**14. Healthy models**

DASH and Nordic models are also healthy models, with similarities with Med Diet, and may be applied successfully, in accordance with cultural traditions and personal preferences in order to maximize adherence.

## **15. Sedentarism**

It is the fourth risk factor for death [22] and large studies are revealing a great mortality risk associated with sedentarism. Ekelund investigated in a large metaanalysis sedentary behavior effects on more than 1 million persons, revealing an association between all-cause mortality and the level of physical activity. There have been compared sitting periods of less than 4 h/day with the highest quartile of moderate or intense physical activity. One metabolic equivalent (MET) is defined as the amount of oxygen consumed while sitting at rest and is equal to 3.5 ml O2 per kg body weight × min**.** "The metabolic equivalent of task, or simply metabolic equivalent, is a physiological measure expressing the intensity of physical activities. One MET is the energy equivalent expended by an individual while seated at rest.

There is no risk for people sitting more than 8 h/day, but having more than 35, 5 MET h/week of activity (HR = 1.04, 95% CI–1.1). But those being in the lowest physical activity PA quartile, below 2.5 MET h/week and sitting <4 h/day had an increased risk. *The study conclusion is that 60–75 min/day of physical activity may attenuate or even eliminate the detrimental effect of sedentary style on health outcomes* [23, 24]. **Definition of sitting behavior** (SB): The common behavior that is considered a health threat is sitting. There are two modern definitions of SB [25].


Postural—in a sitting or reclining posture.

Contextual—walking time.

Physiological <1,5 METs.

## **16. Physical activity (PA)**

#### **16.1 Definitions (based on WHO 2020 guidelines)**

Light PA (1.6–3.0 METs), moderate (3–6 METs), and intense (>6 METs) [26]. Light-intensity physical activity.

Light-intensity physical activity is between 1.6 and 3 METs, that is, activities with energy cost less than three times the energy expenditure at rest for that person. This can include slow walking, bathing, or other incidental activities that do not result in a substantial increase in heart rate or breathing rate.

Moderate-intensity physical activity.

On an absolute scale, moderate-intensity refers to the physical activity that is performed between three and less than six times the intensity of rest. On a scale relative to an individual's personal capacity, moderate-intensity physical activity is usually a 5 or 6 on a scale of 0–10; intense PA is at a level higher than 6 MET's..

#### **16.2 Physical activity**

This is essential for health and is an important component of a healthy lifestyle. Promoting continuously all PA benefits will lead finally to a higher percentage of people adopting healthy behaviors. The latest WHO guidelines [26] include the major developments vs. 2010 guidelines, being realized based on larger scientific evidence. Additional health benefits are supported by studies-cognitive health improvement, mental health, sleep, and health-related quality of life, and are emphasized beyond traditionally known benefits for cancer prevention, metabolic diseases prevention, cardiorespiratory fitness improvement, and musculoskeletal and functional health. All these documents are reflecting a maturity of the research, but also the complexity of WHO's definition of health as "a state of complete physical, mental and social wellbeing" [27].

#### *Lifestyle Factors and Obesity DOI: http://dx.doi.org/10.5772/intechopen.100254*

Mentioning that a relation between cardiovascular cause mortality, all-cause mortality, and PA is well proved, WHO guidelines are reaffirming that any level and all intensities of PA are associated with low mortality risk. The incidence of type 2 diabetes is decreasing proportionally with PA level. Benefits are also proven in hypertension, cardiovascular disease, colon cancer, and breast cancer. Meanwhile, adiposity is inversely related to PA and sleep and quality of life (QOL) may be considerably improved according to the level of PA. Development of depression and anxiety may be slower for active people. Guideline's conclusions are that any level of any intensity of PA is associated with lower mortality from all causes but also with reduced incidence for type 2 diabetes, hypertension, and cardiovascular disease.

## **16.3 Recommendations for adults 18: 64 years**


There are specific recommendations for limiting sedentary behavior, which are as follows:


### **16.4 Recommendations for older adults**

Older adults (> 64y) usually have a very low level of physical activity. WHO guidelines are emphasizing rules even for this period of life, bringing the same benefits as for the other adults. Additionally, for older adults, PA may prevent falls and injuries, a decline in bone density and functionality also will attenuate the decline of muscular mass.

Recommendations for older adults are (as described by WHO guidelines 2020) as follows:

• PA should be regularly performed by any older adults.


Important for older adults is that any activity is better than inactivity and PA should be increased gradually, based on personal functional capacities and fitness level.
