tag:theconversation.com,2011:/au/topics/10-000-steps-99289/articles10,000 steps – The Conversation2021-09-10T03:29:12Ztag:theconversation.com,2011:article/1674472021-09-10T03:29:12Z2021-09-10T03:29:12ZAiming for 10,000 steps? It turns out 7,000 could be enough to cut your risk of early death<p>Many Australians are walking for their permitted fitness activity during lockdown. Some, emerging from winter hibernation, are taking part in <a href="https://www.steptember.org.au/the-challenge">STEPtember</a> — a global initiative to raise money for cerebral palsy services and research. </p>
<p>The goal for participants is to reach 10,000 steps each day during the month of September. Indeed, 10,000 steps is the de-facto target around the world that many people associate with being fit, healthy and ageing well. </p>
<p>Now, a <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783711">new study</a> says a lower — and more achievable — daily goal of 7,000 steps will still yield substantial health benefits. </p>
<h2>From marketing to medical advice</h2>
<p>The 10,000 step benchmark originated from a marketing campaign rather than a specific health objective. A Japanese company (<a href="http://www.yamax-yamasa.com/aboutus/">Yamasa Corporation</a>) built a campaign for their new step-tracker off the momentum of the <a href="https://link.springer.com/article/10.2165/00007256-200434010-00001">1964 Tokyo Olympics</a>. The pedometer’s brand name — <em>Manpo-Kei</em> means 10,000 step meter in English — and a new phenomenon was born.</p>
<p>The new study from the US in 2,100 adults aged over 40 found that while 10,000 steps may well be an optimal health goal, adults can still achieve significant health benefits from only 7,000 steps per day. </p>
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<span class="caption">Technology including smart watches help walkers and researchers keep track of steps.</span>
<span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/girl-checks-information-on-screen-600w-478885666.jpg">Shutterstock</a></span>
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<p>The researchers in the new study collected data using wearable sensors (triaxial accelerometers similar to those used in smartwatches and phones) and followed participants over a period of around ten years. Researchers looked at the average step counts and analysed the risk of death (after controlling for other factors that might influence the result, like poor health, smoking, and diet). </p>
<p>Compared to adults who walked less than 7,000 steps per day on average, those who reached between 7,000 and 9,999 steps per day had a 60% to 70% lower risk of early death from any cause. The effect was the same for both men and women. But there wasn’t significant further reduction in the risk of early death for those who walked more than 10,000 steps. </p>
<p>The effective step target might be even lower in <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709">older women</a>. A 2019 study of 16,741 women with a mean age of 72 years found those who averaged around 4,400 steps per day had significantly lower mortality rates when they were followed up more than four years later, compared with the least active women in the study.</p>
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<a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">Do we really need to walk 10,000 steps a day?</a>
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<h2>Not such a need for speed</h2>
<p>The researchers found health benefits were not affected by walking pace (based on the peak steps per minute over a 30-minute period) or intensity (the total time with over 100 steps per minute). </p>
<p>These findings corroborate a <a href="https://jamanetwork.com/journals/jama/fullarticle/2763292">2020 publication</a> and further confirm the WHO’s 2020 physical activity report that tells us “<a href="https://www.who.int/news/item/25-11-2020-every-move-counts-towards-better-health-says-who">every move counts</a>”. Such messaging is echoed in Australia’s <a href="https://theconversation.com/will-the-governments-new-move-it-exercise-campaign-move-us-or-lose-us-100969">Move it</a> campaign. </p>
<p>Research has shown walking to increase our individual speed <a href="https://bjsm.bmj.com/content/52/12/761">could be more important than absolute speed</a> — emphasising the goal to challenge ourselves while out walking for exercise.</p>
<h2>What about during lockdown?</h2>
<p>A large UK study shows prolonged lockdown conditions may limit our movement to <a href="https://onlinelibrary.wiley.com/doi/10.1111/sms.14032">3,500 steps a day</a>. And we know less physical activity not only affects physical health, but also <a href="https://www.who.int/campaigns/connecting-the-world-to-combat-coronavirus/healthyathome">mental health</a>. </p>
<p>Exercise during lockdown is considered an essential activity by <a href="https://www.health.gov.au/news/health-alerts/novel-coronavirus-2019-ncov-health-alert/ongoing-support-during-coronavirus-covid-19/exercising-and-staying-active-during-coronavirus-covid-19-restrictions">national</a> and <a href="https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/publications-and-technical-guidance/noncommunicable-diseases/stay-physically-active-during-self-quarantine">international</a> authorities — as important as obtaining food and medical care. </p>
<p>For the millions of Australians in lockdown right now, this new study brings positive news and a more achievable goal for protecting their <a href="https://www.sciencedirect.com/science/article/abs/pii/S088915912100180X?via%3Dihub">health</a>. </p>
<p>There is no one-size fits all when it comes to fitness. And there are many different <a href="https://theconversation.com/how-to-stay-fit-and-active-at-home-during-the-coronavirus-self-isolation-134044">innovative ways to stay active</a> while we’re at home. </p>
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Read more:
<a href="https://theconversation.com/home-cooking-means-healthier-eating-theres-an-opportunity-to-change-food-habits-for-good-136881">Home cooking means healthier eating – there's an opportunity to change food habits for good</a>
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<h2>Just keep walking</h2>
<p>For those people who don’t have mobility issues, walking provides therapeutic benefits and is an excellent activity for health. It is free of charge, expends energy at any pace, can be done all year round and is a <a href="https://link.springer.com/article/10.2165/00007256-199723050-00004">habit forming activity</a>.</p>
<p>While it is estimated more than a quarter of the world’s population is <a href="https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30357-7/fulltext">physically inactive</a>, an easy and achievable solution might be right on our doorstep. </p>
<p>Whether we walk or do other physical activities, it is important we do so at a speed and intensity appropriate to our personal abilities and physical capacity. </p>
<p>More research is needed to understand the potential long-term health benefits across the lifespan of <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-020-01042-2">light-intensity activities</a> such as household activities like gardening, watering the garden or vacuuming. But evidence continues to affirm that stepping to the beat of your own drum can ensure health benefits, prevent premature death and set attainable benchmarks to make us want to keep active and motivated to continue.</p>
<p>Public health messaging has emphasised the need to <a href="https://www.heartfoundation.org.au/heart-health-education/sit-less-move-more">sit less and move more</a>. Events like STEPtember add to heightened public awareness around the <a href="https://www.thelancet.com/series/physical-activity-2021">health benefits of physical activity</a> and present an opportunity to focus on efficient ways to be active.</p>
<p>Whether you take 7,000 or more steps a day, the most important message is every single step counts. </p>
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Read more:
<a href="https://theconversation.com/why-some-people-find-it-easier-to-stick-to-new-habits-they-formed-during-lockdown-149438">Why some people find it easier to stick to new habits they formed during lockdown</a>
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<p class="fine-print"><em><span>Matthew Ahmadi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>While the figure of 10,000 steps a day has become a popular benchmark, new research finds we might not need to take quite so many strides to cut our chances of an early death.Matthew Ahmadi, Postdoctoral Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1674902021-09-09T10:04:57Z2021-09-09T10:04:57ZWhy 7,000 steps a day is the new 10,000 steps a day<figure><img src="https://images.theconversation.com/files/420025/original/file-20210908-23-xbn82v.jpg?ixlib=rb-1.1.0&rect=22%2C7%2C4899%2C3268&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-using-daily-activity-tracking-app-1969873111">Kaspars Grinvalds/Shutterstock</a></span></figcaption></figure><p>Many of us have smartwatches or apps on our phones that count the number of steps we do. Usually, we aim to reach at least 10,000 steps a day, which we are often reminded is the target to help improve our <a href="https://pubmed.ncbi.nlm.nih.gov/29361921/">health</a>. This target is an arbitrary number that seems to have come from a Japanese <a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">marketing campaign for a pedometer</a>. However, it is now included in daily activity targets by popular smartwatches, such as Fitbit.</p>
<p>When trying to get more active, it can often be demoralising when you look at your step count and realise you haven’t reached that goal of 10,000 steps. In fact, it can even be demotivating, especially in times where many of us are still working from home and only manage to walk from our makeshift offices to the kitchen to get our (usually) unhealthy snack. </p>
<p>The good news for everyone is that the evidence is building to suggest that doing less than 10,000 steps is still good for your health. The most recent large study, led by the <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783711">University of Massachusetts</a>, followed over 2,000 middle-aged adults from different ethnic backgrounds over a period of 11 years. The researchers found that those taking at least 7,000 steps a day had a 50 to 70% lower risk of dying during the study period compared with those taking fewer than 7,000 steps a day. </p>
<p>Another interesting finding from the study was that the risk of dying was not associated with the step intensity. If two people did the same number of steps, the person doing them at a low intensity had no greater risk of dying compared with the person doing them at moderate intensity. </p>
<p>With all research, we have to consider the design of the study and determine the limitations of the research to ensure we draw accurate conclusions. The study led by Massachusetts University collected data over a period of about 11 years. However, the step count was only measured once, over a three-day period, during 2005-06. Mortality and other health measures were followed up in August 2018. </p>
<p>The step count was not monitored throughout the study period, as it would be too onerous for the participants. Therefore, there was a large assumption that people’s daily step count did not change throughout the study period. But how much people can walk can change for various reasons, such as having young children, commute time to work, injury, and many other reasons, so it’s difficult to draw too many conclusions from this type of data. </p>
<h2>Earlier evidence points in the same direction</h2>
<p>The results of the University of Massachusetts study builds on the results from <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709?guestAccessKey=afffe229-3940-4dd1-94e6-56cdd109c457&utm_source=jps&utm_medium=email&utm_campaign=author_alert-jamanetwork&utm_content=author-author_engagement&utm_term=1m">Harvard Medical School</a> which showed that, on average, about 4,400 steps a day is enough to significantly lower mortality of older women during the study duration. However, these participants were older than the Massachusetts study (average age of 72), which might explain why a lower step rate reduced study death rates. Maybe older adults need less activity to gain similar health benefits. </p>
<p>Even though we have to be cautious about how we interpret data from these various studies. It is clear that there are health benefits to doing less than 10,000 steps a day.</p>
<p>While the <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization</a> recommends adults get at least 150 minutes of moderate-intensity exercise a week (or 75 minutes of vigorous exercise), there is no guideline linked to the easily measured step count. This is because of the limited number of studies showing the relationship between step count (and intensity) with health outcomes. </p>
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<img alt="A family cycling in a park." src="https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/420072/original/file-20210908-21-wa9l17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People should aim to get 150 minutes of moderate intensity exercise a week.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-on-cycle-ride-countryside-165826010">Monkey Business Images/Shutterstock</a></span>
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<p>It is clear that more research is needed to help define the daily step volume and intensity to provide people with an easy quantifiable tool to determine activity levels. This may help increase the general physical activity levels of the public where currently <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">one in four of the global population</a> do not meet the recommended levels. </p>
<p>Next time you see your daily step count is below 10,000 steps, do not get demotivated and remember you will get some health benefits from doing around 7,000 steps. If you want to improve your health through increasing your step volume, <a href="https://pubmed.ncbi.nlm.nih.gov/32563261/">research</a> has shown that increasing your daily steps by 1,000 a day has considerable benefit.</p><img src="https://counter.theconversation.com/content/167490/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Bottoms does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study finds huge benefit in taking just 7,000 steps a day. Which may come as a relief to those who never quite make it to 10,000.Lindsay Bottoms, Reader in Exercise and Health Physiology, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1625752021-07-28T12:24:42Z2021-07-28T12:24:42ZHealth apps track vital health stats for millions of people, but doctors aren’t using the data – here’s how it could reduce costs and patient outcomes<figure><img src="https://images.theconversation.com/files/408984/original/file-20210629-20-z39aiu.jpg?ixlib=rb-1.1.0&rect=101%2C50%2C8385%2C5509&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mobile health apps and gadgets could help doctors and patients treat chronic illnesses in real time.</span> <span class="attribution"><a class="source" href="http://www.gettyimages.com/detail/1267542302">Moment via Getty</a></span></figcaption></figure><p>Health-tracking devices and apps are becoming part of everyday life. More <a href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health">than 300,000 mobile phone applications</a> claim to help with managing diverse personal health issues, from monitoring blood glucose levels to conceiving a child.</p>
<p>But so far the potential for health-tracking apps to improve health care has barely been tapped. While they allow a user to collect and record personal health data, and sometimes even share it with friends and family, these apps typically don’t connect that information to a patient’s digital medical chart or make it easier for health care providers to monitor or share feedback with their patients.</p>
<p>As a <a href="https://scholar.google.com/citations?hl=en&user=2SFosXQAAAAJ">professor and a researcher</a> in the field of operations management, my current research focuses on improving the efficiency and effectiveness of health care delivery. My colleagues and I recently published <a href="https://doi.org/10.1097/HJH.0000000000002909">a multiyear study</a> showing that integrating a mobile health app with ongoing medical care can significantly improve the health of patients with hypertension – a widespread, serious and potentially deadly chronic medical condition.</p>
<p>But it’s not easy to use health apps this way as a regular part of medical care in the U.S.</p>
<h2>Case study: Hypertension</h2>
<p>Hypertension, better known as high blood pressure, is one of America’s leading chronic health problems. <a href="https://www.cdc.gov/bloodpressure/facts.htm">According the U.S. Centers for Disease Control and Prevention</a>, hypertension was a primary or contributing cause to nearly half a million deaths in 2018 and affected nearly half of U.S. adults – nearly 110 million people. Left uncontrolled, <a href="https://www.nhlbi.nih.gov/health-topics/high-blood-pressure">high blood pressure </a> can also permanently damage the heart and other parts of the body.</p>
<p>Simple changes in <a href="https://doi.org/10.1016/j.amjmed.2014.10.047">diet, exercise, smoking and drinking</a> can help prevent or postpone the onset of hypertension. Once a person has high blood pressure, the focus of medical care is treatment and management. But patients typically see their doctors only three to four times a year, making it difficult for physicians <a href="https://doi.org/10.1016/j.amjmed.2014.10.047">to track, assess and address the root causes</a> of their hypertension. <a href="https://www.emerald.com/insight/content/doi/10.1108/MD-10-2017-1010/full/html">These visits also tend to be brief,</a> because the fee-for-service insurance payment model motivates doctors to see more patients in a given day. </p>
<p>Prior studies on the <a href="https://doi.org/10.2196/10723">effectiveness of mobile health apps for self-management of hypertension</a> were done in controlled settings in which all the participants agreed to use the app, rather than in clinical settings where patients had a choice of whether to engage with care providers using the app. We wanted to see how a hypertension patient’s use of an app played out in a real-world setting. So one of my study co-authors, a <a href="https://diabeticcareassociates.com/">practicing endocrinologist</a>, developed a proprietary web-based smartphone app to help monitor and treat hypertension between office visits. </p>
<p>Patients who received this app free of charge measured and entered their blood pressure and pulse readings. The physician reviewed these readings once a day and, if needed, recommended interventions such as new medications or changing doses of existing medications, or advised on diet and exercise. My co-author and his medical assistants weren’t paid to monitor these patients. </p>
<p>Patients and staff could also talk directly with one another through the app. This enabled regular <a href="https://doi.org/10.1108/MD-10-2017-1010">communication and joint decision-making</a> between providers and patients on how to best treat their hypertension, which in turn encouraged patients not to abandon the app after only a few uses. </p>
<p>In tracking the condition of 1,600 hypertension patients over the course of four years, we found that a typical app user reduced her <a href="https://www.heart.org/en/health-topics/high-blood-pressure/understanding-blood-pressure-readings">systolic blood pressure</a> – the upper value in a blood pressure reading, indicating the pressure while the heart muscle contracts – by 2 “millimeters of mercury,” or mmHG, compared with someone not using the app. For patients with systolic blood pressure greater than 150 mmHG, the reduction was more than 6 mmHG. These were significant decreases. A reduction of 10 mmHG in systolic blood pressure lowers overall mortality risk by 13%.</p>
<p>Our study bears out the findings of other <a href="https://doi.org/10.1007/s10729-018-9458-2">researchers who have found</a> that using mobile health apps is beneficial for managing chronic conditions.</p>
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<a href="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A gray-haired woman snaps on a bike helmet. She is wearing an Apple watch." src="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/413427/original/file-20210727-18-1ng148f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">You may be collecting health data on your phone, but does your doctor ever see it?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-putting-on-cycling-helmet-royalty-free-image/1255380001">Tara Moore via Getty</a></span>
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<h2>Barriers to connection</h2>
<p>These finding were promising, but there’s a catch: Many patients can’t afford to buy a mobile device and pay for its service.</p>
<p>Further, medical practices need to make a profit to survive, and there is currently no clear way for a provider to charge for <a href="https://www.iqvia.com/insights/the-iqvia-institute/reports/the-growing-value-of-digital-health">time spent</a> providing medical care via an app. However, the massive switch during the COVID-19 pandemic from in-person care to telehealth has driven many insurers <a href="https://www.kff.org/medicare/issue-brief/medicare-and-telehealth-coverage-and-use-during-the-covid-19-pandemic-and-options-for-the-future/">to figure out how to bill for services delivered remotely</a>. These solutions might eventually apply to medical health apps as well.</p>
<p>Developers also have few financial incentives to create apps that integrate with professional health care. Apps commonly earn revenues by converting users into paying customers or ongoing subscribers, or by selling advertising space within the app. The most profitable apps tend to be <a href="https://doi.org/10.1016/j.chb.2019.07.017">mobile phone games, which use psychological techniques to increase sales</a>. </p>
<p>But these would be inappropriate in the medical setting. Selling to a patient – or selling the patient’s attention to advertisers – raises questions like: Is my data safe? Is this a medically necessary sale? Does my doctor earn money from this? These concerns could reduce the trust between physician and patient <a href="https://dx.doi.org/10.1177%2F2333393616664823">that is essential to</a> treating chronic health conditions.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://theconversation.com/us/newsletters/weekly-highlights-61?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=weeklybest">Sign up for our weekly newsletter</a>.]</p>
<p>And the tech has to work. Patients care about how easy it is to use an app, and whether it has the tools that they are looking for. <a href="https://mobius.md/2019/03/20/11-mobile-health-statistics/">Providers are unhappy</a> when their patients have bad experiences with technology. Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029126/#b11-ptj3905356">there are no established standards ensuring</a> that mobile health apps are collecting or delivering accurate information, as there are with most professional medical monitoring equipment.</p>
<p>But as the recognition grows that properly designed health care apps can play a big role in enabling more effective medical care, we could see a major stakeholder step in and provide a monetary incentive for app development and use: the insurance carriers who benefit from lower costs of care. </p>
<p>Ultimately, the key part of treating hypertension and other chronic health problems is the interplay between patient and doctor. <a href="https://doi.org/10.1097/HJH.0000000000002909">Our research shows</a> that a well-designed health app that talks not just to the user but also to the user’s care providers increases the likelihood of that engagement and leads to better treatment and better health.</p><img src="https://counter.theconversation.com/content/162575/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Saligrama Agnihothri does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Connecting health apps to health care can enable better care for patients with chronic diseases, and it has the potential to lower skyrocketing US health spending.Saligrama Agnihothri, Professor of Supply Chain and Business Analytics, Binghamton University, State University of New YorkLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1581872021-04-15T12:48:10Z2021-04-15T12:48:10ZWalking workouts are great for heart, bone, and muscle health – and almost everyone can do it<figure><img src="https://images.theconversation.com/files/395005/original/file-20210414-16-1uzq0m6.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7670%2C5098&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Walking is an easy exercise for everyone to do.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/athletic-young-man-woman-wearing-face-1767653012">antoniodiaz/ Shutterstock</a></span></figcaption></figure><p>Pandemic restrictions have led many people to start <a href="https://pubmed.ncbi.nlm.nih.gov/33801836/">walking more</a>, often because they’ve had few other things to do or just as a way to get moving. Walking workouts have even become popular, with plenty of “challenges” and exercise videos to be found online.</p>
<p>Walking is good for you, there’s not much doubt about this. As a way of adding physical activity into your life, it has many advantages. There’s a very low barrier to entry, meaning almost everyone, regardless of age or ability, can start walking regularly as a form of exercise.</p>
<p>Walking has clear benefits on keeping our bodies functioning as we get older, improving <a href="https://pubmed.ncbi.nlm.nih.gov/29858464/">cardiovascular health</a>, <a href="https://pubmed.ncbi.nlm.nih.gov/29858464/">helping lose fat mass</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7074998/">maintain muscle mass</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/8304358/">helping to maintain bone density as well</a>. And these benefits are true for people of all ages. It seems that the more active you are as a young adult can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6718639/">affect overall health</a> and (in rats, at least) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5500658/">bone and muscle physical function</a> in later life. </p>
<p>Walking outside is also associated with mental health benefits, particularly if you’re able to <a href="https://pubmed.ncbi.nlm.nih.gov/29392643/">walk in parks or green spaces</a>. Such “green exercise” can improve <a href="https://pubmed.ncbi.nlm.nih.gov/32120892/">mental health</a> and wellbeing, reduce <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3710158/">symptoms of depression</a>, and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4025002/">lower blood pressure </a> to a greater degree than similar urban exercise. </p>
<p>These effects are so strong that walking on a treadmill in a sterile laboratory environment, but while watching a TV showing green spaces, can <a href="https://pubmed.ncbi.nlm.nih.gov/32476469/">improve stress responses</a> and improve <a href="https://pubmed.ncbi.nlm.nih.gov/16416750/">self-esteem and mood</a> when compared to watching scenes of urban built environments.</p>
<h2>How many steps?</h2>
<p>But how many steps are required? Although we’re often told to aim for 10,000 steps a day, this number is not really evidence based. In a study of 16,741 older women (average age 72 years), people who <a href="https://pubmed.ncbi.nlm.nih.gov/31141585/">walked less than 2,000 steps</a> a day were shown as having the highest risk of death from many different causes, such as cancer or cardiovascular disease. People who walked more were less likely to die from any cause. </p>
<p>This effect plateaued at about 7,500 steps, suggesting (at least in this population of older women) that activity beyond this didn’t impart further benefit in terms of mortality. Simply put, walking more likely helps you live longer, but 10,000 steps wasn’t any different to 8,000 steps. Similar results are seen in adults older than 40, with a pleateau in effectiveness of increasing step counts <a href="https://pubmed.ncbi.nlm.nih.gov/32207799/">somewhere between 8,000 and 10,000 steps</a>.</p>
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Read more:
<a href="https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765">Do we really need to walk 10,000 steps a day?</a>
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<p>Another factor to consider is walking pace. As intuitive as it may seem, it’s worth pointing out that walking faster is better for you than walking slowly. In a recent <a href="https://jamanetwork.com/journals/jama/article-abstract/2778112">randomised control trial</a>, 12 months of walking five times a week for 50 minutes at low speed didn’t improve measures of fitness, while walking at a faster speed did. (The researchers used a personalised measure for each person – so “fast” versus “slow” depended on each individual.)</p>
<p>Walking speed is also a <a href="https://pubmed.ncbi.nlm.nih.gov/33785308/">predictor of mortality in older people</a>. People who walk slower are much more likely to die over the next 14 years of all causes than those who walked at a faster pace.</p>
<h2>Is walking enough?</h2>
<p>But while walking is good for you, it’s not a magic cure for everything. To gain even further benefits, consider adding in both higher intensity exercises and strengthening exercises, as recommended by the <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization</a> and <a href="https://www.nhs.uk/live-well/exercise/">NHS England</a>. </p>
<p>This should include vigorous, challenging, quick movements that get your heart beating faster and make you out of breath – such as running or cycling up hills, sports games, or walking up stairs. Again, intensity is at play here. So although walking is good for cardiovascular fitness, <a href="https://pubmed.ncbi.nlm.nih.gov/15722695/">running is better</a>, even if you still only use similar amounts of calories on a short run versus a longer walk.</p>
<figure class="align-center ">
<img alt="Five men play basketball outdoors." src="https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/395006/original/file-20210414-19-1lm1elp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The greater the intensity, the better for your health.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-male-basketball-player-taking-free-429546778">bbernard/ Shutterstock</a></span>
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</figure>
<p>Muscle strengthening exercises, such as weightlifting, are also great for building muscle mass and strength at all ages. These will help maintain muscle mass and function with older age, and are associated with reduced incidence of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563593/">chronic diseases</a>. </p>
<p>Importantly, losses in muscle mass and function start in your 30s-40s. So exercising while you’re younger isn’t just good for you now, but could <a href="https://www.frontiersin.org/articles/10.3389/fphys.2019.00645/full">help your health and function</a> decades later.</p>
<p>In place of step counts, the World Health Organization suggests people think of “minutes of activity”, and that people should achieve <a href="https://www.who.int/publications/i/item/9789240015128">at least 150 minutes of moderate intensity exercise a week</a>, or at least 75 minutes vigorous intensity exercise if you prefer. Moderate intensity activity is about a six out of ten on your personal intensity scale – so things like light sports, walking briskly or dancing. </p>
<p>Activity trackers can also help you keep an eye on how many minutes you’re active daily. Most smart phones have apps built in and many are freely available to download.</p>
<p>So, is walking good for you? Yes. Do you need to walk 10,000 steps a day? Probably not, but it’s not going to do you harm if you do. If you are trying to maximise your gain in health benefits through being more active, consider adding in other types of exercises alongside lighter activities like walking that challenge your fitness and strength.</p><img src="https://counter.theconversation.com/content/158187/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Elliott receives funding from The Endocrine Society, The Physiological Society and private philanthropic donors. He is affiliated with The Physiological Society, and is a Trustee of the British Society for Research on Ageing. </span></em></p>But more intense exercises – such as weightlifting – are still important for health and fitness.Bradley Elliott, Senior Lecturer in Physiology, University of WestminsterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1537652021-01-28T16:27:02Z2021-01-28T16:27:02ZDo we really need to walk 10,000 steps a day?<figure><img src="https://images.theconversation.com/files/381115/original/file-20210128-19-wr5avc.jpg?ixlib=rb-1.1.0&rect=44%2C7%2C4950%2C3282&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The 10,000 step target has more to do with marketing than scientific fact. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-attractive-women-their-30s-talking-562075621">Brocreative/ Shutterstock</a></span></figcaption></figure><p>When it comes to being fit and healthy, we’re often reminded to aim to walk 10,000 steps per day. This can be a frustrating target to achieve, especially when we’re busy with work and other commitments. Most of us know by now that 10,000 steps is recommended everywhere as a target to achieve – and yet where did this number actually come from?</p>
<iframe id="noa-web-audio-player" style="border: none" src="https://embed-player.newsoveraudio.com/v4?key=x84olp&id=https://theconversation.com/do-we-really-need-to-walk-10-000-steps-a-day-153765&bgColor=F5F5F5&color=D8352A&playColor=D8352A" width="100%" height="110px"></iframe>
<p>The 10,000 steps a day target seems to have come about from a trade name pedometer sold in 1965 by Yamasa Clock in Japan. The device was called <a href="http://www.yamax-yamasa.com/aboutus/">“Manpo-kei”</a>, which translates to “10,000 steps meter”. This was a marketing tool for the device and has seemed to have stuck across the world as the daily step target. It’s even included in daily activity targets by popular smartwatches, such as Fitbit.</p>
<p>Research has since investigated the 10,000 steps a day target. The fact that <a href="https://pubmed.ncbi.nlm.nih.gov/29361921/">some studies</a> have shown this step target improves heart health, mental health, and even lowers diabetes risk, may, to some extent, explain why we have stuck with this arbitrary number. </p>
<p>In ancient Rome, distances were actually <a href="https://journals.lww.com/acsm-msse/Fulltext/2008/07002/Walking_and_Measurement.4.aspx">measured by counting steps</a>. In fact, the word “mile” was derived from the Latin phrase <em>mila passum</em>, which means <a href="https://www.britannica.com/science/mile">1,000 paces</a> – about 2,000 steps. It’s suggested the average person walks <a href="https://www.tandfonline.com/doi/abs/10.1080/02701367.2001.10608977">about 100 steps per minute</a> – which would mean it would take a little under 30 minutes for the average person to walk a mile. So in order for someone to reach the 10,000 step goal, they would need to walk between four and five miles a day (around two hours of activity). </p>
<p>But while some research has shown health benefits at 10,000 steps, <a href="https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2734709?guestAccessKey=afffe229-3940-4dd1-94e6-56cdd109c457&utm_source=jps&utm_medium=email&utm_campaign=author_alert-jamanetwork&utm_content=author-author_engagement&utm_term=1m">recent research</a> from Harvard Medical School has shown that, on average, approximately 4,400 steps a day is enough to significantly lower the risk of death in women. This was when compared to only walking around 2,700 steps daily. The more steps people walked, the lower their risk of dying was, before levelling off at around 7,500 steps a day. No additional benefits were seen with more steps. Although it’s uncertain whether similar results would be seen in men, it’s one example of how moving a little bit more daily can improve health and lower risk of death. </p>
<figure class="align-center ">
<img alt="Person wearing a smartwatch tying their shoe." src="https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/381117/original/file-20210128-15-ictva.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Benefits were seen even before 10,000 steps.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/count-your-steps-smartwatch-application-can-578757676">dolphfyn/ Shutterstock</a></span>
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<p>While the <a href="https://www.who.int/publications/i/item/9789240015128">World Health Organization recommends</a> adults get at least 150 minutes of moderate intensity physical activity per week (or 75 minutes of vigorous physical activity), research also shows that <a href="https://www.sciencedirect.com/science/article/pii/S0828282X16000647?via%3Dihub">even low-intensity exercise</a> can improve your health – though moderate-intensity exercise improves it to a greater extent. This means your steps throughout the day can contribute to your 150 minutes of target activity. </p>
<p>Activity can also help mitigate the <a href="https://www.nhs.uk/live-well/exercise/why-sitting-too-much-is-bad-for-us/">harms of sitting down</a> for long periods of time. <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)30370-1/fulltext#%20">Research has shown</a> that people who sat for eight or more hours every day had a 59% increased risk of death compared to those sitting less than four hours per day. However, they also found that if people did 60-75 minutes per day of moderate intensity physical activity, this seemed to eliminate this increased risk of death. Therefore, potentially undertaking brisk walking could help mitigate the negative effects of sitting for too long.</p>
<p><a href="https://journals.lww.com/acsm-msse/Fulltext/2021/02000/Daily_Step_Count_and_Postprandial_Fat_Metabolism.10.aspx">Recent research at the University of Texas</a> has also demonstrated that if you’re walking fewer than 5,000 steps a day, your body is less able to metabolise fat the following day. A buildup of fat in the body can also increase a person’s likelihood of developing cardiovascular disease and diabetes. This is further supported by <a href="https://journals.lww.com/acsm-msse/Fulltext/2014/10000/Effects_of_Moderate__and_Intermittent.2.aspx">previous research</a> which shows people who walked less than 4,000 steps a day could not reverse this decreased fat metabolism. </p>
<p>Increasing physical activity such as your step count reduces your risk of death by improving your health, including by reducing risk of developing chronic illnesses such as <a href="https://pubmed.ncbi.nlm.nih.gov/28049634/">dementia</a>, and certain <a href="https://pubmed.ncbi.nlm.nih.gov/23720265/">cancers</a>. In some cases it helps improve health conditions such as <a href="https://pubmed.ncbi.nlm.nih.gov/28708479/">type 2 diabetes</a>. Exercise can also help us improve and maintain our <a href="https://pubmed.ncbi.nlm.nih.gov/17303714/">immune system</a>. However, based on the current research out there, it appears that getting 10,000 steps a day isn’t essential for health benefits – half that target appears to be beneficial.</p>
<p>If you want to increase how many steps you get daily, or simply want to move more, one easy way to do that is to increase your current step count by about 2,000 steps a day. Other easy ways to move more daily include walking to work if possible, or taking part of an online exercise programme if you’re working from home. Meeting with friends for a walk – rather than in a cafe or pub – can also be useful. And given that even small amounts of physical activity positively impact your health, taking regular breaks to move around if you’re working at a desk all day will help to easily get more physical activity.</p><img src="https://counter.theconversation.com/content/153765/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Bottoms does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Even half the amount of steps shows health benefits.Lindsay Bottoms, Reader in Exercise and Health Physiology, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1491722020-12-31T20:19:47Z2020-12-31T20:19:47ZWant to exercise more? Try setting an open goal for your New Year’s resolution<figure><img src="https://images.theconversation.com/files/368153/original/file-20201108-21-12b1zh0.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5447%2C3612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s that time of year when many of us are setting goals for the year ahead. The most common New Year’s resolution – set by <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2018/12/13/new-years-resolutions-2019-exercise-healthy-eating">59%</a> of us - is to exercise more.</p>
<p>But our <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2019.1706616">research</a> suggests the way we typically set goals in exercise <a href="https://bjsm.bmj.com/content/52/8/485">often doesn’t work</a>. So, what should we do instead? </p>
<p>Our research interviewing elite athletes suggests one possibility is to set open goals instead. </p>
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Read more:
<a href="https://theconversation.com/can-trying-to-meet-specific-exercise-goals-put-us-off-being-active-altogether-84062">Can trying to meet specific exercise goals put us off being active altogether?</a>
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<h2>Specific goals can actually put us off</h2>
<p>Generally we’re <a href="https://www.nytimes.com/guides/smarterliving/resolution-ideas">advised</a> to set specific, or SMART, goals (where SMART stands for specific, measurable, achievable, realistic and timebound). Aiming to walk 10,000 steps per day is a common example. </p>
<p>This advice is typically based on <a href="https://www.google.com.au/books/edition/A_Theory_of_Goal_Setting_Task_Performanc/MHR9AAAAMAAJ?hl=en&gbpv=0&bsq=locke%20latham%201990">goal-setting theory</a> from the 1990s. However, that theory has now <a href="https://books.google.com.au/books?id=UDgKbOkYbEgC&printsec=frontcover&dq=locke+latham+2013&hl=en&newbks=1&newbks_redir=0&sa=X&ved=2ahUKEwj-qIeL6rrtAhWqwzgGHaFYDr8Q6AEwAHoECAUQAg#v=onepage&q=locke%20latham%202013&f=false">evolved</a>, with research now suggesting specific goals in some cases can actually put us off. </p>
<p>One problem is specific goals are <a href="https://www.tandfonline.com/doi/full/10.1080/17437199.2019.1706616">all-or-nothing</a>: you either achieve the goal or you fail. </p>
<p>That’s why you might feel you’ve failed after “only” recording 9,000 steps when your goal was 10,000. In reality, 9,000 steps might actually be an achievement (especially on a busy day) — but because you didn’t reach your specific target, it can feel disappointing.</p>
<p>When you stop making progress towards your goal, or start to feel like you’re failing, it’s easy to give up — just like <a href="https://today.yougov.com/topics/lifestyle/articles-reports/2018/12/13/new-years-resolutions-2019-exercise-healthy-eating">many</a> of us do with New Year’s resolutions. </p>
<p>Used incorrectly, specific goals even cause unethical behaviour (like using devices to artificially increase our step counts and <a href="https://metro.co.uk/2019/05/16/fitness-app-users-trying-cheat-step-counters-simple-hack-9570167/">benefit from lower insurance premiums</a>!). </p>
<p>One alternative is to set what’s known as an open goal.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man runs in a park." src="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368157/original/file-20201108-23-j8qyf6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The problem is specific goals are all-or-nothing: you either achieve the goal or you fail.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What are open goals?</h2>
<p>Open goals are non-specific and exploratory, often phrased as aiming to “see how well I can do”. For example, professional golfers in one <a href="https://www.researchgate.net/publication/283564015_Psychological_States_underlying_Excellent_Performance_in_Professional_Golfers_Letting_it_Happen_vs_Making_it_Happen">study</a> described performing at their best when aiming to “see how many under par I can get”. </p>
<p>When colleagues and I <a href="https://www.tandfonline.com/doi/full/10.1080/10413200.2016.1272650">interviewed elite athletes about exceptional performances</a>, a Mount Everest climber described how:</p>
<blockquote>
<p>I was just thinking, ‘Oh I’ll just see how it goes and take it as it comes.’ I climbed higher and higher and the climb had got more and more engrossing and difficult and all-encompassing really […] until I discovered that I’d climbed like 40 metres without consciously knowing what I was doing.</p>
</blockquote>
<p>Open goals don’t just work for elite athletes – they work well in exercise too. <a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029219305874">One study</a> found insufficiently active people performed better (in this study that meant they walked further) when pursuing open goals than they did with SMART goals. </p>
<p>The fitness industry is already starting to use open goals. For example, the <a href="https://www.lesmills.com/fit-planet/health/goal-setting/">Les Mills</a> fitness brand now recommends open goals (“to see how active you can be”), and the <a href="https://support.apple.com/en-au/guide/watch/apd673ee7114/watchos">Apple Watch</a> now incorporates open goals as a workout option. </p>
<h2>Psychological benefits of open goals</h2>
<p>Open goals aren’t just good for performance — they’re also much more psychologically beneficial than SMART goals. </p>
<p>Indeed, the elite athletes who first reported open goals described how they were an important part of experiencing <a href="https://www.youtube.com/watch?v=fXIeFJCqsPs">flow</a> – the enjoyable, rewarding state when everything just seems to click into place and we perform well without even needing to think about it. </p>
<p><a href="https://www.sciencedirect.com/science/article/abs/pii/S1469029219305874">Follow-up studies</a> found open goals – compared to SMART goals — make walking more enjoyable, make people more confident and make them feel they performed better. That boosts motivation and suggests open goals can help people stick with exercise routines longer. </p>
<p>One participant said open goals “took away the trauma of failing”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman goes walking in a field." src="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368154/original/file-20201108-13-p23toq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Open goals aren’t just good for performance - they are also much more psychologically beneficial than SMART goals.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Why do open goals work differently to SMART goals?</h2>
<p>There’s another important difference between open and SMART goals. When you set a SMART goal, you’re identifying something <em>in the future</em> you want to achieve (“I want to be able to walk 10,000 steps every day”). </p>
<p>So pursuing SMART goals is about reducing the gap between where you are now and where you want to get to – you’re always lagging behind where you want to be. That can make it feel like your progress is slow, and <a href="https://www.researchgate.net/profile/Charles_Carver/publication/232551850_Origins_and_Functions_of_Positive_and_Negative_Affect_A_Control-Process_View/links/56606c5f08ae4931cd5977dd.pdf">slow progress doesn’t feel good</a>. </p>
<p>When you set an open goal, your focus is on your starting point. If your goal is to “see how many steps I can reach today”, then as your step count rises, it will feel like you’re making progress. You may start to think, “Oh, I’m already on 2,000 steps… Now it’s 3,000 steps… Let’s see how many I can get to.” </p>
<p>Rather than comparing against where you <em>should</em> be, you’re constantly building on your starting point. </p>
<p>That makes the process much more positive - and <a href="https://academic.oup.com/abm/article-abstract/49/5/715/4562772">the more positive we feel</a> during exercise, the more we’ll want to do it again and again.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man runs on a treadmill" src="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/368156/original/file-20201108-19-annyjj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When you set an open goal, your focus is on your starting point, from which you can only build and make progress.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>To set your own open goals, think first about what you want to improve (for example “being more active”). Then identify what you want to measure, such as your daily average step count. </p>
<p>Phrase your goal in an open-ended, exploratory way: “I want to see how high I can get my average daily step count by the end of the year.” </p>
<p>And then get started! With an open goal, you’re more likely to see progress, enjoy the experience, and stick with it until you’re ready to set — and achieve — more specific goals.</p><img src="https://counter.theconversation.com/content/149172/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Christian Swann has a consultancy role with Movember, and is a member of the British Association of Sport and Exercise Sciences, Exercise and Sports Science Australia, and the Australasian Society for Physical Activity. </span></em></p>You might feel you’ve failed after ‘only’ recording 9,000 steps when your goal was 10,000. In reality, 9,000 steps might be an achievement. Is it time to ditch specific goals in favour of open goals?Christian Swann, Associate Professor in Psychology, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1353222020-04-07T05:10:03Z2020-04-07T05:10:03ZFor older people and those with chronic health conditions, staying active at home is extra important – here’s how<figure><img src="https://images.theconversation.com/files/325571/original/file-20200406-103690-v927kb.jpg?ixlib=rb-1.1.0&rect=0%2C26%2C5955%2C3946&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Fitbit recently released data showing a global decrease in <a href="https://blog.fitbit.com/covid-19-global-activity/">physical activity levels</a> among users of its activity trackers compared to the same time last year.</p>
<p>As we navigate the coronavirus pandemic, this is not altogether surprising. We’re getting less of the “incidental exercise” we normally get from going about our day-to-day activities, and many of our routine exercise options have been curtailed.</p>
<p>While we don’t know for sure how long our lifestyles will be affected in this way, we do know periods of <a href="https://www.sciencedirect.com/science/article/pii/S0140673612610319">reduced physical activity</a> can affect our health. </p>
<p>Older people and those with chronic conditions are <a href="https://www.ncbi.nlm.nih.gov/pubmed/32020713">particularly at risk</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-stay-fit-and-active-at-home-during-the-coronavirus-self-isolation-134044">How to stay fit and active at home during the coronavirus self-isolation</a>
</strong>
</em>
</p>
<hr>
<h2>Cardiorespiratory fitness</h2>
<p>To understand why the consequences of inactivity could be worse for some people, it’s first important to understand the concept of cardiorespiratory fitness. </p>
<p>Cardiorespiratory fitness provides <a href="https://pubmed.ncbi.nlm.nih.gov/18006574/">an indication</a> of our overall health. It tells us how effectively different systems in our body are working together, for example how the lungs and heart transport oxygen to the muscles during activity.</p>
<p>The amount of physical activity we do influences our cardiorespiratory fitness, along with our age. Cardiorespiratory fitness generally peaks in our 20s and then steadily declines <a href="https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.545459">as we get older</a>. If we’re inactive, our cardiorespiratory fitness <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972744/">will decline</a> more quickly.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325572/original/file-20200406-74261-5e5890.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As we get older, our cardiorespiratory fitness declines.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>One <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041046">study</a> looked at five young healthy men who were confined to bed rest for three weeks. On average, their cardiorespiratory fitness decreased 27% over this relatively short period.</p>
<p>These same men were tested <a href="https://www.ahajournals.org/doi/full/10.1161/circ.104.12.1350">30 years later</a>. Notably, three decades of normal ageing had less effect on cardiorespiratory fitness (11% reduction) than three weeks of bed rest. </p>
<p>This study demonstrates even relatively short periods of inactivity can rapidly age the cardiorespiratory system.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-ways-nutrition-could-help-your-immune-system-fight-off-the-coronavirus-133356">5 ways nutrition could help your immune system fight off the coronavirus</a>
</strong>
</em>
</p>
<hr>
<p>But the news isn’t all bad. Resuming physical activity after periods of inactivity can <a href="https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.041046">restore cardiorespiratory fitness</a>, while being <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379873/">physically active</a> can slow the decline in cardiorespiratory fitness associated with normal ageing.</p>
<h2>Staying active at home</h2>
<p>Generally, we know older adults and people with chronic health conditions (such as heart disease or type 2 diabetes) have <a href="https://www.ahajournals.org/doi/full/10.1161/circulationaha.105.545459">lower cardiorespiratory fitness</a> compared to younger active adults.</p>
<p>This can heighten the risk of <a href="https://pubmed.ncbi.nlm.nih.gov/10546694/">health issues</a> like another heart disease event or stroke, and admission to hospital.</p>
<p>While many older people and those with chronic health conditions have been encouraged to stay home during the COVID-19 pandemic, it’s still possible for this group to remain physically active. Here are some tips:</p>
<ol>
<li><p>set a regular time to exercise each day, such as when you wake up or before having lunch, so it becomes routine</p></li>
<li><p>aim to accumulate 30 minutes of exercise on most if not all days. This doesn’t have to all be done at once but could be spread across the day (for example, in three ten-minute sessions)</p></li>
<li><p>use your phone to track your activity. See how many steps you do in a “typical” day during social distancing, then try to increase that number by 100 steps per day. You should aim for at least 5,000 steps a day</p></li>
<li><p>take any opportunity to get in some activity throughout the day. Take the stairs if you can, or walk around the house while talking on the phone</p></li>
<li><p>try to minimise prolonged periods of sedentary time by getting up and moving at least every 30 minutes, for example during the TV ad breaks</p></li>
<li><p>incorporate additional activity into your day through housework and gardening.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-older-people-more-at-risk-of-coronavirus-133770">Why are older people more at risk of coronavirus?</a>
</strong>
</em>
</p>
<hr>
<h2>A sample home exercise program</h2>
<p>First, put on appropriate footwear (runners) to minimise any potential knee, ankle or foot injuries. Also ensure you have a water bottle close by to stay hydrated. </p>
<p>It may be useful to have a chair or bench nearby in case you run into any balance issues during the exercises. </p>
<ul>
<li><p>Start with five minutes of gentle warm up such as a leisurely walk around the back garden or walking up and down the hallway or stairs</p></li>
<li><p>then pick up the pace a little for another ten minutes of cardio – such as brisk walking, or skipping or marching on the spot if space is limited. You should work at an intensity that makes you huff and puff, but at which you could still hold a short conversation with someone next to you</p></li>
</ul>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=666&fit=crop&dpr=1 600w, https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=666&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=666&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=837&fit=crop&dpr=1 754w, https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=837&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/325962/original/file-20200407-74220-1juwgdl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=837&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<ul>
<li><p>next, complete a circuit program. This means doing one set of <a href="https://baker.edu.au/health-hub/keep-it-moving">six to eight exercises</a> (such as squats, push ups, step ups, bicep curls or calf raises) and then repeating the circuit three times</p>
<ul>
<li>these exercises can be done mainly using your own body weight, or for some exercises you can use dumbbells or substitutes such as bottles of water or cans of soup</li>
<li>start with as many repetitions as you can manage and work up to 10-15 repetitions of each exercise</li>
<li>perform each exercise at a controlled tempo (for example, take two seconds to squat down and two seconds to stand up again)</li>
</ul></li>
<li><p>finish with five minutes of gentle cool down similar to your warm up.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/every-cancer-patient-should-be-prescribed-exercise-medicine-95440">Every cancer patient should be prescribed exercise medicine</a>
</strong>
</em>
</p>
<hr>
<p>If you have diabetes, check your blood sugar levels before, during and after you exercise, and avoid injecting insulin into exercising limbs. </p>
<p>If you have a heart condition, it’s important to warm up and cool down properly and take adequate rests (about 45 seconds) after you complete the total repetitions for each exercise. </p>
<p>For people with cancer, consider your current health status before you start exercising, as cancers and associated treatments may affect your ability to perform some activities.</p><img src="https://counter.theconversation.com/content/135322/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Climie receives funding from the Heart Foundation. </span></em></p><p class="fine-print"><em><span>Erin Howden receives funding from the Heart Foundation. </span></em></p>We’ve got 6 tips and a tailored exercise program to help you keep active at home during the coronavirus pandemic.Rachel Climie, Exercise Physiologist and Research Fellow, Baker Heart and Diabetes InstituteErin Howden, Group Leader, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1241322019-10-17T12:00:49Z2019-10-17T12:00:49ZEven short periods of physical inactivity are damaging to our health<figure><img src="https://images.theconversation.com/files/297467/original/file-20191017-98666-flejxd.jpg?ixlib=rb-1.1.0&rect=22%2C11%2C7527%2C5025&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">That two-week beach vacation you've been dreaming of could have long-term effects on your health. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-asian-adult-men-traveler-casual-1428130970?src=3LXUOFrilv26pLU_zD1g8w-1-1">PVStudio/ Shutterstock</a></span></figcaption></figure><p>As a society, we aren’t getting as much exercise as we should. In fact, <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">current activity guidelines</a> state that adults should get at least 150 minutes of moderately intense activity – or 75 minutes of vigorous activity – every week. But <a href="https://www.who.int/news-room/fact-sheets/detail/physical-activity">research has found</a> that one in four adults <a href="https://theconversation.com/qanda-how-often-do-we-need-to-go-to-the-gym-and-other-exercise-questions-answered-74094">aren’t active enough</a>.</p>
<p>It’s easy to see why. Many of us drive to work instead of walking – and for those of us who work desk jobs, many are often so focused on what we’re doing we rarely get up from our desks except to visit the bathroom or get a drink. In short, though we might be busy, we aren’t moving very much. But after dealing with the stress of work week after week, it’s easy to daydream about unwinding on a warm beach, doing nothing but lounge around for a fortnight. But this might not be what our bodies need. In fact, it might actually be more harmful than we realise. </p>
<p><a href="https://link.springer.com/article/10.1007/s00125-018-4603-5">Our research</a> looked at what effect even short periods of physical inactivity had on our bodies. We found that even just two weeks of low activity actually increased participants’ risk of later developing serious health conditions such as cardiovascular disease.</p>
<h2>Keeping active</h2>
<p>We know that physical activity is good for us. This is irrefutable, and we’ve known this for a long time. As far back as the 1950s, the link between day-to-day physical activity and health was first identified in the <a href="http://www.epi.umn.edu/cvdepi/study-synopsis/london-transport-workers-study/">London transport workers study</a>. </p>
<p>The study found that bus drivers were more likely to experience a heart attack compared to their bus conductor counterparts. The main difference between these two groups was that conductors spent their working day on their feet collecting fares from commuters, while bus drivers spent their days sitting down.</p>
<p>Since then, some have branded physical activity a “<a href="https://www.bmj.com/content/366/bmj.l5605">miracle cure</a>” for cardiovascular risk. Yet, as a society, we are <a href="https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-obesity-physical-activity-and-diet/statistics-on-obesity-physical-activity-and-diet-england-2019/part-5-adult-physical-activity">more sedentary than ever</a>, and cardiovascular-related deaths remain the <a href="https://www.bhf.org.uk/what-we-do/our-research/heart-statistics">leading cause of death worldwide</a>.</p>
<p>While we know that having a physically active lifestyle will improve our health, surely we aren’t doing any additional harm, even if we choose not to be physically active? We decided to examine exactly what the harmful effects of being physically inactive are.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/qanda-how-often-do-we-need-to-go-to-the-gym-and-other-exercise-questions-answered-74094">Q&A: How often do we need to go to the gym? (And other exercise questions answered)</a>
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</em>
</p>
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<p>For our study, we recruited young (aged 18-50 years), healthy weight (BMI less than 30), physically active individuals (meaning that they take more than 10,000 steps per day on average). After carrying out assessments to measure blood vessel health, body composition and blood sugar control, we asked them to become inactive for two weeks.</p>
<p>To achieve this, participants were provided with a step counter and asked not to exceed 1,500 steps per day, which equates to approximately two laps of a full sized football pitch. After two weeks, we reassessed their blood vessel health, body composition and blood sugar control to examine what effects two weeks of inactivity had on them. We then asked them to resume their usual routine and behaviours. Two weeks after resuming their normal daily lifestyles, we checked participants’ health markers to see if they’d returned to where they were when they’d started the trial. </p>
<p>Our group of participants successfully reduced their step count by an average of around 10,000 steps per day and, in doing so, increased their waking sedentary time by an average of 103 minutes per day. Artery function decreased following this two-week period of relative inactivity, but returned to their normal levels after two weeks following their usual lifestyles.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297471/original/file-20191017-156314-1g3jhc3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Decreased artery function is an early sign of cardiovascular disease.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/red-blood-cells-artery-flow-inside-622603862?src=k_quBz_JsosPSfw3akzkbw-4-26">Rost9/ Shutterstock</a></span>
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<p>We were interested in seeing how activity levels influenced blood vessel health, since this is where most cardiovascular disease starts. Most of us don’t realise that our blood vessels are a complex system. They’re lined with muscle and constantly adapt to our needs by dilating (opening) and constricting (closing) to distribute blood where it’s most needed. For example, during exercise vessels feeding organs such as the stomach will constrict, as it is inactive at this time, and so blood is redistributed to our working muscles to fuel movement. One of the earliest detectable signs of cardiovascular risk is a reduced function of this dilatory capacity.</p>
<p>To measure this, we used an imaging technique called <a href="https://academic.oup.com/eurheartj/article-abstract/40/30/2534/5519997">flow-mediated dilation</a> or FMD. FMD measures how well the arteries dilate and constrict, and it has been found to predict our future cardiovascular risk.</p>
<h2>Heart health</h2>
<p>We found that after as little as two weeks of inactivity there was a reduction in artery function. This indicates the start of cardiovascular disease development as a result of being inactive. We also observed an increase in traditional risk factors, such as body fat, waist circumference, fitness and diabetes markers, including liver fat, and insulin sensitivity. </p>
<p>Something we also observed – which we initially weren’t researching – was that resuming normal activity levels following two weeks of being physically inactive was below baseline. That is to say, our participants did not return back to normal within two weeks of completing the intervention. </p>
<p>This is interesting to consider, especially regarding the potential longer-term effects of acute physical inactivity. In real-world terms, acute physical inactivity could mean a bout of flu or a two-week beach holiday – anything that can have a potential longer-term effect on our usual habits and behaviour.</p>
<p>These results show us that we need to make changes to public health messages and emphasise the harmful effect of even short-term physical inactivity. Small alterations to daily living can have a significant impact on health – positively, or negatively. People should be encouraged to increase their physical activity levels, in any way possible. Simply increasing daily physical activity can have measurable benefits. This could include having a ten-minute walk during your lunch hour, standing from your desk on an hourly basis to break up sitting time or parking your car at the back of the supermarket car park to get more steps in.</p>
<p>The impact of spending a large proportion of the day being inactive has received a lot of research in recent years. In fact, it has become a hot point of <a href="https://www.nhs.uk/news/lifestyle-and-exercise/lack-of-exercise-as-deadly-as-smoking/">discussion among exercise scientists</a>. As technology advances and our lives become increasingly geared towards convenience, it’s important this kind of research continues. </p>
<p>The health consequences of sedentary behaviour are severe and numerous. Moving more in everyday life could be key in improving your overall health.</p><img src="https://counter.theconversation.com/content/124132/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tori Sprung receives funding from Diabetes UK.</span></em></p><p class="fine-print"><em><span>Kelly Bowden Davies receives funding from Novo Nordisk UK Research Foundation. </span></em></p>Moving daily is essential to keeping ourselves healthy.Tori Sprung, Senior Lecturer in Sport & Exercise Sciences, Liverpool John Moores UniversityKelly Bowden Davies, Teaching Fellow in Sport and Exercise Science, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1090792019-02-06T02:02:25Z2019-02-06T02:02:25ZHealth Check: do we really need to take 10,000 steps a day?<figure><img src="https://images.theconversation.com/files/256976/original/file-20190204-193226-1dq99ek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Walking has a variety of health benefits.</span> <span class="attribution"><span class="source">From shutterstock.com</span></span></figcaption></figure><p>Regular walking produces many health benefits, including reducing our risk of <a href="https://www.ncbi.nlm.nih.gov/pubmed/10961960">heart disease</a>, <a href="https://www.ahajournals.org/doi/full/10.1161/ATVBAHA.112.300878">type 2 diabetes</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1755296612000099">depression</a>.</p>
<p>Best of all, it’s free, we can do it anywhere and, for most of us, it’s <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/Lookup/4177.0Main+Features12013-14?OpenDocument">relatively easy</a> to fit into our daily routines.</p>
<p>We often hear 10,000 as the golden number of steps to strive for in a day. But do we really need to take 10,000 steps a day?</p>
<p>Not necessarily. This figure was originally popularised as part of a marketing campaign, and has <a href="https://www.bbc.com/news/health-42864061">been subject to</a> some criticism. But if it gets you walking more, it might be a good goal to work towards. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-in-terms-of-exercise-is-walking-enough-78604">Health Check: in terms of exercise, is walking enough?</a>
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</em>
</p>
<hr>
<h2>Where did 10,000 come from?</h2>
<p>The 10,000 steps concept was <a href="https://link.springer.com/article/10.2165/00007256-200434010-00001">initially formulated</a> in Japan in the lead-up to the 1964 Tokyo Olympics. There was no real evidence to support this target. Rather, it was a marketing strategy to sell step counters.</p>
<p>There was very little interest in the idea until the turn of the century, when the concept was <a href="https://www.publish.csiro.au/HE/HE03095">revisited</a> by Australian health promotion researchers in 2001 to encourage people to be more active.</p>
<p>Based on accumulated evidence, many physical activity guidelines around the world – including the <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines">Australian guidelines</a> – recommend a minimum of 150 minutes of moderate intensity physical activity a week. This equates to 30 minutes on most days. A half hour of activity corresponds to about 3,000 to 4,000 dedicated steps at a moderate pace.</p>
<p>In Australia, the average adult accumulates about <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.004Chapter5002011-12">7,400</a> steps a day. So an additional 3,000 to 4,000 steps through dedicated walking will get you to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894114/">the 10,000 steps target</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-walking-your-dog-enough-100530">Are you walking your dog enough?</a>
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</em>
</p>
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<h2>One size doesn’t fit all</h2>
<p>Of course, some people accumulate a lot fewer steps per day – for example, older people, those with a chronic disease, and office workers. And others do a lot more: children, runners, and some blue-collar workers. So the 10,000 goal is not suitable for everyone.</p>
<p>Setting a lower individual step goal is fine as long as you try to add about 3,000 to 4,000 steps to your day. This means you will have done your 30 minutes of activity.</p>
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<img alt="" src="https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256977/original/file-20190204-193206-1yxjt0f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">People measure their daily steps using a variety of activity trackers.</span>
<span class="attribution"><span class="source">From shutterstock.com</span></span>
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<p>Studies that examine how the number of daily steps relates to health benefits have mainly been cross-sectional. This means they present a snapshot, and don’t look at how changes in steps affect people’s health over time. Therefore, what we call <a href="https://www.statisticshowto.datasciencecentral.com/reverse-causality">“reverse causality”</a> may occur. So rather than more steps leading to increased health benefits, being healthier may in fact lead to taking more steps. </p>
<p>Nonetheless, <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/s12966-014-0132-x">most studies</a> do find taking more steps is associated with better health outcomes.</p>
<p>Several studies have shown improved health outcomes even in participants who take less than 10,000 steps. An <a href="https://www.ajpmonline.org/article/S0749-3797(09)00394-8/fulltext">Australian study</a>, for example, found people who took more than 5,000 steps a day had a much lower risk of heart disease and stroke than those who took less than 5,000 steps.</p>
<p>Another study found that women who did 5,000 steps a day had a significantly <a href="https://journals.humankinetics.com/doi/abs/10.1123/jpah.9.8.1117">lower risk</a> of being overweight or having high blood pressure than those who did not.</p>
<h2>The more the better</h2>
<p>Many studies do, however, show a greater number of steps leads to increased health benefits. </p>
<p>An <a href="https://www.ajpmonline.org/article/S0749-3797(10)00206-0/fulltext">American study</a> from 2010 found a 10% reduction in the occurrence of metabolic syndrome (a collection of conditions that increase your risk of diabetes, heart disease and stroke) for each 1,000-step increase per day.</p>
<p>An <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141274">Australian study</a> from 2015 demonstrated that each 1,000-step increase per day reduced the risk of dying prematurely of any cause by 6%, with those taking 10,000 or more steps having a 46% lower risk of early death.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-faster-you-walk-the-better-for-long-term-health-especially-as-you-age-97175">The faster you walk, the better for long term health – especially as you age</a>
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<p>Another <a href="https://www.mja.com.au/journal/2017/206/3/daily-step-count-and-need-hospital-care-subsequent-years-community-based-sample">Australian study</a> from 2017 showed people with increasingly higher step counts spent less time in hospital.</p>
<p>So the bottom line is the more steps, the better.</p>
<h2>Step it up</h2>
<p>It’s important to recognise that no public health guideline is entirely appropriate for every person; public health messages are aimed at the population at large.</p>
<p>That being said, we shouldn’t underestimate the power of a simple public health message: 10,000 steps is an <a href="https://www.tandfonline.com/doi/pdf/10.1080/17437199.2015.1104258">easily remembered goal</a> and you can readily <a href="https://www.tandfonline.com/doi/abs/10.1080/02701367.2009.10599604">measure and assess your progress</a>. You can use an activity tracker, or follow your progress through a program such as <a href="https://www.10000steps.org.au">10,000 Steps Australia</a>. </p>
<p>Increasing your activity levels, through increasing your daily step count, is worthwhile; even if 10,000 steps is not the right goal for you. The most important thing is being as active as you can. Striving for 10,000 steps is just one way of doing this.</p><img src="https://counter.theconversation.com/content/109079/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Corneel Vandelanotte receives funding from Queensland Health for maintaining the 10,000 Steps Australia program. He also receives funding from the National Health and Medical Research Council, the Australian Research Council and the National Heart Foundation of Australia. </span></em></p><p class="fine-print"><em><span>Kerry Mummery received funding from Queensland Health for the funding of 10,000 Steps Rockhampton and the dissemination of the 10,000 Steps program across Australia and beyond. He has previously received research funding from the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC). More recently he has received funding from Alberta Health to support the development of the UWALK physical activity promotion program.</span></em></p><p class="fine-print"><em><span>Mitch Duncan has received funding from the Queensland Government for the 10,000 Steps Australia program. He has previously received funding from the Queensland Government and Diabetes Australia. He currently receives funding from the National Health and Medical Research Council, National Heart Foundation, Australian Research Council</span></em></p><p class="fine-print"><em><span>Wendy Brown received funding from Queensland Health to develop the first whole community 10,000 Steps intervention in Rockhampton in 2002. </span></em></p>Many of us are programmed to aim for 10,000 steps a day. This target is not right for everyone – but we can all benefit from setting step goals to increase our activity.Corneel Vandelanotte, Professorial Research Fellow: Physical Activity and Health, CQUniversity AustraliaKerry Mummery, Dean, Faculty of Kinesiology, Sport and Recreation, University of AlbertaMitch Duncan, University of NewcastleWendy Brown, Professor of Human Movement Studies, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1027092018-12-11T01:56:08Z2018-12-11T01:56:08ZHow much physical activity should teenagers do, and how can they get enough?<figure><img src="https://images.theconversation.com/files/249839/original/file-20181210-76983-mvjfb9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Teenagers should try to include a combination of aerobic activities (swimming or walking), strength training (sit ups or weight training) and flexibility training (yoga or stretching).</span> <span class="attribution"><span class="source">www.shutterstock.com</span></span></figcaption></figure><p>Many teenagers spend a lot of time being sedentary (sitting or lying down) at school or work, when travelling and during their free time. Modern conveniences such as smart phones, computers and food delivered to your front door encourage sedentary behaviour. But this lack of physical activity can have negative consequences for your physical and mental health. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-physical-activity-in-australian-schools-can-help-prevent-depression-in-young-people-107889">How physical activity in Australian schools can help prevent depression in young people</a>
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<p>We have all probably been told we have to exercise to stay healthy, but how much physical activity is the right amount for teenagers? And what are the benefits?</p>
<h2>How much and why?</h2>
<p>All Australians aged 13-17 are encouraged to do <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apa1317">60 minutes</a> of physical activity each day. There are <a href="http://www.getmoving.tas.gov.au/__data/assets/pdf_file/0019/263134/PA_guidelines_13-17yrs.PDF">numerous benefits</a> of physical activity, including physical (improved fitness and decreased risk of illness), social (having fun with friends) and emotional (helps manage stress and anxiety) benefits.</p>
<p>You should try to include a combination of aerobic activities (such as swimming or walking), strength training (such as sit ups or weight training) and flexibility training (such as yoga or stretching). </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249838/original/file-20181210-76971-y7213a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Try to include a mix of different types of exercise in your routine.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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</figure>
<p>Try to mix up easy, moderate, and harder activities that are both fun and personally challenging. Limiting sitting time and screen time by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3542098/pdf/1479-5868-10-1.pdf">regularly interrupting</a> periods of sedentary behaviour is another good idea. For example, standing and moving for a few minutes after every hour of sitting.</p>
<p>There are 1,440 minutes in every day, so being physically active for just 60 minutes is easily achievable.</p>
<h2>Planned activities</h2>
<p>There are hundreds of types of physical activities you could do. The most important thing is to do activities you enjoy, because you’ll be more likely to keep doing them. <a href="https://academic.oup.com/jpepsy/article/34/2/217/924953">Research</a> also suggests you’ll be more likely to be physically active if you exercise with your friends. </p>
<p>Doing a Google search for your location and activity (for example, “swimming clubs near me”) will help you find heaps of clubs and groups you can join up to keep active with your friends, and find new friends with similar interests. Check out some of the types of planned physical activities you can participate in, in the diagram below and challenge yourself to try something new. </p>
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<p><iframe id="WrVlx" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/WrVlx/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
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<p>Technology can be both good and bad when it comes to physical activity. Smart phones and computers contribute to sedentary behaviour, but they can also be used to promote and encourage physical activity behaviours. There are numerous <a href="https://campaigns.health.gov.au/girlsmove/mobile-apps">mobile apps</a> that can help motivate you to increase your physical activity. Getting a pedometer or smart watch could also help motivate you to do the recommend minimum of <a href="https://www.10000steps.org.au/">10,000 steps</a> a day.</p>
<h2>Incidental activity</h2>
<p>Another way you can increase your physical activity is to increase the activity you do throughout the day. Incidental activity refers to any movement that increases your level of daily activity. These activities don’t happen at the gym, but instead rely on your daily choices.</p>
<p>For example, office workers are often told to get more activity into their day by doing things such as parking further away from work and walking the rest of the way, and using the stairs instead of the lift. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/249841/original/file-20181210-76989-lret5p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Walking the family pet is a good option to work physical activity into your daily routine.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Similarly, you could:</p>
<ul>
<li> <a href="https://hercanberra.com.au/cpactive/eight-reasons-ride-walk-school-2018">walk or ride to school</a> instead of taking a car or bus</li>
<li> walk around the oval as you chat to your friends at lunchtime instead of sitting </li>
<li> do something active when you meet up with your friends on the weekend, such as swimming at the beach</li>
<li> do an extra lap when you go to the shopping centre and/or, go down every aisle when you go to the supermarket</li>
<li> at family gatherings, play games with your younger siblings and cousins rather than playing on your phone</li>
<li> <a href="https://theconversation.com/are-you-walking-your-dog-enough-100530">take your dog for a walk</a> and a play at the park more often</li>
<li> ride an exercise bike or do some stretching while you watch TV </li>
<li> have “active ads” where you do something active – such as push ups or body weight squats – every time a commercial comes on</li>
<li> playing exergames like Nintendo Wii can be better than just sitting on the couch.</li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/exergames-good-for-play-time-but-should-not-replace-physical-education-83954">Exergames: good for play time, but should not replace physical education</a>
</strong>
</em>
</p>
<hr>
<p>Making these simple choices each day can <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/ejsp.674">become a habit</a> that increases your physical activity and improves your health. Incidental activity doesn’t replace planned exercise, but all the activity you do during the day adds up, and these two forms of activity can work together to increase your physical activity level. </p>
<p>Incidental activity requires no special equipment or preparation. You can just stand up and move at any time you choose. Remember: something is better than nothing and more is better than less.</p><img src="https://counter.theconversation.com/content/102709/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>All Australians aged 13-17 are encouraged to do 60 minutes of physical activity a day.Vaughan Cruickshank, Program Director – Health and Physical Education, Maths/Science, Faculty of Education, University of TasmaniaCasey Peter Mainsbridge, Lecturer in Health and Physical Education, Director of Student Engagement School of Education, University of TasmaniaKira Patterson, Lecturer in Health Pedagogy, University of TasmaniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1016402018-09-24T12:13:13Z2018-09-24T12:13:13ZI ran 100 miles in a day – this is what happened to my body<figure><img src="https://images.theconversation.com/files/237172/original/file-20180919-146148-w65d8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="license">Author provided</span></span></figcaption></figure><p>The marathon race has long been considered the ultimate test of human endurance. But the last few decades have seen growing numbers of runners regularly tackling distances exceeding the traditional marathon. So-called “ultra-marathon runners” contest races from 35 miles (56km) to 100 miles (160km) – and occasionally further – in a single stage. </p>
<p>I began my ultra-marathon journey about ten years ago, but only recently made a second attempt at the elusive 100 miles, after the first was scuppered by my running buddy who, at 83 miles, exclaimed he could no longer see.</p>
<p>This time I chose to venture 100 miles along the North Downs Way. This is a public trail stretching from Farnham in the Surrey hills to Ashford in Kent, with a moderate cumulative climb of 10,000 feet. Traversing the course in its entirety would eventually take me 26 hours and around 215,000 steps.</p>
<p>Before I could attempt the challenge, there was the small task of preparing – physically and mentally – for its diverse and numerous demands. From a marathon running base, I prepared for about six months – training eight times a week. This comprised five to six runs of varying distance on varying terrain, accumulating upwards of 50-60 miles per week. I also incorporated strength sessions to develop my general robustness, and to prepare for the undulating trail.</p>
<p>High mileage training can drain the body of vital nutrients, and so my nutrition had to be comprehensive and targeted. I prioritised my daily protein requirements (140g per day), and ate a lot of fruit and vegetables. Carbohydrates in the diet can be manipulated to promote <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4008803/">endurance adaptation</a> - like my ability to burn fat as an energy source - so I moderated my intake and aligned it to my daily needs. As the weeks and months passed, my physiology changed, and I became stronger, fitter, and leaner. </p>
<h2>Gut instinct</h2>
<p>According to my heart rate monitor, reaching the finish line cost me 11,000 calories. From the very beginning of the race, my muscles exhibited an unrelenting hunger for energy, and satisfying the demand meant eating 200-400 calories per hour – which became increasingly difficult as the race progressed. </p>
<p>With my body’s blood supply channelled to the exercising muscles – and away from the gut – my digestive system began to shutdown at around the 60 mile mark. When this happens, the food you eat empties more slowly from the stomach. It sits and stews in the gut causing symptoms of gastrointestinal (GI) distress – including stomach cramps, nausea, and sickness. These symptoms <a href="https://www.ncbi.nlm.nih.gov/pubmed/12480801">increase with race distance</a>, and are an often cited reason for non-completion of a race. </p>
<p>My symptoms were intensified by plummeting blood sugar levels, caused by an inability to eat or drink – a vicious circle. I arrived at the 60 mile feed station and vehemently force fed myself before moving on. But in 30ºC heat, around 35% of the competitors would eventually succumb to GI distress or dehydration. Will can only take you so far. </p>
<h2>Permanent damage?</h2>
<p>I was also at risk of significantly damaging my muscles and joints. When running an undulating trail, it’s actually the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1332286/">downhill sections</a> that cause the most damage, because the muscles are lengthening under load. As you fight to slow your descent against the force of gravity, your muscle fibres literally tear at the microscopic level, causing markers of cellular damage to accumulate in the blood. This peripheral fatigue causes a paradox – you begin looking forward to the uphill sections.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=276&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=276&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=276&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=346&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=346&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237063/original/file-20180919-158237-425nq0.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=346&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">What does running 100 miles look like?</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>But there’s more to muscle damage than superficial discomfort. It also causes a generalised inflammatory response in the body, triggering a transient suppression of the body’s immune system. This, in turn, is thought to increase the incidence of <a href="https://www.ajol.info/index.php/sasma/article/view/31850">upper respiratory tract infection</a>. It’s not uncommon to develop a runny nose, cough, and sore throat in the days or weeks following a race, as did I within one week of the hundred.</p>
<p>There’s also the risk of trips and falls, magnified by growing fatigue and sleep deprivation. My friend Caroline ran with me for 75 miles, endured the worst of the physiological strain, only to take a tumble in the dark and crack her leg on a rock jutting from the ground, forcing her to retire.</p>
<h2>Heart problems</h2>
<p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538475/">emerging research</a> to suggest that long-term participation in ultra-marathons can increase the risk of cardiovascular complications. My research colleague Scott Chiesa, of the UCL Institute of Cardiovascular Science, explains:</p>
<blockquote>
<p>The severity of ultra-endurance exercise might result in long-term adaptations that are more commonly linked to disease. These include structural and functional changes in the heart and blood vessels, electrical changes in the cardiac nerves, and possible damage to the heart tissue.</p>
</blockquote>
<p>I finished the race with a “sprint” along the final 100 metres. Within 30 minutes my legs had completely seized, and I was quickly reduced to the painful protracted shuffle that would be my norm for the next three to four days. It took close to a month before I felt “normal” again. </p>
<p>Research has shown that most participants approach ultra-marathons as a means of <a href="https://www.jstage.jst.go.jp/article/jshhe1931/72/1/72_1_15/_article">personal accomplishment</a> – despite its popularity as a competitive sport. For me, the physical and mental hardship were worth the trouble, and I feel proud and content with what I achieved. Of course, participation is not without its risks – but the greater the adversity the greater the reward.</p><img src="https://counter.theconversation.com/content/101640/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas B. Tiller does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An ultra-marathon runner and exercise physiologist describes what it’s like to take part in an ultra-endurance event, and the consequences it had on his body.Nicholas B. Tiller, Associate Professor in Applied Physiology, Sheffield Hallam UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1013872018-08-16T20:19:17Z2018-08-16T20:19:17ZTen habits of people who lose weight and keep it off<figure><img src="https://images.theconversation.com/files/231815/original/file-20180814-2918-190hxzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Before you go for seconds after your meal, have a glass of water and wait five minutes before checking in with your hunger again.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><a href="https://www.nature.com/articles/0803015">Most people who diet</a> will regain 50% of the lost weight in the first year after losing it. Much of the rest will regain it in the following three years.</p>
<p>Most people inherently know that keeping a healthy weight boils down to three things: eating healthy, eating less, and being active. But actually doing that can be tough. </p>
<p>We make <a href="http://journals.sagepub.com/doi/abs/10.1177/0013916506295573">more than 200 food decisions a day</a>, and most of these appear to be automatic or habitual, which means we <a href="https://www.ncbi.nlm.nih.gov/pubmed/22682656">unconsciously eat without reflection</a>, deliberation or any sense of awareness of what or how much food we select and consume. So often <a href="https://www.ncbi.nlm.nih.gov/pubmed/17678574">habitual behaviours override</a> our best intentions. </p>
<p>A <a href="https://www.nature.com/articles/s41366-018-0067-4">new study</a> has found the key to staying a healthy weight is to reinforce healthy habits. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-youre-on-a-diet-is-half-the-problem-heres-how-to-be-a-mindful-eater-99207">Thinking you're 'on a diet' is half the problem – here's how to be a mindful eater</a>
</strong>
</em>
</p>
<hr>
<h2>What the new study found</h2>
<p>Imagine each time a person goes home in the evening, they eat a snack. When they first eat the snack, a mental link is formed between the context (getting home) and their response to that context (eating a snack). Every time they subsequently snack in response to getting home, this link strengthens, to the point that getting home prompts them to eat a snack automatically. This is how a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505409/">habit forms</a>.</p>
<p><a href="https://www.nature.com/articles/s41366-018-0067-4">New research has found</a> weight-loss interventions that are founded on habit-change, (forming new habits or breaking old habits) may be effective at helping people lose weight and keep it off.</p>
<p>We recruited 75 volunteers from the community (aged 18-75) with excess weight or obesity and randomised them into three groups. One program promoted breaking old habits, one promoted forming new habits, and one group was a control (no intervention).</p>
<p>The habit-breaking group was sent a text message with a different task to perform every day. These tasks were focused on breaking usual routines and included things such as “drive a different way to work today”, “listen to a new genre of music” or “write a short story”.</p>
<p>The habit-forming group was asked to follow a program that focused on forming habits centred around healthy lifestyle changes. The group was encouraged to incorporate ten healthy tips into their daily routine, so they became second-nature.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/231817/original/file-20180814-2906-toz1kq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you start to snack each day when you get home from work, you’ll form a habit that requires you to do so in that context every day.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Unlike usual weight-loss programs, these interventions did not prescribe specific diet plans or exercise regimes, they simply aimed to change small daily habits.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-are-fasting-diets-and-do-they-help-you-lose-weight-76644">What are 'fasting' diets and do they help you lose weight?</a>
</strong>
</em>
</p>
<hr>
<p>After 12 weeks, the habit-forming and habit-breaking participants had lost an average of 3.1kg. More importantly, after 12 months of no intervention and no contact, they had lost another 2.1kg on average. </p>
<p>Some 67% of participants reduced their total body weight by over 5%, decreasing their overall risk for developing type two diabetes and heart disease. As well as losing weight, most participants also increased their fruit and vegetable intake and improved their mental health.</p>
<p><a href="http://www.academia.edu/2987691/A_new_behavioural_intervention_for_tackling_obesity">Habit-based interventions</a> have the potential to change how we think about weight management and, importantly, how we behave.</p>
<h2>Ten healthy habits you should form</h2>
<p>The <a href="http://www.weightconcern.org.uk/node/11">habits</a> in the habit-forming group, developed by Weight Concern (a UK charity) were:</p>
<ol>
<li><p>keep to a meal routine: eat at roughly the same times each day. <a href="https://www.nature.com/articles/0802530">People who succeed at long term weight loss</a> tend to have a regular meal rhythm (avoidance of snacking and nibbling). A consistent diet regimen across the week and year also <a href="https://www.ncbi.nlm.nih.gov/pubmed/14647183">predicts subsequent long-term weight loss</a> maintenance</p></li>
<li><p>go for healthy fats: choose to eat healthy fats from nuts, avocado and oily fish instead of fast food. Trans-fats are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3955571/">linked to an increased risk</a> of heart-disease</p></li>
<li><p>walk off the weight: aim for 10,000 steps a day. Take the stairs and get off one tram stop earlier to ensure you’re getting your heart rate up every day</p></li>
<li><p>pack healthy snacks when you go out: swap crisps and biscuits for fresh fruit</p></li>
<li><p>always look at the labels: check the fat, sugar and salt content on food labels </p></li>
<li><p>caution with your portions: use smaller plates, and drink a glass of water and wait five minutes then check in with your hunger before going back for seconds</p></li>
<li><p>break up sitting time: decreasing sedentary time and increasing activity is <a href="http://webarchive.nationalarchives.gov.uk/+/http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4080994">linked to substantial health benefits</a>. Time spent sedentary is related to excess weight and obesity, independent of physical activity level</p></li>
<li><p>think about your drinks: choose water and limit fruit juice to one small glass per day</p></li>
<li><p>focus on your food: slow down and eat while sitting at the table, not on the go. Internal cues regulating food intake (hunger/fullness signals) may not be as effective while distracted</p></li>
<li><p>always aim for five serves of vegetables a day, whether fresh, frozen or tinned: fruit and vegetables have high nutritional quality and low energy density. Eating the recommended amount produces health benefits, including <a href="https://www.nhs.uk/live-well/eat-well/why-5-a-day/">reduction in the risk</a> of cancer and coronary heart disease.</p></li>
</ol>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-the-best-diet-for-weight-loss-21557">Health Check: what's the best diet for weight loss?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/101387/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gina Cleo does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A new study has found breaking old and forming new habits is key in keeping weight off.Gina Cleo, Research Fellow, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/844252017-09-28T23:13:15Z2017-09-28T23:13:15ZHow to stop sitting yourself to death<figure><img src="https://images.theconversation.com/files/187902/original/file-20170927-20330-1fkp19r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When we sit, we accumulate calories and excess fat which can cause obesity, diabetes, cancer, heart disease and death. The solution may be as simple as counting.
</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Sitting is probably killing you slowly — whether you exercise vigorously every day or not. Sitting has been referred to as <a href="http://www.techrepublic.com/article/is-sitting-really-the-new-smoking-an-in-depth-discussion-with-the-experts/">the new smoking</a>. And a recent study shows that <a href="http://annals.org/aim/article/2653704/patterns-sedentary-behavior-mortality-u-s-middle-aged-older-adults">risk of death begins to rise if bouts of sitting persist for longer than 10 minutes</a> at a time.</p>
<p>How do we reverse this evolutionary trend towards laziness? This question preoccupies me, as a cardiologist and a senior scientist with the Toronto Rehabilitation Institute and University Health Network. In my clinical practice, I make certain that patients receive appropriate medical therapies to improve their quality of life and longevity. But physical activity is one therapy I cannot prescribe as effectively. </p>
<p>One solution is to think of physical activity as a “pill.” As with other medical prescriptions, this “pill” requires a preparation, a quantity and a strength. </p>
<p>To know how much to take, we must monitor our behaviours. We must count the number of minutes per week we embark on moderate to vigorous physical activity. We must count the number of hours per day we remain sedentary and count the number of minutes we remain sitting at any one point in time. </p>
<h2>What’s wrong with sitting anyway?</h2>
<p>We know that physical inactivity has significant adverse implications to our health. <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31634-3/fulltext">A recent study</a> examining more than 130,000 patients from more than 17 countries worldwide estimated that one in 12 deaths could be prevented if everyone exercised 30 minutes per day, five days per week at just moderate intensity. </p>
<p>Exercise prevents many chronic diseases, including heart attacks, strokes, diabetes and cancer. It <a href="https://www.ncbi.nlm.nih.gov/pubmed/2795824">improves our cardiopulmonary fitness levels</a> — a measure of how efficiently our oxygen is extracted from our blood into our organs and tissues throughout our body — and is linked closely to our overall health and survival.</p>
<p>Now evidence suggests that our <em>sitting times</em> and sedentary behaviour also have important impacts on health, irrespective of physical activity levels. For example, <a href="https://www.ncbi.nlm.nih.gov/pubmed/25599350">a recent review by our team</a> found that sedentary times of six to nine hours or more per day are associated with a higher risk of death, cancer and cardiovascular disease. The greatest risks are linked to type II diabetes. In this study, moderate physical activity only partially reduced, but did not eliminate, the risks. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/187903/original/file-20170927-5909-1utgh3f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A new generation of smartwatches allows people to count their steps and count their minutes of sedentary activity, as well as measuring heart rate and sleep quality.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The <em>duration</em> we sit at any one time may also count against our health. Patients who sit for prolonged periods burn fewer calories than those who stand or move frequently throughout the day. Insufficient calorie expenditures may result in excessive fat, which may be <a href="https://insights.ovid.com/crossref?an=00003677-900000000-99797">toxic to our metabolism</a>. Such toxicity can <a href="https://www.ncbi.nlm.nih.gov/pubmed/17987311">give rise to chronic diseases</a> such as obesity, diabetes, cancer, heart disease and death. </p>
<p>In sum, while moderate to vigorous physical activity may improve our fitness levels, sedentary behaviour may accumulate calories and fat. <a href="http://circ.ahajournals.org/content/134/13/e262">Each behaviour affects our health and survival</a> in different ways. </p>
<h2>Laziness: A new evolutionary trend?</h2>
<p>As humans, we are primed to move. One needs only to look at babies and toddlers who, once they have acquired the motor development skills to crawl and walk, rarely keep still. To explore their environment, they need to move through space. </p>
<p>Then, at some point, a child becomes more sedentary. Perhaps through their first exposure to TV, their first video game or Internet search, children realize that their quest for self-discovery need not involve movement. The seeds of the disease known as physical inactivity are planted, with devastating <a href="http://www.cps.ca/en/documents/position/screen-time-and-young-children">physical and psychosocial health impacts</a>. Parents may offer little treatment to their children, for they too have been inflicted.</p>
<p>Of course, things weren’t always this way. From an evolutionary perspective, we were once hunters and gatherers. This necessitated high amounts of physical activity throughout the day just to procure water and food for survival. It has been estimated that between one third and one quarter of the total energy consumed by our ancestors was burned through physical activity. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/187904/original/file-20170927-24162-13oxe2j.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One 2012 Canadian study found that children who watched just an hour of TV per day were 50 per cent more likely to be overweight than those who watched less.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Contemporary humans <a href="https://books.google.ca/books?hl=en&lr=&id=uMohwgMMrBgC&oi=fnd&pg=PA49&dq=evolution%3B+calorie%3B+ancestors+vs.+contemporaries%3B+physical+activity&ots=IhvDLBb9IF&sig=fFcIhFogBNH1GNj4x1AYZhFuCOA#v=onepage&q&f=false">burn a much smaller component of their total energy</a> through physical activity. Even when compared against highly agricultural societies, the physical activity levels of most adults pale by comparison. For example, one study demonstrated that average daily steps taken in the U.S. population are <a href="https://www.ncbi.nlm.nih.gov/pubmed/20980470">less than half of that among older order Amish communities</a>.</p>
<p>Perhaps not surprisingly, the decline in physical activity levels over the last several decades has come from <a href="https://www.ncbi.nlm.nih.gov/pubmed/24658411">non-recreational physical activity</a>, i.e. work. Most alarming has been the dramatic reduction in physical activity among youth and adolescents. </p>
<p>If this evolutionary trend continues, we are looking at a bleak future.</p>
<h2>Counting can help you survive</h2>
<p>How to reverse this trend? Well, assuming that optimal health requires patients to both undertake moderate to vigorous physical activity and avoid excessive sedentary behaviour, solutions seem rather intuitive. Move more, and sit less. </p>
<p>To avoid sitting yourself to death, you can follow some simple strategies:</p>
<ol>
<li><p><strong>Take frequent standing or walking breaks.</strong></p></li>
<li><p><strong>Limit sitting episodes to under 30 minutes (particularly at work).</strong></p></li>
<li><p><strong>Take 10,000 steps or more per day.</strong></p></li>
<li><p><strong>Engage in 150 minutes of moderate to vigorous physical activity per week.</strong></p></li>
<li><p><strong>Engage in resistance (strength) training two days per week.</strong></p></li>
</ol>
<p>Strength training improves muscle mass and resting metabolism, minimizes weight gain and helps prevent osteoporosis.</p>
<p>While humans are primed to move, urbanization, technology and societal norms have resulted in our physical stagnation. We have become sedentary, physically inactive creatures. And the solution may be as simple as counting. </p>
<p>As I sit here, I am reminded by my cellphone alarm that my 30 minutes of uninterrupted sitting must come to an end. My writing of this article must cease. I ask my nine year old to stop playing video games and to join me for a few minutes of catch outside. He reluctantly agrees, and proceeds by asking Alexa to turn off his TV on his behalf. </p>
<p>Oh well, at least it’s a start.</p><img src="https://counter.theconversation.com/content/84425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. David Alter has received external funding, as part of a research grant from the Heart and Stroke Foundation of Canada. He is also a Research Chair in Cardiovascular and metabolic rehabilitation, Toronto Rehabilitation Institute-University Health Network.</span></em></p>If you sit all day at work, then cancer, diabetes, heart disease and death are the likely outcomes. A cardiologist explains how the simple act of counting can reverse this evolutionary trend.David Alter, Associate Professor of Medicine and Senior Scientist, Toronto Rehabilitation Institute, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/715542017-02-19T19:10:37Z2017-02-19T19:10:37ZNew study shows more time walking means less time in hospital<figure><img src="https://images.theconversation.com/files/153371/original/image-20170119-26582-llr8vc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If all the over-55s got walking, we could save almost $2 billion in health care costs each year.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>In my practice as a GP, I have been impressed by a few energetic and active 80 year olds who remain in good health while many their age have succumbed to various chronic diseases. So in 2005, when the University of Newcastle established a <a href="http://ije.oxfordjournals.org/content/39/6/1452.extract?sid=e7cb7279-d503-43c0-ae54-e3291c8e9887">large community based health study</a> of people aged 55 to 80, I made sure we recorded the participants’ physical activity in detail. </p>
<p>A decade later, we can report the influence of physical activity on the need for hospital care as published in the <a href="https://www.mja.com.au/">Medical Journal of Australia</a> today.</p>
<p>We used pedometers to record daily step counts, giving a much more precise measure of activity than the usual self-report questionnaires. Median daily step counts ranged from 8,600 in the youngest to 3,800 in those over 80 years, and weekend days had on average 620 fewer steps than weekdays.</p>
<p>The inactive people (taking 4,500 steps per day) averaged 0.97 days of hospital care per year. The more active people (taking 8,800 steps per day) needed only 0.68 days of care per year. In our analysis we adjusted for the effects of age, sex, the number of illnesses people had when they started, smoking, alcohol intake and education. </p>
<p>We wondered if the causation might be running the opposite direction. That is, that sick people walk less rather than activity preventing illness. To test this idea, we repeated the analysis ignoring all hospital admissions in the first two years of follow up to remove the immediate effects of serious illness. The difference is shown in the graph below.</p>
<iframe src="https://datawrapper.dwcdn.net/IXblF/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="370"></iframe>
<p>The association extends right across the range of activity levels, showing any activity is good for health, and the more the better. The participants in our study wore the pedometers from morning until night, so a lot of what we recorded as steps was general activity around the house or the workplace, not necessarily continuous walking. <a href="http://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2212264">Recent research</a> shows any that activity is better than sitting down, so even light activity is protective of health. Pedometers don’t capture swimming or cycling accurately, but these things make up a small part of daily activity.</p>
<p>Looking at why these patients were in hospital, more active people had fewer admissions for cancer and diabetes, but surprisingly, there was no difference for heart disease. We suspect that might be due to a gap in the data for heart admissions to private hospitals for a few of the years.</p>
<h2>What if everyone got walking?</h2>
<p>The difference of 0.29 hospital days per year between the inactive and active people is about a 30% reduction. Does this mean if we could get everyone in the population taking 8,800 steps per day we could shut a third of all hospital beds, and send a third of all doctors and nurses off to practice their golf swing? Unfortunately not.</p>
<p>It turns out our study sample is a rather healthy lot, requiring less hospital care than the average for their age. Compared to our average value of less than one day per year of hospital care, figures from the <a href="http://www.aihw.gov.au/haag12-13/admitted-patient-care/">Australian Institute of Health and Welfare</a> for 2014-15 show Australians between 55 and 85 years required 14.2 million days of hospital care, or 2.65 bed days per person.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=258&fit=crop&dpr=1 600w, https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=258&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=258&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=324&fit=crop&dpr=1 754w, https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=324&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/153377/original/image-20170119-26567-gbkyro.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=324&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Getting in 40 minutes of walking a day would reap big rewards in overall health.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Whether increasing activity would be of more or less benefit across the whole of the Australian population is unclear. It may be that the general population would have even more to gain from physical activity than our study participants, or it may be that they have serious chronic diseases that make increased activity impossible.</p>
<p>Let’s imagine for a moment that something changes the walking habits of all Australians, so everyone is walking at least 8,800 steps per day – maybe a combination of a Fitbit craze and an oil shortage that sends petrol to A$10 a litre. What effect would this have on health services? </p>
<p>Considering only the people aged over 55, at a minimum it would reduce the need for hospitalisation by 975,000 bed days per year, for a saving of $1.7 billion dollars. Given there are health benefits at other ages, and the less healthy Australians not represented in our study could benefit more, the actual benefit is likely to be even greater.</p>
<p>An extra 4300 steps per day is not much. It’s just 40 minutes walking, which might include going to the shops, picking up kids, or taking the stairs at work. It doesn’t have to be “exercise”, although higher intensity activity for those who enjoy it has <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apaadult">greater health benefits</a>.</p>
<p>With governments searching for ways to reduce spending, and <a href="http://www.budget.gov.au/2016-17/content/bp1/html/bp1_bs5-01.htm">16% of the federal budget</a> being spent on health, <a href="http://www.thelancet.com/series/urban-design">tackling physical inactivity</a> of individual patients, as well as ensuring our urban centres are walking- and cycling-friendly would make a major difference.</p><img src="https://counter.theconversation.com/content/71554/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Ewald has received funding from NH&MRC to conduct research promoting physical activity, and is a member of the group Doctors for the Environment Australia.
</span></em></p>Walking has been proven to reduce the risk of heart disease, bowel and breast cancers, osteoporosis and diabetes. New data shows it also reduces the need for hospital care.Ben Ewald, Senior Lecturer, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/524962016-02-15T03:19:14Z2016-02-15T03:19:14ZHealth Check: six tips for losing weight without fad diets<figure><img src="https://images.theconversation.com/files/111426/original/image-20160215-22545-mfzgan.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Don't limit yourself to grapefruit – increasing the amount and variety of fruit and vegetables can help you lose weight.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/danzen/4283381883/">Dan Zen/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Monday – start diet. Tuesday – break diet! Wednesday – plan to start again next Monday. </p>
<p>If this is you, it’s probably time to get off the diet roller coaster and make some bigger changes to the way you eat, drink and think about food. </p>
<p>Here are six tips to help you get started. </p>
<h2>1. Improve your diet quality score</h2>
<p>When trying to lose weight, it might be tempting to quit carbs, dairy or another food group altogether. </p>
<p>But to stay healthy, you need to meet your requirements for important nutrients like iron, zinc, calcium, vitamins B and C, folate and fibre. These nutrients are essential for metabolism, growth, repair and fighting disease. </p>
<p>Our review of diet quality indexes used to rate the healthiness of eating habits found that eating nutritious foods was <a href="http://link.springer.com/article/10.1007%2Fs13668-014-0115-1">associated with</a> lower weight gain <a href="http://www.ncbi.nlm.nih.gov/pubmed/26084363">over time</a>. </p>
<p>Improving your diet quality means <a href="https://www.eatforhealth.gov.au/">eating more</a> fruit and vegetables, lean meats, poultry, fish, eggs, tofu, nuts and seeds, legumes, dried beans, wholegrains and dairy (mostly reduced fat).</p>
<p>Rate your diet quality and get brief feedback using our online Healthy Eating Quiz <a href="http://healthyeatingquiz.com.au/">www.healthyeatingquiz.com.au</a>. </p>
<h2>2. Mum was right – eat your veggies</h2>
<p>Fruit and veg are high in fibre, vitamins and phytonutrients, but low in total kilojoules. So eating more can help you manage your weight.</p>
<p>A <a href="http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001878">study of more than 130,000 adults</a> found that those who increased their intake of fruit and vegetables over four years lost weight. For each extra daily serve of vegetables, there was a weight loss of 110 grams over the four years. It was 240 grams for fruit. Small, but it all adds up.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111432/original/image-20160215-22545-fth4vh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Not all vegetables are equal.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/michigancommunities/15168955986/">Michigan Municipal League/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-nd/4.0/">CC BY-NC-ND</a></span>
</figcaption>
</figure>
<p>Drilling down to specific fruit and veg gets interesting. Increasing cauliflower intake was associated with a four-year weight reduction of about 620 grams, with smaller reductions for capsicum (350g), green leafy vegetables (230g) and carrots (180g). The reduction was 620g for blueberries and 500g for apple or pears. </p>
<p>It was not good news all round, though. Corn was associated with a weight gain of 920g, peas 510g and mashed, baked or boiled potatoes 330g. </p>
<h2>3. Limit your portion size</h2>
<p>If you are served larger portions of food and drinks, you <a href="http://www.ncbi.nlm.nih.gov/pubmed/25033958">eat more</a> and consume more kilojoules. That sounds obvious, yet everybody gets caught out when offered big portions – even when you’re determined to stop when you’re full. </p>
<p>Research shows offering larger portions <a href="http://www.ncbi.nlm.nih.gov/pubmed/26368271">leads adults and children to consume</a> an extra 600 to 950 kilojoules (150-230 calories). This is enough to account for a weight gain of more than seven kilograms a year, if the kilojoules aren’t compensated for by doing more exercise or eating less later. </p>
<h2>4. Watch what you drink</h2>
<p>A can of softdrink contains about 600 kilojoules (150 calories). It takes 30-45 minutes to walk those kilojoules off, depending on your size and speed. </p>
<p>Children and adolescents who usually drink a lot sugary drinks are <a href="http://www.ncbi.nlm.nih.gov/pubmed/23763695">55% more likely</a> to be overweight. </p>
<p>Switch to lower sugar versions, water or diet drinks. A meta-analysis of intervention studies (ranging from ten weeks to eight months) found that adults who <a href="http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0051979/">switched</a> had a weight reduction of about 800 grams.</p>
<h2>5. Cue food</h2>
<p>Our world constantly cues us to eat and drink. Think food ads, vending machines and chocolate bars when trying to pay for petrol or groceries. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26644270">Food cues trigger</a> cravings, prompt eating, predict weight gain and are hard to resist. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26640451">They can make you feel hungry</a> even if you are not. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=398&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=398&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=398&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=500&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=500&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111427/original/image-20160215-22550-m6du1d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=500&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ditch the oily popcorn and take your own snacks.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/rpb1001/257368762/">rpb1001/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Try to minimise the time you spend in highly cued food environments. Avoid food courts, take a list when you go to the supermarket and take your own snacks to places where highly palatable food is advertised, like the movies. </p>
<p>This will reduce autopilot eating, which sabotages your willpower. </p>
<h2>6. Resist temptation</h2>
<p>A treatment for food cue reactivity is called <a href="http://www.ncbi.nlm.nih.gov/pubmed/26649466">exposure therapy</a>. With the help of a psychologist or health professional, you <a href="http://www.ncbi.nlm.nih.gov/pubmed/26640451">expose yourself</a> to the sight and smell of favourite foods in locations that commonly trigger overeating, like eating chocolate when watching TV. But, rather than eat the chocolate, you only have a taste <em>without eating</em> it. </p>
<p>Over time, and with persistence, cravings for chocolate reduce, even when cues such as TV ads or people eating chocolate in front of you are present. </p>
<p>You can also draw on your brain’s own self-management skills to resist temptation, but it takes conscious practice. Try this food cue acronym, RROAR (remind, resist, organised alternative, remember and/or reward), to train your brain to resist temptation on autopilot. </p>
<p>When you feel yourself pulled by cues to eat or drink:</p>
<ul>
<li><p><strong>R</strong>emind yourself that you are the boss of you, not a food cue.</p></li>
<li><p><strong>R</strong>esist the tempting food or drink initially by turning your back on the cue. (This gives you time to think about next steps.) </p></li>
<li><p>Have a pre- <strong>O</strong>rganised** A**lternative behaviour to use against food cues. Grab a drink of water, walk around the block, check your phone messages, read, take a walk in the opposite direction. <a href="http://www.ncbi.nlm.nih.gov/pubmed/26375358">Diversion works</a>.</p></li>
<li><p><strong>R</strong>emember what your big-picture goal is. Do you want to eat better to help you feel better, reduce medications, lower blood pressure, improve diabetes control or manage your weight? </p></li>
</ul>
<p>You can add another <strong>R</strong> for** R**eward. <a href="http://www.ncbi.nlm.nih.gov/pubmed/25843244">Financial incentives help change behaviour</a>. Each time you complete your <em>organised alternative</em> behaviour put $1 in a jar. When it builds up, spend it on something you really want. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/111433/original/image-20160215-22545-5usmb5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Swap to small plates to reduce your portion sizes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/booleansplit/3335103177/">Robert S. Donovan/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<h2>You need a plan</h2>
<p>The journey off the diet roller coaster needs a cunning plan. Here’s how you can put it all together. </p>
<ol>
<li><p>Start by <a href="http://healthyeatingquiz.com.au/">assessing your diet quality</a> using the Healthy Eating Quiz. </p></li>
<li><p>Next, plan weekly meals, drinks and snacks. Write a grocery list and buy extra fruit and vegetables.</p></li>
<li><p>Swap to small plates, cups and serving utensils. You’ll serve and eat less without thinking. </p></li>
<li><p>Aim for half your plate covered with vegetables and salad, one-quarter lean protein (trimmed meat, chicken, fish, legumes) and one-quarter grains or starchy vegetables (potato, peas, corn). </p></li>
<li><p>Change your food environment to avoid constant prompts to eat.</p></li>
<li><p>Minimise the places you allow yourself to eat and drink to reduce food cue exposure (not in front of TV or computer, at a desk, or in the car). </p></li>
<li><p>Keep food out of sight (unless it is fruit and vegetables). Store in opaque containers. </p></li>
<li><p>Remove workplace food displays, such as food fundraisers. </p></li>
<li><p>Plan driving and walking routes that do <em>not</em> take you past fast-food outlets or vending machines. </p></li>
<li><p>Prerecord TV shows and fast-forward food ads.</p></li>
</ol><img src="https://counter.theconversation.com/content/52496/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins is affiliated with the Priority Research Centre in Physical Activity and Nutrition, the University of Newcastle, NSW. She created the online Healthy Eating Quiz and Australian Eating Survey. She has received funding from a range of research grants including NHMRC, ARC, Hunter Medical Research Institute, Meat and Livestock Australia. She has consulted to SHINE Australia and Novo Nordisk. Clare Collins is a spokesperson for the Dietitians Association of Australia on specific nutrition issues, including Australia's Healthy Weight Week. </span></em></p>Monday – start diet. Tuesday – break diet! Wednesday – plan to start again next Monday. Sound familiar?Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/474632015-09-13T13:58:31Z2015-09-13T13:58:31ZWhy walking to improve your health is not quite as straightforward as it seems<figure><img src="https://images.theconversation.com/files/94575/original/image-20150913-19819-1a9817s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Getting the public walking</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/56705607@N00/8690966966/in/photolist-eeTPbp-eeTuWe-eeZH11-eeZhn9-eeTBpt-eeZR6d-eeTRrB-eeTrVM-eeU1Kr-eeU6sx-eeU8XR-eeTTDn-eeTC4g-eeZwqw-eeTyui-eeZdTG-eeZBuq-eeTHSZ-eeZLDS-eeZtG3-eeTCNx-eeZjH9-eeZkub-eeZTDQ-eeTH7D-eeZiV7-5qxxri-5jegCv-5jegCt-6ux18h-a1af6C-5jegCr-7BkxgT-5jPhRW-5APJLz-5AU55u-5APPNt-5AU3ds-5APKbt-5AU5Rm-5AU42f-5APMLZ-5APJXn-5APLRa-5AU1Hj-5AU4vJ-5AU46A-5APNWZ-5APNga-5APNk8">Blake Handley/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The US Surgeon General last week issued another call to <a href="http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/exec-summary.html">action</a> to get his nation walking. Faced with the fact that 50% of the US adult population (a statistic replicated in other western countries) suffers from chronic disease or cancer, he has argued that any increase in activity is going to bring significant public health benefits. Walking represents one of the easiest and most effective ways of achieving this goal.</p>
<figure>
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</figure>
<h2>Getting people walking has proved a challenge</h2>
<p>Although this sounds fairly easy in principle, getting people to do more exercise through walking is something that has been at the heart of public health policy in a major form since the publication of<a href="http://health.gov/paguidelines/guidelines/">physical activity guidelines</a> in 2008. These guidelines advocated at least 2.5 hours a week of moderate intensity physical activity, such as brisk walking. This target is echoed by the UK’s <a href="http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx">physical activity guidelines</a> and those in <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines#apaadult">Australia</a>.</p>
<p>The potential benefits in terms of improved public health are clear, if you consider <a href="http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/call-to-action-walking-and-walkable-communites.pdf">that only</a> 54% of adult men and 46% of adult women in the US meet the physical activity goal. Worse still, 28% or men and 32% of women reported that they had not done any physical activity that lasted more than 10 minutes in the previous week of being asked.</p>
<h2>Getting people walking at the right level of intensity is even harder</h2>
<p>Getting people to walk the minimum amount of time is a major challenge. The even bigger challenge comes with the part of the advice that is often ignored or simply not known or understood. In order for their to be a health benefit, the pace at which the walking is done needs to be above a certain intensity. </p>
<p>Although not specifically mentioned in the US Surgeon General’s “Step it Up” programme to promote walking, wearables such as those from Jawbone, Fitbit and others, are one way of tracking the number of steps walked in a day. For most users of these devices, the focus is on getting to the magical 10,000 steps a day. This isn’t really the best target to use however as to achieve the intensity guidelines to achieve a health benefit, it is only the steps that were above a certain pace that count.</p>
<h2>How activity intensity is measured</h2>
<p>To measure activity intensity, a measure called the <a href="https://en.wikipedia.org/wiki/Metabolic_equivalent">Metabolic Equivalent</a>, or MET, is used. 1 MET is the rate of energy consumed by a person at rest (or watching television for example). Moderate intensity activity is <a href="http://health.gov/paguidelines/guidelines/appendix1.aspx">defined</a> as activity that is between 3 - 5.9 METs of energy expenditure. This in turn equates to walking at a pace of 4.8 km per hour (3 miles per hour).</p>
<p>Devices like those from Fitbit track activities at, or above, this level activity as “active minutes”. The target is set at 30 minutes a day and is <a href="https://help.fitbit.com/articles/en_US/Help_article/What-are-very-active-minutes/">recorded</a> only if the wearer does more than 10 minutes at this intensity. </p>
<p>The accuracy of wearables to estimate METs is improved if they have a heart rate monitor built in. </p>
<h2>Recommended activity using METs</h2>
<p>It has been <a href="http://health.gov/paguidelines/guidelines/appendix1.aspx">recommended</a> that a person does between 500 to 1,000 MET-minutes a week to get health benefits. The argument goes that the more METs are expended, the greater the benefit. The recommendations of 2.5 hours a week only gets the walker to the bottom of this range and so theoretically, doing 5 “active” hours of walking would be better. </p>
<p>However, there may be <a href="http://www.researchgate.net/publication/236047642_How_Many_Steps_Are_Enough_Dose-Response_Curves_for_Pedometer_Steps_and_Multiple_Health_Markers_in_a_Community-Based_Sample_of_Older_Australians">evidence</a> that not all health benefits actually do respond to increased levels of activity in a “linear” fashion. In other words, some benefits may plateau after a certain level of activity.</p>
<h2>The problem with the evidence</h2>
<p>The problem with a large amount of the research done in the area of health benefits of walking is that it has been done using surveys and self-reporting which is notoriously inaccurate. Very few studies have been conducted using the “randomised controlled trial” approach to this type of scientific investigation using objective measures of activity that even consumer wearables can now provide. </p>
<p>As at least the US Surgeon General has made clear in his <a href="http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/call-to-action-walking-and-walkable-communites.pdf">call to action</a>, much more research is needed. Not only to make the evidence for the exact nature of the benefits clear, but also to investigate how people can be persuaded to start and stick with a programme of walking to achieve the recommended amounts of exercise. Although walking results in fewer injuries than say, running, it is not completely free of risk and so this is another area that requires more research.</p>
<h2>In the meantime</h2>
<p>In the meantime, if you have a Fitbit (or other wearable), concentrate on the active minute target and less on the number of steps. Aim to get between 2.5 and 5 hours of active walking done a week. If you don’t have a wearable pedometer, <a href="http://www.cdc.gov/physicalactivity/basics/measuring/">another way</a> of measuring the right level of intensity when walking is that you should have enough breath to be able to talk to someone but not be able to sing.</p><img src="https://counter.theconversation.com/content/47463/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>David Glance works in the area of promoting activity using wearables and also owns shares in Fitbit.</span></em></p>The US Surgeon General last week issued another call to action to get his nation walking. Faced with the fact that 50% of the US adult population (a statistic replicated in other western countries) suffers…David Glance, Director of UWA Centre for Software Practice, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/434502015-06-19T12:18:33Z2015-06-19T12:18:33ZWhen it comes to Fitbit’s 10,000 steps, one size doesn’t fit all<figure><img src="https://images.theconversation.com/files/85714/original/image-20150619-3386-rpp1ad.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long walk to fitness</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The rise of wearable fitness technology is something of a paradox. The <a href="http://www.cnet.com/news/fitness-trackers-rise-and-fall/">surge in popularity</a> of devices that monitor the amount of exercise you do suggest more people than ever are interested in maintaining regular fitness regimes. Just witness the success of the company behind fitness tracking bracelet Fitbit, which investors have just deemed <a href="http://www.ft.com/cms/s/0/f4c51d3e-1543-11e5-9509-00144feabdc0.html">worth US$4.1bn</a> (£2.6bn) after it floated on the stock market. Yet this comes at a time when physical inactivity has reached levels of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3645500/pdf/nihms385288.pdf">global pandemic proportion</a>.</p>
<p>This shows how important it is that the public understand and follow science-based health and behaviour advice. The advantage of wearable fitness technology is that it can provide a way for personalised data to shape how much extra physical activity (including exercise) a person needs to do and when.</p>
<p>The <a href="http://www.nhs.uk/Livewell/loseweight/Pages/10000stepschallenge.aspx">well-publicised</a> recommendation to take “10,000 steps a day” is a perfect example. The <a href="https://books.google.co.uk/books?id=EQ3OxfuICAMC&pg=PP5&dq=Manpo-Kei:+The+Art+and+Science+of+Step+Counting+hatano&hl=en&sa=X&ei=YeKDVZr1KMP0UMr-lvgO&ved=0CCAQ6AEwAA#v=onepage&q=Manpo-Kei%3A%20The%20Art%20and%20Science%20of%20Step%20Counting%20hatano&f=false">figure actually originates</a> from Japanese walking clubs and a marketing slogan for pedometers more than 40 years ago. But step counts <a href="http://rubytec.eu/downloads/yamax/f-2004-m.pdf">have been shown</a> to provide a reliable measure of daily activity in healthy adults. They also provide a meaningful everyday metric that allows individuals to self-monitor their physical activity and walking.</p>
<p>The self-monitoring (observing and evaluating one’s behaviour) and goal setting that come with devices like Fitbit are two of the most complementary and potent ways of changing people’s physical activity behaviour. Combining activity trackers, which allow the wearer to observe their steps in real-time and review at their leisure, with goals such as <a href="http://her.oxfordjournals.org/content/26/2/372.full.pdf+html">walking 10,000 steps</a> can make people more motivated and more able to increase or maintain their physical activity levels.</p>
<h2>More is better</h2>
<p>But it is important to realise that 10,000 steps is not a magic threshold. Increasing our time spent walking, regardless of our starting point, is beneficial. At a population level, the biggest changes to health come from improvements at the lower end of the scale. For example, going from 2,000 steps to 4,000 steps will produce greater overall health benefits than going from 4,000 steps to 6,000 steps. At the same time, the <a href="http://www.cmaj.ca/content/174/6/801.full.pdf+html">more active we are</a> (or more steps we take) each day <a href="http://circ.ahajournals.org/content/124/7/789.full.pdf+html">the better</a>. So taking 6,000 steps a day is still better for your health than 4,000 steps.</p>
<p>With the emergence of a large number of activity trackers, a new challenge has emerged for the promotion of 10,000 steps. The <a href="http://www.health.utah.edu/peak/docs/Tudor%20Locke%20Paper.pdf">data behind the recommendation</a> was derived from pedometers which are conventionally worn on the hip. Today, manufacturers tend to produce devices for the wrist because they are more comfortable and convenient for self-monitoring. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85716/original/image-20150619-3347-1jfulp7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Step-by-step improvement.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>But devices worn on the extremities will pick up extra movement <a href="http://iopscience.iop.org/0967-3334/35/11/2191/pdf/0967-3334_35_11_2191.pdf">compared with hip-worn monitors</a>. That means they may miscount other large movements from daily life, such as sweeping the floor or doing the dishes, as steps. As a result, it is important for people to be aware that wrist-worn devices may inflate their daily step count.</p>
<p>In general, we should remember that, when it comes to physical activity, “some is good but more is better”. But we can also use step counters to tackle the problems of long periods of sedentary behaviour (sitting). For example, many of us will have particular times of the day (perhaps during work or during the evening) where we spend most of our time sitting. By continuing to accumulate steps during these periods we can simultaneously target reductions in our sitting time.</p>
<p>By monitoring our sitting behaviours alongside the aim of achieving 10,000 steps, we can start to break up these extensive sedentary periods with bouts of activity. Not only would we take more steps but also we would spend less time sitting for long periods. <a href="http://sites.garmin.com/en-US/vivo/vivofit/">Some fitness trackers</a> have started implementing this idea by prompting the wearer when they have been inactive for “too long”.</p>
<h2>Lifestyle medicine</h2>
<p>The difficulty with physical activity promotion is that one size doesn’t necessarily fit all. For individuals with health conditions that impact their ability to accumulate higher levels of physical activity, such as rheumatoid arthritis or severe respiratory impairment, it is likely to be more feasible to prescribe lower step-count targets to begin with.</p>
<p>People who spend a lot of time sitting during work, such as taxi drivers, will likely need to accumulate <a href="http://bit.ly/1Rfe1S5">higher step counts</a> to help compensate for the negative effects of prolonged sitting. This has contributed to the concept of “<a href="https://www.mja.com.au/system/files/issues/190_03_020209/egg10622_fm.pdf">lifestyle medicine</a>” (preventing and managing health conditions through lifestyle choices).</p>
<p>If we can get the message out that physical activity trackers need to be combined with this kind of individual goal setting, then we might see both increases in physical activity and reductions in sitting across populations.</p><img src="https://counter.theconversation.com/content/43450/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mark Orme does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fitness devices like Fitbit set an automatic goal of 10,000 steps a day. But this isn’t the magic threshold some make it out to be.Mark Orme, PhD Candidate, Loughborough UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/372862015-03-02T03:42:59Z2015-03-02T03:42:59ZHealth Check: how to exercise safely in the heat<figure><img src="https://images.theconversation.com/files/73121/original/image-20150226-1807-hzlmxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you're not regularly active, extreme exercise and exercise in extreme heat is unwise.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-239818048/stock-photo-tired-woman-runner-taking-a-rest-after-running-hard-in-countryside-road-sweaty-athlete-after.html?src=jQxMS54jYe8X9RUXRnMCdQ-3-127&ws=1">lzf/Shutterstock</a></span></figcaption></figure><p>Exercise alone can be hard, but exercising in the heat is a whole lot harder. Put simply, this is due to the balance between how much heat the body generates and how much it is capable of losing.</p>
<p>Human core body temperature typically remains around 36.5°C to 37°C, with small fluctuations across the day. Larger changes above 40°C can be dangerous. </p>
<p>Fortunately, humans are relatively well-adapted to dealing with the heat. One theory is that humans evolved a <a href="https://www.youtube.com/watch?v=826HMLoiE_o">survival advantage as hunters</a> because they could outlast animals that were less able to manage long periods of <a href="http://www.nature.com/nature/journal/v432/n7015/abs/nature03052.html">exertion under hot conditions</a>. </p>
<h2>How do we regulate our temperature?</h2>
<p><strong>1. Radiation:</strong> There are so many small blood vessels in the skin that, in total, they can receive up to 60% of output from the heart at rest. </p>
<p>As blood flows from the core of the body to the skin, opening of these small blood vessels allows more surface area for heat exchange with the environment. </p>
<p>Radiation of heat occurs when the surrounding environment is less hot than the skin surface. At rest in a cool environment, 60% of heat loss is by <a href="http://link.springer.com/article/10.1007/BF00596389">radiation</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=384&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=384&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=384&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=482&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=482&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73139/original/image-20150226-1814-1fsca4t.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=482&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-177791000/stock-vector-vector-illustration-of-diagram-of-human-skin-anatomy.html?src=_xkOoBHTHcJ67yFbZbDW-A-1-1&ws=1">stockshoppe/Shutterstock</a></span>
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</figure>
<p><strong>2. Evaporation:</strong> As core temperature rises, sweat glands in the skin are activated, promoting heat loss via the combined processes of <a href="https://theconversation.com/want-to-keep-cool-on-hot-summer-days-heres-how-34489">convection, conduction and evaporation</a>. </p>
<p>These forms of heat exchange become more important as heat production rises (such as during exercise), and as the environment becomes hotter and radiation less effective.</p>
<h2>Why is it so hard to exercise in the heat?</h2>
<p>Muscles that are active during exercise demand more energy and, consequently, increased blood supply and delivery of oxygen. This means the heart has to work harder to re-circulate blood to the active muscles. </p>
<p>Exercising muscles also generate heat, as a by-product of chemical reactions inside cells. This increases core body temperature which, if not compensated for, can compromise the ongoing function of the central nervous system and/or muscle cells themselves. </p>
<p>To lose heat, blood needs to be sent to the small arteries under the skin surface, so that heat transfer can take place via radiation. Sweating alone is relatively ineffective if this re-distribution of blood does not occur concurrently. </p>
<p>So when exercise occurs under circumstances where heat loss is challenged (because the gradient between skin and environmental temperatures is narrow), more blood needs to be directed to the skin at the same time as this blood is needed in the muscles to increase workload. </p>
<p>A competition therefore develops between the skin and working muscles for the limited maximal blood flow that the heart can manage.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73122/original/image-20150226-1819-l51osa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Acclimatisation can increase a person’s capacity to heat loss.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-201434165/stock-photo-man-fitness-runner-drinking-and-splashing-water-in-his-face-funny-image-of-handsome-male.html?src=jQxMS54jYe8X9RUXRnMCdQ-2-73&ws=1">Milles Studio/Shutterstock</a></span>
</figcaption>
</figure>
<p>Different theories explain fatigue (the point at which you cannot maintain exercise duration and/or intensity) as either the inability to sustain oxygen delivery to the muscle in the face of thermoregulatory demand, or an inability to control body and brain temperature during exercise in hot environments. </p>
<p>The causes of fatigue are of great interest to exercise scientists concerned with sport and workplace performance. We know that acclimation (the process of repeated exercise in hot conditions) can enhance an individual’s capacity for heat loss and, therefore, improve exercise performance and delay fatigue. </p>
<p>Several steps in the exercise and thermoregulatory chain are amenable to adaptations that improve performance, including enhanced <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3006409/">function</a> and <a href="http://www.ncbi.nlm.nih.gov/pubmed/21131471">structure</a> of the blood vessels, the function and size of the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240883/">heart</a> and even <a href="http://www.ncbi.nlm.nih.gov/pubmed/1798375">blood volume</a> itself.</p>
<h2>Who is at risk of heat stroke?</h2>
<p>Heat stroke is a serious illness and those most at risk include adults aged over 65 years, babies and young children, pregnant women, people with existing medical conditions and those on particular medications. Most obviously, those who already have heart problems are at particular risk. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/73137/original/image-20150226-1758-efnocd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older people are at greater risk of heat-related illness.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-141240130/stock-photo-portrait-an-elderly-woman.html?src=cQBoG_PFJsn_PXbyX5_qpQ-1-133&ws=1">De Visu/Shutterstock</a></span>
</figcaption>
</figure>
<p>Such is the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC192832/">risk of heat illness</a> that 10,000 excess deaths occurred during a heatwave in Europe in 2003. </p>
<p>In the Australian summer of 2009, hot conditions in Victoria and South Australia were linked with higher rates of illness and more than 200 extra deaths than would normally occur, particularly among the elderly and those with heart disease.</p>
<p>Early signs of heat exhaustion can include dizziness, headache and nausea. More severe cases of heat stroke involve hot dry skin with (paradoxically) no sweating, confusion and fainting.</p>
<p>Sports Medicine Australia has produced a <a href="http://sma.org.au/wp-content/uploads/2009/05/hot-weather-guidelines-web-download-doc-2007.pdf">helpful guide</a> to performance of sport or exercise in hot weather, which details the risk and symptoms of heat illness. </p>
<h2>What’s the best way to deal with the heat?</h2>
<p>For professional athletes, exercising in warm conditions can improve performance and is sometimes essential to prepare for different environmental conditions, such as preparing for an Olympic games in a hot country. </p>
<p>Regardless, it’s important to take precautions to reduce the likelihood of heat illness by staying hydrated, wearing appropriate clothing and knowing your limits.</p>
<p>For people who don’t exercise regularly or those who are at increased risk of heat-related illness, avoid exercising in the heat, such as the middle of the day in summer or rooms with poor air circulation. </p>
<p>Instead, opt for a prescribed, gradual and incremental exercise program that improves your cardiovascular and thermoregulatory tolerance. Gradual and repeated heat exposure, even in the absence of exercise, may also be <a href="http://www.ncbi.nlm.nih.gov/pubmed/25705824">good for your health</a>. </p>
<p>The good news is that even exercise in normal or cool conditions will improve thermoregulatory capacity and resilience under hot conditions. But if it’s out of the ordinary for you, extreme exercise or exercise in extremes, is equally unwise.</p><img src="https://counter.theconversation.com/content/37286/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Howard Carter receives funding from the National Heart Foundation of Australia.</span></em></p><p class="fine-print"><em><span>Daniel Green receives funding from the Australian Research Council, National Heath and Medical Research Council, National Heart Foundation of Australia.</span></em></p>Exercise alone can be hard, but exercising in the heat is a whole lot harder. Put simply, this is due to the balance between how much heat the body generates and how much it is capable of losing.Howard Carter, Research Associate, School of Sports Science, Exercise and Health, The University of Western AustraliaDaniel Green, Winthrop Professor, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/115872013-05-02T20:10:31Z2013-05-02T20:10:31ZYou don’t have to be the biggest loser to achieve weight loss success<figure><img src="https://images.theconversation.com/files/23015/original/n6jbpf8w-1367274953.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Losing just 5% of your body weight is likely to improve your health.</span> <span class="attribution"><span class="source">Image from shutterstock.com</span></span></figcaption></figure><p>Weight-loss ads and television shows regularly profile people who have transformed their lives through major losses of 30 kilograms or more. These weight-loss ambassadors try to inspire us to do the same by telling us they feel more alive, they can play with their kids and their confidence has grown – now they can fit into a size ten dress. </p>
<p>These messages are echoed by health promotion agencies that encourage us to fight the obesity epidemic – and the rise of chronic diseases – by achieving and maintaining a healthy weight.</p>
<p>Major weight loss certainly sounds like a good plan if you’re overweight or obese and serious about improving your health. But the reality is it’s incredibly difficult to lose 30 kg, and even if you do, it’s even harder to keep off in the long term. </p>
<p>Instead, international guidelines <a href="http://andevidencelibrary.com/files/Docs/WM%20Position%20Paper.pdf">commonly recommend</a> an initial weight loss target of 10% of your starting body weight. Australia’s National Health and Medical Research Council (NHMRC) draft <a href="http://consultations.nhmrc.gov.au/public_consultations/obesity-guidelines">guidelines for the management of overweight and obesity</a> recommend starting with a more modest weight loss goal of 5% or 5kg, whichever is higher.</p>
<p>For people who are overweight (with a <a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">body mass index</a> or BMI of 25 to 29) or have crossed over into obesity (with a BMI of 30 to 35), a 5% to 10% weight loss is enough to improve your health and reduce risk factors for chronic conditions such as type 2 diabetes and heart disease. After two years, your <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1796695/">risk of developing type 2 diabetes diabetes</a> will have halved. </p>
<p>Some heavier people who have a BMI over 30 may need to lose <a href="http://www.sign.ac.uk/guidelines/fulltext/115/">15% to 20% of their weight</a> to get the same improvement in risk profile.</p>
<h2>Managing expectations</h2>
<p>The strongest predictor of <a href="http://www.ncbi.nlm.nih.gov/pubmed/16339128">dropping out of a weight-loss program</a> is starting off with an expectation of losing a really large amount of weight. So, one of the practical problems in starting the weight-loss journey is that people rarely want to limit their weight loss to 5% of their starting weight. </p>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/16339128">This 2005 study of 1,785 obese Italians</a> is a good example. The group had a mean BMI of 38. Their maximum or “dream” weight loss goal was 32% of their starting body weight, and their minimum “acceptable” weight loss was 23%. </p>
<p>This weight loss expectation is five to six times more weight than is needed to improve their health, well-being and quality of life and to reduce their medication needs. </p>
<p>It’s therefore important for health professionals to manage their patients’ weight-loss expectations. Start with a goal of 10% of initial body weight and focus on health improvement, reductions in medication use and improved quality of life. Once this has been achieved, then you can revise the goals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=303&fit=crop&dpr=1 600w, https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=303&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=303&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=381&fit=crop&dpr=1 754w, https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=381&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/23034/original/g7p4ch7g-1367287296.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=381&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Aim to lose 5% of your starting body weight – and keep it off.</span>
<span class="attribution"><span class="source">Image from shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Losing weight and keeping it off</h2>
<p>The good news is that we now know a lot more about how to successfully maintain a reasonable weight loss. </p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/21779086">2011 study</a> of more than 5,000 Americans with existing type 2 diabetes found that almost one quarter had maintained a weight loss of 10% or more of their starting weight after four years. Importantly, success was associated with attending more treatment sessions, reporting greater adherence to the lower kilojoule diet and burning more kilojoules in physical activity.</p>
<p>A <a href="http://www.ncbi.nlm.nih.gov/pubmed/17904936">review of the long-term weight loss trials</a> found a mean weight loss of 3kg to 6kg (3% to 6%) was maintained in trials that extended to four years. </p>
<p>It’s important to note that participants regain some weight once treatment the ends. This is completely normal, and should be expected because as soon as you ease off on the kilojoule restriction or exercise routine needed for weight loss, your weight will creep back up. </p>
<p>Therefore, based on current research, the definition of successful long-term weight loss is being able to maintain a weight loss of 5% of your starting body weight for more than a year. </p>
<p>Bariatric surgery is the <a href="http://www.ncbi.nlm.nih.gov/pubmed/23235396">only intervention</a> where weight losses greater than 10% body weight have been maintained for 10 years or longer.</p>
<h2>Step by step weight loss</h2>
<p>Weight loss is never easy but a little common sense can go a long way in helping you achieve your goals. If you are planing to lose weight, here are some things to keep in mind:</p>
<ol>
<li><p>Clarify your reasons for weight loss and identify your “dream” weight versus your “acceptable” weight</p></li>
<li><p>Set an initial weight loss goal of 5% to 10% of your starting weight, to avoid triggering a drop out</p></li>
<li><p>Participate fully in your diet and exercise program. The more sessions you attend or the more entries you make in web programs, the more weight you lose</p></li>
<li><p><a href="http://www.ncbi.nlm.nih.gov/pubmed/22836690">Enlist the help</a> of a weight-loss professional such as a dietitian, or another person trying to lose weight</p></li>
<li><p>Self-monitor both your physical activity and eating habits to make sure there is an increase in the kilojoules you burn up in exercise and a decrease in your kilojoules intake</p></li>
<li><p>Hang in there – the <a href="http://ajcn.nutrition.org/content/82/1/222S.full">National Weight Control Registry</a> of people who have kept at least 13 kg off for five years report that it <em>does</em> get easier over time.</p></li>
</ol>
<p>Finally, long-term weight loss depends on long-term lifestyle changes. Being physically active each day, reducing your daily kilojoules intake, maintain healthy eating habits on weekends and holidays, and jumping on weight rebounds when they’re small will all increase your chance of success. </p><img src="https://counter.theconversation.com/content/11587/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Clare Collins has received funding for weight loss studies from ARC, NHMRC, HMRI, Heart Foundation, Coal & Allied and SP Health Co Pty Ltd. She is a consultant to Shine Australia who produce the Biggest Loser.</span></em></p>Weight-loss ads and television shows regularly profile people who have transformed their lives through major losses of 30 kilograms or more. These weight-loss ambassadors try to inspire us to do the same…Clare Collins, Professor in Nutrition and Dietetics, University of NewcastleLicensed as Creative Commons – attribution, no derivatives.