How To Start Exercising Safely If You’re Unfit Or Have A Medical Condition

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Photograph: Courtesy World Obesity Federation

It’s pretty much always better to exercise than not, but it’s also true that many people need to take care about how they go about that exercise when starting out. Whether you’re returning to training after a sedentary spell or figuring out how to exercise safely with a chronic condition, it’s important to make sure you start in a safe and sustainable way.

The free EXi app aims to help. It creates a 12-week training programme tailored to the information you enter, including details like medical conditions, and your general health and fitness levels.

EXI has been created by a team of medical experts and is approved by the NHS. We spoke to chartered physiotherapist Carron Manning, co-founder and clinical director of the app, about what people need to be particularly careful about when starting exercising and how EXI can help.

What are the risks of starting to exercise with too gung-ho an approach?

From a medical point of view there’s a risk that if you do too much too soon, then you can get an injury – musculoskeletal injuries are common. Another important aspect is that if you have a disease like cardiovascular disease or diabetes, the medical guidelines are clear about the exercise intensity you should start with. If you have a cardiovascular disease we will limit your intensity level for safety.

The other major factor is that from a psychological point of view if you do too much too soon, you’ll have this association with exercise being difficult or unpleasant. Then you’re much more likely to stop. We see that with high-intensity exercise, people start and then stop.

If you take a more graduated approach, behaviour change becomes achievable and reinforces that message that exercise is safe and good for you, and you can continue to do it.

Who needs to be particularly cautious?

I don’t want to make it sound like exercise is unsafe, but there are a few conditions for which we control that intensity level a little bit. For example, on the app we restrict people with cardiovascular disease to low- and moderate-intensity activity – we don’t have high intensity as an option.

However, the risk of not doing exercise if you have heart disease is still greater than the risk of doing exercise with heart disease – you’re more likely to suffer a significant cardiovascular event like a heart attack. It’s always better to exercise, and it’s even better if you control that and keep it in these low and medium zones.

The medical guidelines for exercise for people with chronic conditions are fairly clear. If you were exercising with a medical team in a hospital and you had facilities on site, we could push you hard and the risk is very low. But if you’re doing it yourself then it is a good idea to know how hard you can safely push yourself.

How can you start exercising safely if you are simply unfit?

We want you to get to 150 minutes of moderate-intensity exercise per week, or 75 minutes of high-intensity exercise, but start slower and build more gradually.

A good way to start would possibly be a 10-minute walk three times a week. Then gradually increase. There are three main components to exercise: time, intensity and frequency. Gradually build up those with the goal of meeting the guidelines for activity.

Who is the EXi app aimed at in particular?

We have three main groups. First, people who are sedentary. That’s a huge amount of us – 40% of the UK population aren’t meeting medical guidelines for physical activity.

Second, those at risk of developing a chronic condition, which could be because their resting heart rate or blood pressure is increasing or their weight might be going up. You might also have a genetic risk. There are lots of people who are at risk.

Third, people who already have a diagnosis for a chronic condition, like hypertension, heart disease, or whatever. There are 23 conditions on the app at the moment, and 15 million adults in the UK have one chronic condition, so we’re not talking about small numbers of people.

Only 15% of people really engage with the fitness industry and things like HIIT in gyms. We are looking at the rest. What we do is not high-intensity fitness, it’s just trying to get people moving and engaged with activity for the benefits you’ll see for your health.

How does the app work?

The app asks for information about your current health and fitness, and whether or not you have a medical condition. The app analyses that data and prescribes a personalised and graduated 12-week programme.

It’s actually an indefinite programme, but for the first 12 weeks the exercise gradually increases in time, intensity and frequency. So someone might be prescribed four 15-minute sessions at a low intensity to start with, and over 12 weeks that gradually increases.

We then provide the exercise content that’s relevant to that prescription. If you’re on low intensity you’ll only see low-intensity exercises. We had to produce this content ourselves because low- and moderate-intensity content is almost non-existent.

We have exercise guides, stuff for the gym, and GPS-tracked activities like running, cycling and walking. We don’t mind where you do it or if you use another programme, as long as you’re working at the correct level – that’s what we’re most concerned with.

How do you confirm if someone is working at the right intensity level?

It is based on heart rate. Our app takes your resting heart rate, and works out your maximal heart rate and heart rate zones for low-, moderate- and high-intensity training. We can use the camera flash of a mobile phone to check your heart rate. We also take your exercise heart rate immediately after activity, and the app will analyse that heart rate to see if you’re in the right zone.

If you have an Apple Watch we can take heart rate automatically while exercising and we have haptic feedback on the watch to guide you to work at the right intensity level. We also measure heart rate via other wearables though HealthKit and Google Fit.

We also use the rating of perceived exertion. It’s a really good indicator of how hard someone is working. So if you were meant to be working at a low intensity and you’re saying that was flat-out, too hard, you’d give a score of nine out of 10. The app will tell you to ease off next time.

Download EXi on the App Store and Google Play | Free

Nick Harris-Fry
Senior writer

Nick Harris-Fry is a journalist who has been covering health and fitness since 2015. Nick is an avid runner, covering 70-110km a week, which gives him ample opportunity to test a wide range of running shoes and running gear. He is also the chief tester for fitness trackers and running watches, treadmills and exercise bikes, and workout headphones.