An old English saying goes, “An apple a day keeps the doctor away.” Today, we know that, rather than just eating an apple, regular, if not daily, physical activity is one of the secrets to ironclad health.
The reason lies in how the human lifestyle has evolved. “We have a body built for constant, low-intensity movement, with occasional bursts of speed. Today we have developed thousands of tools that allow for prolonged rest and sustained positions that are unnatural, such as sitting in front of a computer,” explains William Rutzen, an intensive care physician with postgraduate training in nutrology and author of the book “Desinflamar para viver melhor.”
“Planned physical exercise is the only way to escape this unnatural behavior, and in that respect, the more, the better,” the specialist concludes. But how much does it take to avoid frequent trips to the doctor’s office?
Is there an ideal amount of physical activity?
The World Health Organization (WHO) recommends 150 minutes of moderate activity per week, but the experts interviewed by Prime Health Report were unanimous: this amount should be seen as an ideal minimum, but it can (and should!) be increased.
“It’s important to stress that some activity is better than none, more activity brings additional benefits, and all movement counts (going up and down stairs, walking, dancing), not just planned exercise,” emphasizes sports medicine physician Caio Senise Drolshagen, of the Brazilian Olympic Committee and coordinator of the Postgraduate Program in Sports and Exercise Medicine at Cetrus.
So the first step is for the patient to start doing some activity, and for that to include strength exercises. Once the habit takes root, an increase can be considered. “Many individuals can obtain additional benefits by going beyond this target, as long as the increase in load is progressive and compatible with their clinical condition,” cautions sports medicine physician Sebastião Julio Rodrigues Junior, a professor in the medical program at the Faculdade de Medicina de Assis.
Senise suggests that a worthwhile weekly amount could be 300 minutes of light/moderate activity and 150 minutes of vigorous activity. “Beyond 300 minutes, the benefits may increase, but the overall health gain per minute is most significant in the transition from a sedentary lifestyle to light/moderate activity,” the specialist emphasizes.
It’s worth remembering that duration and intensity play different roles in reaching health goals. While duration generally helps increase energy expenditure, in addition to contributing to cardiorespiratory fitness, intensity acts directly on metabolism, typically improving insulin sensitivity, blood pressure and physical conditioning more quickly.
“This doesn’t mean intense workouts are mandatory for everyone. A brisk walk, at a pace where a person can talk but not sing, already represents enough intensity to bring important benefits,” emphasizes Thiago Viana, a sports medicine physician and nutrologist.
This is especially true for patients with a preexisting health problem: higher exercise intensity increases the chance of cardiovascular events in people who have a disease, whether or not it has already been diagnosed and treated, as Senise emphasizes.
There are exercise thresholds that can be dangerous, but they are extremely high — closer to the performance of an athlete than that of an athletic person, as Rutzen distinguishes. “For most people, doing more exercise remains beneficial,” Rodrigues emphasizes.
Precautions when prescribing exercise
But every exercise recommendation calls for care on the part of the physician evaluating the patient. “Not everyone can do continuous 30-minute sessions. In these cases, it’s possible to split exercise into shorter periods spread throughout the day, use lower-impact modalities such as stationary cycling or water exercise, and respect each patient’s functional limitations”, Rodrigues notes.
“The initial goal is not to reach 150 minutes right away, but to build a safe, progressive routine that allows for improvement without pain, excessive fatigue or dropping out,” the specialist continues.
Understanding which conditions the patient has is also essential, “so that the underlying disease is treated appropriately”, Senise underscores.
The type of exercise also matters. “Muscle-strengthening activities (strength or resistance training) need to be done twice a week, with overall health and functionality in mind,” stresses the COB physician.
That’s because focusing on muscle strengthening helps on several fronts. “Preserving muscle mass and strength improves glucose metabolism, reduces the risk of falls, protects bones and joints and contributes to cardiovascular health. The ideal is not to choose between aerobic exercise and weight training, but to combine both,” Rodrigues advises.
And as much as an active, on-the-go routine is encouraged, it is not enough on its own.
A busy routine rarely reaches, in a sustained way, the moderate-to-vigorous zone that generates cardiometabolic adaptation, especially when you consider load progression, an essential training concept that is necessary because we adapt to the stimulus we’ve been given, and what was moderate intensity becomes low intensity, for example,
explains Senise.
How can patients be helped to stick with physical activity in their daily lives?
One of the most important factors in improving exercise adherence is helping the patient find something they enjoy. This should be a joint effort by the physician, physical education professional and physical therapist. “Holding the patient’s interest is essential, because no one sticks with something they find detestable,” Rutzen observes.
“Exercise depends on factors such as motivation, environment, available time, socioeconomic status and family support,” Rodrigues lists.
He and Senise believe it would be important for physicians to view their patients’ activity level as a vital sign, just like blood pressure, heart rate, respiratory rate and body temperature. “Systematically recording it in the medical chart and tracking its progress across appointments could significantly increase how much it is valued in clinical practice,” says the Faculdade de Medicina de Assis professor.
The physicians interviewed also urge their colleagues to invest in proper training in this area, since many different specialties benefit when patients are no longer sedentary.
We cannot base our recommendations, which are still seen as coming from a position of great authority, on opinions. There are many details that need to be considered when recommending new behaviors to someone, which is why studying the basics of nutrition, physical exercise and rest is imperative,
Rutzen emphasizes.
Also, encourage your patient to start slowly.
Most people give up on exercise because they start too fast, feel a lot of pain, get frustrated or end up getting hurt. It’s much better to finish a workout thinking you could do a little more than to finish completely exhausted and with no desire to come back,
Viana concludes.
