Sometimes, I get so passionate about the area of preventive medicine that I just want to be given a microphone that reaches the entire country, and use it to share my message. That’s the best way I can put that feeling into words. I’m constantly learning (via self-education mostly) about the pillars of health we hear spoken about so much now – nutrition, physical activity, stress management and sleep. I’m probably most obsessed by two right now – physical activity and sleep. A third, stress management, is always at the back of my mind, because it’s just such a vast area and as our world grows more digital, it becomes even more important. But we’ll save that for another Friday Focus soon. Today, after focusing on Sleep last week, I want to shift your attention to physical activity – specifically, resistance training.
There has been a huge and very welcome focus in the past couple of years on health promotion, and there have been many campaigns, strategies and even television programmes encouraging people to ‘get more active’ or ‘aim for 10,000 steps a day’, or even more simply ‘find the exercise you love doing and stick to it.’ I welcome this, because in my book, any shift in mindset to normalize an active lifestyle and de-normalise sedentary behavior is a positive. As a doctor, I do like to be aware of guidelines, and I like to be able to discuss them with patients, because guidelines, however broad, generally represent an evidence-based form of advice to give, which can be adapted to each patient’s abilities. In terms of physical activity, I’ve spoken before about our national guidelines for aerobic activity of 150 minutes of moderate intensity activity per week (or 30 minutes, five days per week – or 75 minutes of vigorous activity per week). I feel that this message has begun to trickle into the public domain, particularly as walking as an activity is free, accessible to many, and can be done with friends, family or a good Podcast, music or audiobook.
But how good is our awareness of the OTHER aspects of our physical activity guidelines? Whether you’re a doctor, healthcare professional or outside of this field, do you know what these are? In Ireland, for adults between 18 and 65, it is advised to include activity that ‘improves muscular strength and balance’ on at least two days of your week. The advice in this context is similar for adults aged 65+. In the U.K., the guidance is similar. But personally, I just don’t feel, see or hear the ‘strength and balance’ component of these guidelines being widely promoted or emphasized. I’ve been trying to figure out why that is. A big catalyst for me in deciding to write this article was a review published by Public Health England in June, which highlighted the importance of muscle and bone strengthening and balance activities for adults, both young and old. Key quotes I took from this review were:
- ‘Alongside aerobic exercise such as brisk walking, all adults should be aiming to do strengthening and balancing activities twice per week. On average we’re all living longer and this mixture of physical activities will help us stay well in our youth and remain independent as we age.’
- ‘It’s clear that we need to give equal weighting to activities that boost muscle and bone strength and improve balance rather than simply focusing on aerobic exercise.’
- ‘There is significant potential to make savings to health and social care services if we do more to promote muscle strengthening and balance activities and recognise their role in helping to keep people healthy and independent for longer, particularly as they age.’
The review found the most benefit from such activities as ball games, racquet sports, dance, Nordic walking and resistance training (both weight and bodyweight based). It also highlighted the key role these activities play in improving our overall health both physically and mentally, as well as giving us the best chance at healthy ageing and remaining functionally independent as we grow old.
I read this, and just thought, holy moly, HOW can we get these information out there. How can we get people engaging with this recommendation? I see so much frailty in our ageing population in the acute hospital setting where I work, which can result in falls, fractures and disability, and if we have something that we know reduces and prevents this, why wouldn’t we shout about it? I decided writing a short article was a start.
There are two key messages I want to get across in this post – why strength and balance activities are important (and therefore why we should be doing them regularly), and how you can find a way to fit them in that works for you.
Why Should I Focus On Strength and Balance?
Because I want to keep my key messages focused, I’m not going to expose you to a wide range of studies – nor do I think that would be helpful. For writing this post, I contacted David Nolan, Sports and Exercise Science graduate, Head Coach at Synapse Performance and founder of the Synapse Performance Podcast. I really enjoy this Podcast, and asked David if he could send me some quality studies looking at the health benefits of resistance training, for me to read prior to writing this. I also did a bit of my own research, of course. David kindly sent me two very large reviews which were fascinating to read (and if you want the links to those just leave a comment at the end!) This data, a Ted Talk I’ve linked below, plus that which Public Health England discussed in their review, is what I’ve based this post on, to simplify for you the vast physical and mental benefits strength and balance activities provide. To start, I’m going to first give you some bullet points of well-documented physiological benefits of resistance training below, and then I’m going to move to discuss, my second point, a key topic very close to my heart – independence and functionality in ageing, and how regular strength and balance activities can help maintain both.
Health Benefits of Resistance Training:
- Increased bone mineral density
- Improved muscular quality and strength
- Improved insulin sensitivity in those with type 2 diabetes
- Improved cognitive functioning
- Improved sleep quality
- Reduced blood pressure
- Reduced risk of colon cancer
- Reduced low back pain
- Reduced depression and improved self-esteem
- Reduced fear of falling
- Reduced risk of mortality
I watched an incredible Ted Talk with this article in mind – it was from the TEDxUCD series last year, titled ‘Muscle Matters’ by Dr. Brendan Egan, Associate Professor of Sports and Exercise Physiology at the School of Health and Human Performance at Dublin City University. I have linked it above, firstly because it’s so fantastic and informative, and secondly because there are some key points in it I want to include here.
Strength and Balance for Independence
We all know that modern medicine has brought us many wonderful things. Among that is a vast array of medicines that, among many things, has allowed us to live much longer. As a result, worldwide we have become an ‘ageing population’, and in addition to this, we live longer with chronic conditions such as heart disease, diabetes, and cancer. We also know that as we age, we become increasingly frail. The age-related loss of muscle tissue, known as ‘sarcopenia’, directly translates into a loss of strength, and is closely linked to frailty. We lose muscle as we age, and as Dr. Egan mentions in his talk, after the age of 30, the average loss of muscle tissue per decade is 3-8%. The important connection here is that these chronic diseases I’ve mentioned above are all associated with sarcopenia. Age plus chronic disease = a double whammy for our muscle tissue. Our strength affects our balance, and as a result of sarcopenia many elderly people are predisposed to falls and resultant injuries such as fractures. I’ve worked in emergency departments as part of my training, and I’ve lost count of the number of elderly frail patients I’ve admitted who have suffered falls and such consequences.
Being honest, I really think this is THE most important point of the emphasis we should be giving resistance training. I feel really strongly about it as a doctor, and as a grand-daughter who has seen a grand-parent grow increasingly frail, and gone through many thoughts and frustration trying to figure out how to get them stronger to prevent further falls. A fall can be totally life-changing for a person, physically and mentally. Fractures, soft tissue injuries, head injuries, and on top of that, one of the biggest challenges in the recovery phase of a fall – the development of a ‘fear of falling.’ There is a huge impact on the patient, and also their family and friends who care for them.
So if we know that there is naturally a loss of muscle tissue as age, that the world we live in predisposes us to sedentary lifestyles, and that adding a chronic disease into the mix accelerates that process, what can we do about it? Well, the beauty of it is, in this day and age of science, we know what we can do. We can act to preserve, maintain and ideally increase muscle strength, to keep our ageing population stronger, and increase their chances of remaining independent and functional for longer. Being able to perform your ‘A.D.L.s’, or ‘Activities of Daily Living’ is a key indicator we look at in patients in and outside the hospital – simple things like being able to dress yourself, manage your hygiene needs like toileting and showering, and simply getting from A to B to do the shopping or cooking. An inability to manage one’s own ADLs is a big indicator of a person’s functional capacity and therefore independence. If you think about it, it makes sense to say that we need to have a degree to strength to carry out these ADLs – getting yourself up and out of a chair, gripping a kettle to make a cuppa, walking to the shops – without the muscle mass to do these things, a person can find themselves quite dependent on others for day to day care.
Okay. Let’s focus on what we CAN do. Because what makes me feel inspired about this topic is that we are EMPOWERED by the research we have on reducing and/or preventing sarcopenia and resultant frailty. The main issues I see are a lack of both awareness, and the capacity to implement changes. The data tells us that when we expose individuals to resistance or strength training programs, we see increases in muscle mass, and therefore increases in strength. The principles of resistance training back us up here – chiefly, that our bodies adapt to the load we expose them to. Of course, there are barriers to getting people to engage with resistance training – motivation, time constraints, physical limitations, fear and uncertainty, and affordability in terms of gym or sports club memberships to name a few. Behaviour and attitude changes are complex, and take time. But if we don’t shout out about this, a key public health issue that we have the power to reduce and ideally prevent, we will never start a change cycle.
So whether you’re reading this and thinking of yourself, or a relative, here are some simple things you can do for positive change today:
- Look at WHAT you CAN do. Can you afford a gym? Or do you enjoy ball or racket sports, as suggested by Public Health England? If neither tickles your fancy, bodyweight exercise, which was briefly mentioned by Dr. Egan, are just as good for seeing positive changes, especially when starting out. What sort of exercises do I mean? Push-ups, squats, tricep dips, the plank – all free, accessible, and feasible to do on a regular basis, wherever you are.
- Look at HOW you CAN do it. One of the reviews I read for this post discussed a ‘minimal dose’ example of a workout – in brief, 3-10 resistance exercises performed for a single set, taking less than 60 minutes, performed twice per week – and concluded this minimal dose might be all that’s needed for positive health adaptations i.e. maintaining or increasing muscle mass and strength. The ‘How’ is the most important aspect I think – it requires you to look at your week, and when you can make time to engage in these activities. Most importantly, make sure it’s a time you can stick to regularly.
- Look at WHERE you CAN do it. Is that a gym? A sports club? At home? Whatever the location, make sure it’s accessible to you, an environment you aren’t afraid of, and like I said above, one you enjoy going to. There is no point signing up to the gym and paying all that money if you really aren’t a gym lover – you will stick to what you enjoy.
- Look at how SAFELY you CAN do it. If you have an existing health condition, or a musculoskeletal niggle or injury, and even if you don’t, it’s advisable to check in with your GP (and/or a physiotherapist in the case of joint/muscle issues) to make sure you’re medically cleared to start a resistance program. If you join a gym or club, it’s a great idea to speak with a trainer there to ensure your form and technique are correct, as this prevents development of potential injuries, and sets a pace for you starting off.
- Look at WHO you CAN do it with. Have you a family member, girlfriend/boyfriend or friend who’s keen to make similar changes? Having a buddy is such a great idea for sticking to workouts, especially if you struggle with motivation. You can keep each other going, check in with how you’re feeling during your training, and inspire each other on the days you find it hardest to stick to your plan.
Phew! I think I’m incapable of writing a short post guys. Or at least, not when it’s an area I’m so passionate about. I hope you enjoyed reading this article, and I hope it inspires you to be more aware of this issue, and the positive steps we can take to tackle it. I believe that, similarly to the advice we give on aerobic activity and walking, we should as doctors be prescribing strength and balance activities to patients too. I would love your feedback – drop me an email, send me a message or comment on Instagram/Twitter/Facebook (@theirishbalance) or comment here!
Ciara 🙂 x