Exercise - Module 154
What's free, doesn't require a prescription, and can improve your health immediately? Exercise!
In this article you will learn about:
• why exercise is so important for health and general wellbeing, and the reasons people are less active than previous generations
• how much and what types of physical activity adults and children should be doing each week
• the patient groups that should adopt a cautious approach to physical activity, and the measures they can take to ensure they exercise safely.
Download a pdf version of this module here
Download the Test Your Knowledge questions here
No matter how old or unfit you are, there is a huge amount of evidence supporting physical activity asa way of making you both happier and healthier.
The health benefits are well documented – exercise has been shown to reduce the risk of many long-term conditions, including heart disease, diabetes and some cancers (see right) – but happier?
It's true: research has shown that being physically active can boost energy levels, mood and sleep quality, as well as reducing the risk of developing several mental health conditions such as depression, dementia and Alzheimer's disease. And of course, when combined with a sensible diet, it can do wonders for the waistline.
How much exercise?
Current guidance states that to stay healthy or improve health, adults should try and be active every day and do a minimum of 150 minutes of moderate intensity physical activity each week.
Moderate intensity means that the exercise should raise the heart rate and bring on a slight sweat – a good indication is being able to talk, but not sing. So while walking fast, cycling, sports such as badminton and volleyball, and more strenuous chores such as mowing the lawn count as moderate exercise, shopping, light housework and gentle walking do not.
An alternative is 75 minutes per week of strenuous physical activity, which includes pursuits such as running, aerobics, and playing sports such as rugby, football or tennis. A third option is a mixture of both moderate and strenuous exercise.
Regardless of the intensity of the aerobic activity undertaken, all adults should do activities on at least two days a week that strengthen all the major muscle groups (legs, arms, hips, back, abdomen and so on), such as weights, exercises that use the body as resistance (such as push ups and sit ups), heavy gardening or yoga.
Recommendations are different for other age groups. For example, children under five should be physically active for at least three hours a day, which ideally should include some light activity such as walking and general playing plus more energetic activities such as jumping, climbing and skipping. Similarly, young people aged five to 18 years should be encouraged to do at least an hour of physical activity a day, which should include a mix of moderate and vigorous exercise, and on three days a week should also involve muscle- and bone-strengthening activities.
These activities should be appropriate for the child's age and developmental stage, so younger children might enjoy swinging on playground equipment, whereas older children may prefer activities such as rock climbing and gymnastics.
Then and now
Some of the above guidelines may appear obvious, but the NHS considers them necessary given that people are simply less active nowadays. This is not because we are lazier than our grandparents were, but is mainly due to technology making our lives easier.
People used to walk or cycle to work, but now tend to drive or take public transport – and the work itself is far less likely to involve manual labour. Clothes and dishes used to be washed by hand, now machines take the strain. Overall, chores are far less demanding than they used to be.
But it is not just technology that is to blame. Our lifestyles are far more sedentary, with people spending the majority of their leisure time watching TV, listening to music or playing computer games. It has been estimated that adults now spend more than seven hours a day sitting down. Many elderly people (aged over 65 years) spend more than 10 hours a day either sitting or lying down.
So it is important for families to get off the sofa and build more activity into their everyday lives, whether that involves going for a bike ride or swimming, or simply walking short distances instead of taking the car everywhere.
Exercise in pregnancy
Although maintaining fitness levels can help women better cope with the demands of both pregnancy and labour, and get back into shape afterwards, most are likely to slow down as the pregnancy progresses.
A good rule is to advise them to ensure they can maintain a conversation while exercising – if they get breathless, they should slow down.
Other tips include:
• don't try and do more than before you were pregnant
• if you go to classes or a gym, make sure the instructor knows you are pregnant
and adapts exercises accordingly
• drink plenty of water
• don't lie flat on your back, particularly after 16 weeks, or you may feel faint
• don't do contact sports or activities where you may fall
• don't exercise at heights over 2,500m above sea level or go scuba diving.
There are some exercises that are particularly beneficial for pregnant women. These include stomach strengthening exercises that will help minimise backache as the baby grows and encourage the stomach muscles to come back together after the baby is born, and pelvic floor exercises to prepare the body for labour and avoid any incontinence issues either during pregnancy or afterwards. Women suffering from any pelvic or back conditions during pregnancy should seek medical advice before exercising.
Exercise after surgery
Patients who have recently had surgery – including those women who have recently given birth, particularly if they have had a Caesarean section or any stitches – should take medical advice before exercising. What women can do and how soon they can do it will depend on the procedure they have undergone, and the surgeon is the best person to ask.
Exercise is not usually recommended for the first few weeks unless it is part of the post-surgery recovery process (and the patient will have been advised of this upon discharge from hospital), and listening to the body is key – if the individual feels tired or something hurts, they should stop immediately and seek medical advice if the discomfort continues or worsens.
Exercise for older people
Adults aged 65 years and over are more likely to have issues with mobility and long-term health conditions such as diabetes or heart conditions that limit their capacity for exercise. Therefore, they should aim to be as active as possible, doing low-impact activities, rather than aiming for the recommended 150 minutes of moderate intensity exercise. Low-impact exercise decreases the chance of heart disease as much as high-impact activities such as running, but puts much less stress on the joints and reduces the risk of injury.
Encouraging older people to stay as active as possible is not only important for the health benefits it provides, but also for mental wellbeing, social interaction, and maintaining independence.
The health benefits of exercise
Research has shown that people who do regular physical activity have a lower risk of developing a range of conditions
Source: NHS Live Well website
UP TO 30%
lower risk of depression, dementia, falls and early death
UP TO 35%
lower risk of coronary heart disease and stroke
UP TO 20%
lower risk of breast cancer
UP TO 83%
lower risk of osteoarthritis
UP TO 50%
lower risk of colon cancer and type 2 diabetes
UP TO 68%
lower risk of hip fracture
Key points
Taking regular exercise benefits health in many ways – both physically and mentally.
• People are much less active than they used to be due to the advent of labour-saving devices and more sedentary lifestyles.
• Adults should do two and a half hours of moderate exercise a week, plus muscle strengthening activities on at least two days per week.
• Young people aged five to 18 years should do at least an hour of moderate and vigorous exercise a week, including some activities that strengthen the muscles and bones.
• Children under five should be physically active for at least three hours a day.
• Certain patient groups need to be cautious in their approach to exercise, including pregnant women, new mothers and those who are elderly or who have recently had surgery.
Evaluation
• Survey some people you know – maybe family members or your colleagues, but try to include an adult, a young person, a child under five and someone aged over 65 years – to find out how much physical activity they do each week, and what type.
• How many of the people you surveyed are meeting the advice set out in this article? If not,
which activities would you recommend to improve their exercise levels?
• Find out what exercise classes are available in your local area for the following groups:
–Pregnant women
–Women who have recently given birth
–The elderly.
Keep your list handy in case any of your customers ask for further information.
Information
nhs.uk/livewell/fitness
NHS advice on fitness
tinyurl.com/otcexercise1
NHS guide to exercising during pregnancy
ageuk.org.uk/health-wellbeing
Age UK advice on fitness
nhs.uk/change4life
Change4Life tips on exercise
tinyurl.com/otcexercise2
Royal College of Obstetricians and Gynaecologists advice on exercise
in pregnancy
