We are all aware of the pathetic state of the Maltese population’s physical activity record. Yet this is nothing new and not just a local problem. However, it is time to grab the proverbial bull by the horns and banish the spectre of our nation’s physical inactivity once and for all.

Let’s start from the basics. In 1995, the American Society of Sports Medicine issued guidelines on physical activity for adults aged 18 to 65. Since then these have been clarified and expanded to include all age groups. Hence adults should do 30 minutes of moderately intensive exercise at least five times a week. This can be substituted by 20 minutes of vigorous activities three days each week or a combination of moderate and vigorous activities. What is very relevant for the time pressed or physically challenged is that shorter bursts of exercise > 10 minutes each, if added up, will have the same benefit. Muscle strengthening is also important and eight to 10 exercise activities that strengthen major muscles, such as weight lifting or calisthenics, should be performed at least twice a week. Other organisations also recommend daily stretching to improve balance and reduce the likelihood of injury.

These recommendations are above and beyond normal daily activities including light housekeeping. However, strenuous activities such as lifting or gardening can be factored in. The scientific basis for these exercise recommendations has expanded in the past decade, supporting these guidelines as effective for reducing the risk of cardiac disease, as well as a long list of important chronic diseases including stroke, hypertension, Type 2 diabetes, colon and breast cancer, anxiety and depression. In addition, muscle strengthening reduces the risk of osteoporosis and osteopenia, fractures, and all-cause mortality.

Health professionals and government authorities play a vital role in encouraging people to exercise. Indeed, most doctors endorse the importance of exercise counselling. However, lack of time and knowledge, perceived lack of motivation by patients, and minimal or no reimbursement for patient counselling serve as barriers to accomplishing this task (Abramson 2000). Personally, I would rather prescribe exercise, with its many benefits and few risks over a lifetime, than a medicine cabinet full of pills. While awaiting appropriate governmental protocols and structures, all health professionals still have the generic tools for caring for patients:

· Education, to help our patients understand the health implications of physical inactivity

· Guidance, so that patients feel safe and unafraid to explore new behaviours

· Appreciation of small changes, in order to enhance confidence and self-efficacy

·  Concrete strategies, so that patients know how to begin, how to overcome barriers, and how to stick with a programme

·  Encouragement to experience enjoyment of their activities and pride in their efforts and accomplishments. (Lowther 2002)

The vital role physical activity plays in society has been recognised by the European Federation of Sports Medicine Associations (EFSMA) such that in Rome last year the Exercise as a Health Prescription programme was launched. The aim of this programme is to promote the role of physical activity in the prevention and treatment of disease and to establish evidence based guidelines that can be followed by all practitioners.

Prescribing exercise should be an integral aspect of a health professional’s daily practice. The take home message is keep things simple, with gradual exercise increments, otherwise you incur the risk of aggravating a problem and antagonising the patient towards exercise, which is the last thing you want. Asking the patient if he/she is reaping the benefits that should accompany regular exercise, since if the answer is in the negative the whole programme might need reviewing. Results are long-term and this should be stressed at every opportunity. Short-term goals only serve to keep the individual motivated and to quantify the work being done.

 

Dr Micallef Stafrace is a sports and exercise medicine consultant and senior lecturer is sports science

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