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Dr Peter Hill

Dr Peter Hill

Get Moving

"You may not be able to outrun a bad diet but exercise is still good for you."

Having discussed the first ‘Food as Medicine’ topic in last week’s blog, it’s the turn of the second of the 5 Pillars; ‘Get Moving’, which is essentially about physical activity or exercise. This week we will take a look at some home-based exercise options developed by experts at the Mayo Clinic and the Center for Disease Control and Prevention in the USA. 

But before we go any further, I suggest that you complete this simple Physical Activity Readiness self-assessment questionnaire to see if you should chat to your doctor before you ‘Get Moving’. Simply tick  Yes or No in the box that corresponds to your answer:

 ‘Get Moving’ Self-Assessment QuestionnaireYesNo
Has your doctor ever said that you have a heart or other condition and that you should only undertake physical activity recommended by a doctor?  
Do you feel pain in your chest when undertaking physical activity?    
Are you using medicines for blood pressure or any heart condition?  
In the past month, have you had any chest pain when not undertaking physical activity?  
Do you lose your balance because of dizziness or do you ever get faint or lose consciousness?  
Do you have any bone or joint problems that might be aggravated by exercise?  
Do you know of any other reason why you should not exercise?  

If you answered YES to any of the above questions then I suggest that you chat to your doctor BEFORE you start exercising. If you answered NO to all the questions then you may be able to undertake any exercise activity you want—as long as you start slowly and build up gradually. If uncertain, then chat to your doctor about the kinds of physical activities you wish to undertake and follow his/her advice.

Before you ‘leap’ into exercising ( pardon the pun), it’s important to think carefully about where exactly you find yourself on the exercise continuum. To help you do this we are going to take a look at the Stages of Change Model developed by psychologists Prochaska and DiClemente. According to the model we go through 5 stages as we change behaviour, such as when we start exercising.

  1. Precontemplation – no interest in exercising
    1. Contemplation – thinking about exercising but no plan made as yet
    1. Preparation – exercise plan in place
    1. Action – started exercising 
    1. Maintenance – sustained exercise

Research shows that when people fail to exercise, or don’t sustain an exercise programme,   it’s often because they skip the Preparation stage and go from Precontemplation or Contemplation directly to Action. You need to prepare well; think through the process in detail and, most importantly, choose exercises that you LIKE doing. As we all know only too well there is a 6th stage which we don’t like to talk about: Relapse. The good news is we can rehabilitate our relapses and get going once again.

Now let’s assume that you answered NO to all the questions included in the questionnaire and that you have moved through the first two stages of change. You are now ready to consider the first suggested exercise option we call Foundation. This option consists of a total of 150 minutes of moderate-intensity aerobic activity every week (e.g. 30 minutes a day 5 times a week). Add a daily dose of core muscle-strengthening exercise which will help you strengthen and stabilise your core muscles so that you are better able to prevent injury when you move on to more general muscle strengthening exercises.

An excellent, safe and cheap moderate-intensity aerobic activitythat you can do, indoors or out and at any time of the day or night, is brisk walking. The following two links to short YouTube videos provide some useful tips on brisk walking: 

The world-famous Mayo Clinic suggests a simple and effective core strengthening excise as demonstrated in this image;

Lie on your back with your knees bent. Tighten your abdominal muscles. Raise your hips off the floor until your hips are aligned with your knees and shoulders. Hold for three deep breaths. Return to the starting position and repeat. Do this 10 times for one set and then repeat until you can comfortably complete 3 sets. Do this once or twice a day.

Another example of core muscle strengthening exercises is demonstrated in this short YouTube video; https://www.youtube.com/watch?v=RSxqzpqUFK4

Once you feel that you have stabilised and strengthened your core muscles then you are ready to move on to the Progress phase of your exercise programme.  Walking briskly for at least 150 minutes per week and doing your core muscle strengthening exercises are key. Listen to your body but ‘push the envelope’ if you feel comfortable in doing so.

With the Progress option, you are going to add some general muscle-strengthening exercises to your programme. These exercises should be done TWICE a week. One piece of equipment the Mayo Clinic suggests using to help you do these exercises is a relatively inexpensive resistance tube.  Resistance tubes come in different colours denoting different levels of resistance. You will need to match your purchase with your level of fitness. Take a look at this short video for information on how to choose the correct resistance tube: http://www.mayoclinic.org/healthy-lifestyle/fitness/multimedia/resistance-tubing/vid-20084665

If you click on the links below you will find several exercises that you can do in the privacy of your own home.

For more information on the Mayo Clinic exercise programme please go to http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046031?pg=1

The last exercise option is aimed at older adults, i.e. people aged 65 and older who are able to exercise aerobically. The Center for Disease Control & Prevention recommends that older adults should DOUBLE their moderate exercise aerobic activity from  150 minutes to 300 minutes per week. That’s right –  we need more not less aerobic exercise as we get older.  And remember to also keep doing your daily core muscle and general muscle strengthening exercises.

I want to end with a reminder that while exercise has many benefits – and we all need to ‘get moving’ –  and please remember that “you can’t outrun a bad diet” when it comes to losing weight. If you have any comments on this week’s posts, or if you have any questions or suggestions relating to exercise, please email me at care@caleb.co.za, I would love to hear from you.

Dr Peter Hill

References:

1. Warburton DE, Jamnik VK, Bredin SS, et al. Evidence-based risk assessment and recommendations for physical activity clearance: An introduction. Appl Physiol Nutr Metab. 2011;36 Suppl 1:S1-2. doi: 10.1139/h11-060

2. Prochaska J O, Norcross JC, Diclemente CC. Changing For Good. 1995; Avon Books. New York, New York.  

3. https://www.webmd.com/fitness-exercise/news/20181210/new-exercise-guidelines-urge-everyone-just-move

4. https://www.youtube.com/watch?v=YlG_BQ2rBf0

5. https://www.youtube.com/watch?v=hOS1wq7SyyE

6. http://www.mayoclinic.org/healthy-lifestyle/fitness/multimedia/resistance-tubing/vid-20084665

7. http://www.mayoclinic.org/healthy-lifestyle/fitness/in-depth/strength-training/art-20046031?pg=1

8. https://www.cdc.gov/physicalactivity/basics/older_adults/index.htm

9.Malhotra A, Noakes T, Phinney S. Its time to bust the myth of physical inactivity and obesity: you cannot outrun a bad diet. Br J Sports Med, May 2015. https://bjsm.bmj.com/content/bjsports/early/2015/05/07/bjsports-2015-094911.full.pdf

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