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Sport & fitness: On your marks?

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Sport & fitness: On your marks?

Despite the widely reported benefits of regular exercise, half of women and a third of men in England are currently not active enough to stay healthy

 

 

Learning objectives

After reading this feature you should be able to:

  • Recommend the appropriate level of physical activity for a person’s age or condition
  • Explain how to exercise safely
  • Advise on the treatment of common sports injuries.

 

Physical inactivity directly contributes to one in six deaths in the UK, the same number as smoking, according to a recent report by Public Health England.1 Increasing physical activity not only reduces the risk of obesity, diabetes, hypertension, stroke, heart disease, musculoskeletal conditions, cancer, depression and non-vascular dementia, it also improves emotional and mental wellbeing and is one of the most effective ways to improve both individual and community health and wellbeing in general.

“Fitness is a potential growth area for pharmacy as it dovetails with services we already provide, such as weight management and smoking cessation, and fits with the healthy lifestyle messages that pharmacy should promote,” says Yvonne Tuckley, Numark’s learning and development manager.

“But, apart from those pharmacies that have health trainers, we don’t see many getting involved beyond signposting and general healthy living advice.” Pharmacists can easily introduce the subject of exercise when conducting consultations on smoking, weight management and as part of a MUR, she says. It also can be discussed when patients are suffering from stress, back pain or sleeping difficulties.

Encouraging people to become more active should be part of a pharmacist’s advice in any weight loss programme. Gareth Rowe, pharmacist and owner at Nantymoel Pharmacy, Bridgend and a Numark member, is a keen sportsman who is enthusiastic about passing onto customers his own experiences of the benefits of keeping fit.

He has been involved in martial arts since the age of 15 and competes at an international level. “Promoting exercise is a great role for pharmacists. I like to talk to customers about sport and exercise at every opportunity. I raise it as part of a lifestyle discussion when doing MURs and there is also an ideal opportunity if people are wanting to lose weight. At the moment we are running a stroke campaign for the local health board, so this is another chance to raise the issue of doing regular exercise and watching their weight with customers.

“We also know that exercise is good for stress relief, depression and psychological wellbeing, and I always highlight the positive effects of the social aspects of engaging in sport.” Gareth also offers nutritional advice to people interested in sport and sells sport supplements. “I [take] supplements myself, so I also bring that into the conversation,” he says.

Current evidence

Department of Health guidelines in 20112 set out the amount and type of physical activity that everybody should be aiming for at each stage of their lives. The guidelines draw on global evidence for the benefits of regular physical activity.

Even relatively small increases in physical activity are associated with some protection against chronic diseases and an improved quality of life, says the report,  while numerous other studies add to the considerable evidence on the benefits of exercise. These include:

Walking is linked to lower breast cancer risk.3

Walking at least seven hours a week is associated with a 14 per cent lower risk of developing breast cancer after the menopause. The study, which monitored 73,615 post-menopausal women, found that exercise helped women whether or not they were overweight, and even if they gained weight during the study.

Lack of exercise is linked with twice as many deaths as obesity4

This study of over 334,000 people found that twice as many deaths may be attributable to lack of physical activity compared with the number of deaths attributable to obesity. A modest increase in physical activity, such as a brisk 20-minute walk each day, could be enough to reduce an individual’s risk of early death, the researchers concluded.

“This is a simple message: just a small amount of physical activity each day could have substantial health benefits for people who are physically inactive,” says Professor Ulf Ekelund from the Medical Research Council epidemiology unit at the University of Cambridge, who led the study.

Light jogging could lead to a longer life5

Researchers compared 1,000 healthy joggers with 400 healthy, but sedentary, non-joggers. The joggers were likely to live longer if they jogged two to three times a week or between one to 2.4 hours a week. “This study shows that you don’t have to run marathons to keep your heart healthy,” says Maureen Talbot, senior cardiac nurse at the British Heart Foundation.

Cyclists who stay active in old age are likely to have better fitness levels6

The research studied 125 healthy amateur cyclists aged between 55 and 79 years. Even the oldest participants performed to the levels of normal healthy young adults and this group of healthy and active older adults had greater levels of fitness than their sedentary peers.

Moderate exercise reduces death risk in elderly men with high blood pressure7

Researchers assessed the fitness status of 2,153 men, aged 70 years and older with high blood pressure, by a standard treadmill exercise test and followed them over nine years. They found that elderly men with high blood pressure can lower their risk of death with even moderate levels of fitness. The fittest of the elderly men were half as likely to die as the least fit.

Brief advice in pharmacy is effective8

NICE says there is strong evidence for the effectiveness of counselling and brief advice in primary care to increase an individual’s physical activity. It recommends that pharmacists identify those who are inactive and deliver programmes of brief advice including a package of support. It says pedometers can work well to stimulate physical activity – an item that could be sold in pharmacies.

Sports injuries

The commonest sports injuries that people are likely to seek advice from pharmacy about will be due to:

  • Overuse
  • Poor training practises
  • Failure to use proper equipment
  • Lack of conditioning
  • Insufficient warm-up and stretching.

London Sports Injury Clinic medical director, Dr Ralph Rogers, says a common problem is that many people take up an activity too enthusiastically, then suffer from overuse injuries. “If someone does more than 10 per cent of the physical activity they normally do, they are likely to suffer overuse injuries,” he says.

When advising on increasing physical activity, the first thing pharmacists should do is advise people to do it gradually. “Rather than rushing off to lift weights or go jogging, people should start doing extra activities such as getting off the bus three stops earlier, taking a walk round the block during their lunch break or climbing the stairs instead of taking the lift. Exercise has to become regular first, then people can start increasing the load.”

Dr Daniel Fong, senior lecturer in rehabilitation science at Loughborough University, says there are a number of steps people should go through to help prevent common sport injuries, the most important being a warm-up exercise for 15 minutes to help prepare the muscles. This should involve as many joints as possible, including the spine, to help stretch the muscles to the extent the body will experience during sports.

“Doing some fitness training to help strengthen the small and core muscles of the knee joint would also be beneficial, as many sports require people to land with a squatted knee. A good landing technique is also essential when it comes to avoiding sprains while playing ball games, for example, which require a lot of side stepping movements.”

Jenny Pacey, personal trainer and Olympic athlete, adds that before a hard workout people should also make sure they are fully hydrated, have had a good night’s sleep (around eight hours) because lack of sleep increases injury risk, and have had a light snack so they are energised.

Reflection exercise 1

Injuries can be reduced by:

  • Warming up properly
  • Not pushing the body beyond its current fitness level
  • Using appropriate equipment for specific sports (e.g. suitable running shoes, shin guards for football and a gum shield for rugby)
  • Receiving coaching to learn correct techniques

Management of common sports injuries

Strains, sprains and muscular injuries A sprain happens when one or more of the ligaments affected are stretched, twisted or torn. A strain, also known as pulling a muscle, happens when muscle tissues or fibres are stretched or torn. Signs of a sprain or strain can include pain, swelling, bruising and tenderness around a joint or in a muscle. It may be difficult to move the affected body part. Minor sprains and strains can usually be treated with self-care techniques, such as PRICE therapy:

  • Protect – the area from further injury
  • Rest – avoid exercise and reduce daily physical activity
  • Ice – apply an ice pack to the affected area for 15-20 minutes every two to three hours
  • Compression – use elastic compression bandages to limit swelling
  • Elevation – keep the injured body part raised above the level of the heart.

Advise customers that they should try to move a sprained joint as soon as it is not too painful to do so, but a strained muscle should be immobilised for at least a few days.Painkillers, such as paracetamol, can be used to help ease any pain. NSAID tablets or creams, such as ibuprofen, can also be used to both help ease pain and reduce any swelling.

Tennis elbow

Tennis elbow is a painful condition that affects the outside of the elbow. It is caused by strenuous overuse of the muscles and tendons of the forearm and around the elbow joint. Symptoms include swelling around the outer edge of the elbow, tenderness around the elbow and pain on movement. It is a self-limiting condition, but it can last for several weeks or months because tendons heal slowly.

Painkillers, such as paracetamol, can help with the pain and ibuprofen can relieve the inflammation. Topical NSAIDs in the form of creams and gels can also be applied to the painful area.

Blisters

Blisters are common in people who play sport or are very active and are usually caused by an injury to the skin from friction, which causes fluid to collect under the damaged layer of skin, cushioning the tissue underneath and protecting it from further damage. Customers should be advised not to pierce a blister with a needle because it could lead to an infection.

Small blisters can be covered with a plaster. Larger blisters can be covered with a gauze pad or dressing that can be taped in place. Hydrocolloid dressings have been shown to help prevent discomfort and encourage healing.

Advise plasters for small blisters

 

Athlete’s foot

Athlete’s foot is a common fungal infection of the foot, often caused by feet becoming damp and sweaty during sporting activities. An itchy red rash develops in the spaces between the toes and the affected skin may be scaly, flaky and dry. Athlete’s foot can be treated using antifungal medication available over the counter.

To prevent a reoccurrence customers should be advised to wash their feet regularly using soap and water, dry their feet thoroughly after washing them, and wear clean cotton socks, which are changed regularly to help keep the feet dry. They should also avoid sharing towels.

Itchy red rash of athlete's foot

 

Verrucas

Verrucas are caused by a virus that invades the skin through tiny cuts or scrapes. They are contagious and are commonly spread via the contaminated surface of floors in swimming pools or communal showers. The pressure from normal standing and walking can make verrucas painful. While they are harmless and may go away without treatment, verrucas can be treated with a range of lotions, paints and special plasters that contain salicylic acid.

 

Physical activity guidelines

Under fives

Children of pre-school age should be physically active daily for at least 180 minutes spread throughout the day. Children and young people (5-18 years) All children and young people should engage in moderate to vigorous intensity physical activity for at least 60 minutes and up to several hours every day.

Adults (19-64 years)

Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes of moderate intensity activity in bouts of 10 minutes or more, or do 30 minutes on at least five days a week.

Older adults (65-plus years)

Older adults who participate in any amount of physical activity gain some health benefits, including maintenance of good physical and cognitive function. Some physical activity is better than none and more physical activity provides greater health benefits. Ideally older adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes of moderate intensity activity in bouts of 10 minutes or more.

People with diabetes

Diabetes UK says people with diabetes should be encouraged to exercise regularly for better blood sugar control and to reduce the risk of cardiovascular diseases. The reason for this is that muscles which are working use more glucose than those that are resting. People with diabetes should do 150 minutes of moderate intensity activity a week.

People who are overweight or obese

NICE says interventions to increase physical activity in people who are overweight or obese should:

  • Focus on activities that fit easily into their everyday life, such as walking
  • Be tailored to individual preferences and circumstances
  • Aim to encourage people’s belief in their ability to change.8

Prevention

NICE recommends that pharmacists should discuss increasing physical activity with people at times when weight gain is more likely, such as during and after pregnancy, the menopause and while stopping smoking.9

 

References

  1. Public Health England. ‘Everybody active, every day: a framework to embed physical activity into daily life’. October 2014
  2. Department of Health. ‘Start active stay active’. 2011
  3. Hildebrand J. Recreational physical activity and leisure-time sitting in relation to postmenopausal breast cancer risk. Published online October 4, 2013 in Cancer Epidemiology, Biomarkers and Prevention
  4. Ekelund U et al. Activity and all-cause mortality across levels of overall and abdominal adiposity in European men and women: the European Prospective Investigation into Cancer and Nutrition Study (EPIC). American Journal of Clinical Nutrition; January 2015
  5. Journal of the American College of Cardiology. February 2015 www.acc.org/about-acc/press-releases/2015/02/02/11/24/light-jogging-may-be-mostoptimal-for-longevity?w_nav=TI
  6. Pollock D, Carter S, Velloso P et al. An investigation into the relationship between age and physiological function in highly active older adults. The Journal of Physiology. 2015. Volume 593, Issue 3; 657-680
  7. American Heart Association’s journal Hypertension. May 2014. http://newsroom.heart.org/news/elderly-men-with-high-blood-pressure-lower-death-riskwith-moderate-fitness
  8. NICE. Physical activity: brief advice for adults in primary care. May 2013
  9. Guidance on the prevention of overweight and obesity in adults and children. NICE. Issued 2006; modified March 2015
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