Exercise and your health: A guide to getting started

Following your recent physiotherapy session, you should now have a better understanding of your symptoms.

Musculoskeletal conditions can cause persistent symptoms that significantly impact your function and overall well-being. Effectively managing your condition is crucial for regaining normal function and getting back to the activities you enjoy. Exercise is one of the most evidenced and effective conservative treatments for common musculoskeletal conditions.

In this guide, we use the term “exercise” to refer to intentional, goal-oriented bodily movement, which is a key component of your recovery.

When not to exercise (contraindications)

It’s important to know when to rest your body and when to seek medical advice before continuing with exercise.

Always consult you GP or physiotherapist if you experience any of the following:

• Intense chest pain or pressure
• Severe or unexplained shortness of breath
• Unexplained dizziness or faintness.

It is important to always follow medical advice if you have a history of health conditions. Please refer to the end of this leaflet for more ‘further information’ on which conditions this may include.

Why should we do exercise?

Exercise is one of the most evidenced tools for managing long term health and musculoskeletal conditions.

It’s a common belief that rest is always the best solution for joint and muscle pain, but in many cases, consistent exercise can significantly reduce pain, improve function, and prevent future issues. This is because of the range of benefits that exercise has on a person.

Physical benefits

• Strengthens bones and muscles.
• Reduces muscle and joint pain.
• Improves flexibility and mobility.
• Helps to lose weight in a healthy way – Burns extra calories and increases metabolism.
• Improves cardiovascular health – Improves heart function and blood pressure control which can reduce the risk of heart related conditions.
• Reduces risks of bone fractures – Resistance/strength training reduces risk of developing osteoporosis by improving bone density and consequently bone strength.

Mental health benefits

• Reduces stress and anxiety – Releases endorphins which are natural mood lifters. Studies show that regular exercise can reduce anxiety symptoms in some people.
• Alleviates depression – Can be effective at managing mild to moderate depression. Research indicates physically active individuals have a lower risk of developing depression.
• Improves general mood – Provides a sense of accomplishment and can be a great distraction from worries.
• Boosts self-esteem and confidence – As you achieve fitness goals and feel better physically.
• Enhances cognitive function – Associated with improved memory, focus, and problem-solving skills, especially in older adults.

Functional benefits

• Improves sleep – Regular exercise can help you fall asleep faster and sleep more soundly.
• Increases energy – Regular exercise can help reduce fatigue
• Boosts immune system function.
• Improves quality of life – A combination of the benefits listed above may allow you to engage with more activities than you could previously.

What are the types of exercise?

It is generally considered there are three main categories of exercise which aim to achieve different physical effects on the body. It is important to note that these physical effects are not exclusive to one category of exercise and there are a lot of crossovers on the effects on the body.

Cardiovascular exercise

Cardiovascular exercises are those that intentionally raise your heart rate and cause you to breathe more heavily. Over time, this causes your body to adapt its internal processes to help your body to become more efficient and ready for future exercise. Cardiovascular exercises can improve your heart’s health because of these changes.

The World Health Organisation recommends that people engage with a minimum of 150 minutes of moderate-intensity exercise or 75 minutes of vigorous activity per week. This could be done in a combination of both.

People who are physically active for 2 hours and 30 minutes a week have a 33% lower risk of all-cause mortality than those who are physically inactive.

• Moderate intensity exercise = 50-60% of your max heart rate, if you can talk while exercising but not sing this is likely moderate activity. Examples include brisk walk, fitness class, swimming, hiking, dance.
  
• Vigorous activity = 70-85% of your max heart rate, if you can’t talk without pausing for breath then this is likely vigorous activity. Examples include running, cycling, swimming, rowing, and competitive sport. You should experience increased breathing, difficulty talking, sweating, and a raised heart rate

Strengthening exercise

Strengthening exercises involve moving against some form of resistance to strengthen the muscles that move and support your joints. You can use weight, a resistance band or try exercising in water.

A common misconception that some people have is that regular strengthening will make them look ‘too muscular’. The reality is that building significant muscle mass takes a large amount of dedication and multiple years of consistent training focused on hypertrophy to achieve. Instead you are more likely to see improvements in aches and pains.

You should practise strengthening exercises 2 times per week with 1 day of rest in between to allow your muscles time to recover. These exercises should aim to be difficult and cause significant fatigue at your muscles.

Range of motion exercises

Range of motion exercises involve taking joints through its full range of movement. These exercises are good for posture and strength as well as helping to improve flexibility.

To practise range of motion exercises, push the joint through a range of movement that feels comfortable and then gently ease it a little bit further into discomfort. Hold the joint into this position for 30 seconds to 2 minutes. This can often help to improve joint stiffness.

Lengthening a muscle is not a quick process and often requires 2-3 months of consistent stretching to see some improvement. You should aim to engage with range of motion exercises 5-7 times per week to achieve this consistency.

Goal setting

Your physiotherapist may advise you on what you should focus on with exercise to support your rehabilitation. This can be determined by the mechanism of your musculoskeletal symptoms/condition or by your personal physical goals.

Exercise can be chosen to help improve:

• Cardiovascular fitness
• Flexibility
• Pain
• Muscle power or muscle endurance depending on your goals.

Goal setting can be an effective way to boost motivation and consistency with training.

Short-term goals (2-4 weeks)

What they are?

Short-term goals are small, achievable steps that help you get started. They focus on building consistency and confidence.

Why they matter?

They help overcome the initial barriers to exercise, such as lack of motivation or uncertainty. Achieving short-term goals gives you a sense of accomplishment and encourages you to keep going.

Intermediate-term goals (1–3 months)

What they are?

These goals build on your short-term successes. They focus on improving your fitness level and making exercise a regular part of your routine.

Why they matter?

They help you develop habits and track progress over time. Intermediate goals keep you engaged and prevent plateaus.

Long-term goals (3–6+ months)

What they are?

Long-term goals reflect your bigger health and fitness aspirations. They are often outcome-based and require sustained effort.

Why they matter?

They give you a clear vision of what you’re working toward. Long-term goals help you stay committed and focused, even when your progress feels slow.

Setting exercise goals

To set effective exercise goals, you could use the SMART principle:

This involves making your goals specific, measurable, attainable, relevant, and time-bound. Start by defining what you want to achieve and why, then set clear measurements for success with a realistic deadline.

Starting exercise

Starting an exercise routine is one of the best things that you can do for your health. To establish your exercise routine you should think about ‘preparation and recovery’ and ‘choosing the right movement’

Preparation

You should aim to start exercise well hydrated, and you should keep consuming water throughout exercise. A good rule is 1 litre = 1 hour exercise.

Choose clothing that you feel comfortable in, but also that you can move freely in.

Your exercise routine should incorporate a 5-10 min warm up to prepare your body for the activity ahead. The goal is to raise your heart rate and break a light sweat which increases blood flow and your body’s temperature.

Recovery

After exercising you should aim to replenish the calories that you have burnt to avoid burnout throughout your day. Having a large meal that hits all nutrition groups is the ideal.

Following your exercise routine, you should incorporate a 5-10 minute cool down to allow your heart rate and breathing to return to normal gradually.

Daily stretching after exercise routine can be beneficial at managing ‘delayed onset muscle soreness’ (DOMS). Initially this may feel more painful but will typically ease after 5 minutes of stretching.

Choosing the right movement

This will depend on what your personal goals are and how much experience you have exercising.

Setting an effective goal will help you to focus on movements that help you to achieve that goal. For example if your goal is to build strength around a joint you should focus more on strengthening exercises.

If you are starting exercise for the first time in a while you should aim to focus on a low-impact and a balanced exercise routine that incorporates flexibility, strengthening and cardiovascular fitness.

Low impact exercises can be achieved using exercises that can be slowed and controlled and often keep both feet on the ground. Examples of some low impact exercises include: swimming, cycling, cross trainer, weighted exercise machines (commonly found in a gym).

Progressing exercise

If you are starting exercise for the first time in a while, it is always sensible to start low and progress slowly.

The 10% rule

A good rule to use is to progress one factor of your exercise by no more than 10% per week. You should not change more than one factor at a time to avoid significant overloading which may lead to musculoskeletal injures.

For example you could progress one of these following factors by 10% per week: weight lifted, repetitions, sets, workout frequency, or decreasing rest periods.

This is not an exact science but a general guide to work within.

Getting stronger

You can use exercise to improve the strength of muscles. This is achieved by challenging the muscle with movement and aiming to exercise to fatigue. A guide to achieving this fatigue is using your ‘repetitions in reserve’ (RIR).

RIR is a measure of exercise intensity, representing the estimated number of additional repetitions you could have completed of an exercise with good form before reaching technical failure (inability to perform another repetition of the exercise).

Progressive overload is a training idea that involves gradually increasing the stress or demand placed on your body. This is when the intensity of an exercise is increased over time to stimulate continuous improvement in strength, endurance, and muscle mass. It works by adapting the body’s stress level, with consistent adaptation to avoid injury.

You should apply progressive overload by progressively increasing the weight lifted, repetitions, sets, workout frequency, or decreasing rest periods, ensuring changes are gradual using the ‘10% rule’ to allow for recovery and adaptation.

Pain with exercise

Side effects of exercise

It is common to experience muscle soreness during and after exercising for up to 1 week. This soreness is delayed onset of muscle soreness (DOMS) which is often described as a constant aching pain which can be sharp when palpating or using the muscle.

DOMS are a positive sign that your muscles are being exercised to fatigue which longer-term leads to improvements in muscles strength. It is common for the experience of DOMS to reduce in intensity when you have been exercising consistently for a long time (2months+).

If you experience bruising or new significant swelling over a joint or muscle, you should stop exercise and seek medical advice if you see no improvements.

Recovering from musculoskeletal pain

If you are experiencing a recreation of your painful symptoms with exercise it is important to monitor the intensity of this pain. If your pain is acute and caused by a traumatic injury you should seek or follow the advice that your physiotherapist recommended on exercising.

Generally it is okay to exercise into some discomfort if your pains are caused by a long term musculoskeletal condition. An easy rule to follow is avoiding exercise that causes more than 4/10 pain. If you experience pain at a higher intensity, you should not stop exercising but simply adapt it by reducing the volume or difficulty of the exercise.

How to access exercise

You do not need to use exercise facilities (e.g. gyms or sports clubs) to engage with exercise effectively. Exercises with body weight can be really challenging and can help you to easily achieve cardiovascular fitness, flexibility, pain relief, or muscle strengthening goals at home.

Gym memberships

Gyms are great facilities that provide access to a variety of equipment to help strengthen your muscles and improve cardiovascular fitness. They typically have a range of equipment from weighted machines to cardiovascular machines, and free-weights.

Some people like the input of a personal trainer to support their personal fitness goals. Using a personal trainer is significantly more expensive than exercising independently, but can be a great option for those who want direct guidance and further education when exercising.

Some gyms setup by your local council services could offer discounts for NHS staff, so make sure to check this before signing up!

Staff Social Club (SSC) gym membership

If you are a member of the Staff Social Club, you can choose to become a member of the 24-hour Royal Victoria Infirmary and Freeman Hospital Fitness Centres for an extra £10 per month. If you are not already a member of the staff social club, any staff member can join for £3 per month (£13 total per month to access the fitness centres).

To access the staff social club gym, you will need to complete a fitness centre application and view the virtual induction which can be both be found at this address:

Once you have completed the applications and viewed the virtual induction, you will need to email your application to nuth.staffsocialclub@nhs.net.

Physical hobbies and sports

One of the most important components of achieving your personal fitness goal is to remain consistent for a prolonged period. Finding a physical activity that you enjoy can help you to remain consistent and be really important in achieving your fitness goals.

You do not need to use a gym to continue your personal fitness journey and not everyone enjoys going to the gym, and that’s okay!

Whatever your personal fitness goal is, this can usually be supported by engaging with a physical activity or sport.

It is important that when choosing an activity to support your personal fitness goal that it is relevant to your goal. Your chosen activity should be challenging and fatiguing for the body part you want to focus on.

For example – someone looking to improve the strength in their arms is unlikely to achieve this by only running because the muscles in your arms are not being challenged and fatigued with this exercise OR someone looking to improve their flexibility is unlikely to achieve this by only swimming breaststroke.

Some helpful resources to help you find a new activity

• Information Now – this is a website setup and monitored by Newcastle City council that lists a range of different activities ranging from dancing to climbing and where to access them.
  
• Couch to 5K app – this application has a progressive NHS programme designed to help people who have not run in a long time start running whilst minimising the risk of injury.
  
• All Trails app – this is an application that allows for people to publish and share their favourite cycling and hiking routes across the UK – details on the route’s distance, elevation, time and graded difficulty can be found with each route that is published.
  
• Local leisure facilities – locations providing public access to sports and exercise facilities.
  
• 10 minute workouts – equipment free fitness videos.
  
• The occupational health service provides an introduction to chair Pilates online video led by a Physiotherapist. This is only available to staff in the trust.

Further information

If you have any of the conditions listed below and you have not been advised on exercise, you should seek advice from your GP or specialist doctor.

What about work?

Stay active at work or return to work as soon as possible; if necessary, with temporarily modified duties. This helps you keep your ‘work fitness’ and prevents your body getting weak, which can prolong your pain.

Maintaining all normal activities including work improves your chances of recovery by keeping you moving.

Working in discomfort is unlikely to lead to any long-term problems and can reduce the risk of re-injury’. It also helps to regain any strength that has been lost in the early stages when the pain stopped you moving normally. The more time spent away from work, the greater the risk to your long-term quality of life.

You may not be able to return to your full duties straight away. It may take a short period of adjustment before you resume full duties. Often people are concerned about heavy jobs or jobs that require staying in the same position for a long time. You can discuss this with your manager and a short period of modified duties may be possible.

What should I do if I am still experiencing problems?

If you are unable to agree on restricted roles with you manager or you are still having problems (despite following this advice) occupational health can help.

The occupational health team can advise you on how to bridge the gap to help you return to normal activities.

Self-referral

The occupational health physiotherapy team can assist in the management of musculoskeletal problems that affect your ability to work.

Management referral

If you feel your symptoms are having a significant effect on your ability to carry out your role, discuss this with your manager and request a referral to the occupational health service.