Explore concerns

Many people with health problems - and those without - have reasonable concerns about becoming more active

back
next
1
Ask

“What concerns might you have about becoming more active, if you decided to?”

Saying “if you decided to” reminds them that they are the decision maker, not you. This helps keep the discussion open and active, focusing your role on providing support.

For example say ‘Yes, that is a common concern’  or a reflection such as ‘you’re concerned that being more active may make your pain worse’ (said as a statement, not a question)

Your role is to help them feel listened to and understood rather than to immediately jump in to dismiss their concern or to offer information, advice and reassurance.  Acknowledging their views will help them to feel supported and may help them to be more receptive to any new information you might want to share with them.

Allow some space for people to talk about and explore new information, asking ‘what do you think about what I’ve just said?’ rather than asking ‘do you understand?’ which can shut things down. Ask if they need anything clarifying and what concerns they might have about how the information applies to them.

2
Share

If they mention one of these common concerns, click on it to see a useful response.

I’m already breathless

Breathlessness is normal in exercise and is not harmful.  Doing things that make people breathless will help make their muscles stronger and more efficient.

Tips you may wish to share:

  1. Encourage a slow start with a gradual build up to small bouts of activity (this just needs to be a few minutes). This can increase over time
  2. Stay calm when breathless, as panicking will make you feel even more breathless
  3. Ask a physiotherapist or doctor for breathing techniques

 

How can I keep safe when I am active?

There are fewer risks to being active than there are in being inactive.

Tips you may wish to share:

  1. Start slowly and always carry a reliever inhaler with you.
  2. Take regular breaks

 

 

Exercise? – I can’t even….!

Being more active can mean moving more – like gardening or walking up a few stairs.

Tips you may wish to share:

  1. Start with realistic expectations
  2. Start slow, build gradually
  3. Try standing from sitting or just moving from room to room
  4. Stand up at every advertisement break when watching TV
  5. Standing on one leg whilst brushing teeth

Will I be at risk of infections if I exercise in a group/with others?

There is no evidence that being around other people increases the risk of getting infections. Being more physically activity the reduces the risk of exacerbations and hospital time.

Tips you may wish to share:

  1. Group activities should be fun and social. Doing more will reduce the risk of infections
  2. Ask about any local activities

I can’t afford it – I don’t have any equipment or trainers/kit

Doing more doesn’t need any special equipment or clothing and can be done at home. Wear whatever is comfortable.

Tips you may wish to share:

  1. Try standing from sitting or just moving from room to room.
  2. Stand up at every advertisement break when watching TV
  3. Stand on one leg whilst brushing teeth
  4. Go onto tip toes ten times when waiting at a bus stop
  5. Most exercises can be done using your own body weight or  or something you have in your house (a water bottle/food can).

 

I don’t have time!

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 things, and activities like walking to the bus stop, cycling to work and gardening all count towards health benefits and feeling better. Regular activity can be fitted into an individuals daily routine.

Tips you may wish to share:

  • Start slowly and gradually build up
  • Experiment with different activities
  • Build activity into daily routines
  • Be active with other people to get some support

 

I’m not confident

Encourage a slow, steady increase in activity, for example 2 stairs – stop.  2 stairs – stop.

Tips you may wish to share:

  • Don’t be discouraged by any previous failed attempt
  • Set a small goal each day
  • Start slowly and build up gradually
  • Find an enjoyable activity

 

 

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:

  1. Make moving more something sociable to do.
  2. Ask friends or family to join in, like going to the park together

What’s the point? This won’t make a difference to me

There is strong evidence to show that moving more and increase physical activity levels will make a difference.  There are many benefits to moving more including reduced risk of infections, reduced time spent in hospital, living longer and having fun with friends and family

Tips you may wish to share:

  1. Don’t expect big changes straight away
  2. The benefits from moving more will take time and they won’t always be immediately obvious

I’m too ill

Even when individual have bad symptoms, feel unwell or their disease has progressed, there are still benefits to be gained from being more active. Passive movements can help and Tens machines/carers may be able to help.

Tips you may wish to share:

  1. Small movements can help – like sitting on the edge of the bed, arm exercises and squeezing a stress ball
  2. Try to stand up during advert break
  3. Modify what is done depending on symptoms

 

It’s really embarrassing

It can be liberating and empowering to exercise with people with similar conditions or the same level as function.  Exercising with other people can build confidence, increasing social activity and is a chance to make friends.

Tips you may wish to share:

  1. Look out for a club or group that offers something enjoyable
  2. Enjoy the social aspect of physical activity

I’ve got an oxygen cylinder/specialist equipment

It is safe to be more physically active on oxygen.

Tips you may wish to share:

  1. Put the oxygen cylinder in a rucksack
  2. Chair exercises will stop the cylinder getting in the way

 

The weather/pollution limits me

Different people in different parts of the country are affected by pollution. In the cold, use a balaclava or scarf to humidify and warm the air.  If it’s cold or pollution levels are high, choose an inside activity

Tips you may wish to share:

  1. Start slowly and build up gradually
  2. Schedule different types of activity according to the seasons

I’m too old

People are never too old to be active.  Start slowly and build up gradually.

Is it safe for me to be active?

It is safe to be more active. The risk of death from physical activity is extremely low.

(For men it is 1 death per 23 million hours and women it is 1 death per 36.5 million hours)

References

Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355-1361.

Whang W, Manson JE, Hu FB, et al. Physical exertion, exercise, and sudden cardiac death in women. JAMA. 2006;295(12):1399-1403.

I am overweight – will exercising help me lose weight?

Exercise alone, without concomitant dietary caloric restriction and behaviour modification, produces only modest weight loss. The most successful programs for long-term weight control in diabetes involve combinations of dietary modification, exercise, and behaviour change (Pan et al., 1997; Sigal et al., 2004)

However, even with modest weight loss there are significant benefits in regular exercise:

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

Tips you may wish to share:

  1. All physical activity helps and can be beneficial.
  2. 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, indicating that you are slightly out of breath.

 

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. It can be a way for individuals to take back some control over their health

Tips you may wish to share:

  • Encourage a slow start with a gradual build up to small bouts of activity (this just needs to be a few minutes). This can increase over time
  • Increase the number of activity sessions first, then increase the duration each activity, followed by the intensity of an activity

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

Regular physical activity has been shown to reduce pain. Pain does not necessarily suggest that there is any joint damage and some mild discomfort after activity does not mean there has been damage. It is normal for anyone who is not used to being physically active to experience some muscle soreness after doing a new exercise. As people become accustomed to the activity this pain will reduce.

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

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 required to safely undertake progressive, moderate intensity activity. Important exceptions to this are people experiencing active symptoms (see below) or previously inactive people who disregard advice to build up gradually. An additional list of contraindications is listed below [1,2].

Significant events are so rare that medical screening has the potential to be an unnecessary barrier to physical activity. Screening is most effective when focused on active symptoms and co-morbidity [3].

It is fairly common for gyms to request 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 with gradual build up of activity (over 3 months or so) reduces the chances of poor outcomes.

This flow diagram will help you decide who might need referral for formal assessment before increasing their physical activity levels and may help address queries from gyms:

Notes

Signs and symptoms, at rest or during activity; includes pain, discomfort in the chest, neck, jaw, arms, or other areas that may result from ischaemia; shortness of breath at rest or with mild exertion; dizziness or syncope; orthopnea or paroxysmal nocturnal dyspnea; ankle edema; palpitations or tachycardia; intermittent claudication; known heart murmur; or unusual fatigue or shortness of breath with usual activities

  1. An easy way to explain the intensity of exercise is the talk test:
  • Moderate intensity: breathing rate is increased but you can still talk
  • Vigorous intensity: breathing rate is further increased and it is not possible to talk in full sentences

 

  1. Patients with active symptoms or high risk necessitating medical screening will require formal investigations such as cardiac stress testing

Contraindications to physical activity include:

  • Unstable angina
  • Severe valvular stenosis or regurgitation
  • Active myocarditis or pericarditis
  • Ventricular tachycardia (uncontrolled)
  • Decompensated heart failure
  • Blood pressure >200/115 mmHg
  • Recent myocardial infarction (< six weeks)
  • Other clinical entities known to worsen during exercise
  • Acute Systemic infection

Tips:

Remember being physically active/exercising isn’t just about going to the gym. Consider trying something different like brisk walking or dance classes that you might enjoy more. There are so many different environments where you can be active.’

References

1) Fletcher GF, Ades PA, Kligfield P, et al. Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation. 2013;128(8):873-934.

2) Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015;25 Suppl 3:1-72.

3) Thompson PD, Arena R, Riebe D, Pescatello LS, Medicine ACoS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-7.

What should I do if I feel unwell during physical activity?

It is normal for anyone who is not used to being physically active to experience some muscle soreness after doing a new activity and this pain will reduce as they become more accustomed to the activity.  Worsening symptoms may be due to increasing activity too quickly – reducing activity levels a little and then gradually increasing them again more slowly can help

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.

Tips you may wish to share:

  • Encourage a slow, steady increase in activity to allow for adaptation 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 physical activity is very low. The risk to health from being inactive far outweighs the risk from regular physical activity.

For the majority of people starting moderate intensity activity, medical screening is not indicated. It is often an unnecessary barrier to physical activity.

Who has increased risk?

  • Habitually sedentary individuals 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 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

References

Whang W, Manson JE, Hu FB, et al. Physical exertion, exercise, and sudden cardiac death in women. JAMA. 2006;295(12):1399-1403.

Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355-1361

Thompson PD, Arena R, Riebe D, Pescatello LS, Medicine ACoS. ACSM’s new preparticipation health screening recommendations from ACSM’s guidelines for exercise testing and prescription, ninth edition. Curr Sports Med Rep. 2013;12(4):215-217.

3
Ask

“Has that helped?”

Did you know?

Start gently and build up slowly

Pulmonary rehabilitation makes you fitter and helps you manage your condition better

The risk of death from physical activity is extremely low. For Men it is 1 death per 23 million hours and Women it is 1 death per 36.5 million hours.

  1. Albert CM, Mittleman MA, Chae CU, Lee IM, Hennekens CH, Manson JE. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355-1361.
  2. Whang W, Manson JE, Hu FB, et al. Physical exertion, exercise, and sudden cardiac death in women. JAMA. 2006;295(12):1399-1403.

Getting breathless when you're active is normal, and good for you!