Exercise and physical activity

What is physical activity?

Physical activity is any activity that that helps to improve or maintain physical fitness as well as health in general.

It can include:

• Everyday activities. For example, walking or cycling to work or school, doing housework, gardening, DIY around the house, or any active or manual work that may be part of a job.

• Active recreational activities. This includes activities such as dancing, active play amongst children, or walking or cycling for recreation.

• Sport. For example, exercise and fitness training at a gym or during an exercise class, swimming and competitive sports such as football, rugby and tennis, etc.

Patient picks for Healthcare

General health and lifestyle

Study of homeopathy clinical trials reveals poor research practice

The body of evidence for homeopathy as a treatment for health conditions has long been contested by scientists. Now, a new study of homeopathy clinical trials concludes that the true impact of homeopathic remedies is likely to be overestimated and misleading.

by Amberley Davis

General health and lifestyle

Medical negligence

Most people receive good care from healthcare professionals. Sometimes, people receive poor care. If this happens, they may wish to make a complaint. If sub-standard care has led to avoidable harm, they may also wish to make a claim for compensation for medical negligence.

by Dr Doug McKechnie, MRCGP

How much physical activity should you do?

In the UK over 6.3 million adults (about 4 out of 10) aged 40 to 60 do not achieve 10 minutes of continuous brisk walking over the course of a month and are missing out on important health benefits.

Lifestyles have changed over time, and people in the UK are 20% less active now than they were in the 1960s, walking on average 15 miles less a year than two decades ago.

The sedentary nature of modern, busy lives makes it difficult for many to find the time for enough exercise to benefit their health but it is important to try to make physical activity part of everyday life.

Adults should aim to do a mixture of aerobic activities and muscle-strengthening activities.

Current recommendations

During the daytime, all age groups should minimise the amount of time spent sitting (being sedentary). There is good evidence that if someone is currently not active at all, taking a brisk walk for 10 minutes a day brings health benefits. However the more that is done, the greater the benefits.

In the following recommendations:

• Moderate-intensity activity means an activity that causes breathing to be a bit faster, makes people feel a bit warmer and notice their heart beating faster - for example, walking briskly.

• Vigorous-intensity activity will usually make people breathe very hard so they feel short of breath, make their heartbeat quickly and mean they will be unable to carry on a conversation - for example, running or cycling fast or uphill.

Under-5s

• Physical activity in young children shouldn't need to be encouraged as it comes naturally! However, it is still important to allow young children play from birth, particularly through floor-based play and water-based activities in safe environments.

• Children of preschool age who are capable of walking unaided should be physically active daily for at least 180 minutes (three hours), spread throughout the day.

Children and young people (aged 5-18 years)

• Moderate- to vigorous-intensity physical activity for at least 60 minutes and up to several hours every day. This can be made up from various shorter sessions and a mixture of different activities. For example, a mixture of play, physical education (PE) at school, games, dance, cycling, a brisk walk to school, sports, various outdoor activities, etc.

• Vigorous-intensity activities, including those that strengthen muscle and bone, should be incorporated at least three days a week.

Adults (aged 19-64 years)

• Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate-intensity activity in bouts of 10 minutes or more. For example, 30 minutes on at least five days a week.

• Comparable benefits can be achieved by 75 minutes of vigorous-intensity activity spread across the week or combinations of moderate-intensity and vigorous-intensity activity.

Older adults (aged 65 years and older)

• Older adults who participate in any amount of physical activity gain some health benefits. Some physical activity is better than none and more physical activity provides greater health benefits.

• Older adults should aim to be active daily and, if possible, aim for the same amount of physical activity as younger adults.

Aerobic activities

Aerobic activities are any activity that makes the heart and lungs work harder. To gain health benefits, government experts in the UK suggest that people should do at least 30 minutes of moderate-intensity physical activity on most days of the week.

• 30 minutes at least is ideal but this does not have to be done all at once. For example, cycling to work and back for 15 minutes each way adds up to 30 minutes.

• Moderate-intensity physical activity, as explained above, means that people get warm, mildly out of breath and mildly sweaty. For example, brisk walking, jogging, swimming, cycling, dancing, badminton, tennis, etc. However, as mentioned above, normal activities that are part of a daily routine (everyday activities) may make up some of the 30 minutes. For example, housework, DIY, climbing lots of stairs, and gardening can all make people mildly out of breath and mildly sweaty.

• On most days is recommended because the benefits of physical activity cannot be "stored up". It needs to be done regularly. Being physically active on at least five days a week is recommended.

The amount of physical activity may need to be a little more in some situations:

• If people are at risk of putting on weight, they should ideally build up to 45-60 minutes of moderate-intensity physical activity on most days to help to manage their weight.

• If someone's body mass index (BMI) was in the obese category and they have lost a lot of weight, or if someone is obese and trying to lose weight, they should ideally build up to 60-90 minutes of moderate-intensity physical activity on most days to help manage their weight.

See also the separate article called Do 30-day fitness challenges actually work?

Muscle-strengthening activities

In addition to the above aerobic activities, adults should also aim to do a minimum of two sessions of muscle-strengthening activities per week.

Muscle-strengthening activities can include climbing stairs, walking uphill, lifting or carrying shopping, digging the garden, weight training, Pilates, yoga or similar resistance exercises that use the major muscle groups.

Ideally, the activities and exercises should not only aim to improve or maintain your muscle strength but also aim to maintain or improve your flexibility and balance.

A session at a gym is an option but activities at home can be equally as good. For example, stair climbing, stretching and resistance exercises can be done at home without any special clothing or equipment.

A session should be a minimum of 8-10 exercises using the major muscle groups. Ideally, to help build up muscle strength, some sort of resistance (such as a weight for arm exercises) should be used and 8-12 repetitions of each exercise should be done.

The level (weight) of each exercise should be so that 8-12 repetitions can be done before the muscle group gets tired and having to stop. So, for example, for the upper arm muscles, this would involve holding a weight in the hand and bending (flexing) the arm up and down 8-12 times. This should make the arm muscles tire. Heavier weights with fewer repetitions can be done if preferred. The exercises can be done one after another to complete a session or can be split up over a day in, say, bouts of 10 minutes.

If intense muscle-strengthening exercises are being done for a particular sport, then these muscle-strengthening sessions should not be on consecutive days.

What about older people and pregnant women?

Older people

People over the age of 65 you should still aim to do the same amount of aerobic activity and muscle-strengthening activity as younger adults, depending on their ability. As well as this, a particular goal for older people should be, where possible, to do activities to help with flexibility and balance.

This is to help reduce the risk of falls and injury from falls. Examples of activities to help flexibility include yoga, housework such as vacuuming, and DIY. Examples of activities to help balance include dancing, t'ai chi or keep fit classes. Special keep fit classes for older people are available in many areas and will usually include activities for flexibility and balance.

Pregnant women

Pregnant women can continue with their normal activities when you are pregnant but should adjust what they do depending on levels of tiredness, etc. There are lots of benefits from being physically active in pregnancy but this should be started gradually if someone is normally sedentary.

What are the health benefits of physical activity?

The health benefits of doing regular physical activity have been shown in many studies.

There are still benefits to be gained for anyone who increases their physical activity levels, even if they are already doing 30 minutes of moderate-intensity activity on most days.

Overall, people who do the recommended levels of physical activity can reduce their risk of premature death by 20-30%. Other health benefits include the following:

High blood pressure

Regular physical activity can help to lower blood pressure levels in high blood pressure. It can also help to prevent high blood pressure from developing. High blood pressure is one of the risk factors for heart disease and stroke.

Coronary heart disease

The risk of developing coronary heart disease, such as angina or a heart attack, is much reduced in people who are regularly physically active. Inactive people have almost double the risk of having a heart attack compared with those who are regularly physically active.

People with heart disease are advised to carry out regular physical activity as an important way to help prevent heart disease from getting worse. Special rehabilitation physical activity programmes exist for people who have had a heart attack or have another heart problem. These are supervised by physical activity specialists who can demonstrate safe physical activity.

Stroke

Physically active people are less likely to have a stroke. One study found that women aged 45 and older who walk briskly (at least three miles per hour), or who walk for more than two hours a week, reduced their risk of stroke by a third compared with less active women.

Cholesterol

Regular physical activity has been shown to raise levels of high-density lipoprotein (HDL) cholesterol. This is good cholesterol because it may actually help to protect against cardiovascular disease (coronary heart disease, stroke and peripheral arterial disease).

HDL cholesterol seems to help prevent patches of atheroma forming. These are like small fatty lumps that develop within the inside lining of blood vessels (arteries) and are involved in the development of cardiovascular disease.

Diabetes

Physically active people have a lower risk of developing type 2 diabetes than inactive people. The greater the amount of physical activity, the lower your risk of developing type 2 diabetes. Regular physical activity can help diabetic control in people who have diabetes and can reduce the risks of impaired glucose tolerance (pre-diabetes) from developing into diabetes.

Weight control

Physical activity may help get rid of excess fat. Regular physical activity combined with a healthy diet is usually the best way of losing weight, and keeping that weight off. Regular physical activity may also offset the harmful effects of being obese or overweight. See the separate leaflet called Weight Loss (Weight Reduction) for more advice on this.

Bone and joint problems

Regular weight-bearing physical activity can also help to prevent 'thinning' of the bones (osteoporosis). The pulling and tugging on the bones by muscles during exercise stimulates bone-making cells, which strengthens the bones.

If bones are stronger, there is a reduced risk of breaking bones w in older age. (Weight-bearing physical activity means physical activity where the feet and legs bear the body's weight, such as brisk walking, aerobics, dancing, running, etc.)

Physical activity has also been shown to treat lower back pain and help the symptoms of osteoarthritis in some people.

Cancer

Regular physical activity can help to reduce the chance of developing cancer. It roughly halves the chance of developing oesophageal or bowel (colorectal) cancer. Breast cancer and cancer of the uterus (endometrial cancer) are also both less common in women who are regularly physically active.

It used to be thought that the lower risk of cancer in people who are physically active is because they are also more likely not to be overweight or obese. However, it is now clear that regular physical activity reduces your risk of many cancers even in people who are overweight or obese.

Mental health

Physical activity is thought to help ease stress, boost energy levels and improve general well-being and self-esteem. It can also help to reduce anger. There is good evidence that regular physical activity reduces the chance of developing depression.

As well as this, physical activity can make sleep better. (However, this is more the case if the activity is done during the daytime or early evening, not near to bedtime.)

Keeping mobile and more independent

Regular physical activity throughout life can help to keep people more mobile as they get older. Remaining mobile is one of the things that helps older people keep independent and able to live by themselves at home.

As mentioned above, as people get older, flexibility and balance exercises are important to help reduce the risk of falling and becoming injured. People over 70 are less likely to fall and be injured if they are regularly physically active.

Memory loss and dementia

Regular physical activity may help to prevent some types of dementia. Regular physical activity may also help to keep people with dementia mobile for longer.

Smoking cessation

Increasing physical activity levels has been shown to help people trying to quit smoking. It can help to reduce the desire to smoke and can also help with withdrawal symptoms. See our series of leaflets about smoking and how to stop, particularly the one called How to Quit Smoking.

For children

There are many benefits to regular physical activity for children. It helps with healthy growth and development and, if children are physically active, they are less likely to become overweight or obese adults.

A recent study found that teenagers who carry a gene for obesity are less likely to become overweight or obese if they are physically active for an hour a day. If an overweight child becomes an overweight or obese adult, they are more likely to develop health problems.

Such problems include diabetes, stroke, heart disease and cancer. Regular physical activity also helps children to socialise and mix with others and helps with their psychological well-being.

A study that took place in Southern California also found that children with average or above-average fitness levels did better in terms of their academic performance than children with below-average fitness levels. However, more studies are needed to confirm this potential benefit.

What are the risks of physical activity?

There are very few reasons why physical activity may be harmful. A common false belief is that physical activity may be bad for the heart. Physical activity is actually important for most people with heart disease provided they follow guidance given by a health professional or an exercise specialist.

In general, the potential benefits to health will greatly outweigh any small risks involved, as long as activity is built up gradually.

However, sometimes problems can occur with physical activity:

• Injury is possible. Sprains, and sometimes more serious injuries, are a risk with some types of physical activity. The risk of injury is reduced by warming up before any activity and by using suitable equipment. You can find out more in the separate leaflet called Sports Injuries.

• In extremely rare cases, sudden death can occur in people who are doing some physical activity. However, most of the time, there is an underlying heart problem (which may not have been previously diagnosed). It is the excess stress that is placed on the person's body during exercise that causes the sudden death. It should be stressed that, in general, regular exercise protects the heart.

Do I need to see a doctor before I start any physical activity?

Not usually, no. Someone intending to start a very vigorous physical activity programme might be sensible to seek advice from a sports doctor. Someone who is worried that a joint or back problem might be made worse by increasing physical activity might be sensible to consult with a physiotherapist.

People with the following conditions should speak to a doctor urgently:

• People with chest pains, particularly if chest pain is brought on by exercise.

• People who have had falls due to becoming dizzy or blacking out.

• People who become very breathless on mild exertion. This might be due to lack of conditioning and improved by exercise but there are other conditions that can cause this.

Tips when considering increasing physical activity levels

Physical activity is not just for young sporty types. It is never too late to start to gain the benefits, no matter how old or unfit someone is.

• It is best gradually to build up the level of activity. Start with 10 minutes and over time build this up to 30 minutes. Brisk walking is a great activity to start with.

• One big obstacle is the uphill battle to become fit. Many people feel that the first few attempts at physical activity are quite a struggle. Do not become disheartened. Each time is likely to become easier and more enjoyable.

• Try to keep physical activity high on your list of priorities. If one kind of activity becomes boring, try switching to another type. A variety of different activities may be better. Physical activity needs to be something that you enjoy or it will not be something that you will keep up.

• Set yourself an achievable goal, like walking briskly for 10 minutes a day every day for two weeks, then treating yourself when you achieve it. The next goal could be to do the same but for 20 minutes. Some people set their goals too high. Be aware of this pitfall. The marathon can come later.

• Use everyday activities as part of your physical activity programme. Consider a brisk walk to work or to the shops instead of using a car or bus; take the stairs in the office or shopping centre and not the lift, etc. Reduce the amount of time that you spend being inactive (watching TV, sitting in front of a computer screen, etc). You may find the 'Couch to 5k' advice helpful - see Further reading below.

• Remember to include some muscle-strengthening exercises.

• See if there are any groups or initiatives in your local area. For example, Exercise Referral Schemes run in some areas. They are programmes designed especially for people with various medical conditions (such as asthma, high blood pressure, type 2 diabetes, chronic obstructive pulmonary disease, anxiety, depression or obesity) who may benefit from increasing their physical activity levels. There are also a number of government campaigns and initiatives aimed at increasing physical activity levels in everyone.

Most importantly, do something! Ideally do something you enjoy or which has purpose, like cycling to work to save on travel costs.

Using a pedometer or activity tracker

A pedometer is a small step-counting device, usually worn on a belt, that counts the number of steps taken, by sensing the motion of the body. There are also activity trackers that are worn like a watch and many apps are available for smartphones that use the phone's accelerometer to measure steps.

Many people find these devices to be useful tools to help motivate them when they are trying to increase their physical activity levels. Measuring the number of steps taken on an average day can give a baseline step count.

A very sedentary person will take between 1,000-3,000 steps per day. However, most people are in the range of 4,000-6,000 steps per day. About 30 minutes of brisk walking should be around 3,000 steps.

So, a good target could be to add 3,000 steps to the baseline number and aim for this. It may be preferred to build up gradually by increments of 500-1,000 steps. The magic number to aim for in the end is at least 10,000 steps per day. This number is thought to be high enough to keep people fit and healthy.

New research about people with a sedentary lifestyle

Recent research has suggested that a sedentary lifestyle in general may have adverse health effects even in people who also do the recommended amounts of moderate exercise. A sedentary lifestyle may still increase the risk of obesity, diabetes, heart disease and cancer.

It is not certain why this is and further research is needed. However, it is thought perhaps to be related to the effect that sitting down too much has on certain enzymes in the body which help to process fat and sugar.

So to combat this:

• Take regular breaks from your desk while you are at work (a short break of a few minutes every hour).

• Take the stairs and not the lift.

• Walk to the shops instead of taking the car.

• Stand up while you are talking on the phone.

• Don't spend hours sitting in front of the television, etc.