Keep on Moving!

Keep on Moving!

May 1, 2024

Joy Stepinski, MSN, RN-BC

The warmth of spring and bright sunshine often bring a deep desire to be outside, especially in regions emerging from a long cold winter. Spending more time outdoors naturally increases activity, such as walking, gardening, or yard work. Some may be drawn to jogging, bicycling, hiking, or swimming in an ocean or lake. Despite nice weather, exercise is a vital component of whole health and longevity, which creates a feeling of fulfillment and strength in the physical body.

While exercising may be a common or desired goal for most people, not moving has enormous implications on health. The World Health Organization (WHO) reports that physical inactivity is the fourth leading risk factor relating to 6% of global mortality after high blood pressure, smoking, and diabetes [1]. Many chronic conditions are intricately related to lack of movement, such as cardiovascular disease, systemic inflammation, obesity, metabolic dysfunction, loss of bone density, chronic pain, depression, cognitive decline [2], and more.

Immobility in the hospital environment can be quite profound. Many studies about older hospitalized adults show the negative ramifications. One-third of this population experience a decline in their ability to participate in basic daily activities just by being hospitalized! Such examples include moving from the bed to a chair, walking, and toileting. A new dependency on others in order to walk just within the hospital room occurs in 15% [3] of older hospitalized adults. One study noted persistent symptoms three months after discharge. Unfortunately, helping patients to move is one of the most frequently missed pieces of nursing care in the healthcare facility!

Even in young healthy adults, immobility and prolonged bedrest cause the loss of muscle mass and strength, slower gait speed, and reduced coordination. People may experience less energy, increased falls, poor circulation, blood clots, pneumonia, inadequate nutrition and hydration, bowel and bladder dysfunction, compromised skin and pressure injuries, and psychological changes [4].  This is quite a list!

Warnings about immobility and a sedentary lifestyle are not new. The health literature in the 1960s described the effect of immobility on the body, physiologically and psychologically. The United States Public Health Service declared disability from lack of movement had resulted in one of the top preventable health issues, which could be reduced by as much as 75% [5]!

A sedentary lifestyle brings detrimental effects to health. When people lie down or sit for most of the day, apart from sleeping, they expend low energy. Not surprisingly, being sedentary is considered the lowest end of the physical activity spectrum [6]. Western adults tend to spend an estimated 55 to 70% of the day engaging in sedentary behaviors, equivalent to sitting for 9 to 11 hours per day [6]. Not moving around is directly related to poor health outcomes, including chronic diseases (i.e., cardiovascular disease, cancer, diabetes) and mortality.

Health literature points to the deleterious effects that excessive sitting causes. A meta-analysis [7] investigating the results of six studies between 1989 and 2013 calculated their data from 595,086 adults. Findings showed that sitting 10 hours per day, even after physical exercise, led to a 34% increased risk of mortality. Each hour of sitting resulted in a 2% higher risk of death, but sitting for more than seven hours increased the risk by 5% for each hour of sitting. To protect one’s health, movement is imperative!

A separate Australian longitudinal analysis reviewed data from the 45 and Up Study, based on participant questionnaires from 2006 through 2009 (n = 149,077). The authors reported a median follow-up period of 8.9 years for all-cause mortality and 7.4 years for cardiovascular disease mortality. The results demonstrated strong evidence that increased sitting and a low amount of moderate to vigorous physical activity were associated with higher cardiovascular disease mortality.

A common assumption is that immobility goes hand-in-hand with aging. However, a small randomized control trial showed that age-related loss of muscle mass can be reversed with physical exercise of moderate intensity [8].          

In Blue Zone regions, where the highest numbers of centenarians reside, frequent activity is the way of life. In the book, The Blue Zones by Dan Buettner [9], the author makes pertinent suggestions about engaging in natural movement. Choose physical activities that are truly enjoyed and focus on accomplishing those. Do not force yourself to go to the gym if that is not your desire. Incorporate activity into your lifestyle, such as biking instead of driving. Walk with other people to establish camaraderie around movement. Plant a garden, which also can relieve stress.

Establishing habits that center around being active helps to incorporate physical activity. Schedule a formal time to exercise. Take the stairs instead of the elevator. Set a timer to be reminded when to move. When routines are part of the day, movement occurs naturally. Increased activity helps the body to be more resilient. Keep on moving!

References:

1.      Ricci, F., Izzicupo, P., Moscucci, F., Sciomer, S., Maffei, S., Di Baldassarre, A., ... & Gallina, S. (2020). Recommendations for physical inactivity and sedentary behavior during the coronavirus disease (COVID-19) pandemic. Frontiers in Public Health, 8, 199.

2.      Park, J. H., Moon, J. H., Kim, H. J., Kong, M. H., & Oh, Y. H. (2020). Sedentary lifestyle: Overview of updated evidence of potential health risks. Korean Journal of Family Medicine, 41(6), 365–373. https://doi.org/10.4082/kjfm.20.0165

3.      Callen, B. L., Mahoney, J. E., Wells, T. J., Enloe, M., & Hughes, S. (2004). Admission and discharge mobility of frail hospitalized older adults. Medsurg Nursing, 13(3).

4.      Schreiber, M. L. (2021). Mobility: A pathway to recovery. MEDSURG Nursing, 30(4), 279 – 281.

5.      Graf, C. (2006). Functional decline in hospitalized older adults. American Journal of Nursing, 106(1), 58 – 67.

6.      Stamatakis, E., Gale, J., Bauman, A., Ekelund, U., Hamer, M., & Ding, D. (2019). Sitting time, physical activity, and risk of mortality in adults. Journal of the American College of Cardiology, 73(16), 2062-2072.

7.      Chau, J. Y., Grunseit, A. C., Chey, T., Stamatakis, E., Brown, W. J., Matthews, C. E., ... & Van Der Ploeg, H. P. (2013). Daily sitting time and all-cause mortality: A meta-analysis. PloS One, 8(11), e80000.

8.      Létocart, A. J., Mabesoone, F., Charleux, F., Couppé, C., Svensson, R. B., Marin, F., ... & Grosset, J. F. (2021). Muscles adaptation to aging and training: Architectural changes–a randomised trial. BMC Geriatrics, 21, 1-18.

9.      Buettner, D. (2012). The Blue Zones (2nd ed.). National Geographic Partners, LLC.