Exercise during lockdown

This paper has been authored by Dr. Clare Fernandes, Society of Occupational Medicine

In general, physical health comprises exercise, diet and lifestyle, sleep and managing health conditions, and this paper reviews physical health in the circumstances we are currently experiencing during lock down.

Exercise is of particular importance as I think this has been impacted upon the most during the lock down.

There are two main benefits: physical – most obvious and mental – the less obvious.

Outside of lock down the message would be the same but it is easier to ignore.

Our average step count is down by 50% by not commuting to work/ around offices/ by not leaving our houses as much as we might normally do by leading our normal life. The benefits of the passive exercise we do in our daily lives is not being realised.

The negative effects of not experiencing this passive activity in our daily routine is perhaps not a conscious consideration.   

The gyms/ sport centres/ boot camps are closed, and social distancing makes outside exercise hard.

There is increased burden in maintaining physical wellbeing with current working patterns and heightened demands:

The physical benefits

Even stretching results in these benefits:

  • Maintaining physical resilience: generally speaking, our body’s response to fight the virus through our immune system. The immune system ranges from physical barriers such as the integrity of our skin to our antibodies that adapt to and fight off infections.
  • Better circulation. To get the blood and immune cells around the body to where they are needed for regeneration and repair, but also get cell waste products away from cells and eliminated from the body.
  • Stronger bones and joints: helps keep the skeleton in optimum position by improving the posture resulting in fewer aches and pains and better balance.
  • Cortisol regulation: helps to maintain essential functions and regulation.
  • Weight regulation: maintaining a healthy weight mean less work for lungs and heart when undertaking daily activities.
  • Better sleep: sleep is important for restoration of the body – for cell repair to help maintain the integrity of our immune system and general health.

Mental health benefits

Research from previous epidemics has shown that quarantine can result in high levels of psychological distress

  • For control: to control what we can control is an important resilience technique
  • For resilience: exercise can be using in coping strategies when addressing mental health problems.
  • For a ‘physiological feel good’: exercise releases endorphins, a natural chemical that makes feel good.
  • Reduced cortisol release: cortisol is a naturally occurring chemical that is released in the stress response and constitutes some of the symptoms experienced.
  • Reduces mental fatigue.
  • Improves sleep: better sleep reduces poor mental health and exacerbations of poor mental health.
  • Exercise is part of the evidenced based treatment for depression and anxiety

The Government advice

Taking daily exercise is one of the four reasons the government has advised that it is fine to leave your household

You can do one form of exercise outside each day, for example a walk, run, or cycle – alone or with members of your household.

Infection control measures still need to be followed when doing so:

  1. While you’re out, always keep at least two metres or more away from anyone outside of your household. This will stop the virus spreading.
  2. Minimise time outside and wash your hands when you return home.
  3. If you’re self-isolating because you have symptoms, or someone in your household has them, or you're defined as extremely vulnerable on medical grounds, you shouldn't leave home but that doesn't mean you should stop moving. It's really important to use movement and activity as a way of breaking up your routine, but only if you feel well enough.
  4. If you’re unwell, use your energy to get better and don't try to be active. If you can get out of bed, then do so, but don't try to do too much.
  5. Finally, if you’re feeling better after having had the virus, return to your normal routine very gradually and make sure to have additional rest periods during and after exercise.

What constitutes exercise?

Public Health England advice is as follows:

  • Adults should do some type of physical activity every day.
  • Any type of activity is good for you.
  • The more you do the better.
  • Even 10 minutes at a time shows benefit.
  • The ideal is 150 minutes a week of moderate exercise or 75 of vigorous exercise, or a mix.
  • Strength and flexibility training should be undertaken at least twice a week.
  • Moderate intensity activity: will raise your heart rate, and make you breathe faster and feel warmer. One way to tell if you're working at a moderate intensity level is if you can still talk, but not sing
  • Vigorous intensity activity: makes you breathe hard and fast. If you're working at this level, you will not be able to say more than a few words without pausing for breath.

Strength and flexibility exercises are also important, particularly for those who cannot do the above and particularly due to space constraints, social distancing and quarantine.

Strength and flexibility exercises can be adapted from normal home activities which can be important for those short on time and needing to multitask to include to include exercise in their day but also can also be adapted to become intensive exercise

Perhaps what you don’t think of as exercise, but are strength exercises include:

  • Carrying heavy shopping bags
  • Yoga
  • Tai Chi
  • Pilates
  • Lifting weights
  • Working with resistance bands
  • Doing exercises that use your own body weight, such as push-ups and sit-ups
  • Heavy gardening, such as digging and shovelling
  • Wheeling a wheelchair
  • Lifting and carrying children

To get health benefits from strength exercises, you should do them to the point where you need a short rest before repeating the activity.

How should I go about this?

Start small.

Choose things that suit your circumstances: What will benefit you the most? What do you like to do?

Make a plan: to help with keeping the effort you make sustainable.

Adapt to the day / or your situation:

For example, if you are feeling….

  • Confined to the desk? : Neck/back/shoulder exercises or desk exercises may be appropriate.
  • Stressed? Try yoga
  • Sore? Try yoga/ Pilates
  • Lazy? Perhaps sofa stretches
  • Busy? Take a rain check or work some exercise into housework or childcare.

How to keep going

  1. REMEMBER WHY YOU STARTED

Taking the first step is always the hardest part. Find a way to tap into that motivation you felt at the beginning of the year and use it to your advantage—even when January is long gone and most have given up on their resolutions.

  1. MAKE A SCHEDULE/ PLAN

It’s beneficial to create a schedule. Blocking out time for exercise will force you to stay on track and remind you to make it a priority instead of putting it on the backburner when other work starts piling up.

https://www.nhs.uk/live-well/exercise/12-week-fitness-plan/ Variety of plans including couch to 5K

https://www.nhs.uk/oneyou/active10/home App based plan for walking

  1. SET GOALS.

It may seem obvious, but setting goals for yourself is one way to guarantee you’re constantly reaching for something. Aim to work out a certain number of times a week or set a certain number of miles you want to run at one time. Your goal shouldn’t be your only motivation, but it can help keep you going.

  1. DOWNLOAD A FITNESS APP.

Work out buddies outside of the household are not possible at present.

Asana Rebel App and tap into your inner yogi or check out the 7 Minute Workout app. The more fun you have exercising, the more likely you are to stick with it.

  1. REWARD YOURSELF.

Celebrate your wins, even if they’re small. Reward yourself in some way. You’ve earned it and you’re more likely to remember those wins the next time you’re struggling to keep going. 

  1. CHANGE and ADAPT

You can also try mixing things up and listen to podcasts or audiobooks to keep your interest when music isn’t enough anymore.

Another trick? Try a new exercise. If you’ve only ever done cardio, try hitting the weight room. If you’ve always lifted, maybe try a bike ride, or another activity that stretches you in a new way.

  1. TRACK YOUR PROGRESS.

It’s difficult to see changes in yourself over time, which is why tracking your progress is beneficial. Keep track of your times or personal bests and fitness wins. Before long, you’ll be able to look back and see just how far you’ve come.

Committing to fitness has physical and mental health benefits. At the end of the day, you’re doing something for you that will make you feel better, and that’s what’s most important

  1. WORK WITH OTHERS

Within household or challenge friends and colleagues to work remotely together on, eg. Abs challenge

Other considerations

There are particular groups of people for whom exercise helps mitigate symptoms/ health issues and the reduction in physical lifestyle during lock down would prove more challenging to their health because exercise has a direct or indirect therapeutic benefit or for other reasons: seek further help on this topic from your healthcare team if need be.

This list includes, but is not exclusive to those with:

Diabetes

Hypertension

Chronic depression

Chronic anxiety

Arthritis

Schizophrenia

Bipolar disorder

Resources

There are a variety of medically approved resources and others that may be helpful:

Quaratrain is recommended by the British Society of Exercise Medicine: set up by Nottingham University specifically for lock down

The NHS website has a variety of plans to follow.

Sport England has a variety of options for a variety of levels of abilities and also that you can do with your household

Desk based exercise for working around your desk, but also general exercises designed to help target the area of the body that can be in fixed, static contraction during prolonged desk use to help negate some of the aches and pains associated with this

And there are other options if you have different physical needs.

  • Visit the NRAS exercise area on the NRAS website if you have RA or other form of inflammatory arthritis. nras.org.uk/exercise

You can do it!

The need for active physical activity is more important during lock down as we cannot reap the benefits of passive exercise.

Even 10 minutes of aerobic or non-aerobic exercise can benefit your health currently.

The benefits are multiple, including the mental effects.

Think about the talk test when looking at the ideal amount of exercise you should take per week and try to implement where possible.

There are a variety of things that count as exercise. You should take this into account when deciding what to do, and continue to follow the government guidance for infection control whist doing so.

Useful sources of information

  1. Sources of a variety of different exercises

https://www.nhs.uk/conditions/nhs-fitness-studio/

https://quarantrain.org/  Recommended by BASEM : variety of options and languages 

  1. Make plans to help with sustainability

https://www.nhs.uk/live-well/exercise/12-week-fitness-plan/ varierty of plans including couch to 5K

https://www.nhs.uk/oneyou/active10/home app based plan for walking

  1. Live scheduled training to help you feel part of a community, but also pre-recorded sessions to work around you in a variety of online and app formats: https://www.youtube.com/channel/UCAxW1XT0iEJo0TYlRfn6rYQ Joe wicks live and recorded sessions

https://www.instagram.com/nickonhands/?hl=en live sessions

https://visionaware.org/for-seniors/health-and-aging/fitness-and-fun/developing-balance/

https://www.sportengland.org/stayinworkoutfree, for a variety of abilities and for kids!

https://apps.apple.com/us/app/7-minute-workout/id650762525 HIIT

  1. At desk exercises and exercises that will help with the effects of prolonged desk work:

https://www.nwbh.nhs.uk/healthandwellbeing/PublishingImages/desk-based-exercise/MSK%20challenge%20fund%20desk%20excerise%20booklet.pdf

https://www.oxfordhealth.nhs.uk/wp-content/uploads/2014/08/OP-153.15-Neck-exercises.pdf

https://www.ouh.nhs.uk/patient-guide/leaflets/files/5314Pshoulder.pdf

https://www.ouh.nhs.uk/patient-guide/leaflets/files/5712Plowbackpain.pdf

  1. Considerations for those who are differently abled:

https://www.nhs.uk/Livewell/fitness/Documents/chair-workout.jpg

https://www.nhs.uk/live-well/exercise/sitting-exercises/

https://visionaware.org/for-seniors/health-and-aging/fitness-and-fun/developing-balance/