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Canberra physiotherapy students’ commit to making every contact count for physical activity!

10 Sep, 17 | by BJSM

By Nicole Freene @NicoleFreene

A recent Australian study found no change in physical activity levels over the last 20 years. Nearly 60% of Australian adults are not doing enough to receive the health benefits of physical activity [1].

Health professionals need to take advantage of any opportunity to promote physical activity.

In 2015, Ann Gates (@exerciseworks) and her team launched a worldwide interdisciplinary, undergraduate teaching resource on exercise medicine for the prevention and treatment of non-communicable diseases. The physical activity resources consist of national and international strategies and infographics, background introductions, specific disease and health condition slide-sets, a text module, and advice on how to use the resources effectively.  They created a ‘Movement for Movement’ [2, 3]. Part of their mission states:

“A qualified doctor, nurse, midwife or allied health professional may see nearly half a million patients during their career: this has enormous potential for advocacy and the promotion of physical activity. Let’s make every contact count, for physical activity!”

At the University of Canberra we are cultivating this culture of physical activity promotion in our future physiotherapists. We aim to contribute to the movement of global health professionals that are ready to address the worldwide increase in non-communicable diseases. We have introduced the ‘Movement for Movement’ teaching resources to complement our current curriculum. Educating health professionals on the importance of physical activity is a strategy that has been clearly outlined in action plans to promote physical activity around the world [4-6].

The University of Canberra is ranked among the top 100 young universities in the world and is committed to preparing professional and highly employable graduates with the right mix of skills and knowledge. At the University of Canberra we have approximately 320 pre-qualification physiotherapists, a combination of both undergraduate (240) and postgraduate students (80).

In semester-1 2017 the ‘Movement for Movement’ disease and health condition slide-sets were made available to undergraduate and postgraduate physiotherapy students within the unit Cardiothoracic Interventions, and also distributed among the physiotherapy teaching staff. A focus of this unit is exercise-based cardiac rehabilitation. The ‘Movement for Movement’ slide-sets provide information on exercise and physical activity in heart disease and hypertension. The slide-sets also cover a number of non-communicable diseases, such as type 2 diabetes and cancer, and other conditions including pregnancy, surgery, and primary prevention of chronic disease.

Physiotherapy students were provided with the ‘Movement for Movement’ slides for review and future reference. All students were allocated time for self-directed learning to review all the slide presentations. Some of the material within the slide-sets was also covered in face-to-face lectures during the unit. Those that used the resource were asked to provide feedback via a brief survey. Students agreed that the ‘Movement for Movement’ content was engaging, presented in an interesting way and had excellent visual impact. The content in all topics increased their understanding of the benefits of physical activity and exercise; in particular, osteoarthritis, rheumatoid arthritis and dementia.

The students commented:

Really great resource for future and general understanding [of the health benefits of physical activity].

Having a background in exercise science, the material was nothing new, however it was a good refresher for me and I learnt the most from the pregnancy slides 🙂

Was presented very well. Was good for people wanting to complete at their own pace.

Great resources, thank you!

There are plans to distribute these resources more widely within the Faculty of Health to other disciplines such as Pharmacy, Nursing, and Occupational Therapy.

Physiotherapists should use their exercise specialization skills to promote physical activity in any setting. Providing the ‘Movement for Movement’ slide-sets has introduced and reinforced to our students the benefits of exercise and physical activity for a number of conditions early in their pre-qualification training. By educating our future physiotherapists at the University of Canberra to promote physical activity at any opportunity, we aim to make every contact count!


  1. Chau J, Chey T, Burks-Young S, et al. Trends in prevalence of leisure time physical activity and inactivity: results from Australian National Health Surveys 1989 to 2011. Aust N Z J Public Health 2017 doi: 10.1111/1753-6405.12699 [Published Online First: 27 July 2017].
  2. Gates AB. Making every contact count for physical activity–for tomorrow’s patients: the launch of the interdisciplinary, undergraduate, resources on exercise medicine and health in the U.K. Br J Sports Med 2016;50(6):322-23 doi: 10.1136/bjsports-2015-095489 [Published Online First: 19 October 2015].
  3. Gates AB, Kerry R, Moffatt F, et al. Movement for movement: exercise as everybody’s business? Br J Sports Med 2017;51(10):767-68 doi: 10.1136/bjsports-2016-096857 [Published Online First: 2 May 2017].
  4. National Heart Foundation of Australia. Blueprint for an active Australia. 2014.
  5. World Health Organisation. Physical Activity Strategy for the WHO European Region 2016-2025. 2016.
  6. World Health Organisation. Draft WHO global action plan on physical activity 2018 – 2030. 2017.



Clinical Assistant Professor Nicole Freene is a physiotherapist at the University of Canberra.



Ann Gates @exerciseworks

New (free, online) course highlights the importance of physical activity in healthcare services

1 Feb, 17 | by BJSM

  • NEW Exercise and Health course by Peoples-uni, pulls together a set of presentations developed by an international team of experts, led by Ann Gates, CEO of Exercise Works
  • The program contains data from different countries and encourages students to perform interventions to increase physical activity locally and/or nationally.

Peoples-uni, the UK-based charity focused on providing affordable education in Public Health, recently debuted its new short online course, Exercise and Health: The course is based on a set of world class presentations prepared by an international team of experts in exercise and health, led by Ann Gates, CEO of Exercise Works and a member of the World Heart Federation Emerging Leaders Programme. This organization is dedicated to leading the global fight against cardiovascular disease (CVD), including heart disease and stroke and other non-communicable diseases (NCDs) with physical activity and exercise.

The course is an inter-disciplinary educational resource designed to help global healthcare professionals and community health advocates understand four important points:

  • The size of the problem of physical inactivity in populations globally
  • The role of physical inactivity in non-communicable diseases
  • The benefits of exercise in treatments and prevention
  • To encourage students and those who access the course to perform and evaluate interventions to increase physical activity in their patients at local and/or national settings.

The course contains presentations and resources made available to all undergraduate medical and health schools to use. These have been endorsed by the United Kingdom Council of Deans of Health. Data from different recognized sources such as Global Observatory for Physical Activity and the World Health Organization are also included. At the end of the course, students can earn a certificate.

Ann Gates: “We are delighted to partner with the Peoples-uni on this exciting leadership initiative to provide low and middle income health care students with access and support to the Movement for Movement campaign and educational resources. We hope that this work inspires health care professionals to help patients, communities and nations to move more, and move well!”

Professor Richard Heller from People’s-uni affirms: “We are proud and delighted to provide access to this excellent set of resources, on a topic of major public health importance, to a global audience of health professionals.”

Professor Ged Byrne, Health Education England’s Director of Education and Quality for the North confirms: “I support this initiative and look forward to the impact it will have on educating health professionals about the importance of physical activity on health. This is very relevant to Making Every Contact Count “ 

Physical exercise to address cardiovascular and other diseases

The World Health Organization (WHO) and the Institute for Health Metrics and Evaluation, identifies cardiovascular diseases (CVD) such as heart disease or stroke, as the number one cause of death around the world, and 1 in 3 deaths globally are as result of CVD, yet most premature heart disease and stroke is preventable.

Many of these NCDs relate to sedentary and physically inactive lifestyles and physical inactivity is the fourth leading risk factor for global mortality. Regular moderate intensity physical activity (walking, cycling or leisure activities) is proven to provide very significant benefits for health and wellbeing as they can reduce the risk of CVD, type 2 diabetes, colon cancer, breast cancer, and depression (WHO).

That is why physical activity promotion, or the inclusion of exercise and active lifestyles in the designing of active lives is key. Therefore, training of health professionals in the benefits of exercise on their interventions and methods is an essential part in the strategy against CVD and other diseases, and Peoples-uni has joined this initiative to promote and protect individual health through regular physical activity.

How to access the course and about People’s-uni OOC courses

The program is part of People’s-uni short Online Open Courses (OOC), a range of short courses designed for self-study, available for free in an open access site, which also offers the possibility for to earn a certificate. The OOC initiative by Peoples-uni is a simple, quick, an affordable way for health professionals, or anyone interested in, in getting more specialization in certain public health related topics, or going deep into certain areas of general interest. For more information:

About Peoples-uni

Peoples-uni is a UK-based charity dedicated to offer affordable education in Public Health. Its main mission is to contribute to improvements in the health of populations in low- to middle-income countries by building Public Health capacity via e-learning at very low cost. To do that, Peoples-uni initiative offers master-level educative programs and short Open Online Courses (OOC). Individual course module development and delivery teams have involved more than 250 volunteers from more than 40 different countries

For more information visit

About Ann Gates and the team of contributors for the resources

Ann Gates ()is a health care leader, clinical pharmacist, and exercise educationalist. She started her career as a clinical pharmacist in the NHS but quickly became interested in leadership and service planning. Ann is CEO and founder of Exercise Works but has also worked as NHS Director of Strategic Planning and as Head of Health Strategy, for Trent Strategic Health Authority, UK. She is passionate about global health, action on inequalities, and exercise medicine.

The resources were curated and authored by Ann as part of an international, collaborative health project including over 60 expert authors, health care students and educational evaluators.


World Heart Federation, fact sheet –

Exercise medicine resources launched for health and social care students

18 Nov, 16 | by BJSM

*Media Release*

Working with the Council of Deans of Health, Exercise Works! has launched the latest update of its physical activity and health resources designed specifically to support teaching in undergraduate health programmes. The “Movement for Movement” resources equip health and social care students to promote physical activity in the prevention and treatment of disease.

The resources on exercise medicine and health for undergraduate education were endorsed by the Council of Deans of Health when they were first launched in 2015. The revised version contains the latest evidence for future health professionals to use in discussing lifestyle medicine with their patients and deliver safe and effective exercise advice.

Ann Gates, Director of Exercise Works! said:

“I’m delighted to be able to launch these updated resources that address one of the most pressing public health challenges of our time. I look forward to seeing how universities use them to strengthen teaching about exercise in their programmes.”

Read more about Movement for Movement in this:

BJSM blog: A Movement for Movement: what’s art got to do with it? A lot. and;

BJSM Editorial: Movement for movement: exercise as everybody’s business?


For more information: Contact Ann Gates @exerciseworks


A Movement for Movement: what’s art got to do with it? A lot.

23 Oct, 16 | by BJSM

By Ann Gates @exerciseworks

The newly published “Movement for Movement” editorial (Gates et al) heralds a new era of framing and dealing with the deeply entrenched life style issues that contribute to the rise in the global burden of diseases (1). It uses physical activity as a case study and identifies areas where the physical activity community must work to build capacity and cultural practices in order to implement sustainable results (2). Overall, the editorial addresses: (i) moving forward as a community of practice, (ii) initiating action by the many, and (iii) synergising the way we work together to achieve the World Health Organization goals for physical activity.



The editorial, together with Figure 1 and the web appendix, highlight positive examples from working as a “community of practice.” They also relate principles from the Impressionist Art Movement.

The Impressionist’s way of working and achievements demonstrate disruptive innovation, and different ways of working in a community of practice to propel bottom-up change. The result, was a legacy of respect for their art and culture

Attributes of the Impressionist movement fit perfectly with the wider community approach necessary to deliver physical activity guidelines and strategies. There are 3 basic elements to a community of practice: the domain, the community,  and the practice (3). These basics deliver the desired operational outcomes. Figure 1 demonstrates concrete examples of how this could, should or would work (3).


How real is a community of practice for physical activity and are we already starting to work in this way?

The concept of a community of practice is not new. Further, examples of ways of working as a community of practice for physical activity are already distinguishing themselves:

  1. Social media is similar to the “Salon” culture of Impressionist artists, painters and patrons, as it serves as a test bed for new ideas and feedback. It provides a conduit for continuous professional development and social interest sharing. This reflects the rapid learning style of the artists and how they adapted they own techniques to create masterpieces that challenged society and the public’s perception of what constituted art. Action by physical activity advocates on social media is no different: one great “retweet or share” is rapidly adapted to real life action and further creativity!
  2. The use of massive open online courses provides the opportunity for all to garner knowledge and skills, but it is only the first step. Increasingly such open online courses can be supported (as opposed to just self-study) and especially by volunteers and enable sharing and caring through discussion forums and which is essential for PA implementation. It provides the platform for “conversations” and generates the community feedback needed to inspire participants to reflect and act differently. Further, it translates knowledge into everyday clinical practice and strategic influence. This mirrors the way in which the Impressionists developed their unique art style and mastery.
  3. By combining these new paradigms and shifting the way in which we share, learn, translate knowledge and apply skills to individuals, patients and communities, we can start to realise something special: a unique way of progressing the physical activity agenda and culture of change. The recent use of national and international infographics to convey a public health message (4) is an example of how organisations and individuals are changing the communication values of health practice.

In summary, the community of practice approach has the currency to transcend the barriers and doubters, ignore the financial politics that have prevented a societal culture of “active lives for all”, and enable a movement for movement that is truly a social, cultural –a rich movement of people who can do (5).

“A Movement for Movement” as a community of practice

So what has the art got to do with communities of practice? Perhaps Monet, describes it well: “It’s on the strength of observation and reflection that one finds a way. So we must dig and delve unceasingly”.

May we aspire to apply these community of practice principles to our own work in SEM, and disease prevention (7) – a physical activity advocacy movement that transcends (8): cultures, politics, and strategic inertia, would indeed be an impressive work of great art.

A movement for movement that can make every contact count and every influence matter for patients, communities and nations.

Let’s start painting the future together! (9)

Read the full editorial HERE.


  1. Pedersen BK, Saltin B. Exercise as medicine – evidence for prescribing exercise as therapy in 26 different chronic diseases. Scand J Med Sci Sports. 2015 Dec;25 Suppl 3:1–72.
  2. Reis RS, Salvo D, Ogilvie D, Lambert EV, Goenka S, Brownson RC. Scaling up physical activity interventions worldwide: stepping up to larger and smarter approaches to get people moving. The Lancet [Internet]. 2016 Jul [cited 2016 Aug 11]; Available from:
  3. Wenger-Trayner E, Wenger-Trayner B. Introduction to communities of practice [Internet]. 2015 [cited 2016 Aug 11]. Available from:
  4. Infographics: Infographic. Make physical activity a part of daily life at all stages in life. Ann B Gates, AD Murray. Br J Sports Med bjsports-2016-096643Published Online First: 29 July 2016doi:10.1136/bjsports-2016-096643
  5. Andersen LB, Mota J, Di Pietro L. Update on the global pandemic of physical inactivity. The Lancet [Internet]. 2016 Jul [cited 2016 Aug 11]; Available from:
  6. Global Burden of Disease Study 2013 Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. The Lancet. 2015 Aug;386(9995):743–800.
  7. le May A. Communities of Practice in Health and Social Care. Oxford: John Wiley & Sons; 2009.
  8. Wenger E. Communities of Practice: Learning, Meaning, And Identity. New Ed edition. Cambridge, U.K.; New York, N.Y.: Cambridge University Press; 2000.
  9. Ganz M. In: Nohria N, Khurana R, editors. Handbook of Leadership Theory and Practice: A Harvard Business School Centennial. Boston, Mass: Harvard Business School Press; 2010.


Ann Gates is a Member of the World Heart Federation Emerging Leaders Programme, Associate Editor of The British Journal of Sport and Exercise Medicine, and CEO of Exercise Works! She is passionate and interested in cultures and art.

Glasgow Medical School leading the way on physical activity education: our three steps to success!

27 Mar, 16 | by BJSM

By Dr John Paul Leach

Like many clinicians and medical educators, I am convinced of the need to energetically promote physical activity to all strata of society, but especially students and patients.

I am lucky, in that my joint role as an educator and clinician, I have a chance to do just this – promote physical activity for individual patients, and also l educate our future doctors that exercise is a vital [clinical] sign thus, laying the foundations of a grassroots approach to enhance physical activity.

March 28 Glasgow Med Students

Used with permission from Glasgow Medical School

I am a consultant neurologist in Glasgow, and for the last year I have been Head of Fifth Year in the University of Glasgow’s School of Medicine, UK. It is rewarding and productive to wear both hats, in the fight to get people moving more.

One of the main challenges in the campaign to make physical activity part of everyday life, is its inclusion in everyday medical practice. The Scottish Government has rightly become convinced that changing how our population engages with regular physical activity, will secure the long term benefit across all aspects of society and life. The Academy of Medical Royal Colleges has also been unequivocal in its support for promotion of physical activity: recognising the efficacy, and cost effectiveness of physical activity, and its long term benefits in treatment and prevention of many chronic illnesses.

If the notion of increasing counselling and prescription in physical activity in primary and secondary care is to have any chance, it must become part of clinical thinking and practice, and at the earliest stages of medical training.

The School of Medicine at the University of Glasgow has led the way in implementing changes to enhance consideration of physical activity by its students in both personal and professional settings. Three central considerations for Glasgow Medical School are:

  • Physical activity promotion became a new theme for one of our sessions in Preparation for Practice and also for a fourth year Academic Day. It was great to see the students respond to the leadership and exhortations by Ann Gates (@exerciseworks) on a “movement for movement” by standing for the entire 45-minute talk! The Twitter and other social media feedback showed their engagement as they heard about the evidence base for the benefits of exercise in medical conditions and rehabilitation, as per the World Health Organization and Chief Medical Officers’ guidance.

This taught material was directly examined in the written finals of the medical school – we suspect anther first for Glasgow!

  • If healthcare professionals are to be credible advocates for healthy lifestyles, they need to be visible exponents. Further, the evidence for exercise in preventing career burnout for healthcare workers is developing. For both reasons, we sought to encourage our students to exercise more, including drafting a statement produced by our senior management group, encouraging staff and students to continue regular exercise during term time, unless prevented by fixed teaching commitments.
  • Is this making a difference? It is naive to think practice is changing already, but we have begun to audit physical activity discussions in our neurology unit. We suspect this is rarely discussed or documented, but if things keep on like this we expect more such discussions and interventions in coming years!

We see these as the first steps in providing comprehensive advice for patients. The only way to guarantee future positive moves for physical activity promotion is to have continued buy-in by all doctors, especially at a junior level.

The next step is: “it’s time to get the profession and the public, moving”.

We hope that Glasgow Medical School continues to champion the way!


Dr John Paul Leach, Consultant Neurologist, Honorary Associate Clinical Professor, Head of Fifth Year, Glasgow Medical School, Glasgow, Scotland, UK. and @jpleach246

Undergraduate Physiotherapists at Sheffield Hallam University use Interdisciplinary Exercise Medicine Resources

14 Nov, 15 | by BJSM

By Anna Lowe

In 2014 Exercise Works! (an organisation that promotes the prevention and treatment of non-communicable diseases) made huge steps forward to enhance the exercise-related content of medical undergraduate curricula. The project “Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients” (Tomorrow’s Doctors), funded by Public Health England, led to the development of exercise medicine and chronic disease resources for all UK undergraduate medical degrees.


Following on from the success of “Tomorrow’s Doctors”, these resources have been revised and made available for all undergraduate nursing, midwifery and Allied Health Professions courses internationally.

At Sheffield Hallam University we have approximately 300 undergraduate physiotherapy students and we are delighted to be using the resources to support our training of “Tomorrow’s Physiotherapists”.  Our physiotherapy approaches must evolve to keep up with a changing and growing population.  Exercise medicine is a core part of our undergraduate curriculum, in view of the rise of long-term conditions and the ageing population, the need for exercise prescription skills is greater than ever before.  The resources are a selection of PowerPoint presentations on subjects ranging from “Mental Health & Exercise” to “Physical Activity Leadership”.  We will evaluate staff and student perspectives and promote the resources to other health courses within the University.

Sheffield has a rich history of physical activity and it has recently claimed the title of The Outdoor City.  It borders the Peak District and benefits from an abundance of green space and beautiful landscape; something that brings many students to the city and keeps them here long after their studies finish.  With the help of Olympic Legacy projects such as Move More (a city-wide physical activity strategy) and the National Centre for Sports and Exercise Medicine the physical activity infrastructure continues to grow and physical activity is becoming firmly embedded in the personality of the city.

Despite this, Sheffield is a city of contrast with large geographic variations in health and disability. Contemporary health education requires a deep understanding of the wider determinants of health, particularly in relation to health behaviours.  Every patient contact is an opportunity to impact, not only on the presenting complaint, but also on overall health & wellbeing.  A physiotherapist may see up to half a million patients in their career, many of these patients will have long-term conditions and will therefore be at risk of disability and early death.  As a profession we must ensure that we keep exercise at the heart of everything we do and that no opportunity is wasted!


Anna Lowe is a Senior Lecturer in Physiotherapy at Sheffield Hallam University


Ann B Gates is founder of Exercise Works!


World Heart Day: Promote physical activity for cardiovascular health!

26 Sep, 14 | by BJSM

By @exerciseworks

heart dayCardiovascular disease (CVD) is the world’s number one killer. It’s already responsible for 17.3 million deaths per year, and by 2030, expected to rise to 23 million deaths. This year, World Heart Day’s theme on September 29th, 2014 is creating heart-healthy environments. Join us in creating a healthier future for all. Help influence the design of physical activity opportunities that are fun, engaging and most importantly offer better health options for all our patients!

Physical inactivity is the world’s 4th biggest cause of death. Sedentary living has become the norm. We’ve created environments where we are expected to sit and stare. The places in which we live, work and play should not increase our risk of heart disease and stroke. Active transport, active environments, and active spaces can make our lives healthier and more playful (Gates, 2014). We need to actively design heart healthy environments and change those places which encourage sedentary lifestyles. Physical activity and heart healthy exercise is an important part of our daily life. The environments where we live, work, and play hugely effect our ability to make the right choices for our heart health, especially in increasingly urban environments.

So how can health professionals achieve everyone active, every day, within heart healthy environments?

Here are my views:

  • All health professionals have a unique role to promote physical activity and protect the public from sedentary behaviours and the risks of non-communicable diseases (NCDs). They need to promote physical activity within the consult environment. They need to shift the paradigm of a medicalised approach to one that proactively, and engagingly, increases exercise as a medicine in patient care. Patients deserve a choice- and that choice should include a variety of options for exercise prescription.
  • Health professionals need to provide “teachable moments” on heart disease risk within every consult and promote heart healthy exercise and physical activities. Cradle to grave. All cultures. Within all abilities. Every consult.
  • The culture of physical inactivity within a patient’s life and in the communities where they live and work needs to change. Health professionals need to be trained, skilled and capable to influence patients’ heart healthy choices within those environments. Informed patients are our best advocates!
  • In a heart-healthy environment people have the opportunity to make the right choices for their health. So whatever gender, culture, social status, or other determinants of heart health your patients have, isn’t it time to make every contact count for physical activity advice and heart health? Isn’t it time to use your professional influence to change environments within the home, work, school, communities, and in other ‘inactivity generating, life sapping environments’?
  • Let’s use what strategic support we already have. Recent research shows the challenge of national level change. However, Public Health England identified that by moving professionals to mobilize their networks for influence, we can strategically achieve sustained change on physical inactivity. We already know the National Health Service (NHS) and many international health organisations already have the information and clinical networks to advocate for ‘Making Every Contact Count’. Their action is key to getting nations active. All sectors and disciplines can play a role, not just those who already work in health. Professionals and advocates in urban planning, product design, social care, psychology, sport and leisure, media, trade unions, education and business can help bring radical change. But we need to work effectively and collaboratively to ensure long lasting heart health, for everybody. Become disruptive innovators for heart health!
  • Encourage all patients to enjoy variety of heart healthy exercises. For some ideas for patients’ exercises see here and further resources.
  • NHS and health care commissioners should be ‘governed’ to:
    • require training of provider staff on the role of physical activity in the care pathway and opportunities for maximising patient care through its use (NICE PH44 2013)
    • Require brief intervention training in physical activity provider contracts to ensure that all patients access exercise advice and support (NICE PH44 2013)
  • NHS and health care providers should be ‘legally’ required to:
    • ensure all health and social care staff are trained and assessed for their competence in brief interventions and motivational interviewing techniques for lifestyle modification e.g. physical activity and mental wellbeing (such as ensuring this is an essential skill in all health care job descriptions)
    • create an environment which values a ‘making every contact count approach’ to personalised care.

By creating heart healthy environments, collaborating across sectors, and training health care professionals to make every contact count for physical activity we can make the future of heart health better.

Seeing patients in your clinic today? Then please provide health healthy exercise choices for every patient. Be world class in heart health- help your adult patients to walk more, sit less and exercise for at least 150 minutes each week. Help children to access at least 60 minutes each day of active play. Together we can beat heart disease and physical inactivity!

Also, watch (and share) this great short video: Make a healthy heart your goal: Get active on World Heart Day

Follow #worldheartday #heartchoices

Ann Gates MRPharmS @exerciseworks

Member of the Emerging Leaders Programme 2014-2015, World Heart Federation.






Seeing patients today? “Heart healthy” exercise advice can be a life saver for men, women and children via @exerciseworks

26 Feb, 14 | by BJSM

@exerciseworks guest blog series on physical activity and cardiovascular health: Part 2

Heart disease is the leading cause of death for both men and women.

exercise works 2Reduction of heart disease risk in patients is significantly linked to modifiable factors (such as tobacco use, poor diet, physical inactivity, obesity, alcohol use) or factors that can be changed to reduce the risk of further ill health and heart disease (such as appropriate blood pressure control, lipid management and the availability of essential medicines and technologies to treat cardiovascular disease). More than half of the deaths worldwide (due to heart disease) are in men.

Physical inactivity is a major contributor to all types of cardiovascular disease risk- yet regular physical activity can help maintain a healthy weight, lower cholesterol and blood pressure, and help reduce the risks associated with an inactive lifestyle. Children who are inactive are also at risk of developing heart disease and stroke risks earlier in life. A simple solution, you would think, such as helping each of your patients to exercise more, would and should work!

Providing physical activity advice and support to every patient, is an essential part in the prevention and treatment of all aspects of heart disease and stroke health care.  The World Health Organisation is clear on the physical activity message:

Every adult needs to enjoy physical activity for at least 150 mins a week:

  • Adults aged 19–64 should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week or do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week or an equivalent combination of moderate- and vigorous-intensity activity.
  • Aerobic activity should be performed in bouts of at least 10 minutes duration.
  • For additional health benefits, adults should increase their moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.
  • Muscle-strengthening activities should be done involving major muscle groups on 2 or more days a week.

An exercise prescription can include walking, hiking, swimming, dancing, running, jogging, sports and gym activities, or physical activities in leisure time also help to promote heart health!

Every child and teenager needs to enjoy active play and opportunities to exercise:

  • Children and youth aged 5–17 should accumulate at least 60 minutes of moderate- to vigorous-intensity physical activity daily.
  • Amounts of physical activity greater than 60 minutes provide additional health benefits.
  • Most of the daily physical activity should be aerobic. Vigorous-intensity activities should be incorporated, including those that strengthen muscle and bone*, at least 3 times per week.
  • *For this age group, bone-loading activities can be performed as part of playing games, running, turning or jumping.

The exercise ‘prescription’ for children and young adults should emphasise active play, fun, inclusivity and less sitting.

Health professionals are skilled at supporting patients to make the right choices for their best health outcomes. There is no better preventative medicine that you can prescribe than to help encourage and support your patients to exercise daily!

The clinical benefits of regular physical activity on cardiovascular risk factors for patients have been well reviewed but you can summarise for patients as:

  • able to exercise more: regular exercise increases exercise tolerance and stamina
  • reducing body weight: a loss of just 5 to 10 percent of weight can lower your patient’s risk of coronary heart disease. Regular exercise advice together with a healthy eating programme can help your patients achieve this. Many people may need more than 150 minutes/week of moderate intensity activity a week to stay at a stable weight, as well as to lose weight or keep off weight they have lost. (U.S. Dept. of Health and Human Services. 2008 Physical Activity Guidelines for Americans, 2008)
  • a lowering in blood pressure: the average reduction in blood pressure ranges from 7.4mm to 5.8mm Hg in hypertensive study patients
  • reduction in ‘bad’ (LDL and total) cholesterol
  • increase in good (HDL) cholesterol
  • increase in insulin sensitivity: both aerobic and resistance training improve insulin action, blood glucose control, and fat oxidation and storage in muscle. This means that the risks of developing metabolic disorders and type 2 diabetes are significantly reduced with regular physical activity

And finally, as I’m a British Association Cardiac Pulmonary Rehabilitation exercise instructor….

Cardiac or stroke rehabilitation programmes (cardiac rehab) reduce the risks of a further cardiac event by stabilizing, slowing or even reversing the progression of cardiovascular disease. In the USA, only 14-35% of heart attack survivors and only 31% of coronary artery bypass surgery participate in a cardiac rehab programme. In the UK, the average attendance rate post cardiac event is 43%.

Please support, advise, engage, signpost, enable, encourage, prescribe, refer and educate patients as to the benefits of attending their local cardiac rehabilitation programme- it is life-saving medicine after a cardiac event and continuing as a lifelong prescription. Every patient should be able to access cardiac rehabilitation programmes locally, and bespoke to their cultural needs.

In summary: heart healthy exercise prescriptions are critical care medicine at their finest. Let’s start prescribing exercise and fun, physical activities and monitoring our patients at risk of heart disease, every consult they attend, and at every opportunity in their health care pathway!

And remember….. refills and repeat prescriptions of this life saving prescription are on a weekly basis of 150 minutes/week, but review as a ‘vital sign’, every consult!


Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works! in celebration of World Heart Month February.

Member of the WHF Champion Advocates Programme – Emerging Leaders Programme.

Info graphics courtesy of the World Heart Federation Champion Advocates Programme.


Seeing patients today? There is one life saving intervention you can prescribe- it’s called daily exercise! via @exerciseworks

23 Jan, 14 | by Karim Khan

@exerciseworks guest blog series on physical activity and cardiovascular health: Part 1

Daily life in the 21st century, often limits our health outcomes and aspirations. Our world: whatever nation we are part of, and the communities in which we live, together with our loved ones, have stopped moving at the levels of physical activity consistent with daily health. Urbanization, sedentary lifestyles, poverty, obesogenic environments, poor access to healthy food choices are all examples of how the global epidemic of inactivity and the pandemic health burden of non-communicable diseases (NCDs).

The World Health Organisation believes that more than 60% of the global population is not sufficiently active. In fact, inactivity is the world’s 4th biggest killer. The link between inactivity and heart and stroke disease is well documented. The total number of deaths due to heart and stroke disease is now over 17.3 million a year. Today, in your clinic, hospital ward, or community dwelling there are patients at risk of heart disease and premature death. That loss of diversity and life’s potential is no longer acceptable as an outcome for heart health.

Ann 17 mil deathsPhysical activity, at any age, for any gender, within all cultures and ethnicities, within any ability, can protect your patient against a multitude of chronic health problems, including many forms of heart and stroke disease. Exercise works by regulating and maintaining weight and improving the body’s use of insulin. It also reduces the body’s inflammatory responses thought to increase the risks of a variety of NCDs. In 2012, we asked all health professionals to help encourage their patients to become more physically active and to embrace the concept of exercise as a ‘vital sign’ in their daily, clinical practice. This is because the known health benefits were becoming clinically clear: asking your patients to exercise for at least 150 minutes a week, significantly reduces their risk of chronic diseases, especially heart and stroke disease. Most importantly, it makes patients feel in control of their health, able to move without pain and discomfort, reduces their risks of disability and significantly improves their quality of life. For the secondary prevention of heart disease, the evidence for physical activity shows it is effective in reducing cardiovascular risk.

So, when you see your patient during your consultations as a doctor or allied health professional, what are your clinical decisions going to be, today?  Are you going to champion the best medical evidence to date and prescribe a graduated dose of medical treatment in the form of exercise? Or are you going to ‘disable’ the patient by not addressing a root cause of their ill health, by not prescribing a medicine (such as exercise), which in fact, works better than most medicines, especially in heart disease and stroke?

As part of brief intervention, you can choose a specific exercise prescription, which supports and prevents your patient from the risks of inactivity and significant ill health, and lowers their risk of heart disease.

Helping them to exercise, daily, within their abilities, environments, lifestyle, and do whatever it takes to save their life from disability and further risks of cardiovascular disease is a critical medical intervention. As an example, a middle aged woman, doing less than 60 minutes of exercise per week, doubles her risk of dying from a cardiovascular event compared to a physically active woman of the same age. If that minimally active woman was a loved one, wouldn’t you want someone to help and support her to get physically active?

Ann Gates shoesA basic form of brief intervention, is to ask your patients to start a daily, walking programme, and sit much, much, less.  Suggest they aim for at least 150 minutes each week of moderate ‘effort’ exercise. Follow up with each patient, at each visit, on that exercise advice. Monitor the exercise prescription.

By choosing to prescribe a medicine that’s evidence based, easy to take, has few harmful side effects, and great health outcome data, you can feel that you have excelled in your clinical practice. Patients may be reluctant to take your advice and the medicine. But if you were an oncologist, and your patient needed the best cancer treatment, you’d persuade them to accept chemotherapy based on the clinical evidence. So why is inactivity and heart disease prevention any different?

All health professionals can be and make the difference: to help reduce physical inactivity by 10% and help your clinical specialty colleagues, to confidently prescribe a range of disease specific exercises for all suitable patients. This, in conjunction with the medical treatments, will provide an effective approach to improving patient and public health, and be a combined strategy to reducing inactivity in patients with chronic diseases.

By encouraging patients to be more active on a daily basis and helping them choose to improve their leisure physical activities and maybe even try a sporting activity, this new approach has the ability to trend healthier lifestyles within your communities. Perhaps, one day you will realise that by prescribing exercise for your patient, you have helped save their life.

Heart health is important. It is essential that all patients are supported to enjoy daily exercise and physical activities that reduce their risks of heart disease. Help patient’s ask for support to access exercises of their choice, from their health and social care provider.

Globally, the Champion Advocates Programme is a World Heart Federation (WHF) initiative whose goal is to reduce premature deaths caused by cardiovascular disease (CVD) by 25% by 2025. It’s an ambitious goal…..but one that I would love the health, sports and exercise communities to embrace and champion…. because, since when did doctors and allied health professionals, around the world, not rise to a significant clinical challenge and deliver world class medicine!


Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works!

Member of the WHF Champion Advocates Programme – Emerging Leaders Programme.

Info graphics courtesy of the World Heart Federation Champion Advocates Programme.

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“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.


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.

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