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  For Ralph

  INTRODUCTION A World Transformed

  Cast your mind back across the past few weeks,and think about how many times you really used your body as part of everyday life. I’m not talking about formal exercise. This isn’t a listless jog around the local park, or a spin class squeezed between work chores and family duties, motivated in part by guilt at the thought of the monthly gym fee. I mean using your body in a way that was at least a bit strenuous, and would also be more or less comprehensible to, say, someone from Edwardian times. Perhaps striding across town to an engagement, or digging a garden. Maybe cycling up a hill, not dressed in Lycra and as a penance for too much cake, but to fetch something from a shop. If, right now, you’re struggling to immediately recall anything on these lines, you are by no means alone.

  It is fair to say that there is a modern crisis when it comes to physical movement. In the UK, well over three in ten of the adult population lead lives so inactive that their long-term health could be harmed.1 That’s more than 20 million people. An alarming 80 per cent of British children exert themselves so little that they risk growing up with weakened bones, poorly developed cardiovascular systems, and bodies more likely to suffer from chronic illness as they age.2 You can find similar statistics for more or less any other economically developed country in the world, and increasingly for many poorer ones. Possibly the most exhaustive global study, which combined data from 122 nations, found that nearly a third of all adults, and four fifths of adolescents, currently move insufficiently in their lives.3

  What has happened? The short answer is that everyday physical activity more or less disappeared from the world. Regular, informal, unplanned exertion, an integral part of virtually every human life since the first Homo sapiens hunted and foraged, was designed out of existence, and with astonishing rapidity. This process began in the nineteenth century, with mass industrialisation and urbanisation, but has accelerated almost beyond measure in recent decades. It has involved everything from the decline of physical work in favour of desk-based jobs, to homes filled with activity-saving devices, where even mini-exertions like walking to the cinema or a restaurant are being gradually replaced by streamed films and the rise of app-summoned takeaways. The same has happened to our external environment, where the routine effort of walking and cycling has been supplanted by ubiquitous car journeys, many of them carrying one person for a laughably short distance.

  This transformation has been so rapid as to put much of it within living memory. Even in the economically booming UK of the mid-to-late 1950s, barely half of households owned a vacuum cleaner,4 while only a quarter possessed a washing machine, and even many of those who had the latter still used a mangle to dry their clothes.5 Millions of older Britons can thus still recall a human-powered domestic regime of rug beating and hand-washed clothes almost unaltered from the nineteenth century. In the same post-war Britain, around 70 per cent of jobs involved manual labour, as against fewer than a third currently.6 In 1950, around 25 per cent of all trips were still made by bicycle.7 These days that figure is somewhere near 1 per cent,8 with cycling levels so low it is difficult to be more precise. About a quarter of all journeys of less than two miles, the sort of distance you could cycle fairly sedately in ten or fifteen minutes, are done by car.9

  Some of the statistics around inactivity can be genuinely jaw-dropping. In a recent study, Public Health England, the government body charged with improving the nation’s wellbeing, asked people how much cumulative time in an average month they spent walking briskly. Not jogging, or even a gentle trot, just a slightly increased walking pace. The answer from 44 per cent was, ‘Less than ten minutes’ – that is, pretty much not at all.10 Another example comes in the Annual Travel Survey, an examination by the UK’s Department for Transport into the various methods people used to get around over the previous twelve months. The most recent edition, from 2018, asked how many times during the previous year the 15,000-plus panel had walked continuously for twenty minutes or longer. This meant walking at any speed, not even briskly. A whole 18 per cent ticked the box saying, ‘Less than once a year’. Again – pretty much never.11

  There is another element to this physical revolution. The void created by the disappearance of routine movement has, in part, been filled with the notion of exercise, something separate from your everyday life, increasingly commercialised, even fetishised, and thus far from universal. Over recent decades the fitness industry has boomed worldwide, barely making a dent in overall activity levels but allowing governments to focus on the idea of sport as a substitute.

  This is not meant as a condemnation of gym-going or any other type of formal sport. They bring joy and fulfilment to millions, not to mention enormous health benefits. Your body doesn’t care how you exert yourself. The only problem is that not enough people do it. In the UK, more than half the adult population never take part in any sport, ever.12 But the attention devoted to exercise rather than everyday movement has helped shift the public narrative towards one based on oversimplified notions of personal responsibility, as if declining activity levels were caused by nothing more than a mass outbreak of laziness.

  This not only entirely misses the point, but provides an excuse for politicians not to treat inactivity with the complete seriousness it merits. And make no mistake: this is one of the more momentous changes in recent human existence. To get a sense of the scale, consider the findings of what is almost certainly the most thorough academic attempt to total up the number of global deaths each year connected to inactive living. The figure reached was 5.3 million. That’s about the population of Norway, dying earlier than they should.13 It is more than are killed in wars,14 and in many countries more than by tobacco.15 A tally by UK health officials estimates the national death toll due to inactive living at around 100,000 a year.16 By the same gauge of measurement, that’s a small city, something of the size of Worcester. It’s more than 270 people a day – almost 60 per day more than tobacco.

  But the impact goes far beyond mortality statistics and the associated human tragedy they contain. With countless millions of people acquiring lifestyle-related illnesses like type 2 diabetes at ever-earlier ages, and living for many more decades with a series of chronic, debilitating conditions, most experts agree that, if left unchecked, inactivity is on course to make health services fundamentally unviable. This is very much a question of when, not if.

  In the six-plus decades since a pioneering British researcher first demonstrated the link between a lack of movement in people’s everyday lives and chronic illness, knowledge about the sheer range of perils it can cause has multiplied. Many thousands of subsequent studies have clearly established that inactive living, if maintained over years and decades, brings an increased likelihood of not just type 2 diabetes and other metabolic disorders, but heart disease, high blood pressure and strokes, several forms of cancer, poor lung function, as well as depression and anxiety, diminished cognitive function, poorer sleep and, in later life, Alzheimer’s and other sorts of dementia. Not to mention the big ones: increased chances of early death, or, if you do survive into retirement, a reduced chance of being able to live healthily and independently.

  Inactive living is also a key factor in the connected but distinct global health catastrophe of excess weight and obesity. Finally, there is the parallel blight of ailments caused by peop
le sitting down too long, which is also heavily linked to type 2 diabetes and cardiovascular disease.

  Dr Adrian Davies is a British academic who has spent more than thirty years researching ways to keep people moving. He is clear about where we find ourselves: ‘In terms of rigour in science and public health we are at that stage where we absolutely know that Homo sapiens were designed, as hunter-gatherers, to be routinely physically active, chasing antelopes across the prairie or whatever it was. And while we have not been able to change our biological destiny, we have changed the built environment. So instead of hunting an antelope we get in the car and drive to Sainsbury’s.’17

  This book is the story of how routine activity disappeared, and the many consequences it brought. There are several things this book is not. It is not an argument for simply turning back the clock. No one wants a return to mass, repetitive manual labour. And beyond a handful of hair-shirted survivalist types, few would suggest having to carry in piles of wood from a shed every day for heating and cooking. Similarly, domestic appliances like the washing machine and vacuum cleaner have liberated millions of people – almost universally women – from hours of daily drudgery. This is, instead, about finding new ways to put physical effort into modern lives.

  Nor is this intended as a handbook for better health, or a detailed policy manifesto. There are plenty of those already available. Consider it more a guide through this often unnoticed phenomenon and its many consequences, which are hiding in plain sight in virtually every country across the world. But along the way, I hope to point out at least some of the ways through which you might integrate more movement into your routine, and explain the near-magical benefits that can follow. As such, each chapter ends with an idea about how to perhaps integrate more movement into your life. But this is meant just as something to think about, not an instruction, let alone a programme, or a regime.

  Because this book is also a story of hope. Even in an environment designed against human-powered motion, change can be easier than you think. It is still possible to experience movement and exertion as a regular part of your life, not just a chore, a penance. Again, this is not to demean sport. But it is just not the same thing. When you make something routine, normal, even forgettable, you no longer need to carve time out of your day to do it, or feel guilty when you don’t. Instead it embeds, becomes permanent. When this happens it feels almost as if you have been let in on a secret.

  The consequences that follow for your wellbeing can be astounding. The decades of research into the dangers of inactivity have seen a parallel growth in knowledge about the seemingly endless ways that, once you start moving again, the health odds begin to stack once more in your favour, and almost instantly. With scientists better able to electronically monitor the subtleties and variations of movement and exertion, it has become apparent that even pretty moderate, everyday efforts can bring significant results. The more information emerges, the steeper the dose–response curve seems to be. Almost anything, it seems, is better than nothing.

  I will give just one example, which focuses on that most everyday of physical pursuits, cycling for transport. Researchers in Denmark tracked around 30,000 randomly selected people of all ages over about fifteen years. The study found that even after adjusting for other demographic, social and lifestyle factors, including leisure-time exercise, people who cycled to and from work – the average commute was only about fifteen minutes each way – were 40 per cent less likely to have died over the study period than those who did not, from any cause.18

  Forty per cent. It is this sort of statistic which helps you understand why some experts can go a bit misty-eyed when they talk about activity. It’s also why so many of them compare everyday movement to the miracle-giving pill of this book’s title.

  In the public health world the idea of activity-as-a-wonder-medicine is so common as to be considered something of a cliché, but it’s still the most resonant parallel I can find. Imagine if you were a medical researcher and you discovered a drug which would improve people’s health outcomes on the scale of cycle commuting. A Nobel Prize would be more or less guaranteed, as would a knighthood or damehood. In fact, the renown would be so great you’d have a decent chance of ending up with your face on a banknote within your lifetime. And yet this marvel is already here.

  Escape from inactivity

  There is a final element in introducing this story: why is it me telling it? I’m not a scientist, let alone an epidemiologist, the researchers who investigate population-wide health outcomes. I’m a journalist. I cover British politics, based in the Houses of Parliament.

  There are two main reasons for my near-obsessive interest in the subject. One is that my day job involves contact with a lot of politicians, civil servants and other officials, trying to understand why they make certain decisions rather than others. And it’s fair to say that when it comes to public health, something odd is going on. If I have the chance to turn a conversation with one of these people to physical inactivity, more or less all of them agree that, yes, it is a hugely significant problem and more should be done. And yet more or less nothing is done. Even though its consequences have been well known for decades, inactivity is what you might call a normalised catastrophe. Governments rarely pass laws, or hold urgent press conferences to pledge action, instead focusing on generally ineffective public information campaigns.

  Until now, perhaps. By coincidence, this book is being written while the UK and many other countries are in lockdown due to the coronavirus pandemic. And here, as the world has seen, a swift and coherent response to health emergencies is very much politically feasible. Ministers have not hesitated to close whole sections of their national economies and severely restrict individual freedoms to save lives. For the most part, at time of writing, the public have supported these actions. Interventionist health policies are no longer exceptional. And if voters can accept their government effectively locking them in their homes for two months to save lives, perhaps far less intrusive measures to create more everyday activity, for the same reason, are less likely to attract the traditional opposing cry of, ‘Nanny state!’

  There has also already been material change. As the lockdown has been relaxed, governments are urging those returning to work to walk or cycle, so as to avoid either packing into public transport or jamming the streets with cars. Emergency cycle lanes are springing up in cities around the world. And as we will see later, active travel is one of the very best ways to ensure movement is part of your routine.

  So are we entering a new era of government action to banish inactivity, even indirectly? It will be years before we truly know. But a lot of entrenched attitudes will need to shift. Currently, far too much official thinking on the subject remains based around misplaced assumptions. One is that motivation is the missing element in our crisis of immobility, rather than a world redesigned to discourage movement. Another is that if people are inactive then the consequences are theirs alone. This is an issue which not only blights so many individual health outcomes, but on a national level risks bringing down the entire NHS, not to mention the care system for older people. Some crises are just too big to be left to notions of personal responsibility.

  But at the same time, it’s worth noting that coronavirus has, undeniably, seen a lot of people think consciously, perhaps for the first time in years, about their individual relationships with physical activity. At the peak of the lockdown in the UK, government guidelines permitted an hour of outdoor movement or activity a day – as one public health expert told me, probably the first time ministers had mandated exercise to the nation since the Second World War. Parks started to half-resemble some sort of idealised Victorian sanatorium, full of joggers, brisk walkers, people skipping or lifting weights.

  Inside people’s homes, hundreds of thousands of families launched into unfamiliar sequences of star jumps, stomach crunches and press-ups to the on-screen instruction of Joe Wicks, the fitness guru who launched a parallel career as the nation’s de fact
o PE teacher. In a curious inversion, for some Britons, being instructed to shut themselves in their homes for twenty-three hours a day meant they were actually more active than usual.

  Even in normal times, people’s relationship with activity is never straightforward, and is greatly shaped by their background, and the lives they lead. This takes us to the other reason for my passion about this subject: it is what you could call biographical. The fact that, as an adult, I am regularly active, with all the benefits this brings, came about because of circumstances which were almost accidental but became something for which I am intensely, permanently grateful. It’s not an exaggeration to say that everyday movement transformed my life.

  A public health expert might argue, with legitimacy, that coming from the relative privilege of a middle-class family, the statistics favoured me in terms of long-term activity and fitness. But my circumstances were not typical, and there was a period in my young adulthood where a gradual drift towards an increasingly immobile life seemed entirely realistic.

  As a child, my health was blighted by asthma which developed extremely early, after a near-fatal episode of pneumonia when I was two, and was soon diagnosed as severe. The condition is part hereditary, part environmental, and I had it coming at me from both sides. My father and one of my maternal uncles had been badly asthmatic as children, while my mother smoked prodigiously both during her pregnancy with me and throughout my infancy, damaging my nascent lungs.

  I don’t want to portray myself as some sort of tubercular Victorian urchin. Apart from intermittent bouts of wheezing I was an active if alarmingly skinny child, with a passionate interest in playing football, despite my fairly evident lack of talent. But my asthma was serious enough for doctors to try me out on an array of emerging medicines during regular trips to hospital outpatient departments. Things changed when I became a teenager. As can happen with the condition, my asthma improved in daily life but condensed into rare and terrifying episodes of severe wheezing, several of which ended in emergency admissions to hospital. Around 1,400 people a year in the UK currently die because of asthma,19 and under slightly different circumstances I could easily have been one of them.