When To Exercise

I’m often asked when is the most beneficial time to exercise? Well personally I enjoy working out first thing in the morning. But according to leading physiologist Mike Doherty who conducted research on a group of elite swimmers, the immune system can be compromised at different times of the day – and often in the morning. However, whilst it is true to say that the immune system is often compromised in elite athletes due to their intense levels of training, it is most unlikely to occur as a result of ordinary levels of activity such as we perform in the gym or the swimming pool before work in the morning.

For the average person the more varied an exercise programme, for example one which includes treadmill, weights and swimming, performed at any time of the day that suits one’s lifestyle is going to prove beneficial. Because a certain level of moderate activity can enhance the immune system, at the same time as it benefits the body by strengthening bone and muscle, maintaining suppleness and building stamina. All regular, moderate exercise will usually do more good than harm, and of course any activity is better than being inactive doing no exercise at all!

Remember the basic exercise rules:
• Warm up thoroughly
• Increase exercise gradually
• Build up intensity and repetitions slowly
• Stop if you feel any pain
• After activity always ensure a gentle warm down
• Give exercise a miss if you feel unwell

Transformation Shop

We have different resources for different needs, which can help drive improvements organisationally, individually or both.

Organisational Development 

Our aim is to help organisations transform their culture and develop integrated systems of care.  We will help single organisations that want to transform its culture/service or a group of organisations that want to work together to develop networks to deliver integrated systems of care to their populations.

We start with a transformation workshop which helps the key people in the organisation: 

  • Identify the main pressures they will face in the next decade
  • Agree on the principal features of a service transformed to flourish in the new environment

As a result of the Transformation Workshop, organisations can commit to one of our transformation programmes:

The Integrated Systems Development Programme

The Culture Foundations Programme

Individual Development

These programmes are designed for people who want to lead improvement of health and healthcare – either a whole professional group that knows it needs new skills and knowledge to flourish in the new paradigm or individuals who want to transform the care they provide but are too busy for an MBA.

Professional  Development Programme  helping very busy people create and adapt to the new paradigm

Individual & Organisational Development

Masters level modules – on the Five Giants we still have to conquer and the Enablers of transformation

The How To Handbooks – Knowledge Geared For Action
As well as enhancing the Transformation Programmes, the How To Handbooks can be read alone. They are available on paper, Kindle, and digital versions are available for Iphone, Smartphone, Mac, or PC. The first set of titles is:

  • How To Create the Right Healthcare Culture
  • How To Manage Knowledge in a Health Service (coming soon!)

    Healthcare Foundations is a BVHC podcast service. A subscription to this service entitles you to receive podcasts on current healthcare topics that are important to you – topics such as redistribution of resources, streamlining, reducing waste and increasing value will be illuminated by introducing you to distillates from the 1000 greatest books about or relevant to the health of populations and the delivery of high value healthcare. We also have podcasts from 1000 great articles on the science of health service management. 

    Master the language of healthcare -Language creates the social reality of the world in which we work.  Being clear about the meaning of terms is one of the key steps in shaping culture. Even if a word has more than one meaning, it is essential that everyone in a health service is aware of this and agrees which meaning should be used.  For this reason, BVHC has developed the Glossary of 21st Century Healthcare and a range of other resources to help clarify, and make more consistent, the language of healthcare. 

    The BetterValueHealthcare Bookstore – for really good coffee and 1000 really important book

 We also create bespoke solutions to meet your needs – find out more here.

The Walking Plus Programme

Walking is wonderful but it will not improve all four aspects of fitness which all begin with the letter S:

  • strength
  • suppleness
  • stamina
  • skill

Strength

The muscles of the lower limbs are obviously strengthened by walking, but it also strengthens the muscles of the lower back which can reduce the probability of back-ache.   To complement the benefits of walking to the lower limbs, it is useful to exercise:

  • the upper limbs with a set of weights; a small set of weights bought from any store or retail warehouse can help strengthen upper limbs and chest muscles.   Try press-ups; people aged 60 should be able to do ten press-ups to start with but every man should aim to do the same number of press-ups as his age;
  • the core muscles of the body, the muscles round the spine and abdomen: lie on your back and raise your legs from the floor; now criss-cross them 60 times. Now roll over on to your tummy, clasp your hands behind your head, and try to lift your head and shoulders off the carpet; do this 20 times.

Nordic walking also provides excellent exercise to the upper body.

Suppleness

No one understands what causes stiffness. You might find that your legs are stiff after your first long walk, especially if you do an hour of brisk walking, but it will soon pass. The best way of preventing stiffness is to take exercise more frequently. Neither ‘warming up’ is necessary before starting to take your Vital Steps, nor ‘warming down’ after you have finished. That is one of the many good things about walking as a form of exercise.

Walking helps maintain the suppleness and flexibility of the lower limbs, but because the act of walking rarely stretches the muscles and other soft tissues, it is not particularly good as a means of improving suppleness. For this reason, it is good to supplement your walking with other exercises to improve suppleness.

If you want to improve your health, it could be useful to join an introductory class for Yoga, Alexander Technique or Pilates, or consult a Shiatsu teacher.   Such a course will give you exercises that you can, and should, perform everyday, not just for your legs but for your shoulders, arms and spine.   This requires you to build a five minute routine into your day and, like the change needed to find time for extra walking, is just a matter of time management.   All these will undoubtedly improve your posture.

Stamina

Brisk walking can increase your stamina. When you start your Vital Steps programme, you may find it difficult to do brisk walking for more than 1,000 steps, but as you walk more frequently, your stamina will improve. It is, however, often difficult to measure your improvement. For example, you may feel less breathless, or be able to walk briskly for longer, or feel less breathless after brisk walking, but it may simply be the result of slowing down.   An article in the British Medical Journal called “How fast does the Grim Reaper walk?” came to the conclusion that the optimum walking speed to outpace the old chap is 1.36 mph! (1).

The best way to ensure that you keep walking briskly to maintain and improve your stamina is to walk against the clock. Walk 1,000 steps, and measure the time it has taken. A more practical approach is to walk briskly for a constant distance, for example, between certain bus-stops, or from your home to the bus-stop, and make that your test track. At least once a week, walk the track briskly and measure how long it has taken, preferably to the nearest second. The best equipment for increasing stamina is a flight of stairs or, better, four flights.

Death to lifts or they will be the death of you!

Skill

‘Physical activity programmes can help reduce the risk of falling, and therefore fractures, among older people’

At Least Five a Week – Evidence on the Impact of Physical Activity and its Relationship to Health, Department of Health, 2004

The effects of ageing are to reduce the body’s ability to cope with challenges, and one challenge is lack of exercise.   Similarly, even though you remembered how to ride a bicycle, your ability to regain your balance gets less good as you age unless you keep cycling.   This may not seem relevant to walking because people retain the skill of putting one foot in front of the other.   However, the skills that are lost are those that are more subtle but equally important, such as how to:

  • judge how far to lift your foot to clear the kerb or a bump; or
  • recover your balance if you do stumble, particularly if you cannot see where you are putting your feet.

The more you walk the better are these skills preserved but you should try other forms of exercise.   Dancing is particularly good, any sort, Scottish country, ballroom or ballet, and of course dancing has many social benefits.   For people who enjoy sport and television, try the amazing Wii – the technological development that allows you to play dance, box or compete in many other ways in your living room.

The main objective of this book is to help you change your lifestyle so that you walk more on most days of the week but it is strongly recommended that you complement and supplement the additional walking by taking up, or increasing

  • Pilates or Yoga or the Alexander technique for suppleness
  • Tennis or dancing for skill
  • The use of weights or an exercise band for strength

Increased strength and balance skills are essential in reducing the risk of falling (2)

References

(1) Stanaway FF et al (2011) How Fast Does the Grime Reaper Walk? Brit Med J 343,

(2)Morris M.E. (2012) Preventing Falls in Older People Brit Med J 345;14

 

Dr Gray’s Walking Cure

Exercise! exercise! exercise! what do these words conjure up?  The gym, sweat, leotards, slimming, living longer, getting fitter, obesity, cancer, diabetes, heart disease.  Take more exercise is the general advice but how should this be done easily, enjoyably and cheaply?  Daily walking as the answer hardly gets a look-in when the different options are considered, but it is the simplest, most freely available, and medically by far the best of all possible answers.

Walking is the way mankind has kept fit for purpose ever since evolutionary times.  The reasons why we don’t do it enough in developed countries now is because we have made it just too easy NOT to do it.  This book sets a challenge, which you can easily achieve – to walk 1,000,000 EXTRA steps between 2009 and 2013 – revolutionising your daily life, your health, and your carbon footprint.

Walking Plus means walking plus a few minutes of exercise to increase all four aspects of fitness

  • strength
  • stamina
  • skill
  • suppleness

Fitness

The Actual Rate of Decline is faster than the Best Possible Rate of Decline, that is the rate of decline due solely to the ageing process and the difference  between the two is the Fitness Gap. Both the point at which physical decline starts, and the rate at which it proceeds is for the first few decades determined by loss of fitness, and loss of fitness is determined by social factors, namely by the decisions people make about their life and the pressures which influence them decreases

Fitness has four aspects, all beginning with the letter S, and what we call the fifth S,  namely the pSychological benefits of exercise