MORE ABOUT EXERCISE IN THE TIME OF CORONA

A bit more about the use and effects of exercise in these dire times. It seems frivolous to consider anything other than the pandemic at the moment.

I usually refrain from recommending any particular form of exercise and only comment on specific types of activity if they have been scientifically compared – see the PS to my last Blog.

However our options have suddenly become severely curtailed – so what is left? No more walking football, swimming, hockey, taekwondo, cricket, trampolining, gymnastics, archery, Pilates, dancing, squash, martial arts and now even tennis and golf are gone. Here are a few thoughts on what is left.

Walking

Walking is what we do most of but to get the full benefits most of us need to more of it. To follow the recommendations of the DoH – about 150 minutes of moderate exercise per week – our weekly walk dose needs to be about seven or eight miles. If you rely on  a pedometer for measuring your walking activity remember that much of what it measures are the steps you take while pootling about the place. I reckon that for most people the usually recommended 10,000 paces per daily is probably around the DoH guideline.

With walking as with most physical activities, more is better. For instance, to lose weight you will need to up the target to about 15 miles per week or 20,000 paces per day. A recent publication has compared mortality with the number of steps recorded by an accelerometer (a sophisticated form of pedometer) in a cohort of 4,800 subjects followed up for around ten years¹. Compared with a step count of 4,000/day, the 8,000/day group had a 51% lower death rate and the 12,000/day lot had a 65% lower death rate during follow-up.

Faster is also better. Walking at four mph for most people would count as vigorous exercise. The DoH rules are for 75 minutes weekly – just five miles. Again this is not really enough and for the optimal increase in fitness, aim for nearer ten.

Jogging/Running

If you are a regular runner/jogger you don’t need any advice from me. For me this is the gold standard for exercise for maximizing fitness. If you don’t run or jog, the current sudden increase in your leisure time might be an ideal opportunity to start. Begin by walking a set distance – perhaps one or two miles, as fast as you can. The next time out, break into a jog for perhaps 15 seconds every five minutes and increase this slightly every time you go until you can jog 2 or 3 miles without walking. This might take until the pandemic crisis has ended – but what an outcome. If you want a rather more professional approach try the “Couch to 5k” app which will guide you through the process of becoming a jogger painlessly and elegantly. The end game will be being able to take part in “parkrun” but this will have to wait until this brilliant event is restarted.

Cycling

Second only to jogging/running, this does presume access to a bike. The rules for increasing fitness and getting health benefits are much the same as for any other exercise –  between 75 and 150 minutes of cycling weekly, depending upon how hard you push yourself. If you are only slightly short of breath it is moderate, if you are very short of breath it is vigorous. It is not possible to translate this into speed because the degree of effort is so dependent upon fitness level, terrain and wind. The effects are better with short frequent outings than infrequent long ones. The type of bike can matter. I was out for a gentle pedal recently when an old fellow sailed past at an enormous speed. “Much respec” I thought. However when I came upon him later having a breather I noticed that his crossbar was enormous – it was an electric bike!

Cycling has advantages for those with arthritis of hips or knees, both of which can benefit from the movement involved. Cycling can also be combined with shopping (think the old fashioned shopping basket) and is one way of avoiding public transport when going to work. Cycling, however is not entirely without its own problems mainly to do with other road users. A study of 230,000 commuters found that 3,704 went by bike². The incidence of admission to hospital for injury was 50% greater in the cycling to work group. However the balance of advantage remained with the cyclists. The researchers calculated that if 1000 participants changing their mode of commuting to include cycling for a period of 10 years there would be 26 additional admissions to hospital for a first injury (of which three would require a hospital stay of a week or longer), 15 fewer first cancer diagnoses, four fewer cardiovascular disease events, and three fewer deaths overall.

1. DOI: 10.1001/jama.2020.1382
2. http://dx.doi.org/10.1136/bmj.m336

PS

There is a glimmer of hope that a pharmacological contribution to the fight against Covid-19 may be around the corner. A small trial from France of an antibiotic, azithromycin, and an antimalarial, hydroxyquinoline, has shown that the combination can result in rapid clearance of the virus from affected persons. No lessening of mortality has yet been shown but keep your fingers crossed.