Exercise: The ignored wonderpill

 Exercise has been more popular than ever. For some years it’s been the thing everyone in healthcare talks about. During the first lockdown one of the trendy things was to join some type of online exercise group or do a zoom workout with your buddies. Either that or you got into making bread (is it too soon for lockdown jokes?). There is the hope we can travel somewhere sunny for the holidays this year, so it’s about time a lot of people started working on their summer body, added to the fact that gyms have just re-opened here in the UK over the last few weeks, probably there being a lot of people who are eager to get their workouts in. Over the years fitness has also become somewhat of a lifestyle, with people who started exercising a week ago creating their own fitness Instagram page and every other influencer on social media sharing their workout routines. I bet you know someone who has done or is planning to do some type of exercise event – a though mudder, hike up a known mountain, do a marathon or half marathon. Physical activity is everywhere.

But how did exercise become so famous and is this fame warranted? You may be thinking, “What a click-bait title you came up with. What do you mean by ‘wonder pill’? Exercise is tiring, difficult and boring. It’s only for meatheads and professional athletes. I’ve got better stuff to do with my life, more important stuff”.

There is a lot to unpack there made up person that is meant to represent the reader, but convincing you of the benefits of exercise and why you should be doing it is exactly my aim here. To start, let me clarify a couple of terms I have used so far. Even though they are often used interchangeably, physical activity and exercise do not mean the same thing.

Physical activity: “any bodily movement produced by the contraction of skeletal muscles that results in a substantial increase in caloric requirements over resting energy expenditure” (Thompson, 2014).

Exercise: “type of physical activity consisting of planned, structured, and repetitive bodily movement done to improve and/or maintain one or more components of physical fitness” (Thompson, 2014).

You will understand soon why I present this distinction.

Even though exercise appears to have become increasingly famous in the last few years, we still need to talk about it as there is still a lot of people who don’t do it. Guthold et al. (2018) looked at worldwide trends on physical activity between 2001 and 2016. In their paper, insufficient physical activity defined as adults not meeting WHO recommendations 2010 on physical activity for health (at least 150 min of moderate intensity, or 75 min of vigorous intensity physical activity per week). The global percentage of people performing insufficient physical activity amongst all countries was 27.5% (Guthold et al, 2018). That’s almost 30% of everyone in the world not doing enough exercise. Even though that doesn’t appear to be a lot, it is a global average, with some countries presenting percentages of almost 40%, such as Latin America and Caribbean countries and overall high-income countries, with the trend being towards rising with the passing of the years (Guthold et al. 2018). Adding to this, there is also the problem that healthcare professionals are often not aware of how much exercise is recommended we do in order to optimize our health. Looking at my own healthcare corner, only around 16% of physiotherapists in UK (Lowe et al, 2017), 10% of physiotherapists in Australia (Freene, 2017), and between 4-6.8% of physiotherapists in Israel (Yona et al., 2019) fully knew the respective national physical activity guidelines.

But why should we care about exercise? What do we gain from it?

To start with we have the obvious benefits of reducing fat (Oja et al, 2015; Miller et al, 2013; Wewege et al, 2017; WHO, 2020), increasing your muscle mass (Schoenfeld and Grgic,  2018; Schoenfeld et al, 2017; WHO, 2020) and muscle strength (Miller et al, 2013; Schoenfeld et al, 2017; WHO, 2020). However it’s not just about how you look. One of the critiques I have towards a big part of the fitness industry is always focusing on aesthetics. Yeah it’s cool and beneficial to have big muscles and look lean, but that continues the stereotype that regular physical exercise is for meatheads and is a disservice to what exercising can do for you.

Regular exercise also takes care of your heart and lungs, improving you blood pressure (Cornelissen and Smart, 2013; WHO, 2020), and how much oxygen your lungs can take in and transfer to the body ( Miller et al, 2013; Oja et al, 2015; Sultana et al, 2019; WHO, 2020). And going completely against the stereotype that exercising is for roid-raging people, there is a significant amount of evidence indicating that exercise offers benefits to your cognitive ability and memory (Blomstrand and Engvall, 2021; Loprinzi et al, 2018; Ludyga et al, 2020; WHO, 2020).

But the non-athletic benefits of health don’t stop there. Taking the risk of sounding like those Billy Mays’ TV-sales commercials, there’s more.

Research has also indicated that regular exercise reduces the risk of dying in general (usually called all cause-mortality)(Saeidifard et al, 2019), reduces the risk of dying from a heart problem (Oja et al, 2015; Saeidifard et al, 2019) or of your heart having reduced blood flow to itself, medically known as myocardial infarctions (Saeidifard et al, 2019).

Adding to this impressive list, which in by no means exhaustive, a more recent finding indicates that exercising regularly made people less likely to be hospitalized or dying from COVID-19 (Sallis et al, 2021). I don’t know about you, but right now you I’ll sign up for that.

Considering all this, I kindly ask you to engage in a thought experiment. Imagine there was a pill that improved you muscles, made you lose fat, improved how your heart, lungs and brain work, made you less likely to die and have heart problems, as well as decreasing your risk of ending up in hospital due to COVID-19. How much would you be willing to pay for it? What if that pill was free, but for it to have effect you would have to take it most days of the week and preparing it takes between 30min to 1hour and requires a fair amount of physical effort? Still sounds like a good bargain, no? Well, that exists: that is what exercise is.

Hopefully by now I have managed to convince you about how beneficial exercise is. But the question lingers: How much exercise should we be doing to benefit our health? Luckily for you, the World Health Organization has just recently updated their physical activity guidelines, so let’s look at their recommendations.

Children and Adolescents (5-17 years)

In this age group, individuals should do an average of at least 60 minutes of moderate to vigorous intensity exercise per day throughout the week, together with strengthening activities or exercises at least 3 days per week (WHO, 2020).

This would mean activities like brisk walking, playing badminton or tennis, low impact aerobic dancing all the way to playing basketball, swimming laps, jogging and resistance training such as bodyweight (Press-ups, pull ups and similar) or exercising with free weights or resistance machines (Hagerman, 2012).

Adults (18-64 years)

Adults should do at least 150-300minutes of moderate-intensity or 75-150 minutes of vigorous intensity aerobic physical activity, or equivalent combination, per week (WHO, 2020). Adding to this, they should perform muscle strengthening activities of moderate or greater intensity, that involve all major muscle groups, on 2 or more days a week (WHO, 2020).

In simpler terms this would look more or less like this:

• 25 to 50 minutes 6 days a week of brisk walking, playing badminton or tennis, low impact aerobic dancing, light effort rowing machine or stationary bike (Hagerman, 2012).
• 15 to 30 minutes 5 days a week of playing basketball, swimming laps, jogging, circuit training, moderate effort rowing machine or stationary bike (Hagerman, 2012).
• In addition or instead of these, two or more days a week of performing body weight exercises such as push-ups, chin-ups, lunges or exercises using free weights or resistance machines that target all major muscle groups (Hagerman, 2012).

Now, for some of you these recommendations may raise concern or even seem impossible to stick to. The WHO guidelines (2020) also give good news regarding these concerns: a constant message throughout the document, for all mentioned age groups is that any or some exercise is better and still provides benefits when compared to none. Interestingly, and on the same note, one of the changes from the previous guidelines to the current ones is that they also included sections on sedentary behaviour (WHO, 2020). It is recommended that together with trying to the weekly minimums of physical activity, you should also aim to reduce the daily amount of time you spend sitting down watching TV or any other screens, driving or at your work desk (WHO), within any practical or reasonable limits you may have to this.

Remember at the start when I explained the distinction between physical activity and exercise? The guidelines I’ve been quoting name themselves physical activity guidelines. However they recommend physical activity in a way that is structured, done in a somewhat planned manner. That, by definition means it is exercise. The reasoning I’m pointing this out is that even though the evidence suggests that some activity is better than none, if you find yourself struggling to reach your health or fitness goals, I would advise you to review your planning, as it may not be enough.

As this text is already quite extensive, I’ll finish on those notes. If there is anything I would like you to take from the text is this: perform as much exercise as you can within your personal limitations, as some is always better than none, at the same time as you reduce the amount of time you spend sitting. Your health will thank you! And if you have any doubts or concerns about your safety to exercise, consult your nearest friendly doctor or physiotherapist.

As always, if you found it informative or helpful, share this text throughout your preferred social media platforms. Stay active while you wait for the next one.

References:

• Blomstrand, P. and Engvall, J. 2021. Effects of a single exercise workout on memory and learning functions in young adults—A systematic review, Translational Sports Medicine, 4(1), pp. 115–127. doi: 10.1002/tsm2.190.
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• Guthold, R., Stevens, G. A., Riley, L .M., Bull, F. C. 2018, Worldwide trends in insufficient physical from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health, [e-journal], 6, pp. 1077-1086. Available through < https://doi.org/10.1016/S2214-109X(18)30357-7 >.
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