Sport and Exercise Medicine: The UK trainee perspective (A BJSM blog series)

By Lucinda Poulton¹, Paul Kelly², Justin Richards², Moiz Moghal³, Wilby Williamson^2,3

Affiliations

1. University of Oxford Medical School (4^th Year Medical Student)

2. British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford

3. OxSport, Nuffield Orthopaedic Centre, Oxford.

Lack of physical activity is a major risk factor for mortality, yet 25% of students at Oxford medical school are unaware of the World Health Organization global guidelines for physical activity¹. There is concern that this gap in awareness and understanding is not limited to our medical students.  With the arrival of Public Health England, there is an increasing responsibility for all doctors to consider the challenges of preventive medicine. Understanding the problems patients face and having the confidence to tackle them is critical. Weiler and colleagues highlighted a UK nationwide deficit in the provision of medical student teaching on physical activity and have championed a call for reform². A survey of 4-6^th year medical students at the University of Oxford aimed to identify where gaps in local education could be improved. The results identified three hurdles to changing patient behaviour – students’ education, knowledge and attitudes to physical activity.

First, searching for physical activity in the Oxford curriculum drew a blank. Whilst other leading risk factors for global mortality such as smoking cessation and dietary changes, were covered, physical activity was not mentioned in the core curriculum. Perhaps this explains why, when asked to rank risk factors for global mortality, physical activity was ranked bottom of the pile by the majority of students.

Should we describe the lack of curriculum as a false start? It certainly appears to leave the students struggling at the next hurdle: grasping the basic knowledge of the role physical activity plays in prevention and treatment of non-communicable diseases. More than 60% of students believed there was no evidence to support promoting physical activity as a preventive approach to bowel and breast cancers ³.  More worryingly, 16% of students said the same for cardiovascular health. Overall, 85% of students felt they had inadequate knowledge of the role of physical activity in preventing and treating chronic disease.

Encouraging behaviour change in patients requires more than just knowledge of guidelines. The ability to motivate, promote patient’s capabilities and identify opportunities for change requires medical professionals to take ownership of this problem, and to have the confidence to do so.

Three groups of 5^th year students were asked to list everything they had, or had not done, in the past week that was a threat to their health. They all keenly acknowledged the risks they took in not eating enough fruits and vegetables, riding bikes without helmets or over indulging in some other vice. But of the 50 students surveyed, none identified a lack of physical activity as a personal risk they had taken. Yet when specifically questioned approximately 90% did not meet physical activity guidelines (150 minutes per week)⁴. How can tomorrow’s doctors encourage physical activity behaviour change when they don’t see it as a problem in themselves?   With the rising burden of non-communicable diseases it is increasingly important for medical students to be prepared and to feel motivated to gain the knowledge and expertise needed to promote physical activity. However, over three-quarters of students felt they hadn’t received enough training, and a majority lacked the confidence to provide advice to patients on physical activity.

Oxford currently leads the world in medical student education⁵. Now they are taking steps to guarantee students receive appropriate training in physical activity and preventive medicine. However, this is a global issue, and our fear is that we are joining a small minority of institutions where educational reform is being driven by passionate physical activity researchers and clinicians. Nationally and internationally, are others taking up the call to champion undergraduate physical activity education? Will the gap in curriculums be filled?

References

1. http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/index.html

2. Weiler R. Et al, Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow’s doctors equipped to follow clinical guidelines?, Br J Sports Med, 46, 1024-6 (2012)

3.http://www.cancerresearchuk.org/cancer-info/cancerstats/causes/lifestyle/physicalactivity/physical-activity-and-risk-of-cancer

4. https://www.gov.uk/government/publications/uk-physical-activity-guidelines

5. http://www.timeshighereducation.co.uk/world-university-rankings/2012-13/subject-ranking/subject/clinical-pre-clinical-health

Acknowledgement

Dr Natasha Jones and Dr Julia Newton

Oxsport, Nuffield Orthopaedic Centre, Oxford.

Contact

Wilby Williamson, Academic Clinical Fellow, Oxford

wilby.williamson@dph.ox.ac.uk

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

Undergraduate perspective on Sports & Exercise Medicine - a BJSM blog series

By Bryn Savill (@BrynSavill) 

The evidence behind exercise as medicine is substantial and it can no longer be ignored.¹ Prof. Blair (2009) named physical inactivity the “Biggest public health issue of the 21^st Century” after discovering that physical inactivity was killing more Americans than smoking, diabetes and obesity combined.² Cardiff Exercise Medicine Symposium hopes to explore the wealth of evidence about physical activity, and inspire us all to be more active and proactive in promoting physical activity both at an individual and policy level.

Symposium Rationale

Physical activity promotion in the UK is limited. This is not unexpected given the reality that healthcare is influenced heavily by the drug, devices and diagnostic trades with the aim of boosting their share price³. Further, the NHS has a strong track record of favoring interventions that involve something to swallow, breathe in and/or a syringe. We need to develop the skills, tools, and collective capacity to not only prescribe exercise as medicine but also move it to the front lines of government healthcare agendas. Of the four key adjustable risk factors to health: alcohol, smoking, food and physical activity – only physical activity seems to lack champions in the higher echelons of government.  We must act now and thrust this physical inactivity plague into the limelight. Physical activity is the polypill that we have been searching for; a moderate level of fitness causes a 44% reduction in mortality ⁴ – how many drugs are that effective?

Physical Inactivity vs Obesity

Everyday the newspapers, TV, and media are full with stories about the obesity crisis whilst we see little press on physical inactivity: yet which is the bigger public health issue – obesity or physical inactivity? Prof. Steven Blair has shown in a number of papers that being fit can alleviate the risks of being fat,^5,6,7,8 and Weiler et al. (2010) argue that health policy should focus on physical inactivity not obesity.⁹

Prof. Blair will be presenting his latest research in the field at the symposium, whilst Prof. Terence Wilkin will be discussing the link between physical activity, genetics and childhood obesity. 

Sedentary behaviour

High levels of sedentary behaviour are damaging to our health, and sitting forms part of our everyday life so it’s an issue which we must address although I’m not in any way saying we should ban sitting; that’s mad! Indeed, sedentary behaviour is now included in the UK physical activity guidelines with the general advice to “minimise the amount of time spent sitting”.

Dr Emmanuel Stamatakis will discuss realigning are public health priorities with sedentary behaviour on the afternoon of Cardiff Exercise Medicine Symposium. 

National exercise guidelines – evidence or opinion?

There is growing confusion over how we should become active, perhaps stoked by programs such as the BBC documentary, “The Truth about Exercise” and Andrew Marr’s recent appearance on the BBC. Whilst providing mixed messages to the public can only serve to negatively impact physical activity levels, we need the debate and research between exercise professionals to continue so we can formulate clear evidence-based guidelines.

At the Symposium, Prof. Jamie Timmons will clear up the confusion by identifying if high intensity interval training has a role to play in the national exercise guidelines. 

Final Thoughts

It’s our responsibility, students and healthcare professionals alike,  to lobby for change, and form a voice to create a compelling fight for the role of physical activity in the health of the nation. Have you ever spoken to anybody who didn’t deem exercise as beneficial for your health? The response is most likely an emphatic “no.” However, do you have the expertise to lead by example and rally for change? Are you up to date with the latest developments in the exercise medicine field? Why not come to Cardiff Exercise Medicine Symposium to learn more about how we can construct effective models of physical activity intervention, the role of sedentary behaviour, the genetics of physical activity, and the interface between obesity and physical activity.

Remember we as emerging and seasoned healthcare practitioners can provide one of the seven “best investments” to combat this public health disaster¹⁰ – Listen to Fiona Bull’s podcast on the “Seven Best Investments”

Cardiff Exercise Medicine Symposium 2013 will be held on the 15^th June at the University Hospital of Wales. For more information on Cardiff Exercise Medicine Symposium & to register CLICK HERE 

References

1 Department of Health (2012). Let’s Get Moving – A Physical Activity Care Pathway. 

2.Blair SN. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 2009;43:1–2.

3. Stamatakis E, Weiler E, and Ioannidis JPA. Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review. Eur J Clin Invest 2013. Article first published online: 25 MAR 2013

4.Lee DC, Sui X, Ortega FB, et al. Comparisons of leisure-time physical activity and cardiorespiratory fitness as predictors of all-cause mortality in men and women. Br J Sports Med 2011;45:504–10.

5. Ortega FB, Lee DC, Katzmarzyk PT, Ruiz JR, Sui X, Church TS, Blair SN. The intriguing metabolically healthy but obese phenotype: cardiovascular prognosis and role of fitness. Eur Heart J. 2013 Feb;34(5):389-97.

6. McAuley PA, Artero EG, Sui X, Lee DC, Church TS, Lavie CJ, Myers JN, España-Romero V, Blair SN. The obesity paradox, cardiorespiratory fitness, and coronary heart disease. Mayo Clin Proc. 2012 May;87(5):443-51

7. Lee DC, Sui X, Church TS, Lavie CJ, Jackson AS, Blair SN. Changes in fitness and fatness on the development of cardiovascular disease risk factors hypertension, metabolic syndrome, and hypercholesterolemia. J Am Coll Cardiol. 2012 Feb 14;59(7):665-72.

8. Lee DC, Park I, Jun TW, Nam BH, Cho SI, Blair SN, Kim YS. Physical activity and body mass index and their associations with the development of type 2 diabetes in korean men. Am J Epidemiol. 2012 Jul 1;176(1):43-51.

9.Weiler R, Stamatakis E, Blair S. Should health policy focus on physical activity rather than obesity? Yes. BMJ 2010;340:c2603.

10. 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;46:709–12.

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Bryn Savill BSc (Hons) is a fourth year medical student at Cardiff University, Wales, having undertaken an intercalated BSc in Sports and Exercise Science at Loughborough University. He sits on the undergraduate committee of the European College of Sports and Exercise Physicians (ECOSEP) and is a Move. Eat. Treat. Ambassador.

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

Sport and Exercise Medicine: The UK trainee perspective (A BJSM blog series)

 By Drs. Andrew Murray (@docandrewmurray) and David White (@rightwhite1)

Health systems worldwide need to think differently. Fancy new medications and rescue helicopters may help once people become unwell, but the 2010 Global Burden of Disease study highlights that over 70% of disease burden in the UK is caused by Non Communicable Diseases- whose principal root causes include physical inactivity, smoking, and excess alcohol.

Physical Activity

Bulletproof evidence worldwide proves that physical inactivity kills a lot of people and makes a lot of people ill through chronic disease. Time and resources need to be directed towards getting people off the couch, which will increase life expectancy, decrease health inequalities, and save lorry loads of cash for health boards and the UK economy.

23 and a half hours is a video worth sharing whilst the 2012 Lancet series highlighted the problem as “pandemic”.

What works to get people active?

Comprehensive and systematic approaches to address excess alcohol and smoking have had considerable success- smoking rates have declined by over 25% in the last 30 years in Scotland.  The same is required for physical inactivity

 “7 Investments that Work for Physical Activity” show where to get maximum bang for your buck. They are evidence supported and applicable to local and national communities.  The 7 investments have also influenced a National Implementation Plan for Physical Activity in Scotland, as well as guided Local Authorities and Community planners.  In Scotland, action plans are moving forward in each of these “7 investment areas.”

As one example, within Health and Social Care the Scottish Government has outlined plans to:

1)    Embed physical activity for health into undergraduate and postgraduate curriculums, CPD and workforce development.

2)    Embed physical activity for health into primary care, using a simple validated assessment tool, brief advice and brief intervention.

3)    Embed physical activity for health into secondary care using a National Secondary Care Pathway.

4)    Inspire medical leaders to prioritise getting people active, championing this in health boards, royal colleges, hospital or department.

Conclusion

Health boards and governments that bury their heads in the sand and hope that the problem of physical inactivity will go away may be consigning their populations to poor health outcomes, and their children to a dark economic future. Those with an interest in Sports and Exercise Medicine are uniquely placed to help populations “sit less and move more.” Sharing and helping implement “7 investments that work” will increase life expectancy, improve life quality, and save cash for the communities, health boards and governments . There is considerable scope and opportunity to create jobs, and make a difference in this area.

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Dr Andrew Murray (@docandrewmurray) is a registrar in SEM and worked for a year as the Scottish Government’s first Physical Activity Champion.

http://www.youtube.com/watch?v=WKvd-yPFuKM&list=PLsRNoUx8w3rM_7URm7bIQXHvQzSOOVigQ&index=5

 Dr David White (@rightwhite1) is currently employed as the Physical Activity Champion within the Scottish Government, working in the offices of the Chief Medical Officer, and the Minister for Commonwealth Games and Sport.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective” monthly blog series.

By Ann Gates (@exerciseworks)

‘Fun exercise advice, every clinic consult.’ Photo credit: Dean Skiba and David Baird, Inclusive Fitness UK.

Many diseases and long term health conditions respond clinically to exercise medicine. Just like medicines, such as statins, different exercises and physical activities have the ability to transform patient’s lives, control their symptoms and prevent and treat disease successfully. The evidence for the clinical practice of ‘exercise as a medicine’ is supported by the UK Chief Medical Officers, the World Health Organization and many international medical organisations. However, it is ultimately prescribed and supported by the health care team that provides direct patient care.

For this reason, within medicine and health care settings we must encourage the perspective that exercise advice and support are critical aspects of ‘world class, personalised patient care’. Many patients may benefit from exercise advice as part of the management and treatment protocols for their diseases and lifestyles. This includes non-communicable diseases and acute problems, such as surgery.

The list of medical evidence supporting specific exercises and fun physical activities for improving quality of life and physical and mental health on personal, national and international levels includes: type 2 diabetes, cancer, heart disease, stroke, osteoporosis, Parkinson’s disease, hypertension, obesity, rheumatoid arthritis, chronic obstructive pulmonary disease (COPD), back pain, anxiety, depression, asthma, peripheral arterial disease, pre and post operative surgery…..

Many health professionals practice medicine because they love patient care and using their skills and knowledge to help patients improve their health. Providing quality exercise advice has a similarly clinically satisfying outcome. Patients can improve their mobility, experience life changing better health and more importantly see their symptoms improve and their risks of serious health problems diminish. This may be demonstrated through improved blood pressure control, better lipid profiles or just simply improved strength and balance that helps reduce falls risk.

A great, inspiring video (see link here) shows how careful motivational support, together with the right exercise advice, at the right time, can transform patient health.

After all, when that patient says:

“Hey Doc, that exercise advice you suggested…….”

“It worked! I can now take my grandchildren to the park, and share in the joy of them growing up…”

“Well, that’s just fantastic!” replied the doctor. “Your blood pressure readings are down, I see you’ve lost weight, and management of your blood pressure is looking good.”

Because patients are worth that ‘brief intervention!”

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Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works!

Video kindly provided with permissions via FitBehavior : promoting health through inspiring patient stories! @FitBehavior

By James R Griffiths

Abstract

Background/Aims

In 2006 NICE concluded that there was insufficient evidence to recommend the use of exercise referral schemes (ERS) to promote physical activity, other than as part of research studies where their effectiveness can be evaluated. Despite this, there are approximately 600 ERS in the UK that primary care have access to. We looked at referring patients into the ERS in Barnsley (run by Barnsley Premier Leisure) from the Emergency Department.

Methods

Patients who attended the Emergency Department over a six-month period were screened for the exercise referral scheme. Posters were placed in the department advertising the scheme and encouraging patients to get more detail from a member of staff. Patients who met the inclusion criteria had a referral form faxed to their GP or practice nurse asking them to refer the patient on to the scheme.

Results

Over the six-month period, 26 patients were referred to their GP or practice nurse. Of these only 10 were subsequently referred on to Barnsley Premier Leisure and only 3 patients attended for an initial assessment. No patients completed the 24 gym or swim sessions.

Conclusion

The results of this pilot study are obviously disappointing. We have tried to identify the barriers preventing patients from completing the scheme and have made changes to the way patients are referred onto the scheme.

We are hopeful that with better engagement from patients and GPs, we will be able to recruit patients on to the exercise referral scheme from the ED.

more…

By Dr. Richard Weiler and Christine Neyndorff

Here is the final update on our successful social media and BJSM blog campaign  (read original call to action here) to get physical activity promotion into the  2013-2016 Hertfordshire Health and Wellbeing Strategy.

Hertfordshire’s 2013-16 Health and Wellbeing Strategy was formally launched on Monday 11 February.

Physical activity was included as one of the 9 key priority areas for 2013-16 and the inclusion is summarised in the table below. The full strategy document can be read here .

Also, here is an accompanying short video explaining the reasons behind the strategy. The footage is fantastic;  it shows many clips of people of all ages being physically active within the County and a few more clips demonstrate visits to the healthcare services for what may well be non-communicable chronic diseases resulting from physical inactivity.

We are extremely grateful for the opportunity to have presented the case for strategic inclusion of a Countywide physical activity plan to key stakeholders, for the numerous reasoned responses to the initial draft that may have stemmed from our social media campaign, and to the Health and Wellbeing Board for responding to the overwhelming consultation feedback.

The bringing together of councils and the healthcare sector in regional Health and Wellbeing boards across England provides a wonderful opportunity for collaborative thinking and strategic cross-sector approaches, largely in accordance with the Global advocacy for physical activity (GAPA) 7 areas of investment that work for physical activity spanning schools, transport, urban design, healthcare, education, community engagement and sport systems. ^1,2

We hope that this story in Hertfordshire will encourage others to try and effect  local change across England to ensure that cross sector physical activity promotion is firmly on the agenda and a key public health and council focus for the coming years.

 References

1. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). Non communicable disease prevention: investments that work for physical activity. Br J Sports Med 2012;46:709–12.

2. Global Advocacy Council for Physical Activity, International Society for Physical Activity and Health. The Toronto Charter for Physical Activity: A Global Call for Action. May 20 2010. http://bjsm.bmj.com/content/46/10/709.full.pdf+html

See previous BJSM blog posts here:

http://blogs.bmj.com/bjsm/2012/05/28/calling-on-physical-activists-and-physical-activity-experts-please-help/

http://blogs.bmj.com/bjsm/2012/10/02/bjsm-social-media-contributes-to-health-policy-re-think-a-success-story-in-hertfordshire/

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Christine Neyndorff,  Director of HSP and Dr. Richard Weiler, “HSP Physical Activity Ambassador”

The Herts Sports and Physical Activity Partnership, known as HSP, was established in 2003 and our vision has remained simple and constant “Working together to encourage more people to be more active more often” . 

HSP is a voluntary organisation with a strategic board including representatives of local agencies and partners committed to working together to increase participation in sport and physical activity and promote the many benefits. The Board is supported by a small team of staff providing leadership and co-ordination to work more effectively together at county level.

Undergraduate perspective on Sports & Exercise Medicine - a BJSM blog series

By Lisa Campkin (@LisaCampkin)

Recently, the term ‘Exercise is Medicine’ was copyrighted by the American College of Sports Medicine. This particular initiative in exercise medicine focuses on the role of clinicians in helping increase their patients’ physical activity levels. Exercise is Medicine has growing influence in the prevention and treatment of non-communicable “lifestyle” disease, and the movement is currently progressing up north into Canada. But a major concern remains: how can physicians follow-up with patients diagnosed with multiple chronic conditions, who need further individualization and support in their exercise programs? Referral to an exercise professional may be an option!

North American organizations as change catalysts 

The Canadian Society for Exercise Physiology (CSEP) is a professional body of exercise physiologists. It is dedicated to the promotion of health, fitness, and performance through the application of knowledge and research related to exercise. As an organization based in scientific thought, applied evidence, and up-to-date advances in exercise physiology research, CSEP and its affiliate members are trained and have a scope of clinical practice related to exercise prescription; they are specialists in the field of health, exercise and rehabilitation. Specifically, a CSEP-CEP (Certified Exercise Physiologist) is certified to evaluate and treat individuals with chronic disease through tailored, progressive physical activity and exercise programs to improve the patients’ health and function.

Both CSEP and ACSM may be considered on the brink of changing the application of medical care and symptom management for those with chronic disease and/or suffering from “exercise deficiency.” Alongside the individual benefits, a patient could experience from increased structured and / or monitored physical activity (i.e. stabilized mood, increased independent living, stronger immune function, better quality of life, etc.) there follows an implication that exercise physiologists could help to decrease national health care costs long-term, through a decreased need for symptom-related prescriptions, fewer hospitalizations and decreased morbidity & mortality due to lifestyle-related disease.

Working models and available resources

Research from New Zealand and Great Britain exemplifies working models of physician-based exercise counselling and referral through the Green Prescription and Exercise Referral Scheme health promotion programs. In Canada, official and widespread programs are not yet in place for physical referral to exercise professionals.

Until such programs are developed, engaging an accredited exercise physiologist is relatively easy from a community and health care standpoint, says Katherine MacKeigan (Director of the Provincial Fitness Unit, located in Edmonton Alberta).  Interested individuals can access the online registry of CEPs or access services through widespread fitness appraisal centers; 27 of which are in the province of Alberta alone.

Although referral is not necessary for patients with varying chronic disease or physical disability, any practicing primary care physicians who can access the referral system can send patients with extended needs and long-term exercise supervision to a CEP. Costs range from CAN $20-150+ per session. Currently the services of a CEP are not covered under the provincial health care fee schedule. Although, certain employee benefits and extended health care may cover assessments for qualified individuals (e.g. through a health spending account). Katherine MacKeigan certainly encompasses a powerful idea with the question “How much is your health worth to you?”

Knowledge transfer as a way forward

The short and long-term positive health implications for persons affected by lifestyle-related disease could be huge if exercise professionals had increased contact with at-risk populations. How can we increase knowledge and awareness of this field of exercise medicine? How can we successfully promote healthy lifestyles through physicians and exercise professionals? One possible avenue is through knowledge transfer (KT), or academic detailing. This process involves an independent organization educating the professional or a group of professionals, using evidence-based and individualized methods to most effectively reach the target audience [1]. This process can help to bypass barriers that even the most experienced clinician can face on a daily basis; a lack of time, energy or desire to self-educate directly from the literature is a common issue in research-based clinical practice. KT helps bring the newest research into the practice of the clinician in a relevant, timely, packaged manner, and it could help to bring the advantages of exercise and exercise professionals to light in the field of medicine.

What do you think? Does exercise physiology and knowledge transfer seem like an important component of the medical field? Should we be teaching those students responsible for the future promotion of physical activity these skills during their undergraduate studies? Is there another avenue or profession that we can explore to help patients with chronic disease return to function and increase their quality of life?

References

1. Campkin L, & Doyle-Baker PK. (Spring/Summer 2012). Five Reasons for Knowledge Transfer. Fitness Informer

Lisa Campkin is a MSc Student, University of Calgary under the supervision of Dr. PK Doyle-Baker. She is interested in exercise physiology, seeing it as a gateway to a decreased incidence of chronic disease worldwide, as well as decreased symptomology and better quality of life for previously diagnosed patients. She can be contacted at lmcampki@ucalgary.ca

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

In the spirit of extreme physical activity promotion, Doc Andrew Murray is off today (weather permitting in Antarctica) to run 7 Ultra Marathons on all 7 continents within 7 days. He’s doing this to raise awareness of the benefits of exercise (he now works on this issue for the Scottish Government) and also for The Scottish Association for Mental Health.

His route is here

He massively appreciates the support he’s had for his previous challenges. If you and/or people you know are interested in supporting Andrew, you have the opportunity to do this in two ways:

1) BE PART OF IT with Andrew and a few well known faces. Visit www.5×50.co.uk <http://www.5×50.co.uk/>  for full information and to join the challenge . By running, walking, cycling 5k a day for the 7 days from 23rd to 29th November we aim to cover the equivalent distance of 5 times round the world. Personally, I’ll be on the running, walking or cycling 5 km for those days to keep up my personal challenge of accumulating 60 minutes of physical activity daily. But this isn’t about me!

It’s about getting people engaged with all physical activity abilities

Please pass this onto your friends and colleagues, they can register here http://5×50.co.uk/register and take the Challenge with you – you can even create a team together.

 A 40 sec video explains why .

2) Andrew is raising money for Scottish Association for Mental Health- GetActive program. This is a great charity that he’s passionate about. His JustGiving page is here.

For a bit of a laugh here is a trailer for some TV he’s making about the trip.

Enjoy.

And remember to also the share the ’7 investments’ link for a balanced comprehensive approach to eradicating physical inactivity.

Message to Andy – if you are looking for something to do, we have a new BJSM podcast up for you – sports cardiology - which includes a paper on whether too much exercise can be harmful. And other podcasts in the editing suite…enjoy!  A personal best wish to you – k2

By Liam West (@Liam_West) & Dr. Mike Loosemore

Undergraduate perspective on Sports & Exercise Medicine (a BJSM blog series)

The field of Sport & Exercise Medicine has two distinct areas. Namely, Exercise Medicine and Sports Medicine. To gain insights and get tips for students looking to follow in their footsteps, I interviewed two influential figures pushing the boundaries of each field.

The first of this two part interview series is with Dr. Mike Loosemore (ML) who is leading the “Exercise Is Medicine” initiative in the UK.

LW: Hi Dr. Loosemore. Could you describe to the undergraduate readers what Exercise Medicine entails?

ML: Exercise Medicine, or ‘Exercise Is Medicine’ as it’s promoted by the American College of Sports Medicine (ACSM), is the idea that exercise is important in preventing chronic non-communicable diseases (NCD) such as Type 2 diabetes mellitus, heart disease & cancer. Exercise can also be prescribed as a treatment for a NCD allowing the patient to simultaneously reap the additional benefits of regular moderate activity such as reducing co-morbidities and improving the patient’s sense of well being.

LW: So essentially undergraduates can view exercise as a more powerful treatment than handing out a single pill in many circumstances?

ML: Yes. Medical school essentially teaches students how to poison patients as that’s what you do by giving small doses of drugs; although obviously if you give them too much of the drug you poison them properly! It’s completely different with exercise. Using exercise we re-establish a natural process which allows the body to heal itself, returning it to the homeostatic state & often improving health considerable. Humans are exercising monkeys, we need to be active and if you don’t exercise enough important functions of your body start to degenerate!

LW: Powerful stuff! Would you be able to share with the readers some of the data surrounding exercise as a treatment for various NCDs?

ML: Here are some basic facts and figures for the undergraduates from the ACSM website. Regular physical activity reduces the;

• Risk of heart disease by 40%
• Incidence of diabetes by roughly 50%
• Risk of developing Alzheimer’s disease by 30%
• Incidence of high blood pressure by nearly 50%
• Risk of stroke by 27%
• Recurrence of breast cancer by almost 50%
• Risk of colon cancer by approximately 60%
• Depression as effectively as Prozac or Behavioural therapy

A pretty impressive intervention that has no medical equivalent that can do one of those things, never mind all of them! If you consider that medical inflation is going up significantly quicker than normal inflation and the population is ageing, we are reaching the edge of a financial cliff as far as healthcare costs are concerned. Currently the vast proportion of the NHS budget is spent on treating disease. Instead we should concentrate on preventing disease occurring in the first place which is relatively cheap! We cannot continue to be a disease service. It is called the National HEALTH Service not the National Disease Service!!!

LW: Hopefully that is a quote that will stick in the mind of many undergraduates! You have briefly touched upon some of the research, but are there any other resources students could use to find out about exercise medicine?

ML: I suggest they go to the ‘Exercise Is Medicine’ website where they can access lots of relevant resources & facts from evidence based research, read the BJSM blog and attend Sport & Exercise Medicine conferences, such as the Cardiff SEMS Olympic Conference 2012 on 15^th December which is aimed primarily at undergraduates.

LW: Finally, if there was only one thing that we could do during our undergraduate career to spread the message of Exercise Medicine what would it be?

ML: Include it in your history paradigm. Every time you take history from a patient, ask about exercise. Two reasons for that;

1. You will find out their individual activities levels and then can encourage them to do more. Any increase in exercise, no matter how small, will start to reduce the risks of chronic NCDs.
2. A doctor asking about exercise sends a very powerful message to the patient and they clearly see that exercise is important.

LW: Thanks Dr. Loosemore for your expert opinion on Exercise Medicine and how undergraduate students can get involved.

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Dr. Mike Loosemore MBBS DCH MRCGP MSc FFSEM(UK) is a Consultant in Sport & Exercise Medicine at the Institute of Sport, Exercise and Health, University College London. He is the lead Sports Physician (South of England) for the English Institute of Sport and currently the doctor to British Boxing. He is currently president of the Sports and Exercise Medicine section at the Royal Society of Medicine and leads the ‘Exercise is Medicine’ task force in the UK.

Liam West BSc (Hons) is a final year medical undergraduate student at Cardiff University, Wales. He coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM.

By Liam West (@Liam_West)

We all know regular physical activity is good for our health. So good in fact that it is often regarded as the equivalent of medicine’s ‘wonder drug.’  Exercise prescription is steadily increasing in practice and there might even be medico-legal implications if we don’t encourage patients to get physically active to reduce their risk factors for morbidity. But how can you enthuse patients to get off the sofa and get moving?

A possible answer – lead by example and propose a challenge!

The www.5×50.co.uk campaign is an effort to raise awareness of the benefits of exercise & physical activity. I am currently helping to promote this campaign across the UK, especially in Wales, so that the message spreads – regular physical activity helps keep you healthy; it helps keep you free of disease; it is effective.

Physical Inactivity kills 9% of the world’s population.

The next stage of the campaign is the ‘Run the World’ challenge. It asks people to walk, cycle or run 5kms (3.1 miles) a day for a week from 23rd November, and involve friends, family, and patients as a taster to get fit. Challenge yourself and your community to be active and share in the experience of the benefits of physical activity. Sign up now!

Andrew Murray wins 2012 North Pole Marathon

Dr. Andrew Murray is making a documentary film about his commitment to the challenge . He is personally going to complete an ice marathon in Antarctica followed by 50kms on 7 different continents in 7 days. We applaud Dr. Murray’s commitment to both being physically activite and promoting its importance!

In comparison to this, 5kms a day from you is a drop in the ocean. But, nonetheless, it is an important drop.

Scotland’s Chief Medical Officer Harry Burns, their NHS executive team & Sports Minister Shona Robison have all signed up to www.5×50.co.uk. Here in Wales both Cardiff & Swansea medical schools, Cardiff City Football Club, the Welsh Rugby Union doctor and some players have signed up along with Public Health Wales – If they can do it, so can you! We all need to be in this together!

We really want UK / world wide doctors, lecturers & students involved as a priority. However, we also want to engage the broader public, so that everyone thinks about how they might become more physically active. We need your help to make a difference:

• Join the challenge and become a physical activity ambassador;
•  Encourage all your friends, families or patients to get more active;
•  Use http://5×50.co.uk/challenges to do so.

‘Run the World’ starts soon (November 23^rd); sign up now and share with your networks!

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Liam West

Founder and President of Cardiff Sports & Exercise Medicine Society (CSEMS); Organiser of the Cardiff SEM Conference 2012; BJSM Associate Editor; Coordinator of the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series for BJSM; Student Representative for the Council of Sport Medicine for the Royal Society of Medicine; Founder of Undergraduate Sports & Exercise Medicine Society (USEMS)

 Dr. Andrew Murray

Scottish Government Physical Activity Champion; @docandrewmurray – Twitter; www.docandrewmurray.com ; General Practitioner, Sport & Exercise Medicine Registrar; Author – Running Beyond Limits