Last partial update: April 2019 - Please read disclaimer before proceeding
The problem; an overview
A major cause of both vascular disease and obesity in Australia is insufficient physical activity. In 2005 30% of adult Australians engaged in no exercise at all and 54% do not do enough to gain any benefit. This figure increased to 75% in adults aged 65 and over.
This has a huge influence on illness in Australia, with 7.5 per cent of all male burden of disease and 6.0% of all female burden of disease being directly attributable to physical inactivity. Physical inactivity ranks only second to smoking as a preventable cause for illness in Australian men and is the most important cause in Australian women. (In women over 30 years of age it is the most important preventable cause of heat attacks.)
Any exercise is significantly beneficial. Even mild exercise such as walking significantly reduces cardiovascular disease, with walking one to three hours per week reducing the risk of a heart attack or death by about 30 per cent. And being fit halves the risk of dying from any cause. As well as being beneficial itself, physical activity helps by reducing other risk factors such as obesity and diabetes.
Source – Adapted from Australian Institute of Health and Welfare: Begg, S. et al: 2007. |
People who gain most benefit from increasing their physical activity levels are those who are least fit!!
A person’s level of fitness has been shown to be a better predictor of risk of death than any other cardiovascular risk factor and, while being physically fit provides the most benefit, it is very important to note that the people who gain most benefit from increasing their physical activity levels are those who are least fit!!! And being active provides a good example for both family and friends, especially children. Families with two active parents are six times more likely to have active children than families with inactive parents.
The following is a list of the benefits of physical activity.
Benefits of physical activity
A reduction in body fat:
Physical activity increases the body’s energy use in two ways. Firstly, the activity itself requires energy. Secondly, the increase in body muscle that occurs with regular exercise increases body energy use when resting. (Maintaining healthy muscle tissue requires considerable energy expenditure even when it is not being used.) The extra energy required for the above is provided by the breakdown of some body fat (unless the person eats more!!). Exercise also decreases apperite and this results is less energy being consumed and stored as fat.
Improved appearance:
As well as making the person’s healthier by reducing their weight, the reduction in body fat and increase in muscle mass that occurs with increases exercise helps improve their body shape. They look better!!!
A reduction in cardiovascular disease risk (and thus decreased mortality):
Exercise reduces cardiovascular disease risk via several mechanisms; a reduction in blood pressure, beneficial changes in blood fats (reduced total cholesterol and increased HDL), and an increase in heart muscle fitness, which acts to decrease the overall workload of the heart.
Physical activity after 50 years of age has been shown in a US study to increase average life expectancy by between 2 and 4 years, depending on the level of exercise, in both men and women.
Improved psychological well-being:
Exercise has many psychological benefits including enhancing body image, enhancing self-esteem and well being, providing a feeling of vitality, and improving mood. Anxiety and depression can be helped significantly by exercise. These psychological benefits occur with as little as 10 minutes of simple exercise (e.g. walking) a day. Exercise can also provide opportunities to increase social contact.
Cancer reduction:
Physical activity significantly reduces the risk of several different cancers, including colon (bowel) cancer and pre- and post- menopausal breast cancer. (See graph above.) The World Health Organisation states that about 10 per cent of breast cancers and 16 percent of colon cancers can be attributed to physical inactivity and these figures are probably underestimates. To gain maximum benefit regarding reducing colon and breast cancer risk, people need to do 30 to 60 minutes of moderate to vigorous exercise per day. This can produce a 30 to 40 per cent reduction in colon cancer risk and a 20 to 30 per cent reduction in breast cancer risk compared with inactive people. This is the same order of risk reduction that is provided by screening for breast cancer and more than that gained from screening for bowel cancer!!! Other cancers such as endometrial (uterine), prostate, ovarian and testicular cancer may be related to exercise also but there is insufficient evidence to substantiate this relationship at present.
Reduced disability from osteoporosis:
Regular weight-bearing exercise increases bone density and thus reduces the likelihood of osteoporosis developing. Exercise also helps improve co-ordination and balance and thus reduces the incidence of falls.
Other physical benefits:
These include improved sleep and a reduction in the rate of cognitive function (thinking ability) loss that occurs with increasing age.
Some benefits of physical activity are immediate
Most people think that physical activity only provides benefits in the future but this is not the case. Immediate benefits from a 30 minute walk (which last for up to 24 hours) include:
- Enzyme changes that improve the effectiveness of insulin and thus decrease the effects of any pre-diabetes condition.
- Lowering of blood pressure
- Improved functioning of the body's immune system
- Improved psychological well-being
In other words, moderate physical activity is a bit like taking a magic pill that will lower blood pressure, improve diabetes and improve mood.
Planning an exercise modification program
The first thing that needs to be done is to look at lifestyle. As with dietary assessment, this will take some time and people need to look at each day of the week separately, dividing each day into several time-components, including working time, time spent traveling to and from work and recreational time.
When examining their daily schedule, people need to consider the exercise they already do and the opportunities available to increase this exercise. Remember to look for similarities and differences in each day. It is often helpful to put all this information in a table, such as the one below. This can be used to assist in planning modifications to present physical activity. Include in the table the type of activity, its duration, and when it occurs during the day.
a. Exercise assessment table
Day
Physical activity as part of normal daily activities
Planned physical
activities
(include type of exercise, time done and duration)
Total time per day
(duration and time of activity)
Opportunities for extra physical activity
(include type of exercise and time period)
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Hopefully assessing daily activities will show where time for extra physical activity can be fitted in. This may involve filling in gaps present in the day, such as opportunities to do exercise to and from work (and at work), or adopting alternatives to present-day activities that will allow increased exercise. Looking at non-physical recreation activities and working out how these can be changed to physical ones can help. A good place to start is looking at TV/ computer use.
Reducing TV and computer time (See section on childhood obesity for more information)
One of the best ways of increasing physical activity is to restrict time spent watching TV and using the computer. With children, TV viewing time is closely related to obesity and reducing time in front of the TV has been shown to be just as effective as active exercise programs in achieving weight loss. Some options include the following.
- Limiting recreational daily TV / computer time. For children, 30 to 60 minutes a day should be adequate and no more than two hours.
- Having a couple of family (all members) ‘TV free’ days each week. People don’t have to watch it just because it is there. (Alternating TV free days or recording certain ‘must see’ shows can get over the problem of a family member feeling hard done by because he/she misses a favourite show.)
- No TV on school days. (Or no TV before school and none before homework/ other home duties are done or while it is still light outside.)
- No TV / computer time until after the family walk or some other activity is done (especially good for children).
- Ensuring that children DO NOT have TVs or internet access in their bedrooms is very beneficial with respect to increasing physical activity and it has the added benefit of increasing their time with other family members.
When watching an occasional favourite TV show, people can always do it while riding an exercise bike.
b. Concentrate on realistically changing behaviours
Concentrate on changing behaviours, not outcomes such as cycling 10km in a certain time. Also, don’t have unrealistic expectations. Rather, aim for achievable initial changes, increase goals gradually, and don’t aim to achieve all dietary and exercise goals at the same time.
c. Make sure the exercise program is flexible
Changing circumstances may necessitate change in a person’s program. Devising a flexible exercise routine will help reduce the impact of factors beyond control, such as the weather and changes in work schedules or health. Plan a structured exercise regime with the help of a qualified exercise consultant if needed.
d. Get assessed first
Professional assessment before commencing an exercise program is often beneficial and is essential in people with existing medical problems.
All people are different and assessment allows the selection of the most appropriate exercise program. This is a lifestyle change, not a once in a lifetime event, and an exercise program therefore warrants careful planning.
Also, if people are to avoid illness and injury, the risks involved in partaking in a particular exercise program need to be discussed with a qualified health professional before commencing that program. This especially applies if people are over 35 years of age, have any heart-disease risk factors (including a family history of heart disease or sudden death) or have other significant medical problems. It is wise to minimise cardiovascular risk factors, such as blood pressure, before exercise is undertaken and this is a good time to assess and treat other health issues. Contraindications to exercise are mentioned at the end of this chapter and include unstable angina, uncontrolled blood pressure, uncontrolled diabetes, uncontrolled heart failure, severe aortic stenosis, a recent complicated heart attack and shortness of breath or chest discomfort with light exercise.
Most injury and illness associated with exercise occurs with more strenuous activity and it is thus important to start at a low intensity level and increase intensity and duration gradually.
National Physical Activity Guidelines for Australians
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Children & young people (Aged 5 to 18 years) |
Adults (aged 18 to 65 years) |
Older adults (aged over 65 years) |
Minimum recommended physical activity levels for maintaining the health of all Australians |
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Frequency |
Each day |
Minimum of 5 days per week |
Minimum of 5 days per week |
Intensity* |
Moderate to vigorous |
Moderate intensity |
Moderate intensity |
Duration |
Accumulate at least 60 minutes per day Spend no more than 2 hours per day using electronic media for entertainment |
Accumulate at least 60 minutes per day in bouts of at least 10 minutes duration
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Accumulate at least 60 minutes per day in bouts of at least 10 minutes duration
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Recommended physical activity levels for those wishing to influence body weight |
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Physical activity aimed at preventing gain in body weight |
60 minutes of moderate to vigorous intensity on most days of the week |
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Physical activity aimed at reducing body weight |
At least 60 to 90 minutes of moderate to vigorous intensity physical activity each day |
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* Intensity of exercise achievable will depend on level of fitness and general health |
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Planning physical activity - How much and what type.
There are two main types of physical activities; those that are part of a person’s normal daily routine, termed incidental physical activities, such as walking to the bus stop, and those that people do for their own sake, termed structured physical activities, such as walking, tennis or jogging. The national physical activity guidelines for Australians, shown in the table above, indicate how people should allocate their weekly physical activity. Both types of exercise are important in increasing energy expenditure and thus assisting in weight loss. However, it is the 30 minutes of moderate-intensity exercise (usually associated with structured physical activities) that provides most of the vascular disease health benefit that can be attained from increased physical activity.
a. Increasing incidental physical activity
In becoming more active, people should increase their normal daily activity. Movement needs to be thought of as an opportunity, not an inconvenience! This may include walking instead of driving, walking when at work rather than telephoning, using stairs rather than lifts or escalators, or getting off the bus or train a stop earlier than needed and walking the rest of the way. Increasing this type of activity is very beneficial in people who are very overweight as more strenuous exercise can be difficult for this group. Everyday activity can be measured by a pedometer, which measures the number of steps taken. People should aim for about 7,500 to 10,000 steps per day. This will burn up about 1,000 kJ of energy. Remember that numerous small amounts of exercise are just as effective as fewer longer periods.
b. Increasing structured physical activities
A structured exercise program should include lifestyle activities such as gardening and leisure-type sports as well as more formal exercise programs. It should also ideally centre around increasing social contact with family and friends.
People should initially aim to build up to 20 to 30 minutes of structured physical activity per day. Structured physical activity should then be gradually increased to and then maintained at a level of at least 30 minutes of medium intensity activity per day for most days of the week. This 30 minutes can be done in one session or in up to 3 sessions. (Best results are gained from physical activity sessions that last 10 minutes or more.)
Medium intensity exercise is the best level for ‘burning off’ fat, although lower levels are also very beneficial. With walking or running to achieve weight loss, it is the distance covered that matters most, not how fast it is done. A good indicator of medium intensity exercise is getting slightly puffed and returning with a ‘glow’. Alternatively, heart rate can be used to assess exercise intensity. Optimum (moderate) exercise levels can be achieved by exercising at 65 per cent of the individual’s maximum heart rate. (Maximum heart rate in beats per minute equals 220 minus the person’s age in years.)
As an example, the maximum heart rate for a 50-year-old would be 220 less 50 beats per minute, which equals 170 beats per minute. Sixty-five per cent of this figure would be 111 beats per minute. Other heart rates for moderate exercise according to age are shown in the table below. This moderate level of exercise needs to be gradually worked up to, especially if the person has not been regularly exercising; 50 per cent of their maximum heart rate would be more appropriate for a beginner.
Remember, with respect to burning up excess fat, the length of time spent exercising is more important than the intensity of the exercise.
Optimum heart rates during exercise according to age
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Age (years) |
Heart rate at moderate exercise level (equivalent to 65% of max heart rate) (beats per minute) |
20 |
130 |
30 |
124 |
40 |
117 |
50 |
111 |
60 |
104 |
70 |
98 |
If desired, people can attempt more strenuous exercise later on to improve their cardiovascular fitness. Vigorous exercise equates to exercising at about 75 per cent of the person’s maximum heart rate (or getting reasonably puffed). The table below shows the exertion levels for different types of exercise. Excessive exercise that is beyond the person’s fitness level should be avoided as it is more likely to cause injury. And injuries are definitely best avoided as they usually take several weeks at least to heal properly and then the person has to gradually build up to their previous level, otherwise re-injury may occur.
Exercising prior to eating, especially before breakfast, helps improve weight loss. Blood glucose levels are lower at these times and a greater proportion of the energy used comes from the breakdown of body fat. Cooling down slowly rather than quickly and not eating too soon after exercise will also help body fat use.
Energy expenditure with different types of exerciseSitting doing nothing Low energy exercise Moderate exercise Vigorous exercise |
Walking and weight loss
Weight loss occurring with walking varies depending on the number of steps taken each day. One kilojoule of energy is expended in taking 5 to 6 steps (for a 75kg person). A pedometer can be used to calculate how many steps are taken. (They are relatively cheap and can be purchased from most electronics or fitness stores.) The current number of steps taken can be determined by taking recordings for a week. People can then increase this gradually in increments of 500 to 1000 steps per day. Taking more than 8,000 steps per day is likely to result in fat loss in most overweight people but this level may need to be reached very slowly, especially in people who are very overweight. (Walking 8,000 steps would expend about 1600kJ of energy.)
Which planned physical activities are right for you?
Activities that can be successfully incorporated into a long-term physical activity program should;
- be ones the person enjoys
- fit easily into the person’s current lifestyle.
- provide a variety of exercise that involves both upper and lower limbs and includes some weight bearing exercise to help prevent osteoporosis. Good choices are walking, jogging, cycling, weight training, rowing, tennis, golf, aerobics and swimming.
- include indoor and outdoor activities so that bad weather doesn’t cause too much disruption
- aim to increase social contact with friends and family. Join a club associated with a physical activity, such as a sports club or a bush walking club, or try walking with other family members or friends. This will provide some of the much needed communication time that often goes missing when work and life become increasingly demanding. Also, the concern of ‘letting friends down’ by not participating will help prevent missing regular activities.
- include some activities that can be performed for many years to come so that the activity program is a long term one. Often people can resurrect activities they enjoyed when younger but have given up.
Barriers to increasing physical activity
Occasionally there are barriers to regular activity that need to be addressed. Concerns about appearance can deter people from exercising and planning a physical activity program should consider such concerns and ensure the activities contemplated can be done in a non-threatening environment.Sometimes purchasing attractive exercise cothing can help. (For women, this should include sports-bras.)
Many people feel that their present lack of fitness means they will not be able to gain benefit from starting an exercise program. The reality is that all exercise is beneficial and exercise levels can be gradually increased from initial modest levels. The ‘no pain, no gain’ slogan is neither helpful nor truthful.
Financial expenses should not be an issue as there are many free physical activities; walking for example.
Commencing and maintaining a new physical activity program
Once a new physical-activity program has been planned, the next step is to decide on a definite starting date. As with dietary change, people should try to choose a day that is usually not too stressful and need to ensure they have the equipment required to carry out their activities.
Hopefully, good planning will have made your changes in physical activity relatively easy. If the reason for increasing physical activity is weight loss, please remember that weight loss from exercise is often slow. Do not be discouraged and remember that the most important task by far is keeping off any weight that is lost. Also remember that there are many other benefits to be gained from exercise.
Regular visits to a GP to monitor progress can help with any problems and act as positive feedback when things are going well. Help should be sought early on if problems occur to avoid substantially braking away from the proposed plan, which can reduce self-esteem and resolve to succeed.
Preventing injury from exercise
Physical injuries are more common in older people, especially when they exercise irregularly. These can be minimised by a five-minute warm up and cool down with each activity, using correct equipment and technique (an exercise trainer or coach can be helpful here), and adequate nutrition and fluids. A resistance and strength training program before or with training for cardiovascular fitness is also of benefit in reducing injury.
Shoulders and knees
Knees and shoulders are the joints that most commonly cause problems with physical activity, especially when starting up. Some strategies to prevent this include the following. (Most will need the help of a professional trained in sports medicine and seeking advice before starting an exercise program is really good advice / essential. Gyms etc normally have such people available.)
- Knees
- ensure that good footwear is used
- when commencing and returning to running do it slowly and consider the impact of running on hard surfaces
- ensure that high impact workouts are balanced with low impact exercise such as swimming or cycling or yoga
- Shoulders
- exercise involving the shoulder is complicated and the advice of a physiotherapist or knowledgeable exercise instructor should be sought when planning an exercise routine to ensure the risk of shoulder damage is minimised. Most of the advice mentioned below will need expert help to implement.
- adopt a balanced exercise routine for shoulders that includes both larger back muscles and rotator cuff muscles.
- overhead activities such as swimming, throwing and shoulder presses are the main cause of the common rotator cuff shoulder injury.
- 50% of the force generated through shoulder activity is originates from the legs and trunk and planned activities need to account for this
- swimming: combine freestyle and backstroke to ensure the shoulder moves through its full range of movements. Use a kick-board/ leg movement to ensure shoulders are not overuse from repetitive overead movements.
- tennis and throwing; learn good techniques from wel qualified coaches. Strengthening and stretching is necessary to help prevent injury from these activities.
- gym workouts; warm up properly and ensure the warm up involves all parts of the body. (Cycling does not do this.)
Death during physical activity
Everyone has heard stories about people dropping dead while exercising. In those very rare cases that occur in people under 30 years of age, it is mostly due to an underlying unknown heart abnormality, such as a congenital heart valve problem. In those over 30 years, it is most likely due to coronary artery disease (heart attacks). (People with a strong family history of heart attacks or who have had a young or ‘young-ish’ sudden death in the family should be assessed by a doctor before exercising.)
While the risk of sudden death is increased during vigorous exercise, this risk is still very, very small and its significance is easily outweighed by the reduction in cardiovascular deaths associated with enjoying a physically active lifestyle (i.e. people who exercise are at much less overall risk). Also people who exercise regularly have a reduced risk of sudden death while exercising.
Proper medical assessment prior to commencing an exercise program and increasing exercise levels gradually can help minimize any risk. Inactive person should take at least eight to twelve weeks to build up their general level of fitness.
Physical activity for children
Exercise is important for all children and, as Australian children are becoming more sedentary, all children should be encouraged to be physically active. Recommendations for physical activity levels for children are provided in the box below.
It is important to remember that a good parent example is a child's best education! If parents are active, children will be too. Families with two active parents are six times more likely to have active children than families with inactive parents.
Any sport / activity that children enjoy should be encouraged. However, it is worthwhile encouraging at least one physical activity that they will be able to continue into their adult life, such as walking, cycling, running, golf, tennis and swimming. Many team sports are great when young and help develop socialising skills. However, they are often ceased after leaving school.
Physical activity for children can be divided into five categories.
- Unstructured activity: Play that kids just do; running, bike riding, skate boarding, throwing a ball or frissbee etc
- Structured activities: Activity classes such as sporting / dance lessons, swimming, little athletics, gym classes for older teenagers
- Organised sport: Playing sport with an organised club.
- Active transport: Walking to school, shops
- Active family activities: Family outings such as picnics, walks, household duties gardening etc. Duties should be scheduled into the child's week.
These activities should be scheduled at suitable times during the week, especially taking advantage of free daylight hours such as after school and during school holidays.
Adolescents and physical activity
- Sports that can be played by both boys and girls can be a good way to assist socialisation without the partie etcs e.g. tennis, sailing, athletics, ten-pin bowling.
- Sports that require a degree of responibility, such as sailing or rowing, are good for older chldren.
- Similarly, encouraging older chldren to referee / coach sports they are already competent at can be a gerat way to increase responsibility / increase exercise
- Appropriate / comfortable sports clothing is important for all children but especially so for adolescents. The right appearance can make all the difference to adolescents, especially girls. (Part of this process is getting a properly fitted sports bra.)
- Part-time and holiday jobs that require some exercise are good; delivering papers for example.
Recommended physical activity levels and recreational ‘screen time’ levels for children |
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Child age group |
Appropriate activity level |
Recreational screen (TV/ computer) time |
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Preschoolers |
Children age 3 to 5 years - Several hours a day – Mostly supervised unstructured play. |
Children under 2 years of age – None Children aged 2 to 5 years – Up to one hour per day |
Primary-school children (Age 6 to 11 years) |
Moderate to vigorous exercise for a minumum of 60 minutes per day (and up to several hours per day). |
No more than 2 hours per day. |
High-school children (Age 12 to 18 years) |
A minimum of 20 minutes vigorous exercise and 40 minutes moderate exercise per day. |
No more than 2 hours per day. |
Outdoor activities for children and reducing short-soightedness (myopia)
It is thought that if current trends regarding urbanisation / indoor living and the use of computers and TVs (that require near vision) continue, then up to 50% of the population will become near sighted. The rate on 2000 was about 20%. All that is needed to prevent this is for children to spend more time outdoors and reduce time doing close-range activities, especially those related to screen viewing. Parents should aim for children to be outdoors for a couple of hours per day. This could also increase opportunities for physical activity.
Physical activity for the elderly
From a peak at age 20, exercise levels fall steadily with increasing age. By the age of 70 they have dramatically reduced in most people, with 40 per cent of people over this age doing no exercise at all. This is unfortunate as exercise has numerous benefits for the elderly. It is impossible here to recommend specific exercises as all elderly people have different levels of fitness and different medical conditions that need to be taken into account when advising them on an exercise program. However, there are exercises for almost everyone.
The numerous advantages of exercise for the elderly include prolonged independence and a reduction in the incidence of falls due to better muscle tone and balance, maintaining heart and lung fitness, a reduced risk of osteoporosis, reduced pain from arthritis, and an increased number of years without disability. Exercise also offers increased socialisation if performed with others, reduces the risk of depression developing, improves thinking, and generally enhances well-being.
See a doctor and physiotherapist and then start up!!
Physical activity for people with cardiovascular disease
Many Australians who have heart pain (angina) or have had a heart attack, stroke or transient ischaemic attacks do inadequate exercise and, while exercise is not without risk, for most people the benefits far outweigh such risk. People with cardiovascular disease (CVD) who exercise are far less likely to die or have another CVD event than those who do not. (The rate of fatal cardiovascular events in patients attending supervised cardiac rehabilitation centres is about one per 750,000 hours of exercise.)
If possible, people with CVD should aim to achieve activity levels appropriate for their age group; although this will obviously not always be possible to attain.
Initiating increased physical activity in people with CVD needs more careful assessment than that required by the general population as each person will have his or her own level of disability associated with their cardiovascular disease. It is therefore important that each person is assessed and a suitable program is worked out before he or she commences or increases physical activity. A cardiac rehabilitation centre or doctor will need to be consulted regarding coordinating this process, which should include medical, physical and fitness assessments and adjustment of medication to optimise treatment of illnesses such as high blood pressure, diabetes, cholesterol and heart failure. This will minimise the risk involved in exercising and allow the person to achieve higher physical activity levels.
It is important that activity levels are initially low and are built up gradually, and proper attention needs to be given to the importance of warming-up and cooling-down in preventing injury. Activity should be ceased if any cardiovascular symptoms occur during exercise and the problem should to be reported to a medical practitioner. This should all be detailed in an exercise plan. Activity should not be recommenced until after a medical review. In some situations, such as a prolonged episode of chest pain, immediate medical help may be needed. Help should be sought if any of the following occur during exercise.
- Chest pain or discomfort occurs. This can take many forms but is usually central in the chest and is often described as a tightness or squeezing feeling. Click here to access information about chest pain.
- Dizziness, light headedness or feeling faint
- Shortness of breath or difficulty breathing
- Nausea
- Uncharacteristic or excessive sweating
- Palpitations, especially if accompanied by feeling unwell
- Undue fatigue
- Symptoms of a hypoglycaemic attack in people with diabetes. These include sweating, weakness, palpitations, shakiness, hunger, tingling lips, dizziness, light headedness or feeling faint.
All people with coronary heart disease or diabetes should be given a written action plan to follow should symptoms occur while exercising.
Contraindications to exercise in people with cardiovascular disease
In some situations exercise is dangerous for people with cardiovascular disease and is contraindicated either permanently or, more commonly, until the clinical situation improves. This includes anyone with the following.
- Unstable angina (Heart pain that is occurring frequently, with minimal activity or at rest.)
- Symptoms such as chest pain or shortness of breath that occur with low activity
- Uncontrolled heart failure
- Uncontrolled diabetes where blood sugars are too high OR to low
- Uncontrolled high blood pressure
- An arrhythmia (palpiations) that is present at rest
- Acute infection or fever
- Severe aortic stenosis (This is an abnormality in the aortic heart valve.)
- Anyone who has suffered a recent heart attack or who has unstable angina and has not been advised by a doctor that exercise is permissable.
This is not an exhaustive list and each person needs to be assessed by their doctor prior to commencing additional physical activity. Many of these problems can be controlled with medication and the person may well then be able to start becoming physically active.
The National Heart Foundation released its position statement on Physical Activity Recommendations for People with Cardiovascular Disease in January 2006 (still curreny as at 2016) and it is well worth reading. It can be accessed at:
http://heartfoundation.org.au/images/uploads/publications/physical-activity-in-patients-with-cvd-management-algorithm.pdf
Physical activity during pregnancy
While there are restrictions on when during pregnancy exercise can be done and the type of exercise that can be done, current medical advice is that in an uncomplicated pregnancy, exercise is generally beneficial for women, whether they are currently 'exercisers' or not. Potential benefits include maintaining a healthy maternal weight, reducing the risk of gestational diabetes (diabetes in pregnancy) occurring and improved mental health / prevention of depression.
Importantly, it has been shown that exercise does not have an effect on birth weight and does not decrease blood flow to the uterus (and thus the foetus).
Suitable aerobic activities early on in pregnacy include running, walking, swimming, dance, yoga and aerobics classes. Generally speaking the exercise guidelines for the general population apply to healthy women; so 150 minutes per week of moderately intensive aerobic exercise.
Some general advice regarding
- Any woman with a pre-existing medical condition should consult with their doctor regarding the limitations on exercise that the condition may cause.
- It is reasonable for all women to discuss exercise during pregnancy at an early pregnancy consultation so that anb exercise program that is best for them can be determined. This will depend on current level of fitness, activities enjoyed, medical problems, may mean getting the help of a physiotherapist.
- Women should avoid getting overheated by limiting the intensity of exercise in hot, humid conditions. (Exercising in the morning can achieve this and has the added benefit of improving sleep and improving mental health.)
- It is important to maintain hydration level during exercise so ensure plenty of water is available.
- The risk of blunt trauma to the abdomen should be avoided. Thus contact sports and sports where falls may occur, such as cycling, should be avoided. (Cycling on an exercise bike is fine.)
- SCUBA diving should be avoided to reduce the risk of decompression sickness in the foetus.
- Women who have led an extremely sedentary life-style prior to becoming pregnant should get advice regarding an appropriate exercise program before commencing exercise.
- Musculoskeletal limitations may guide choice of exercise. For example, avoinding exercise that inceases back pain is important as this often increases as the pregnancy progresses.
- Heart rate monitoring during exercise while pregnant is a less reliable measure of exercise intensity; as heart rate increase anyway in pregnany.
- Exercise levels usually need to be reduced in the later stages of pregnancy. THe body is getting fairly back to normal by about 6 weeks after delivery. At this time it is reasonable to ask your doctor whether it is ok to return to your normal pre-pregnancy exercise routine.
Contraindications to exercising during pregnancy
- Women with significant heart or lung disease, significant anaemia.
- Obstetric conditions including
- Women with pregnancy induced hypertension.
- Women at risk of premature birth. These incluse those with a cervix that is likely to increase the risk of preterm birth. (A short cervix, an incompetent cervix or a cervix that has had a stitch inserted to help prevent preterm birth.); and those with a multiple pregnancy (twins etc)
- Women in premature labour or who have had evidence of premature labour during the pregnancy.
- Women with vaginal bleeding, especially during the second and third trimester.
- Women with ruptured membranes
- Placenta praevia after 26 weeks gestation. (Placenta praevia is where the placenta has attacked over the cervix.)
As stated above, any woman with a pre-existing medical condition should consult with their doctor regarding the limitations on exercise that the condition may place. Conditions that are especially important to discuss with a doctor before commencing exercise include: any heart or lung problem, arrhythmias, high blood pressure, diabetes, being extremely over-weight or extremely under-weight, musculoskeletal problems, epilepsy, thyroid disease and being a smoker.
Finally, any foetal abnormality may have an implications for exercise and needs to be discussed; for example intra-uterine growth restriction.
When to stop exercise and seek medical advice
- If any vaginal bleeding occurs
- If a uterine contraction occurs
- If there is any decrease in foetal movements
- If there is any leakage iof amniotic fluid
- When any unusual symptom occurs, especially any chest pain, unusual shortness of breath, dizziness or headache.
Further information
Walking Groups in Australia (Information about walking groups)
http://www.heartfoundation.org.au/active-living/get-active/walking?gclid=CJn8uObqgM4CFQGbvAodQewJVw
National Heart Foundation
http://www.heartfoundation.org.au