Climbing Everest

 

The World Health Organisation recommend that adults achieve on a weekly basis 150 minutes of moderate physical activity as well as regular muscle strengthening activities. Globally 1 in 4 adults is not achieving this target and more than 80% of teenagers are insufficiently physically active[i].

There are lots of positive impacts of being active every day, over 22 different chronic diseases can be impacted both through reduction in risk of developing the condition and for many also improving outcomes and reducing complications for those living with the disease.  From dementia to diabetes, cancer to depression, being active every day can make a real difference.

Source: PHE Health matters: getting every adult active every day

However despite the evidence of benefits, much like eating healthier, for many people the concept of doing 150 minutes or two and half hours of physical activity every week seems as realistic as climbing Everest, although in reality it’s not much more than the average superhero or wizarding block buster movie.

It’s true that you can achieve the same effect through 75 minutes of vigorous physical activity, but for those who are inactive that is probably more like trying to get them to walk on the moon!

In many countries, including the UK, implementation of the recommendations has tried to break down the concept of the 150 minutes into more manageable blocks.

In the UK inactive adults are defined as those achieving less than 30 minutes a week of moderate physical activity. This recognises that the benefits of activity really start to accumulate once we start to moving for at least 30 minutes of moderate intensity physical activity.

Source: Active Lives Survey (Nov 16-17)[ii]

Most of us when we think about our average week pottering around the house, doing the shopping and perhaps chasing after the kids or the dog, think – ‘I must be doing at least 30 minutes’ a week, but sadly most of that activity won’t be moving fast enough to have any significant impact on your health.

Too many of us rely on step counters to measure physical activity and the evidence suggests that although many people achieving 10,000 steps or more a day may be doing enough of those steps fast enough to impact health, it is possible to get to the step count target and have only achieved limited moderate intensity physical activity.

The key is in the word ‘Moderate’ – moderate physical activity is the type of activity that gets your heart beating a little faster, means you can still carry on a conversation but are a bit short of breath and definitely getting that warm feeling and perhaps a little sweaty.

Public Health England launched the Active10 App in autumn 2017 to help people get a better sense of what kind of walking was fast enough to count as moderate physical activity. The app monitors both the length of time walking and the intensity of walking and when you’ve achieved a ten minute block you get a green light i.e. an Active 10. The aim of the campaign is to try and support people to build at least ten active minutes a day into their lives, i.e. get everyone to at least 70 minutes of moderate physical activity a week.

Although this isn’t 150 minutes and in some countries those achieving 70 minutes would still be seen as inactive adults, we know from the evidence that once a person starts to regularly achieve more than 30 minutes a week of moderate activity they start to see benefit across a whole range of health conditions[iii].

One of the joys of becoming more physically activity is that some of the health impacts start to appear relatively quickly. Some of the fastest impacts are on cardio-vascular health, on average it takes only two weeks to see the benefits to blood pressure, and on mental health where the impact on low mood can be impressive. There is also modality specific evidence that a brisk walk can have a positive impact on lower back pain, breast cancer risk reduction and depression, stress and anxiety[iii].

Sadly too often we have oversold the impact of physical activity on obesity, the evidence clearly shows that you need to manage your diet as well as being physically active to loose weight, but often people expect instantaneous results on their waistline from 15 minutes in the gym. So although ten minutes a day of moderate intensity physical activity is definitely going to impact on your cardiovascular health, it may not change your dress size overnight.

We know that in the UK 4 in 10 adults aged 40-60yrs[iv] are not achieving at least one ten minute brisk walk a month, let alone a week,  and that’s over 6 million adults just in the UK, so we have a long way to go when it comes to getting in those active ten minutes walking every day.

Systematic reviews have demonstrated that there is a direct relationship between the amount of physical activity we do and the benefits to our health, more is better but every bit counts, especially for prevention of diabetes[v]  and coronary heart disease[vi]

We would not expect anyone to go from the sofa to climbing Everest overnight, so perhaps we should changing the conversation when it comes to inactivity and help people build up, this should be a marathon which leads to a lifestyle change rather than a one of New Year’s eve fad that burns out by the 10th Jan.

Ultimately if everyone was active every day for at least ten brisk minutes of walking, cycling or however they want to get hot and sweaty, the returns would be amazing not just for individuals but in terms of the burden of ill health, health service costs and social care costs. Given there are over 200,000 new cases of type 2 diabetes diagnosed each year in England and the overall cost of type 2 diabetes is over 9% of the total national health service budget[vii] , the impact of even a 5-10% reduction in risk could be substantial.

So perhaps it’s time for a new conversation, one that starts with ten minutes every day and builds up, as the new WHO global action plan tag lines says:

Be Active, Everybody, Everywhere, Every Day!

 

References

[i]Physical Activity Fact sheet. WHO. Feb 2018. http://www.who.int/en/news-room/fact-sheets/detail/physical-activity

[ii]https://www.sportengland.org/media/13217/v-mass-markets-digital-content-editorial-team-active-lives-march-2018-active-lives-adult-survey-nov-16-17-final.pdf

[iii]https://www.dors.it/documentazione/testo/201709/Evidence_summary_PHE_2017.pdf

[iv] https://www.gov.uk/government/news/6-million-adults-do-not-do-a-monthly-brisk-10-minute-walk

[v] https://link.springer.com/article/10.1007/s00125-016-4079-0

[vi] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3158733/

[vii] https://www.england.nhs.uk/diabetes/diabetes-prevention/