Good morning and welcome to another edition of the Weekly Wellbeing Round-Up. This week I thought I would get your monday morning off to a great start by offering you…a miracle cure. The ultimate tonic with guaranteed improvement to your health and wellbeing. It has been shown to improve physical and mental health and cognition as well as reducing the risk of cancer, heart disease, diabetes and other long-term conditions. It works as well as if not better than many drugs and unlike drugs there are no side effects as long as it is taken in the appropriate dose. Best of all, it’s free and available to every person on the planet. You don’t need a prescription from a doctor, and you don’t need any special training or expensive kit. You can start treating yourself with this wonder drug whenever and wherever you like. I am, of course, referring to the medicine of movement: physical activity. People are, I hope, used to health professionals banging on endlessly about this. I thought it was worth reminding ourselves why this is such an important issue, before we explore the benefits of it and then take a pragmatic approach to moving more.
The bad news about physical activity
Let’s start with looking at the scale of the challenge that we face in terms of physical activity being a part of our daily lives. Once upon a time, it was. We were hunter-gatherers, often chasing our prey over long distances. If we sat still, we perished. Nowadays, our day-to-day existence is much more sedentary. We have enjoyed the benefits of tremendous technological advances and the associated convenience, but there are also tremendous downsides that are gradually becoming more and more apparent. The nearest we get to hunting our food may be tapping our password into our device when doing our online food shop from the couch. Being inactive has roughly the same health risks as smoking 15 cigarettes a day and the overall risk of mortality due to inactivity may be double that of obesity. . This is worth thinking about for a minute: most people would clearly not choose to take up smoking, but by default we risk choosing inactivity. The irony of all of this is that by sitting still we still perish (sooner) but for now for entirely different reasons.
I used to think, a long time ago, that by default we were probably active enough and that to stay healthy all people needed to do was to avoid eating too much unhealthy food. I have come to the realisation that this is nowhere near enough. The default, the baseline that we operate from in today’s world, is not just inadequate but actually toxic. In 1949, 34% of all journeys travelled by a mechanical mode were by bicycle. Nowadays it’s less than 2%. The design of our homes and our cities, our patterns of working, our use of technology and all the associated infrastructure have all contributed unwittingly to the making us less physically active. The consequence of all of this is that almost half of adults over 65 years of age are inactive, and most working adults spend at least 5 hours of their day entirely sedentary. To overcome this requires thought, planning and effort.
The good news about physical activity
Before you sink into despondency, there is good news. These problems did not appear overnight with a bang. A lot of it has been incremental. The good news is therefore that we can take the same approach to addressing the balance. Let’s leave aside the need to lobby government about how we build communities and transport links in future, how we make cities safe for cycling and encourage working lives that are more physically active. These things are important but you and I can’t do anything about them right now, whereas there are other changes that you can start with today to help you and, if you are a medical professional, your patients.
My top tips for physical activity
- Make the first few steps. The really good news about becoming more physically active is that the greatest reduction in risk of cardiovascular disease (heart attacks, stroke and diabetes) occurs in those who go from being completely inactive to mildly active. If you break into a sweat at the thought of breaking into a sweat and are put off by images in your head of lycra-clad latte-sipping gym bunnies in a spinning class or ex-military personnel with personality disorders barking instructions to groups of miserable looking people dragging mud-covered tractor tires across the park in the rain – never fear. The journey of a thousand miles literally begins with a single step. If you don’t do anything that gets your heart rate up at present, try starting with just 5 minutes a day of brisk walking round your garden or down the street and back. All you need are shoes on your feet. Public Health England have a nice app which you can download onto your smartphone called Active 10. You can get it for iOS devices from the app store, or for android devices from Google Play.
- Make it rational, routine and relevant. For us to face the challenges of inactivity individually and collectively, it’s only going to work if physical activity becomes a simple, meaningful and sustainable part of our lives. If a gym subscription works for you because you will feel motivated by parting with your hard-earned cash, you like the idea of being able to work out in all weathers and at any time of day, or you just like sitting in the cafe and chatting afterwards, then great. If you have a dog, make the walks a bit longer and for part of each walk push yourself a bit harder to get your heart rate up. If you don’t have a dog, think about getting one. They provide people with company, keep their owners fitter than non-dog walkers, and encourage socialisation. I love chatting with other dog walkers when I’m out and about. If your job involves walking, whether it be commuting or delivering the post, use the opportunity to do likewise. Try getting off the bus, tube or train a stop or two earlier. Use the stairs at work rather than the lift. Consider getting a standing desk. You could suggest standing or walking meetings when appropriate – just think how much quicker they would go without people distracted by their laptops and phones!
- Make a plan. I posted about this a few weeks ago. Whatever you do, plan how it’s going to happen. In my personal experience, if I don’t make a plan then nothing changes. Once you have a regular slot and you’ve done it often enough then it becomes a habit and so more likely to stick.
- Make it social. Behaviour change is more likely to occur if it is socialised. Taking part in physical activity with others is beneficial for a number of reasons. Firstly most of us are social animals to one degree or another, so it’s a good way of connecting for our mental wellbeing. Secondly, we are in effect making ourselves accountable to others or even allowing them to be our “referee”. Your friend/spouse/cycling club/fellow dog walkers will encourage and check up on you. If you aren’t sure what you would like to do, check out what information is available from your local council, community centre, library or GP surgery. 5. Make it pleasurable. Pick something that you enjoy. Don’t think of it as “exercise”, which sounds like something you have been told to do and probably won’t enjoy. Instead think of it as something that gives you pleasure, makes you feel good and helps you connect with others. Just getting out of the house and enjoying some fresh air and daylight is good for your wellbeing. Two of my most favourite things are going for a bike ride on a sunday morning with my friend Al and taking my dog Prince for walk in the afternoon.The fact that the my sunday morning bike ride includes breakfast and a cuppa and that my afternoon walk involves a pint in my local is not a coincidence and a great example of “temptation bundling” – having a reward which is associated with a specific activity.
Real life examples of the benefits of physical activity
I thought I would finish with two stories from this week. The first was from a patient that I reviewed as part of teaching our medical students about mental health. They had seen one of my colleagues previously with a longstanding history of depression. They were physically inactive and presenting with a lot of physical symptoms which were really manifestations of how they felt in themselves. They had been consulting about these physical symptoms frequently and eventually were persuaded by my colleague that the root cause of their symptoms was their depression. They were encouraged to start being more physically active. When I reviewed them with our medical students, they were transformed. I asked them what they felt the reason was for the improvement and they told me that they had started to walk every day for half an hour, either in the park or up and down in their garden. Their mood was better. They had more energy, were sleeping better and were much less bothered by the occasional aches and pains that previously had preoccupied them. They also had a much better understanding of how their mood might influence physical symptoms as a result.
The other story I really enjoyed listening to this week was that of Vassos Alexander, sports presenter, formerly of Radio 5 Live and now Virgin radio. He was interviewed by Dr Rangan Chatterjee in Episode 31 of the Feel Better Live More podcast. He described himself as being overweight, unfit and a smoker in his early 30’s. He decided he wanted to make some changes. He decided to go for a run. His first run lasted just a few minutes. He describes being out of breath and having to pretend to some of his neighbours that he had just finished a run, to avoid embarrassment. Vassos didn’t give up, however. To cut a long story short, in 2017 he completed the Spartathlon, an endurance event run over 153 miles. His enthusiasm for running, it’s benefits and his encouraging other people just to get out there and do something is infectious. Well worth a listen.
We’re almost done. I wanted to finish off with something to challenge and encourage you, your family, friends or patients. There is a great video available on YouTube called “Twenty three and a half hours“. It’s got a fantastic punch line at the end and is well worth 5 minutes of your time.
That’s it for this week. I hope that you have found this week’s wellbeing round-up helpful. As ever, I would appreciate your feedback and you sharing it with others if you have enjoyed it. You can subscribe to the blog to automatically receive email updates in future. Until next week, take care of yourselves!
Dr Richard Pile.