By Ann Gates

(@exerciseworks)

Giving regular exercise advice and support as part of every health care consultation is fast becoming a critical health intervention in the prevention of the ‘tsunami’ of lifestyle diseases such as obesity, diabetes and related cancers. In May 2012 the U.S. Centre for Disease Control together with the Institute of Medicine released a national report detailing recommendations to combat the ‘Weight of the Nation’. The data predicted 42 percent (or 32 million more people) of the American population would be obese by 2030, while 11 percent would be severely obese. The economic costs for the associated health care services: $550 billion. This is an unsustainable cost for most health care systems and countries. This burden of lifestyle diseases and suffering is an unacceptable outcome for 21^st  century medicine.

The ‘Weight of the Nation 2012’ report summarised the key actions as:

1. Integrating physical activity into people’s daily lives
2. Making healthy food and beverage options available everywhere
3. Transforming marketing and messages about nutrition and physical activity
4. Making schools a gateway to healthy weights
5. Galvanizing employers and health care professionals to support healthy lifestyles

Several ‘best practice’ initiatives covering both healthier diets and integrating physical activity are identified. The authors report that physical activity should be a ‘routine and integral part of daily life’.

This provides the ‘call to action’  for health professionals to lead on giving exercise advice and support to patients, relatives and caregivers on why regular exercise helps prevent and treat many lifestyle diseases or ‘non communicable diseases’ (#NCDs). 36 million people, around the world, die from lifestyle diseases each year. They are names and faces in every doctor’s waiting room, every hospital outpatient clinic and everybody’s family. This is a global health issue that needs urgent health professional intervention by every health professional around the world.

Giving physical activity advice to everyone is not as easy as it seems. We know that when doctors give exercise advice to patients that they are more likely to follow that advice (read more here).  We also know that brief intervention during doctor –patient consultations is cost effective.

Exercise advice to patients should include warm up, exercise plan and cool down instructions on how to exercise effectively and safely. A weekly, balanced exercise programme for patients with chronic diseases should include cardiovascular, strength, flexibility and balance exercises. Different diseases often respond better to different types of exercises and physical activities. For example, Nordic walking or ballet has been shown to help improve the symptoms of patients with Parkinson’s disease.

Patients deserve the choice to choose how to incorporate ‘exercise as a medicine’ into their daily lives and in the prevention and management of long term diseases. Health care professionals can use tools like the American Cancer Society’s ‘Make Time-Break Time’ infographic to help patients understand the risks of inactivity and sedentary behaviour to their health during the day. This helps patients to ‘choose’ to increase their activity levels as part of the clinical management of their health condition.

The more health professionals consult with their patients on the benefits of regular exercise and more patients start to realise the benefits to their health, the more likely health care organisations around the world can start to address the obesity and non communicable diseases epidemic in a sustainable way.

This is a call to action to change our clinical practice and implement the concept of exercise as a medicine in the prevention and treatment of chronic diseases. Exercise advice and support should be part of EVERY consultation.

It is also time for sports and exercise professionals, health care professionals and patients to work together to help improve both the weight and health of nations all around the world.

Follow this link to see ‘part 1′ of this blog. It has 292 tweets to date – a BJSM record! Thanks everyone for promoting physical activity.

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Ann Gates BPharm(Hons)  MRPharmS

Personal Trainer, Chronic Disease Exercise Specialist, BACPR Exercise Instructor.

Founder of Exercise Works!

www.exercise-works.org

@exerciseworks

email: ann@exercise-works.org

Guest blog by Ann Gates (@exerciseworks)

Call to action for ALL heath professionals:

Exercise direction to patients is emerging as an essential clinical skill in the prevention and treatment of both acute and chronic lifestyle diseases. Dr Bob Sallis MD has long advocated that regular exercise is a medical ‘vital sign’ in assessing and directing a patient with a lifestyle disease to enjoying exercise as a medicine. 

36 million people around the world die from preventable lifestyle diseases (non communicable diseases; NCDs) such as heart disease, cancer, obesity, diabetes and mental health problems. This means that 36 MILLION people would benefit from exercise advice and support in preventing and treating these diseases.

Just one in three doctors gives exercise advice as part of every consultation to their patients.

If EVERY doctor and EVERY health professional is able to ‘direct’ and ‘support’ patients to regular exercise, as part of every consultation, then the health and economic consequences of inactivity and sedentary behaviour could start to be addressed. Patients could then be supported, proactively, to better lifelong health. NCDs will cost health economies $47 trillion by 2030. This is an unsustainable approach to health care services.

When doctors and health professionals give advice as part of the consultation, patients don’t question that advice and direction. For example, a patient needing warfarin or aspirin in the treatment of atrial fibrillation doesn’t debate the clinical outcomes of that decision: they may discuss NNT’s and NNHs, but generally the patient will follow the doctor’s prescription.

If physiotherapists are giving advice to help a patient breathe easier, the patient will generally follow the advice to improve their symptoms.

In fact brief intervention of exercise advice as a therapeutic intervention has recently been shown to be more effective in sustaining regular exercise than exercise on prescription schemes.

This should come as no surprise to health professionals who use the ‘art of a medical direction’ in guiding and motivating patients to better health: this can be used to great success in primary care, secondary care, health clinics, communities, cities or nations. Follow this link for more information. 

What can we do?

World Physical Activity Day on the 6^th April 2012 is an opportunity for sports and exercise professionals to lead the way on global exercise advice. Every health professional should give exercise advice to patients and the public. The medicine behind exercise as a critical public health intervention is now no longer debatable. Here is some evidence.

Adult patients should be advised to ‘enjoy’ stamina or endurance exercises for the minimum of 30 minutes, on at least five days of the week (ensuring they get slightly breathless).

Strength, flexibility and balance exercises should be advised twice a week. Age specific UK physical activity guidelines can be found here.

For World Physical Activity Day 6^th April 2012: Make a difference to every consultation: include exercise advice, every patient!

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Ann Gates BPharm(Hons)  MRPharmS

Personal Trainer, Chronic Disease Exercise Specialist, BACPR Exercise Instructor.

Founder of Exercise Works!

@exerciseworks

email: ann@exercise-works.org

Guest Blog by Dr Pria Krishnasamy

The UK trainee perspective (The BJSM blog features the trainee perspective every two weeks)*

As I edge closer to the crossroads of my own career, I muse aloud as to where Sport and Exercise Medicine (SEM) is heading?  Is the majority of our workload going to involve musculoskeletal medicine or should the young generation coming through break free from the current mould and realize the vision of Exercise Medicine that the Faculty (FSEM) have fought so hard to promote and to what our specialty owes its existence?  I feel the urge to answer the call of cynics …

It is hard to believe bygone statements like these (in the caption) in current times.  However, I should say that Sir William Arbuthnot Lane started promoting exercise, fruit and vegetables and bran cereal as an answer to bowel problems in 1925, a good 40 years ahead of his time.  We now know that exercise should be undertaken at a sufficient intensity to make one at least moderately breathless.  Those who have gradually built endurance over time can be encouraged to perform vigorous intensity activity.  My mission is to spread the word of exercise and share a way in which SEM will develop.

“My Best Move” is a pilot project to encourage exercise prescription in primary care for long-term conditions.  The project was initiated to help Department of Health (DoH) recommendations to be translated into primary care practice.  General guidance is sometimes just not enough and physical inactivity remains one of the five big risk factors for long-term conditions equal in importance to smoking, obesity and hypertension.  Since its introduction, the project has been greeted with much enthusiasm in the primary care sector and the extra boost and guidance in the form of training is being welcomed.  It is hoped that this will start a new wave in the community that will lead to more active lifestyles despite any chronic conditions that individuals may have, without them feeling hindered by their conditions.

Taking this vision forward, an Exercise Center of Excellence is needed.  A place where both able bodied and persons with disabilities, no matter what long term conditions they have, are able to be seen and given specialist care to enable them to live life to the fullest.  By tailoring individual exercise prescription and rehabilitation according to patients needs, the aim is to enhance quality of life, improve absenteeism and return individuals to work, which will reap significant economic gains.

Everyone needs to start taking ownership of their own health and start making small gains rather than relying on the policymakers, the health service or their doctor.  The gains, after all, are to one’s own health and well-being.

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Dr Pria Krishnasamy is a Sport and Exercise Medicine Registrar in London and enjoys long walks in the countryside, martial arts, playing tennis, and dinners with good friends.

Dr James Thing co-ordinates “Sport and Exercise Medicine: The UK trainee perspective”  which runs every two weeks.

Guest blog By Dr Matthew Stride

The UK trainee perspective (A monthly BJSM blog feature)*

The year 2012 represents a pivotal time for the speciality of Sport and Exercise Medicine. Time will tell whether the Olympic and Paralympic Games will leave any significant lasting ‘legacy’ on the health of our nation.¹ However there is no doubt that the subsequent months after the Games will represent the strongest test for the integrity and future of the speciality.

Consultant SEM Physicians were envisaged, when the training program was inaugurated in 2007, to be instrumental in delivering the legacy. Now five years on, if this is going to come to fruition, there has to be a greater shift towards health promotion and a greater acceptance of exercise medicine than there is currently. As it is primarily through this role that SEM consultants are likely to be (and arguably should be) employed in the not too distant future.²

The SEM curriculum has a greater emphasis on the role of regular exercise for health and chronic disease management than in other countries.³ This includes public health training, knowledge and experience of exercise physiology, exercise testing and exercise prescription in health and disease states, in both the primary and secondary care setting. It is this training and expertise in exercise medicine that is unique to the SEM curriculum and separates us from any other speciality. Musculoskeletal medicine and sport injuries are a comparatively smaller part of the curriculum, yet continue to be by far the largest focus of interest and expertise (the ‘traditional’ Sports physician.) There seems to be a marked, noticeable disparity between curriculum content and SEM physicians who currently specialise in exercise medicine. This imbalance may be largely driven by the historical context of the speciality development. However if this continues then deliverance of the post games legacy may not happen and the speciality training program may not last for much longer.

Exercise medicine needs greater emphasis and acceptance if more SEM Consultants are to be employed in the NHS.⁴ Exercise medicine is an integral part of the training and cannot be dismissed. After all, its inclusion helped the speciality to gain recognition and led to the supposed governmental promise that SEM physicians will be trained to ensure the games leaves a lasting legacy on the health of our nation.

References

1. London 2012: Legacy. A Position Paper from the Faculty of Sport and Exercise Medicine. Available at
2. Sport and Exercise Medicine. A Fresh Approach.
3. Cullen M.  Crossroads or threshold? Sport and exercise medicine as a specialty in the UK. Br J Sports Med 2009;43:1083-1084.
4. O’Halloran P, Tzortziou Brown V, Morgan K et al.The role of the sports and exercise medicine physician in the National Health Service: a questionnaire-based survey. Br J Sports Med. 2009;43(14):1143-8.

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Dr Matthew Stride is a Specialist Registrar in Sport and Exercise Medicine. He is now in the final year of the training program in the London Deanery. He is currently based at Homerton University hospital and has been made an honorary research fellow at Imperial College. He is also a football club doctor.

Three exciting updates from the frontlines of health promotion through physical activity.

Illustration by Liisa Sorsa, 23.5 hours video

First, congratulations to Professor Steven Blair for winning the Bloomberg Manulife Prize for the Promotion of Active Health. This international competition celebrates a researcher whose work promises to broaden understanding of how physical activity, nutrition or psychosocial factors influence personal health and well-being.

Professor Blair has tirelessly raised awareness of the burden of low fitness. His dedicated data gathering and adroit analysis has allowed him to deduce that physical inactivity is the biggest public health problem of the 21st century. His 2009 editorial in BJSM shares this title and has been downloaded more than 20,000 times (available free online).

To read more about the award, follow this link to the Globe and Mail.

Secondly, after garnering global attention, Mike Evan’s videos 23.1/2 hours is being translated into multiple languages. Sports Medicine colleagues will ensure the video can be enjoyed by speakers of Arabic, Spanish, Chinese, and Italian. And there will likely be more offers to come.

This will further enable the first physical activity ‘YouTube sensation’ – 23 1/2  - to promote behaviour change, while recognizing the physical activity challenges in a wide range of countries.

While 1.6 million hits demonstrates 23.1/2’s current success, translation into multiple languages may take this video to the ‘next level’ with a goal of 10 million views!

The video has already gained international traction as shown by the breakdown of views per country: US 844, 664, Canada 320, 000, UK 61, 345, Australia 49, 100, India 32,000, Netherlands 14, 977, Singapore 13,761, Germany 13, 345, Malaysia 11, 986, Sweden 11,589, Israel 11, 387, Saudi Arabia 10, 786, Mexico 10, 607…and the list goes on.

If you haven’t watched the video yet, check it out here (and note Steve Blair’s fun cameo at around 2 minutes 50).

And a third exciting sign of progess was Scotland appointing a physician to head their campaign against physical inactivity.

Doctor Andrew Murray (@docAndrewMurray) – who clearly has to differentiate himself from his colleague “Andy Murray” (@andy_murray).

The more important of the two, although seemingly not by # of Twitter followers, Doctor Murray, makes the point that “having a low level of fitness is equivalent in risk to having diabetes, smoking, and being obese combined”. BJSM likes that emphasis – amazing but true. All the best in the job DocAndy – we look forward to interviewing you for a BJSM podcast (with subtitles).

For more information on this check out the BBC article: GP runner Andrew Murray given sports education role

So – things are moving in the right direction – let’s all take up the cudgels and promote, promote, promote. Remember that Kotter said transformational changes takes 10 times as much communication as you expect it will need (plus 7 other things: see BJSM article on Kotter’s eight-step programme for transformational change).

Related BJSM publications

Rhodes RE and Dickau L. 2011. Moderators of the intention-behaviour relationship in the physical activity domain: a systematic review . BJSM. Published Online First: 25 Jan, 2012.

Burton NW, Khan A, and Brown WJ. How, where and with whom? Physical activity context preferences of three adult groups at risk of inactivity. BJSM. Published Online First: 20 Jan, 2012.

Bauman A, Titze S, Rissel Cand Oja P. 2011. Changing gears: bicycling as the panacea for physical inactivity? BJSM 45:761-762. (Free online!)

Khan, KM. 2009. Mid-year review: physical inactivity universally accepted as the biggest public health problem of the 21st century, shoulder exam challenges, and progress against the scourges of anterior knee pain and ACL injuries. BJSM, 43:469-470. (Free online!)

First – credit to New York Times. Specifically Gretchen Reynolds who provides wise perspectives on sport and exercise medicine. Like this piece about exercise for brain function. Gretchen provides balanced, topical sports medicine coverage – she picks the emerging winners and doesn’t get blinded by fads. She has been on exercise and brain function for a while – if it were a stock, think Apple over recent years or Blackberry during 2000-2005. The NYT’s Tara Parker-Pope is active on Twitter (@NYTimesWell) – definitely good to follow.

Second, the BJSM actively promotes this area of Exercise is Medicine. One review relating resistance training and cognitive benefit will get you started. In the same issue, the paragon of the field, Art Kramer, summarizes aerobic exercise effects.

For more spice and intrigue, consider Leon Flicker’s gentle rebuke to the NIH for their failing to acknowledge the evidence for exercise and brain function in their 2010 consensus statement. An Australian had to lead that push because US researchers want NIH funding – don’t bite the hand that feeds you! But why didn’t the NIH do a better job? Is this a case for Ray Moynihan? (Twitter @RayMoynihan and ‘Selling Sickness’ via Amazon). To spell it out, do major agencies undervalue the benefits of physical activity for health because there is no corporate support? (Omission rather than commission?).

OK – enough for a weekend!
Take home message = exercise for your brain – your heart will thank you for it!

And third, remember that any drug trial that shows a positive effect will have 10 to 100 to 1000 times more marketing budget support than a similar exercise study. So when the evidence is emerging for physical activity benefits – see lead link to New York Times….magnify the headline fonts and the coverage volume by 10 to 100 to 1000 for a fair comparison with anticholinesterases. I’m reaching for my walking shoes and my dumbell!

See link to smokadiabesity epidemic here

1 Man, 52 jobs, 52 weeks. Sean Aiken, talks about finding the fulfilling job and discovering his passion. Not an easy thing to do.

For those of us passionate about sharing the powerful health benefits of Physical Activity, the challenge is message delivery. How do we motivate patients to embark on Physical Activity lifestyle interventions?

Translating knowledge into action (and maintenance) is a public health dilemma. A practical solution is a complex key to the puzzle. Evidence for practical tools, such as using pedometers,  is emerging.

What are your comments/thoughts?

Couch to 5K motivated my mum to “get off the couch” and put on running shoes. For the first time, ever.

Do you know of people who have been thinking about a more active lifestyle? Do they need a practical, no-brainer approach to ‘Just Do It’?

Couch to 5K transforms absolute beginners into motivated runners by giving them a place to start. Laura on the NHS Choices Couch to 5K podcasts literally talks participants through the process. Step-by-step, from Week 1 to Week 9, from Couch to 5K.

To borrow some words from the Couch to 5K website, it’s  “Achieveable, Free and Easy”!

Do you take care of endurance athletes? Consider the Ironman Sports Medicine Conference in Kona, Hawaii. The 2011 Meeting is in the first week of October (2nd-6th) and it leads up to the World Championship which is on October 8th.

The conference is multidisciplinary and very collegial; all hands are on deck to provide coverage for the event.

Kona has a great vibe and you’ll have fun. The family will love it as you have half-days for academia and the other half day to explore this interesting island (active volcano!), get advice in the run or swim clinic, and actually practice what we preach — do at least 60 minutes of accumulated physical activity for the day!

Bob Sallis is the conference chair and you can listen to him talk about exercise is medicine on a BJSM podcast