How do we tackle sedentary lifestyle in Singapore?
Singapore’s population is aging rapidly and it is no surprise that this leads to an impending huge burden on healthcare. The only way to mitigate this effectively, does not lie in solely increasing the supply of hospital beds and polyclinics throughout the island but to have a focus on preventative health and this has to happen urgently. As the saying goes, “the best time to plant a tree is 20 years ago”, the best time to prevent any lifestyle disease is before they have the disease. There are many in the population that are in the category of ‘sub-health’. A state where there are disturbances in the physical characteristics or psychological factors without typical pathological features yet. An example would be someone who has pre-diabetes may not have blood sugar levels high enough for medical interventions, yet have signs of fatigue or low energy. It is important that sub-health is addressed before they deteriorate into diseases. The healthcare sector alone would not be able to champion this as they are more used to treating diseases than keeping people healthy, hence partnerships would be vital to the success of adding healthy years to the population.
It is not unknown how dangerous a sedentary lifestyle is and yet a large section of the population still continues to lead a sedentary life. This would lead to various very preventable diseases such as musculoskeletal disorders, diabetes, ischemic heart diseases and many more. We do not even need to look far to find someone we know to be guilty of this. Compliance with the minimum activity guidelines set out by the Health Promotion Board is difficult to meet because it is a complex issue that requires looking into so we can identify the root causes and hence apply the necessary intervention to address them. Our population can be divided into 3 main categories - 1) Sedentary 2) Active and 3) Very active. The 1st group are those who cannot meet the minimum criteria for active living (150 mins of moderate exercise a week). The second group may hit the minimum recommended hours of moderate hours a week but may lack certain components of fitness e.g strengthening and balance that may be crucial for healthy living and for avoiding usage of healthcare services. In this third category, this group is en route to healthy living and aging well.
To ensure that no one is left behind, the approach for each group of category of the population has to be different. For the sedentary group, the main goal would be for them to hit at least the minimum criteria in terms of active hours. In order to do this we have to first find out where the gaps are that cause them not to hit the minimum criteria. Some reasons may be lack of knowledge, poor motivation, a culture that exercise is a recreational activity vs essential for human survival, lack of time. Only after finding out the root cause can the strategy be targeted. Health coaches trained in behavioral modification can help identify behavior anchors and come up with strategies to overcome dysfunctional health behaviors so that they can be on the path to health. In addition, the health coach may be able to select the right behavior to start working on. Choose a behavior that is too difficult to change and very often, it is unsuccessful. Selecting a behavior that is not helpful to better their health and the individual does not improve their health. As this group has the highest risk of lifestyle diseases, most of the focus should be on them.
In the second group where certain aspects of fitness may be lacking but they have some form of awareness and strategies to meet the minimum criteria, knowledge of these other areas of fitness may be the issue. For instance, people in this category may complete ten thousand steps on a regular basis but do not perform any form of strength training. They may meet the minimum criteria to be out of the category of sedentary but may be subjected to sacropenia or loss of muscle mass and strength. Some of the eldery do not perform sufficient balance training which may put them at risk of falls. People in this category may get complacent as they may feel they are active sufficiently but this notion is very dangerous for they may be lacking in important components of health. Supplementation of training may not be difficult if we are able to embed them into their daily routine. Filling the knowledge gap may be the main strategy that is required to ensure an all rounded level of fitness.
For the third group, we will have to aid them in maintaining their current level of activities through prevention of overuse injuries and ensuring adequate recovery. This group may also be subjected to injuries where the healthcare system’s role is to aid them to return to their pre-injury level of activity as much as possible. Many drop out from sports upon acquiring injuries that may be caused traumatically or due to overuse. With the right rehabilitation, we should aim to bring them back to as close to their pre-injury level of sports participation as possible. Sports allows individuals to be part of a community and it can be a positive source of motivation to be active. Even if they are not able to return to the same level of sports participation, we should try to keep them as active as possible. For example, even if you had to give up contact sports after injury, there is always some alternative sport that can be safe enough to participate in.
We need to shift the paradigm where keeping active is the default and where aging does not equate to becoming weaker. Only then, do we have a fighting chance to tackle issues related to our growingly aging population. So let's get out of our chairs, take the stairs, walk further, lift more and stay active throughout our lives.
