Autumn Speakers Series: Practising what we preach – Sit Less Move More!
Dawn Skelton is an exercise physiologist with a scientific research background. She is currently Professor of Ageing and Health at Glasgow Caledonian University, in 2015 received an Honorary Doctorate for Umea University in Sweden for her work with exercise and older people and in 2016 was honoured by the Chartered Society of Physiotherapy with an Hon FCSP. Along with Susie Dinan Young, she designed and undertook the FaME (Falls Management Exercise) programme which forms the basis of the Postural Stability Instructor Training delivered by Later Life Training.
There has been a flurry of activity in research (eg. early physical therapy reduces length of stay and care needs on discharge), as well as in practice, on the importance of patients moving more and the perils of deconditioning whilst in hospital. #EndPJParalysis has had a huge profile and is starting to make inroads in terms of getting patients dressed and potentially more comfortable to move about more. But are we seeing a change in how much patients are moving?
Recently Juliet Harvey has published an article ‘What happened to my legs when I broke my arm?’ describing a participant in one of her trials who happened to be wearing an objective monitor that recorded how much time she spent sitting vs upright for a few weeks before and after her fracture. Sadly whilst in hospital (for a broken arm!) her sedentary time was nearly 99% of the day (perhaps worse), and even 4 weeks later her sedentary time was still much higher than it had been in the weeks before her fracture. We don’t know if this was due to a heightened fear of falling, or a mind-shift that movement can’t be that important as she was not encouraged to move whilst in hospital. Whatever is happening, a hospital admission in the previous year (for whatever reason) is a strong and independent risk factor for functional decline in the over 75s (adjusted odds ratio of 3.92) and this may be due to declining levels of physical activity leading to deconditioning and muscle loss in particular. There is also a strong relationship between speed of functional decline in those older people who ‘take to their bed’ when poorly, or have had a fall that does not require hospital admission. Keeping moving to help maintain muscle strength (and size!) when we are transitioning to frailty is vital!
We all know that physical activity is important for health. We all know that maintenance of strength and balance is important to prevent frailty and remain active. Yet we are not consistent in our approach with patients. Every contact should include a discussion about being as active as possible and the importance of strength and balance to reduce symptoms and slow progression of frailty. Perhaps we are still concerned about falls rates on our wards and so, indirectly or not, try to avoid exposure to risk (by not encouraging movement) or the staff are just too busy for someone to be encouraged to move with support. Whatever happens, we must change the public perception that ageing and ill-health mean sitting more. Prolonged sitting has many detrimental effects on the body, including loss of muscle mass, stiffness, low mood and changes in cardiovascular markers.
There are some simple bits of advice that you can offer patients:
- Whilst in hospital – try to do a ‘sit to stand’ about once an hour (this will help maintain muscle strength as they are lifting body weight repetitively over the day and this has a training effect on muscles eg. Harvey et al. 2018). If you have the energy or feel safe enough, walk around the bed or the ward to help circulation. Once home, continue to do this throughout the day, perhaps do 2-3 ‘sit to stands’ in one go each time.
- Once home, stand on one leg while you wait for the kettle to boil (preferably with just fingertip support on the kitchen counter so you feel wobbly but are safe) which will help improve strength in the ankles and improve balance. Remember to stand on the other leg next time!
- Think about joining an exercise class near you once a week to build on strength, balance and activity levels or, if a class isn’t for you, download a home exercise booklet from Age UK or Later Life Training.
The importance of moving more and sitting less is being highlighted at the Autumn Meeting. Looking forward to seeing you there, but watch out, I may suggest you stand up and move about! There will be all sorts of activities during the conference, such as a walking tour, runs, Tai Chi, stretch and stability exercises and a giant puzzle in the exhibition hall. I know that Julie and Geraint are looking for any other ideas, such as Yoga, so anyone who would like to suggest ideas or facilitate a session should email registrations [at] bgs [dot] org [dot] uk