Physical exercise and sports should be essential activities (and more so in a pandemic)

With which he is passing, it is natural that the covid-19 and its serious consequences are on everyone’s lips. However, today more than ever, it is good for us to remember that physical inactivity and the sedentary lifestyle They have also been doing their thing for a long time.

Own World Health Organization (WHO) has recognized that lack of physical activity is an important risk factor for increasing the number of people who get sick and the premature mortality. In fact, 2020 estimates indicated that failing to meet the recommendations of physical activity it is responsible worldwide for more than 5 million deaths each year. Dimensions of pandemic, definitely.

Recently, a study based on data from more than a million people indicated that, if the physical activity practice was sufficient – equivalent to 60-75 minutes per day of moderate intensity physical activity -, would serve to counteract the increase in mortality risk which involves sitting for more than four hours a day.

Do not forget to be sitting a long time it is a dangerous practice and nada sana, especially if it is combined with little practice of physical activity. In fact, this combination increases the risk of mortality as well as the tobacco o la obesity.

However, despite the evidence, only 18% of adults aged 65 to 74 and 15% of over 75 years meet minimum exercise guidelines cardiovascular and muscular strength established by the WHO. That is, do more than 150 minutes of moderate-vigorous aerobic physical activity per week and muscle strengthening exercises at least 2 times a week.

Moreover, even if they did, it would also be insufficient. Because these levels of physical activity they can mitigate but not eliminate the risk associated with watching television for more than 3 hours a day.

Physical inactivity and sedentary lifestyle, two old known public health problems

In older people, if the physical inactivity is combined with a style of sedentary life, muscle mass and physical function are reduced. As a consequence, the ability to perform daily activities, increases the risk of falls and independence and quality of life are lost. In addition, sedentary life also worsens chronic health problems, including hypertension, cardio-vascular and cerebro-vascular diseases, diabetes, the depression and the dementia.

This is not to be taken as a joke. Staying immobilized for periods as short as 5 days, even in young people, reduces muscle mass up to 4%, strength 9% and up to 10% our cardiovascular capacity. In the case of being bedridden in the hospital, only three weeks of complete rest would be similar to a deterioration in functional capacity equivalent to 30 years of aging.

To make matters worse, it has been proven that it is enough to reduce the number of daily steps for 14 days to increase the risk of metabolic disease future and resistance to insulin, typical of type II diabetes and obesity. It is confirmed that we are designed to move. And that, if we don’t, the burden of disease and mortality will skyrocket exponentially.

Despite the great advances in science, at the moment there are no drugs that can improve the physical ability in older people. It doesn’t even seem likely that any will develop in the immediate future. The only “vaccine” we have is physical exercise. With the advantage that it is cheap, efficient and safe and there is no supply problem, no queues or shifts: everyone could start taking it from this moment.

Confined and inactive

Worldwide, the SARS-CoV-2 It has had a great impact on the habitual practice of physical activity. In the specific case of Spain, it was the European country that most reduced the number of daily steps of the population – 38% less – during the first weeks of confinement. Less physical activity practice than was already considered insufficient.

In the time that we are having to live, we must maintain the levels of physical activity the highest possible. Among other things because, in case of illness or even hospitalization, the functional capacity that we have will act as a true life insurance to deal more successfully with the disease itself or the Collateral damage of aggressive treatments pharmacological that they can prescribe for us. In other words, the better we are when we get sick, the more likely we are to overcome the disease.

Walking is not enough

The physical exercise improves physical function and quality of life. But it also reduces the burden of noncommunicable diseases and the overall mortality early, including cause-specific mortality from cardiovascular disease, cancer, and chronic diseases of the lower respiratory tract. And although it is better than nothing, walking is not enough.

In 2020, the World Health Organization published the new guidelines on physical activity and sedentary behavior in which it recommended strongly the practice of multicomponent physical activity of moderate or intense intensity three or more days a week. This includes doing exercises to improve cardiovascular endurance (such as walking) with strength training and balance.

From the Public University of Navarra We have implemented a multicomponent program of individualized physical exercise for the prevention of frailty and the risk of falls called VIVIFRAIL. It includes walking exercises for cardiovascular resistance training, as well as moving moderate weights to increase limb strength, as well as balance and mobility exercises.

It has been shown that, applied in over 70 years, the VIVIFRAIL program fulfills its objective of combating fragility (low body mass, strength, mobility, level of physical activity, energy). Or what is the same, optimizes and prevents the loss of functional capacity during aging.

As if that were not enough, in pacute hospitalized patients, Supervised exercise interventions based on the VIVIFRAIL methodology have also been shown to be safe and effective in attenuating functional impairment and even preventing cognitive impairment.

The importance of prescribing exercise

Is it ethical not to prescribe physical exercise? Despite all that has been discussed so far, the exercise has not yet been fully integrated into the usual practice of the primary or geriatric medicine. Furthermore, it is practically absent from the basic training of most doctors and other health professionals. However, physicians should be the first “prescribers of physical exercise,” and medical schools should teach that skeletal muscle remains a plastic fabric and adaptable throughout human life.

Regarding the physical educators, should take a more active role in directing, monitoring and evaluating the exercise practice in people of any age who have a health problem, those with functional diversity or with different capacities, especially in the health environment.

On the other hand, we must not forget a message as simple as it is important: exercise is not only for children and young adults. Older people can adapt al exercise and deserve to benefit from it. It is never too late – and you are never too old – to contract your muscles.

It seems indisputable is that more research is needed on exercise interventions for older adults, the “forgotten ones” in medical studies. Especially to clear doubts about the safety, efficacy and inherent variability between people in response to exercise.

Understanding this variability is essential to identify the best method of treatment (simple exercises or multi-component exercises) and decide the intensity (low, moderate or high intensity resistance exercises). The global idea that “exercise is medicine”. But just as not all drugs cure cancer, not all types of exercise (cardiovascular, strength training, balance) have the same effects on disease and functional capacity.

Be that as it may, the aphysical activity it should be considered, with and without a pandemic, as an essential activity with an impact on public health. This should be one of the great challenges for public health and sanitary policies in the coming years.

* This article was published on The Conversation and reproduced here under the Creative Commons license. Click here to read the original version.

* Mikel Izquierdo, Professor and Director of the Department of Health Sciences, Public University of Navarra.

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