August 17, 2008
Long Journey to Fitness Begins With Single Step
By LYNDSAY MOSS
China's Olympics have captivated even the couch potatoes among us, but Scots need motivation to build exercise into their lives.
But the fact is, with Scotland named the second-fattest nation in the world, we cannot ignore the need to encourage people to get a bit more active.
One barrier to this has been confusion over what levels of activity people should be aiming for.
According to the Fitness Industry Association (FIA), 30 minutes of exercise a day, three times a week, is enough to "radically transform your life".
It says that getting active regularly - whether it's a brisk walk or a trip to the gym - reduces your chances of getting life- threatening diseases.
The British Heart Foundation urges people to aim to build up to at least 30 minutes of moderate intensity physical activity five or more days a week.
"During moderate exercise you should be breathing more heavily than normal and feel slightly warmer," the charity says.
Cancer Research UK also says that just 30 minutes of moderate activity a day, five days a week, can have a positive effect on your health.
But the World Cancer Research Fund goes further, advocating being physically active every day for at least 30 minutes.
"The more you do the better," the charity says. "Try to build some activity into your everyday life."
This week, there may have been a few sharp intakes of breath at the suggestion that 90 minutes of exercise, on five days of the week, was the level required to stay fit and healthy.
In fact this recommendation, based on international research, is the level most likely to work in people needing to lose weight, rather than those of a normal weight.
Given that 60 per cent of adults over the age of 16 in Scotland are overweight or obese, this 90-minute figure is one which most should probably be taking heed of.
GPs around the country have now been sent advice on exercise levels to try to reduce confusion over what should be recommended.
For an average healthy person, this means a minimum of 30 minutes of moderate activity at least five days a week. Those who are overweight or obese should aim for between 60 and 90 minutes, perhaps built up in shorter bouts of between ten and 15 minutes over the day.
While such advice is welcome, some still have doubts over whether it goes too far - or not far enough.
Mary Allison, from NHS Health Scotland, said the aim of their guidance - Energising Lives - was to lay down in one document the best evidence available on what works and for whom.
But she conceded doctors and other health professionals knew it was not realistic to expect people to start exercising 90 minutes a day if they were used to doing nothing.
"You don't start by telling someone with a significant weight problem that they have to do an hour-and-a-half a day of exercise," Ms Allison said. "You start by assessing where they are at the moment and setting sensible, realistic goals for them. "
Ms Allison said the advice to aim for 30 minutes a day of activity had not changed for the past decade and denied there had been mixed messages on exercise recommendations from health professionals. But she said the clear message they hoped to get across was that any amount of exercise would help. "Every single minute of activity is a calorie burned. But the bottom line for most Scottish people is they are not burning many at all. So 30 minutes is realistic and achievable and will burn calories."
Nanette Mutrie, professor of exercise and sport psychology at Strathclyde University, pointed out the message to get 30 minutes of exercise a day was not widely known.
"More people are beginning to know the 30-minutes-a-day message," Prof Mutrie said. "But at the moment not everyone will know that."
Prof Mutrie said the 30-minute target was a good starting point, but was not designed to help people lose weight.
"That is the bottom line and there will be bonuses if people do more vigorous exercise and there will be bonuses if people do more than the minimum requirement."
Prof Mutrie said the most recent evidence suggested two out of three people in Scotland were not achieving 30 minutes of activity five times a week and it was necessary to improve this in the coming years.
But there have been suggestions that too much exercise could be bad for you. In the early 1980s, when everyone was donning tracksuits to take part in the then-new jogging craze, some suggested this could lead to more arthritis and orthopaedic injuries.
Last week researchers from the University of California at Stanford found that elderly joggers remained fit and active for longer than non-runners, and were half as likely to die prematurely. They were also less likely to succumb to a range of age- related illnesses, including heart disease, cancer and neurological disorders.
There was also no evidence that runners were more likely to suffer osteoarthritis, contrary to the earlier predictions. Runners did not need more total knee replacements than non-runners.
Anyone with potential health or fitness problems is urged to see their doctor before starting physical activity to get advice on what they could safely manage.
While taking exercise too far is obviously not recommended, because of the risks of injury, most experts believe the majority of people are far from having this problem.
Dr Colin Waine, the chairman of the National Obesity Forum, suggested to combat potential problems, people build up their levels of exercise gradually.
"The important thing to emphasise is that it needn't be 90 consecutive minutes. It can be 90 minutes over a 24-hour period," he said.
"Not everyone can go jogging, but the vast majority of people can walk. Swimming is also fine and so is gardening, such as digging and cutting lawns - not just pruning. "
But Robin Cope, founder of fitness provider British Military Fitness, warned that telling people - especially those who were inactive - they must get 90 minutes of exercise a day was counter- productive. "That's a bit over the top. If you give people targets like that they are never going to achieve them."
Mr Cope, whose company runs military-style fitness classes around the UK, said people should aim to eat less and start exercising gradually.
"Start off walking in the park if you can," he suggested. "If you are that obese then clearly you need to take it a bit more gently. People should look at types of exercise they enjoy - people join gyms but then don't go."
Mr Cope also points to making exercise more appealing and social - something Health Scotland guidance also highlights.
He said the best guidance should be to do as much exercise as they could sensibly manage and gradually increase it. "If it takes you 20 years to get unfit, you're not going to solve it in a few minutes."
As the Olympics captivates audiences, health chiefs will be hoping that some of athletes' enthusiasm will rub off on those sitting in front of the TV at home.
If it doesn't, Scotland could see itself soon breaking world records in obesity levels rather than any sport.
The Expert's Insight
Making exercise part of daily routine is key
David Stalker Operations director, Fitness Industry Association
MANY barriers stand in the way of people taking more exercise. There is a perception that going to the gym is only for those with perfect bodies, not normal people. And that can be a difficult psychological barrier to get around.
The workplace can also be a barrier to exercise. All the research shows firms that make an effort to look after the wellbeing of staff - such as offering flexitime and perhaps onsite exercise facilities - have better staff retention and less absence.
It is difficult if you work 9-5 to find the time or energy to exercise. People also have family pressures, which mean after work they need to be at home rather than at the gym.
One of the biggest problems is convincing people exercise can be fun.
If someone enjoys an activity, it makes it more likely they will continue with it. And exercise should involve the whole family.
Some people may see cost as a barrier to getting fit, but there are options to suit all budgets.
Getting enough exercise is about fitting it into your routine. This could mean walking up the escalator, taking the stairs rather than the lift and walking to your local shops. These are little steps to improving health, along with a healthy diet.
We also need to get more children involved in exercise. The earlier you start, the more likely it is healthy habits will continue in later life.
The Insider's View
We must work together to improve health
Mary Allison head of better health at NHS Health Scotland
SCOTLAND was one of the first countries in the world to communicate to the public the importance of moderate daily activity such as brisk walking.
The Gavin Hastings walking campaign in 1998 made clear that "walking a mile uses the same energy as running a mile".
In the ten years since, we have seen many positive changes - walk- to-school campaigns, Paths to Health groups all over Scotland, a vast expansion in off-road cycling and walking trails and a slight increase in the activity levels of older adults. However, Scotland has a very long way to go.
Our role in NHS Health Scotland is to know the scale of our health challenges, what we can do about them and help professionals and the public understand what these challenges mean for them and what they can do to help each other and themselves.
We know two-thirds of Scots are inactive and most will visit their GP practice at least once in a year. It is therefore vital GP staff take this opportunity to convey the message that 30 minutes of moderate activity a day is essential to stay well and feel well. However, we need to convey in a sensitive way that this is the minimum required and to help each other build small goals which slowly raise our daily activity.
We know modern lives fight against us in achieving this, but the sad fact remains that if we do not support each other to keep trying, then we will continue to die earlier than we need to.
BMI - Body Mass Index
An indicator of healthy body weight, calculated by dividing weight in kilograms by the square of the height in metres.
A condition of excess fat accumulated on the body. An adult with a body mass index of above 30 is classed as obese.
The performance of any physical activity that improves health or that is used for recreation, or for correction of physical injury or deformity.
More commonly referred to as gym, a place where people go to exercise and take part in indoor sports.
Someone who spends most of their time on the couch, usually watching television and eating junk food.
"The decline in daily levels of physical activity and the rise of sedentary lifestyles are increasingly seen as important factors contributing to the obesity epidemic in developed countries" - Scottish Public Health Observatory, Obesity in Scotland report 2007
"Walking has been described as near-perfect exercise. Even walking at a moderate pace of 5kph expends sufficient energy to meet the definition of moderate intensity physical activity" - Let's Make Scotland More Active: A strategy for physical activity
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