More about running

Hash House Harriers

I am a great fan of parkrun but this is not the only example of running-as-fun as potential therapy or prevention. My friend from Zimbabwe wrote in after my most recent blog:

“Dr Hugh does not mention the Hash House Harriers in this article. The Hash is a worldwide fun social running Club, but perhaps it is not mentioned because its joke slogan is ‘A beer drinking Club with a running problem’!!!. It was started in Kuala Lumpur in 1938 and now has chapters world wide.

I just wanted to comment that I have been with the Hash for over 40 years and many of our older members are now in their late 70s and early 80s. We are not as quick as we were and some now just walk, but their fitness is testament to Dr Hugh’s comment!” – many thanks, Don, for this contribution.

I would add that Hash House Harriers use a format somewhat similar to the old-fashioned paper chase or Hare and Hounds. Sadly our local Harriers became defunct many years ago –  a committed organiser or small group are necessary and we lost ours. However, Harrying is certainly fun and though I can not find any research to verify it, I am convinced that it does increase aerobic fitness and brings all the health and well-being benefits of this effect.

So, you could add Harrying to my suggestions for exercise prescription – if there is an HHH club in your area.

In favour of prescribing exercise

In 2016, the British Medical Journal (BMJ) published an article titled “Doctors should be able to prescribe exercise like a drug.” “Sedentary lifestyle is responsible for about 5.3 million deaths a year globally” (probably a gross underestimate) but doctors only recommend exercise during about a quarter of the consultations in which it would be helpful (probably on overestimate). It is well known that simply telling patients to exercise is very ineffective – “Proper implementation of exercise guidelines in clinical practice requires that exercise be prescribed for patients in a manner analogous to a drug prescription”. I discussed some of the difficulties of such implementation in my last blog – lack of time, lack of incentive, lack of training, lack of a referral route and lack of confidence that the prescription would be heeded.

BUT – there is an assumption that if a medical condition is likely to respond to any particular intervention, that intervention should be prescribed or recommended.

Against prescribing exercise

The much respected general practitioner commentator, Dr Margaret McCartney, has recently published an article in the BMJ, “Prescribing parkrun: medicalising a walk in the park.” Her objections to prescribing parkrun are all about the interpretation of “prescription”. Margaret acknowledges that parkrun, now attracting about 200,000 people a week, can make a real difference to public health. However she says that the word “prescribing” encapsulates power and command, and that turning parkrun into a prescription makes it less about pleasure and fun, more like work and compliance. Prescribing, she holds, implies that “I have the authority to prescribe and you must follow my orders.” Oh dear, what a primitive view of the interaction between members of the medical profession and their customers. In my view, giving a prescription these days should involve a discussion with the patient about the appropriate way to manage their problems, be it lifestyle change or medication, with the final decision being down to the patient. True, this often means the patient accepting the doctor’s recommendation but this may be a statin or a parkrun – or both!

Margaret does have one very valid objection to prescribing parkrun and that is the commercial opportunities which it opens up. But the same is true for medication – Drug companies make huge profits from the drugs they manufacture and they are quite happy to see their products endorsed by health agencies or the Department of Health.

Side effects

Like all other prescriptions, running can cause side-effects.  I will discuss these next time.

PS
Canadian Air force exercises

I had an interesting response to my blog about the XBX and 5BX exercise programmes. The respondent had knee pain after starting the XBX programme and reminded me to caution people, particularly older exercisers, to start slowly and build up carefully.

She also commented on the absence on any instructions for older people. I agree –  it is the assumption of all exercise programmes that no-one over the age of 60 takes vigorous exercise! In my book (Get off the couch before it’s too late) I have used existing guidelines for monitoring physical fitness and responses to exercise but I have had to add data to cover older people because none of the existing information covers us. Outrageous! Until there is better information from the creators of exercise advice we just have to use our common sense to make our own. The tendency must be to reduce gradually the demands which we make on ourselves, responding to how different exercises affect us. For instance, I used to run three times a week but have now reduced it to twice a week because more frequent outings tend to bring on muscle and joint pain.