Key Points
- Exercise should be self-empowering, inclusive, non-stigmatising, and indvidualised
- For best health outcomes exercise should include a minimum of > 75 min of activity per week + 2 resistance sessions
- Short bouts of exercise initially can encourage better adherence
- Accumulating exercise throughout the day is as effective as a training ‘session’
- Outdoor exercise might have additional benefits to mental health and quality of life but it is individual as some people may suffer anxiety when training outdoors
It can be difficult to get into the ‘health habit’ of exercising regularly and adherence to exercise plans and even awareness of what constitutes effective exercise is poor. Much of our attention is drawn to elite-level physique or strength competitors, people for whom exercise is an integral part of their career (like many instafluencers) or top sportspeople. However, exercising for health is a little different to exercising to be better (or the best) at a particular sport and being aware of the ‘minimum effective doses’ of exercise and the most effective ways to create the habit of physical activity are critical to maintaining health in the long-term.
The research points towards certain critical factors that help to maximise longer-term results. These include exercise regimens that 1:
- Are person-centred.
- Contain choice and flexibility.
- Shift mindset away from seeing people as ‘patients’ who ‘must’ exercise to people who have lived experiences that can meaningfully contribute to exercise programs.
- Establish healthy relationships with people and their whanau and environment to enable a better environment for exercise.
- Highlight the value of engaging in exercise.
- Include resistance and aerobic elements.
- Have a minimum of two sessions per week.
- Are inclusive and informal.
Plans should include 2, 3:
- Moderate intensity cardio >150 min, or more than 75 min of vigorous activity (or a combination thereof)
- At least 2 resistance training sessions per week
- Resistance training sessions should use loads of 70-90% of 1RM for more than 2 sets per exercise with 1-3 minute rest intervals.
- Additional health benefits are noted with greater than 5 hours of moderate-intensity activity per week.3
Note: Intensity of aerobic activity is defined by the ‘talk test’ in which during moderate-intensity exercise you can speak (but not sing) and during vigorous activity, it would be difficult to say more than a few words at a time.
Doing ‘good’ is better than not doing ‘perfect’
Remember that any movement and physical activity is better than nothing and even moderate exercise like regular walking,4 stair walking, bodyweight exercise,5 or abbreviated training regimens like high-intensity interval training, are beneficial to a range of health outcomes.5
If you aren’t in a regular habit of exercise, it is more important to focus on building sustainable habits of health than trying to do the ‘perfect’ exercise regimen. Short bouts of exercise initially might help people to develop a habit of health, allowing them to both adhere and increase activity over time.6
If you aren’t in a regular habit of exercise, it is more important to focus on building sustainable habits of health than trying to do the ‘perfect’ exercise regimen
A recent (2020) study published in Preventative Medicine Reports, demonstrated that a lower exercise recommendation led participants to feel that their activity level was more adequate, which in turn predicted greater engagement in physical activity and perceived health. This more adaptive mindset predicted greater self-efficacy and participation in physical activity the following week. The authors concluded. “Rather than inducing complacency, recommendations prescribing a relatively lower (vs. higher) amount of physical activity may be more effective at promoting physical activity and health by inducing adaptive mindsets.”
Fuel yourself
Increased exercise results in more energy being expended. While this is often beneficial and desired to improve body composition, many people chronically under-eat and this can lead to fatigue, increased pain, irritable bowel symptoms, and predispose one to injury. So, it’s important to ensure that you are fuelling yourself adequately (from mostly unrefined, nutrient-dense foods).
Avoid weight-stigma
It is also imperative for the health and fitness professional (and the client!) to not stigmatise people through weight-related biases. A 2018 review found evidence of weight bias in 70 and 85% of studies on the topic (n = 11, 20, in fitness or nutrition professionals respectively).7 In my clinical practice we always focus on the client and health, not weight. It is far more important to help the client to achieve their goals in a way that they determine than to project social or other conditioning upon them. And, when a health and client-centric approach is taken, the ‘form’ (size/shape) that is appropriate to the client will be achieved without having to focus on weight.
Can you ‘accumulate’ exercise?
There doesn’t appear to be much difference between accumulating exercise (over a day) vs completing a standard session once per day so long as the same amount of work overall is completed. Some studies have shown improved weight loss and LDL-cholesterol from accumulated training vs a once-daily session.8
There doesn’t appear to be much difference between accumulating exercise (over a day) vs completing a standard session once per day
Take home message: Just get the work in. A great way to achieve the optimal dose of exercise is to break it up and do little bits throughout the day.
Is it more effective to train indoors or outdoors?
Exercising outdoors in natural or semi-natural environments (like woods, parks etc.) is considered by some to be more beneficial to health than exercising indoors (for example, at the gym). Being outside in ‘green’ areas has indeed shown benefits to some health measures such as blood pressure.9 However, the effects of exercise in green areas on other aspects of health isn’t well known. A 2019 review looked at this topic. Although the studies lacked homogeneity (i.e., they had different outcomes, methods, and measures) results tended to favour green exercise for attention, health-related quality of life, self-reported health, social support, and social interactions. For other outcomes, there were mostly no differences between green or indoor exercise, but two studies reported better effects for indoor exercise for health-related quality of life and diastolic and mean blood pressure.10 These results suggest that exercising outdoors in natural settings might be more beneficial to health, however, some individuals might experience adverse effects if they feel less safe or secure in these environments as compared to exercising indoors and so practitioners should always individualise exercise recommendations to the psychosocial state and preferences of the client.
Exercising outdoors in natural settings might be more beneficial to health
Structured or unstructured exercise?
Longer structured plans appear to promote greater adherence than shorter ones.11
Supervised or unsupervised?
While several studies have shown that prescribed and directed or supervised exercise can provide slightly larger benefits than self-directed exercise, self-directed exercise is effective and can lead to longer-term adherence to physical activity.6, 12 It has also been demonstrated that various exercise modalities are effective for improving health and that the autonomy of self-directed exercise might improve adherence. Short bouts of exercise initially might help people to develop a habit of health, allowing them to both adhere and increase activity over time.6
References
1. Middleton R, Moxham L, Parrish D. Diabetes, older people and exercise: recommendations for health promotion programs. Australian Nursing and Midwifery Journal. 2016;23(9):32.
2. Pimenta LD, Massini DA, Santos Dd, Vasconcelos CMT, Simionato AR, Gomes LAT, et al. Bone Health, Muscle Strength and Lean Mass: Relationships and exercise recommendations. Revista Brasileira de Medicina do Esporte. 2019;25:245-51.
3. Piercy KL, Troiano RP. Physical Activity Guidelines for Americans From the US Department of Health and Human Services. Circulation: Cardiovascular Quality and Outcomes. 2018;11(11):e005263.
4. Sydora BC, Turner C, Malley A, Davenport M, Yuksel N, Shandro T, et al. Can walking exercise programs improve health for women in menopause transition and postmenopausal? Findings from a scoping review. Menopause. 2020;27(8):952-63.
5. Füzéki E, Banzer W. Physical Activity Recommendations for Health and Beyond in Currently Inactive Populations. International Journal of Environmental Research and Public Health. 2018;15(5):1042.
6. Byrne H, Caulfield B, De Vito G. Self-directed exercise programmes in sedentary middle-aged individuals in good overall health; a systematic review. Preventive Medicine. 2018;114:156-63.
7. Panza GA, Armstrong LE, Taylor BA, Puhl RM, Livingston J, Pescatello LS. Weight bias among exercise and nutrition professionals: a systematic review. Obesity Reviews. 2018;19(11):1492-503.
8. Murphy MH, Lahart I, Carlin A, Murtagh E. The Effects of Continuous Compared to Accumulated Exercise on Health: A Meta-Analytic Review. Sports Medicine. 2019;49(10):1585-607.
9. Yau KK-Y, Loke AY. Effects of forest bathing on pre-hypertensive and hypertensive adults: a review of the literature. Environmental Health and Preventive Medicine. 2020;25(1):23.
10. Mnich C, Weyland S, Jekauc D, Schipperijn J. Psychosocial and Physiological Health Outcomes of Green Exercise in Children and Adolescents—A Systematic Review. International Journal of Environmental Research and Public Health. 2019;16(21):4266.
11. Rowley N, Mann S, Steele J, Horton E, Jimenez A. The effects of exercise referral schemes in the United Kingdom in those with cardiovascular, mental health, and musculoskeletal disorders: a preliminary systematic review. BMC Public Health. 2018;18(1):949.
12. Sanz-Baños Y, Pastor-Mira M-Á, Lledó A, López-Roig S, Peñacoba C, Sánchez-Meca J. Do women with fibromyalgia adhere to walking for exercise programs to improve their health? Systematic review and meta-analysis. Disability and Rehabilitation. 2018;40(21):2475-87.
