Physical activity
There is a strong evidence base for the effect of exercise on reducing cardiorespiratory risk. Increased physical activity can generate a 20-35% reduction in the risk of CVD, CHD or stroke.16
Physical activity has the benefit of increasing the pumping capacity of the heart, reducing the heart rate both at rest and during exercise, reducing blood pressure, improving insulin sensitivity, demonstrating a positive effect on the levels of high and low density cholesterol, along with a positive impact on a person's weight.
All adults should aim to be active daily and to avoid prolonged periods of sedentary behaviour.
Adults are recommended to undertake each week at least:
- 150 minutes of moderate intensity aerobic exercise (to the point of being breathless) or
- 75 minutes of vigorous activity or
- A mix of moderate or vigorous aerobic activity.10
One way to approach these guidelines would be to undertake thirty minutes of aerobic exercise on at least five days each week. Activity in bouts of ten minutes or more has been shown to be as effective as longer periods provided the total recommended amount of exercise each week is achieved.10
Moderate intensity exercises include brisk walking, cycling or using the stairs, all of which can be incorporated into an individual's daily activities.
These guidelines are a minimum recommended activity level, with higher activity levels having a greater benefit.
Patients with medical conditions that restrict their ability to exercise should be encouraged to exercise to their maximum safe capacity.10
Walking is one of the most common forms of exercise undertaken by the general population. It has the advantage of being cheap and easily accessible. The recommendation to achieve 10,000 steps daily may be viewed as unattainable and de-motivating. Sedentary individuals can be encouraged to increase their physical activity levels by 2000 steps daily, undertaken at moderate intensity. This would equate to an additional 150 minutes of physical activity each week.4
When advised to increase their activity levels patients may suggest that they do not have enough time to exercise or that it is too expensive to join a gym or purchase exercise equipment. These patients should be encouraged to incorporate exercise into their daily routine. This could involve taking the stairs rather than the lift or escalator, parking at the far side of a car park rather than outside of the shop or getting off the bus one stop early and walking the final distance home. Patients can also be advised that everyday activities such as housework, gardening, dancing, work-related activity or 'Do It Yourself' can all be considered as part of their daily physical activity level.
In some areas the NHS has offered exercise referral schemes where patients are offered discounted or free access to gym sessions, yoga classes or similar forms of physical activity.
In all cases it is essential to get "buy-in" from the patient to increase adherence with the recommended exercise or activity regime.