In the morning, grab a quick breakfast and then on to the work room in the attic. Downstairs for coffee, and then back to work. Grab a sandwich before the next digital meeting. Okay, one more cup of coffee, with a cookie. Oh! Is it already so late? So! Close the laptop and start making dinner. Then you collapse on the couch. Conclusion at the end of the evening: You have taken only 3,648 steps today.Due to the coronavirus pandemic, this has become a daily routine for many people. Working from home is the norm; team or indoor sports are sometimes allowed and sometimes not, and outings are hardly ever possible anymore. As a result, large groups of people are getting physically inactive. The first international studies have indicated that the number of steps that people are taking each day has decreased drastically. This is the case throughout the entire Western world.The ancient Greeks already knew thisThe Greek physician Hippocrates — the founder of modern medicine — said it as early as 400 BC: “Eating alone will not keep a man well; he must also take exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health.”Taking a giant leap in time, we see that, since the 1950s, more attention has been paid to the fact that humanity has been getting less exercise. This has given scholars interesting food for thought, reaching a climax in 2012. In that year, the scientific journal The Lancet declared the lack of sufficient exercise—in other words, physical inactivity—to be a pandemic. Researchers have estimated that 5.3 million deaths (9% of all deaths worldwide) are due to lack of exercise.ChildrenThijs Eijsvogels, an exercise physiologist at Radboud university medical center, conducts a considerable amount of research on the influence of exercise on the body, particularly for patients with cardiovascular problems. He explains, “Scientists have described physical inactivity as one of the greatest threats to public health, with major social and economic consequences as well. The effects are comparable to those of smoking.” Scientific evidence now exists to show that 26 diseases and conditions are caused at least in part by lack of exercise. These conditions include cardiovascular diseases, Type II diabetes, certain types of cancer, dementia, and mental deterioration. Thijs: “If exercise was available in the form of a pill, it would be the most commonly prescribed drug in the world.”Many people in the Netherlands also do not get enough exercise. According to Statistics Netherlands, less than half of all adults meet the Health Council’s guidelines: at least 150 minutes of moderate to intense exercise (like walking or cycling) per week, and muscle-strengthening exercise twice a week. Another poor signal with regard to the future is that even young people are getting less exercise. Thijs: “We are seeing the same figures internationally. In general, the wealthier a land is, the lower will be the number of people who meet the guidelines. Due to the worldwide outbreak of the new coronavirus, we are thus now facing a pandemic within a pandemic.”Faster breathing and elevated heart rateWhat happens in the body during physical activity? Thijs: “Exercise leads to an increase in the heart rate. At rest, it varies between 60 and 100 beats per minute. During exertion, it increases. At very high intensities, it can even increase to more than 180 beats per minute. When the heart rate is increased, more blood is pumped through the body. The breathing rate increases as well (from 12–15 breaths per minute at rest up to 40–50 breaths per minute during exercise), in order to provide the muscles with sufficient oxygen. Regular participation in sports or exercise can also lead to improvements in risk factors. For example, it decreases body weight and blood pressure, increases the level of HDL cholesterol in the blood while reducing LDL cholesterol, improves the regulation of blood-sugar levels, and decreases inflammation values. These favorable adjustments have a range of positive effects. For example, it impedes atherosclerotic processes, thereby reducing the risk of heart attack.The extent of change is nevertheless highly dependent on the individual and the person’s health status prior to the training program, as well as on its intensity and duration. For example, with regard to blood pressure, systolic pressure decreases by an average of 5–17 mmHg (mm mercury), with diastolic pressure decreasing by an average of 2–10 mmHg. The effect can be less for healthy (and young) people, however, probably because their blood pressure is usually well-regulated, thus making the effects of exertion less visible.”Fitbits and smartwatchesAt any rate, there are plenty of reasons to get more exercise. Even before the outbreak of the coronavirus pandemic, however, we were already not doing enough. The lock-downs have not made things any easier. In the journal Annals of Internal Medicine, researchers have indicated that, during the first wave of the coronavirus, people took around 11% fewer steps each day. Thijs: “Data from the Netherlands also indicate that people have been getting less exercise, because the gyms have been closed and team sports were no longer allowed. This was often measured using questionnaires.”One disadvantage of questionnaires is that they are subjective. Thijs has noticed that people are not very good at estimating their exercising behavior, and they are therefore likely to over-estimate or under-estimate the amount of time they spend exercising. “A shift is taking place within our field of research. It is increasingly becoming the standard to measure exercise objectively using wearables, like a smartwatch or Fitbit. In some studies, we are able to use special movement monitors to make highly accurate measurements of people’s exercise and sitting behavior. These objective data demonstrate that, during the summer, we did not return to pre-pandemic levels of exercise. The important question now concerns how and when we will return to the former levels.”Tips for people working from homeA walk around the block“Start and end your working day by taking a brief walk around the block. Even 10 minutes twice a day is a good start.”Raise your laptop“It’s not necessary to buy a fancy standing desk if your work requires you to spend a lot of time sitting. Make one yourself by putting the laptop on a stool or a stack of books on your desk.”Competition“For people who miss the competitive element of their sports, the Netherlands Brain Foundation has developed the ‘Ommetje’ [walk] app. You can use it to challenge friends and colleagues to a daily walk.”Calling is also a possibility“Meetings with others do not always have to be by video call. If you call each other on the phone, you can take a walk outside at the same time.”European sitting championThere is something else. It seems that we here in the Netherlands are quite good at sitting. In late 2020, Thijs and his colleagues published a study indicating that healthy Dutch people sit for an average of nine hours a day, and that the rate for patients with cardiovascular diseases is as high as 10 hours. “The Netherlands is the European sitting champion. This is even despite studies showing that the amount of time spent sitting increases the risk of many chronic diseases, regardless of the time spent exercising.” In other words, even if you get enough exercise but also spend a lot of time sitting, you will lose some of the health advantages of an active lifestyle. The Health Council thus recommends that, in addition to getting enough exercise, it is important to try to spend less time sitting. “For example, sitting for more than 30 minutes at a time is apparently hazardous. Standing up briefly at regular intervals, stretching your legs, or walking around a bit either at home or at work can be helpful.”Exercise is good. More exercise is betterMight there be a few glimmers of hope? Thijs: “We have observed that people have started walking more as a result of the coronavirus pandemic. In March, the number of hits in Google for the search term ‘exercie at home’ increased exponentially. Such awareness of inactivity is a step in the right direction.” In addition, studies are increasingly showing that every little bit helps. Each additional step counts toward reducing the risk of chronic disease. As formulated by the Health Council: “Exercise is good. More exercise is better,” Thijs continues. “If 150 minutes per week or 10,000 steps per day is too scary, try to look at what would be feasible. If you usually take 4,000 steps, try to take 5,000 per day. Try to find something that will give you pleasure or challenge.”How does Thijs do that himself, actually? “Now, I have to confess that I’ve also been getting less exercise due to the coronavirus pandemic. I have now bought a jump-rope, though, and so I no longer have any excuse to spend my whole day sitting at my computer!”Text: Pauline Dekhuijzen. This article was first published in Radbode. Photo: Eric Scholten.