This article was first published in Practice Life, March-April 2016 p23-25
Exercise and physical activity at work: what’s the evidence?
A cruel irony of veterinary practice is that whilst vets are often great at preventative medicine for our patients, our lifestyles and work demands don’t always leave much time for us to look after ourselves.
In the typical veterinary day free time is often short, and multiple competing demands mean our own health can come low on the priority list. Spending most of our working time on other-directed care giving; care for ourselves can be neglected.
If you just had a few minutes a day to take back and use to look after yourself, what would be the best evidenced thing you could do?
There’s lots of advice out there on this, when talking with vets about wellbeing I sometimes look at ways to incorporate the Five Ways to Wellbeing into the working day. Connecting, taking Notice, learning, giving, and being active might sound simplistic, but there is good evidence that they can help with mental and in some cases physical wellbeing.
Perhaps the largest evidence base lies with the last one of the five: being active. If you’ve just spent all day on your feet operating, or lifting obese and poorly packaged pets in non-ergonomically designed carriers onto a consult room table, I know from experience the most appealing way to spend your small amount of free time may be with your feet up, but the evidence for activity for health is compelling.
Benefits of exercise
So what is the evidence for physical activity?
The government and Chief Medical Officers issue recommendations for physical activity based on a large and detailed evidence base:
Physical activity: definition and current UK recommendations. Reproduced edited from CMO (2016) and NICE (2016)
Definition
Physical activity includes everyday activity such as walking and cycling, work-related activity, housework, DIY and gardening. It also includes recreational activities such as working out in a gym, dancing, or playing active games, as well as organised and competitive sport.
National recommendations
The CMOs’ current recommendations for physical activity state:
– Adults 19 years and over should aim to be active daily. Over a week, this should add up to at least 150 minutes of moderate intensity1 physical activity in bouts of 10 minutes or more.
– Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous intensity2 activity.
– All adults should also undertake physical activity to improve muscle strength on at least 2 days a week.
– They should minimise the amount of time spent being sedentary (sitting) for extended periods.
– Older adults (65 years and over) who are at risk of falls should incorporate physical activity to improve balance and coordination on at least 2 days a week.
– Individual physical and mental capabilities should be considered when interpreting the guidelines, but the key issue is that some activity is better than no activity.
1 Moderate-intensity physical activity leads to faster breathing, increased heart rate and feeling warmer. Moderate-intensity physical activity could include walking at 3–4 mph, and household tasks such as vacuum cleaning or mowing the lawn.
2 Vigorous-intensity physical activity leads to very hard breathing, shortness of breath, rapid heartbeat and should leave a person unable to maintain a conversation comfortably. Vigorous-intensity activity could include running at 6–8 mph, cycling at 12–14 mph or swimming slow crawl.
There is a causal relationship between the amount of physical activity people do and all-cause mortality. Physical inactivity is now the fourth biggest risk factor for global mortality. Regular physical activity (30 minutes of moderate intensity physical activity on at least 5 days a week) can reduce the risk, and help to manage over 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions. Even small increases in physical activity are associated with some protection against chronic diseases and an improved quality of life. Benefits of physical activity can also extend beyond health, improving workplace productivity (WHO, 2010; Chief Medical Officers, 2011.) There is a curvilinear dose–response relationship between physical activity and diseases such as coronary heart disease and type 2 diabetes, it generally holds that the higher the level of physical activity or fitness, the lower the risk of disease (Department of Health, 2004). There isn’t enough evidence yet to recommend specific amounts of activity to prevent different conditions, but as the evidence base grows we are understanding more about what types of activity can help.
Exercise and mental health
Having worked in veterinary practice, and spoken to a lot of vets in different areas of veterinary life through Vetlife Helpline and my research one of the areas I’m particularly interested in is how physical activity can benefit mental health and wellbeing.
Physical activity can have a positive effect on wellbeing, mood, sense of achievement, relaxation and release from daily stress (Chief Medical Officers of England, 2011). The Royal College of Psychiatrists makes recommendations for the types of exercise that can help with mental health and wellbeing, (Box 2), emphasising how exercise can give back feelings of control, offer an escape from other pressures, and be a source of companionship.
Activity for Wellbeing, from Royal College of Psychiatrists (2016): Physical Activity and Mental Health
Activity for mental health should:
– Be enjoyable – if you don’t know what you might enjoy, try a few different things
– Help you to feel more competent, or capable.
– Give you a sense of control over your life – that you have choices you can make (so it isn’t helpful if you start to feel that you have to exercise). The sense that you are looking after yourself can also feel good.
– Help you to escape for a while from the pressures of life.
– Be shared. The companionship involved can be just as important as the physical activity.
For those living with symptoms of a mental health condition, meta-analysis and reviews suggest that exercise and physical activity can have benefits too. Physical activity has a significant effect reducing depressive symptoms across a range of mental health conditions (Rosenbaum et al., 2014). We still need to understand more about what can help people with mental health conditions with adherence to exercise, it can be difficult to function at all when affected by severe depressive symptoms and fatigue, and exercise may not feel achievable. The Royal College of Psychiatrists recommends using SMART goals and to increase exercise gradually (RCPsych, 2016).
S – Specific (clear)
M – Measurable – you will know when you’ve achieved them
A – Achievable – you can achieve them
R – Relevant – they mean something to you
T – Time-based – you set yourself a time limit to achieve your goals
Sacrifices and barriers to exercise
NICE and CMO guidance also discusses the importance of understanding the barriers to physical activity (NICE 2008, CMO 2011). When I’ve talked with vets in practice about their options for exercise, time is often felt to be a major obstacle, or physical factors such as the ease of access to safe exercise when working long hours on call.
I’m often struck when talking with new graduates or final year vet students about their involvement in sport and exercise is just how many of them have sacrificed activities they were talented in and got great pleasure from to prioritise study. Work is important but the benefits of exercise are strongly evidenced, and are worth protecting time for where possible.
Having non veterinary activities in your life can also be protective psychologically. A vocation like veterinary work that can give great value and meaning when veterinary life is going well, but if there is a problem at work, a bad clinical outcome or complaint, if all someone has is veterinary they can be vulnerable to difficulties of wellbeing. Having non veterinary friends and activities can help protect people at times like that, and help them to get through difficult veterinary times without them having such a catastrophic impact.
How employers can help
Employers can help task saturated time poor veterinary staff to increase their physical activity. NICE, The National Institute for Health and Care Excellence publishes guidance on physical activity in the workplace (NICE, 2008). They recommend employers in organisations of all sizes should develop an organisation-wide plan or policy to encourage and support employees to be more physically active. This should be based on consultation with staff and include measures to maximise the opportunity for all employees to participate. It should be supported by management and have dedicated resources. They recommend an organisation-wide, multi-component programme to encourage and support employees to be physically active, including:
- flexible working policies and incentive schemes
- policies to encourage employees to walk, cycle or use other modes of transport involving physical activity (to travel to and from work and as part of their working day)
- the dissemination of information (including written information) on how to be more physically active and on the health benefits of such activity. This could include information on local opportunities to be physically active (both within and outside the workplace) tailored to meet specific needs, for example, the needs of shift workers
- ongoing advice and support to help people plan how they are going to increase their levels of physical activity
- the offer of a confidential, independent health check administered by a suitably qualified practitioner and focused on physical activity
The evidence this guidance is based on is interesting, one study on workplace activity found that posters to encourage stair climbing may have an effect, but only in the short term; others found that using pedometers and goal setting can increase step counts; that workplace screening and health checks can help to increase physical activity; and that health information can in some cases help too.
Physical environment is also important, and a way in which employers can help with facilities and practice behaviours. It may not be possible for vets to avoid driving to calls or to work if they need a car for on call, but providing safe facilities for exercise whether that be through subsidised gym membership or facilities at work for people working long hours on call.
Employers can also help to combat the impact of sedentary behaviour on veterinary staff. Evidence suggests sedentary behaviour is independently associated with all-cause mortality, type 2 diabetes, some types of cancer and metabolic dysfunction. There’s also an association between sedentary behaviour and overweight and obesity. Interestingly these relationships are independent of the level of overall physical activity, so, spending large amounts of time being sedentary may increase the risk of some health outcomes, even among people who are active at the recommended levels (Sedentary Behaviour and Obesity Expert Working Group, 2010).
Standing desks, facilitating brief activity breaks and periods of walking to break up periods of sedentary work can help. The evidence on this is growing, there isn’t yet enough data to recommend a maximum amount of time to be sedentary for health, but based on the current evidence, the guidance is that reducing total sedentary time and breaking up extended periods of sitting is strongly recommended (Group, 2010, Chief Medical Officers of England, 2011).
Some tips to increase physical activity:
Buy a pedometer or tech:
Some people find pedometers, wearable tech or apps that measure physical activity through the day can be motivating and help increase activity and energy expenditure.
Look out what’s available for free:
There are lots of free schemes which can help with community and group participation in exercise, for example:
Parkrun offer free weekly 5K timed runs, currently at 379 locations around the UK. There are http://www.parkrun.org.uk/
Sustrans is a UK charity enabling people to travel by foot, bike or public transport for more of the journeys, they can work with employers to promote active travel and work to develop high quality walking and cycle networks. www.sustrans.org.uk
Take the stairs:
As simple as it sounds.
Stand up:
Also simple. Consider standing desks, stand up while talking on the phone.
Walk:
Even 5 minute walking breaks can help physical and mental health.
Have walk meetings, Where you can, turn meetings with others in the practice into a short walk. Difficult conversations can be easier when walking too!
Find a sport you love:
As well as increasing daily physical activity through everyday activity such as active work, and active recreation like walking, structured exercise like sport or fitness training can bring further benefits.
If you’re interested in more about ways to increase physical activity, The University of Edinburgh have a free online course, starting in summer 2016. More details here: https://www.coursera.org/learn/get-active
References
CHIEF MEDICAL OFFICERS OF ENGLAND, S., WALES, AND NORTHERN IRELAND 2011. Start active, stay active: a report on physical activity from the four home countries’ Chief Medical Officers. Crown.
SEDENTARY BEHAVIOUR AND OBESITY EXPERT WORKING GROUP, 2010. Sedentary Behaviour and Obesity: Review of the Current Scientific Evidence. London: Department of Health.
HEALTH, D. O. 2004. At least five a week: Evidence on the impact of physical activity and its relationship to health. A report from the Chief Medical Officer. .
NICE 2008. NICE Guidelines: Physical Activity in the Workplace.
RCPSYCH. 2016. Physical Activity and Mental Health [Online]. Available: http://www.rcpsych.ac.uk/healthadvice/treatmentswellbeing/physicalactivity.aspx [Accessed January 2016].
ROSENBAUM, S., TIEDEMANN, A., SHERRINGTON, C., CURTIS, J. & WARD, P. B. 2014. Physical activity interventions for people with mental illness: a systematic review and meta-analysis. The Journal of clinical psychiatry, 75, 964.
WHO 2010. World Health Organization Global Recommendations on Physical Activity for Health
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