Getting everyone moving more
The British Heart Foundation 2015 publication “Physical activity statistics” includes a number of ideas for increasing physical activity in adults
Active commuting, defined as walking or bicycling to work, has been shown to be positively associated with physical fitness and inversely associated with BMI, obesity, blood pressure, and insulin levels. Active commuting reduces heart disease, cancer, and age-related mortality, cycling being more effective than walking. The bicycle hire system in major cities (ie “Boris Bikes”) has increased active travel.
Sustrans (sustrans.com) is a charity that aims to enable and increase public exercise by walking, cycling, and public transport leading to healthier, cheaper journeys. Their flagship project is the National Cycle Network, which has created over 14,000 miles of signed cycle routes throughout the UK, although about 70% of the network is on previously existing, mostly minor roads where motor traffic will be encountered. On the downside, it is to be deplored that some train companies prevent the carriage of bicycles on commuter trains.
In the workplace
Adults spend up to 60% of their waking hours in the workplace which should therefore be a useful place to start. Such initiatives include creating workplace exercise facilities, providing one to one exercise advice, encouraging the use of stairs rather than lifts, providing short breaks during the working day for employees to engage in physical activity.
The Alberta Centre for Active Living (ACAL) has analysed some of the factors currently used to encourage increased physical activity in the workplace. They include challenges and competitions (pedometer challenges, physical activity, and sitting logs), information and counselling (posters and handouts, individual and shared counselling), organisational (regular active breaks and moving about), the physical environment (office layout, active workstations, secure bike racks).
There will be much more about this next week when we have the treat of a Guest Blog from a real expert in workplace exercise – Becca Clayton of Tonic Wellbeing..
In the environment
Improving the environment in a number of ways can encourage exercise – walking and cycling trails, outdoor gyms, traffic calming, encouraging “active travel” – ie walking or cycling rather than taking the bus or train and notices promoting the use of stairs rather than lifts in public places.
In the United States, Active Living Research has expanded the theme by specifying some of the environmental improvements which can encourage greater physical activity – including aesthetics of the area, plenty of vegetation, parks with open vistas, perceived safety from traffic and crime, general neatness and play and exercise equipment. The importance of a good exercise environment was shown by the International Physical Activity and Environment Network. Across 14 cities on five continents, the difference in physical activity between participants living in the most and the least activity-friendly neighbourhoods ranged from 68 min/week to 89 min/week.
Another initiative has been the Parkrun scheme – every Saturday morning some 300 parks around the country host 5km runs without charge. Before the pandemic, about 50,000 runners are out there each weekend. In a few week’s time there may be even more. An excellent introduction to this form of exercise is the “Couch to 5k” initiative which helps anyone to get off the sofa and gradually increase their activity level to walking/walk-jogging/jogging 5k. The programme is supported by a website, a phone app, and plenty of available encouraging and motivating podcasts.
Social support systems, group activities, buddy systems, and “Walking for Health” groups all promote more exercise taking. Telephone support and mass media campaigns have their place.
A number of interventions to increase physical activity within various populations have been delivered via the internet. This has the benefit of reaching a large number of individuals at a low cost relative to other types of intervention, such as making physical environmental changes or having regular direct contact with individuals. Internet-delivered interventions have produced positive results but there is still insufficient evidence of their ability to produce long-term change. They have the particular advantages of providing easy self-monitoring and feedback information and enabling communication with health professionals or other users via email and chat. Many people find that feeding their accelerometer results onto a website allows them to follow their performance. Comparing it to that of others should be an effective incentive.
The Journal of the American Medical Association has just published a study of the factors which contribute hospitalisation for severe Covid. disease. These included obesity in 30%, type 2 diabetes in 20%, hypertension in 26%, and heart failure in 11% – all conditions preventable by adequate physical activity. Altogether the investigators estimate that almost two-thirds (63.5%) of the hospitalisations were attributable to these conditions.
As one author says: “We are closing businesses and stopping people from seeing their loved ones, but we are not telling them to lose weight and do some exercise. We should be focusing public health messages on reducing diabetes and obesity as a means to reducing severe COVID disease”
Thanks as always. I’d just like to point out that all diabetes is not avoidable. I’m a type 1, and have been for 48 years. I’m grateful for the encouragement to take more exercise, but it would be good if you would differentiate between the types of diabetes.
Quite right Carmel and my apologies. I do usually make that distinction clear but on this occasion I was quoting from a press release from one of the investigators. I would also be wrong to imply that all type 2 diabetes is avoidable. The great majority of type 2 diabetics are overweight but a small minority are both of normal weight and take plenty of exercise.