How much exercise is enough?

Today we lead more sedentary lives than ever. Modern technology predominates at work and at home, with less need to regularly move our bodies. We are the first generation to have to consciously incorporate movement into our everyday lives, with people in the UK 20% less active on average than in the 1960s [1].

Inactivity results in preventable inflammation, hormone imbalances, limited stress tolerance and increased risk of heart disease, cancer, diabetes and mental health problems [2]. Inactivity also leads to premature death, with around 3.2 million people globally [3] and 70,000 in the UK alone, dying each year due to sedentary lifestyles [4]. So, how much activity should we be doing?

The UK Chief Medical Officer’s Guidance recommends that adults do at least 150 minutes of ‘moderate intensity’ or 75 minutes of ‘vigorous intensity’ cardiovascular exercise each week (more on this later). We should also aim to do resistance (strength) training on at least 2 days per week, which might include weight training, yoga or even carrying heavy bags. We should also reduce sedentary (sitting) time throughout the day wherever possible, by standing up, walking and climbing stairs, as applicable to individual ability.

Additionally, for older adults, maintaining balance is important to reduce risk of falls and frailty, with activities such as dancing, tai chi and bowls especially helpful [5]. However, many of us don’t regularly meet these recommendations, with 1 in 4 women and 1 in 5 men in the UK classed as physically inactive [1].

Movement is medicine

Movement and exercise are not technically the same thing. Movement is just that, moving our bodies more, in as many ways as possible. Exercise, however, usually describes an activity designed to generate a specific physiological response. Both are important to health and should be seen as synergistic when thinking about how to increase our physical activity.

In general, the more we move day to day – standing, walking, cycling, climbing stairs – the greater the health benefits. Additionally, if our baseline level of activity is higher, we also derive greater benefit from exercise. Conversely, if our bodies are not accustomed to regular movement, sudden bursts of intense exercise can result in injury or increased levels of cellular inflammation, which may conversely have negative impact on overall health.

Therefore, at One5 Health we usually recommend increasing daily movement as the foundation to building overall physical activity, and exercise as a means to further optimise health.

Staying active as we get older

Physical activity becomes even more important as we age. Older adults who move and exercise regularly will continue to perform everyday tasks and maintain their independence for longer. Additional benefits include healthier weight, improved blood pressure, better cognitive function, reduced falls risk [8] and even slowing the onset of dementia [9][10].

Maintaining motivation to stay active is not always easy however and may become more difficult as we get older. Exercising with others, whether friends, family or even pets can be especially helpful. Exercise classes with your local gym are also a great option, provided they are pitched at an appropriate intensity for your level of fitness.

Exercise intensity is different for everyone

The UK CMOs guidance is a useful place to start, but there’s a lot of room for interpretation. In particular, when it comes to cardiovascular exercise, the same activities will not necessarily produce the same physiological response in everybody, so it’s important to tailor this general guidance to your individual needs.

People of different ages, abilities and fitness levels will require different amounts of activity in order to reach the desired ‘intensity’ and resultant cardiovascular response. Getting out of breath, increasing your heart rate and starting to sweat are useful general indicators, but what constitutes ‘moderate intensity’ for one person might be ‘vigorous intensity’ for another, and vice versa. For example, an older, less fit person might achieve ‘vigorous’ intensity by walking briskly for one mile, while a younger, fitter person might require fifteen minutes of fast running to achieve the same physiological response.

Ultimately everyone is different, so it’s important to be aware of how your body responds to an activity in real time. Being mindful of your breathing and heart rate is important, but wearable technology can provide further insight into how hard your body is working. Heart-rate monitors are increasingly affordable and can help you understand your cardiovascular response to specific activities, and to reach a specific target heart-rate.

Heart rate monitoring is useful

Heart rate is a useful indicator of how hard your heart and cardiovascular system are working during exercise. Target heart rate ranges for ‘moderate’ and ‘vigorous’ exercise can be calculated as a percentage of your predicted maximum heart rate, which changes as we age (see table below).

A target heart rate for ‘moderate’ intensity can be calculated as 50-70% of your maximum, and ‘vigorous’ intensity as 70-85% of maximum [6][7]. Both can be easily worked out here using the British Heart Foundation’s handy tool.

Example activities

With the above in mind, below are some indicative examples of activities that might be classed as ‘moderate’ or ‘vigorous’ intensity. However this ultimately depends on the individual undertaking the activity, and is a guide only:

Moderate intensity activities

• Brisk walking
• Jogging (whilst able to hold a conversation)
• Recreational swimming
• Recreational racket sports
• Recreational team sports
• Recreational cycling (eg. commuting)
• Dancing
• Hiking

Vigorous intensity activities

• Running (not able to hold a conversation)
• Competitive swimming
• Competitive racket sports
• Competitive team sports
• Competitive cycling

Getting in good habits

Adjusting one’s lifestyle to include more activity can be challenging at first. Here are some useful tips to keep in mind:

• Think of movement as an opportunity, not an inconvenience
• Any increase in activity is beneficial to health – start small and progress from there
• Be active every day in as many ways as you can
• Try incorporating activity into daily routines, such as walking or cycling to work or the shops instead of taking the bus or car
• Find forms of exercise that you enjoy to help stay motivated – try new things and invite friends to make activity more fun
• Plan at least 30 minutes of moderate intensity physical activity on most, ideally all days
• If you can, also enjoy some regular, vigorous activity for extra health and fitness benefits

The bottom line

To improve health, we should all aim to include more movement into our daily lives, standing, walking, climbing stair etc wherever possible. In addition, exercise can be used to optimise health and ensure we meet the recommended guidance described below:

1. Increase cardiovascular exercise – aim for 150 mins moderate intensity or 75 mins vigorous intensity each week

2. Do some strength training – on at least 2 days each week, such as weights, yoga, Pilates or carrying heavy bags

3. Reduce sedentary time – stand up, walk and climb stairs throughout the day

4. For older adults (over 65), also work improve balance – try some tai chi, dancing or bowls to improve balance

If you’ve found this article useful and would like further tailored information on how to increase your activity levels in the context of holistic health, book in for a Well Man or Well Woman health check with one of our expert GPs today.

References

1. Public Health England, "Guidance: Health Matters: Getting every adult active everyday," GOV.UK, 19 July 2016. [Online]. Available: https://www.gov.uk/government/publications/health-matters-getting-every-adult-active-every-day/health-matters-getting-every-adult-active-every-day.
2. A. Biswas, "Sedentary Time and Its Association With Risk for Disease Incidence, Mortality, and Hospitalization in Adults," Annals of Internal Medicine, vol. 162, no. 2, pp. 123-132, 2015.
3. World Health Organisation, "The Global Health Observatory: Physical Inactivity," WHO, 2020. [Online]. Available: https://www.who.int/data/gho/indicator-metadata-registry/imr-details/3416.
4. The Lancet, "Series from the Lancet journals: Physical Activity 2016: Progress and challenges," 27 July 2016. [Online]. Available: https://www.thelancet.com/series/physical-activity-2016.
5. UK Chief Medical Officers, "UK Chief Medical Officers' Physical Activity Guidelines," 7 September 2019. [Online]. Available: https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report.
6. British Heart Foundation, "Your Heart Rate," [Online]. Available: https://www.bhf.org.uk/informationsupport/how-a-healthy-heart-works/your-heart-rate.
7. American Heart Association, "Target Heart Rates Chart," [Online]. Available: https://www.heart.org/en/healthy-living/fitness/fitness-basics/target-heart-rates.
8. A. Sobhani, "Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS)," BMC Geriatrics, vol. 22, no. 498, 2022.
9. I. O. Ayenigbara, "Preventive Measures against the Development of Dementia in Old Age," Korean Journal of Family Medicine, vol. 43, no. 3, pp. 157 - 167, 2022.
10. Q. Huang, "The Association between Physical Activity and Cognitive Function: Data from the China Health and Nutrition Survey," Behavioural Neurology, no. 3438078, 2022.