Lack of exercise is contributing to a burgeoning health crisis. To get back in shape, we need to remodel not just our bodies, but our cities and workplaces. By Nicky Pellegrino.
It is difficult to believe today but in the relatively recent past, medical experts believed vigorous exercise might be bad for our health and that elite athletes risked an early death.
Ironically, just as it was becoming accepted that we are biologically designed for movement and that physical activity, without overdoing it, is absolutely crucial for our mental and physical health, the human race was starting to become less active.
The constant invention of more labour-saving devices means that now even minor exertions, such as getting off the sofa to change the TV channel or walking around a video store to choose a movie, are unnecessary. We have created what medical journal the Lancet described as a "pandemic of physical inactivity".
"We are the undermuscled generation," University of Auckland nutrition professor David Cameron-Smith told the Listener after research at the university's Liggins Institute three years ago sounded the alarm about "an epidemic of frailty". "We are puny compared with previous generations."
The loss begins early and for many years we hardly notice. But weakness matters. "It's staggering how frail some otherwise healthy 50-year-old men are," Cameron-Smith said.
"At some point in your life, the hardest thing you will have to do is get up out of your chair or get yourself up off the floor after a fall, and your maximum strength determines whether you can or can't do that … or whether you're stuck on the toilet and can't get up.
"Weak people at 50 are going to be the weakest people at 70, unless we shift ourselves dramatically."
And we're not. The statistics make grim reading. One in eight New Zealand adults is active for less than 30 minutes a week. Only 7 per cent of children meet the Ministry of Health guideline of at least one hour of moderate to vigorous activity a day. And we are not alone – when Public Health England asked people how much cumulative time in an average month they spent walking briskly, 44 per cent ticked less than 10 minutes. In the meantime, the fitness industry has boomed. Forbes predicts that Peloton, an at-home fitness company that sells connected exercise bikes and related fitness subscriptions, will reach a revenue of US$3.6 billion in the 2021 financial year.
So, what's going on? And more importantly, what can we do about it? That was what Peter Walker wanted to know when he set out to research his latest book, The Miracle Pill.
Walker isn't a scientist; he is a political correspondent for UK newspaper the Guardian. He was disturbed by the way everyday physical activity has disappeared from our lives and convinced of the "near-magical benefits" of moving more.
There hasn't been a sudden global outbreak of idleness, he says. The real problem is that disincentives to move are to be found almost everywhere we go.
"One of the more obvious examples is going into an office block, hotel or any big building," he says. "There will almost certainly be a set of gleaming lifts as you walk through the door. But if you try to find the stairs, you have to hunt down a corridor and then risk setting off an alarm, or getting locked on the stairwell."
Walker gets his own dose of daily activity cycling from his home in Camberwell, South London, to his job in the House of Commons, but concedes that cycling is not for everyone.
"There aren't enough safe bike routes and a lot of people quite reasonably feel that sharing a road with cars driving fast isn't much fun," he says.
Better than nothing
It all sounds like we are doomed but, encouragingly, Walker doesn't think so. In fact, he describes The Miracle Pill as a story of hope.
"Before I started researching the book, I knew how bad it was for you in the long term to be inactive," he says. "But what I didn't realise was how quickly things could turn round. The US Centers for Disease Control says that on the same day that you're vigorously physically active you will have this whole list of benefits: your body will cope with glucose better, you will sleep better, your mental state will be better and your blood pressure will be lower. That is all from one bout of exercise, so the dose response curve is incredibly steep. And that is a hopeful thing. People don't have to aim for running a marathon or doing 10,000 steps a day, because virtually anything is better than nothing."
Elite sport has seen a lot of investment. Walker cites the UK Olympic budget, which rose from £59 million in 1996 to £274 million by 2016. In New Zealand, the Government contributed $136 million to host the latest America's Cup.
There is no evidence that this kind of thing boosts the numbers of ordinary people taking part in sports. In fact, in this country, there is a downward trend, according to data collected by Sports New Zealand, with fewer eight- to 14-year-olds belonging to sports teams or clubs outside school and 18- to 24-year-olds spending less time being physically active.
The same research shows that, across the board, females spend less time than males being active. And people from high-deprivation areas participate in fewer sports and activities than others each week.
As for gym-going, it is estimated that about 400,000 New Zealanders hold memberships but, as one fitness industry analyst admitted to Walker, the business model of gyms is built on a good proportion of members being "sleepers", who pay but don't bother to go.
"Studies have shown again and again that not enough people manage to do formal sport," he says. "Maybe they work long hours or they've got young kids, but it doesn't work. Governments have to realise that it's not just about saying sport is great, do it. If you really want physical movement to embed in someone's life, it has to be in the form of incidental activity."
What particularly shocked Walker was how sedentary kids are these days. The tendency is to blame screen-time, but when he fitted a high-tech fitness tracker to his nine-year-old son, he found that the child's weekend was full of movement. School days, conversely, were mostly spent in a chair. There, his son was sitting for six hours a day, three times as much as on the weekend.
"I don't want to criticise the school, because they do an amazing job of teaching kids with a wide range of abilities," says Walker. "But I think it's possible to have the same amount of education and to integrate more movement into it."
Activity is particularly crucial in childhood because that is when we build strong bones and cardiovascular systems, but hopefully it also sets up good habits for life. There is no mandate for a minimum level of activity in the school curriculum, but a recent research paper from the University of Otago recommended introducing one, stressing that the situation was urgent.
Walker's story of hope visits some of the places where the problem is already being addressed. In Scotland, he met former school principal Elaine Wyllie who, appalled by the lack of physical fitness shown by many of her pupils, introduced what came to be called the Daily Mile.
"Every day, the kids are taken out for a mile run," Walker explains. "They wear their normal school clothes, so don't have to change into their sports gear. It always takes place outside and they can chat as they go."
Initially, the kids were exhausted, but then they started to enjoy their 15 minutes of fresh air and freedom, and the initiative has now spread to more than 7000 British primary schools and beyond to other countries. "The studies they've done in schools that have the Daily Mile show that apart from physical fitness, their concentration tends to be better and there's some evidence that even academic attainment improves, and it's just running round chatting to your mates, which is what kids are supposed to do."
Meanwhile, Finland has a national action plan called Finnish Schools on the Move, which most of its schools participate in. They implement individual plans to increase activity, which involve the way kids travel to school, physical activity breaks and active learning – getting them up and out of their chairs during normal lesson time.
It isn't news that prolonged, uninterrupted sitting is bad for us. But for many it has become the way we have to spend our work time and choose to spend our leisure – five to nine hours sitting in a day is normal, according to various surveys.
This affects so much about the way our bodies work. Resting muscles produce fewer of the proteins that break down triglycerides – a type of fat found in the blood that is released for energy. The absence of muscle contraction isn't helpful for the correct processing of blood glucose, either. Being sedentary is bad for our health in a dizzying array of ways. One US study, which tracked a large group of people over a long term, found that those who sat for more than six hours a day were more likely to acquire a long list of conditions ranging from Alzheimer's to type 2 diabetes, cardiovascular problems and cancer.
There are solutions such as standing desks, walking meetings, Swiss balls, and phones and watches that sound an alarm reminding us to get up and move around every 30 minutes.
Even insurers are getting in on the act; AIA is offering rewards points and an initial 10 per cent premium discount on health and life insurance for people who use wearable health devices such as Fitbits and sign up to its "AIA Vitality" programme for an $11.50 monthly fee.
But many of us are still sitting for too long. Ironically, while writing about this during the extended UK lockdown, Walker has been working from home and, deprived of his usual daily cycle commute, been more desk-bound than ever. "Sometimes I'll realise I've been sitting there for two hours and I've not shifted at all."
In New Zealand, there were winners and losers in the exercise stakes during the national Level 4 lockdown last year, according to a survey by the University of Otago. Overall activity decreased, but some people who were only moderately active before did manage to exercise more and maintained the change into Level 2.
Walker has adapted, taking up running for the first time in his life, encouraged by a 2017 study that showed that although regular activity brings greater benefits, so-called weekend warriors are still 30 per cent less likely to die than people who are inactive, even when they don't meet minimum-activity guidelines.
Walker may also want to take up energetic fidgeting as, remarkably, it has real benefits, according to leading authority on obesity James Levine, author of Get Up! Why your chair is killing you and what you can do about it. He calculated that toe tappers and arm swingers expend considerably more energy than someone who sits motionless in a chair.
Although no one is denying that vigorous exercise is the ideal, it seems that so called "exercise snacking" – small bursts of activity throughout a day – is better than nothing. Even the first minute of exercise improves your health, just getting out of a chair and walking a few steps.
"The message that can't be stressed enough is that there are remarkably few circumstances in which being physically active for even slightly longer or a bit more vigorously will not do you some good," says Walker.
None of that is remotely contentious nowadays. One theory that is more controversial, however, is that it is better to be heavy and healthy than skinny and inactive. Some studies say yes, but others have claimed it not to be the case.
"Much cleverer people than me have been arguing about this for years," says Walker. "But the one thing they agree on is that whatever your BMI [body mass index], being active is almost always going to be much better for you, whether or not you end up losing weight.
"A lot of governments are focused on obesity and it's a really important public-health issue. But losing weight in the long term is extraordinarily difficult. So I think it's important for people to just be active anyway. If you lose weight, that's brilliant, and if you don't, you'll still get some benefits."
We have known since workplace studies in the 1950s that there is a connection between better health and being more active. Bus conductors on double-deckers who were climbing and descending 500 to 750 steps a day were healthier than their sedentary bus-driver colleagues. Postal workers who delivered mail by bike or on foot had half the incidence of heart disease of their desk-bound fellow workers. But despite health campaigns such as Push Play, most of us move less today than we would have back then. Walker is hopeful that the post-pandemic era will be the time when finally we do something about it.
"Certainly, in the UK, a lot of the political discourse is seeing the world after Covid as an almost post-1945 mood," he says. "In the UK, after World War II, you had the establishment of the National Health Service and the welfare state. There were some very big changes because the attitude was, we've suffered enormously for six years, so we want the world to be better now."
Covid has shown what governments can do, says Walker. If you can effectively shut down an economy to save 200,000 lives, then you can introduce some robust public-health policies to save the lives of the 100,000 people who die each year in the UK as a result of inactivity. In New Zealand, a 2015 statement from the College of Public Health Medicine said that a lack of physical activity caused 12.7 per cent of all deaths. To solve this problem will require long-term planning from reasonably interventionist governments to re-engineer our built environments, says Walker, making it easier for people to cycle to wherever they need to go, or walk up stairs rather than take the lift.
"It can be done; it just takes time," he says. "There are lots of cities around the world that are reshaping themselves and making it easier for people to move. But the ones where things are getting notably better are where they've had this slightly nanny-state approach.
"The Dutch have got the highest cycling levels in the world; something like 25 per cent of all trips are done by bike there. In the 50s and 60s, they had similar city layouts to most other countries. There was the rise of the car and they built highways in cities. Then, from the 1970s, they had this coherent policy of trying to change it. For my previous book, Bike Nation, I talked to the head of the Royal Dutch Cycling Union and asked what countries such as Britain could do and, basically, she said, 'Well, I'd start 30 or 40 years ago.'"
Late is better than never, says Walker. In fact, he believes we don't have a choice.
"If we keep with current activity levels then health services as we know them are not going to be viable in 20 or 30 years' time, and that's going to concentrate a few minds. No prime minister is going to want to be known in retrospect as someone who could have acted but didn't."