Scared off the couch

(February 11, 2018) One of the things that really bothers me about the Physical Activity and Health movement has been their tendency to catastrophise inactivity. ‘Catastrophising’ is a term that seems to have come from psychotherapy, where it was used to describe a tendency to exaggerate the seriousness of a situation and to forecast an irrationally gloomy outlook. Catastrophising has since been used to describe individual’s responses to pain and chronic conditions and also to describe communication styles that take the form of scare tactics. It is these kind of communication styles that have been adopted for public health messaging that I have difficulty with – I reckon they do more harm than good!

For example if I pop online, the New Zealand Ministry of Health tells me that physical activity reduces my risk of a range of health conditions, and helps me manage the ones that I have. Other sites tell me that physical activity can help people live longer, healthier lives; that physical activity is important because of its health benefits; that it can help prevent or manage conditions like heart disease, cancer, osteoporosis, diabetes, obesity, high blood pressure, and depression. Despite their myopia such lists and rhetoric are endless and everywhere.

Now I’m sure that the public health officials who generated those messages had only the best of intentions but they really needed to stop and reflect a little more on what they might be unintentionally creating. Seems to me they are seeing this physical activity thing from only one perspective – that’s their own medical model of health perspective! Scaring the bejeezus out of people, convincing them that they are destined to ill health or a premature death if they don’t get exercising, might work and work well for some people – but it’s the people who don’t respond to those messages that I fret about. It’s great that some people are spurred into action by these health reminders, but I’m concerned about the effect that this approach has on others’ perceptions of exercise and what it will do to their future intentions concerning exercise.

The problem is that catastrophising tends to identify and stigmatise certain sectors of the population who fall short of the supposed standards of ‘normal’ due to their inactivity and lack of fitness (see overweight, type II diabetes, heart disease). In effect this approach tacitly blames them for being in, or allowing themselves to fall into that state, and then not so subtly scares them or shames them into being more physically active. Now embarrassing and bullying people into doing something they do not enjoy, might ‘stick’ for some individuals, but for others it might just as easily elicit feelings of fear, anxiety and helplessness. Sure we know that physical activity has strong links with overweight, diabetes and heart disease, but we also know that many times exercise has little to no effect on such diseases or risk factors – there are other factors in play. We also know that many people will be spooked into trying to exercise for the sake of their health but the exercise thing won’t stick! There are many reasons why regular exercise will be challenging for some. Others will stubbornly reject the exercise ‘thing’ outright.

So what does catastrophising do to those people? I think that catatrophising with its readiness to name, blame and shame the inactive, can in effect ‘corner’ and pressure some individuals into attempting something they are not really ready for or convinced about – and it has be hard to resist the moral panic surrounding being inactive or being overweight.

Declaring crises and epidemics, with a little bit of hand wringing and public posturing, may give the appearance of ‘action’ and might help leverage money and resources for further research and programmes, but it is hard to imagine how these can be considered positive or encouraging for everyone. I can’t see how such approaches could be particularly helpful in fostering lifelong physical activity. I’d much prefer to see people exercising because they WANT to rather than succumbing to pressure and exercising because they feel they SHOULD or MUST. I’d rather see people GUIDED into habitual physical activity than GUILTED into an exercise regime – but that’s just me wearing my physical education hat talking. More on this later.

Best Phil