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Obesity-related

The latest in osteoarthritis rehabilitation: exercise and education still on top

23 Aug, 13 | by Karim Khan

 By Lindsay Davey from Toronto Physiotherapy 

@Toronto_Physio

Newton Barrett Senior Olympics, Carbondale, ILWith aging populations and growing obesity rates, the total number of individuals suffering from chronic joint conditions including osteoarthritis is expected to nearly double between 2005 and 2030, reaching 41 million in the United States alone.  This growth coincides with a proportional increase in health care intervention and expenditure.  New estimates suggest that total hip arthroplasty for the treatment of hip osteoarthritis may grow by as much as 174% by 2030, to 572,000 primary (first time) surgeries each year in the United States (ref1).

Today, physical rehabilitation is standard practice for the non-pharmacological management of osteoarthritis.  Physiotherapy as a discipline is effective in managing the symptoms of osteoarthritis  – pain, stiffness, weakness, locking, etc. Which of the specific physiotherapy modalities works best remains unclear (such as tissue and joint manipulation; exercise therapy; therapeutic ultrasound and laser; interferential current; transcutaneous electrical stimulation; education and behavior modification; braces and insoles; etc.).

The journal Osteoarthritis and Cartilage does a nice job of summarizing the most influential clinical studies of osteoarthritis rehabilitation published in the past year (ref2).  The authors conclude that:

“Modalities such as 890-nm radiation [therapeutic laser], interferential current, short wave diathermy, ultrasound and neuromuscular functional electrical stimulation did not demonstrate benefit over sham controls in those with knee OA [osteoarthritis]”.

These results add to a growing body of clinically-relevant evidence that is generally supportive of these conclusions, but conflicting evidence exists.  The latest Cochrane review 2010 (ref3) concluded that ultrasound may in fact reduce pain and improve function, but the quality of evidence was too low at the time to draw strong conclusions.  Additional research is required to exclude these modalities entirely from osteoarthritis rehabilitation protocols, but it would be safe to say at the very least that they are no slam-dunk.

Of all the therapies evaluated over the last year, exercise therapy (a mainstay of physiotherapy rehabilitation) received the greatest support for improving both pain and function.  All studies that examined exercise protocols demonstrated some benefit.  Exercise therapy for osteoarthritis is well-supported by the broader body of rehabilitation research.  In addition to exercise therapy, education with respect to self-management was also found to be beneficial.  The scientific rationale for exercise promoting healing – mechanotherapy – is outlined in this Open Access BJSM paper  (free full text HERE) (ref4).

Therapists need to keep on top of the latest research and modify their treatment methodology to reflect the best available data, keeping in mind that multiple independent randomized controlled clinical studies are needed in order to build conclusive evidence.  The current best evidence suggests that exercise therapy should be a priority of osteoarthritis rehabilitation protocols.

References

  1. Nho S.J., Kymes S.M., et al. The burden of hip osteoarthritis in the United States: epidemiological and economic considerations. J Am Acad Orthop Surg. 2013;21 Suppl 1: S1-6.
  2. Davis A.M., MacKay C., Osteoarthritis Year in Review: Outcome of Rehabilitation. Osteoarthritis and Cartilage2013, doi: 10.1016/j.joca.2013.08.013.
  3. Rutjes A.W.S., Nuesch E., et al. Therapeutic ultrasound for osteoarthritis of the knee or hip. Cochrane Database Syst Rev. 2010 Jan 20;(1).
  4. Khan KM, Scott A. Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. Br J Sports Med. 2009 Apr;43(4):247-52. doi: 10.1136/bjsm.2008.054239. Epub 2009 Feb 24.

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Lindsay J Davey, MScPT, MSc, CAFCI, CDT

Lindsay Davey is a practicing physiotherapist and owner of Toronto Physiotherapy. She is affiliated with the University of Toronto through her roles as a clinical reasoning tutor for students in the Physical Therapy program and an active member of the Clinical Education Advisory Committee.

 

 

 

‘FIFA 11 for Health’ – a School-based Intervention in Mexico for the Prevention of Obesity and Non-communicable Diseases

17 Mar, 13 | by Karim Khan

By: Barriguete Melendez J A1, Dvorak J 2, Córdova Villalobos J A3, Juan Lopez M4, Davila Torres Javier5, Compeán Palacios J6, Junge A2 Fuller C W2, Valdés-Olmedo JC7. (See below for affiliations)

Currently, in all regions of the world apart from Africa, more deaths are linked to non-communicable diseases (NCDs) than communicable diseases [WHO, 2010]. Being overweight is a major contributory risk factor for non-communicable diseases such as high blood pressure, coronary heart disease and Type II diabetes. Of the six World Health Organization (WHO) designated regions, the Region of the Americas has the highest prevalence (>60%) of overweight adults (aged 20+ years). Mexico is no exception – the proportion of Mexican adults who are overweight or obese has increased from 61.8% in 2000 to 69.7% in 2006 to 71.2% in 2012.1

The prevalence of overweight and obese adolescents is of even greater concern; for example, the prevalence of overweight and obesity among girls (12 to 19 years old) has grown rapidly in less then 30 years; in this period, the prevalence has more than tripled, rising from 11.1% in 1988 to 28.3% in 1999 to 33.4% in 2006 and now standing at 35.8% in 2012.2 There are 22 million adolescents many of whom are overweight or obese and this imposes a large financial burden on the universal public health system. This situation sent strong alarm bells to the Government and Ministry of Health in Mexico as the prevalence of NCDs represents an important economic impact for families and countries. In 2008, medical expenditure on overweight and obesity in Mexico cost US$4.5 billion (~0.5% of GDP).3

Solutions – a partnership between government and FIFA

Following a detailed evaluation of successful ‘Community-based Interventions’ for adolescents involving sport, the Mexican Ministry of Health found that in 2006 Fédération Internationale de Football Association (FIFA) recognised the unique role that football could play in the promotion of exercise and health behaviours to reduce the burden of NCDs through an initiative entitled `Football for Health´. 4 The role that sport could play in combating NCDs was later reinforced by the International Olympic Committee.5,6 In 2009, FIFA began implementing the ‘FIFA 11 for Health’ programme in Africa.4, 6,7

 Implementing the ‘FIFA 11 for Health’ programme as a community-based intervention to tackle obesity and NCDs in Mexico offered many potential benefits. The program provides a positive collaboration with the Mexican Football Federation which provides access to a huge number of active football players and fans all around the country. Football is enormous popularity in Mexico — national teams won the 2011 FIFA U-17 World Cup and the 2012 Olympic Football Tournament. A collaborative group consisting of the Mexico Ministries of Health and Education, Mexico Football Federation and FIFA, decided to implement the ‘FIFA 11 for Health’, Mexico, first as a pilot study, in three cities – Toluca, Puebla and Mexico City. These efforts were supported by three professional football teams and coaches – Toluca, Puebla and Cruz Azul – to evaluate the logistics and resources within the country. This was then followed by a staged nationwide implementation.

A global program with a Mexican focus

The ‘FIFA 11 for Health’ programme was specifically adapted for implementation to boys and girls within Mexican schools over an 11-week period. The programme consisted of 11 ‘Play football’ sessions: Passing, Heading, Dribbling, Shielding, Defending, Trapping, Building fitness, Shooting, Goalkeeping and Teamwork, with 11 complimentary ‘health messages’: Play football, Respect girls and women, Protect yourself from HIV and sexually transmitted diseases, Avoid drugs, alcohol and tobacco, Control your weight, Wash your hands, Drink clean water, Eat a balanced diet, Get vaccinated, Take your prescribed medication and Fair play.

Each ‘health message’ is supported by an international football star: Chicharito (Mexico), Diego Forlan (Uruguay), Neymar (Brazil), Cristiano Ronaldo (Portugal), Samuel Eto’o (Cameroon), Carles Puyol (Spain), Marta (Brazil), Lionel Messi (Argentina), Didier Drogba (Ivory Coast), Gianluigi Buffon (Italy), Vicente del Bosque (Spain). The implementation methodology for the ‘FIFA 11 for Health’ programme was taught to 21 physical activity school teachers and 9 football team coaches during a 5-day training course. These teachers and football coaches subsequently presented the programme to 842 high school 1st grade children. The programme not only increased the children’s knowledge on health issues and football skills, but was also popular among children who recommended the programme to other children because it was fun and easy to participate in.

National role out – scale up

After the successful pilot study in 2012, it was decided at Ministerial level to go ‘nationwide’ with the project, in four phases involving public, and social institutions: Foundations (Fundación Mexicana para la Salud [FUNSALUD], Fundacion Rio Arronte, Fomento Banamex), Football Federation. The aim is to expand the implementation, from the 21 schools involved in the 2012 pilot study to a nationwide implementation of 32,135 public schools in 2015; from 21 physical activity teachers in 2012 to 22,141 teachers in 2015; from 840 children in 2012 to 2’173, 406 children in 2015. The ‘FIFA 11 for Health’, Mexico project is an ambitious project that aims to reach the whole country, to share successful preventive interventions, to promote health and to tackle the problem of obesity and NCDs in Mexico.

This success story in Mexico provides an important model for other nations considering how to address the major problem of NCDs. Mexico is among the 19 countries that have adopted FIFA’s  ’11 for Health’ – a program that fits very well within the World Health Organizations ‘7 Investments’9 for NCD prevention. The BJSM welcomes success stories from all nations and diverse community settings (e.g., sport, schools) as part of its commitment to implementation.

 

Mexico

Acknowledgement. Salomón Chertorivski, Decio de María, Javier Salinas, Miguel Limón, Gloria Cervantes and Cecilia López. Edomex Gabriel O`Shea y Raymundo Martínez. Puebla Jorge Aguilar y Luis Maldonado. Mexico City. Armando Ahued y Luis Eduardo Sánchez.

References

1. Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Instituto Nacional de Salud Pública. Secretaría de Salud. Mexico. P 28.

2. Encuesta Nacional de Salud y Nutrición (ENSANUT 2012). Instituto Nacional de Salud Pública. Secretaría de Salud. Mexico. P 30.

3. Economic Department 2011 MoH Mexico.

4. Fuller CW, Junge A, DeCelles J, et al. ‘Football for Health’–a football-basedhealth-promotion programme for children in South Africa: a parallel cohort study. Br J Sports Med 2010; 44:546–54.

5. The Olympic Movement in Society. Proceedings from the XIII Olympic Congress. Recommendations of Theme ‘Olympism and Youth’. Olympic Congress 2009. Copenhagen, Demark, 2009.

6. Mountjoy M, Andersen L B, Armstrong N, et al. International Olympic Committee consensus statement on the health and fitness of young people through physical activity and sport. Br J Sports Med 2011; 45:839–848.

7. Fuller CW, Junge A, Dorasami R, et al. ‘11 for Health’, a football-based health education programme for children: a two-cohort study in Mauritius and Zimbabwe. Br J Sport Med 2011; 45: 612-618.

8. Dvorak J, Fuller CW, Junge A. Planning and implementing a nationwide football-based health-education programme. Br J Sports Med 2012; 46: 6-10.

9. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:709–712. Br J Sports Med 2012;46(10):709-12.

Authors’ affiliations: 1Instituto Nacional de Ciencias Médicas y Nutrición. Mexico; 2 FIFA Medical Assessment and Research Centre, Zurich, Switzerland; 3 Medicine National Academy, Mexico; 4 Ministery of Health, Mexico. 5 IMSS, Mexico; 6 Mexican Football Federation. Mexico; 7 Mexican Health Foundation (FUNSALUD).

 

Physical inactivity in Nigeria: A short analysis (part 2 of 2)

21 Sep, 12 | by Karim Khan

Guest blog by Damilola Alawode (@DAlawode)

 Read part 1 here

In Nigeria, government policies (e.g., policies that might influence health) can arise at three levels. There is the Federal Government, state governments, and local governments. Local governments tend to follow the policy laid down by state governments. Though there is a national health promotion draft policy, there is no legislation compelling the Federal Government to reduce or combat the scourge of NCDs through promotion of physical activity. Unfortunately, Nigeria does not have a goal of reducing physical inactivity by 10% as the government of Canada did for year 2003 or the Healthy People 2020 policy (a 10-year health agenda released by the US Department of Health and Human services in 2010), which identifies physical activity as a leading health indicator.

However, the FG through the National Sports Commission (NSC) set up a body known as the Nigeria Academicals Sports Committee (NASCOM) headed by a former Nigerian soccer star to collaborate with both state and local governments in promoting an initiative on physical activities in secondary schools (read more here). The initiative started with soccer, and it has been extended to 4 other sports (tennis, table tennis, basketball and swimming); athletics will start later in the year. The schools are required to train teams that would represent them in inter-school competitions from the local to the states up to the national level, thereby maintaining and promoting a culture of physical activity among the students. This is a good initiative that should be built upon by all levels of government as well as the private sector so as to sustain its impact.

The “Walk and Live” program

A state government in the southwest part of the country (The state of Osun) organizes what they call the “Walk and live” program. It is a once a month city walk similar to what takes place in the city of Mombasa, Kenya. It is an attempt to keep citizens of the state fit. Although this initiative can be improved, it has brought the importance of physical fitness to the forefront of more people. This should be applauded, but the message on the importance of having at least 30 minutes of physical activity everyday should be made known to all through different channels and utilising the best methods of public health education and support. This state has also made it mandatory for physical education to be taught in elementary schools, hoping it would make children enjoy the culture of daily participation in physical activities from an early age. This is a commendable policy which other states should look to implement.

The Medical and Dental Council of Nigeria regulates undergraduate medical education and, regrettably, physical activity does not feature within the undergraduate curriculum (in related news, stay tuned for the new BJSM undergraduate blog series). This is a fundamental flaw which should be rectified as patients deserve evidence based professional practice. However this is hampered in Nigeria due to the lack of training in physical activity promotion and behaviour change unlike countries such as USA, Canada and South Africa where sports and exercise medicine specialists use exercise and tailored physical activity to treat and prevent chronic diseases.

The ideal medical curriculum

This can be remedied if the Medical and Dental Council of Nigeria (MDCN) as the regulating authority for training doctors ensures that:

  1. A review of the medical curricular requirements to include emphasis and guidance for physical activity education.
  2. Refresher courses are offered on the significance and management of NCDs and reduction of physical inactivity

These two recommendations are crucial because a majority of the 32% of private facilities registered with the federal ministry of health are primary health care facilities; if we add this number to the public primary healthcare facilities and we have a very significant pool of healthcare facilities that are the first point of patient contact with probably being staffed by doctors who may not be up to date with managing physical inactivity induced illnesses.

We advocate for setting up a body (like the US National Society for Practitioners of Physical Activity and Public Health and the American College of Sports Medicine) to develop specialists in physical activity and public health. This will ensure that there is a practitioner workforce as well as academic trainers to ensure that in future, the medical curriculum includes physical activity promotion (more info here). This model is presently being used in the United States and may also be put in place in Nigeria. This involves training in competencies areas such as use of data and scientific information; planning and evaluation; intervention; organisational structure; and exercise science in public health.

Graduate training should also be created to guide the next generation of researchers in this field. Global capacity in exercise science, physical education, physical therapy, public health, architecture and planning, and environmental health should be increased. There is an urgent need for integration and comprehensive approaches to public health and physical activity.

Also more research into programmes that will increase physical activity and reduce physical inactivity are needed to help to build evidence base for our national policies and action plans.

Next steps – Olympic Legacy?

In conclusion, following the poor performance of Nigeria’s team at the 2012 London Olympics, the Federal Government has ordered a comprehensive re-organisation of the sports sector. I hope this will also have a positive effect on promotion of physical activity in the country and its people.

It will also be of immense national benefit if the appropriate authorities, private organisations and individuals take steps to implement a “Call to action” message. These key actions, namely reducing inactivity and sedentary behaviour, enabling patients and the public to access regular physical activity and exercise as part of an integral part of their daily lives, are necessary to advance global health through physical activities and is something that Nigeria can deliver.

 

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Damilola  A. Alawode (MBChB ile-ife) is a Public Health resident in the Department of Community Medicine, Federal Medical Centre, Ido-Ekiti, Nigeria, a Msc Student (Sports and Exercise Medicine, University of Bath, United Kingdom), an advocate for the promotion of physical activities and a blog writer on Sports and Exercise medicine for Naijamedics.com.

Twitter: @DAlawode  

Email:  dalawode2002@yahoo.com

Acknowledgements

Ann Gates (www.exercise-works.org); A source of inspiration and motivation; and for sharing her resources.

Dr. Dayo Osholowu (IOC certified Sport Medicine Clinician and Director Sport Medicine Program, Lagoon Hospital Lagos state, Nigeria); for his advice and contribution to the piece.

Dr. Stathi Afroditi (Director of Sudies SEM, University of Bath United Kingdom); for her comments on an earlier draft of this report.

References

  1. Abubakari AR et al, Systemic review of the prevalence of diabetes, overweight/obesity and physical inactivity in Ghanaians and Nigerians. Public Health Journal, 2008 Feb;122(2):173-182 http://www.ncbi.nim.nih.gov/pubmed/18035383
  2. Adegoke BO et al, Physical Inactivity in Nigerian young adults; Prevalence and socio-demographic correlates. Journal of Physical Activity and Health, 2011 Nov;8(8);11 35-42 http://www.ncbi.nim.nih.gov/pubmed/22039132
  3. Canadian Fitness and Lifestyle Research Institute (CFLRI) reports 2001 https://www.phecanada.ca/economic-costs-inactivity
  4. California Centre for Physical Activity (CCPA), California department of Health services; The economic costs of physical inactivity, overweight and obesity in Californian adults, 2005 report https://www.phecanada.ca/economic-costs-inactivity
  5. Cost of physical Inactivity, 2008 a publication of Physical and Health Education Canada https://www.phecanada.ca/economic-costs-inactivity
  6. Federal Ministry of Health, Nigeria Report 2010 Health promotion draft policy.   www.scribd.com/doc/43538097/Nigeria
  7. Lancet Physical Activity series: Physical Activity 5; The pandemic of physical inactivity; global action for public health. Lancet 2012, 380: 294-305 Published online July 18, 2012 http://dx.doi.org/10.1016/S0140-6736(12)60898-8
  8. National Society for Physical Activity Practitioners in Public Health. http://www.nspapph.org/new-acsm-nspapph-physical-activity-inpublic-health-specialist-paphs-certification (accessed Jan 19, 2012)
  9. Nigeria demographic and Health Survey 2008 by National Population Commission, Federal Republic of Nigeria and DHSmeasure,2009 http://www.measuredhs.com/../FR222pdf
  10. Odegbami Segun, Mission to Addis Ababa, Segun Odegbami’s Official blog, 2012 Apr 30 http://mathematical7.com/mission-to-addis-ababa/
  11. Odunaiya NA et al, Physical activity levels of Senior Secondary School Students in Ibadan, Western Nigeria. West Indian Medical Journal 2010 Oct;59(5):529-534 http://www.ncbi.nim.nih.gov/m/pubmed/21473401/
  12. Osun State Goverment report June 2012, Walk and Live. http://osunstate.gov.ng/index.php?option=com_content&view=article&id=204&catid=7&Itemid=199
  13.  Business day Newspaper August 15 2012, Poor Olympics outing: FG orders re-organization of sport sector.   www.businessdayonline.com/NG/lndex….
  14. Sallis RE, Exercise is medicine and physicians need to prescribe it. Br J Sports Med 2009 43: 3-4  bjsm.bmj.com/content/43/1.toc

 

  1. WHO Non-Communicable Diseases report, 2004   www.who.int/../ncd_report_chapter1.pdf
  2. WHO, A framework to monitor and evaluate the implementation: Global Strategy on Diet, Physical Activity and Health, 2008. http://www.who.int/dietphysicalactivity/DPASindicators/en/index.html (accessed Jan 19,2012)

The Move Eat Treat Campaign: promoting preventative medicine

2 Apr, 12 | by Karim Khan

Guest blog by @JosephLightfoot

 

The State Of Our Health

Britain is facing a health crisis and the statistics paint a bleak picture for the future.

Why Is This Happening?

Humans are evolved to be highly active and to consume natural, unrefined food. However, our lifestyles have changed radically. As a population, we are now largely sedentary and consume more refined food. Our lives are out of step with our genetic heritage resulting in obesity and chronic disease.

Healthcare professionals do an incredible job in challenging conditions. However, our training lacks emphasis on how to use lifestyle advice to empower people to live healthy lives.

My Personal Experience

If I had to sum up my time at medical school in one sentence, I’d do so like this:

I have learnt about disease, but I haven’t learnt about health.

Whilst there are many contributing factors to the current state of our nation’s health, I think the lack of education for healthcare professionals on lifestyle advice is a particularly important area.

The lack of education and training has resulted in many professionals who are unable to effectively help their patients stay healthy, and a healthcare system, which focuses almost entirely on reactive measures and only steps in when patients are already ill.

I don’t think this is good enough.

The Future

My vision for healthcare can be summed up by this fantastic quote from Thomas Edison.

“The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.”

The Move Eat Treat Campaign

In order to achieve this vision, I founded a campaign called Move. Eat. Treat. Along with the rest of the campaign team, I am working to promote the importance of preventative medicine with the aim of eventually developing a healthcare system, which doesn’t wait until patients become ill before it acts, but works to keep the population healthy – a true health service that is proactive rather than reactive.

We believe that the best way to achieve this is to educate healthcare professionals on how to deliver effective lifestyle advice. We hope that this will lead to a sea-change in culture within the healthcare system to one that assertively seeks prevention instead of cure. Then this will be followed by policy and organisational changes to prioritise prevention via promotion of healthy lifestyles.

Lifestyle should be a core theme of healthcare education, alongside other key pillars such as anatomy, physiology, and pathology. This campaign wants to pave the way for updated curriculums and provide education to both undergraduates and current healthcare professionals.

We Need Your Help

However, we need your help. The most successful campaigns have all had significant public backing. The first goal of the Move Eat Treat campaign is to gain 100 000 signatures on our petition.

With support, we have a voice and we can lobby the people and organisations that can bring about the changes in the healthcare and education systems that are so desperately needed.

You can sign that petition HERE .

We hope you’ll also consider sharing the campaign with friends and colleagues via email and social media. The infographics used above which illustrate the problems we face can be freely downloaded HERE.

A Final Word

The Move. Eat. Treat. vision is a lofty one, but with your help we believe we can make a positive change to healthcare philosophy and help keep people healthy.

Move. Eat. Treat isn’t the same old drone from your doctor about losing weight. It’s about creating innovative solutions, tools and guidance to really equip people to be, and more importantly, stay healthy.

 

***************************************************************************

Joseph Lightfoot BSc(Hons) is a final year medical student at the University of Manchester.  He is also currently the strength and conditioning coach to England Under 19 Lacrosse team. Along with the other members of the Move Eat Treat team he is campaigning for a proactive healthcare system.

 

For more information about the campaign and our goals visit www.moveeattreat.org

23 and a half hours video passes 2 million views!

12 Dec, 11 | by Karim Khan

Mike Evans circulated this to his hockey team of kids early in December 2011.  #1 educational video on YouTube. Remember that low fitness (<30 mins of physical activity daily) kills more Americans that smoking, diabetes, and obesity combined (smokadiabesity).

Click on this link. Watch it, share it. Do it yourself.

Encourage patients to watch it and start today! Great ‘sticky’ message capturing Steve Blair’s evidence that this treatment will save more American’s lives than a cure for smoking, diabetes and obesity put together. That’s a fact!

It passed 2 million views in February, 2012. Wow!!

Fit is not actually ‘vs.’ Fat – Guest Blog by Professor Timothy Noakes

30 Nov, 11 | by Karim Khan

On Monday the Guardian published It’s not obesity that’s killing us – it’s the lack of exercise. Inspired by research presented at UKSEM (see also Blair Physical inactivity: the biggest public health problem of the 21st century, and BJSM Warmup 2011; 45), the Guardian exhorted us to focus less on obesity and more on physical activity. With 191 comments, 1000 Facebook likes, and 71 tweets (in 48 hours) it doesn’t take a social media expert to figure that this topic is hot.

A critical question is whether exercise is THE primary tool for weight loss (rather than just as part of a healthy lifestyle).

Does exercise promote weight loss?

King, Horner et. al’s have a great article – Exercise, appetite and weight managementin BJSM Online first.

Professor Timothy Noakes (and @GaryTaubes) add these insights to the discussion in this guest blog:

Photo courtesy of Gavin Clarke, Flickr cc

What astonishes me is the continuing failure of so many people, my medical colleagues included, to realize that the solution to personal obesity is so simple. The cause for most people is exactly as Gary Taubes described it – a diet too low in fat and protein and too high in carbohydrate especially sugar. If you are over forty, overweight, personally motivated, and not eating a high fat/high protein/low carbohydrate diet, then you are missing out – your life is passing you by.

The second key is also as Taubes describes it – obesity begets inactivity whereas leanness promotes activity. Trying to get lean by exercising whilst continuing to eat the “healthy” high carbohydrate diet will be unhelpful for most with an elevated BMI (and who are are therefore by definition, carbohydrate intolerant/resistant). You need first to lose the weight by changing to a high fat/high protein/low carbohydrate diet. As the weight falls of (as it does very dramatically at rates that most will not believe), the desire to exercise becomes increasingly overwhelming. In time the desire to exercise becomes addictive.

Trying to encourage overweight people to exercise without first changing their habitual eating patterns (not diet, please note) will never produce the same outcome as will one in which the initial focus is on changing to a high fat/high protein/low carbohydrate diet.

As Gary Taubes describes, this has been known since 1861 but was written out of the medical and popular literature after 1970 when Dr Ancel Keys essentially single handedly developed the global fear of fatty foods that mislead the world and led directly to the epidemic of obesity and diabetes that began to engulf especially people in the developed world especially after about 1977.

Until we rid ourselves of the ridiculous idea that carbohydrate foods are somehow “healthy” (for all) and fatty foods are unhealthy, and as long as we allow our eating patterns to be dictated by industries that aim remorselessly to increase global consumption of sugar and refined carbohydrates, then we cannot solve the global problem of obesity and diabetes.

But at an individual level we can take control by realizing that obesity is a genetic/nutritional disorder caused by excessive carbohydrate consumption in those who are carbohydrate-resistant (and who are therefore unable to metabolize carbohydrates especially fructose, appropriately but who will store the excess calories in fat, rather than expend them in physical endeavor).

Dr. Timothy Noakes is a Sports Physician, Exercise Physiologist and Discovery Health Professor of Exercise and Sports Science at the University of Cape Town and Sports Science Institute of South Africa.

via American College of Sports Medicine – a ‘retweet’ effectively!

19 Sep, 11 | by Karim Khan

ACSM posted the following to members…

Yesterday’s U.N. Side Event on Physical Activity and Noncommunicable Diseases (NCDs) brought together an extraordinary group of world ministers of health, public health professionals, physical activity advocates, scientists, elite athletes and other experts. The focus was on physical activity as a global health opportunity, informing the deliberations of the U.N. High-Level Meeting on Noncommunicable Diseases taking place today and tomorrow.

Live Webcast U.N. Roundtables

The U.N. sessions on NCDs will be webcast live at www.un.org/webcast ( http://www.un.org/webcast ) . Under Live Schedule at right, click on Channel 4 to access the roundtable discussions on NCDs (Monday at 10:00 a.m. and 3:00 p.m. EDT).

Congratulations Sweden! http://www.fyss.se/

17 Feb, 11 | by Karim Khan

No apologies for plugging the Swedish National Institute for Public Health who have produced an amazing medical tool – evidence based exercise prescription for many, many, medical conditions. If you are in the UK you will be familar with the BNF – this should accompany every BNF and be used more often!

In Australia the equivalent is MIMS and in Canada CPS.  Clinicians should be reaching for this instrument more often than the stethoscope – it would have more impact as an intervention by any measure!
The great thing is that it can be downloaded for free! No excuses!

The link to the downloadable PDF version is in the subject line of this blog. You can read the authors’ brief editorial in this month’s BJSM for free.

We had planned to have the BJSM podcast done by March 1st and we still may – but the issue busted to the home page ahead of schedule so please bear with us if you are looking for the podcast. Lots of great podcasts up on the home page for free (the one with Steven Blair is very relevant) but nothing about this Bible of Physical Activity Prescription yet. I’ll update on the podcast here and via Twitter (@BJSM_BMJ).

Paradox in Australia – ‘crediting’ the sport and exercise medicine specialty but forcing patients to pay more to see the docs!

25 Nov, 10 | by Karim Khan

Recent specialist status has led Australian sports and exercise physicians receiving more referrals from GPs; MRI referral is also in the specialist’s scope of practice. However, at the same time as these physicians were recognized for having special expertise in exercise prescription — addressing the worlds biggest public health problem —  physical inactivity, patient rebates for the service was cut!

An umbrella body for Australian sport has expressed its concern over this paradox; local media have followed the story but the Minister for Health has not commented when this blog was posted.

Couple of powerful (short) videos – Are you drinking fat?

8 Nov, 10 | by Karim Khan

New York City Health Department has launched an aggressive video campaign to educate Yorkers that sodas have 16 packs of sugar in a 20 oz drink (about 600 ml, say 1.5 cans). The story is certainly ‘sticky’ – clear, unexpected, concrete, credible, emotional.

The background, of course is that obesity is not as big a problem as inactivity/lack of fitness. Imagine if we could get folks to appreciate that lack of fitness is EIGHT times as bad for you as drinking that soda! Now there’s a video for someone to make!

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