How do you explain the paradox that people exercise too little against their own better knowledge and thus put their health at risk? Or let me put it like this: Why do they act against their own body?
Völler: It only seems like a contradiction. People who lack exercise have their own role models who reached old age even without physical activity. In addition, they have a different body awareness or understanding and do not feel the need that they must or should exercise. On the one hand, disposition, i.e. hereditary factors, plays a role, on the other the social environment has a great influence. Those who have never learned to exercise and do not know anyone in their immediate surroundings who exercises will not miss it.
Brand: This is not only true for exercise but also in many other situations. We often know that we behave irrationally but do it anyway. People follow their habits and in particular organize their leisure time so that it is comfortable. And this is exactly where the problems with exercising begin: First of all, exercising takes time - time that I liked to use for something else in my old life without exercise. And now I am supposed to take this time for something that will make me run out of breath, and do this regularly? People who exercise regularly and extensively have learned - through many repetitions - that enduring the exertion of jogging will be worth it in some way. People have to get over the erroneous assumption that exercise is only “worthwhile” when it is exhausting. The only way to start a healthier life is to find the physical activity on which you don’t mind spending some time. Training and exertion can come later and, in fact, often come automatically without having to force yourself.
During the pandemic we are currently forced to protect ourselves from a largely unknown disease by changing our behavior accordingly. To prevent well-known and frequently occurring cardiovascular diseases, a change in behavior seems to be comparatively difficult. How can we increase motivation here?
Brand: Many people in Germany seem to have behaved very reasonably for some time and willingly adapted their behavior during COVID-19. From my point of view, this has something to do with the urgency of the behavioral change that we saw every day, for example on TV. The news coverage made it very clear that not only could the virus theoretically affect anyone, but that you yourself could be next tomorrow and you can effectively adjust your behavior tomorrow. When it comes to preventive health care through physical activity and exercise, we are dealing with another dimension in terms of time. Imagine a 30-year-old person: if he or she regularly exercises twice or three times a week now, he or she may not have a heart attack in 20 years. Does that prompt you to take immediate action in the same way? You have to approach the promotion of exercise and physical activity differently, in a psychologically more subtle way. The students at the Department of Sports and Health Sciences in Potsdam learn a lot about what can be done to help people motivating themselves for exercise, for example that it is more valuable to help them experience exercising than to talk about the potential positive effects.
Völler: During the lockdown everyone could move freely. Hiking, jogging, and cycling were possible and many people who enjoy exercise practiced it. An equally large proportion of the population probably perceived the lockdown as a restriction of freedom of movement or even happily accepted this. I doubt whether the latter see the connection between the higher risk the SARS-CoV-2 virus poses in the presence of cardiovascular diseases or risk factors such as high blood pressure. I don’t think that this connection is recognized by many people or increases their motivation to be physically active.
Brand: Of course it is unrealistic, but if there were campaigns for physical activity and exercise as insistent as for the protection against corona, we would certainly also see changes in this area - at least for a while. After all, the difficult motivational situation remains: The campaign wants you to do something you don’t really want to do, but which will eventually makes it less likely for health problems to develop in the future. However, people believe that they need to rest now because the next day will be hard enough. It is usually not enough to hope for the rationality of people..
Many diseases, especially of the musculoskeletal and cardiovascular system but also of the mind, are treated with the help of exercise. What effects do you see in patients?
Völler: Especially in people with said diseases, the benefit of regular exercise is greater than in healthy people.
Brand: There are now very impressive findings on the importance of exercise in treating depressive disorders. Early works on this subject were often methodologically weak and findings were unconvincing. This has changed over the past ten years, and it has become clear that therapy results improve if exercise is involved.
People who started exercising after a long period of inactivity or in medical rehab not only report positive physical effects but also an improved level of well-being. Relapsing into old habits is nevertheless quite common. What is the reason and how can you counteract it?
Völler: The effects of an active lifestyle are manifold. In addition to better fitness, there is also improved immunity and a more stable mood. However, if people do not get permanent support, depending on their social environment they often fall back into familiar behavioral patterns. Therefore, schools and companies must pay more attention to a healthy lifestyle. In addition to exercise, nutrition also plays a major role. School and company-facilitated sports should be an integral part of everyday life.
Brand: But as a sports fan and exercise promoter you also have to be careful not to fall into the trap of pretending that exercise makes you feel good immediately! This is not the case. When an untrained and a trained person go running together, only one of them will feel good at a faster pace. It’s about finding the kind of physical activity that is perfect for you. You can even get help: There are experts at every school, every health center and certainly also at many gyms who know how to offer sport and exercise in a way that is enjoyable and fun.
Together with colleagues from around the world, Prof. Ralf Brand conducted a large-scale study on the effects of the pandemic-related lockdown on exercise behavior and subjective well-being. They collected data from more than 16,000 participants in 32 countries; an article with results from the study has been submitted for peer review to an international research journal. “The data show that those who had been regularly active before Covid-19 remained as active during the lockdown as they had been before or even increased their activity levels,” Brand says. “Many of those who had been going to gyms before went jogging during this time or created exercise opportunities at home. It is interesting that many of those who had never or rarely exercised before the lockdown became more active during the crisis.” The researchers also found differences in the effects of exercise behavior change during Covid-19: Adoption of exercise for those who were inactive or rarely active before the lockdown did not lead to positive changes in mood. If you had been sufficiently active before the crisis, this was, in some way, a protective factor for a relatively good mood during the crisis.
Prof. Dr. med. Heinz Völler is Professor of Rehabilitation Medicine at the Faculty of Health Sciences and also Medical Director of “Klinik am See”, a rehabilitation center for internal medicine in Rüdersdorf. In the Covid-19 pandemic, he constantly faces the challenge of offering patients and employees the greatest possible level of protection. Patients who come directly from the hospital must show a negative smear test. Those who were at home after a hospital stay have to keep a symptom diary for a week. “If a SARS-CoV-2 infection is suspected, a smear test is carried out on site and the patient has to stay in quarantine until the result is available,” Völler describes the tightened admission procedure. The employees also keep a symptom diary, receive regular smear tests, and are exempted from work. Group sizes were reduced and meal times changed to comply with social distance rules. In addition, the already high hygiene standards were intensified. “So far there have been no infections, so that the risk group of patients with cardiac diseases could undergo regular rehabilitation,” Völler says.
Prof. Ralf Brand has received university diplomas in psychology and physical education. He is Professor of Sport and Exercise Psychology at the University of Potsdam and Affiliate Professor at the Department of Kinesiology at Iowa State University (USA).
Prof. Dr. med. Heinz Völler is a specialist of internal medicine, cardiology, and social medicine. He is Professor of Rehabilitation Medicine at the Faculty of health Sciences of the University of Potsdam, the Brandenburg Medical School Theodor Fontane (MHB), and the Brandenburg University of Technology Cottbus-Senftenberg. He is Medical Director of the rehabilitation center “Klinik am See“ in Rüdersdorf.
This text was published in the university magazine Portal Wissen - Two 2020 „Health“.