Juneathon 2011 Day : Back to the Canal

2011 Streak 154/365: Run - 6.53 miles, Time 1hr 2min, Weather - hot and sunny

The rubble of Nash mills

Part 1

As an aside in my last post I said that Dr Johnson had a good quote for just about everything but I didn’t really expect him to have much to say about exercise. After all my image of him is of a gouty man at home in an ale house. My instinct was that if he ever thought about exercise he would be dismissive but I was wrong as he was able to see right to the heart of the matter:

The necessity of action is not only demonstrable from the fabric of the body, but evident from observation of the universal practice of mankind, who for the preservation of health in those whose rank or wealth exempts them from the necessity of lucrative labour, have invented sports and diversions, though not of equal use to the world with manual trades, yet of equal fatigue to those who practice them, and differing only from the drudgery of the husbandman or manufacturer, as they are acts of choice, and therefore performed without the painful sense of compulsion. The huntsman rises early, pursues his game through all the dangers and obstructions of the chase, swims rivers, and scales precipices, till he returns home no less harassed than the soldier, and has perhaps sometimes incurred as great hazard or wounds or death: yet he has no motive to incite his ardour; he is neither subject to the commands of a general, nor dreads any penalties for neglect and disobedience; he has neither profit nor honour to expect from his perils and his conquests; but toils without the hope of mural or civic garlands, and must content himself with the praise of his tenants and companions."

Johnson: Rambler #85 (January 8, 1751)

Apart from the acute observation the phrase which struck me was ‘lucrative labour’ and the neat divide between the wealthy and those who work was physically hard. In two and a half centuries  things have changed. A middle has developed and grown so that a majority of us are now sedentary, which means that we fall into the wealthy category of having to invent exercise.

I must admit that I do not feel like a landowner or Eighteenth Century gentleman but for that short time I am out on my run I have joined their ranks.

Part 2

The today’s run was something of a landmark - I was back to my home run; back to the canal. Since returning all my runs have been round the park, which has been perfectly fine but I find it psychologically difficult to run many laps. If I want to run further I have to have a route that goes there and back or is a bigger loop.

This morning I planned 6 miles and rather pathetically was quite excited by the idea going back to the towpath I like to claim as my own. Gosh! Looking forward to something is always worrying because I assume I will be disappointed but this was not the case. As soon as I reached the canal and felt the cooling of the the trees and water and saw the beauty of the stillness I just said to myself “welcome back”.

Part 3

The picture shows all that is left of what once was a very significant paper mill. It was John Dickinson's second mill and dated from 1811. Now it has been demolished for housing and all the stone and brick has been ground up into a fine rubble.

Official Advice on Exercise Pt 2

Official advice on the amount of exercise needed is quite simple:

■ Children and young people should achieve a total of at least 60 minutes of at least moderate intensity physical activity each day. At least twice a week this should include activities to improve bone health (activities that produce high physical stresses on the bones), muscle strength and flexibility.
■ For general health benefit, adults should achieve a total of at least 30 minutes a day of at least moderate intensity physical activity on 5 or more days of the week.
■ The recommended levels of activity can be achieved either by doing all the daily activity in one session, or through several shorter bouts of activity of 10 minutes or more. The activity can be lifestyle activity or structured exercise or sport, or a combination of these.
■ It is likely that for many people, 45-60 minutes of moderate intensity physical activity a day is necessary to prevent obesity. For bone health, activities that produce high physical stresses on the bones are necessary.
■ The recommendations for adults are also appropriate for older adults. Older people should take particular care to keep moving and retain their mobility through daily activity. Additionally, specific activities that promote improved strength, co-ordination and balance are particularly beneficial for older people.

That’s all there is.

When I first read them I thought they were very soft. There is no mention of vigorous, nothing about raising the pulse rate or breathing heavily and nothing about being able to gradually do more with practice. As for breaking it up into 10 minutes units I thought it was the slippery slope to counting any slight movement as exercise.

But I was probably being a bit snooty because I run and know the feeling of wellbeing that sweeps through you after a good session. I therefore know in my bones that exercise is good for you. So my viewpoint is distorted especially as I have little understanding of the general level of inactivity in the population as a whole or how hard it is to start from a low base.

Reading the 2004 report by the Chief Medical Officer changed my mind (it can be downloaded here) as it shows the evidence base for the recommendations, which can be summarised by this quote:

The World Health Organization has reported that physical inactivity is one of the 10 leading causes of death in developed countries, producing 1.9 million deaths worldwide per year.21 It estimates that physical inactivity is responsible for the following proportions of ‘disability-adjusted life years’ in developed countries:

■ 23% of cardiovascular disease for men and 22% for women
■ 16% of colon cancer for men and 17% for women
■ 15% of type 2 diabetes
■ 12% of stroke for men and 13% for women
■ 11% of breast cancer. Becoming more active can bring substantial benefit.

There is a clear dose-response relationship between physical activity and all-cause mortality, and between physical activity and diseases such as coronary heart disease and type 2 diabetes: greater benefits occur with greater activity participation (see Figure 1). From a public health perspective, helping people to move from an inactive level to low to moderately active levels will produce the greatest reduction in risk. A physical activity energy expenditure of 500-1,000kcals per week (about 6-12 miles of walking for an average-weight individual, compatible with the current physical activity recommendations for adults) reduces the risk of premature death by 20-30%. These considerable health benefits hold for both women and men and are evident even up to the age of 80 years.

This is clear. If more people adopted this regime of moderate exercise there would be dramatic change. However in the back of my mind is the quote from Jerry Morris saying that vigorous activity was necessary and his survey of civil servant showed gardening was not enough. I presume later surveys have different results but is vigorous exercise really unnecessary?

It seems that there is might be some debate. In 2007 the American Heart Association modified its advice by incorporating vigorous exercise and resistance training. The base recommendation was still 30 minutes of moderate activity 5 times a week, but 3 sessions of vigorous exercise could be substituted, if preferred, or moderate and vigorous sessions could be mixed. The Guardian report of this change was exaggerated and had the headline “The era of gentle exercise is over: it’s official you’ve got to work up a sweat”, which is a complete misrepresentation (the NHS Behind the Headlines response is here). Although the American report was merely an enhancement of the existing recommendations, it did acknowledge that there were still some people who believed that only vigorous exercise had a health effect and that recent evidence gives some indication that vigorous exercise is more beneficial for cardiac disease.

However in terms of a public health message the last thing you want is debate. It is important to stand firm with advice and only change it when counter evidence is very clear. Any sign of confusion is an excuse for people to do nothing. You need only look at diet, where there is a perception of scientists always changing their minds (even if this is not the case) to see how that works.

Additionally getting people to move from nothing to something is very difficult and you do not want to make the task seem daunting. (Again diet is the example ‘5 a day’ for fruit and vegetables was chosen as a target that would not be too off-putting; it is not necessarily the optimum).

So I can now see why the current advice is good. It has a the maximum chance of making an impact but it needs to seep into the general consciousness in the same way as '5 a day'. If we walk on average only half a mile a day and 38% of adults have less than 30 minutes of moderate activity a week. There is a long, long way to go.

Official Advice on Exercise Pt 1

The example of exercise advice given from the health perspective was randomly chosen: I searched Google, found the recommendations from an NHS website and the job was done. It was the only article I read and as it lived up (or down) to my expectation by advocating a gentle approach that almost suggests you can exercise without any great effort, I looked no further. But this is not good enough because: 1) it goes against the principle of always trying to disprove your own assumptions; 2) it is only fair to look further.

So here is a record of my search for official advice on exercise to see whether it is clearly presented and easy to find. I will do this in two posts. The first will look at the sources of information on the Web; the second will look at the content of the advice and its consistency.

Sources of Information

1) Directgov is designed to be the citizens portal for government information and advice and is the obvious place to start. The front page has a link to a index page on 'health and wellbeing', where there is a section for 'healthy living' but this doesn't have exercise as a subheading so the only option is a click to another index page: 'more about healthy living'. Here again there is nothing about exercise I can go to 'Change4life' but there is also a heading 'sports facilities and events', which seems at first to be unlikely. Strangely it is what is needed as it contains links to:
keeping fit (young peoples section);
staying physically active (pensions and retirement planning section);
fitness advice on NHS Choices.
At last some information!

There was of course no need to go through the linky links, there is a search box. The search term 'exercise' threw up the 'sports facilities and events' page as the first hit but I ignored it because, at the time, I thought the strap line 'Find a local gym or sports facility and look up local and national sporting events' made it seem irrelevant. However I did strike gold because the next hit was a newslink to the 2004 report by the Chief Medical Officer's on exercise, which I was able to download from the DoH site.

(Totally by the way their search engine is a bit weird. The results for 'exercise recommendations' or 'exercise guidelines' offered 'NHS to offer acupuncture for back pain' as the first result)

2) Change4life. Apparently the Government is spending £75m on this campaign to encourage us to eat more healthily and exercise more. So surely this must be the place for good advice. It is aimed at families so presumably it's written to advise parents on what's good for them and their kids, ie its supposed to be read by adults.

Oh the bright colours! Oh the perky language! It makes you feel like you are being talked at by the presenters of Playdays. Here is the introduction to 'Why Change4Life?'

Well done! Visiting this site is your first step in making a Change4Life, and you're not alone. Lots of people like you are already enjoying making a Change4Life! The way we live nowadays means a lot of us, especially our kids, have fallen into unhelpful habits. This means all of us need to make small changes to eat well, move more, and live longer.

There is so much I could say about this but I will restrict myself to one small question. Why 'unhelpful' when the obvious word is unhealthy? Sometimes a single word can show a rottenness of thought behind the writing. Here is how they explain why we should encourage our kids to be more active:

Activity raises kids’ heartbeats and helps pump blood around their bodies. It’s like a mini workout for their lungs and muscles! It also decreases their chances of getting life-threatening diseases.

I am comatose with despair!

3) NHS Choices LiveWell. This fitness section is a proper grown-up site and actually quite good. The information on the why and how of exercise is clearly laid out and there is a good range of side links to supporting information (eg a link to Sustrans to help people get cycling and a video wall of tips from Olympic athletes). This is the place to find the Government's advice but this is not the end of the story because there are always other places to look.

4) More from NHS Choices. Entering the term 'exercise' in the search box brings up many more pages of advice that are not linked-to from the fitness site. A lot of them are plain pages of text and are thus probably excluded for looking a bit dull but they contain good, solid information. This on what type of exercise? is a good example. ( on a side note this page is not only dated it shows when it will next be reviewed. I wish this practice was more common)

5) Department of Health. This has more background information to support the exercise campaigns. From here you can Chief Medical Officers report as well as the NICE guidelines for health professionals on increasing physical activity. There is also the action plan published february this year, which brings together both the advice and plans to increase activity. This has to be done because the shocking statistics found in these documents show that:

Around 65% of men and 76% of women are not physically active enough to meet national guidelines (to be at least moderately active for at least 30 minutes on 5 or more days a week). 30% of boys and 39% of girls aged 2–15 years do not achieve the recommended physical activity levels for their age (at least 60 minutes of at least moderate- intensity physical activity each day).

Between 1995–97 and 2005, the average distance walked had dropped from 200 to 197 miles per person, per year. The average distance cycled fell from 43 to 36 miles per person per year.

6) Behind the Headlines This is a brilliant NHS site that looks at the actual research findings behind health stories in the news and puts them into context and assess how significant they might be. Although this is not the place for the official government advice it is worth checking So far they have analysed 243 stories related to lifestyle and exercise. If searching for articles about exercise it is important to remember that the search engine covers the whole of the NHS Choices site and so the phrase 'behind the headlines' should be included in the search.

7) NICE. As well as the guidelines for health professionals I mentioned earlier, NICE have produced a report on creating physical environments that support increased levels of physical activity. It can be downloaded from this page, where you can also have access to their background information. This is one of the fundamental issues and shows how any attempt to change peoples pattern of behaviour has far reaching ramification that reach into many other areas of government.

8) NHS Evidence In my rather sad way I got quite excited when I found this search portal for health information that covers published, research, grey literature, guidelines and reports. The results page gives the option of refining by type of publication.

9) Other Bodies. There are all sorts of other bodies that have some sort of stake in physical activity from the well known such as Sports England or slightly more esoteric like the Outdoor Health Forum but I feel that I am wandering away from the core subject of official advice into a thicket of bureaucratic bodies and background information and I know that madness lies there. However I must pass-on my favourite line from the website of the Physical Activity Alliance "Currently, the Alliance has no formal status; there is no legal entity; there are no staff, no premises, no agreed strategy or delivery plan/programme."  Brilliant!

More Jerry Morris

I have been thinking more about the article about Jerry Morris I linked-to recently and realise that I need to explain why I found it both interesting and uplifting.

The main reason is a straightforward admiration for anybody who has spent his life trying to make things better for others. Such people, who try to solve problems practically, based on knowledge and understanding, are the backbone of the country (compared to most of the people in the media who seem to float on clouds of opinion). Jerry Morris was a high level example and, from the evidence of the article, it looks as if he led a virtuous life.

Times Past

Another reason is probably nostalgia. When I read it I could almost imagine a black and white film of the forties with the central character calmly displaying determination in the face of adversity, moral strength, and practical intelligence (he would probably have to be played by John Laurie because I think it was the law at the time that all Scotsmen had to be played by John Laurie). But deeper than an internal cinema is the attraction of looking back at what has changed and what is still the same.

He worked when we were changing from a physically demanding life to the more domesticated, sedentary world we now inhabit. To be able to compare bus drivers to bus conductors was a wonderful opportunity because class, background, lifestyle, diet of both was very similar and it was possible to isolate the differences caused by exercise. This is no longer the case: there are very few conductors; there are far more differences between those who take exercise and those who don't and there are far more confounding factors.

I also found his regret at the passing of the can-do attitude of the 40s to be poignant. i am sure that it is not that we are any less practical or enterprising now but rather we have lost faith in the idea that national plans and initiatives can make things better. Our default position is cynicism and it is a shame that it is so. The post war period, up until the mid 70s, was probably the high point of optimistic thinking, ie a belief that life could be made better, planning could improve the lot of everybody and the application of science would be beneficial. It is not easy to recapture that mood but I still think there is a lot to recommend in the idea of rounding-up all the experts on a subject, sending them away to the Hebrides and not letting them back until they come up with a workable plan.

Applying the Lessons

Although he made is discovery a lifetime ago, there is now a general understanding of the importance of exercise, I am not sure the full message has been accepted. He is very clear that there needs to be vigorous exercise (gardening by itself is not enough) but a lot of the health advice offered today tones that down. We pussyfoot.

I looked at the exercise recommendations on the NHS Choices. Although it contains some sensible advice, nowhere does it mention the need to raise the pulse rate. Vigorous? The word is shunned as we cannot make even the tiniest suggestion of effort in case we scare people off. I understand the motive, and we certainly don’t want to make things seem overly forbidding, but our bodies were evolved for exercise; there is pleasure in breathing heavily. More to the point vigorous exercise is necessary and we are diluting what we know to be true in an effort to make it more palatable. That does nobody any good.

“Exercise normalises the working of the body”. I like that quote. I think it should be at the head of all the health advice.

The Necessity of Exercise

This quote says it all:

“For the first time in history,” says Morris, “the mass of the population has deliberately got to take exercise. It’s a new phenomenon, which is not appreciated.” For decades he has tried to persuade governments to make exercise easier. He was involved in the pioneering English National Fitness Survey of 1990, which found that half of women aged 55 to 64 could not comfortably walk a mile. These people were in effect disabled. The government ignored the report. Since then, British exercise levels haven’t changed much. His voice becomes high-pitched with outrage: “Just imagine, what historians in the future are going to say about the way we’ve allowed this epidemic of childhood obesity. ‘Disgrace’ is a sort of mild word.”

A Sedentary Life

It was a tiny moment. In some ways like glimpsing a passing reflection of yourself, in a shop window, and seeing yourself as if you were a stranger and realising you look slightly different than your normal self image.

I decided to clear my desk. Not a momentous event, just something that has to be done periodically when my effective working area becomes too reduced by piles of stuff I accumulate. Then everything has to be swept away as I have an overwhelming desire for open space. Yesterday, after I had finished, I looked with satisfaction at a worktop with only a computer screen, keyboard, mouse, notebook and pen. I sat down and felt happy. It was then that the tiny moment of insight and realised how much of my time is spent sitting down. Damn I thought, there is no way round it, I lead a sedentary life.

My self image is of being quite active, someone who enjoys a certain amount of physical challenge and the satisfaction that comes from justified tiredness. In short: someone who runs. But in terms of time this is small beer - most of the time I sit.

I don't know what to do with this insight. I don't know whether I ought to spend more time on easy runs, cycle rides or just being outdoors or whether I ought to be more generally active. At the very least I ought to be aware of my posture, because what you do for most of the day is bound to have a great impact on you body form. I will have to look afresh at the physical component of my whole day, rather than focusing on the bits I enter into my running diary. In other words think about health in general.


Postscript

Whilst I was sitting around thinking these things I came across this article on Jerry Morris. It is based on an interview given a shortly before his death and is quite inspiring. He is an obviously great figure (though perhaps little known outside his speciality) who is important to all of us mid-pack runners and general exercisers because he was the first person to show the link between vigorous exercise and a reduction of heart disease. The piece is titled 'The man who invented exercise' and so we obviously owe him debt.