life, you can expect the increase of your muscle strength by climbing up anddown stairs or slopes.
For example, let’s use the stairs instead of an escalator or lift at a train station or building.

24

(3) Specific examples
Let’s see the cases where the person achieved the goal for the quantity of physical activity byadding some activities in his/her daily life.
Case 1. Mr. A, an office worker who commutes by train
Activities
Mon
Commuting

NEA

Total

0Ex

2Ex

2Ex

0Ex

2Ex

2Ex

1Ex

2Ex

3Ex

0Ex

2Ex

2Ex

0Ex

2Ex

2Ex

CommutingTues
CommutingExerciseCommutingPhysical activity of Mr. A in a week○

Volleyball (20 min.): 1 Ex /timeOnce a week
Brisk walking (30 min.): 2 Ex /timeOnce a week○

Wed
CommutingCommutingVolleyball

Thur
CommutingCommutingFri
CommutingSat

Sun

Commuting

Walkinga dog

Playing withchild

Playingwith child

Walkinga dog

Washinga car

Washing
a car

0Ex

Brisk
walking

Brisk
walking

Total
Activities
Mon
CommutingCommutingCommutingCommuting

3Ex

16Ex

19Ex

Exercise

NEA

Total

0Ex

3Ex

3Ex

0Ex

3Ex

3Ex

Walking a dog (20 min.): 1 Ex / time
Twice a week
Playing with child (30 min.): 2 Ex /timeOnce a week
Washing a car (40 min.): 2 Ex / time
Once a week
Evaluation and goal
Mr. A was short of 4 Ex in the quantityof physical activity to reach the goal of
23 Ex. Physical fitness test showed that
he had lower endurance than the goal.
↓
Mr. A decided to add the following
activities, utilizing the lunch time.

Physical activity that Mr. A added

1Ex

2Ex

3Ex

0Ex

3Ex

3Ex

CommutingTaking walkCommutingCommutingVolleyball

1Ex

2Ex

3Ex

Walkinga dog

Playing withchild

Playingwith child

Walkinga dog

Washinga car

Washinga car

ExerciseVolleyball (20 min.): 1 Ex /timeOnce a week○

Commuting

Total

5Ex

Volleyball

Fri

Sun

3Ex

Commuting:
2 Ex / day(40 minutes round trip) 5 times /week

○

Thur

Sat

2Ex

Taking walk

Wed
Commuting

3Ex

Daily activities

Taking walkTues
Commuting3Ex

Exercise

Daily activities

Taking a walk :(at lunch time)

1 Ex / day
3 times /week

Results

Brisk
walking

Brisk
walking

0Ex

3Ex

3Ex

2Ex

3Ex

5Ex

4Ex

19Ex

23Ex

25

Mr. A achieved the goal for thequantity of both physical activity
and exercise. He plans to continue
exercise, so as to achieve the goalof endurance as well by increasing
the time of brisk walking.

Case 2. Mrs. B, a housewife who stays at home most of the day
Activities

Exercise

NEA

Total

0Ex

3Ex

3Ex

3Ex

2Ex

5Ex

Physical activity of Mrs. B in a week○

Mon
Shopping

Sweeping
floor

Sweeping
floor

Playing withchild

Playing withchild

Aerobics

Shopping

Sweeping
floor

Sweeping
floor

Tue

Wed

Aerobics

Aerobics

Thur
Playing withchild

Playing withchild

Shopping

Aerobics

Playing withchild

Playing withchild

Gardening

Gardening

0Ex

3Ex

3Ex

0Ex

2Ex

2Ex

Total

Activities
Mon

0Ex

2Ex

2Ex

0Ex

2Ex

2Ex

6Ex

15Ex

21Ex

Exercise

NEA

Total

0Ex

3Ex

3Ex

Daily activities

Playing withchild

Aerobics

Shopping

Sweeping
floor

Sweeping
floor

Playing withchild

Playing withchild

Shopping

Aerobics

Aerobics

Thur

Fri
Aerobics

1 Ex / time
3 times /week

Playing with child (30 min.): 2 Ex /time
3 times / week
Sweeping floor (40 min.): 2 Ex / time
Once a week
1 Ex / time
Twice a week

Evaluation and goal
Mrs. B was short of 2 Ex in the quantityof physical activity to reach the goal of
23 Ex. Physical fitness test showed that
she had lower muscle strength than thegoal.
↓
Mrs. B decided to add the following
activities, during the weekend.

Physical activity that Mrs. B added
3Ex

Playing withchild

3 Ex / time
Twice a week

4Ex

Sweeping
floor

Tues

Wed

1Ex

Aerobics

Sun

Shopping○

Shopping:(20 min. round trip)

3Ex
Aerobics

Sweeping
floor

Aerobics (30 min.):

Gardening (40 min.):

Fri

Sat

Exercise

2Ex

5Ex

○

Exercise

Resistance training (20 min.): 1 Ex
/time
Twice a week

Aerobics

0Ex

3Ex

3Ex

0Ex

2Ex

2Ex

3Ex

1Ex

4Ex

1Ex

2Ex

3Ex

Aerobics

Results
Sat

Playing withchild

Playing withchild

Gardening

Gardening

Sun

Total

Resistancetraining

Resistance

1Ex

2Ex

3Ex

8Ex

15Ex

23Ex

training

26

Mrs. B achieved the goal for thequantity of both physical activity
and exercise. She plans to continue
resistance training, so as to achieve
the goal of muscle strength.

【Reference】Setting a goal for the quantity of exercise to reduce visceral fat～ for the persons with metabolic syndrome or prodromal one ～To prevent lifestyle-related diseases, especially metabolic syndrome, it is effective to reduce
one’s visceral fat by increasing the quantity of exercise and improving his/her diet. Let’s set
a goal to reduce the visceral fat, using the following sheet.
SHEET FOR REDUCING VISCERAL FAT

To reduce visceral fat without vigorous effort～Keeping a good balance of exercise and diet～If you have abdominal circumference ≥ 85cm (for male) or ≥ 90cm (for

腹囲が
男性
85cm
以上、女性90cm以上の人は、次の①～⑤の順番に
female),let’sfollow
the following calculation to plan a method suitable foryou to reduce your abdominal circumference.
①
What is your abdominal①あなたの腹囲は？
circumference?

①ｃｍ

is your short-term②What
当面目標とする腹囲は？goal for abdominal circumference?

②

90cm
メタボリックシンドロームの基準値は男性85cm、女性
The cut-off
abdominal circumference for metabolic syndromeis
85cmですが、それを大幅に超える場合は、無理をせずに段階的
for male and 90cm for female. If your abdominal circumference
is muchな目標を立てましょう。
higher than this value, set a reasonable and gradual goal.

ｃｍlong does it take to achieve③How
当面のは？ the goal?

Steady course：

①－②

ｃｍ

１ｃｍ／月 ＝
÷1cm/month

③

かmo.
月

急いでがん
Quick
course：①－②ｃｍ

２ｃｍ／月 ＝
÷ 2cm/month

③

かmo.
月

of energy
to be reduced to achieve the goal
④Amount
目標達成まで減らさなければならないエネルギー量は？
※①－②

× 7,000kcal

ｃｍ

＝

④

kcal
Amount of energy to

④

kcal

÷

③

＝
mo. ÷ 30
30日
か月
days

1日あたりにbe reduced per day
減らすエネルギー

kcal※ To reduce abdominal circumference by 1cm (=body weight by 1kg), about 7,000 kcal should be⑤How do you reduce this amount of energy ?
Amountof energy to
1日あたりにbe reduced per day
減らすエネルギー

kcal

By exercise

kcal

By dietkcal
27

Energyexpenditureby exercise量
運動 で消費する
エネルギー

Brisk
Bicycling
自転車
水泳 (light effort)
walking Swimming

Golf
ゴルフ

Light
jogging

Running

Tennis
テニス(Singles)

METs

4.0

8.0

4.0

3.5

6.0

8.0

7.0

Time

10 min10 min

2020
min

6060
min

3030
min

15
15min

2020min

Ex

0.7
0.

1.3

1.3

3.5

3.0

2.0

2.3

体重別エネルギー消費量

Energy expenditure by body weight

50kg

25kcal

60kcal

55kcal130kcal130kcal90kcal105kcal60kg

30kcal75kcal

65kcal

155kcal155kcal110kcal125kcal

70kg

35kcal

85kcal75kcal185kcal185kcal130kcal145kcal

80kg

40kcal100kcal85kcal210kcal210kcal145kcal170kcalEnergyexpenditure is calculated by “(METs × body ×時間（
weigh×time(h)×1.05)– resting metabolic rate”.
h）×1.05の式から得られた値かエネルギー消費量は、強度（メッツ）×
All the values are shown in 5 kcal unit.

Measurementof abdominal circumference
腹囲の測定方法・ Measure at the navel level, at the standing position.

・腹囲は・ Stand with both feet together: the arms are placed naturally on the sides.
・ Try not to strain the abdominal muscles
・ Breathe naturally and read the scale of tape measure at the end of exhalation.

・・^ Make sure that the tape measure is placed horizontally around the back/waist.
・・ For an accurate measurement, do not wear underwear
Measuring siteof abdominal circumference
腹囲の測定部位28

4. To achieve the goal
(1) Advice for achieving the goal
Here is the advice for you to achieve the goal that you have set for the quantity of physicalactivity. For which, it is important that you increase the quantity of NEA in your daily life andpractice exercise suitable to your life style.
Furthermore, to achieve the goal, it is effective to exercise considering your current life stage.

(A) Advice for increasing the quantity of NEA
To increase the quantity of NEA, it is effective to increase the number of steps in your daily
life. Let’s achieve your goal for physical activity by acquiring a walking habit.
{ Six key points to develop a walking habit in your daily lifec Let’s learn the number of steps by the time of walking. For example, walking for 10
minutes roughly corresponds to 1,000 steps.
d Let’s learn the number of steps by experience of your behavioral pattern. For example, you
can learn how many steps you usually take for going to a supermarket or commuting.
e Do not try too hard from the start. If you plan to increase your steps by 4,000 steps, startwith an increment of 1,000 steps a day. You can gradually increase the number of steps to4,000 steps in 3 months.
f Walking does not have to be continuous. You can aim at total 10,000 steps in a day(70,000 steps for a week).
g You should create as many opportunities as possible to walk as a mode of transportation inyour daily life.
h Let’s walk with a specific purpose. It may be good to go shopping or visiting historicalsites during the weekend.
29

(B) Advice for increasing the quantity of exercise
It is important to maintain the reference quantity of exercise per week. For example, you cando brisk walking at a pace suitable to your lifestyle, either once a week for 60 minutes or 6
times a week for 10 minutes each.

(2) Advice for achieving the goal, according to one’s current stage
These are the advices that may help you in achieving the goal suitable for your current stage.
First, find out your current stage by referring to the flow chart below.
Next, proceed to the page shown in the box of your stage. You will find an advice to practiceand continue the physical activity and exercise suitable to your current stage. Then, let’s
consider how you are going to incorporate physical activity and exercise into your daily life.
You should evaluate the quantity of physical activity every 3 to 6 months, to adjust the goal
and also to re-evaluate your stage.

“What’s your current stage?”
Question
運動
実践onに
exercise practiceStartAnswer to the following questions
with “yes” or “no”. Follow the arrows
and circle the box corresponding to
your stage.

Do you currently meet the reference quantity of 23 Ex per
week by NEA or/and exercise?
No
いいえ

Yes
はい

Yes
はい

Do you sometimes increase the quantityof NEA or do exercise?

No
いいえ

No
いいえ

Do you intend to increase NEA or do
exercise in the near future?
No
いいえ

A
A 前熟考
Pre-contemplation
ステージ
stage (p. 31)

Yes
はい

C
C
準備
Preparatory
ステージ
stage
(p. 33)

Yes
はい

B
B 熟考
Contemplation
ステージ
stage
(p. 32)

Did you regularly undertake NEA or/and
exercise to meet the reference of
23 Ex per week in the past 6 months?
No
いいえ
Continue
継続しているが< 6months
6

D
D 実行
Practicestageステージ(p. 34)Yes
はいContinue
6ヵ月以上≥ 6 months

E
E 維持
Maintenanceステージ
stage (p. 35)* NEA: non-exercise activity

30

A.

For the persons in the pre-contemplation stage

The persons in this stage are…
Currently, you are not doing any exercise and the quantity of your NEA is also low. Yet, you still
do not consider starting exercise or increasing NEA in the near future.
You have not achieved the goal of the quantity of physical activity necessary for healthpromotion. If you remain in the current stage, you will be at risk of developing lifestyle-relateddiseases. First, let’s start with considering increasing the quantity of physical activity.

Advice：Let’s imagine your future health status!
○ Perhaps, you are focusing too much on the burden of exercise, aren’t you? Let’s turnyour attention to the future benefits too. First, please imagine the immediate effects: youwill be more resistant to diseases, you will lose your weight, you no longer lose yourbreath when you climb stairs, and you do not need a special effort when you stand up.
○ If you continue to keep the quantity of your physical activity low, what will happen to
your body in the future? Imagine also the influences on other people around you.
Whatever little effort you make now will bring you a much better future. Just imagine
yourself being more active and healthy.
○ You may say that you do not like or are not good at or are not confident with or have notime to do any exercise. You can even prevent lifestyle-related diseases by increasing
NEA, instead of doing exercise.

Be more active, rather than do nothing.
Let’s start with what you can do.
○ Let’s start with what you can do immediately. It is better to do even a little activity,
rather than do nothing. As a starter, let’s challenge stretching, walking and climbing
stairs, all of which you can do without any special preparation.
○ You may consider consulting a specialist about the types of exercise suitable for you
and how to increase your NEA. Surely, you will receive a helpful advice from him/her.

31

B. For the persons in the contemplation stage

The persons in this stage are…
Currently, you are not doing any exercise and the quantity of your NEA is also low. Thus, youhave not achieved the goal of the quantity of physical activity necessary for health promotion. If
you maintain the current status, you will be at risk of developing lifestyle-related diseases.
What a wonderful that you are planning to increase your NEA and start exercise in the near
future. Let’s take a first step toward realization of your plan.
Advice：Let’s start with increasing the quantity of physical activity!
○ Even without doing exercise, you can maintain and promote your health by moving
actively in your daily life. The recommended quantity of physical activity for healthpromotion corresponds to about 8,000 to 10,000 steps per day. You do not need to aim
at this goal from the start. Let’s start with the steps you can do and increase gradually.
○ How about start with an increment of 1,000 steps a day, and then gradually increase thenumber of steps, as you get used to it? Walking for 10 minutes roughly corresponds to
1,000 steps.
○ You do not have to focus too much on the number of steps. You may set a goal of doing
the activities, such as taking a walk, commuting, floor cleaning, gardening, car washing,carrying a load and playing with a child, for about 60 minutes in total every day. Even
without allocating a separate time for exercise, you could also exercise while you dohousework.

How do you feel after you tried?
○ You may notice that there are unexpectedly many things you can do to increase NEA.
Now, you know that you can do. Let’s have self-confidence.
○ Let’s set a minimum goal that you can easily accomplish everyday, like taking slightly
large steps while walking or stretching your back once every hour.
○ Let’s find a place for walking in a nearby park or on the way to your office. By looking
into your daily life, let’s consider when, where and how much activity you can do.
○ At the beginning, you may start with a little exercise, for example once in the weekend
for 30 minutes. Anyway, let’s start a new challenging exercise even for a short time.
○ You may consider consulting a specialist about the types of exercise suitable for you
and how to increase your NEA. Surely, you will receive a helpful advice from him/her

32

C. For the persons in the preparatory stage

The persons in this stage are…
Currently, you have not achieved the goal of the quantity of physical activity necessary for healthpromotion. Yet, you are occasionally trying to increase NEA and do exercise. Unfortunately, thecurrent quantity of physical activity is not sufficient to prevent lifestyle-related diseases. So, let’schange the frequency of activities from “occasionally” to “regularly”.
Advice：Let’s start with doing exercise once a week, andenjoy continuing it!
○ You have tried, even occasionally, to increase NEA or do exercise. You’ve done well.
As this cannot be done easily, you should have self-confidence. What you have to donext is to change the frequency of activities from “occasionally” to “regularly”.
○ For health promotion, you are advised to increase NEA and continue them and do
exercise of at least 4 Ex per week, which corresponds to brisk walking, bicycling or
dancing for about one hour per week, or aerobics, swimming, jogging, playing tennis orsoccer for about 40 minutes per week.
○ You can do these exercises at once or can divide into 2, 3 or 6 times in a week. For
example, you can do brisk walking either once a week for 60 minutes, twice a week for
30 minutes each or 3 times a week for 20 minutes each.

Devise a way to continue the exercise!
○ Let’s place the items that encourage you to practice exercise around you. For example,
you may post your goal of exercise program (e.g. number of steps) on your fridge, orplace your walking shoes in a visible place at the entrance; or hang your sportswear inyour room.
○ First, let’s grasp when, where and how long you undertake the activities. Based on
which, you can set a specific and practical goal of exercise. If you cannot achieve yourgoal, your goal may not be realistic. Let’s set a 95% achievable and short-term goal.
○ Let’s ask your family or friends to give you a moral support or join you in exercising. It
may be a good idea to declare your goal of exercise in front of them.

33

D. For the persons in the practice stage

The persons in this stage are…
Currently, you undertake a great quantity of NEA or exercise regularly. You have achieved thegoal of the quantity of physical activity necessary for health promotion. You can maintain andpromote your health by continuing the current practice. As it is still less than 6 months since you
performed physical activity regularly, there is a risk that you may go back to the previous
sedentary life. Let’s continue the current practice, while being cautious of the risk of rebounding.

Advice：Let’s try to keep the current practice!
○ You have increased your NEA and practiced exercise. You have done very well.
Now, it is time to consider how you can keep these practices.
○ Let’s look back now. You must have been tempted to give up several times. You haveovercome the situations that stopped you to continue the exercise (e.g. working late,taking care of your family). You could anyway manage to continue the exercise, forwhich you should have self-confidence.
○ Now, you must be aware of the physical effects of exercise; e.g., you feel less tired; youcan climb the stairs more easily; your abdominal circumference is reduced and yourclothes fit better; and you no longer have stiff shoulders. Let’s recognize these effects
again.
○ Let’s control the various factors that could interfere with your current exercise habit.
For example, prepare indoor activities in case of bad weather, as a replacement ofwalking; if you’ve got a sudden work by which you could not do the planned exercise,increase the quantity of physical activity on another day so that you can maintain thegoal of Ex per week; and if you feel bored with the routine program, change the routefor walking or try a different type of exercise.
○ Let’s put the schedules of NEA and exercise in your personal notebook or calendar inadvance. By which, a higher priority will be placed on these activities in your mind.
○ Sometimes, you may not feel like doing any exercise. Even if that happens, you should
anyway go to the place of exercise or change your clothes for exercise.

34

E. For the persons in the maintenance stage
The persons in this stage are…
Currently, you undertake a great quantity of NEA or exercise regularly. You have achieved thegoal of the quantity of physical activity necessary for health promotion. You can maintain andpromote your health by continuing the current practice. Let’s maintain the current condition.
Advice：Let’s have a confidence that you have continued.
Let’s invite your family and friends to join you.
○ How wonderful that you could continue your program in spite of the many temptations
and difficulties that you have encountered. You should congratulate yourself.
○ Let’s recognize again the physical effects of exercise that you feel in your daily life; e.g.,
you feel less tired; you can climb the stairs more easily; your abdominal circumference
is reduced and your clothes fit better; and you no longer have stiff shoulders.
○ Let’s control the various factors that could interfere with your NEA and exercise. For
example, prepare indoor activities in case of bad weather, as a replacement of walking;if you’ve got a sudden work by which you could not do the planned exercise, increase
the quantity of physical activity on another day so that you can maintain the goal of Ex
per week; and if you feel bored with the routine program, change the route for walking
or try a different type of physical activity.
○ Let’s put the schedules of NEA and exercise in your personal notebook or calendar inadvance. By which, a higher priority will be placed on these activities in your mind.
○ Having continued the program for a certain period, reward yourself for your effort. The
reward may be traveling, taking a special meal or buying a new sportswear you wanted.
○ Lastly, you should understand that it is not unusual that your program can be interrupted
by some reasons. Yet, it is only yourself who can restart the program. Be prepared also
for the risk of rebounding. However, even if you have stopped your habit temporarily
for some reason, do not feel anxious too much. Instead of trying very hard to restart the
program in a rush, take your time in going back to your previous exercise habit.
Check the following:c Are you sure that your physical activity program is not biased to a certain type ofactions?
d Are you enjoying the physical activity instead of doing it as an obligation?
e Are you certain that your physical activity is not adversely affecting your physicalcondition?
If your condition falls on any of the above c-e, you should consult a specialist on exercise.

35

5. Notes on practicing exercise
When you do exercise, it is important to pay attention to your physical condition and theweather on that day, as well as your chronic illness, so as to avoid any accident. If you sufferfrom a chronic illness, consult your doctor so that you can practice exercise safely.
In addition, it is important that you select the type of exercise suitable to your physical fitness,
and also that you do warm-ups and cool-down, including stretching, before and after exercise.
(1) Notes for a safe exercise
c To prevent an accident and reduce the fatigue after exercise, make sure to do the warm-up
and cool-down exercises. Please also refer to “(2) Warm-up and cool-down exercises” (p.37).
d If you have chronic knee pain or backaches, consult your doctor or a specialist on exercise
before starting the exercise program. If a strong pain occurs during or after exercise, stop theexercise immediately.
e If you suffer from a chronic disease such as cardiovascular ones, exercise may quickly
elevate your blood pressure. Do not start the exercise without consulting your doctor or a
specialist on exercise. Check your blood pressure and physical condition before exercise, andif you do not feel quite well, you should stop the exercise.
f Adjust the quantity or intensity of exercise to suit your physical condition on that day.
g When you exercise outdoors or at a place with high temperature during summer, you must
be careful not to suffer from dehydration or heat stroke. To prevent these symptoms, makesure to drink sufficient fluids before, during and after exercise.
h You should wear clothes that are suitable for the season, with which you can move freely.
It is recommended to wear the sports shoes that do not place the burden to your knees orankle joints.

36

Fig. 4. An example of good sports shoes
The cushioned heels
are less likely to add
burden to the knees

Sports shoes (e.g. jogging
shoes, tennis shoes) aresuitable.

There is sufficientspace in the toes, andyou do not feel tight

The soles should be soft.

(2) Warm-up and cool-down exercise
It is known that injuries and pain caused by physical activity and exercise are likely to occur
at the sites that are frequently and actively used. Warm-up and cool-down exercise (including
stretching) should be selected in accordance with the type of exercise, focusing on the sites where
injuries or pain are likely to occur.

Light exercise: slow and large motions to relax muscles and joints① Knee bends② Light leg stretch⑤ Rotate upper body ⑥ Back stretch③ Upper body bends④ Side stretch⑦Rotate wrists and ankles ⑧Light jump ⑨Deep breath37

Stretching：slowly extend (for about 20 sec.) to relax muscles and joints〔Leg〕 ① Calf

② Upper back〔Body trunk〕①buttock/lumber〔Shoulder/arm〕① Shoulders③ Quadricepts②Hamstring② Triceps④ Inner thigh③ Neck

③ Wrists

Key points
c Do not hold your breath.
d Stretch slowly for 20 to 30 seconds.
e Stretch moderately, at the level without a pain.
f Feel that the stretched muscle is sufficiently extended.
g Do not use a recoiling power or put too much pressure.

38

Appe ndix

39

Appendix 1. Tables for METs and Ex of each physical activity
For your reference to self-evaluate the quantity of your physical activity and plan various
combinations of physical activity (exercise and NEA) to meet the exercise guide, the following
tables show the time corresponding to one Ex (METs·hour) for various types of physical activity.

Exercise of 3 METs or more (included in the computation of the goal for the quantity of exercise)Time (min/day)
METs
Specific physical activities
corresponding
to 1 Ex
3.0
Bicycling using a stationary ergometer: 50 watts, very light effort;
20
Weight lifting (light or moderate effort); Bowling; Playing frisbee; Volleyball
3.5
Calisthenics (home exercise, light or moderate effprt);
18
Playing golf (using power cart, excluding the waiting time. See Note 2)
3.8
Walking for exercise (level, 94 m/min.)
16
4.0
Walking at a brisk pace (level, 95-100 m/min.); Water exercise/stretching;
15
Table tennis, ping-pong; Tai chi, Water aerobics/calisthenics
4.5
Badminton, golf (walking and carrying clubs, excluding the waiting time)13
4.8
Ballet; modern dance; twist, jazz or tap dancing
13
5.0
Softball or baseball; Children’s games (hopscotch, dodge ball, playground12
apparatus, marbles etc.); Walking (level, very brisk pace, 107 m/min.)5.5
Bicycling using a stationary ergometer: 100 watts, light effort
11
6.0
Weight lifting (power lifting or body building, vigorous effort); Slimnatics;
jazzercise; Jog/walk combination (jogging component of less than 10 min.);10
Basketball; Swimming, leisurely
6.5
Aerobics
9
7.0
Jogging; Soccer; Tennis; Swimming, backstroke; skating; skiing
9
7.5
Mountain climbing: with 1-2 kg load
88.0
Cycling (approx. 20km/h), leisure, moderate effort; Running: 134 m/min.,8
Swimming, slow crawl (approx. 45 m/min.), moderate or light effort
10.0
Running: 161 m/min.; judo; jujitsu; karate; kick boxing; tae-kwon-do; rugby;
6
Swimming, breast stroke
11.0
Swimming, butterfly; Swimming, fast crawl (approx 70 m/min.), vigorous effort
5
15.0
Running, stairs, up
4
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of Physical Activities: An update of activity codes and MET
intensities. Med Sci Sports Exerc 2000; 32(Suppl): S498-S516.
Note 1: When there are multiple values for a single activity, the one that is considered to appear more frequently is listed(c.f., taking the value for leisure activity over that for competitive sport).
Note 2: Each value represents that while engaged in activity, not while resting. For example, if one played golf using a power cart,
and if s/he spent 2 hours out of total 4 hours for waiting, the calculation should be 3.5 METs x 2 hours = 7 Ex(METs·hour).

40Nonexercise activity (NEA) of 3 METs or more (included in the computation of the goal for the quantityof physical activity)
Time (min/day)
METs
Description of activities
corresponding
to 1 Ex
3.0
Walking (level, 67 m/min.); Walking with small child(ren); Walking the dog;
Shopping; Fishing (from boat, sitting (2.5) to fishing in stream (6.0));
20
House cleaning; Putting away household items; Carpentry; Packing;Playing guitar, rock and roll band (standing); Loading/unloading a car;
Walking down the stairs; Child care, standing
3.3
Walking (level, 80 m/min., moderate pace) commuting;18
Carpet sweeping; Sweeping floors
3.5
Mopping; Vacuuming; Packing/unpacking box; Carrying light load;
17
Electrical work and plumbing
3.8
Walking for exercise (level, 94 m/min.),16
Scrubbing floor on hands and knees; Scrubbing bathroom/bathtab
4.0
Walking at a brisk pace (level, 95-100 m/min.);Bicycling: <16 km/h, leisure, to work or for pleasure;
Walk/run - playing with child(ren), or animals, moderate;
15
Pushing the wheelchair; Raking roof with snow rake; Playing drums;
Playing with a child (walk or run, at a moderate intensity)
4.5
Planting seedlings/shrubs, weeding, cultivating garden;
13
Farming: feeding cattle/horses
5.0
Walk/run – Playing with child(ren), or animals, vigorously;
12
Working at a very brisk pace (level, 107 m/min.)
5.5
Mowing lawn, walk, power mower
11
6.0
Moving furniture, household items, carrying boxes, Shoveling snow by hand
108.0
Carrying heavy load;
Farming: forking straw bales, cleaning corral or barn, poultry, vigorously
8
Climbing the stairs
9.0
Carrying load upstairs
7
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of Physical Activities: An update of activity codes and MET
intensities. Med Sci Sports Exerc 2000; 32(Suppl): S498-S516.
Note 1: When there are multiple values for a single activity, the one that is considered to appear more frequently is listed
Note 2: Each value represents that while engaged in activity, not while resting.

41

Activities of less than 3 METs (excluded in the computation of the goals for the quantity of physicalactivity and exercise)
METs
Description of activities
1.0
Sitting quietly (or lying down); Watching TV or listening to music; Reclining; Riding in a car
1.2
Standing quietly
1.3
Sitting – reading book or newspaper
1.5
Sitting – talking or talking on the phone, reading, eating, driving a car, light desk work, knitting,
doing a manual craft and typing
Taking care of a pet (in a sitting position, light intensity); Bathing (sitting)
1.8
Standing - talking or talking on the phone, reading and doing a manual craft;
2.0
Cooking or food preparing – standing or sitting;
Implied standing – laundry, fold or hang cloths, put clothes in washer or dryer, packing;Playing guitar, classical or folk (sitting); Dressing, undressing;Talking and eating or eating only (standing); Grooming (brushing teeth, washing, shaving etc.);
Showering, toweling off (standing);
Walking slowly (level, outdoors or indoors ground, less than 54 m/min. )2.3
Wash dishes (standing); ironing;
Implied walking – putting away clothes, gathering cloths to pack; putting away laundry
Standing - casino gambling, duplicating machine (standing);
Standing – light work (bartening, store clerk, factory worker)
2.5
Stretching* and hatha yoga*;Light cleaning (dusting, straightening up, changing linen and carrying out trash);Serving food, setting table, cooking or food preparation, and putting away (walking) etc.;
Watering plants; Sitting - playing with child(ren) or animals; Child care (sitting/kneeling);
Playing piano or organ; Farming: driving harvester, cutting hay, irrigation work;
Playing catch* (football or baseball); Operating a motor scooter or motorcycle;
Pushing or pulling stroller with child or walking with children; Walking (level, 54 m/min.)
2.8
Standing - playing with child(ren) or animals*Indicates exercise: the others are classified as nonexercise activity (NEA).
Ainsworth BE, Haskell WL, Whitt MC, et al. Compendium of Physical Activities: An update of activity codes and MET
intensities. Med Sci Sports Exerc 2000; 32(Suppl): S498-S516.
Note 1: When there are multiple values for a single activity, the one that is considered to appear more frequently is listed(c.f., taking the value for leisure activity over that for competitive sport).
Note 2: Each value represents that while engaged in activity, not while resting.

42Appendix 2. Case examples of approaches to increase the quantity of physical activity
according to one’s lifestyleSpecific examples are shown here to illustrate how to increase the quantity of physicalactivity according to one’s exercise habit, lifestyle and physical condition. You may refer to an
example close to your case or the one that you find interesting, so as to increase the quantity ofyour physical activity.

Case 1. A man in his 30’s who wants to prevent metabolic syndrome.
Health promotion by working out a lack of exercise“Reduce the visceral fat by brisk walking!”

Case 2. A man in his 50’s wishing to treat metabolic syndrome
Reduce the abdominal circumference by physical activity“Increase the quantity of physical activity in your daily life”

Case 3. A woman in her 30’s who wants to practice an active lifestyle
Healthy weight control through exercises“Gain a smart figure by exercise once a week!”

Case 4. A woman in her 40’s who wants to regain the slim figure
Health promotion through diet and exercise“Healthy weight control through exercise and diet!”

Case 5. A woman in her 50’s who wants to remove anxiety on her health after illness
Regain an active body through exercise“Regain health through exercise after an illness”

Case 6. A woman in her 60s who wants to live a more active life
A more active life by increasing physical fitness“A fatigue-free life with increased muscle strength”

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Case 1

“Reduce the visceral fat by brisk walking!”
Mr. Koji, 38 years old, sales representative(1) How did he get started to increase the quantity of physical activity?
Mr. Koji had engaged actively in athletic activities at the high school and had been confidentof his physical fitness. Having been employed after graduation, however, he had little time forexercise. In addition, he was often involved in the drink/dinner related to his job after work.
As a result, he gained weight by 25 kg (60kg→85 kg). At that time, his boss was hospitalizedwith myocardial infarction, which made him worry about his own health. He lost his breath
when he climbed the stairs to the third floor and he also found his colleagues easily climbed
faster than him, which further bothered him. He was told at the health guidance after thehealth check-up that “You will be at risk of developing lifestyle-related disease if you
continue the current life style”. So he decided to lose his weight.
(2) Device to increase the quantity of physical activity
He has ever gone to a fitness club regularly. However, when he could not go there for several
days due to his work, he often gave up continuing it. Following the suggestion by hiscolleagues, he started commuting by train, instead of car. As a daily goal, he decided to walkfor about 30 minutes (round trip between the station and the office) with a speed by which hefeels a bit hard to breathe.
Wearing a pedometer, he set a goal to walk 10,000 steps a day. He entered the number ofsteps in his PC, and drew a graph to check the daily difference.
He weighed himself everyday, with paying particular attention to his abdominal
circumference. And, he set a goal to lose 5 kg within 3 months.
He also improved his diet, by stopping to eat fast, reducing the intake of fried food,increasing the intake of vegetables and replacing regular canned coffee with sugar-free one.
[Exercise program for Mr. Koji]
Brisk walking for 30 minutes, 5 times a week

4 METs × 30/60 × 5 = 10Ex/week(3) Results after 3 months
By acquiring the daily walking habit, the mean number of steps per day increased from 5,500
to 10,000 steps, and he also lost body weight by 4 kg.
Looking at a positive effect on weight reduction, he would wish to continue the program.
However, he tends to sweat a lot and thus, it is hard for him to continue the walking exercise
in summer. Besides, he may have to stop the walking exercise during the rainy season too.
So, he is now considering to stop the morning exercise for a while because of his sweatingproblem, and instead, he could get off the train at the next to the nearest station (to increase
the walking distance) or stop at an air-conditioned fitness club on his way back from work.

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Case 2

“Increase the quantity of physical activity in your daily life”
Mr. Shinji, 50 years old(1) How did he get started to increase the quantity of physical activity?
Mr. Shinji was conscious of a lack of exercise, but he was too busy with his work to allocate
time for exercise. Meanwhile, he began to put on fat around his abdominal and his cholesterollevel and blood pressure showed the abnormal levels. At a health check-up, he was told that
he had developed a visceral fat syndrome and fatty liver, which made him decide to lose hisweight.
Then, he devised to increase the quantity of physical activity in his daily life.
(2) Device to increase the quantity of physical activity
Usually, it takes about 10 minutes to walk from home to the nearest station. In the morning,
he normally walks in a hurry, while he often walks more slowly on his way home. By
walking this distance, whether it is fast or slowly, he could add 20 minutes of walking a day.
In addition, it takes about 10 minutes between his office and the nearest station. There areseveral stairs on the way, and if he uses the station exit close to the office, he uses more stairs.
He decided to take a walk outside the office for a change for about 10 minutes after lunch.
In the weekends, he used to stay at home most of the time, but he decided to walk outside forat least 20 minutes (1 Ex) by going to a supermarket or taking a walk in the neighborhood.
He also decided to start gardening in the weekend, which takes about 1 to 2 hours each time.
Of which, he spend about 30 minutes for the activities with slightly higher intensity, such as
weeding and leveling the ground.
(3) Results after 6 months
Mr. Shinji has not started any exercise yet, but he has lost his weight by 3 kg in 6 months. He
noticed that he reduced his abdominal circumference by one notch of his belt. The results of
his blood test showed that he is now outside the critical levels. Although he is not yet quite
confident with his physical fitness, he feels that he can now walk more easily than before.
Mr. Shinji’s physical activity
Weekdays (5 days a week)
Walking from home to the station (20 minutes round trip)
Walking from his office to the nearest station (20 minutes round trip)
Going out at lunch time on foot (20 minutes round trip)
Stairs at the station and office (5 minutes)
Total
Weekend (2 days a week)
Shopping and taking a walk (20 minutes round trip)
Gardening (30 minutes)
Total

1 Ex
1 Ex
1 Ex
0.5 Ex3.5 Ex
1 Ex
2 Ex
3 Ex

3.5 × 5 + 3 × 2 = 23.5 Ex

Total Ex in a week45

Case 3“Gain a smart figure by exercise once a week!”

Ms. Mika, 30 years old, office worker working 5 days a week, with exercise experience(1) How did she get started to increase the quantity of physical activity?
When she became 30 years old, she suddenly began to feel stiff shoulders and easily-fatigued.
She was shocked as she looked old, when she saw her own figure in a large mirror at a
department store. She has been interested in dieting and has tried many methods, though she
has not yet found the one suitable for her. Her BMI is 20, which is in the normal range, but
the percentage body fat is as high as 30%. At the health check-up, she learnt that her bonemineral density was only 75% of the average for her age.
She became worried that she would be bent with age, if she maintains the current conditions.
(2) Device to increase the quantity of physical activity
At the health guidance, she was told that an extreme diet may reduce her bone mineral density
and also that the high percentage of body fat is possibly due to low muscle mass, rather thanhigh body fat. Therefore, she decided to participate in an exercise program once a week.
She leant that muscle training is necessary to maintain and increase the bone mineral density
and stretching is effective for easing stiff shoulders.
Exercise program for Ms. Mika
• Aerobic exercises
1. Walking (80 m/min.), for 20 minutes,

3.3 METs × 20/60 × 1 ≈ 1 ExÈ
2. When she gets used to walking, increase the time to 30 minutes, 3.3 METs × 30/60 × 1 ≈ 1.5 Ex
È
3. When her muscle strength increases, walk faster.
Brisk walking 30 minutes,
4 METs × 30/60 × 1 = 2 Ex
• 7 types of resistance training (10 to 15 times for each action, start with one set)----- 20 minutes for the entire program
3 METs × 20/60 × 1 = 1 ExÈWhen she gets used to resistance training, increase the load by one of the following methods:
c 15 to 20 times for each action (30 minutes)
1.5 Exd 2 sets of all types of action (40 minutes)
2 Ex• Gymnastics, for 15 minutes
She started with the program of 2 Ex in total, which increased to 4 Ex in 3 months. Although she
undertook the program once a week only, she could eventually meet the reference quantity.
In her daily life, she started using the stairs for 10 minutes daily, which increased the quantity ofphysical activity by 10 Ex.

(3) Results after 6 months
Her posture has been improved. She noticed that she is now walking more lightly.

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Case 4.

“Healthy weight control through exercise and diet!”
Ms. Yumiko, 45 years old, housewife(1) How did she get started to increase the quantity of physical activity?
Ms. Yumiko has junior high school and high school children. She weighed 55 kg when she
got married, but perhaps due to a fatty diet that her fast-growing children preferred, she now
weighs 78 kg. Encouraged by advice given at the health guidance after a health check-up,“Now, you have visceral fat syndrome, but you can improve the symptoms of lifestyle-relateddiseases if you lose your weight by 3 kg”, she decided to participate in the exercise class.
Ms. Yumiko’s current quantity of physical activity
Mean number of steps per week is 6000 steps; No time is allocated for exercise.
(Judging from the number of steps as 6,000 steps per week, the quantity of her daily NEA
corresponds to 3,000 steps per day ≈ 30 minutes of NEA: e.g. house cleaning, gardening).
Quantity of physical activity per week: 3 METs ×30/60×7 = 10.5 Ex
The above assessment shows that she was short of about 13 Ex to reach the reference of 23 Ex.
(2) Device to increase the quantity of physical activity
She started the following program. Because of the excessive body weight, she decided to startwith walking at a normal speed, a bicycle ergometer and resistance training.
As for diet, she reduced the intake of fried food and snack. She also began to be concerned
about the appropriate food intake for her, using the “Japanese Food Guide Spinning Top.”
Exercise program for Ms. Yumiko* Walking (30 minutes with normal speed), 4 times a week
3 METs × 30/60 × 4 = 6 Ex
* Bicycle ergometer (30 minutes), twice a week
4 METs × 30/60 × 2 = 4 Ex
* Resistance training (squatting, sit-ups etc.) (15 minutes), twice a week
4 MESs × 15/60 × 2 = 2 Ex
Quantity of physical activity → 22.5 Ex . . . . . . . . She needs just one more effort!
Quantity of exercise→
6 Ex . . . . . . . . She has met the reference value!
(3) Results after 3 months
The evaluation after 3 months showed that she lost her weight by 4 kg, with improvements inall the tested parameters, and in particular her blood glucose level and lipid profile got back to
the normal ranges. Exercise has become an essential part of Ms. Yumiko’s daily life, and she
had got a habit of walking after supper with her husband, Mr. Takashi. She was also told by
her daughter recently that she has recently become attractive. In this way, Ms. Yumiko is
enjoying a purposeful life now.
47

Case 5.

“Regain health through exercise after an illness!”
Ms. Keiko, 55 years old, she is concerned about her health after an illness(1) How did she get started to increase to increase the quantity of physical activity?
Ms. Keiko stopped all types of exercises for 1 year, because of a breast cancer operation andthe subsequent treatment. Having sufferance from this life-threatening illness, she lost all
confidence in her own physical fitness. During the past one year, she gained 7 kg (height, 155cm; weight, 64.6 kg; BMI, 26.9), due to overeting with a belief that she could regain her
physical strength by eating a lot and also to staying in bed for treatment. When she began to
be concerned about the current condition, her doctor suggested that she should start exercise.
(2) Device to increase the quantity of physical activity
With no experience of exercise at all and having just recovered from illness, she felt anxious
to plan the exercise program on her own. So, her doctor introduced a health facility with the
Health Fitness Programmer, where she started the training program twice a week.
Twice a week exercise program for Ms. Keiko• Aerobic exercises*Aquatic walking 500 m (30 minutes; net 15 minutes)
4 METs × 15/60 × 2 = 2 Ex
*Bicycle ergometer (40W) (30 minutes)
4 METs × 30/60 × 2 = 4 Ex
• 4 types of resistance training (15 times each, with intensity by which you can do 20 times)----- 20minutes for the entire program
3 METs × 20/60 × 2 = 2 Ex
Total
8 Ex
(3) Results after one year
After one year of training, she now enjoys her daily life by incorporating various devices tomaintain the exercise habit. She gets along well with other participants of the same class. Her
physical fitness has improved, so that she is now able to walk fast. She also enjoys aerobics
and aquabics at her own pace. She has lost her weight by 9 kg. Her doctor says that she is in avery good condition and praises her efforts to have continued the exercise program.
Ms. Keiko’s current exercise program• Aerobic exercises* Walking (90 m/min., 30 minutes), twice a week
4 METs × 30/60 × 2 = 4 Ex
* Aerobics (30 minutes), once a week
6 METs × 30/60 × 1 = 3 Ex
* Aquabics (45 minutes), once a week
4 METs × 45/60 × 1 = 3 Ex
• 5 types of resistance training (15 times each, with intensity by which you can do 20 times)----- 20 minutes for the entire program, twice a week
3 METs × 20/60 × 2 = 2 Ex
Total
12 Ex

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Case 6.

“A fatigue-free life with increased muscle strength”
Ms. Noriko, 68 years old, with hypertension and left knee pain

(1) How did she get started to increase the quantity of physical activity?
Ms. Noriko currently lives alone. Because she feels knee pain and gets easily tired when shewalks, she hardly goes out.
Yet, she wanted to do something to prevent being bedridden. Then, she came across a leaflet
on a city-organized program to prevent becoming in need of nursing care, and decided toparticipate in the program.
(2) Device to increase the quantity of physical activity
The initial exercise program, once a week (total 12 sessions) for 3 months(Stretching while sitting, 15 minutes)
Calisthenics while sitting
20 minutes
Exercise to increase muscle strength by using own weight while sitting(7 types × 10 times = 1 set) 20 minutes
Light exercise for total 40 minutes = 2 Ex
Since she had started attending the exercise program, her posture improved and she becameless likely to be tired. The number of steps per day was 3,200 steps before starting theexercise program, which subsequently increased to 4,200s steps.
Increase of 1,000 steps equivalents to 10 minutes of physical activity

0.5 × 7 = 3.5 Ex
Increase of total 6 Ex

(3) Results after 3 months
Although the quantity of physical activity has not yet reached the goal in the exercise
guideline, a positive effect was observed in the physical fitness test for prevention of being inneed of nursing care. Initially, Ms. Noriko was not certain if she could continue the programfor 3 months, but she gained self-confidence after having completed the program. She used tohave the impression of exercise as “hard” or “demanding” only, though in fact, she even felt
young again by enjoying the exercise with other participants. She also used to have a fear of
falling when going down the stairs, but as she gained self-confidence in her physical fitness,
she now actively goes out again.
At the end of the 3-month program, she decided to continue to attend the class. When there
is no class, she undertakes 10-minute exercise 3 times a week, with watching TV at home.
Body weight
Physical fitness
10 m walking at full power
Standing on one foot, with eyes opened
Grip strength4950.5 kg → 49.9 kg
6.6 seconds → 6.3 seconds
15 seconds → 23 seconds
22 kg → 24 kg

Appendix 3. An Example of press release

Exercise and Physical Activity Guide
for Health Promotion 2006
1. For people who want to increase physical activity for health promotion
 Health promotion by physical activity
Let’s walk to achieve the following goals in everyday life.
Corresponds to..

Walking
per day

per week

60 min4 Km

7 hour28 Km¾ When one uses a pedometer…
The goal should be set as 10,000 steps per day (70,000 per week),
including 2,000~4,000 steps unconsciously taken in everyday life.

 Health promotion by exercises
Let’s practice more exercises, in addition to physical activity ineveryday life, according to your lifestyle and physical fitness. For
example, the following goals can be set (*).
Corresponds to..

per week

60 min

6 Km

per week

35 min

4 Km

Brisk walking

Jogging*In this case, the goal of walking should be 50 minutes per day (350 minutes per week)

2. For people who are conscious about visceral fat
Let’s try to achieve the following goals, so as to reduce visceral fat andimprove the metabolic syndrome. People with no exercise habit could
start with one fifth of these goals, and then increase the amount of
exercise gradually.
Corresponds to..

per week

150 min 15 Km

per week

90 min 11 Km

Brisk walking

JoggingNote) Make sure to do warm-up and cooling-down before/after exercise, which should be suitable to your physical fitness. For more detailed
information, refer to the website of the Ministry of Health, Labour and Welfare of Japan (http://www.mhlw.go.jp/bunya/kenkou/undou.html).

50