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

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”!

As you know, the American College of Sports Medicine is actively advocating clinicians take a more active role in exercise prescription. The organization also aims to be politically active – an essential for behaviour change. Here you see a letter that Robert Sallis shared with members; also new ACSM president James Pivarnik wrote to President Obama’s nominee for Surgeon-General. Interesting times with much more attention to behaviour change and advocacy than there was in the past.

- K. Khan

Prevention involves lifestyle changes, not just diagnostics

As health system reform takes center stage in the United States, prevention has become a hot topic among lawmakers, media and the public.

Some question the cost savings of preventive health care. Does it save money in the long run, or is it an expensive indulgence with too little benefit to justify the up-front cost?

Answer: It depends. While many diagnostics, such as colonoscopies and mammograms, save lives and head off expensive treatment regimens, some may be unneeded. Sound medical judgment and appropriate guidelines are required.

But, everyone can practice prevention in the form of healthy lifestyles, and it doesn’t cost a dime. Better nutrition and higher levels of physical activity don’t increase cost, and they bring a huge payoff in terms of lower health-care costs, increased productivity and greater quality of life. Getting more active, eating a bit healthier, incorporating some kind of movement into everyday life – those are the main keys to health, longevity and disease prevention. It was recently reported that treating obesity was responsible for the biggest jump in health care spending in recent years; obese populations accounted for $303.1 billion in health care costs in 2006, nearly doubling the $166.7 billion spent on these individuals in 2001.

In a very real sense, exercise is medicine. Studies repeatedly show that physical activity and exercise can help prevent obesity, cardiovascular disease, diabetes and other chronic conditions.

And leading a healthier lifestyle needn’t mean hitting the treadmill every night or becoming fanatical about exercise. Walking for 30 minutes each night after dinner or during a lunch hour has powerful preventive effects and requires just a pair of comfortable walking shoes.

Physicians and other health care providers should encourage patients to become physically active. A public survey conducted in 2007 by the American College of Sports Medicine found that nearly two-thirds of patients (65 percent) would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

Bottom line: While we trim unnecessary costs to better manage health-care resources, let’s keep in mind the powerful and necessary cost-effective potential of healthy lifestyles. Truly, exercise is medicine—a prescription for better health.

Sincerely,

Robert Sallis, M.D., FACSM

Dear Dr. Benjamin,

Congratulations on your nomination as United States Surgeon General. Based on your extraordinary career and your commitment to addressing health disparities among underserved populations, no doubt your tenure will be marked by great progress toward the goal of improved health for all Americans.

Each United States Surgeon General has the unique opportunity to create his or her own lasting legacy. Dr. Koop focused on smoking prevention. Dr. Satcher, one of your own mentors, released the first comprehensive report on mental health. We encourage you to build your own legacy around the concept o prevention through healthy lifestyles – a legacy that is both sustainable and cost-effective.This also is an important issue for Members of Congress, many of whom believe that promoting prevention and wellness initiatives will bring down costs and help people lead healthier lives.  ACSM would be honored to partner with you on such an initiative.

The American College of Sports Medicine (ACSM), the largest sports medicine and exercise science organization in the world, stands ready to work with you to increase healthy behaviors – especially physical activity – throughout the life span.  During this crucial period of health system reform, we’ve been advocating for strategies that support preventive medicine not just through diagnostic testing, but by promoting healthy, active behaviors that all Americans can achieve at little or no cost.

In fact, ACSM already has a working agreement with the Surgeon General’s office, focused initially on a series of healthy-lifestyle public service announcements for our Exercise is Medicine™ program, a program that specifically calls on doctors to encourage their patients to incorporate physical activity and exercise into their daily routine. As you are well aware, physical activity can prevent and treat a host of chronic conditions – such as heart disease, type II diabetes, and obesity – that currently plague our country. Your example as one whose family has suffered from preventable disease and who demonstrates healthy lifestyles can be powerful indeed.

Anytime either before or after your appointment is confirmed, we would welcome the opportunity to meet with you and your staff to discuss how we, along with other leading health organizations, can enhance the prevention paradigm through physical activity.

Again, Dr. Benjamin, I extend our deepest congratulations and best wishes.

Sincerely,

James Pivarnik, Ph.D., FACSM

President, American College of Sports Medicine