Based upon their epidemiological evidence from large studies within the general population, Dr. Rubén López-Bueno and Prof. Dr. Borja del Pozo Cruz discuss the cardiovascular benefits of regular physical activity.
Dr. Rubén López-Bueno is Post-doctoral researcher at the Department of Physical Medicine and Nursing of the University of Zaragoza in Spain.
Dr. Borja del Pozo Cruz is principal researcher in Applied Health Sciences at the University of Cadiz in Spain, and adjunct associate professor in the Department of Sports Science and Clinical Biomechanics at the University of Southern Denmark.
The interview was recorded on January 10th, 2024.
Moderators: Prof. Dr. Florian Custodis (Saarbrücken, Germany) and Prof. Dr. Gunnar Heine (Frankfurt, Germany).
Articles discussed:
Prospective Associations of Different Combinations of Aerobic and Muscle-Strengthening Activity With All-Cause, Cardiovascular, and Cancer Mortality.
López-Bueno R, Ahmadi M, Stamatakis E, Yang L, Del Pozo Cruz B.
JAMA Intern Med 2023
doi: 10.1001/jamainternmed.2023.3093
Prospective Associations of Daily Step Counts and Intensity With Cancer and Cardiovascular Disease Incidence and Mortality and All-Cause Mortality.
Del Pozo Cruz B, Ahmadi MN, Lee IM, Stamatakis E.
JAMA Intern Med 2022
doi: 10.1001/jamainternmed.2022.4000
Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK.
Del Pozo Cruz B, Ahmadi M, Naismith SL, Stamatakis E.
JAMA Neurol 2022
doi: 10.1001/jamaneurol.2022.2672
Occupational physical activity and longevity in working men and women in Norway: a prospective cohort study.
Dalene KE, Tarp J, Selmer RM, Ariansen IKH, Nystad W, Coenen P, Anderssen SA, Steene-Johannessen J, Ekelund U.
Lancet Public Health 2021
doi: 10.1016/S2468-2667(21)00032-3
Association of “Weekend Warrior” and Other Leisure Time Physical Activity Patterns With Risks for All-Cause, Cardiovascular Disease, and Cancer Mortality.
O’Donovan G, Lee IM, Hamer M, Stamatakis E
JAMA Intern Med 2017
doi: 10.1001/jamainternmed.2016.8014
Association of the “Weekend Warrior” and Other Leisure-time Physical Activity Patterns With All-Cause and Cause-Specific Mortality: A Nationwide Cohort Study.
Dos Santos M, Ferrari G, Lee DH, Rey-López JP, Aune D, Liao B, Huang W, Nie J, Wang Y, Giovannucci E, Rezende LFM
JAMA Intern Med 2022
doi: 10.1001/jamainternmed.2022.2488
Accelerometer-Derived “Weekend Warrior” Physical Activity and Incident Cardiovascular Disease.
Khurshid S, Al-Alusi MA, Churchill TW, Guseh JS, Ellinor PT
JAMA 2023
doi: 10.1001/jama.2023.10875
Dear colleagues in partnership with the the and theology trans marus at home welcomes Professor B in K andalia and Dr Ruben Lopez Bueno andag arogan with whom we would like to discuss the impact of regular physical activity on cardiovascular outcome and overall survival in the general population based upon their epidemiological research that
Has recently been published in Jamma internal medicine so for the second time within few weeks we have two researchers from Spain within one webinar dear B de we’re happy to host you tonight thanks for accepting our invitation welcome you both also from my side we’re really
Happy to have you here today because we would like to talk about sport Sports and sports Sciences today and as our viewers will be aware of 224 is a year of sports packed with sports we have the Olympic Games and also the Euro 2024 will take place and um as you know
Sports and sport is a relevant ingredient for public health and we have always the questions so what is the remind the the right amount of exercise how should we train and on what level should we exercise what is the optimal number of daily steps we should take to
Increase longevity and therefore we are really happy to have some great experts in the fields of sports Sciences we have as going to introduced uben Lopez Bueno who’s a postdoctoral researcher at the department of Physical Medicine and nursing of the University of thotha in Spain and we have borad Del polus he is
A principal researcher and applied Health Sciences at the University of cadis in Spain and also an adjunct associate professor in the department of sports science and clinical biomechanics at the University of Southern Denmark so um without any further delay um we should address all those questions and
We’re really happy to host you and we are really looking forward for your data yeah thank you so much so I thought it was important first of all to introduce uh some differences between between uh physical activity exercise and sports so that the public can understand uh this
And how this different might apply to uh to each of the uh um you know for every person is watching this this uh webinar or or this uh chat um so first of all physical activity uh might be defined as any uh bodily movement that results in energy expenditure so anything that we
Do you know uh uh any any any step we do any uh any run any St with climb anything that moves our body and produce some and result in some form of energy expenditure is physical activity is uh movement exercise on the uh contrary is a is a physical activity that is planned
And normally is uh focused on improving uh a fitness component could be uh muscular it could be you know cardiovascular fitness any of the fitness component flexibility any of the fitness components so these two are quite different and if you ask people about uh physical activity and exercise
You know people tend to to um use those interchangeably uh in the in the same in the same man but I think it’s important to differenciate because because uh uh physical activity uh has perhap perhaps uh more implications for for public health in the sense of you know there
Might be people that do not exercise but they do a lot of physical activity so if you ask people hey you know uh have you exercise today probably majority of the population would say no uh but if you put an accelerometer or uh you know a smartwatch or even the smartphones that
Is able to uh count the the movement that they do there’s probably a movement there and that movement is associated with health benefits every movement count that’s the motto of the World Health Organization in the last uh physical activity for public health guidelines so so I think you know making
This distinction is is is very important in our study we use the term physical activity uh more focused though on lesser time physical activi so so you know things that people might uh engage in their lesser time rather than when they work or or when they do um
Household chores or any other type physical activi so I just thought that you know making this extension you know could people could put people in in the in the in the perspective that we uh or through we uh which we uh uh launch and did our study um
Yeah I don’t know rben if you have anything to add to that or because we focused on lesser time physical activity right so you can perhaps describe more uh you know what what type of physical activity we differentiated whether it was moderate and what included moderate because I recall the questions were
Included as well some light intensity physical activity in that and then how we were able to separate moderate from from uh vigorous physical it and and what kind of question is if you want to elaborate that that would be great I think for the for the audience yeah H
Well thank you for for having us in this um in your YouTube channel in this serious uh concerning different topics in in in our in research areas uh borha has summarized uh the the difference between physical activity and exercise perfectly I don’t have nothing more to add regarding this issue concerning the
Physical activity intensity that we used in in our our study in in Jama internal medicine physical activity through questioners valid validated questionnaires and uh well the the way they divided ER or considered which was moderate or which was intense physical activity ER was considering the the point in which well you have
Difficulties or you start to breathe uh heavier than usual and then if the question is if the answer is affirmative to this question then ER the physical activity was considered ER more than than moderate and and to surpass the threshold of the of the high intensity or or vigorous intensity so the the
Threshold the line between the two intensities is is considered in this self reported uh questionnaire we used is considered uh concerning the the the way you breathe and the the the effort you feel when you are doing any type of physical activity ER irrespective of this is um
Occupational this is Leisure this is commuting physical activity because domains of physical activity matter matter is is something that we we have investigated uh this few years ago and what we have seen ER is the that depending on the the the way and the domain that you you do this physical
Activity is more linked to to get more benefits for for your overall health preventing diseases um having longer lives and concerning this issue we have seen or many many Studies have seen that ER at least leure physical activity and commuting physical activity are usually healthier and provide more benefits than occupational
Physical although I must say that there is a one two important studies one of them published in lanet Public Health by ulon and colleagues that but they didn’t observe that detrimental association between occupational physical activity and mortality but uh most of the evidence that we have nowadays points towards the the fact
That occupational physical activity May don’t May don’t be as beneficial as the other domains is it correct or what do you think about this yeah I mean I’m I’m I’m well aware of of some of those and I was involved myself on some of those as well one with
You re and I have some working progress in this area as well uh and I uh read of ean’s contribution uh recently and and it seems that once you control for compounder such as uh uh um uh social economical confounders you know that that detrimental Association disappear
In any case I think is it is an area of of interest for for physical activity and more broadly for health promotion but it’s still require some uh you know in the same way that we use now aeromet to to monitor physical activity I think it require some more Nuance devices that
Are able to capture uh uh occupational physical activity per say like you know some arm movements or trunk movements and and and the load uh during during those activities so I don’t think we are yet any closer to any definitive uh uh answer to to that but definitely I think considering the
Domain uh physical activity the domains of physical activities uh is something worth pursuing and this is why uh in our study again going back to our study we focus on lesser time physical activity because simply uh uh the the benefits seems to be clearer or less Marky let’s
Say this so let’s that’s leads me to my first question um this is really interesting um and and the question is always to how to quantify uh uh um activity and as you mentioned you used Accel Accel MATC and um could you could you tell us something about your your uh
Methodology about about techniques to to quantify um um besides that um measurements with accels we didn’t use accelerometers for for the JAMA Internal Medicine study as the National Health inter survey which is the the the survey we we used to uh retrieve data uh concerning physical activity lure time physical
Activity is based on on self-reports they they used validated questionnaires but they didn’t use um accelerometers okay I know um nowadays studies U are being conducted using using more accelerometers but with the this is not possible with the National Health interface survey from the US uh the thing is that they they were
Collecting this information regarding physical activity during many years using using this methodology because it’s cheaper and they they can get uh data from from a larger population uh to get data through accelerometry with a large population is is really expensive and it’s a is really difficult sometimes you need a lot of
Resources ER we are use we are nowadays using using acceler data from from data sets such as the UK biobank but most of the of the existing data sets uh have not data on based on accelerometer on accelerometer so um we couldn’t use this this information this
Is a clear limitation of of our study of the jam Internal Medicine study but um on the contrary uh the self-reported data uh also provided a a larger data set uh which is around 400,000 U people participating in this study which is really difficult to get with the
Accelerometers and not only that but also H the large followup period because H data sets based on accelerometry are relatively recent and National Health Health interace survey we are we were uh retrieving data from the 90s from the 199s so this this data from from that decade is not available in
Other data set so the the followup period in our study is longer than most most of the existing studies that use accelerometers so it it has um clear strong points when you compare it with with other studies and and this is this this point concerning the the longer
Followup I think is is it’s a good point for our study and of course a limitation of our study is that the the data we collect we collected or the the the survey collected is not based on on accelerometry which can provide some type of bias uh because you know when when people
Report concerning physical activity there is always a some kind of bias concerning measurement but there may also if I may interrupt you also be a bias when you apply accelerometers because surely people who take part in a study and who receive this accelerometer for a couple
Of days they may be motivated to move more during these days and once the study period stops and they have to send the device back then they may fall back so I guess both ways may have their limitations may they not that’s totally totally correct gunar
Because H as you have said ER and and that’s really fair to say accelerometers have also limitations because when you you are wearing an accelerometer you tend to move more and there are a studies proving that that that you tend to move more because you know someone is
Is observing you and when someone is observing you uh you usually change your behavior and yes this is this is a bias also in the accelerometer studies and there is also other vas for example uh accelerometers don’t usually count on the physical stationary physical activ for example when you are using a
Stationary bike theel the accelerer is not going to count any what you are doing ER on the stationary bike or for another example uh resistance training when you are raising barbs you are racing bars uh doing heavy lifting um that doesn’t count for theet so in in this sense self-reported physical activity
Data is is more valid to measure physical activity than accelerometers because they count on uh a stationary physical activity and resistance training or flexibility training which is another example okay let’s dive a little deeper into your your your data um I I think maybe we should cut it in half there there are
Two great papers in in in in in in Jama one uh investigated step count and and the number of Step count and uh uh and points and the other was um um certain amounts of physical activity and and mortality and maybe you could lead us uh
Through uh uh to the main main findings first the steps and then the other okay so first of all I think uh it will be fair for me to to say why we focused on steps uh and that’s a that’s a very simple uh simple answer if you if I
Would have that question uh and it’s simply because it’s something that people understand and this goes back and relates back to my to my first point on differentiating this between physical activity and and exercise right so so exercise and the term exercise is for exercisers so only people that exercise
Are able to relate to exercise for the rest of the population which is majority of the population they don’t know what it is uh and they might think are I’m inactive but if you think in terms of the steps oh yeah everyone understands uh steps so we thought if we were able
To you know supplement uh the current physical activity excise recommendations with step metrics so how many steps do we need do we need more intense or less intense steps or it doesn’t matter for broader Health outcomes that will be a great contribution in terms of Public
Health so that was mainly the reason why I will focus on the steps and the main thing uh there were three I say three main findings from the uh from that study first of all uh any step count towards improving Health uh now we assessed in that study from
Memory uh CBD incidents cancer incident all C mortality CBD mortality and cancer mortality so five app comes all together and in a separate paper in another Jama uh Branch journal and Jama neurology we assessed incident of Dementia in all six outcomes we observed exactly the same patterns we obset at those response such
As every increase in steps was associated with less risk of disease or mortality from the very first one so that’s the main or one of the main uh uh findings second we sort of observed that the benefits plateau at 10,000 steps so after which mean after 10,000 we sort of
Didn’t observe any any uh uh you know any farther gains in any of the of the outcomes that we assessed so that’s that’s that’s very important because this this to findings I think are telling us a couple of things at least so so the first one uh you know these
Findings can be used for uh sorry by uh Public Health promoters such as you know doctors in their Clinic so if if you get an inactive uh patient in your clinic say Primary Care uh GP you know standard Community cleaning you can motivate that person say look you don’t need to do
Okay if you do 10,000 steps yes you get you know the maximum obser benefits in a studies but you get benefits from the very first step beyond your Baseline so that’s very motivating for the the least uh uh active segment of of the population right um and then second is
You might not need to go you know 15,000 20,000 steps if you do like if you hit if you’re active and you’re able to hit the 10,000 step that’s that’s that’s enough and probably the other important thing from those studies is that we didn’t differentiate really between
Domains in this case so we we simply with the xometry uh from the UK bio Bank in this case uh we were able to re record like all our steps throughout the day so that means that any estate could count uh whether it was at home uh at
Work or in your lesson uh probably the last important finding is that Ts that were somewhat uh intense uh that that could be you know if you go for a and then you you get breathless you’re unable to maintain a uh you know a normal compensation what you were
Working that that we could Define uh you know intense steps in that way so that people can understand a little bit if you from those 10,000 let’s say if you hit like three 3,000 more intense that would be even better that will provide even more benefits for for for your health
I think that that summarizes very much my uh tour studies before we come to the second paper may I just briefly ask you if we look at the curves that you publish there are even some curves that suggest really a U-shaped relationship so where the best prognostic implications if you had have around
About 10,000 steps and then some of these curves just to go in the bad Direction and this was particularly impressive in my view uh with regard to dementia which you published in the um L of Neurology neurolog um so do you have any suggestion this may happen yeah um
My my first hypothesis there and I think that’s the one that we clearly St in the manuscript is that this is a statistical uh issue really so so we didn’t have many many people you know at the higher end of a step count and because we don’t
Have many many people there and the number of events is also low you know you can see the the confidence interval it’s going super wide right so that that that is the the main to me that’s the main reason why we observed uh uh you know such uh uh you
Shape c there but in reality you know we couldn’t even interpret properly more than Beyond 10,000 12,000 steps that that that that is uh that is my take and that was our discussions as well I got these questions from reviewers but it’s purely an statistical artifact of of the data um which which
In itself is very interesting because it’s posting the it’s posting the question of okay uh and this data doesn’t exist yet but it would be super interesting uh research study what happened with the people that do a lot of steps like you know 20 25,000 we were
Able to collect uh to have a a data set with with such data in it it would be super interesting to analyze what happened down the track with their health uh outcomes including mortality or CBD but unfortunately we don’t have yet I think there’s people that trying
To pull together a data set such a data set but we don’t have yet uh availability to that so so in my view and just to recap is simply an statistical artifact okay great thank you so going further on from from Step counts to different forms and different combinations um of moderate vigorous
Exercise so Ruben would you like to to give us uh a brief wrap up on your paper yes concerning the the main results the main findings of the J Internal Medicine paper regarding combinations of uh moderate vigorous and muscle strengthening physical activity concerning this paper
Um we we so uh an interesting issue that we are nowadays uh trying to delve more into which is that er every every of the three types of physical activity each of them provides May provide ER different benefits through different probably different mechanisms and uh which is most
Interesting about this is that if you want to to live longer or if you want to ER prevent more common diseases regarding cardiovascular health mainly cancer ER you may do these three types of physical activity okay you you should do at least Le a minimum of moderate physical activity a
Minimum of vigorous physical activity and a minimum of two training sessions of muscle strengthening physical activity what we saw is that a combination of these three types of physical activity is optimal to get uh higher reductions of all cause mortality and uh cancer and cardiovascular mortality this
This um this is H uh compulsory uh you need if you want to optimize uh the the the lower risk or you you want to lower your your risk of mortality in an optimal way you need to do at least this three types of physical activity if you
Want to get an optimal reduction then you need to do at at least two mle strengthening physical activity training sessions per week so this is a finding that uh we consider that is really critical ER because okay we know ER that the World Health Organization is is noway recommending muscle strengthening
Physical activity and aerobic physical activity but they don’t do any distinction between moderate and vigorous in the sense that both of both of them are necessary okay they they they recommend okay do 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity or an equivalent combination of
The two but they don’t recommend please do some Er moderate physical activity and do also some vigorous physical activities so do the the two types of aerobic physical activity and um add to this physical to this aerobic physical activity please add uh two sessions of res distance training
Per week and then you will get uh an optimal benefit to reduce your your mortality risk this is very important for us because we see so many patients who come to us cardiologist nephologist who tell us well I do not do regular physical activity but I as exercise but I do my
Gardening I do household work so I’m active all day long but based upon your results you would clearly recommend them to do at least three times per week or so some vigorous exercise in addition which would mean either to go jogging or for at least a brisk walk in order to really start
Sweating if I got it right yes you are correct gar uh what we have to consider here is that uh maybe vigorous physical activity for an older person is simply jogging or or walking at a briis pace but for a younger person a younger adult ER this
Might not be enough to be considered as vigorous physical activity so it also depends on the the the the the age the sex um and your maybe also your your physical fitness it also depends on this just to consider what is vigorous physical activity for you might don’t be
A vigorous physical activity for me might be moderate okay or the other way around uh but what what we have seen because our study is more based on on medium age and older adults is that um considering this uh breathe starting to breathe heavier uh issue so that you can
Consider that that well then then you are starting to do vigorous physical activity because you are you are accelerating your brief and you are feeling that you are doing more effort than than usual ER then we can we can consider this uh vigorous pH physical activity and yes if
You are not doing this type of vigorous physical activity and you are not feeling this these uh symptoms then H you are not making the most of your time to reduce your your mortality risk okay it’s better if if you do something that that than if you
Do nothing okay it’s it’s always to to it’s always better to to do any any physical activity okay because you will you will reduce I I don’t mind if it’s moderate physical activity I don’t mind if it’s if it’s vigorous physical activity or muscle strengthening physical activity you are going to
Reduce your your mortality risk okay doing any of these three types and sometimes people are really busy and they don’t have time to to do these three types of physical activity and it’s easier for them H to do moderate or sometimes ER several minutes of vigorous intensity physical activity but they
Don’t have the resources or they don’t have time to go to the gym and do the do some resistance resistance training but if you are able to and you have the time and and you want to live longer and a healthier life it is recommended according to to to what we
Have observed in in this study it is recommended that you do the the the three types of physical activity if uh someone tells you well as you mentioned um I I do not have enough time do is there any data to to to support an accumulation of of uh all those threes
All those three forms in maybe one or two two questions yeah we we didn’t we didn’t examine ER when this uh these three types of physical activity were were did were were done we we didn’t observe that we we didn’t have the the the data but this is a a really interesting question
The data we collected is is on is based on on a weekly basis H but we don’t know if the the phys the vigorous physical activity they did was the same day that they did the mle strengthening physical activity we we don’t know that because we don’t have
That that that data that that will be really interesting to to have H but what we know up to now is that with the weekend warrior hypothesis there are several papers published regarding this irrespective of the um accumulation of physical activity I mean h if you do most of your physical activity
On the weekend or if you do it during the weekdays from Monday to to Thursday it doesn’t really matter concerning the reduction of mortality risk it doesn’t matter so we have a we have observed not not as not Bor me but other researchers have observed in important studies also published in Jama
That the pattern the the way you accumulate physical your physical activity is irrespective of uh if you ACC acculate on the week on weekdays or on or you accumulate more physical activity on in in in two days and Saturday and and Sunday which is also called The Weekend Warrior pattern so
Irrespective of this you will you will also get similar uh mortality risk reductions there there’s an really critical study published by Cari and and colleagues in Jam that is is based on on this topic and these are the main conclusions of of the of the study it’s is totally respective if you do
Physical activity concentrated in in two or three days uh per week or if you do it more spread H along the week it it doesn’t matter what which matters is uh the the quantity and the quality these these two things but not not the spreading of the physical with regard to the muscle
Strengthening activity do they our patients really have to go to the gym or can this also be done at home like some push-ups situps pull-ups again surely depending on the strength of the individual patient but does this really require a gym which also takes some time and truely some money to go
There no it doesn’t require regime in fact ER several questions not not in our study but but in other studies they have question about it h where do you usually er do your resistance training at home uh in a gym and irrespective of of this uh answer um
You can do it at at home or in a gym the the benefits are going to be the same I will I will also focus more on the type of exercises but which is mostly recommended is the whole body exercises whole body exercises like squats uh push-ups um Olympic uh movements such as
Uh jerks and snatch you know this this these movements this exercises that implies the the whole body the whole body ER these are highly recommended because you you are working in a balanced way most of your muscles and you are saving time because you are
Not going one by one muscle one by one by muscle which is uh you’re more more um a body building bodybuilding um planning bodybuilding plan but uh when when we we speak about health concerning Health um the the types of plans concerning resistant training are different than bodybuilders
So we we look more for for whole body exercises implying more coordination and um and not not focusing on too much on on single masses you know two times per week 10 minutes or so would be fine for our patience and sufficient yeah um it’s it’s enough with two sessions per
Week 10 minutes 15 20 minutes the but 10 minutes if if you are efficient enough and you include four or five exercises in involving uh the whole bodies of your the whole Muses of your body then it’s enough and with regard to the mechanism um of exercise if I do
Cardiorespiratory Fitness well I know I I um I protect heart and vasculature and but with those types of uh Core Fitness or even muscle strength Fitness uh uh um exercises could you speculate on on on the mechanism what is it that uh uh uh that makes those activities protect us from from
Dying would you like to answer yeah I can give it a go so so there’s few there’s few probably mechanisms that that uh that might be in place there so so um so the first one is that if you work your muscles you keep mile for longer right that keeps you
Moving for longer so that will uh that that implies that that you’re healthy for longer and you’ll die later so that’s first second uh muscles and Metabolism are connected so you move your muscles you know you’re you’re doing a favor to your circulatory system which impacts your hair but also impact
Your brain so it keeps you healthy overall and also you you know if we think about uh weight which is a major concern for many uh non non chronic diseases sorry non ncds non-communicable diseases I say uh so you know when you work your muscles you create an energy
Deficit which means you are burning calories and energy even you know after uh you are done with your exercise s that’s that’s that’s uh definitely of benefit so there there’s multiple mechanisms by which you know keeping your your muscles uh strong will uh will make you a favor and will increase the
Longevity of of uh of people in general yeah and and also don’t forget that you are also preventing sarcopenia uh you are also preventing in osteoporosis um you know you are increasing your bone density bone mineral ER this have also implications directly connected with um with your health
Since uh your muscles are healthier your bones are healthier your joints are healthier you are you are also preventing arthritis H then you are going to move more so it’s everything connected everything is is connected regarding the and if you move more your cardiorespiratory system is going to to
Be trained your physical fitness is is going to be higher and as we know when your physical fitness is higher H your uh your risk for for mortality is lower so everything is connected and uh everything is matters and of course musle strengthening activity plays a role and plays a different role than
Aerobic physical activity plays in some ways are connected because you can also train um aerobics with racing barles if you do it with a lot of repetitions without no rest okay your your your heart is is going to your heart rate is going to to increase and similar
Adaptations that you also get with h with jogging or with other cardiorespiratory more involved exercises you are you are able also to get with the muscle strengthening depending on on the orientation that you give to your to your training okay but um there is there is also true that the
The benefits that you can get concerning um bones joints and muscles when you do muscle strengthening physical activity are different and probably are higher and are there are more benefits for for for these components of our body with mcle strengthen in physical activity than with aerobic physical activity which
Usually focus more on the cardiorespiratory system so the the the two ways are are important uh to to do uh in order to to provide benefits to different body systems do you agree B yeah yeah absolutely I think we are we all in the same page I think we we we
All here agree that we need to engage in both types of physical activity uh to maximize and to optimize the health benefits of of movement so great as time flies um B this I think this was a good uh conclusion to this uh uh topic we
Learned a lot today thank you both I think maybe the the the the two key figures um uh I’m taking home is that uh every step counts to reduce uh mortality and reduce risk and if you have done 10,000 steps you can stop and uh of course everybody should
Combine uh different form of exercise moderate vigorous and even muscle strength and I think this is a really important uh um uh uh uh notice for for our patients that we we we should communicate in in Daily clinical practice so I think uh this is a really
Uh relevant um field and those are relevant facts for daily practice so thanks for having you both here today thanks for coming and um for the sport year 224 all the best thank you thank you thank you thank You