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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 –

Not all steps are equal: Changing algorithms in wearable trackers changes outcomes

20 Jan, 17 | by BJSM

By Muaddi Alharbi, Robyn Gallagher, Lis Neubeck, Adrian Bauman, Patrick Gallagher

This blog discusses JM, a female patient recovering from a heart attack. She is just one example of many patients I have encountered who monitor and track their activity using a wearable tracker. JM shared her experiences and her disappointment that her normal walk had less activity recorded from one day to the next. Her friends at cardiac rehabilitation all noticed the same thing and had the same concerns. Fortunately, I was able to let them know that Fitbit had changed its algorithm for tracking minutes of moderate to vigorous activity and that this was the reason for the lower recorded activity levels.

What does this change in algorithm mean?

The algorithm for activity trackers has changed so that increments of moderate to vigorous activity are no longer recorded in single minutes, but in 10-minute bouts. Previously, Fitbit just counted very active minutes when calculating a user’s overall minutes, but from now on it will only count active minutes if a wearer engages in an activity for over 10 minutes. So, in practical terms this doesn’t mean much to an athlete (who believes more in the ‘no pain no gain’ approach), but to someone starting a recovery activity program the sudden change could be the difference between achieving goals and giving up. A patient exercising for 39 minutes for example would now see their activity recorded as three 10-minute bouts, not as four 10-minute bouts. Thus, the 10-minute bout threshold would need to be met with each separate exercise or physical activity session. More importantly, the change to the algorithm is more likely to affect how the device tracks the length of time the wearer spends sitting down (sedentary time). Not standing is linked to many chronic health problems, as is sitting for up to 7 or 8 hours a day – which can increase the risk of death by 5%1, 2.

Wearable activity tracking devices have sparked interest worldwide and provide a novel approach to monitoring physical activity. Data generated by these devices can be used by consumers, researchers, clinicians, and insurers to improve health and wellness. They can also help people to have better discussions with their doctor about their health. These benefits are so valuable that the National Health Service NHS ( in the United Kingdom has even announced that it will provide trackers and apps upon prescription to people with heart disease. Given their important role in managing health and wellbeing, it is not surprising that global wearable tracker sales have dramatically increased. A report showed ( 5a47b) Fitbit, the most popular brand of tracker, has sold almost 21.5 million devices worldwide with the Apple Smartwatch hot on its heels with 12 million sales.

How precise do we need activity trackers to be? This is debatable. Manufacturers can change the algorithm they are using to calculate activity at any time, and from time to time, they have made such changes. But they don’t need to tell users – and that is the problem. This can have marked effects on activity outcomes and monitoring.

Every minute matters

Wearable activity trackers provide innovative ways to monitor your physical activity in real time, with little inconvenience. Importantly activity trackers may also be an activity motivator.  Indeed, they have the potential to motivate wearers to achieve their activity goals through a combination of elements such as self-monitoring, continuous feedback on progress, the ability to set reasonable goals, access to social support, and enhanced self-confidence. But how important is the device’s tracking accuracy and encouragement for the wearer to achieve personal activity goals (e.g. number of step counts or active minutes)? This is the issue we need to debate.

A change in the algorithm will change the results. So, when Fitbit™ announced it was changing the algorithm used to track active minutes it was understandable that the wearer was left feeling very confused about what the new readings may mean. Fitbit™ explained that the new10-minute rule meant that from now on, the wearers’ active minutes may sometimes appear lower than what they were used to.  Highly active people who do a lot of physical activity over the day may regard this as only a small change that requires a relatively simple adjustment in how they monitor their daily activity. For other less active wearers, changing the algorithm may motivate them to set small goals – that is to encourage them to complete the 10-minute bout of activity.

Yet, things are not so simple for researchers and for patients recovering from a disease, where every minute of activity matters for monitoring or motivational purposes. For instance, the severity of disease for patients with heart failure is different than for patients who have not experienced heart damage such as occurs with elective coronary interventions. This can affect the patient’s personal goals for achieving the recommended accumulation of active minutes. It appears the manufacturers are not fully clear about the different ways the devices are used, or can be used. Contributing to the confusion is the fact that the manufacturers are very secretive about the algorithms they use to calculate the active minutes.

Can we trust our trackers?

Before we can trust our trackers we need research that shows the algorithms are good for accurately calculating cumulative moderate/vigorous minutes of activity and steps over the day. This will help to sharpen the accuracy of the trackers, build credibility, and to make sure the tracker algorithm supports the health experts’ recommendations for physical activity.

Studies lose precious time

Research is being undertaken and the evidence is building on the accuracy of the algorithms being used in activity trackers. Some studies have even recommended the use of Fitbit devices in specific clinical settings to measure physical activity. For instance, Alharbi et al.3 revealed Fitbit-Flex is an accurate monitor to measure free living physical activity (i.e., step counts and minutes of moderate to vigorous physical activity) in phase III cardiac rehabilitation participants. This study clearly demonstrated Fitbit-Flex being within 20% of the acceptable validity criteria for clinical purposes to measure step counts and minutes of moderate to vigorous physical activity. However, Fitbit-Flex exceeded the acceptable validity criteria for research purposes which is within 3%3. Similarly, a study conducted in a laboratory setting showed Fitbit-One has high accuracy to measure step counts in healthy young adults, with percent relative error below 1.3% for all tested treadmill walking speeds and for multiple placements (e.g. on the hip or in the pocket)4. Therefore, when manufacturers make changes to the algorithm the evidence from these studies becomes outdated, and so reopens the question of their reliability.

Where to from here?

Change is constant in the world of health and fitness. One such change is that people are gaining more control over their lifestyles, health, and future well-being by using wearable activity monitoring devices. There is no doubt that these trackers help to achieve better health outcomes and disease reduction. But tracker manufacturers need to keep users and researchers up to date about any changes they make to the algorithms. Being informed fosters trust and strengthens connections between users and manufacturers. It also helps researchers, physicians, clinicians, healthcare systems and insurance providers to properly respond the changes and assist people to achieve their health goals.

Take home messages

  • Clinicians, patients and researchers are eager to have accurate trackers to monitor and motivate physical activity. Therefore, tracker manufacturers should ensure that the device algorithm provides a high level of accuracy similar to those of known devices such as a research-grade accelerometer (the Acti-Graph)
  • System developers and designers need to ensure open lines of communication with researchers and consumers when changing algorithms to gain their trust
  • Researchers should be mindful of the possibility that tracker manufactures may change their algorithms in the middle of a longitudinal research study without any notification. Thus, supplementary evidence of field-based performance is crucial to ensure data safety


Muaddi Alharbi is doing his PhD in activity tracking and has worked extensively with cardiac patients. You can find out more on Twitter @muad11


  1. Chau JY, Grunseit AC, Chey T, et al. Daily sitting time and all-cause mortality: a meta-analysis. PLoS One. 2013; 8: 1-14.
  2. Ekelund U, Steene-Johannessen J, Brown WJ, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta-analysis of data from more than 1 million men and women. The Lancet. 2016; 388: 1302-10.
  3. Alharbi M, Bauman A, Neubeck L and Gallagher R. Validation of Fitbit-Flex as a measure of free-living physical activity in a community-based phase III cardiac rehabilitation population. Eur J Prev Cardiol. 2016; 23: 1476-85.
  4. Takacs J, Pollock CL, Guenther JR, Bahar M, Napier C and Hunt MA. Validation of the Fitbit One activity monitor device during treadmill walking. J Sci Med Sport. 2014; 17: 496-500.

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.

#MakeYourDayHarder campaign launch: who, what, when, where, and why?

10 Jun, 15 | by BJSM

By Dr. Mike Evans


What: on June 11 we are launching #MakeYourDayHarder campaign where people make their day harder (get off a stop early, park at the back of lot, take stairs, have a walking meeting, ride, walk to lunch, etc..) and then share +/- pic/video on social media (twitter, FB, instagram) with the #MakeYourDayHarder hashtag.

Why: see below (PA=Physical Activity). The black line is sedentary time.

sedentary time

Sitting disease has become an independent risk factor for poor health outcomes. People who are active but sit all day have worse outcomes. Read about the evidence HERE. Also, read the consensus statement and guidelines – recently published in the BJSM – geared at sedentary office workers.

What it’s not: this is not about workouts, sports etc.., its about working activity into your average day. Sidney Crosby is not our hero. The guy/gal who take the stairs while everybody else is escalating.

Who: An Olympian/Doctor (@JaneSThornton), a design agency (@pivoting), a patient engagement star (@emily_Nicholas8) and me (@docmikeevans) (and you). We don’t have any funding. We are just doing this to see if we can start to make a little social nudge towards more activity in our days. Kind of an experiment to see if we can start changing the culture of easy.

Website: Launching this week and will summarize science about both sitting disease and challenges (i have arthritis, i am too tired, too busy, etc..)

Want more info? This less than 4 minute video explains the plan:

Not enough? Here’s theWhiteboard explaining the science:

The launch: You can soft launch anytime (i.e. tweet #MakeYourDayHarder about something today) or join us virtually or in person at hard launch on june 11.  I am giving a speech that day at the YMCA on “The Better Life Experiment at 6 pm to launch.

We need you to help us spread the word, and share your pics, videos, and tweets.


Doctors’ role in physical activity adherence: how can we keep patients on the road to better health?

1 May, 15 | by BJSM

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

By Steffan Griffin (@lifestylemedic)

So your patient saw Mike Evans’ 23.5 hours video and s/he understands that physical activity is the polypill that will maximise their chances of living a healthy life (Also see this blog de-bunking physical activity myths). They even started walking for 10 minute periods three times a day. But that was twelve weeks ago and it’s since started getting dark earlier and their daughter has started another after-school class, which further limits their spare time. Is physical activity still a priority or will the habit gently dissolve?

We all know patients who have a yo-yo relationship with physical activity, but what can we do to try and facilitate a sustainable change? In these individuals, how can we maximise the chances of adherence to a physical activity pledge/programme? This blog adresses the evidence relating to certain interventions and techniques proposed to affect adherence. It also provides some top tips to use in practice.

Why is adherence important?

Long-term adherence to physical activity is essential for the maintenance of health benefits. It has a long-term survival benefit¹, and is linked to greater fitness improvements and disease-specific outcomes as well as increased physical function and quality of life². Yet as you know, around 50% will drop out of a PA programme within a few months³.

Who is most likely to drop-out?

Essentially, exactly the population we want to get and keep active! Demographic risk factors for low adherence include older age, female gender, non-white ethnicity and low socio-economic status. Couple this with pre-existing chronic disease and/or lower physical function and weight issues and you’ve found your perfect recipe⁴ for a yo-yoer.

How can we keep these patients on the straight and narrow?

As Jorgen Jevre stated in relation to lower back pain in his recent fantastic BJSM blog, there is no golden ticket in medicine, and this especially true in trying to get and keep patients being physically active. So after assessing your patient’s activity levels, what can you do in the time you have left with your patients?

Tip 1: Inform,,

  • mamilHow can being active benefit them?
  • What counts as activity?

Physical activity doesn’t have to mean becoming a MAMIL (middle age man in lycra).



What does/did the patient enjoy? Enjoyment is a good indicator of long-term behaviour change.

Tip 2: Be #SMART,,

Goal-setting is a good way to increase adherence. Make goals Specific (Who, What, Where, When, Why?), Measurable, Attainable, Realistic and Temporal (setting subsequent shorter term goals is better than one huge longer-term one).

Tip 3: #SmashThroughBarriers,,

Identify the barriers and strategise on how they can be overcome. Teach the patient how to use this approach by themselves too.

Tip 4: #TeamEffort

Suggest that the patient involves those around them in their goals. Is group activity more suitable/realistic? Social support increases the connectedness to the activity and is more likely to lead to internalised behaviours,,, the ‘golden snitch’ of health psychology.

Tip 5: MI (not the MI you’re thinking about)

Motivational Interviewing is a patient-centred form of discussion used to strengthen an individual’s motivation for a specific goal by exploring the person’s own reasons for change⁷. It may sound a bit hippy, but you can’t argue with the fact that 80% of relevant studies report that MI outperforms traditional advice-giving⁸.


Essentially, instead of adopting an expert position, the goal is to guide the patient towards directing themselves as to why/how they might increase their PA. Whilst you provide information (with permission!), the key objective is to elicit some form of patient-based change-talk.

Step 1: Engage with the patient and establish an agreed focus for the conversation

Step 2: Evoke the patient’s own motivation to change, followed by planning if the person is ready for this.

Dr Brian Johnson provides a great overview and video examples of good practice in the fantastic ‘Motivate 2 Move’ module. This document also provides a fantastic example of using MI to increase PA.

How can I summarise these tips?

The ultimate goal for long term adherence is facilitate the internalization of the desired behaviours in patients. Deci and Ryan’s⁹ self-determination theory essentially deals with this, claiming that our inherent propensity for personal development and wellbeing are governed by a few basic pscychological needs:

  • Autonomy: the degree of personal control/choice in the matter
  • Competence: the degree of proficiency related to a certain behaviour, task or skill
  • Relatedness: the degree to which we feel connected to the behaviour in question

Focusing on each factor¹⁰

Autonomy: take the perspective of the client/patient, support their choices, minimise pressure

Competence: be realistic, limit negative feedback, provide optimally challenging goals

Relatedness: create an empathetic and positive environment

If you use these as the clinical framework to increase and maintain adherence in your patients, be it regarding physical activity or otherwise (diet, smoking, alcohol etc) and utilise the MI techniques, you will hopefully find that your patients are much better at sticking to the right path.


1. Morey MC, Pieper CF, Crowley GM, Sullivan RJ, Puglisi CM. Exercise adherence and 10-year mortality in chronically ill older adults [comment]. J Am Geriatr Soc. 2002;50(12):1929–1933

2. Belza B, Topolski T, Kinne S, Patrick DL, Ramsey SD. Does adherence make a difference? Results from a community-based aquatic exercise program. Nurs Res. 2002;51(5):285–291.

3. Dishman RK. Overview. In: Dishman RK, ed. Exercise adherence: It’s impact on public health. Champaign, IL: Human Kinetics; 1988.

4. Allen, Kelli, and Miriam C. Morey. “Physical activity and adherence.” Improving Patient Treatment Adherence. Springer New York, 2010. 9-38.

5. Rejeski WJ, Brawley LR, Ambrosius WT, et al. Older adults with chronic disease: benefits of group-mediated counseling in the promotion of physically active lifestyles. Health Psychol. 2003;22(4):414–423

6. The Writing Group for the Activity Counseling Trial Research Group. Effects of physical activity counseling in primary care: the activity counseling trial: a randomized controlled trial. JAMA. 2001;286: 677–687.

7. What is motivational interviewing? Motivational Interviewing Network of Trainers (MINT) (Accessed 04/02/2015)

8. Rubak S, Sandback A, Lauritzen T, Chitensen B. Motivational interviewing: a systemic review and meta-analysis. British Journal of General Practitioners. 2005;55(513):305-312.

9. Ryan, R. and Deci, E. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist. 2000; 55, pp. 68-78.

10. Teixeira PJ, Carraca EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self-determination theory: a systematic review. Int J Behav Nutr Phys Act. 2012;9:78.


Steffan Griffin is a third year medical student at the University of Birmingham currently intercalating at Cardiff Metropolitan University in Sports Science. As an ambassador for Move.Eat.Treat and the president of the Birmingham University Sport and Exercise Medicine Society (BUSEMS), he is passionate about the role of exercise as a proactive healthcare tool. He is involved with the Undergraduate Sports & Exercise Medicine Society (USEMS) committee as the Conference Officer. He combines a passion for all things SEM related with an avid interest in sport, and tries to live as active a life as possible.

Dr. Liam West BSc (Hons) MBBCh PGCert SEM (@Liam_West) is a graduate of Cardiff Medical School and now works as a junior doctor at the John Radcliffe Hospital, Oxford. In addition to his role as an associate editor for BJSM he also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

The Body Matters: Massive Open Online Course (MOOC) via McGill University, Canada.

3 Mar, 15 | by Karim Khan

MOOCTo all 23,000+ participants in Body Matters, the Massive Open Online Course (MOOC), congratulations on a wise choice and thanks for asking a BJSM opinion. What a great set of lectures to open the course! Kudos to Professor Ian Shrier and McGill University.

For those not privy to the MOOC, the class posed this question. ‘Is there anything to the idea that exercising way over the minimum requirement has harmful effects? Assuming no injuries etc. are people who run ultramarathon distances doing more harm than someone who puts in 150 minutes per week?’

No-one has all the answers so I plan to make 5 comments to stimulate more discussion. And remember, it’s a safe place to disagree.

1. 150 minutes per week is a minimum – it represents 22 minutes a day! These 22 minutes are the most valuable in your day to promote health. Interestingly, a recent BMJ Analysis paper (not open access) and podcast (open access) suggested that this was too much – a ‘stretch goal’ as it were. Really? I was shocked! Isn’t 22 minutes equal to one minute per hour? OK – let’s say you have narcolepsy (no offence) – then 22 minutes is 2 minutes every hour of the 11 hours you are awake. Too much? Wow!! Listen here and make up your own mind. Of course one could argue that public health advice should be based on the data. In that case one wouldn’t negotiate the minutes depending on what might be palatable. You might want to discuss this in your MOOC.

2. Would it be more palatable to call the ‘150 minutes a week’ just 23.5 hours of sitting and lying a day? ‘Look, you can sit around, watch TV, lie on a floating device in a massive Caribbean hotel pool, get hours of massage and spa treatment, sleep, but try to limit that to 23.5 hours a day, OK?’ Seem unrealistic? Impossible? Many of you will be familiar with this idea – as popularized (‘viralized’?) by the indomitable Canadian doctor – Mike Evans (@DocMikeEvans). Is he a guest professor in this MOOC? Watch the 23.5 hours YouTube video here. I would DEMAND that your professor, Ian Shrier, gets Dr Mike on board! When the class has 23,000 votes you should be able to beat a professor into submission. Please don’t take that literally.

3. Doses beyond 150 minutes per week. Is 60 minutes the magic number?

Do you drive the worst car possible? The bare minimum to get from A to B. Do you have the worst possible accommodation and food? Just to survive? Unfortunately, that’s all many people can afford to do. But many others are in a position to upgrade beyond basic food, shelter and transport. They are prepared to pay for what they perceive as value.

The bare minimum of physical activity is 22 minutes a day – 150 minutes per week. That is an appropriate public health guideline and the correct focus for the committees that made these recommendations. The most bang for very little buck. However, the evidence is very clear that an additional 30 minutes a day of physical activity (let’s call it 60 minutes in total for convenience) brings substantial additional benefit. This will prevent cardiac disease, cancers and dementia. My favourite paper capturing this is by the quietly spoken Professor Ken Powell in partnership with – you guessed it – Steven Blair. I’ve reproduced the key graph here.







On the vertical axis, ‘Relative Risk’ of 1.0 represents risk of many chronic conditions in the setting of physical inactivity (first column, 0 minutes of physical activity daily). On the horizontal axis, you can see how various doses of physical activity reduce the risk of diseases. Move one bar to the right, and notice that at 30 minutes of physical activity daily (‘150 minutes a week’) there is a Relative Risk of 0.7 (compared with 1.0) which represents a 30% reduction in risk of disease. Moving further along to the right, 60 minutes of physical activity a day provides a Relative Risk of 0.5, a 50% reduction in major diseases.

Can you imagine the popularity of a drug if one were to provide such benefits? Would you want to take one pill (30% risk reduction – 22 minutes a day?) or would you sneak a 2nd pill when the supervisor was distracted on Facebook (this would give you a 50% reduction in risk of major diseases).

If you were not already aware of this, then you have learned something very practical in this course – you can reduce your risk of the major killers grouped as ‘non-communicable diseases’ by an additional 20% just by building an extra 30 minutes of physical activity into your day. Walking is fine – no lycra required. 10 minute bouts are fine – you learned that on Monday.

Two points to go – what about long distance running/ultramarathons – safe or harmful? I’ll share some thoughts about (4) running and the risk of osteoarthritis, and (5) many many marathons and the heart.

But not today. I’m choosing to boost my physical activity dose from 30 minutes to 60 minutes by riding home from work. I’ll answer the rest of the question tomorrow, all being well.

Karim Khan (@BJSM_BMJ)
One of the 3 lead editors at the BJSM – along with Babette Pluim (@DocPluim) and Jill Cook (@ProfJillCook).

Map of where participants in the MOOC are based

Map of where participants in the MOOC are based


Why Physical Inactivity is the Cinderella of non-communicable diseases: 8 common myths de-bunked

4 Feb, 15 | by BJSM

By Thea Franke and Christina Thiele

Originally published on the Centre for Hip Health and Mobility’s blog (Follow: @Mobility_Health)

Much like Cinderella, physical inactivity goes under-recognized and largely under-appreciated. Bull and Bauman (2011) state that physical inactivity receives a “poverty of policy attention and resourcing proportionate to its importance.”

Addressing physical inactivity needs to be a global public health top-priority. Physical inactivity is the fourth leading risk factor for preventable non-communicable diseases, “preceded only by tobacco use, hypertension, and high blood glucose levels, and accounting for more than 3 million preventable deaths globally in 2010.” (Bull & Bauman, 2011)

ABauman_CHHM-cReturning to the Cinderella analogy, who in the public health realm are the ugly stepsisters keeping Cinderella out of the limelight? How can we enable everyone to play a role as physical activity’s Prince Charming?

Stemming from an engaging recent talk with Professor Adrian Bauman at the Centre for Hip Health and Mobility, we highlight the common myths that contribute to physical inactivity’s treatment as the Cinderella of non-communicable diseases.

Myth #1
The strength of evidence of physical inactivity’s impact on health outcomes is relatively new and not fully accepted.

We’ve had epidemiologic evidence on physical activity, inactivity and health since 1953 (Morris, Lancet). Not only that but 20 years ago Morris described physical activity as the “best buy in public health”.

Myth #2
There is a lack of consensus-based guidelines on how much activity is needed for disease prevention.

We’ve had excellent physical activity guidelines for 13 years (Australia 1999, rev 2012); elsewhere, Global PA guidelines, WHO 2010.

Myth #3
Physical activity is not understood or identified as a discrete risk, because it is a behaviour embedded within everyday life.

In reality physical activity is defined as all large muscle-related bodily movement” (Caspersen, Powell, & Christenson, 1985) and can take on different meanings depending on your cultural and socioeconomic context. In low- and middle-income countries it can mean your daily activities, in other settings it can mean “sports activity”. Clearer communications about “physical activity for health” can be helpful here.

Myth #4
Physical inactivity cannot be measured reliably to provide valid estimates of risk.

Physical activity measures are well established in research (and have been for some time). (Taylor, 2014).

Myth #5
Physical inactivity is not recognized as a problem for low- and middle-income countries.

Low and middle income countries are increasingly affected by inactivity especially due to urbanization and economic growth.

Myth #6
Population-wide levels of participation in physical activity cannot be changed.

Emerging evidence shows that physical inactivity is difficult to change but not impossible as emerging evidence has shown (Pratt et al., 2014). Although complex, multi-sectoral approaches are needed and possible, plus we cannot afford to NOT fix it.

The physical activity community must communicate consistently that there is sufficient evidence to act. In 2011 an economic review of physical activity NCD Prevention: Investments That Work for Physical Activity identifies specific interventions, which are supported by evidence, and is available here.

Myth #7
Lack of “ownership” of the problem and control of the relevant solutions by any single government ministry requires integrated action and partnerships beyond the health sector.

At the individual, societal and political levels we share a responsibility for advocating for change and promoting physical activity as a way to prevent death.

Myth #8
There are insufficient use of advocacy and communications strategies to make a strong and convincing case for the importance of physical activity.

Understanding of the overwhelming burden physical inactivity has on population health is increasing. In accordance, NGO advocacy and improved strategic communication has been on the rise in the past 3 – 4 years.

In Conclusion
Sure, the causes of physical inactivity are more complex than just two ugly stepsisters. But with increased advocacy and support from national and provincial governments to create tailored on-the-ground, evidence-based strategies, action from professionals across disciplines, and individuals that serve as examples and daily champions, there are many opportunities for us to collectively save Cinderella so she can live an active life in good health.

Read Bauman’s article: Physical Inactivity: The “Cinderella” Risk Factor for Non-communicable Disease Prevention

Or this related BJSM Material

*NEW* Gates A. 2015. Training tomorrow’s doctors, in exercise medicine, for tomorrow’s patients (Online only) bjsports-2014-094442.

Bull F. 2012. NON COMMUNICABLE DISEASE PREVENTION: Investments that work for physical activity. BJSM 46:709-712.

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

Hellenius M, Sundberg C. 2011. Physical activity as medicine: time to translate evidence into clinical practice. BJSM, 45:158.

Blair SN. 2009. Physical inactivity: the biggest public health problem of the 21st century. 43:1-2.

Owen N, Salmon J, Koohsari M. 2014 Sedentary behaviour and health: mapping environmental and social contexts to underpin chronic disease prevention. BJSM 48:174-177.

BJSM Podcast: Fit vs fat with Steven Blair

BJSM Podcast: Bob Sallis on Exericise as Medicine

About the authors

Thea Franke is a PhD student in the Interdisciplinary Program at the University of British Columbia. Her doctoral work focuses on the intersections between the built and social environment, older adults’ mobility and health. Her recent publication in The Journal of Aging Studies examined key factors that facilitated physical activity in highly active community dwelling older adults.

Christina Thiele is the award winning Communications and Community Relations Manager at the Centre for Hip Health and Mobility. She develops and implements strategic communications and community relations plans that support CHHM’s health promotion mandate.


Bull, F. C., & Bauman, A. E. (2011). Physical inactivity: the “Cinderella” risk factor for noncommunicable disease prevention. Journal of health communication, 16(sup2), 13-26.

Caspersen , C. J. , Powell , K. E. , & Christenson , G. M. ( 1985 ). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports , 100 ( 2 ), 126 – 131.

Pratt, M., Perez, L. G., Goenka, S., Brownson, R. C., Bauman, A., Sarmiento, O. L., & Hallal, P. C. (2014). Can Population Levels of Physical Activity Be Increased? Global Evidence and Experience. Prog Cardiovasc Dis. doi: 10.1016/j.pcad.2014.09.002

Taylor, D. (2014). Physical activity is medicine for older adults. Postgraduate medical journal, 90(1059), 26-32.

Stand and Deliver: Behaviour change implementation for #ActiveWorking

30 Jan, 15 | by BJSM

Undergraduate perspective on Sports & Exercise Medicine  a BJSM blog series

By Rory Heath (@roryjheath)

Part 2 of a 2-part series

The first part this series reminded us that inactivity in the workplace is bad for your health – as bad as smoking. Sedentary behaviour also reduces workplace productivity; employees report more fatigue and restlessness, while chronic diseases increase time spent on sick leave.

standing deskThe Active Working movement can prevent disease, reduce NHS expenditure and increase productivity; but how do we implement it? Here are presentation highlights from the recent Active Working Summit.

Blood Glucose (CGM) Responses to Sitting and Standing in Desk-Based Workers.

Professor John Buckley, Applied Exercise Science in Health, University of Chester

  • 18 mini-breaks from seated positions are better than having one chunk of exercise in a day to reduce blood glucose and cardiovascular disease risk.
  • Standing at work lowered post-prandial blood plasma glucose.
  • Alternating sitting and standing was comparable to uninterrupted sitting regarding plasma glucose. Sitting and light intensity activity breaks lowered plasma glucose (Bailey and Locke, 2014).
  • Short, light active breaks from seated work (of >2 mins, 3x hour) attenuates post meal glucose rise: Activity is key.

Workplace Health: A Summary of Sit-Stand Workstation Research.

Dr Hidde van der Ploeg, Senior Researcher, Department of Public & Occupational Health, VU University Medical Center, Amsterdam

  • Standing has benefits compared to sitting e.g. employees report less fatigue. However, prolonged standing can increase risk of varicose veins and musculoskeletal problems.
    – The solution is moving: alternating standing, sitting and other positions.
  • With sitting, the dose is the poison. It is natural and promotes rest but, ‘we’ve made our lives so comfortable we can sit all day if we want to’.
  • Factors affecting peoples use of sit-stand workstations:
    -Facilitators: Supportive culture, physical benefits, perceived benefits for productivity.
    -Barriers: Self-consciousness about standing up, poor desk design.

Breaking Up Prolonged Sitting in Offices & Call Centres.

Dr Philippa Dall, Senior Research Fellow, Department of Psychology, Glasgow Caledonian University

  • ~1 million people work in call centres and 8 million in offices. #ActiveWorking initiatives could affect a huge population.
  • Prolonged sitting is commonly defined as ‘sitting continuously without getting up, for more than 30 minutes’. è How does this compare to your workplace?
  • Screen prompts reduce sitting time by modest amounts, but the real benefit is found by using sit-stand desks, which reduce sitting time 23% and prolonged sitting by 47%.

Tools & Tracking Devices to Self-Monitor Sitting Time & Activity Levels in the Workplace

Dr Charlotte Edwardson, Lecturer in Physical Activity, Sedentary Behaviour & Health, NIHR Leicester-Loughborough

  • Data is motivational. People can see how far they’ve come and how far they need to go.
  • Pedometers = basic form of self-monitoring and can increase physical activity 27%. This positively affects blood pressure, BMI and weight.
  • Current devices track exercise but not sitting. They may not encourage you to break up the time spent sitting. Standing registers as inactivity with these devices – hence may not reduce sitting time. Wrist worn devices struggle to differentiate between sitting and standing.
  • The most accessible method of tracking inactivity are apps like ‘Sitting Timer’. Apps are cheaply added to pre-existing devices – no need for new expensive gadgets.
  • The technology market continues to increase: View this Epigenetics and Technology post for more information.

The Implications of Sit-Stand & Active Movement Behavioural Change in the Workplace.

Dr Mike Loosemore (@doctorloosemore), Lead Consultant Sports Physician, English Institute of Sport, University College London

  • Solutions must take employee concerns into consideration to make empathetic changes.
  • We must integrate low-level activity into our daily routines, through sit-stand desks, using stairs, ‘walking meetings’ and other small changes that do not reduce productivity.
  • How do we turn ‘dead time’ (sitting), into ‘live time’?
    -“We should…promote integration into daily routine.
    -It’s not about data and performance monitoring, rather participation and enjoyment.
    -We shouldn’t focus on the elite, or already active, but on making activity accessible to everyone.
    -Not with a fitness regime, but by behaviour change.”

Takeaway thoughts

Dame Carol Black (@DameCarolBlack) closed by reiterating the positive benefits that changing sedentary working environments has in creating healthy, well-engaged workforces. Such workforces ‘benefit the individual, the employer and the economy’.

#ActiveWorking aims at a more accommodating target with high rewards for public health. By promoting activity at work, hours of low-aerobic activity can be attained, with concurrent health and productivity benefits.

Overall, the event refreshingly approached exercise-promotion through making workplaces more active, contrasting to the classic approach focused on exercise prescription.

Innovative urban planning, government policy and technology all help to create environments to shape behavioural habits and attitudes towards activity. Employees can lobby employers for workplace change. Active Working can stand as a health-promotion tool in its own right.

Try #ActiveWorking yourself, by participating in a challenge to convert 2-4 hours of sitting time, to standing time during the office working day. Register at

Also listen to a great talk from the TED series on Walking Meetings HERE.


Rory Heath (@roryjheath) is a third year medical student at King’s College London (KCL) and has a keen interest in sport, diet and exercise. He has played county rugby and rugby league for London and South. He is currently the KCL representative of the undergraduate London Sport & Exercise Medicine Society (LSEMS). ( He runs a blog at

Dr. Liam West BSc (Hons) MBBCh PGCert SEM (@Liam_West) is a Cardiff Medical School graduate and now a junior doctor at the John Radcliffe Hospital, Oxford. He is an Associate Editor for BJSM and also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.


If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

Physios’ role in physical activity promotion for women and girls: #thisgirlcan #thisphysiocan

28 Jan, 15 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Claire Treen @ClaireTreen

Britain’s elite sporting culture accelerated in 2014, with women at the top of international sport. At the Sochi Winter Olympics Lizzy Yarnold won gold in the skeleton and snowboarder Jenny Jones picking up Great Britain’s (GB) first ever medal in a snow event. Northern Ireland’s Kelly Gallagher, with guide Chalotte Evans, took Britain’s first gold at a Winter Paralympics, in the visually impaired downhill skiing. The England Women’s Rugby team won the World Cup, and England Rugby contracted full time professional female players for the first time. Millions of pounds of investment, a grassroots programme and professionalization of Women’s football are paying dividends, with the England Women’s football team attracting nearly 50 000 to Wembley for November’s international against Germany. Things have moved on from 1921, when the FA deemed football “quite unsuitable for females” (FA involvement in the women’s game only re-emerged in the late 1960s)[1]. Athlete and mother of two, Jo Pavey won European Gold in the 10 000m, citing happiness and balance as key to her achieving her goal.

girl runnerBut how does this affect most women in Britain? Are they inspired? Do they exercise regularly? Are they even comfortable doing sport and exercise?

Consider these key statements from the Health Survey for England 2012[2]:

  • 67% of men and 55% of women aged 16 or over met recommended aerobic activity levels
  • 26% of women and 19% of men were classed as inactive, defined as less than 30 minutes/week of moderate physical activity, or 15 minutes/week of vigorous physical activity, or an equivalent combination of these.
  • 22% of women between 16 and 24 years are classed as inactive (vs 8% of men)

Inactive women are the ‘sitting ducks’ facing the significant health risks outlined in Rory Heath’s recent BJSM blog on sedentary behaviour. This is no less than the biggest public health problem of the 21st century.[3]

Sport England recently commissioned research into women aged 14 to 40. They found 2 million fewer women played sport regularly than men, but 75% of them would like to be more active. What’s stopping them?

Sport England CEO Jennie Price says research found that alongside familiar themes such as time and money, one of the biggest barriers to exercise was fear of judgement. Fear of judgement for not being the right size, not being fit enough, not being skilled enough. Sport England are addressing it with an innovative, prominent social marketing campaign. Using real women and with tag lines like “Damn right I look hot,” and the hashtag #thisgirlcan, it demands to be noticed.

lapping everyone on the couch

What can physios do?

In the most recent Frontline, CSP professional adviser Carley King states: “Exercise is one of the pillars of physiotherapy practice, and we are one of the key professions involved in the battle against sedentary behaviour…exploring barriers such as fear with patients and collaboratively looking at potential solutions can increase engagement with exercise.”[4] Further, she notes that there are a vast array of barriers to exercise, and physios should be mindful of these when encouraging an increase in physical activity or prescribing exercises.

At the University of Bristol, Sport and Exercise Physios actively identified these issues and helped address issues facing female students, staff and women in Bristol. Examples of their diverse work are:

Working with the student’s union on “Fit and Fabulous”, which is a programme designed to provide a wide variety of activities for female students for minimal cost. Activities such as female only swimming sessions have helped young women be active and establish good patterns for life.

Helping provide exercise groups for women with particular needs, such as those from the University’s Islamic society. Physios set up female only group exercise classes, without music, in a private room. Demonstrating sensitivity to religious and cultural needs helped break down barriers to exercise.

Contributing to unique running workshops in collaboration with RunBristol and Parkrun, and organising and delivering Women’s Running Evenings alongside coaches and nutritionists. By working closely with other health and sport and exercise professionals and educating women on matters such as injury management and gait, they are giving them the skills to do sport comfortably and confidently, and helping them achieve their goals.

Helping uncover and manage delicate ‘female issues’, such as pelvic floor dysfunction and urinary incontinence (UI), a cause of withdrawal from sport and exercise.[5] UI is common, with prevalence varying between 10 and 55% in 15-64 year old women and is documented as a potential issue for high impact athletes. [6] Physios formed closer relationships with Women’s Health Physios at St Michael’s Hospital, (nearby NHS maternity and teaching hospital), thus helping patients to access specialist, free physio help without needing a GP referral. My MSc research examined the needs of women returning to physical activity and exercise postpartum. Women identified the need for accurate, research based and appropriate information on return to exercise post childbirth. They were fearful of doing the ‘wrong thing’, so education leaflets were created to address this. Women’s need for help and support was also discussed, and whilst that needs to come from those closest to them, physios and health care professionals can provide encouragement.

Helping to increase patient awareness of what is available to women locally for little or no cost, for example, free swims for pregnant women in Bristol

Bristol Uni Physios showed great flexibility in adapting their skills across a wide range of clinical needs in a non-judgemental environment, working 1:1 with female Olympic medallists, elderly osteoporotic women attending a weekly balance class, and many in between. The importance of being able to work with women of all shapes, sizes and differing goals cannot be underestimated if we are to improve female sports participation levels. Just speaking with women and helping them overcome injury puts them in a position to recommence or continue doing sport. We should not be shy about letting them know how we can help!

As a University physio and manager, I advocated for women’s sport and exercise in a predominantly male environment, which has been hugely challenging. Greatest successes in addressing social and cultural barriers, at all levels, came when I was not acting alone, but in collaboration with students, the student’s union, medics, health care and exercise professionals, ACPSEM colleagues and mentors, coaches and academics. Beyond the clinic, we must continue open discussion and use social media to explore how we can help women minimise morbidity and mortality risks associated with inactivity. More research into why women are inactive and effective strategies to increase activity is needed.

In 2015, big money and the media spotlight is on women’s sport. The Women’s Tennis Association recently announced a 10 year, $525 million deal for television rights (the largest ever in women’s sports), and Sky Sports will show every ball of England Women’s Cricket teams Ashes defence. It’s our professional responsibility to help ensure there is a ‘trickle down’ effect to all British women, and that ‘legacy’ becomes more than a buzzword. Will we, as physios, rise to the challenge?


Claire Treen is a Sport and Exercise Physiotherapist and honorary member of staff at University of Bristol She is also the blog editor for the Association of Chartered Society of Physiotherapists in Sport and Exercise Medicine (ACSEM @physiosinsport) regular BJSM blog series. If you are a physio and would like to write a blog for ACPSEM, please email



[3] Blair, S. 2009. Physical inactivity: the biggest public health problem of the 21st century. Br J Sports Med 43: 1-2


[5] Bo, K and Morkved, S. 2013. Effect of pelvic floor muscle training during pregnancy and after childbirth on prevention and treatment of urinary incontinence: a systematic review. British Journal of Sports Medicine; 48: 299-310.

[6] Bo, K. 2004. Urinary incontinence, pelvic floor, exercise and sport. Sports Medicine 34(7):451-464.

Sitting Ducks – Sedentary Behaviour and its Health Risks: Part One of a Two Part Series

21 Jan, 15 | by BJSM

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

By Rory Heath (@Roryjheath)

The recent Inaugural Active Working Summit, January 8th, 2015, brought together representatives from healthcare, scientific research and commercial organisations with an aim to promote wellness at work.

At BJSM, we’ve covered the benefits of exercise on the brain before and even proposed a ‘Tour de Office’. Here, we profile a great example of progress in the field, demonstrating the latest research into problems and their solutions.

I will present the Summit’s findings as part of a two part series: 1. Sedentary Behaviour & its Health Risks and; 2. Implementation of Active Working  and related workplace behaviours changes.

Setting the Scene – How Much Time Do We Sit? Changing Patterns of Sedentary Behaviour. Dr Stacy Clemes, Senior Lecturer in Human Biology, Loughborough University

  • During waking hours 65% of an average person’s day is spent sedentary; 9-10 hours for adults.
  • Sitting at work = 60% of total daily sitting time on a weekday, but even on weekends people still sit for 8 hours.
    – Activity at work can have great effect to reduce sedentary behaviour time!
  • High work sitters spent >7.5 hours sitting at work.
    – How many hours does a typical medical student spend sitting down in preclinical?
  • Even in the ‘active’ education and retail sectors, employees spend >6 and 2 hours respectively sitting at work, with 10 and 6 hours totally spent sitting over the day. Employees in Telecommunications spend >12 hours sitting a day!
  • More sedentary at work = more sedentary at home. Unfortunately, these people do not tend to compensate by increasing activity in their leisure time. (Clemes et al., 2015)

Why Sitting is Bad – Effects on Heart Disease, Obesity and Diabetes.
Dr Jason Gill, Reader, Institute of Cardiovascular and Medical Sciences, University of Glasgow

  • Even if a person completes the recommended daily 30 minutes of exercise, the amount of time spent sitting in the day still substantially affects mortality risk.
  • Diabetes; A major cause of blindness, amputation and mortality. NHS diabetes spending is projected to double to £16.9 billion by 2035 (see here).
  • People that sit the most have a 112% increase in the Relative Risk (RR) of Diabetes and a 147% increase in the RR of cardiovascular events compared to people who sit down the least. Overall mortality is increased by 50%. Sitting down has similar mortality rates to smoking (Wilmot et al, 2012, Diabetologia)
  • It’s been shown that prolonged sitting adversely affects glucose metabolism. However, sitting with ‘light-moderate’ intensity breaks can significantly reduce glucose and insulin levels.

Sedentary Behaviour and Risk Co-Relation to Cancer and Mental Health.
Dr David Dunstan, Professor & Head, Physical Activity Laboratory, Baker IDI –

Positive associations between Cancer and Sedentary Behaviour exist:
– Lung cancer increases by 54%
– Uterine cancer 66%
– Colon Cancer 30% increased risk.

Despite these associations, there is a lack of high quality studies. ‘We may see stronger relationships between sedentary behaviour and cancers if we measured it better’.

  • Potential mechanisms – Sedentary behaviour contributes to an interrelated network of increased body fat, altered production of sex hormones, metabolic dysfunction, leptin, adiponectin and inflammation, encouraging cancer development.

Mental health

The risk of anxiety and depression is significantly higher in those who sit more while increased activity shows better subjective mental heath and vitality.
Potential mechanism: Physical activity displaces sedentary behaviour and has proven benefits. Perhaps there is also a ‘social withdrawal hypothesis involvement’.

  • Sitting has a higher rate of subjective fatigue than standing.

A Brief Overview of Global Sedentary Science Research.
Dr Sebastien Chastin, Senior Research Fellow in Behaviour Dynamics, Glasgow Caledonian University

  • 1953 ‘London Bus Study’ – bus drivers had a higher mortality rate due to Cardiovascular Disease compared to the more active bus conductors. If a conductor’s ‘Low level activity’ is beneficial, this should translate similar benefits in our modern world. (J Morris et al., 1953)
  • Start Active, Stay Active states that all ages should ‘minimise the amount of time spent being sedentary for extended periods’. It’s now time to convert studies and new policy into change and progress in the workplace.
  • For every €100 spent on Nutrition, €35 is spent on Physical Activity but only €6 Euros are spent on Sedentary Behaviour research ➔ more funding is needed.

The Sitting Time Bomb – Are We Prepared?
Dr Tom Yates, Senior Lecturer in Physical Activity, Sedentary Behaviour & Health, Diabetes Research Centre, University of Leicester

  • We are now victims of our own environment. Historically human mortality was due to infective causes; now our greatest killers are self-inflicted Physical Inactivity, Smoking, Diabetes and CVD.
  • We spend £8 billion on T2D, 14 billion on CVD and 9 billion on cancer. These are preventable – it is the interaction of our genes and our environment that is causing these diseases.
  • The classic medical solution is to provide a pill:
    Pharmaceutical companies spend between $873 million to $8 billion in drug development. This completely dwarfs the money spent on research into sedentary behaviour.
  • We treat obesity through invasive, dangerous surgery. We must find a preventative, cheaper, safer option; through changes to environment and policy. It is possible – look at the change in smoking.

Takeaway thoughts

Public Health focuses on promoting Exercise but neglects sitting, where people spend the majority of their time. There is a grey area between moderate and sedentary activity that needs to be addressed in public health policy.

  • You can still be active whilst sitting. Fidgeting and moving around can reduce time spent sitting still. Choose your office furniture wisely, choose ergonomic chairs and sit-stand desks.
    ‘Just moving around will lead to benefits’.
  • We urgently need large scale long term intervention studies to evaluate effect of interventions to reducing sitting on health outcomes in real world settings.

#ActiveWorking is gaining momentum and will continue to change workplaces in the future. To see tweets from myself and others from the event, enter #ActiveWorking on Twitter. To find out more about the event, check out (@getGBstanding) and (@ACTIVEworking), and subscribe to hear the latest details of next year’s event.

In the meantime; stand, walk, fidget and move as much as you can before the second blog is posted!

Rory Heath (@roryjheath) is a third year medical student at King’s College London (KCL) and has a keen interest in sport, diet and exercise. He has played county rugby and rugby league for London and South. He is currently the KCL representative of the undergraduate London Sport & Exercise Medicine Society (LSEMS). ( He runs a blog at

Dr. Liam West BSc (Hons) MBBCh PGCert SEM (@Liam_West) is a Cardiff Medical School graduate and now a junior doctor at the John Radcliffe Hospital, Oxford. He is an Associate Editor for BJSM and also coordinates the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series.

If you would like to contribute to the “Undergraduate Perspective on Sports & Exercise Medicine” Blog Series please email LIAMWESTSEM@HOTMAIL.CO.UK for further information.

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