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Care of sports team and endurance athletes, exercise Rx in primary care, and anti-doping: stellar line-up of pre-conference courses May, 2016 in Victoria, Canada – register now!

15 Apr, 16 | by BJSM

CASEM logoThere is still time to sign up for the Canadian Academy of Sport and Exercise Medicine (CASEM) Pre-conference courses held the 3 days before CASEM’s annual scientific meeting May 18-21, 2016: “High Performance on the Pacific Edge”.  All courses are now accredited.

This two-day course, chaired by Dr. Taryn Taylor, will address and prepare physicians to provide medical care to athletes. The target audience is a physician of any specialty, with or without their CASEM diploma, who wishes to develop and enhance their knowledge of and skill in the care of the athlete and the role of the team physician. This course may also be of interest to allied health professionals who are involved with the care of sports team athletes.

This program has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 12 Mainpro-M1 credits

Hosted by CASEM but presented by Exercise is Medicine Canada (EIMC) all delegates are invited to attend the one day program on “Exercise Prescription in Primary Care” – The Exercise Vital Sign (EVS) is the most important vital sign you need to monitor with the majority of patients seen in primary care today.  Learn how to efficiently integrate the EVS into your daily practice and to provide basic exercise counselling and prescription for your patients to prevent, manage and treat chronic diseases.

This program meets the accreditation criteria of the College of Family Physicians of Canada and has been accredited for up to 6 Mainpro-C credits and 0 Mainpro-M1 credits.

Now travelling to the West Coast, this one-day workshop, chaired by Dr. Andrew Marshall, is designed specifically to address sport medicine clinical issues in swimming, biking and endurance/ultra running.  As endurance events such as Ironman and ultra-running become mainstream, sport medicine physicians are faced with the challenge of providing prevention strategies and treatment and management to the types of injuries high volume training can cause.

This program has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 7 Mainpro-M1 credits 

It is said that “Doping is a hindrance to sports ethics and a threat to the health of athletes” – CASEM will provide a comprehensive 3-hour session on all you need to know about doping in your role as a sport medicine physician.  Experts will be on hand from CCES and WADA and experienced Team Physicians will provide their insight and own experiences.

This program has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 3 Mainpro-M1 credits 

The 2016 Victoria meeting will provide a plethora of plenaries and workshops over 3-days in Victoria, BC.  Delegates will be housed at the beautiful Fairmont Empress Hotel connected to the Victoria Conference Centre where the CASEM meeting will bring together experts in the field of sport medicine.

This program has been accredited by the College of Family Physicians of Canada and the BC Chapter for up to 16 Mainpro-M1 credits 

SOCIAL PROGRAM- The social program has been set and we are once again pitting teams against each other as we head to a local pub for a CASEM dedicated Trivia Night on Thursday at the “Sticky Wicket”.  We have made a significant change to the Gala Dinner in 2016.  We are moving it to Friday night in the Empress’ famous Crystal Ballroom and we encourage you all to attend.  Over and above the sumptuous 4-course dinner, the Victoria band Timebenders will play into the wee hours of Saturday morning – as a consideration to the oldies out there we have started programming for Saturday a smidgeon later!  The 5km sightseeing run will return and give delegates a chance to experience Victoria sights and sounds on foot –  100% of monies collected will be donated to a local charity.

Last but not least, each delegate will receive a CASEM surprise gift in their registration packs – what is it?  Register to find out!

Information and registration for ALL programs can be found at:http://casem-acmse.org/news/casem_annual_symposium/victoria-2016/delegates-2016/ 

The role of exercise intervention in adopting a ‘choosing wisely culture’ in clinical practice

18 May, 15 | by BJSM

fsem_v_Variation_1

News Release – The Faculty of Sport and Exercise Medicine

The Faculty of Sport and Exercise Medicine UK (FSEM) supports the launch of a Choosing Wisley Programme in clinical practice by the Academy of Medical Royal Colleges. As the NHS faces a £30bn funding gap by 2020[i] the need to tackle preventable illness and disease effectively and efficiently has never been greater.

Medical decisions based on the best match between what is known about the benefits and harms of each intervention and the goals and preferences of each patient is a common sense approach outlined in the Choosing Wisely in the UK report. However, the pressure on general practitioners and doctors to provide a quick solution is enormous, while sickness and absence rises with an increase in many preventable conditions.

A sustainable alternative intervention is available, which can improve public health for the long term and reduce the pressures facing the NHS. Physical activity and Exercise Medicine are under resourced and under used by the health profession and can provide cost effective prevention and intervention for many common conditions and illnesses [ii].

A good example of this in practice is the management of musculoskeletal (MSK) conditions, which account for up to 30% of all primary care consultations [iii]. Sport and Exercise Medicine doctors can offer alternative pathways in managing common MSK conditions. The majority do not convert to surgery or need disease modifying drugs and can be managed in different models of care which streamline the pathway for patients and can be more cost effective for commissioners, while still attractive for hospital trusts.

If the NHS routinely offered an effective and patient centred programme of physical activity and exercise medicine interventions, it could lead to a real reduction in the over-use of more established clinical treatments.

For further information view the FSEM’s Manifesto – Making the Physically Active Choice.

For further evidence of the effectiveness of exercise medicine in treating MSK conditions view – A Fresh Approach in Practice

References

[i]  NHS England 2013

[ii] A Fresh Approach – FSEM NHS information document 2012

[iii] A Fresh Approach in Practice – NHS Information document 2014

 

“Do you even lift, Bro?”

16 Jul, 13 | by Karim Khan

By Ann Gates

The recent viral videos and ‘outtakes’ of the responses to this pertinent (and yes, hilariously funny) rhetorical question got me thinking… what a great question to trend in the fight against the type 2 diabetes epidemic.

lifting

Photo credit: Dean Skiba and David Baird, Inclusive Fitness UK.

Type 2 diabetes is largely preventable and treatable with the right medicines, a healthy, balanced diet and regular daily exercise. Recent studies show that adding in resistance or ‘strength’ training confers significant results in the overall management and health outcomes of Type 2 diabetes. Two particular studies warrant highlighting:

  • The Umpierre, 2011 study clearly shows that a structured exercise plan including strength training, is associated with greater health outcomes including a significant HbA(1c) reduction in patients with type 2 diabetes than with exercise plans without strength training. Structured exercise training such as aerobic exercise, resistance training, or both combined of more than 150 minutes per week is associated with greater HbA(1c) declines and is also  a cost effective management approach in type 2 diabetes. However, the physical activity advice is associated with lower HbA(1c) only when combined with dietary advice. This adds even more weight to the question ‘do you even lift. Bro?’ The study clearly demonstrates that a combination of cardiovascular exercise and strength training improves the overall management and cost effectiveness of type 2 diabetes care.
  • The second study of interest showed that men who do strength (resistance) training regularly—for example, for 30 minutes per day, five days per week—may be able to reduce their risk of type 2 diabetes by up to 34%. In this new 2012 study, by Harvard School of Public Health (HSPH) and University of Southern Denmark researchers also combined strength training and aerobic exercise, such as brisk walking or running, and showed that men may be able to reduce their type 2 diabetes risk even further—up to 59%!

59% reduction of risk of type 2 diabetes is surely something that all health commissioners, doctors, sports and exercise specialists, allied health professionals and patients at risk of developing type 2 diabetes should be aiming for with structured exercise plans and lifestyle advice.

In fact, wouldn’t it be fantastic if patients actually knew this benefit of a regular exercise plan including strength exercises as part of routine exercise plans in the prevention and treatment of type 2 diabetes? Wouldn’t it be a great idea to use social media in this way, to get the message over to health professionals and their patients that yes … medically and scientifically……..strength training works!

So actually, as dangerous as asking the question is, ‘Do you even lift, Bro?’ (you have to watch the videos to really appreciate the risks of this scenario….!).

The enlightened answer is…

 “Bro….. I lift because it reduces my risks of type 2 diabetes by 39%, I run because it reduces those risks further by 25%, I also add in balance and flexibility training ‘cause man… that really helps you feel good in yourself…… I combine all of this with a healthy diet….”

And the outtakes may well result in better national, local and individual health in the management of type 2 diabetes!

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

Ann Gates is the founder of Exercise Works! @exerciseworks

Disclosures: Many thanks to my ‘physiotherapy student’ son for enlightening his mum on what’s funny and cool in the world!

Strength training support should be offered to all patients at risk of type 2 diabetes.

Well-rOunded dOctOrs (!) Not necessarily a good thing in this case

18 Jun, 13 | by Karim Khan

By  Dr Rajat Chauhan,

Sports-Exercise Medicine & Musculoskeletal Medicine Physician; BJSM Associate Editor (India)@drrajatchauhan

march coverFrom the time of Hippocrates and probably even before, we have known the benefits of physical activity and exercise in health. In today’s world of evidence based medicine, it is even more important for research to back up our gut feeling. The last two decades of research show how big an impact ‘Physical activity and exercise’ have in reducing risk of non-communicable chronic disease morbidity and premature mortality.

The cover of March 2011 edition of BJSM did its bit by suggesting that every doctor consultation room needed to have a copy of the free PDF ‘Physical Activity in the Prevention and Treatment of Disease‘, (a ground breaking book by Professional Associations for Physical Activity (Sweden)) and then to use it 20-30 times daily. The editorial was so appropriately titled “Physical activity as medicine: time to translate evidence into clinical practice” (see full text here – FREE).

You may have thought that all these efforts put together would have changed the healthcare fraternity’s attitude in recommending ‘physical activity’ to patients. In this presentation, I have put down the reasons why we, doctors, are neglecting one of our duties. I have also suggested a couple of solutions.

This presentation targets practicing doctors and medical students, so they are better informed about the role of physical activity and exercise which is often mentioned in medical schools in passing. It’s also for the public, to make them aware that it’s their right to know better. Why should they trust someone who doesn’t practice what s/he preaches!

Please view the presentation HERE, and share with your friends and colleagues.

 

Keep miling and smiling,

Dr Rajat Chauhan

Rajat Chauhan

@drrajatchauhan

Ultra Runner, Sports-Exercise & Pain physician practicing (un)common medicine. Columnist – Mint newspaper, Blogger – Forbes India, Associate Editor – BJSM

New Delhi, India · about.me/drrajatchauhan

Attention doctors: please mind the physical activity gap

20 May, 13 | by Karim Khan

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

By Lucinda Poulton1, Paul Kelly2, Justin Richards2, Moiz Moghal3, Wilby Williamson2,3

Affiliations

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

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

3. OxSport, Nuffield Orthopaedic Centre, Oxford.

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 4-6th 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 5th 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.

“What exercise can I do Doc?”

1 Mar, 13 | by Karim Khan

By Ann Gates (@exerciseworks)

Can health care consultations change to incorporate best practice ‘exercise medicine?’

Treadmill-web

In 2012, we sent out a ‘call to action’ to ALL health professionals about the pandemic of obesity and non communicable diseases (NCDs) which results in 36 million patients (worldwide) dying from preventable and treatable diseases. This call was enthusiastically answered by many health professionals and health organisations. However, inactivity is still the world’s 4th leading cause of death and the recent global physical inactivity maps could be easily be superimposed across the world obesity maps, showing a similar distribution of chronic disease and inactivity. This is no medical coincidence.

It is well documented, (and we all know), that the relationships between preventable diseases, inactivity and the determinants of those diseases are complex and multi-factorial. The time has arrived for health professionals to give an ‘evidence based brief intervention’ exercise prescription. This ‘prescription to exercise’ should be championed by all health, sports and exercise, and fitness professionals. It is not a specialism that is just for a few to practice. Giving exercise advice should be as medically intuitive as writing a medicine prescription or providing a referral.

We know that in sustained behaviour change, brief interventions work! Consider the example of a patient with breast cancer; we treat the disease by advising the patient on the options of chemotherapy, surgery, radiotherapy and a variety of other key health care interventions. Patients follow and respect our advice during a time of despair, confusion and worry. That’s because health professionals are trained to help provide the best support and medical advice they can give to breast cancer patients. And, (in the majority of cases), patients are grateful and benefit clinically from that expert advice. However, in many breast cancer consultations, patients are still not offered exercise advice despite evidence that this supports the patient clinically and emotionally. So why aren’t we seeing brief intervention exercise advice in all consultations, when health professionals know that it can significantly reduce the risks of chronic diseases and their symptoms?

Consider the situation we have globally. Patients are facing the greatest risk of NCDs through inactivity, poor lifestyle habits and lack of access to suitable exercise and physical activity opportunities. If we think about the patient in the consultation, why is it that we can’t give exercise as a medicine? Patients are suffering from obesity, cancer, diabetes, heart disease, stroke, osteoporosis, and poor mental health. Yet we know that a variety of medicines and treatments are available. Is it not conceivable that trained health professionals can’t give disease specific, exercise advice?

And of course the basic answer is that all health professionals can give quality exercise advice to their patients: even if it’s just an enthusiastic endorsement of national and international exercise guidelines as a brief intervention!

We ought to be giving more to our patients. In 21st century medicine we should go beyond the basics.

We should know which exercises work best for a Parkinson’s disease patient or any other disease or ailment. Just like we know how to prescribe which medicines to an asthma patient. When exercise medicine is incorporated as part of clinical training for all health professionals, and supported by cultural change within health organisations and the public at large- we will then be moving to this ideal patient/health professional consultation scenario:

What exercise can I do Doc?” asked the patient

There are lots of fun exercises and physical activity opportunities to improve your symptoms/disease condition by…” replied the health professional.

And yes- health care consultations can change, evolve AND deliver better exercise advice to the majority of patients.

McGraw Medical Education Australia has published a series of ‘patient exercise sheets’ by Exercise Works!

For further details and licensing arrangements please contact: Mr Andy Santhosh andy_santhosh@mcgraw-hill.com +61 2 9900 1826

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

Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works!

Exercise physiologists and chronic disease management in North America: A role of importance

6 Feb, 13 | by Karim Khan

Undergraduate perspective on Sports & Exercise Medicine  a BJSM blog series

By Lisa Campkin (@LisaCampkin)

rx exercise

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.

Generation Games: An update on upcoming launch of innovative website

3 Jan, 13 | by Karim Khan

By Drs. Moiz Moghal and Natasha Jones

generation games There is rising awareness that physical inactivity is a major health problem. Momentum is gathering at a local level to try to reverse this trend. An exercise prescription or a brief intervention on its own is not enough. The challenge is to integrate an exercise medicine service with proactive partners who can successfully deliver the tools required to change behaviour to an activated community.

In Oxfordshire, the Department of Sport & Exercise Medicine at the Oxford University Hospitals NHS Trust in a unique collaboration with AgeUK Oxfordshire, have been commissioned by the PCT to develop a service to facilitate individualised exercise prescription and signposting for local opportunities to be active. This is targeting people over the age of 50 years and has been achieved through the development of an innovative website called Generation Games which is due to launch next month.

Generation Games is designed to be used by the individual or by the healthcare professional. It will take the user through PAR-Q and GPPAQ before asking about individual barriers to exercise. Following this, the individual will be given a personalised exercise prescription or will be advised to see their GP to ensure that it is safe for them to exercise. Once this has been confirmed, they will be given a detailed list of all opportunities to be active in their local area. The options will be widespread ranging from seated exercise to Nordic Walks to team sports. Working with a well established partner such as AgeUK Oxfordshire will help us to access hard to reach groups, in particular the lonely and isolated. Even a lack of IT access or knowledge is not a barrier as this service can also be accessed via local AgeUK Oxfordshire branches or by phone.

A key part of this project will be to get local healthcare professionals to use the service. We know that practitioners in primary care are best placed to deliver physical activity guidance (1). As such, we hope to visit GP practices across the county to spread the word and to demonstrate the website. The website also provides a useful learning resource regarding the role of physical activity in chronic disease and also references some key papers related to this topic. We hope that this will also provide valuable feedback in order to allow us to continually improve the service. The same will be done using patient focus groups through AgeUK Oxfordshire. We hope to establish firm links with well-established rehabilitation services but also to give access to other specialist departments whose patients we know may benefit, such as cancer and mental health services.

We believe that the message of the benefits of physical activity speaks for itself. In the development of Generation Games we hope that we have made it as easy and as safe as possible for the individual or the healthcare professional in Oxfordshire to access an exercise prescription and to find interesting and fun local activities that will keep them motivated to be active.

Please feel free to access the website on:

www.generationgames.org.uk

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

Dr Moiz Moghal is a Specialist Registrar Sport & Exercise Medicine, Oxford Deanery

Dr Natasha Jones is a Consultant in Sport & Exercise Medicine, Oxford University Hospitals NHS Trust

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

REFERENCE:

1.         Green prescriptions: attitudes and perceptions of general practitioners towards prescribing exercise. British Journal of General Practice, 1997, 47, 567-569.

‘Run the World’ to change health behaviours – are you ready to practise what you preach?

8 Nov, 12 | by Karim Khan

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 23rd); sign up now and share with your networks!

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

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

Feasibility and efficiency of an under-desk exercise device: a pilot study

24 Sep, 12 | by Karim Khan

By Drs  Vadim N. Dedov and Irina V. Dedova

ABSTRACT

Background/Aim – Sedentary behaviour is associated with a variety of chronic diseases and considered as a health hazard. Worksite interventions, which decrease sedentary time and increase physical activity during working hours, may improve health of sedentary workers.

Methods – In this study we tested a specially designed exercise device, which allowed linear feet movements at the horizontal plane and hence the under-desk use. The device had friction resistance mechanism, which was equipped with a temperature sensor for objective monitoring of exercise intensity, duration and amount of exercise. Four healthy volunteers were provided with continuous access to the device during their normal activities at the desk.

Results – It was shown that the amount of exercise achieved during 30-minute dedicated device usage at moderate intensity was 131.0 kC⁰, as measured by the heat production in the device. According to the current exercise guidelines, this amount of exercise could be considered as the recommended daily amount of physical activity. Exercise concurrent with the use of computer resulted in the device usage equal to 251.6 kC⁰. The concurrent exercise was of lower intensity than dedicated exercise, but longer duration of device usage, which was achieved in several bouts, resulted in accumulation of significant total amounts of exercise.

Conclusion This study suggested for the first time that under desk exercise could complement the use of computer and result in accumulation of amounts of exercise exceeding the recommended daily amounts of physical activity. Larger studies are warranted for evaluation of under desk exercise in various sedentary occupations.

 

INTRODUCTION

Physical inactivity is considered as an important health hazard and reduction of sedentary behaviour could improve population health by preventing the development of chronic diseases.1 However, the levels of physical activity at work are continuously declining2 and full-time workers in sedentary occupations remains immobile for approximately 11 hours per day and don’t have enough leisure time for sufficient exercise.3 Unfortunately, modern megatrends in information and communication technology may negate the effects of planned physical activity interventions.4 Conversely, regular physical activity in the workplace would result in decrease of sedentary time and hence in improvement of employees’ health. A variety of worksite exercise programmes were tested to increase employees’ physical activity.5 However, it might be argued that short bouts of exercise (e.g. use of stairs) are not lengthy enough for substantial reduction of sedentary time, whereas dedicated exercise bouts require allocation of extra time during working hours.

Exercise devices facilitate regular physical activity and three major types of conventional fitness machines were tested in the workplace. The use of treadmill was shown to be compatible with the worksite activities of medical transcriptionists6 and it was calculated that replacement of sitting with walking-and-working computer time for 2-3 hours/day would result in a weight loss of 20-30 kg/year in obese workers.7 However, treadmill walking caused decrease in the measures of fine motor skills and math problem as compared with seated conditions.8 A miniature bike installed in the office was used for 23.4 minutes a day on 3 out of 5 working days.9 A miniature stepping device increased the energy expenditure over sitting condition and it was calculated that, if it used to replace sitting by 2 hours per day, weight loss of 20 kg/year could occur.10

The under desk exercise device would have the advantage of convenience and accessibility for prolonged use during working hours. In this study we tested feasibility and efficiency of specially designed under-desk exercise device.

 

METHODS

A novel resistance exercise device MedExercise ST (MDXD Pty Ltd, Australia) was used in this study (Figure 1A). Changes of temperature in the resistance unit were measured with a temperature sensor connected to the industrial multimeter IP57 (Digitech, Australia). Data was collected using respective software Multimeter V1.0 from Digitech and then converted into Excel databases (Microsoft, U.S.A.) for analysis. The average exercise-induced rise in temperature was calculated after subtraction of ambient temperature values. The heat production during usage of the device was expressed in kCo (average + SD), which was the average exercise-induced rise of temperature multiplied by the duration of recording in seconds. Fingertip pulse-oximeter CMS-50E (Contec, China) and corresponding SpO2 Review software were used for the continuous measurement of heart rates during the exercise. Overall, four healthy volunteers, aged between 36 and 49 years, participated in this study. Respective informed concerns were obtained. Statistical analysis was performed using the Student’s t-test.

 

RESULTS

Figure 1A shows the user sitting in the stationary chair, such as a standard visitor chair. During the exercise user’s feet were moving in horizontal plane without rising of the knee that allowed leg movements under the desk. Repeated leg flexion-extension cycles resulted in physical efforts of the user and respective heat production in the resistance mechanism of the device due to friction. Figure 1B shows that the usage of device installed under the desk caused a fast rise of temperature to the plateau level, whereas stopping of exercise resulted in a drop of temperature to the pre-exercise values.

The current physical activity guidelines suggest that all healthy adults aged 18 to 65 years need moderate intensity aerobic physical activity for a minimum of 30 min on 5 days each week’.11 Therefore, 30-minute usage of under-desk exercise device in moderate intensity could be considered as the recommended daily amount of exercise. Accordingly, the device was used for 30 minutes (Fig. 1B, pattern filled area) with no other activities involved (dedicated exercise). At this intensity of device usage, a pulse rate of the participant was around 100 bpm (Fig. 1C), which indicated a moderate intensity of exercise in healthy adults.12

The amount of device usage and hence the amount of exercise were calculated as the average exercise-induced temperature rise multiplied by the duration of recording expressed in seconds (Fig. 1B, double sided arrow). Overall, dedicated under desk exercise for 30 minutes resulted in the average temperature rise of 43.4+6.6 C⁰ and the corresponding total amount of device usage of 131.0+15.7 kC⁰ (n=5) (Fig. 1E and 1G, respectively). According to the current exercise guidelines,11 this amount of exercise might be considered as the recommended daily amount of physical activity, which was achieved solely by using of under-desk exercise device.

For the next set of experiments, the under-desk exercise device was used, while working with desk computer (concurrent exercise). A typical recording of exercise intensities during the concurrent exercise is presented at Fig. 1D. In this example a total duration of recording was 232 minutes (double sided arrow), which included the actual using of the device at various intensities for 146 minutes (pattern filled areas), breaks and time away from the desk. In contrast to the uniform intensity of device usage in dedicated exercise (Fig. 1B), the concurrent exercise pattern demonstrated significant variability in exercise intensity (Fig. 1D). Overall, the recording time was 221.6+67.5 minutes (n=7), including 128.5+25.1 minutes of actual exercise, which constituted 58% of the total recording time (Fig.1F). The average intensity of concurrent exercise was 18.9+4.7 C⁰ and a total amount of device usage amounted to 251.6+55.5 kC⁰.

Therefore, the average intensity of concurrent exercise was 2.3 times lower than in dedicated exercise (Fig. 1E). However, the longer total duration of device usage (Fig. 1F), which was accumulated during several exercise bouts separated by breaks, resulted in 1.9-fold larger amount of exercise than in 30-minute dedicated exercise (Fig. 1G). It could be calculated that on average 68.7 minutes of concurrent usage of the device was required to equal the recommended daily amount of physical activity achieved by the 30-minute dedicated exercise using the same exercise device.

 

DISCUSSION

Significant evidence is presented for the benefits of worksite exercise in sustaining employee health, whereas the technical features of conventional fitness machines may limit their use in the workplace. For example, installation of  ‘walk-and-work’ desk, which is based on treadmill, requires a significant modification of the workplace.13 In contrast, MedExercise ST was designed for use under the desk and hence can be used seated with the standard desks and chairs with no modifications.

Using this device, we have demonstrated for the first time the feasibility of effective under desk exercise at sufficient intensity and duration to be considered as the recommended daily amount of physical activity.11 This pilot study also suggested that the under-desk exercise machine could be used concurrent with computer and hence in the workplace. Therefore, it might be an effective tool for reducing time spent sedentary while at work and for achieving the recommended daily amount of exercise. Since the lower average intensity of concurrent exercise, it required longer duration of device usage (e.g. 68.7 minutes) to equal the recommended 30-minute daily exercise of moderate intensity.11 Nonetheless, 68.7 minutes constitutes only ~10.4% of daily sedentary time of working population.3

Importantly, the concurrent exercise does not require significant modifications of the lifestyle in order to allocate dedicated time for exercise. It might result in better adherence to regular physical activity regime and provide better health outcomes when used in combination with other modes of physical activity. Limitations of our study include a small number of participants and types of sedentary activities that warrants further studies. Future research is also needed to evaluate effect of the under desk exercise on employee productivity, health and weight loss.

 

Competing interests

Dr Vadim Dedov has a stake in MDXD Pty Ltd, which designed and produced the equipment used in this study.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Contributorship Statement

Both authors contributed equally in experimental design, data collection and analysis, and preparation of manuscript, which has been read and approved by them.

References

1.    Lee IM, Shiroma EJ, Lobelo F, et al. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012;380:219-29.

2.    Castillo-Retamal M, Hinckson EA. Measuring physical activity and sedentary behaviour at work: a review. Work 2011;40:345-57.

3.    Tudor-Locke C, Leonardi C, Johnson WD, et al. Time spent in physical activity and sedentary behaviors on the working day: the American time use survey. J Occup Environ Med 2011;53:1382-7.

4.    Pratt M, Sarmiento OL, Montes F, et al. The implications of megatrends in information and communication technology and transportation for changes in global physical activity. Lancet 2012;380:282-93.

5.    Archer WR, Batan MC, Buchanan LR, et al. Promising practices for the prevention and control of obesity in the worksite. Am J Health Promot 2011;25:12-26.

6.    Thompson WG, Levine JA. Productivity of transcriptionists using a treadmill desk. Work 2011;40:473-7.

7.    Levine JA, Miller JM. The energy expenditure of using a “walk-and-work” desk for office workers with obesity. Br J Sports Med 2007;41:558-61.

8.    John D, Bassett D, Thompson D, et al. Effect of using a treadmill workstation on performance of simulated office work tasks. J Phys Act Health 2009;6:617-24.

9.    Carr LJ, Walaska KA, Marcus BH. Feasibility of a portable pedal exercise machine for reducing sedentary time in the workplace. Br. J. Sports. Med. 2012;46:430-5.

10.  McAlpine DA, Manohar CU, McCrady SK, et al. An office-place stepping device to promote workplace physical activity. Br J Sports Med 2007;41:903-7.

11.  Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports. Exerc. 2007;39:1423-34.

12.  Norton K, Norton L, Sadgrove D. Position statement on physical activity and exercise intensity terminology. J Sci Med Sport 2010;13:496-502.

13.  Thompson WG, Foster RC, Eide DS, et al. Feasibility of a walking workstation to increase daily walking. Br. J. Sports Med. 2008;42:225-8.

Figure caption

Figure 1. (A) Position of the participant in stationary chair during exercise, using MedExercie ST device; (B) An example of exercise-induced temperature rise during 30-minute dedicated under desk exercise; (C) An example of the exercise-induced changes of participant’s pulse rate during 30-minute dedicated under desk exercise (bmp – beats per minute); (D) An example of exercise-induced temperature changes during under desk exercise concurrent with the use of computer; B-D: Pattern filled areas are periods of the actual using of the device. Double sided arrows show the duration of exercise intensity recordings. (E) Average intensity of device usage during the dedicated (DE) and concurrent (CE) under desk exercise, *P<0.01. (F) Average recording time of the dedicated (DR) and concurrent (CR) under desk exercise, and average duration of the actual device usage during concurrent exercise (CE); (G) A total amount of exercise achieved during dedicated (DE) and concurrent (CE) under desk exercise, *P<0.01.

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Vadim N. Dedov, M.D., Ph.DFaculty of Medicine, University of New South Wales, NSW, Australia

Irina V. Dedova, M.D., Ph.DSchool of Medical Sciences, University of New South Wales, NSW, Australia

 

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