#B2Rhealth Exercise Culture

Team #B2Rhealth took on the width of Scotland in 2018, one hundred and five miles over two days, cycling, running and kayaking. Heaven.

Team #B2Rhealth took on the width of Scotland in 2018, one hundred and five miles over two days, cycling, running and kayaking. Heaven.

A major goal of Back to Roots is addressing the global challenge that is physical inactivity.1

We know that exercise adherence is a big problem2 and that the number one driver in adult participation in physical activity is joy and passion.3 It is on this basis that #B2Rhealth is most widely known, an attempt to make physical activity fun, heavily underpinned by 'play'. You can see our Ted-talk style discussion on the topic here.

To this end, play can often be misconceived as something less serious than ‘work’, however life is play and it encompasses everything from mathematicians besting each other with calculus to rough and tumble wrestling. Even in research, we are fundamentally ‘playing’ with variables and in the words of Stuart Brown, founder of the National Institute for Play:4

The opposite of play is not work - it’s depression
— Stuart Brown, cited in Sapolsky (2017) P.205

The type of play people might most associate with #B2Rhealth is the rough and tumble or playful movement, which is underpinned by a shift from traditional towards non-linear pedagogy. Chow et al (2016)5 summarised the inherent weaknesses of traditional coaching methods:

  • being too operational (lacking a substantial theoretical framework)

  • overemphasis of specific methods such as verbal instruction and imitation

  • promotes teaching and instructional practices rather than providing a learning-centred philosophy

  • implies that common movement templates exist towards which all learners should aspire, rather than promoting individualised movement solutions

  • being overly concerned with time spent rehearsing putative ‘classical techniques’ or movement templates.

Paul McCambridge has been fascinated by play for nearly twenty years and is currently writing a book to help reconceptualise how serious we should be taking it.

Paul McCambridge has been fascinated by play for nearly twenty years and is currently writing a book to help reconceptualise how serious we should be taking it.

We individualise all our movement and exercise programming which, for the reasons above, explain why we are heavily influenced by a ‘constraint-led approach’ over a traditional one.6 As healthcare professionals, we do not take our responsibility lightly in guiding people back towards an active lifestyle, essentially playing the role of physical education (PE) in adults.

The 10 000 hour rule for mastery was flawed from the start
— Cote and Hancock, 2014

To understand the breadth and diversity of #B2Rhealth programmes, it’s helpful to consider a historical concept in PE which is early specialisation. The early specialisation pathway involves a significant amount of practice in a specific sport domain, exposure to minimal play time in one sport and experience of relatively few or no other sports in the early years.7 The early specialisation pathway was influenced by ideas from deliberate practice, an approach proposing that expertise in sport requires intense and focused practice in any given domain. This gave birth to the idea that a developing child must adhere to a highly specialised programme from early childhood in order to undertake the 10 000 hours of deliberate practice needed to 'excel'. The orginal data8 supporting the concept of deliberate practice and the 10 000 hours rule was reavaluated in 20129 where major flaws in interpretation were exposed. For a more comprehensive discussion on the research see the review in Chow et al (2016)5 P.28.

The authors crucially omitted the standard deviation in the supposed 10 000 hours to become an expert. Had they not done this the data would have shown that in chess players10 (which influenced the original 10 000 hours finding) a range of 3016-23608 hours was actually required to master.

Not chess, but one of our favourite games ‘Quarto’. Traditional pedagogy would have it that we require 10 000 hours to master, but for the reasons discussed, is flawed and for any given person could be much more, or less.

Not chess, but one of our favourite games ‘Quarto’. Traditional pedagogy would have it that we require 10 000 hours to master, but for the reasons discussed, is flawed and for any given person could be much more, or less.

The 10 000 hours have been heavily criticised for this oversight in the individual variability required to master a craft and ‘overspecialisation’ has had very serious implications. Chow et al describe how in order to achieve an average of 10 000 hours in ten years, an eight year old child might need to train for twenty hours a week which is educationally unsupportable and biologically dangerous. These dangers include burnout, dropout, overuse injuries and lower levels of attainment.11

Recall reference 3 where we found that joy and passion were the biggest factors in exercise adherence in adults. This concept of early-specialisation and early drop-out in our children potentially has major public health implications. Cote and Hancock12 found that drop out rates during adolescence is estimated at one third of all participants between 10 and 17 years of age are withdrawing from sports programmes every year.

Gymnastic strength training runs through #B2Rhealth programmes, the versatility and conditioning achieved through gymnastics is reflected in its consistency throughout the history of Physical Education.

Gymnastic strength training runs through #B2Rhealth programmes, the versatility and conditioning achieved through gymnastics is reflected in its consistency throughout the history of Physical Education.

It is reasonable to suggest that those early experiences in adolescence frame a persons relationship with physical activity for the rest of their life, and these are the people perhaps more likely to suffer from a host of lifestyle diseases that result in them seeking help from us healthcare professionals. Perhaps if we took a more general approach to physical activity, we could prevent many of the implications of overspecialisation and the traditional teaching methods.

In healthcare we advocate generalists over specialists. We bring in specialists as guest teachers in our workshops, then repackage and apply generally.
— #B2Rhealth

It is on this basis that the programmes #B2Rhealth provide are to cultivate generalists. It makes sense to us that we have to be more than just one facet of physical activity to become generalists. In western cultures, current physical education practices have their historical roots in military drill, gymnastics and games.13 Military style physical training might seem a long way from current thinking in education, but it has had a profound influence on the conduct and substance of Physical Education.5

 

This early form of PE was centred around miltary preparation that included combat, marching and gymnastics. These rituals served the dual purpose of conditioning the body for military campigns and behaviour control to establish conformation. At the same time this approach was consistent with other classroom practices which were instruction, imitation and recital based (for example learning the times table or rote memory in spelling and grammar).14

An important activity that underpins the importance of physical conditioning and body mangement, in the broadest sense, was the introduction of gymnastics to schools, which had first been introduced in Germany, Sweden and Denmark.15

Through use of apparatus and structured calisthenics, children were taught via instruction by imitation with personal demonstration and all children simultaneously copying a 'template'action on command. 16

Gymnastic strength training builds not just strong bodies, but resilient joints that are life ready.

Gymnastic strength training builds not just strong bodies, but resilient joints that are life ready.

However, by the 1930s many teachers (mainly women) had begun to question the educational value of this regimented approach and began to adopt ideas of Laban, with its emphasis on 'Movement education' and 'creativity' in elementary schools.

With the onset of World War II in 1939, physical education was also influenced by combat and commando training using obstacles such as logs, ropes, nets, walls and ditches which were introduced into army training to produce battle conditioning. 17

However, rather than regimented teaching styles associated with militaristic training methods, this vigorous form of physical training led to a new teaching technique as children found their own ways of achieving task goals like climbing, hanging, heaving and balancing skills. At this point 'teaching' began to adopt a child-centred focus with children showing the teachers what could be done. 17

Most, if not all of us will be most familiar with team games from our PE, which was first introduced into english public schools in the 1850s; the goal of which was to 'build-character' by developing courage, loyalty, cooperation, capacity to act fairly and take defeat well. It was not until the 1950s that games took such a central role in physical education curriculums and was largely due to an influx of male teachers. 18

The fact that ‘dance’ or movement therapies were predominantly driven by females, does not make it any less important for us males to develop some competence here if we wish to provide this element of a well rounded programme.

The fact that ‘dance’ or movement therapies were predominantly driven by females, does not make it any less important for us males to develop some competence here if we wish to provide this element of a well rounded programme.

Back to Roots exercise programming is informed and influenced by all these critical periods through the history of physical education. A hallmark of our programmes is gymnastic strength training, which as discussed, has been consistent through the eras in terms of physical conditioning. Contemporary clinical practice dictates that we simply have to be evidence informed and this evidence tells us that there is no one exercise that is superior to any others. 1 The evidence also suggests that we have to be able to individualise our prescription - for which there is no one model template that tell us an absolute superiority in technique for everyone, supporting our non-linear pedagogical approach. 5

Sample constraint-led nonlinear pedagogy. Searching for individual solutions in a rock climbing task.

Sample constraint-led nonlinear pedagogy. Searching for individual solutions in a rock climbing task.

We pride ourselves on being innovative and creative in finding lots of ways to move and solve tasks. We take play seriously and a growing body of literature supports this. 20

Luke is very passionate about Capoeira and this is how he brings in components of flow and rhythm to his programmes. Here is a sample session with his méstre Claudio Campos.

There is also a growing body of evidence supporting relaxed, flowful movement, or dance for persistent / chronic pain, building on those initial foundations laid out by Laban.19 For these reasons, you can expect some form of martial art or discipline of dance to form a component of our programmes.

#B2Rhealth is inspired by some of the worlds longest lived cultures
— Blue Zones

Back to Roots, as a healthcare philosophy is inspired heavily by some of the worlds longest lived cultures, coined Blue Zones. One of the distinguishing features of these people is their ‘background exercise’. They have never been to a gym, never done a ‘training session’, however they move naturally, and they move a lot. We do not have to move to Okinawa, Ikaria, Costa Rica, Sardinia or California, but can we learn from these people and move naturally, move often and in nature our-selves? We think so and you can expect us to support you too as well.

Move naturally, move often, and move in nature. Better still, build these principles into your background exercise profile and do not call it exercise. Replicate and learn from Blue Zones and just see it as something you do, to get to work for example. No gym needed.

Move naturally, move often, and move in nature. Better still, build these principles into your background exercise profile and do not call it exercise. Replicate and learn from Blue Zones and just see it as something you do, to get to work for example. No gym needed.

Our repetoire of exercise prescription is starting to broaden, but as illustrated in the European Spine Journal,20 the fact that the literature shows no support for superiority over anything else, including; aquatic exercises, stretching, aerobic, strength training, endurance, balance, yoga or tai chi, we should interpret this as liberating.

The fact no exercise has been shown superior to any others for back pain , should be interpreted as liberating
— European Spine Journal (2018)

In fact the authors of that study advocate that this brings us to a conclusion where choice of prescription fundamentally comes down to patient preferences and clinician experience. But is this suprising really? Luke for example is not well versed in Yoga, so he is less likely to feel confident coaching someone else through this. However Luke is passionate about Capoeira, jump rope and boxing, these are likely to form some component of what he might prescribe and the evidence supports this. You can expect a variety of influences in your programme here based on the person you are working with; yoga, crossfit, weight lifting, cross country skiing, juggling....we really are our own limitation here.

Below you can see a few of the influences on Luke. There is an old joke amongst personal trainers and healthcare professionals about how we learn a new exercise or movement and then suddenly all our clients Monday morning get that exercise. This is a part of being human, we give what makes us feel safe. Our response to this is to expose ourself to as many things as we can knowing that this will be impacting those who seek us for help? This ultimately gives us choices to be able to help someone else find something they enjoy. Other clinicians will have other backgrounds and influences to draw upon, see Asbjørn and May above.

If you have read this far, we hope we have made you think a little about how you might prescribe or programme exercise. We hope we have made you at least aware how many options you have based on the evidence but also based on your own strengths and interests.

If you are interested in how we programme then by now you should see the disciplines that run though all our programmes do have a historical grounding in physical education, with the flexibility of the #B2Rhealthcareprofessional you are working with also built in. We are very passionate about making exercise individualised, enjoyable, diverse and we have an enormous evidence base to provide on request, some of which have been scattered through this article.

Finally, we hope we have made a case for becoming a more rounded generalist and to never stop learning and repackaging.


Luke R. Davies,

#B2Rhealth :)


Rhys in his happy place, the Brecon Beacons on dawn patrol with ‘Jax’.


REFERENCES

  1. Hartvigsen, J. et al. (2018). What Low Back Pain is and why we Need to Pay Attention, The Lancet Series on Low Back Pain

  2. Babatunde, F. O. (2017). A Therapist-focused Knowledge Translation Intervention for Improving Patient Adherence in Musculoskeletal Physiotherapy Practice, Archives of Physiotherapy, 7(1).

  3. Angel, S. (2018). Movement perceived as Chores or a source of Joy; A Phenomenological-Hermeneutic Study of Physical Activity and Health, International Journal of Qualitative Studies on Health and Well-being, 13(1).

  4. Sapolsky, R. (2017). Behave; The Biology of Humans at our Best and Worst, Penguin Random House, UK.

  5. Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York.

  6. Renshaw, I. et al. (2018). The Constraints Led Approach; Principles for Sports Coaching and Practice Design, Routledge, London.

  7. Cote, J. & Erickson, K. (2015). Diversification and deliberate play during the sampling years. In. J Baker & Farrow (Eds), Routledge Handbook of Sports Expertise P.305-316, In Chow et al (2016) Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P.27.

  8. Ericsson K. A. et al. (1993). The Role of Deliberate Practice in the Acquisition of Expert Performance, Psychological Review, 100, P.363-406.

  9. Tucker, R. and Collins, M. (2012). What Makes Champions? A Review of the Relative Contribution of Genes and Training to Sporting Success, British Journal of Sports Medicine, 46(8), P.555-561.

  10. Simon, H. A. and Chase, W. G. (1973). Skill in Chess. American Scientist, 61, 394-403.

  11. Baker, J. et al (2009). What do we Know About Early Sport Specialisation? Not Much!, High Ability Studies, 20, P.77-89.

  12. Cote, J. and Hancock, D. J. (2014). Evidence Based Policies for Youth Sport Programmes, International Journal of Sport Policy and Politics.

  13. Moy, B. and Renshaw, I. (2009). How Current Pedagogy Methods in Games Teaching in the UK, Australia and the US Have Been Shaped by Historical, Socio Cultural, Environmental and Political Constraints, Paper Presented at the 26th ACHPER International Conference: Creating Active Futures, QUT, Brisbane. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P. 161.

  14. Kirk, D. (1998). Schooling Bodies: School Practice and Public Discourse 1880-1950. European Physical Education Review, 11(3), P.239-255. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York.

  15. Philips. M. and Roper, A. P. (2006). History of Physical Education. London: Sage. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P. 161.

  16. Metzler, M. W. (2000). International Models of Physical Education, Boston: Allyn & Bacon. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P. 161.

  17. McIntosh, P. et al (1986). Landmarks in the History of Physical Education (Rev Ed). London: Routledge & Kegan Paul. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P. 161.

  18. Kirk, D. (1992). Defining physical Education: The Social Construction of a School Subject in Postwar Britain. London, Routledge. In Chow, J. Y. et al. (2016). Nonlinear Pedagogy in Skill Acquisition; an Introduction, Routledge, New York. P. 161.

  19. Shim, M. and Bradt, J. (2019). Mechanisms of Dance / Movement Therapy for Building Resilience in People Experiencing Chronic Pain, American Journal of Dance Therapy, 40(74)

  20. Oliviera, C. B. et al. (2018). Clinical Practice Guidelines for the Management of Non-specific Low Back Pain in Primary Care: An Updated Overview, European Spine Journal, 27(11), P.2791-2803.