Does it matter whether I enjoy exercise?

Tegan Taylor: Normally when we meet under these circumstances, we are doing Coronacast. But this is different somehow.

Norman Swan: It is, because last week we put Coronacast to bed forever. It's gone.

Tegan Taylor: Too bed forever, because it's time to wake up a different podcast.

Norman Swan: That's right. And before we get to that different podcast, just to reiterate, we're still covering Covid on the Health Report, but this is a very different podcast now.

Tegan Taylor: It's not that different, we're still answering audience questions, but this time they can be about anything and everything, including maybe what that rash might be. It's a podcast where we're going to answer the health questions that everyone's asking.

Norman Swan: And we'll tell you how to send in your questions at the end of the podcast, but it does arise from Coronacast because in the first six months of Coronacast we had 200,000 questions from you. So we're looking forward to 200,000 questions about all your health concerns, and we'll try to answer one or two of them.

Tegan Taylor: Well, today's one is all about exercise, and whether or not you actually have to enjoy doing it.

Norman Swan: And you're…?

Tegan Taylor: Tegan Taylor. And you're…?

Norman Swan: Norman Swan. And we're both on…?

Tegan Taylor: Gadigal land.

Norman Swan: Let's go.

And today's question is from Rhiannon.

Rhiannon: I'm just wondering, does it matter if I enjoy the exercise? Some forms of exercise can feel really boring and repetitive and not like something I actually want to do. But other types of exercise are more fun. So I'm just wondering if enjoying the exercise makes any kind of difference.

Tegan Taylor: Okay, Dr Swan, what do you reckon? Do you have to enjoy exercise for it to be good for you?

Norman Swan: Well, I just think people should suck it up. I mean, do you really have to enjoy it? You've just got to do it, haven't you?

Tegan Taylor: Spoken like a true slave of the Stairmaster.

Norman Swan: Well, that's right, and a true Scot. Do you have to have to smile when you're doing it? You can be utterly miserable in the rain and still get on with it.

Tegan Taylor: See, while of this hedonist over here is like; Why shouldn't I be able to enjoy the things? There are so many exercises to choose from, why would I stick it out on something that I hate when I could choose something that I love?

Norman Swan: Yeah, I do get a bit sceptical sometimes, you know, this idea of walking around the park, having a chat with your friends, is that actually enough?

Tegan Taylor: Well, I think that sounds like a lovely way to spend a morning but exercising can sometimes feel a bit like superannuation. Like I know it will probably help me to not die as young but what does it do for me today? What kind of boxes are we asking exercise to tick here?

Norman Swan: Well, one is the physiological effects, which are really incontrovertible. But it's got to be progressive exercise, exercise which really tests your body over a period of time. So if you're walking around the park and you do that in 25, 30 minutes, a week or two later you should be trying to do it in 20 minutes, then 15 or add a hill, you should always be pushing your body a little bit, that reinvigorates the body, it's good for your cardiovascular system, it makes your arteries more elastic, it helps to clean out the old dead cells from inside your body. So in other words, there's a rejuvenation effect, particularly if you do muscle exercises.

And there's almost certainly a physical effect on organs like the brain in terms of preventing dementia, and it prevents cancer. So the hormones that induce cell growth go down when you exercise. And if you have cancer, you're more likely to do better if you're exercising. So exercise is an anti-cancer therapy as well.

Another is cognitive. If you're going to the gym, you're counting your number of exercises, counting the number of reps, there's a cognitive element to it where you're exercising your brain. God knows what actually listening on your earphones to a podcast does to you as you're exercising as well…

Tegan Taylor: I think it's very enriching.

Norman Swan: It's pretty convincing that you should do exercise. And that's where enjoyment comes in.

Tegan Taylor: Okay, I do want to talk about enjoyment, that's the point of today. But looking at the Australian physical activity recommendations, we're looking at between two and a half and five hours of moderate intensity physical activity a week, one to two and a half hours of vigorous physical activity a week. And then also muscle strengthening exercises. That's actually quite a lot of exercise, depending on who you are. Actually getting that can be quite tricky.

Norman Swan: So if you divide it up by days, it's 40, 45 minutes to an hour on most days of the week. And it's a mixture of aerobic (walking around the park, getting your heart rate up) and muscle strengthening. But muscle strengthening exercises often have an aerobic effect as well. So if you do a squat, you know…I am doing a squat, nobody can see me doing a squat…

Tegan Taylor: I can see you.

Norman Swan: You can feel it. That's right. You do a squat. If you do ten squats down where you're just…sorry…

Tegan Taylor: He's trying to squat and talk at the same time, it's not working.

Norman Swan: I know, I've got a Y chromosome, I can't do two things at one time. But if you do a squat and you do ten squats, your heart rate goes up. So there are muscle strengthening exercises that do both. The key here is you've got to do it and you've got to be consistent. And that's, as I said before or was implying, where enjoyment comes in.

Tegan Taylor: Okay, so talk to me about that, because we hear a lot of sort of pop science about the psychology of building habits and if you just build a habit then it becomes really easy to do something. What do we actually know about the science of habits to start with? And also how that actually applies to something that's actually bigger than washing your hands after going to the toilet. Like, exercise is a more complex routine than that.

Norman Swan: Well, let's start with the habit formation because with exercise, it's got a poor track record. A high proportion of the population don't do any exercise at all. And it's even higher proportion of the population don't get adequate exercise according to the recommendations. And if you look at things like gym memberships, there's a high dropout rate, and it's particularly in the first three to six months. So you take out a gym membership, you want to do the right thing, and three to six months later, you're not going to the gym.

Wearables on your wrist, people use that for up to nine months, and then they stop using it. So there is a dropout rate from exercise. So you can go on all you like about 150 minutes a week of moderate intensity exercise, but you've actually got to do that, and you've got to keep on doing that.

And what we know about habit formation is that you've got to get something out of it. What's in it for me, what do I get? And what the research suggests is, if you enjoy it, then you stick with it. And enjoyment means my mood is elevated after I come out, I feel better having done the exercise. And one of the factors that feeds into that is intensity. So if your exercise is reasonably intense, in other words you're pushing yourself, and this doesn't mean you've got to be super fit with a washboard abdomen or fantastic muscles, reasonable intensity exercise could actually just be (for somebody who's been sedentary) a walk around the park. But intensity does improve your mood and improve the enjoyment. And that starts to cement it into a habit, a bit like a drug does. You're not going to continue on a drug if you don't get anything out of the drug.

Tegan Taylor: Don't do drugs, kids.

Norman Swan: Don't do drugs, but do exercise. And they say the turning point with exercise is the pleasure to displeasure ratio. So as long as the pleasure ratio is higher than the displeasure, you will keep on doing it. And if you've got a coach, a good coach doesn't do the same thing all the time, understands you and says, look, you'd be better off doing this with other people, you'd be better off going in a group, you don't seem to be enjoying the squats, why don't you do some dips or what have you. And it's really critical in the first few months because if you get beyond the first three or six months through that positive mood post-exercise glow, then you're much more likely to continue in the long term, which is what counts.

Tegan Taylor: Okay, I have a question for you then Mr Pleasure Versus Displeasure Ratio, because I know that your preferred form of exercise is sweating it out on an elliptical trainer. And I want to know what pleasure, if at all, you're getting out of that.

Norman Swan: So I go to the gym and I don't necessarily enjoy the individual exercises. So if I go on the elliptical, I've really got to be listening to a podcast at the same time…

Tegan Taylor: The Health Report?

Norman Swan: Usually the Health Report. But I'm listening to something and that gets me through. But interestingly I've started in the last year or two to stop listening to podcasts and actually become much more mindful of the exercise itself, which helps to clear my mind. And I now vary it, five to ten minutes on the rowing machine, five to ten minutes on the elliptical, five to ten minutes on a bike, and if my knee puts up with it, I'll do five to ten minutes on a treadmill. And then I do weights. And what I know is at the end of that hour-long session, I feel great, and I feel lousy if I don't do it, and that keeps me going through it.

Tegan Taylor: So even though in the moment it might not be a pleasurable experience, there is actually a relatively quick payoff in that you feel better immediately after. It's not sort of like you're waiting to be, you know, 20 years older than you are and that you're going to have better cardiovascular health.

Norman Swan: That's not going to keep anybody going here.

Tegan Taylor: Well, there was a study showing that even highly motivated heart failure patients still weren't participating in their physical activity if they didn't enjoy it. So even in people where the short-term benefit was very close, that enjoyment was still a really important part of keeping them motivated.

Norman Swan: Very important, you've got to feel good at the end of it. And you've got to do the sort of exercise that makes you feel good. I know what you do, but you might as well tell…

Tegan Taylor: I like rock climbing and rock climbing doesn't like me. But I like everything. I love hiking with my dogs. I love doing yoga. I've started swimming in a lake near my house. And honestly, for me, thinking about this question, I've tried to do a lot of mental work these past couple of years to unlink my brain from the idea that I need to exercise to earn food or to burn fat, and it's actually helped me enjoy exercise more, which probably has led me to doing more exercise, which is basically exactly what you're saying.

Norman Swan: That's so interesting that you say that, I'm exactly the same. When people say, 'Why do you exercise?' I say, 'To eat.' But I don't say that anymore because I really feel good at the end of it.

Tegan Taylor: This is it. And I also think that there's the mental health…I mean, we're talking about health in very, very broad terms here. And you've got to include mental health in that equation, you know, is exercise good for you? Yes, because of all the things you said about how blood flow to the brain is good for preventing dementia, but also being out in nature is so restorative and so good, seeing my dogs happy makes me happy. So there's so many different facets to this.

Norman Swan: And as we know, the brain is part of the body. And if your brain is feeling good, the body is too.

Tegan Taylor: So I guess one of the reasons why we have conversations like this now is because our lifestyles have evolved in a way where the path of least resistance is to not move, because we're in cars, our town planning is in this way, that it's easiest to get into a car, we're not moving incidentally throughout the day anywhere near the amounts that we were, say, 100 years ago. So what's a useful tip for people who are listening where, sure, like exercise might be enjoyable or might not be, but actually getting to an enjoyable form of exercise is…there's so many barriers in the way.

Norman Swan: It's true, particularly if you're not near a gym, and so on, and you do have to find your own way. And it's interesting what you say about being in the outdoors. I mean, I'm a hill walker, a climber from way back, and I never used to think (and still don't) of climbing up a hill or a mountain as exercise. It's a psychological thing, I feel so great after it. And you've got to find that way.

And the other thing is if you can find other people to do it with, no matter what it is, that's going to work. And then time. You were talking about how we do know that if you up the intensity, you can reduce the time.

Tegan Taylor: So this is high intensity interval training.

Norman Swan: That's right. So the idea here is…and you've got to be careful, if you've got a history of heart disease and so on, you've just got to be really careful about how hard you push yourself. But this is where you have a spurt, if you're on a bike, pedal like mad, as if somebody's chasing you for your life, and you do that for 20 seconds, and then you slow down for 30 seconds. Nobody's really quite sure what the right time durations are. But you go for spurts, and you get your pulse up doing that. And you can substitute for cardiovascular health, you know, 45 minutes of exercise down to just a few minutes and make it much quicker, but you've really got to push yourself.

Tegan Taylor: So we've got this idea that like the social aspect of exercise can help you enjoy it. Enjoying exercise means you do it more, which is good for your health and good for your mental health. So I guess we kind of have a verdict for Rhiannon.

Norman Swan: That's right. Yep, you've got to enjoy it to do it.

Tegan Taylor: Well, that's all we've got time for on What's That Rash? for today. We would love to know what your health question is though, because we want to be answering your questions. The way to submit a health question, the best way is to follow us on Instagram @ABChealth and send us a voice memo. Or if you're old fashioned like Norman, you could send us an email.

Norman Swan: And the email address is ThatRash@abc.net.au. So whether you're modern or old fashioned, send in your questions.

Tegan Taylor: And it is the end of Coronacast but it's not the end of coronavirus by any means, and it's not the end of our coverage either. So if you want to continue getting Covid updates from Norman and Tegan, we haven't forgotten about you. You can find them at the Health Report.

Norman Swan: See you next time on What's That Rash?.

Tegan Taylor: See you then.