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

With the one that is falling, it is natural that 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 sedentary lifestyle have also been doing their thing for a long time.

The World Health Organization (WHO) itself has recognized that lack of physical activity is an important risk factor for increasing the number of people who fall ill and premature mortality. In fact, 2020 estimates indicated that failure to adhere to physical activity recommendations is responsible worldwide for more than 5 million deaths every year. Pandemic dimensions, no doubt.

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

Do not forget that sitting for a long time is a dangerous and unhealthy practice, especially if it is combined with little practice of physical activity. In fact, this combination increases the risk of mortality the same as smoking or obesity.

However, despite the evidence, only 18% of adults aged 65 to 74 and 15% of those over 75 meet the minimum guidelines of cardiovascular exercises and of muscular force 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 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 physical inactivity is combined with a sedentary lifestyle, muscle mass and physical function are reduced. As a consequence, the ability to perform daily activities decreases, the risk of falls increases, and independence and quality of life are lost. In addition, a sedentary life also worsens chronic health problems, including hypertension, cardiovascular and cerebrovascular diseases, diabetes, depression and dementia.

This is not to be taken as a joke. Remain immobilized for such short periods about 5 days, even in young people, it reduces muscle mass by 4%, strength by 9% and our cardiovascular capacity by up to 10%. 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 top it all, it has been proven how just reduce the number of daily steps for 14 days to increase the risk of future metabolic disease and insulin resistance, 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 physical capacity 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, SARS-CoV-2 has had a great impact on the habitual practice of physical activity. In the specific case of Spain, it was the European country that reduced the number of daily steps of the population the most –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 as high as possible. Among other things because, in case of illness or even hospitalization, the functional capacity that we have it will act as a true life insurance to deal more successfully with the disease itself or the collateral effects of the aggressive pharmacological treatments that may be prescribed to 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

Physical exercise improves physical function and quality of life. But it also reduces the burden of noncommunicable diseases and premature overall mortality, including cause-specific mortality from cardiovascular disease, cancer, and chronic lower respiratory diseases. 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 strongly recommended 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 launched 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 to people over 70 years of age, the VIVIFRAIL program fulfills its objective of combating frailty (low body mass, strength, mobility, level of physical activity, energy). Or what is the same, optimizes and prevents loss of functional capacity during aging.

As if that were not enough, in acute 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.

Example of a physical exercise wheel from the VIVIFRAIL multi-component program for robust people. Free download from https://vivifrail.com/es/documentation/

The importance of prescribing exercise

¿It is ethical not to prescribe physical exercise? Despite all that has been discussed so far, exercise has not yet been fully integrated into the routine practice of 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 an adaptable, plastic tissue throughout human life.

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

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

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

Understanding this variability is essential to identify the best treatment method (simple exercises or multi-component exercises) and to decide the intensity (low, moderate or high intensity resistance exercises). The global idea that “exercise is medicine” is true. 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, physical activity 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.

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