Regular exercise for 2020

New Year resolutions are a great way to kick-start living a healthier life after all the excesses of the festive season, whether it’s quitting smoking, reducing alcohol, eating better, or doing more exercise. But two weeks into 2020 those well-intentioned resolutions start to feel a little harder to keep up. Research from Strava (a social media platform for cyclists and runners to share their activity) has predicted that the 19th January 2020 will be the day most people give up their New Year resolutions.

My own resolution was the brilliantly vague ‘get fitter’. I always far preferred team sports to individual disciplines, but the reality of a junior doctor’s unpredictable rota has finally, in 2019, laid my amateur volleyball career to rest. And so with the rest of town it seems, I have been dragging myself to the local gym these first two weeks of January.

The department of Health and Social Care published new guidelines in September on the recommended amount of physical activity adults should undertake. It advises 150 minutes of moderate intensity activity (such as brisk walking or cycling), or 75 minutes of vigorous intensity activity (such as running), or even shorter durations of very vigorous intensity activity (sprinting or stair climbing), or a combination of the above. However, they have now adopted a ‘some is good, more is better’ statement to encourage those starting from a low baseline level of activity.

Regular exercise has been described as a ‘miracle cure’ in a publication by the Academy of Medical Royal Colleges, improving symptoms of COPD, angina, peripheral vascular disease, mental health conditions and chronic pain, and reducing the risk of some cancers. As heathcare professionals we should be recommending exercise to our patients like medicine. We can’t assume every patient knows the importance of regular physical activity.

We must also not forget the importance of exercise in our own lives. We need to look after ourselves so that we can, in turn, look after our patients. At population level, working lives are becoming more sedentary and medicine is no exception. Electronic investigation requests means fewer trips to various departments to work patients up, and electronic prescribing means no one needs to dash to the ward at the far end of the hospital anymore to prescribe antiemetics for a vomiting patient.

To let you into a secret: I don’t see my new gym habit sticking. It clearly works for some people (the gleaming biceps that surround me twice weekly attest to that), but I find it incredibly dull. There are however, many creative and sociable ways I have found that have helped me work more exercise into the weekly routine that I’m planning to revive. In the interest of looking after ourselves, each other and our patients, I thought I would share them with you.

  1. GoodGym – a community of runners who combine running with stop-offs for physical tasks at community projects, weekly group runs, or running to visit an isolated older person in the local community. Free to use (but donations welcome) there is nothing not to like. https://www.goodgym.org
  2. Find something to train for – whether it’s a running, cycling, swimming event, or all three(!). Having a sporting event on the horizon is often the motivation required to get out of bed on a Sunday morning. https://findarace.com is a great place to start.
  3. Strava – If you’ve not heard of Strava you must be living under a rock. A social fitness network, using GPS data through your phone or fitness device. There is something so gratifying about the way Strava congratulates you on outperforming yourself, and when you repeat the same route or route segment that I can only recommend with an addiction warning. It is truly flexible, supporting your individual activity but keeping you connected to the Strava community.

Do you have other ideas? Any strategies that you have managed to work around the long hours a career in medicine demands? Or perhaps something a patient has recommended? I would love to hear them.

Comments (7) Add yours ↓
  1. Michael Kirby Professor

    Exercise is good for our prostate cancer patients too!!!
    Research does suggest that exercise after diagnosis could help with delaying or deterring prostate cancer recurrence or progression. There are even studies showing benefits for delaying prostate cancer death. Two early studies were published in 2011. There are at least three more now looking at hard outcomes, like prostate cancer death outcomes, all suggesting that exercise has a benefit. Initial studies pointed towards needing to do vigorous exercise, but the subsequent studies that have come out since then are even suggesting even less intense exercise has a benefit. Three hours of walking per week, appears beneficial, so very moderate.

    We can impact our survival from CVD and reduce the risk of diabetes by brisk walking, ideally twice a day, enough to get heart rate up a little bit.
    I tell the patients that 20-30 mins exercise improves insulin sensitivity for 15 hrs ( hence the need to do it twice a day)
    Nice one Hannah

    January 16, 2020 Reply
  2. Culley Carson Professor

    Great comments!! Starting an exercise program in January is a regular event for many of us. Sticking with it is the real challenge. There are mounting data for the benefits of exercise for all medical conditions. Improvements in COPD, patients on chemotherapy, arthritis, etc all benefit as do the CV status for all of us. While there are no tried and true motivational techniques, I fine that having a trainer or exercise class is great as you pay if you don’t show up and money is a major motivator!! Twice a day is ideal but difficult for most working adults. the 150 hours a week is a more achievable goal for many.

    The bottom line is starting and continuing vigorous exercise to the ability of the individual. Combined with a reasonable diet, not only will there be more years but better years as well

    January 16, 2020 Reply
  3. Brian Dye Lawyer

    I’m 64. I’m not a doctor (I’m one of those pesky lawyers, if you ask). For a few years now, I’ve gone to the gym and personally trained three times a week. I also use the Gym as a basis to develop the strength to run strong. I think the key to interest is variety.
    So I do a few little programmes and my personal trainer keeps building on them. I do stretching; core work; static and dynamic stability exercises enhance balance; plyometrics to develop explosive movements, springiness and elasticity, and instantaneous control; I lift weights to develop strength (also a natural way of averting osteopaonia etc) I won’t bore you by going on.

    I found that, with consistent work, over a few years, my whole body gradually adapted from the flabby individual who used to inhabit it, through muscular hypertrophy, to become, stronger, statically and dynamically stable, agile and flexible, In good humour my wife says I’ve gone back to being the man in our wedding photographs! In my view, you don’t need to be very good to have the benefits: you just have to be consistent, for this to happen. I find that no month passes, but there is something, physically, more that I can achieve now that I couldn’t do before. So, by my experience, I’d just encourage people like Hannah to keep gym up, and the benefits are sure to come.

    I haven’t mentioned doing any cardio work in the Gym. That’s because I believe cardio work is best done outdoors, in the Sun, Rain and Wind. I run 50-80k a week. It sounds a fair amount, but it’s only a few hours and it’s easy once you’ve been doing it consistently. I always take 2 good rest days per week off for recovery, I have a regular sports massage, which is also fun, and I look after Nutrition, so I do try to look after myself. To date, I’ve never actually been injured and it’s the Gym that keeps me strong. My experience is that you never look after yourself better than when you are doing an exercise programme – in my case, running.

    In running, just as in Gym, I find variety is the key: both in the type of running and the type of surface I run on. So one day you might find me doing 16x200m fast on the track, with 90 secs jog recovery; or another day, a medium pace 10k tempo on the road; or 5×1 mile hard, with 3 mins recovery each rep – deliberately not enough time fully to recover; and. on Sundays, you’ll always find me out running an easy pace 25k-30k cross country, mud, hills, descents – I love them all. This isn’t at all boring, and it definitely keeps me fit. So here too rarely does a month go by but I find I can do something faster than I could before. I never use Strava because I feel it sets people up in competition in training, whereas I think training should be very relaxed and a place for experiment and adaption. I want to save competition only for race day.

    I’m not a doctor, so I’m not primarily motivated by the health benefits of doing this. Rather, I have come to think of this lifestyle as being “who I am”. For me that’s key: enjoyment and personal development are the rationale; and health benefits I think of as collateral. I may be 65 this year, but, in my mind, I think of myself as an athlete, even if not a very good one, the best I can be, and I think it’s fair to give this description. This year I’m even having extra fun, because I’ve signed up for a Ballet class, which it was my resolution to start for the New Year – and do you know what? I’m finding I can do it and I’m not the worst!

    What impact has it made on my health? Here’s what I’ve noticed. As I say, I’m 64; but I have VO2 max of 56, which a 22 year old would be quite happy with. At night, my resting heart rate falls to 35-38 bpm – at his best, I think Usain Bolt got as low as 25 bpm, so I’m not quite there yet…. but maybe in the future? As far as my maximum heart rate is concerned, sometimes, when I’m sprinting, it can be 219 bpm, no problem: I don’t believe all this stuff that the max heart rate of someone of my age is 155 bpm or so. As far as endurance is concerned, I ran the Berlin marathon a few months ago in under 3 1/2 hours and, for the whole of the second half of the marathon, my heart rate was 173-181: it felt very comfortable. I have a BMI is 21.5 – but I can burn as much as 5000kcal on 35k hilly cross country on a Sunday, so I enjoy my food. As far as my upper body is concerned, I can cleanly lift 87.5kg. Mentally, I find that being physically strong instills a lot of confidence. What’s not to like?, as the OP puts it.

    Professor Kirby suggests 2x30mins brisk walk per day. Professor Carson suggests vigorous exercise, although I am not sure my sort is quite what he had in mind. Obviously, these things need to be tailored to the individual and his/her own starting point, and it’s not my suggestion that anyone necessarily follows me. But what I do say is that exercise can be very interesting and huge fun; it’s not just for New Year – it can be a permanent lifestyle, enjoyed as much by older people as well as young. My example to match Hannah’s is my Running Club which often goes cross country running on a Sunday morning; we all go out together; teenagers, Mums, fathers, older people, middle aged people, all running together – I feel it reflects something primitive people did during our Evolution whether as part of a hunt or otherwise; and it embodies a huge sense of Community, and it’s a great leveller – there is no distinction between “old” or “young”.

    Yes, this lifestyle does need time allocated to it. Like young doctors, I too have huge work pressures. I manage a caseload, just as they do: I’m in court regularly. Like young doctors, everything that happens to me is last minute.com – in my case, late papers, late statements, etc from clients and then I have often to react on the hoof etc. So there is always a incentive to give up or to prioritise work over exercise. I’ve found the only way to make a Gym and Exercise lifestyle work is to say “No” to work pressures when they try overwhelm, as they always seek to do, and just insist on making the time to go the gym and, in my case, go running. Is that the 5:00 am alarm clock I’m hearing ringing?

    I suppose the main point I want to make is that none of this is difficult. I started somewhere at a low level, carried on, and look what happened! Anyone can do do this, of whatever age, at whatever level appropriate to himself or herself.

    January 17, 2020 Reply
  4. Ben Challacombe Consultant

    Hannah
    What a great piece. Exercise is so key for both us and our patients. I spend lots of time speaking to patients prior to prostate surgery on how to get fit. For those not used to exercise I suggest 30-60 mins a day walking- uphill is available, walking a friends dog, swimming if they can. It’s difficult to go from the couch to half marathons in a short time so realistic goals are important. I don’t believe that just doing calorie reduction alone will work for most people. Plus exercise or only helps lose weight but also helps cardiovascularly and pelvic floor tone. Patients need to see some energy and enthusiasm from their physician I think and I try to bring that.
    For me personally exercise is key to my physical and mental health. I do a background of 3 sessions a week running cycling or swimming. I agree that goals such as events at important. Eg BIKE TO BAUS. which we do each year. Park run is also great and I do that with the family. A 5km timed run in a local park. There are now thousands all around the world and we recently did one in Australia. https://www.parkrun.org.uk/

    Let’s get out there and do it.
    See you at the BAUS 2020 fun run!

    Ben

    January 18, 2020 Reply
  5. Michael Kirby Professor

    You lead by example Brian, as we all should!!

    Even small changes to physical activity, such as an additional 5 minutes/day, can improve health and well-being.
    The latest evidence suggests that there is a clear and steep dose–response association between moderate-intensity physical activity and reduced premature mortality risk up to 150 minutes/week, or 7500 steps/day, after which limited gains may be seen.
    Walking pace is one of the best predictors of overall health status – slow walkers have a similar level of risk as smokers.
    Use “How to recommend physical activity to people with diabetes safely” from Diabetes & Primary Care to personalise walking recommendations (http://bit.ly/2lUwgJG).

    January 20, 2020 Reply
  6. Christian Brown Consultant

    Great read. The digital platform for exercise and sharing experiences, places and photos whilst training for an event, getting fit or running the hills with your dog at the weekend (my most common Strava post) is a great motivator. There is no doubt that following other’s progress is a strong motivator.

    There are several on line training programs that I highlight to patients who ask ‘Is there anything I can do myself to help?’ For some who have never exercised this is well worth it https://www.nhs.uk/live-well/exercise/couch-to-5k-week-by-week/

    January 25, 2020 Reply
  7. Roger Kirby Professor of Urology

    With as little as 22 minutes per day of brisk activity, the risk of developing a dementia, type 2 diabetes, and many major cancers is reduced by 30-45%. Exercise is also an effective treatment for disease, reducing mental ill-health, the recurrence of cancer, and complications of diabetes.
    Hannah is correct- exercise is the universal panacea!

    January 31, 2020 Reply

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