Common concerns about being active

I am already in pain, being active will just make it worse…

It is normal for anyone who’s not used to being physically active to experience some muscle soreness after doing a new exercise, and pain doesn’t necessarily means that the activity has caused any damage. As you become used to the activity this pain will usually reduce. Many of those that have musculoskeletal pain actually find that being more active helps to reduce their pain, as stronger muscles are able to better support their joints and the spine.

Tips you may wish to share:

• Ensure an adequate warm up and cool down of 5-10 minutes
• Exercise at the time of day when pain is usually least severe

What is meant by physical activity and what counts as moderate?

Moderate intensity activity is any activity that makes you breathe faster whilst still being able to hold a conversation compared to vigorous activity where you are breathing too fast to hold a conversion. This will vary on an individual’s personal fitness levels.

Activity/exercise doesn’t have to be strenuous to be beneficial and don’t worry, it doesn’t have to be in a gym or exercise class to count. Every activity counts in as little as 10 minute bursts.

The UK CMOs guide is to build up to at least 150 minutes of moderate intensity aerobic activity or 75 minutes for vigorous activity and perform muscle strengthening activities twice a week. It’s also a good idea for those over 65 to perform balance exercises twice a week.

Tips you may wish to share:

• Build up gradually in as little as 10 minute bursts
• Try and build activity into the daily routine and pick enjoyable activities
• Suggested activities include brisk walking, swimming, jogging, yoga, pilates/tai chi, housework, gardening, cycling, taking the stairs and dancing
• Muscle strengthening exercises vary from body weight or chair based exercises being performed in 8-12 repetitions involving all major muscle groups, bag carrying or a Tai Chi class, this is also helpful to maintain balance

I am already very busy, how can I find the time to fit this in?

Finding time to be more active, especially at the beginning, can be a challenge. It is important to remember that exercise and activity are not necessarily the same thing, and activities like walking to the bus stop, cycling to work, doing the housework and gardening all count towards health benefits and feeling better. The more the better!

This form of regular activity can easily fit into an individual’s daily routine. Some people even find that doing regular activity helps to make them more confident and efficient with specific tasks, actually saving them time in the long run.

Tips you may wish to share:

• Start slowly and gradually build up
• Experiment with different activities
• Build activity into daily routines

I already feel tired and you want me to do more…

Becoming more active is the most important treatment for persistent fatigue as it helps with body reconditioning and boosts energy levels. Many people find it a good way to take back some control over their health.

Tips you may wish to share:

• Start slow and build up gradually in small bouts of activity (this just needs to be a few minutes). Then increase it over time
• Increase the number of activity sessions first, then the duration of each activity, followed by the intensity

I’ve already tried this before but stopped because I saw no benefit…

The benefits of increasing activity levels may not necessarily be immediately apparent, so it is important to try to stick with it. A common reason for people finding that things didn’t improve, or got worse, with physical activity is that they did too much too quickly.

Start slow and increase steadily by listening to your body, allowing you to adapt to the new activity. Another reason that people stop is that they didn’t really enjoy it. So, try and find something that you enjoy, then you’ll find it’s easier to stick with it.

Tips you may wish to share:

• Don’t be discouraged by previous failed attempts
• Small changes now can lead to large benefits in the future
• Start slowly and build up gradually
• Find an enjoyable activity

How do I know when to stop exercise?

Dizziness, sickness or excessive tiredness are signals to stop exercising and wait for symptoms to settle. Warning signs to seek urgent medical attention include blacking out, chest pain, or excessive shortness of breath. If you notice any skin changes around your socket or residual limb, such as sores or broken skin, or worsening pain/discomfort you should contact your local prosthetic centre for advice.

Tips you may wish to share:

• Start slow and increase your activity steadily to allow you to adapt to the new activity
• During the first 2-3 months of increasing physical activity it is sensible to be physically active with other people

I am worried about having a heart attack if I become more active

The risk of dying during exercise is very low indeed. The risk to health from being inactive far outweighs the risk of regular physical activity. For the majority of people wishing to start moderate intensity activity, medical screening is not really needed and is often an unnecessary barrier to physical activity.

Who has an increased risk?

People who are always may have unknown cardiovascular disease so should increase physical activity very gradually – suddenly doing vigorous intensity activity may increase risk of myocardial infarction in this inactive group by 100-fold. Those with active symptoms such as chest pain, acute breathlessness, palpitations, or signs of heart failure may have serious underlying pathology and should be referred for specialist investigation.

Tips you may wish to share:

• If starting physical activity for the first time build up very gradually over 3 months
• Avoid sudden unaccustomed vigorous physical activity. Vigorous activity increases breathing to the level that it makes it hard to complete a sentence

No one in my community does exercise, it’s not in our culture…

A daily routine such as using the stairs or walking to the shops are physical activity opportunities that are shared across all communities. Other fun and social activities such as dancing might be culturally acceptable activity and worth a go.

Tips you may wish to share:

• Do activities you enjoy
• Build activities into your daily routine

I don’t know where to start…

Start with what you can do and build up gradually. Look at how being active could fit into daily activities.

Tips you may wish to share:

• Use a mobile phone to keep a step diary and target 10,000 steps every day
• Join a friend who is already active so they can share their tips
• Go for a walk down the street or round the block

I don’t want to go to a gym…

It’s ok, you’re not alone. Instead home based exercises can reduce the rate and risk of falls just as well as group-based programmes so going to a gym isn’t necessary. Special exercises (sometimes called ‘strength and balance training’) can help to build up muscle strength and

improve balance. These can make a person steadier on their feet and less likely to fall. They can be particularly helpful for older people who have already had one or more falls, or who have problems with balance or walking. These exercises should be designed specifically to take into account individual needs by a suitably trained healthcare professional who can also provide follow up support.

Tips you may wish to share:

• Exercise doesn’t have to mean going to the gym. It can be a household task such as gardening, going out for a walk with a friend/family member or climbing the stairs
• The talk-test is a good way of identifying moderate intensity activity. This is when individuals can talk but not sing during exercise and feel sweaty. The target is to complete 150 minutes per week, broken down into a minimum of 10 minute sessions.

I get put off by the weather!

If it’s too hot, cold, wet or windy outside, or pollution levels are high, choose an inside activity. Many activities don’t need you to be outside, such as swimming, home exercises, dance classes and many more. Many people find that being active outside is important to them, but having an alternative plan for when the weather is not good can help to keep you active until it improves.

Tips you may wish to share:

• Dress for the weather, but remember expensive clothing is not needed
• Check the local weather forecast for ‘breaks’ in inclement weather
• Chose activities according to the season
• Consider indoor activities that you may enjoy

I can’t afford it…

Being more active doesn’t need any special equipment or clothing. Wear comfortable clothes and be active anywhere, even at home. For those that are inactive and wishing to become more active, GPs in some parts of the country might be able to refer you to an exercise programme. Speak to your local GP to see if this is something that you can access.

Tips you may wish to share:

• Free smart phone apps, pedometers or a notebook can be used to track progress/the number of steps
• Community activities can be free or subsidised
• When watching TV, stand up at every ad break
• Most exercises can be done using just your own body weight or a water bottle, or something you have in your house

I don’t enjoy it!

Try to make being more active fun. Things like singing, dancing, sex, games with grandchildren, gardening, household jobs and shopping all count.

Tips you may wish to share:

• Make moving a more sociable activity
• Ask friends or family to join in, like going to the park together

I haven’t done any exercise before…

Often people feel it’s too late to start exercising. However, it’s never too late to start and the benefits, which are wide ranging, can be felt straight away. In the longer term, regular exercise will improve mobility and ability to do everyday tasks.

Tips you may wish to share:

• Make a start!
• Try and make it part of a routine
• Get support from family and/or friends
• Start slow and build up from 10 minutes. Progress the duration first then the intensity. Aim for 30-45 minutes three times per week
• Aim to incorporate aerobic activity with resistance and balance training

I am overweight, will exercising help me lose weight?

Exercise alone, without thinking about your diet or your eating habits, will achieve only modest weight loss. The most successful approach to long-term weight control, especially for those with diabetes, involves a combination of changing your diet, exercise routine, and habits.

However, even with modest weight loss there are amazing benefits  to being active regularly:

• Improved glycaemic control
• Reduced diabetic and cardiovascular problems
• Lower blood pressure
• Stronger bones
• Leaner, stronger muscles

Tips you may wish to share:

• All physical activity helps and can be beneficial
• Start slowly with gentle activity, like walking, gradually working up to 30 minutes a day of moderate intensity exercise, five times a week
• Moderate-intensity activity raises the heart rate and increases rate of breathing. A useful test for moderate intensity exercise is if you can still talk but can’t sing the words to a song during exercise, which means you’re probably slightly out of breath.

I can’t find the motivation to exercise…

It’s ok. We’d recommend a slow start and build yourself up gradually. Group activities can be motivating and a way to meet new people too.

It’s too difficult to get anywhere to exercise…

You can be more active at home, or fit it into the daily routine.

Tips you may wish to share:

• Park in a car parking space further from your destination
• Dance around the living room

My gym said I need medical clearance before being active: am I OK to exercise?

For the vast majority of people, medical clearance is not needed to safely undertake progressive, moderate intensity activity. Important exceptions to this are people who are experiencing active symptoms (see below) or previously inactive people who try to go too fast too quickly.

Significant physical problems due to being active are so rare that medical screening has the potential to be an unnecessary barrier to physical activity. However, screening is most effective when it’s looking into active symptoms and co-morbidity.

It is quite common for gyms to ask for a medical letter for people to use their facilities. Consider the option of providing a signed letter to overcome this barrier for individuals. Encouraging a slow start and gradually building up of activity (over 3 months or so) reduces the chances of poor outcomes and disenchantment.