Saturday, 17th December 2022

An overview of exercise

Over the past three and half years I have written nearly 200 of these blogs. I have tried to take you through a description of what exercise does, how it works, what it does for us, its effects on a large variety of diseases, both for prevention and treatment, how it can be harmful and, most importantly, how avoidance of exercise can be much more harmful. The blogs are indexed under the subject headings so if you wish to look up any particular topic it should be easy to do so.

A summary

Regular exercise is the most effective ‘treatment’ available for the prevention and treatment of a wide range of diseases, and for maintaining physical fitness, muscular strength and activity in old age –  and especially for improving quality of life. Indeed, a dose response relationship between the amount of exercise taken and quality of life has been demonstrated , which means that the more active a person is, the better their quality of life. In his Annual Report in 2009, England’s Chief Medical Officer stated that the benefits of regular physical activity on health, longevity and well-being ‘easily surpass the effectiveness of any drugs or other medical treatment’ This fact is gradually being appreciated  by the medical profession, but promoting exercise remains a major challenge in a world that seems to reduce or eliminate physical activity at every opportunity.

The dose response

There is a dose response relationship for the amount of exercise taken and the resulting beneficial effects. The more exercise a person takes, the more advantages are gained.. In relative terms, however, the greatest return on an individual’s efforts comes from increasing from a low level of exercise to the next level up. In other words, the greatest relative benefit is gained by those who move from doing nothing to doing a small amount. Be aware, however, that such benefits are well below those that can be attained by doing even more.

The dose-response associations between total physical activity and risks of some cancers, diabetes and coronary heart disease have been assessed in a number of large meta-analyses. The greatest reductions in risk were achieved at between 600 MET minutes per week and 4,000 MET minutes per week (equivalent to walking at 3 mph for between three and 18 hours per week). Note that this included all physical activities undertaken. Greater exercise doses had reducing impacts. While the greater the dose of exercise, the greater its effect, it is also true that it is less likely for the majority of people to maintain it. This is why it is important to explore numerous strategies to maintain a reasonable level of compliance.

Levels of exercise

The levels of exercise recommended by governments across the world reflect this reality. They are set at a level that has definite benefits but are not high enough to discourage most would-be exercisers from engaging regularly. When it comes to exercise, individual differences, attitudes and opportunities have to be recognised.. The fundamental message to take from these blogs is this: if you do not exercise, start in a small way; if you exercise a little, increase it by a small amount;  continue this gentle progression to aim as high as is practical for you. Whatever it is that you do to increase your physical activity, be sure to make it something that is enjoyable. Without this, your chances of success are lessened and  sooner or later you will fail to maintain your good intentions.

Too late to benefit?

It is never too late to start exercising. If exercise is maintained for at least a decade, starting later in life can become as effective as longer-term exercise. However, the benefits of physical activity can only be gained by those who are physically able to do it and also able to continue it. Once disability has become established, taking up exercise is much less likely to be successful . Exercise is not something a person can bank for future times. People should never delay it, for fear of it becoming too late.

Despite the known facts of the benefits of physical activity, less than 10 per cent of the population take the minimum amount recommended by the DoH for good health. Political action is needed to achieve public awareness of these facts and to encourage everyone, and particularly older age groups, to increase their exercising habits. Perhaps the best target group would be the recently retired. They are young enough to be able to start exercising and have the time to do it. The gains will be substantial.. They have every prospect of remaining well, living longer and enjoying life more. The period of ill health, which may occur at the end of life will be reduced, with huge financial benefits for the individual and for society as a whole.

Future blogs

This series has reached a natural end point. In the New Year I will change tack with more emphasis on teaching new exercisers about what they should do and how to get the best out of regular physical exercise. So keep watching this space!!



5 responses to “An overview of exercise”

  1. Mary Waltham says:

    Thank you for all your advice, encouragement and wisdom. Such a precious help for all of us.

  2. Ian says:

    Great as usual, Hugh!

    I`d like to include a piece by you in the Walk Alton Herald pieces early is 2022… about a short, focused, article on the benefits of walking in then countryside?

    Copy deadline end of December….

  3. Ann says:

    Hello Hugh,
    I had a heart attack eighteen years ago in my forties and went through Alton cardic rehab and changed my exercise routine from just regular swimming to a wider variety of cv and strength exercises. I have continued with this ever since. I am interested that since my annual medication review has gone on line, I am never asked about my exercise routine. I always talked about exercise in the face to face appointments pre pandemic. Surely the online forms for post heart attack medication reviews should include questions about exercise as well as weight, blood pressure and medication side effects?

    • Hugh Bethell says:

      Thank you Ann – you raise a very important point. The on-line review should certainly include questions about exercise, but unfortunately there is no incentive for GPs to seek such information. GPs’ pay is partly decided by their compliance with collecting certain disease-related information, monitoring certain conditions and prescribing certain drugs. This mechanism is known as the Quality and Outcomes Framework (QOF). (It may account for the doctor taking more interest in the computer screen than you!)
      Despite regular exercise being one of the most effective measures for the prevention and treatment of a large number of diseases of later life, there is only one exercise-related query in QOF – the number of COPD patients receiving pulmonary rehabilitation!
      I will raise your query with the QOF panel. I will let you know what happens but I am not expecting a change of policy any time soon.

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