Time for action on fitness

The Covid-19 pandemic has had a mixed effect on the nation’s fitness regimes. As lockdown eases, how can pharmacy teams encourage customers to get back on track with their fitness goals?

Exercising once a day was one of the only reasons people were allowed to leave their homes during lockdown, and even then, choices were limited. Covid-19 saw the closure of sporting activities and facilities such as gyms and swimming pools, while home working for many meant losing the benefit of a walk on their daily commute.

Data from the British Psychological Society (BPS) shows that pre-Covid-19, more men (65 per cent) than women (61 per cent) met the World Health Organization’s (WHO) physical activity guidelines of 150 minutes of moderate to vigorous physical activity (MVPA) every week. 

At the other end of the spectrum, data from the Health Survey for England, published in December 2019, showed that approximately a quarter of UK adults were classified as inactive – considered to be less than 30 minutes MVPA per week. There was no real difference between men and women, with 26 per cent of men and 27 per cent of women being inactive. 

Although physical activity levels remained relatively stable over the pandemic period, according to the BPS, measures taken to contain Covid-19 have potentially led to reduced physical activity for those in vulnerable or clinically at-risk groups that were asked to shield, and young people who have missed out on their usual school-based activities. In addition, anecdotal evidence suggests that while some people were inspired to take up new sports and activities during the lockdown periods, others were left with less time or motivation to keep moving.

Mitigating risks

The health implications of physical inactivity account for up to eight per cent of non-communicable diseases and deaths across the world, including coronary heart disease, stroke, hypertension, type 2 diabetes and several cancers, according to recent research by Professor Peter Katzmarzyk from Pennington Biomedical Research Center in the USA.

In addition to the long-term negative health effects of physical inactivity, some people may have more immediate negative consequences. For example, older adults and those living with long-term conditions may experience deconditioning – a decline in muscle strength and bulk – due to a reduction in physical activity and mobility, which may exacerbate existing health inequalities and risks.

In order to mitigate these risks, in November 2020, the WHO launched a new global guideline on physical activity and sedentary behaviour, as well as highlighting what counts towards meeting these goals. These match UK public health guidance on the topic. 

The key recommendations for adults, including those living with long term conditions or disabilities at any age, are that individuals should:

• Aim to do 150-300 minutes of moderate intensity, or 75-150 minutes of vigorous-intensity physical activity, or some equivalent combination every week
• Undertake muscle-strengthening activity, such as weights or core conditioning, at moderate or greater intensity at least twice a week
• Older adults, aged 65 and over, should do physical activity that emphasises functional balance and strength training at moderate or greater intensity on three or more days a week to enhance functional capacity and prevent falls
• Women should do regular physical activity throughout pregnancy and after birth, including aerobic and muscle-strengthening activities.

The WHO guidelines also stress that it is not enough just to increase activity, but people also need to actively reduce sedentary behaviour and aim to exceed these weekly recommendations to offset the health harms of prolonged sitting. A high daily tally of sedentary time, defined as 10 or more hours, has been linked to a significantly heightened risk of death, particularly among people who are physically inactive. However, 30-40 minutes of MVPA per day substantially weakens this risk, bringing it down to levels associated with very low amounts of sedentary time.

Benefits of movement

The WHO emphasises that any amount of movement that expends energy is better for health than none. And it’s important to note that physical activity is about so much more than just sport. 

Moderate intensity physical activity is classed as anything that increases heart rate and induces a degree of breathlessness where it’s still possible to talk, such as brisk walking, dancing or raking up leaves. Vigorous intensity physical activity substantially increases heart and breathing rates, such as cycling, running, jogging, swimming or playing tennis, but it can also include carrying heavy objects, walking up the stairs, or digging the garden.

Physical activity also has psychological benefits. The BPS says that meeting the recommended physical activity guidelines can help to reduce the risk of poor mental health, and data from Sport England suggests that since Covid-19, 65 per cent of people have realised as much, now viewing physical activity as important for their mental health.

Preparation is key

New research by sports equipment retailer Decathlon also shows that 90 per cent of Brits want to pursue a fitness or health goal once Covid-19 restrictions have lifted, as 43 per cent say Covid-19 has made them realise the importance of their health, and 40 per cent admitted they have gained weight since the start of the pandemic. 

Whether those goals mean hitting the gym, or simply meeting friends for a walk, pharmacy teams are in the ideal position to encourage and support customers to get back to a form of exercise that suits their needs and ability, but it’s also worth reminding them to take things slowly at first. 

“With the re-opening of gyms, it can be easy for us to rush back into our pre-lockdown five-days-a-week gym routine,” says LloydsPharmacy pharmacist Anshu Kaura. “However, it’s vital that we ease our bodies back into it gently. We can’t expect our body to pick up those 15-kilogram weights straight away, so start off with smaller ones and work your way back up to that pre-lockdown weight you may be used to.”

It’s also important for people to take their individual health needs into account and adjust the intensity of exercise accordingly. “If you have back pain, for example, you should be very careful if doing any weight training, or do the exercise without weights,” says Anshu. “However, simple back stretches can actually help reduce pain and therefore is something to focus on.”

Back pain is a common health issue in the UK, manifesting itself in many ways. “One-third of the UK adult population experiences lower back pain and, of these, around one in five will consult their GP,” says Elvy Mardjono, senior brand manager for Mentholatum’s ‘Mind Your Back’ campaign. One of the main triggers for back pain is “poor preparation when exercising”, she adds, with research for the campaign finding that 20 per cent of respondents noted back strains as the biggest problem they had when exercising.

“In addition, overexerting or repetitive movement can cause injury,”Elvy explains. “For example, lifting weights that are too heavy or overlooking correct exercise postures can quickly mean a muscle is torn or joint and tendon pain.”

Prevention first

Of course, it’s always better to prevent these injuries in the first place. “It’s important to spend time waking up the body and priming it for the exercise ahead so a good warm up is essential, otherwise there is a danger of an injury, sprain, strains and muscles and joint aches,” says Kaye Mackay, senior brand manager for Deep Heat and Deep Freeze. “Plus, a warm-up loosens muscles, increases blood flow and fires up muscles and tendons to help them stretch and move more easily and minimizes the risk of injuries. We suggest people do a dynamic warm up of aerobic activity with gentle stretching, focusing on the areas that they are about to use most in their chosen activity.”

Equally, there is a temptation to just stop straight after exercising, but taking the time to do a proper cool down is also beneficial for the body in multiple ways. “Gentle stretches – such as hamstring, quad, arm and groin stretches – will help release any build-up of lactic acid and increase flexibility,” says Kaye.

As well as taking time to cool down at the end of a session, building rest periods into exercise plans is also important. “Naturally, after a big work-out, our body can feel achy and sore due to the fact our muscles have worked harder than they’re used to or in a different way”, says Anshu. “If you do experience aches and pains, listen to your body and give it time to recover between each session.” 

Activity against Covid-19

Pharmacy teams can ensure that customers are aware of the many, and perhaps unexpected, benefits of getting active, such as fighting Covid-19 infection.

Taking regular physical activity has been found to cut the risk of dying from Covid-19 and other infectious diseases by 37 per cent, and also reduce susceptibility to such viruses by 31 per cent, according to a new global study published in the journal Sports Medicine. 

Encouragingly, the research also found that physical activity may have the potential to boost the effectiveness of vaccines by up to 40 per cent. This could help to motivate some pharmacy customers to get active, given the current Covid-19 vaccination drive and desire for life to return to some form of normality. 

“Our research shows that if you are active – engaging in 150 minutes per week or 30-minutes five days a week – it protects you against the risk of infectious disease,” says Professor Sebastien Chastin, senior research fellow at Glasgow Caledonian University and lead author of the research. “You don’t need to go to a gym, as dancing around the living room, going for a run or walk is just as effective. In this period of pandemic, being outside is better than in a gym or closed environment.”

Treating injuries

Encouraging customers to get moving also opens up further scope for pharmacy teams to give advice on managing common sports injuries, many of which can be treated effectively at home with over-the-counter (OTC) products and self care techniques. 

• Sprains and strains

“It’s important that customers are able to recognise what kind of pain they have, so that they know the most effective way to help treat or manage the pain”, says Kaye Mackay, senior brand manager for Deep Heat and Deep Freeze.

Most mild sprains and strains can usually be treated with the PRICE technique of protection, rest, ice, compression and elevation, and they should improve within 72 hours. For over-use injuries, sprains and strains, after 72 hours of cold treatment, Kaye recommends “a heat treatment to help with rehabilitation”, and says “a topical NSAID is important to help relieve inflammatory pain in the back, muscles or joints”. 

However, if after a mild sprain the customer still feels heat and the swelling is not subsiding after 72 hours, they should seek medical help urgently.

• Blisters

Though painful, most blisters heal on their own unless they become infected, but they can be easily prevented in the first place by covering tender spots with a friction-resistant dressing or plaster. If they do occur then specialist blister plasters claim to aid rapid healing by absorbing the fluid, protecting skin from bacteria and helping relieve the pain of friction and pressure.

• Shin splints

Anyone taking part in strenuous exercise that involves impact or a lot of stopping and starting – such as long-distance running, tennis and basketball – can suffer from shin splints. This is the general term for exercise-induced pain at the front of the shins.

The most common cause is medial tibial stress syndrome (MTSS), which is the result of frequent and intense periods of exercise when the body is not used to it. According to NHS advice, it is important that sufferers don’t continue to exercise in case the pain is a sign of an injury to the bone and surrounding tissues, so customers should take a break from load-bearing exercise for at least two weeks and speak to their GP if the problem persists.

• Tennis elbow 

Tennis elbow – or lateral epicondylitis – is a self-limiting condition usually caused by overuse of the muscles attached to the elbow which straighten the wrist, leading to pain around the outside of the elbow when bending, extending or lifting the arm. If these muscles and tendons are strained, tiny tears and inflammation can develop near the bony lump (the lateral epicondyle) on the outside of the elbow. 

Avoiding the activity should help the symptoms to improve, as will applying a cold or gel compress to the area. Paracetamol can help with the pain, and ibuprofen will reduce any swelling, but customers should consult a GP if the condition persists. 

OTC assistance

In addition to rest, there are plenty of products that pharmacy teams can recommend to help customers ease pain caused by their return to a more active lifestyle.

Most customers will experience aches and pains along the way, so as well as basic paracetamol and ibuprofen, Elaine Walker, senior brand manager at Deep Relief, says “a selection of topical analgesic products is essential in every household’s self care toolkit [including] topical gels, patches, sprays, creams, glide-ons and roll-ons, with cold and hot therapy options.”

Pharmacies should aim to keep a well-signposted and well-stocked topical pain relief section, with clear advice on which products to use for different types of pain or injury to make self-selection easier. Helping customers play their part in self care will make it easy for them to treat the common mishaps that can arise from exercise and support them to stay on track with their activity goals.

Further information: 

The British Psychological Society (BPS) has published six new guidance documents to help health care professionals encourage people to adopt healthy behaviours during the pandemic, including guidance on physical activity and sedentary behaviour.