ENCOURAGING EXERCISE part 5

Some more approaches to promoting exercise

Applying the concept of biological age

Our chronological age is a measure of how long we have been on this earth. Our biological age is the age at which our current physical performance is the average. This is largely our cardiorespiratory fitness. For the unfit, knowing that the biological fitness is significantly older than chronological age should be a spur to increasing activity and thus reach age-average fitness and bring the two ages into harmony.

Food labelling to include the “activity equivalent” of the calories about to be consumed.

The results do not make very comfortable reading, which may be all to the good, provided it does not induce a sense of despair in the consumer. For instance it takes a person of average weight about 26 minutes to walk off the calories in a can of fizzy drink. It takes a run of about 43 minutes to burn off a quarter of a large pizza – oh dear.

Regular telephone support and follow-up of absences for those prescribed exercise programmes.

There is some evidence that this approach is both effective and cost effective in increasing long term compliance with exercise programmes.

Smartphone apps for encouraging exercise.

Some apps concentrate on helping with behavioural change. Others measure activity, like the pedometer apps and the Public Health England app, “Active 10”. Results of exercise episodes, for instance runs, can be uploaded to a website which will track your performance and compare it with previous performances or compare you with other participants. The idea is that competition is a stimulus and should encourage you to keep exercising and even to up your game. So far there is little evidence that they really do increase physical activity. One block to their implementation is the need for the user to be motivated to do so in the first instance.

Reducing the exercise targets, particularly for older people.

The thinking is that for some folk even the rather modest goals set by the DoH and other national bodies may be a put-off. Setting lower targets may help older sedentary people to move towards recommended activity levels – all exercise is good and a little is a lot better than none.

Fitness trackers

At an individual level, sedentary individuals can do much for themselves by just getting out of the chair and walking about for a few minutes every hour, going out for short walks, pacing about when answering the telephone.  A pedometer or fitness tracker should be an excellent addition to the armamentarium for encouraging increased exercise – worn regularly it provides the baseline and allows you to set targets which are easily monitored.

Such “trackers” come in a variety of forms with a variety of characteristics. They can monitor movement, calories burned, and heart rate and even sleep patterns. The consumers Association produces a listing of available devices ranging in price from £18 to £700.  If you decide that this is the right approach for you, choose one which is appropriate for the sport or activity which you wish to track. Sadly, and grist to the mill of pedometer opponents, one controlled trial of weight loss strategies found that overweight people using exercise trackers lost less weight over two years  than their controls who did not use trackers!

Does exercise promotion work?

An analysis of the trials of physical activity promotion in 1996 concluded that “interventions that encourage walking and do not require attendance at a facility are most likely to lead to sustainable increases in overall physical activity. Brisk walking has the greatest potential for increasing overall activity levels of a sedentary population and meeting current public health recommendations.”. For those who would promote exercise, nagging is not the answer but gentle persuasion just might work, a bit. People need to be persuaded of the joys of exercise. Choose an exercise which you will enjoy and go for it. The feel-good effects will be surprising and the post exercise glow has been described as “on the orgasmic spectrum”

Nudging.

Ultimately it is necessary to nudge people into exercise, remembering those motivating factors identified by the Allied Dunbar Fitness Survey. For men they were “to feel in good shape physically”, “to improve or maintain health”, “to feel a sense of achievement” and “to get outdoors”. Specifically for men were “having fun” and “relaxing” and for women “looking good” and “controlling body weight”. Remember also than many people are put off exercise because they do not regard themselves as “sporty” , because they are shy, feel overweight or lack energy.

Political action

The promotion of exercise in the community requires a politically led multidisciplinary approach strongly supported by the medical profession. Unfortunately we do not yet know how this may best be implemented. Sport England, which was set up in 1994 with National Lottery money to do just this, has overseen a reduction rather than increase in sports participation over the past few years. Now Sport England has joined with The Faculty of Sport and Exercise Medicine and Public Health England to launch a new project, “Moving Medicine”. This aims to educate doctors and their patients to turn to exercise as the treatment of choice for many clinical problems and to introduce a culture of physical activity into the lives of us all. It is encouraging to see how many other organisations are involved in promoting exercise and producing policies to enable exercise to become the norm rather than the exception – the World Health Organisation, the National Institute for Health and Care Excellence, the UK Health Forum, Sustrans, the Sport and Recreation Alliance, the Department of Transport, the Local Government Association, the Royal Society for Public Health to mention just a few. My hope is that political actions and public education will produce a cultural shift which will make inactivity as unacceptable as cigarette smoking. To be effective this needs to be supported by the full weight of public opinion and public pressure, though it will be difficult to tax it!