Explore concerns

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

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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.

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Share

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

I’m already in pain and doing more will just make that worse...

Regular physical activity has been shown to reduce pain in most people with musculoskeletal pain, with research finding that it can give as much pain relief as paracetamol or ibuprofen [1]. Importantly, physical activity does not come with the side effects of these medications. Pain does not necessarily suggest that there is any joint damage and some mild discomfort after activity does not mean there has been damage [2]. 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 [3]
  • Exercise at the time of day when pain is usually least severe
  • If joints are sore, time activity with painkillers

References:

1         Fransen M, McConnell S, Harmer AR, et al.Exercise for osteoarthritis of the knee: A Cochrane systematic review. Br J Sports Med2015;49:1554–7. doi:10.1136/bjsports-2015-095424

2         Smith BE, Hendrick P, Smith TO, et al.Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med2017;51:1679–87. doi:10.1136/bjsports-2016-097383

3         Moore G, Durstine JL, Painter P. ACSM’s Exercise Management for Persons With Chronic Diseases and Disabilities, 4E:Human Kinetics 2016. https://books.google.co.uk/books?id=mEjZCwAAQBAJ

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’ve already tried this before, but I stopped because I saw no benefit

The benefits of increasing activity levels may not necessarily be immediately apparent.

A common reason for people finding that things didn’t improve, or got worse, with physical activity is that they did too much too quickly. Encourage a slow, steady increase in activity to allow for adaptation to the new activity.

Tips you may wish to share:

  • Don’t be discouraged by previous failed attempts
  • Small changes now can lead to large benefits in the future
  • Start slowly and build up gradually
  • Find an enjoyable activity

I’m already very busy, how can I find the time to fit this in?

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. Review the ‘Next Steps’ page to see how this could be done

No one in my community does exercise, it is not in our culture…

A daily routine such as using the stairs or walking to the shops are physical activity opportunities that are shared across all communities. Other activities such as dancing might be culturally acceptable activity.

Tips you may wish to share:

  • Do enjoyable activities
  • Build activities into your daily routine

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 focussed 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

  1. Signs and symptoms, at rest or during activity; includes pain, discomfort in the chest, neck, jaw, arms, or other areas that may result from ischemia; 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
  2. 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
  3. 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

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.

How do I know when to stop exercising?

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 [3, 4]. 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 [5]
  • 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 [5]

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

Response:

The risk of dropping down dead from physical activity is very low [1,2]. The risk to health from being inactive far outweighs the risk of 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 [3]
  • 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 investigation5

Tips:

  1. If starting physical activity for the first time build up very gradually over 3 months.
  2. Avoid sudden unaccustomed vigorous physical activity. Vigorous activity makes you increase your breathing to the level that it makes it hard to complete a sentence.

References

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

4. 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

5. 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.

I don't have the confidence to exercise

Some people find that being active with other people can build confidence, increase social activity and provide a chance to make new friends. Others benefit from doing activities on their own to start with. When they are more confident in their ability to be active they may feel ready to join others.

Tips you may wish to share:

  1. The ‘arrange support‘ section will help to identify a club or group that offers something enjoyable
  2. Find ways to be active with friends or fa
  3. Build extra activity into the daily routine, such as opportunities to walk or exercise at home

I get put off by the weather!

If it’s cold or pollution levels are high, choose an inside activity, go outside to be more active when the weather is better.

Tips you may want to share:

  1. Dress for the weather, but remember expensive clothing is not needed
  2. Check the local weather forecast for ‘breaks’ in inclement weather
  3. Chose activities according to the season
  4. Start slowly and pace yourself

I don't know where to start...

Start with what you can do and build up gradually. Look at how being active could fit into daily activities.

Tips you may wish to share:

  1. Use a mobile phone to keep a step diary and target 10,000 steps every day.
  2. Join a friend who is already active so they can share their tips.
  3. Go for a walk down the street or round the block

 

I can't find the motivation to exercise

Recommend a slow start and build up gradually. Group activities can be motivating and a way to meet new people.

 

I can't afford it

Being more active doesn’t need any special equipment or clothing. Wear comfortable clothes and be active anywhere, even at home.

Tips you may wish to share:

  1. Free smart phone apps, pedometers or a notebook can be used to track progress/the number of steps
  2. Community activities can be free or subsidised
  3. When watching tv, stand up at every ad break
  4. Most exercises can be done using just your own body weight or a water bottle, or something you have in your house

It's too difficult to get anywhere to exercise

You can be more active at home, or fit it into the daily routine.

Tips you may wish to share:

  1. Park in a car parking space further from your destination.
  2. Dance around the living room
3
Ask

“Has that helped?”

Did you know?

Start gently and build up slowly

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.

Brisk walking can count and is a great activity to start with

All physical activity counts towards moving more