An intervention that doesn’t require a prescription, yet improves both physical and mental health – sounds good, right?

There’s something out there that lowers the risk of many long-term conditions – from heart disease and type 2 diabetes to cancer and dementia. Better still, it can help mental health too, boosting energy levels, sleep quality and mood, and reducing levels of stress and depression. There’s more good news: it can help people stay well for longer, and extend live expectancy. And there are no catches: it is free and easily available, regardless of age, gender, religion and sexual orientation.

So what’s this magic remedy? It’s exercise. If physical activity was a pill, everyone would take it, and the NHS would have no issues with funding it, because it’s one of the most cost-effective health interventions there is.

Does it really make that much of a difference?

The evidence for exercise is both compelling and robust. There are many research papers on the subject – too wide ranging and numerous to list – but summarised neatly in an infographic issued by England’s Department of Health: physical activity cuts the chance of adults developing type 2 diabetes by 40 per cent; cardiovascular disease by 35 per cent; falls, depression and dementia by 30 per cent; joint and back pain by 25 per cent; and cancers of the colon and breast by 20 per cent.

A 2007 paper put the cost of inactivity to the NHS at £1.06 billion. As staggering an amount as this is, it’s actually a conservative estimate, based only on national cases of coronary heart disease, stroke, diabetes, colorectal cancer and breast cancer. Other conditions that physical activity can help to manage and prevent, such as osteoporosis, falls and hypertension, were excluded from the calculation.

The wider economic cost is almost too huge to imagine. For example, the cost of sickness absence has been estimated at £5.5 billion a year, and the cost of premature deaths of people of working age from lifestyle-related disease has been put at around £1 billion a year. It is indisputable: exercise makes a difference, although it needs to be combined with a healthy diet in order to maximise its potential.

How much are we talking about?

Having established the benefits of exercise, the amount that people need to be doing depends on their age:

  • Children under five years need to be active every day. Even as tiny babies, they can be encouraged to push and pull, reach and grab. Once walking independently, they should be doing at least three hours of physical activity every day. While even standing up counts, active play is the best approach as it will inevitably involve more energetic moments of climbing, skipping, jumping and running
  • Between the ages of five and 18 years, children need to be physically active for at least an hour a day, with both moderate and vigorous activities included. On three days a week, these activities should involve muscle strengthening and bone building
  • Adults aged 19 to 64 years should aim for at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week plus strengthening exercises on two or more days a week
  • Older adults aged 65 years and over should aim for the same as younger adults, as long as they don’t have any health conditions that limit their mobility. Anyone at risk of falls, perhaps because of poor coordination due to a medical condition, should do exercises to improve balance on at least two days a week.

What’s what?

Moderate exercise includes activities such as fast or hill walking, and sports that involve short, high intensity bursts in between longer and lower energy stints, such as basketball. It’s anything that raises the heart rate, increases the breathing rate and makes the individual feel warmer. A good gauge is still being able to talk but not sing. A step up from this are vigorous activities such as running, aerobics, martial arts, and sports such as tennis and football when breathing speeds up to the point that conversation becomes tricky.

Strengthening exercises should exert all the major muscles – legs, hips, back, abdomen, chest, shoulders and arms – using weights or the body’s own weight, as is the case with push ups, yoga, and resistance band work. To get the greatest benefit out of these activities, they should be done until it becomes difficult to complete another repetition. Bone building exercises – particularly important for children – are anything that impact the skeleton and encourage it to become stronger. Hopscotch, climbing on playground equipment and skipping with a rope all count. Balance-improving pursuits include tai chi and dancing.

Some activities, such as circuit training, rugby and netball, are both aerobic and strengthening. But not all exercise needs to be done in a gym or on a sports field, or even while wearing fitness gear: heavy gardening and carrying grocery shopping
help build strength, while mowing the lawn and walking the dog are purposeful and calorie-burning.

Post-exercise slump

Tempting as it is to get the required amount of exercise and then crash on the sofa with a TV box set, that isn’t the way to go. While the relationship between sedentary behaviour and being overweight or obese is both obvious and well established, there is a growing body of evidence suggesting that there is also an link with illnesses such as type 2 diabetes. The body’s metabolism seems to slow down when we are sitting, much as an astronaut’s does when he or she is in a zero gravity environment, causing loss of muscle and bone mass and accelerating the ageing process.

This is the case even if exercise targets are being met. As a report entitled Start Active, Stay Active, commissioned by the four UK chief medical officers, stated: “Spending large amounts of time being sedentary may increase the risk of some health outcomes, even among people who are active at the recommended levels.”

Sedentary behaviour isn’t confined to the living room: it also encompasses screen time – including homework and computer use – and periods spent on transport, such as commuting and driving. Data suggests that young people in the UK are sedentary for between seven and eight hours a day on average. This is a problem as it is likely to continue into adulthood and result in weight gain and other health issues.

Tackling this isn’t easy, however. Life is busy, so it seems easier to strap a child into a car seat or buggy than to let them walk, just as it can appear easier to drive a child to school instead of walking. As time-poor adults, taking the lift feels a quicker option than walking up the stairs, and when we’re tired in the evening, a trip to the pub or cinema is more tempting than going to the gym.

Everyday easy

The easiest way to be less sedentary is to make activity part of everyday life. Active video games make a fun replacement for sedentary screen time, the outdoors can be made considerably more exciting if there are pavement chalks available to draw out a hopscotch grid. A school run that takes a long time for a child to walk could be made quicker with the addition of a scooter.

Parents can set an example by walking instead of using the car for short journeys, using stairs in preference to escalators and lifts, and substituting TV time with more active hobbies. Even office work, which is a major contributing factor to the sedentary lifestyles of many adults, can be made more active by standing rather than sitting on the bus or train commute, going to see colleagues at desks instead of emailing, and taking a walk to the kitchen to make drinks throughout the day. Joining a sports team at or after work not only boosts activity levels but also releases tension and provides some much needed social contact.

Older people can find it a challenge to be more active, but a little research often yields surprising results. In many areas, there are dance classes, bowls clubs, health walks and community volunteering roles on offer. Leisure pursuits can be made more energetic with a little thought: walking rather than driving or getting the bus to bingo, for example, and interspersing television watching with light tasks that need doing around the house and garden.

The key is to start small and build up, especially for people who have been inactive for some time or who find it hard to prioritise exercise. Breaking up sedentary time with shorter sessions of physical activity that are easy to slot into day-to-day life gives the body time to adapt, and these sessions soon become habits that can be extended. Fitness trackers such as pedometers and activity watches and apps can be great motivators. And there are other benefits too.

Walking or cycling to work or school is not only healthier for body and mind, but it reduces emissions and congestion, making the streets and communities safer and generally more pleasant to be in: everyone’s a winner.

Find out more

  • A wealth of resources on exercise – from information about the benefits of workouts and fitness plans such as Couch to 5K – are available via NHS Choices.
  • The NHS infographic on the benefits of physical activity for adults, can be used by pharmacy staff as a talking point or part of a display
  • The BBC's Get Inspired guide has a list of more than 70 activities, from archery and bobsleigh to snooker and wrestling, with tips, links and information to help people get started.

It is indisputable: exercise makes a difference, although it needs to be combined with a healthy diet in order to maximise its potential

Originally Published by Training Matters

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