As a Physiotherapist, my area of expertise is human movement; Restoring movement and function after an injury, illness, or due disease, or simply ageing, is a large part of what I do, so the phrase 'movement is medicine' would seem an obvious statement to me.
When I trained as a Cancer Rehabilitation Physio a few years ago, there was an abundance of research supporting exercise in cancer sufferers and survivors, with 150 minutes of moderate exercise per week being the 'magic' amount to improve outcomes. Getting a little breathless and sweaty (but still able to hold a conversation) has been proven to enhance recovery from cancer treatments, leading to better quality of life and functional recovery, increased survival rate, plus importantly this level of exercise also decreases the risk of recurrence, development of subsequent cancers, and improved overall life expectancy.
The same amount of exercise has also demonstrated improvements in overall sleep quality in the general population through various studies, as well as improve - or even relieve - depression and anxiety symptoms. In a recent conversation with a psychologist, he advised he rarely uses medication prescriptions now, but always suggests daily movement for his patients, so even modern medical advances are choosing exercise over pharmaceuticals.
Regular exercise (30 mins per day) has also demonstrated significant improvements in cognitive function (memory, concentration, learning, emotional responses), potentially delaying dementia onset, and even showing benefit in schizophrenia. It's well known to lower blood pressure and improve heart health, as well supporting blood sugar stability which is why it's often recommended as a management strategy for people who suffer with Type II diabetes.
Research also suggests that it's never too late to start with an exercise regime, as many effects of lifestyle diseases can be offset and even reversed. Our bodies are actually quite forgiving, so starting something now is still better than nothing at all. There's evidence that gut microbiome is more diverse in people who exercise; the full reasons why this might be is not totally understood, but it could be linked to making healthier choices overall (See below as a driver for change).
Given these extensive benefits of exercise, why is it that just 63% of UK adults undertake the recommended amount of daily/weekly exercise? Possibly due to motivation. We all have times when we're keen as a bean and others when we'd rather curl up and watch TV. The type of exercise is important, and the ease which it takes to do it. Half an hour's travel to a gym is not going to be as tempting as literally exiting your front door to go for a walk around the block, and of course there's enjoyment. You're more likely to undertake a form of exercise you actually enjoy, so when picking a new regime, think about what makes you happy; even dancing around the kitchen for 20 mins is 'exercise', though sadly there are many people who would still rather pop a pill as it's 'easier' than moving your body.
(References: Spector, 2020; Burrell Education 3rd Age Course Notes, 2021, PINC & STEEL Certification Course Notes, 2016);
Exercise is a keystone habit that triggers widespread change; it’s a driver of health related behavioural changes, meaning you’re more likely to prioritise sleep and good food decisions if you start with exercise. And this is where the debate comes in with the type of exercise and what's right for you.
Interestingly, if you want to lose weight, exercise hasn't actually been found to contribute in terms of directly impacting on weight loss, but as mentioned above, you're more likely to eat healthily if you're moving more. Unfortunately, you're also more likely to eat more as exercise triggers hunger responses, so the choice of food is important. Congratulating yourself for a good bout of exercise with a can of coke and a Snickers isn't likely to lead to a smaller waist line if that's your goal!
There are also other considerations; longer workouts (60 mins and more) and endurance sports can actually lead to your body triggering a stress response and releasing cortisol (our stress hormone). This not only inhibits your body's weight loss attempts but in turn stores even more fat, especially around the midline, and triggers cravings to boot! It's a survival mechanism from hunter/gatherer days which is still inherent within us.
Additionally, working out later in the day has been found to trigger a cortisol response, which in turn not only stores more fat (as above) but also inhibits sleep, releasing even more cortisol and locking fat in. So timing is crucial.
Consider this: the energy our body uses to stay alive and function comprises 70% of our total energy expenditure and is predetermined by our genetics. 10% is used to digest food, and 10% is used for small movements such as fidgeting, sitting and standing. How much is left which can be affected by exercise? Just 10%. Which is why weight loss through exercise alone isn't a win win scenario. If you're tired after exercising, you're not likely to be making any progress either; this is your body's response to decrease energy expenditure and reduce metabolic rate as an attempt to over-ride perceived threat; exercising and using up fat stores makes your brain think you're under attack and preservation is needed, so it 'protects' you by storing fat through decreased movement, and triggering hunger to take on more energy. This process is more prevalent in overweight people; this is a clever protection mechanism but not exactly desirable in our modern world.
So, if you get tired after a long walk, are marathon training, or wanting to shift some extra pounds, there's a role for strength training. Resistance workouts (using weights or body weight) and/or short sharp busts or exercise such as HIIT and tabata have sound scientific evidence behind them. Your brain and body doesn't trigger the stress response, so you don't lock the fat in and you don't crave foods after a workout to the same level as with long or punishing workouts or training sessions.
These types of exercise also build testosterone, which in turn builds muscle mass. Lean muscle not only stores fuel (food) taken on board (meaning it doesn't convert to fat as readily), but also burns more calories even after a workout has ended, with HIIT training demonstrating fat burning 24 hours later; how cool is that?
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