According to the latest annual report from the chief medical officer (CMO), ‘the benefits of regular physical activity to health, longevity, well-being and protection from serious illness have long been established. They easily surpass the effectiveness of any drugs or other medical treatment.’1 The problem is that most men are not following the prescription.

According to the Men’s Health Forum, just 40% of men meet the CMO’s recommendations for physical activity (30min of at least moderate intensity activity on five or more days of the week). The Forum reckons that if all men were exercising at the recommended levels, premature male mortality (deaths before the age of 75 years) could be reduced by 20-30%, saving about 36,000 male lives every year. So what can you as a nursing professional do to help?

BE REALISTIC

Every day we come across men who would benefit from increased exercise both physically and mentally, but how do you communicate that in a way that will be effective? Stern exhortations to greater activity rarely get anywhere – they just sound like nagging. The good news is that while the CMO’s guidelines might be a desirable target, the reluctant exerciser does not have to exercise at that level to enjoy enormous benefits.

Telling an overweight, unfit man who hasn’t exercised since school (and quite possibly has unpleasant memories of it) that he should jog or go to the gym and the only sweat he is likely to break into is one of panic. Probably just as well given that vigorously exercising his long-sedentary frame could do more harm than good.

For me, the first – and perhaps only – rule of exercise is: do not get injured. All the other advice boils down to this really. A useful rule of thumb for remaining uninjured is: do not do more today than you will be able to do tomorrow. Whatever you suggest, your advice should end with this maxim.

The classic pattern when men in their 30s and 40s return to exercise is that, in a rush of enthusiasm, they dash out and do something they used to do when they were younger – football, squash or some other competitive or physical sport. This is a big mistake. Even if they do not get injured, which is likely, they will find that a day or two later their joints ache so much they can barely get out of bed. This will mark the end of a new exercise regime.

GET INSIDE A MAN’S HEAD

First of all, you need to be sure before you tell anyone to do anything too energetic that the man is able to do it. I am not just talking about physical fitness here. (As nurses you will know better than I do the need, before recommending exercise, to satisfy yourself that there are no heart problems, hypertension, joint, back or weight problems or other medical condition that could interfere with it.) You need to get inside the man’s head too. Most men are interested in sport (see Men’s Health Week, overleaf), yet few participate in it. Why? Those unpleasant PE classes may have something to do with it. It is certainly a conundrum that goes right to the centre of the male psyche.

I will be honest with you. I am tall, not too embarrassed about my physique (I swim) and not too overweight. I am no sportsman but nor, as a kid, was I the last person picked for the football team. For all that, I really do not think I would go to a gym if you paid me. I do not know how all the equipment works, which requires asking for help, something most men are reluctant to do. And the gym is one of the few places on the planet where I am guaranteed to find hordes of other blokes who are fitter than me, stronger than me, betterlooking than me and younger than me. Why on earth would I want to go there? Life is tough enough, thanks.

Be realistic. Men who are interested in exercise for its own sake are probably already doing it. To get more men exercising you need to be more subtle. The key thing, it seems to me, is to make exercise easy or fun or something that is built in seamlessly to the average day – preferably all three.

As in all nursing, you need to get to know your patient to know how best to encourage him to take the medicine.

FIND A NEW ANGLE

Many men like numbers so a few wellchosen statistics may help. For example, taking no exercise is as bad foryou as smoking. This may make a proudly non-smoking man sit up and take notice (even if he does not give you this impression at the time). Mention the Swedish study that followed over 2,000 men who were aged 50 years in the early 1970s for 35 years, which found that the health benefits of taking regular moderate exercise are as high as for giving up smoking.2 Mention that the British Heart Foundation reckons that at least one-third of deaths from coronary heart disease (CHD) are the result of lack of exercise. (This compares to one-fifth of CHD deaths attributed to smoking.)3

Some men may find the word ‘exercise’ a turn-off – part of that healthy but boring ‘use it or lose it’, ‘five a day’ discourse of moderation and abstinence that characterises so much health promotion. You need to find a new angle. Perhaps mention another patient who started a new physical activity and who benefited enormously in ways you think will appeal to the man you are talking to – perhaps this other patient lost weight, looked younger (and got a new job), had time to himself which improved his work or family life or whatever.

TRY WALKING, NOT RUNNING

Sustrans, the sustainable transport charity, has the right idea. It approaches the subject from the smart transport angle rather than that of exercise, bringing the two together in an active travel and men’s health information sheet. ‘ Sustrans promotes cycling and walking. The latter is probably one of the best single health recommendations you can make.

Last year. Harvard Men’s Health Watch (HMHW) sifted through 4,295 articles published on walking since 1970 and chose the 18 best observational studies. Pulling together the results, it found that walking reduced the risk of heart problems by 31% and cut the risk of dying during the study period by 32 %.5

Walking is the ultimate seamless exercise. It is hassle-free. No sweat in every sense of the expression. You do not need to warm up or down. You do not need to shower afterwards. You are very unlikely to get injured. No special arrangements, skills, training or clothes are needed. Walking can be part of everyday life. Walk to work, walk to the shops, walk the dog, walk to the station. Park your car some distance from your destination and walk to and from it. For the more competitive male, suggest he gets a pedometer to count his steps or set him some other walking challenge.

Best of all, get him walking up the stairs. Tell the man that as an activity this betters even weight-lifting. HMHW cite an admittedly small Canadian study that monitored 17 healthy male volunteers with an average age of 64 years while they walked, lifted weights, or climbed stairs. Stair-climbing was twice as taxing as brisk walking on the level and 50% harder than lifting weights. But they add a health warning for the less fit: ‘Begin modestly with a flight or two, and then add more as you improve.’

To stay well’, HMHW conclude, ‘walk for 30 to 45 minutes nearly every day. Do it all at once or in chunks as short as 5 to 10 minutes. Aim for a brisk pace of three to four miles an hour, but remember that you’ll get plenty of benefit from strolling at a slower pace as long as you stick with it.”

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