Intended for healthcare professionals

Opinion Dissecting Health

Scarlett McNally: Exercise can do wonders for social care

BMJ 2022; 379 doi: (Published 26 October 2022) Cite this as: BMJ 2022;379:o2538
  1. Scarlett McNally, professor
  1. Eastbourne
  1. scarlettmcnally{at}
    Follow Scarlett on Twitter @scarlettmcnally

We need urgent radical solutions for the crisis in social care, to prevent the collapse not just of the NHS but of the entire UK economy. Social care is facing extreme difficulties with funding and workforce shortages. Staff are poorly paid, and 10% of posts are vacant.1

The UK has an estimated 10 million unpaid carers since the start of the pandemic.2 Hospitals are full, with patients who are sicker and frailer after pandemic lockdowns and have nowhere to go even when declared “medically fit for discharge.” This disrupts the flow of patients through hospitals, and the bed shortage leads to “corridor care” in emergency departments, with ambulances queuing to hand over.

The situation is about to get worse: 19% of the UK population is over 65.3 In Northern Ireland the number of people over 65 more than doubled between the censuses in 2011 and 2021.4 Projections show that each person will need an average of 10 years of social care.5 The UK has only 3.2 “working age” adults (ages 16-64) to each older person6—but only 76% of working age adults are in employment,7 and income tax alone will never cover social care.


We must, then, focus on prevention. The need for social care is not inevitable. Ageing does not have to be associated with a loss of fitness.8 Exercise and strength training can restore muscle and balance and are proved to reduce the impact of falls and fractures. “Use it or lose it” is an apposite motto.

The UK’s chief medical officers recommend that every adult embarks on physical activity for 150 minutes a week and does strength training twice a week.9 For frail older adults they suggest activities such as climbing stairs. Japan, with 2.0 “working age” adults to each older adult, recommends 30 minutes of daily brisk walking plus strengthening exercises for all middle aged and older people, to prevent “locomotive syndrome”—reduced mobility (and independence) owing to impairment of locomotive ability.10

The NHS is on an emergency footing, and prevention is key to relieving some of the pressures it faces in the long term. So, how do we encourage people to become more active? Unless their clinician promotes the benefits of keeping active, each patient tends to think that they are the exception. Deconditioning is reversible, but this requires initiatives such as #EndPJParalysis.11 In some cases, the stairlift that allows someone to be discharged from hospital should be seen as only temporary. We should all watch the “one minute consultation” videos about increasing exercise at Every one of the 1.5 million NHS staff—including clinical, non-registered clinical, managerial, administrative, and estates—should undergo “making every contact count” training.

Clinicians should lead with simple messages. The main work in spreading the message needs to be done by the public, media, families, communities, and decision makers. The BMA urges “anchor institutions,” such as the NHS, to change environments and cultures to permit “living well” at any age,12 and “social prescribing” may help. Being active and mobile is linked to social connectedness or “aspirational ageing.”13 This requires green space, safe outdoor environments, age friendly public transport networks, cycle lanes, and cycle parking for staff and visitors to maximise the benefits that electric cycles can have for middle aged or disabled people.14

Big changes are possible, since 47% of over 65s do no exercise at all.15 Doing squats means that, when you break your arm, you won’t need a carer and hoist to get out of bed. Exercise can be a miracle cure for social care as well as for health.16


  • Competing interests: None.

  • Provenance and peer review: Commissioned; not peer reviewed.