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World Health Organisation to develop Global Action Plan to Promote Physical Activity

22 May, 17 | by BJSM

By Charlie FosterTrevor ShiltonLucy Westerman, Justin Varney,  and Fiona Bull

More people moving more is central to a healthier world. Unfortunately, evidence tells us that people everywhere are less active than ever before, and the burden of chronic noncommunicable diseases rises unabated.

In response, the WHO has launched their strategy to develop a new Global Action Plan to Promote Physical Activity.

Years of advocacy have culminated in this unique opportunity; the development and comprehensive implementation of a global action plan to promote physical activity. This in many ways, will shape the future.

Why is WHO suddenly talking about physical activity?

WHO has encouraged member state governments to promote physical activity for over a decade. Since the 2004 WHO Global Strategy on Diet, Physical Activity and Health, and inclusion of physical activity as a key risk factor and opportunity in the 2013 Global Action Plan on NCDs, the International Society for Physical Activity and Health (ISPAH) has been a lead advocate to promote physical activity. Its numerous resources, including a policy framework (the Toronto Charter, 2010) and policy investment decision tool (What Works: The Seven Best Investments for Physical Activity, 2011) guide countries with the rationale and operational choices for physical activity promotion.

What’s helped get physical activity on the global agenda?

Recent progress toward a Global Action Plan to Promote Physical Activity comes thanks to the tireless work of various key individuals and organisations. This includes ThaiHealth. ISPAH, in partnership with the BJSM. These organizations, along with others, are leading the push for greater recognition of physical activity as a key component of health, and social and sustainable development. An inactive world is unhealthier, uneconomic and unsustainable.

Broader policy priorities have emerged highlighting the pivotal role of physical activity in: (i) achieving the Sustainable Development Goals (SDGs), (ii) making the Global Action Plan to Promote Physical Activity a catalytic opportunity across multiple sectors, and (iii) providing a framework for a truly embedded whole system approach to moving nations. The NCD Alliance, ISPAH and partners will mobilize civil society advocates from across sectors to contribute to the development of a strong Global Action Plan, to call for renewed commitment from governments to boost physical activity, and to enhance the feasibility, sustainability and accountability of its implementation.

How will the Bangkok Declaration on Physical Activity and Health help?

Actions on physical activity can contribute to achieving eight sustainable development goals

The BKKD will help more people from more sectors engage in elevating physical activity as a local, national and global priority. It:

  • advocates for investment and actions at country, regional and global levels
  • provides a case for partnerships with sectors inside and outside of health
  • details six actions which could advance progress toward achieving WHO targets of increasing physical activity and reducing NCD burden by 2025
  • contributes to mitigating climate change, reducing inequalities and supporting more sustainable cities and communities in a rapidly urbanising world.

Use the BKKD in your practice, teachings and advocacy, share it far and wide. Get it at

The more engaged we all are, the better the ultimate health of our planet.


Competing Interests

All authors were involved in developing and promoting the BKKD

Further Reading

  1. International Society for Physical Activity and Health. The Bangkok Declaration on Physical Activity for Global Health and Sustainable Development. Bangkok: ISPAH; 2017 [cited 2017 May 14]. Available from:
  2. Bull F, Gauvin L, Bauman A, Shilton T, Kohl H, Salmon A. The Toronto Charter for Physical Activity: a global call for action. 2010;7(4):421-2.
  3. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med2012;46:709–712


Figure 1           Actions on physical activity can contribute to achieving eight of the sustainable development goals

Authors: Charlie Foster1  Trevor ShiltonLucy WestermanJustin VarneyFiona Bull5

  1. Nuffield Department of Population Health, University of Oxford, UK & President of International Society of Physical Activity and Health (2016-2018),
  2. National Heart Foundation, Perth, Western Australia, Australia & Global Advocacy for Physical Activity (GAPA),
  3. NCD Alliance, Geneva, Switzerland,
  4. Healthy People Division, Public Health England, UK,
  5. Prevention of Noncommunicable Diseases and Mental Health, World Health Organisation, Geneva, Switzerland, Past President of ISPAH (2014-2016)

A historic celebration of World Physical Activity Day 2017, and partnership for sustained dissemination of the EuroFIT program

13 May, 17 | by BJSM

By Dr. Marcos Agostinho

A historic celebration of World Physical Activity Day 2017 took place in The City of Football, home of the Portuguese Football Federation (FPF), with a formal public presentation of the National Program for the Promotion of Physical Activity. The program was coordinated by the Health Ministry, in Portugal’s Directorate-General of Health (DGS), and was presented by its Director, Professor Pedro Teixeira, from The Faculty of Human Kinetics – University of Lisbon (FMH).

With the participation of Portugal’s Ministers of Health and Education, the celebration was also marked by the signing of a unique formal partnership between the FPF, DGS and FMH for the dissemination of The EuroFIT program, derived from a EU H2020 funded project. EuroFIT uses some of the biggest national and European football clubs’ venues for the fight against sedentary lifestyles and related problems.

EuroFIT (European Fans In Training) is a social innovation program aimed at improving physical activity and sedentary behaviour through elite European football clubs. Its overall objective is to build new social partnerships between football clubs, fans and researchers that harness the power of football to deliver an innovative public health programme. The innovation will address the problems of physical inactivity, sedentary behaviour and poor diet. More can be found here:

As for Portugal’s recent National Program for the Promotion of Physical Activity (PNPAF), four primary strategic objectives were created for the 2017-2020 period:

  1. Promote awareness, physical literacy and the readiness of the entire population to practice regular physical activity and reduce sedentary time;
  2. Promote the generalization of assessment, counseling and referral of physical activity at the primary health care level;
  3. Encourage environments that promote physical activity in leisure spaces, in the workplace, in schools and universities, in transportation and in health services;
  4. Promote epidemiological surveillance and research, and value and disseminate good practices in the field of physical activity promotion and sport.

More information can be found here at the official program’s website:


Dr. Marcos Agostinho, MD, PGDip (SEM), BASc (MB)

Primary Care Sports Medicine Physician (CUF Torres Vedras Hospital), Family Physician & General Practitioner (USF Santa Cruz), Collaborator for The National Program for the Promotion of Physical Activity (DGS Portugal), Associate Editor British Journal of Sports Medicine (BJSM), Associate Editor BMJ Open Sport & Exercise Medicine (BMJ)

The sedentary office: the need for more pragmatic guidelines

26 Jun, 15 | by BJSM

Letter to the Editor by: Dr Kelly Mackenzie, Specialty Registrar in Public Health / Academic Public Health Fellow

In response to:  JP Buckley & A Hedge et al (2015). The sedentary office: a growing case for change towards better health and productivity.

We welcome the development of quantifiable targets relating to workplace sedentary.  However, given the low quality evidence, it was expected that the recommendations would have been more pragmatic.

For desk-based workers, an initial target of two hours per day of standing/light activity eventually progressing to four hours per day, would be difficult to accumulate without the use of environmental and/or ergonomic adaptations such as adjustable-height desks.  As these interventions have a relatively high initial cost (around £300-1000 for an adjustable-height desk1), this recommendation is unlikely to be achievable in most workplaces.  Financial gains due to increased productivity and decreased absenteeism can be made to offset these costs, but tend to only be realised in the longer-term, so will not provide a viable justification for many organisations.

Instead, initial recommendations need to provide realistic targets that involve no/low cost changes that can be accumulated incidentally throughout the working day e.g. by encouraging standing/walking meetings.  The recommendations could then be taken up by a range of organisations, hence promoting maximal public health benefits.


  1. Height Adjustable, (Accessed on 16th June 2015)

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.

Obesity in the Middle East : A serious public health concern and initiatives to improve diet and physical activity

18 Jun, 14 | by Karim Khan

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

By Dr Farrah Jawad

Obesity is becoming a major public health issue in the Middle East and in other developing regions. Estimations of overweight or obese individuals include: 42.2% of Kuwaiti adolescent males and 42.4% of Bahraini adolescent females 1. The World Health Organisation indicates that the global burden of non-communicable diseases in developing countries will substantially increase over the next decade2. Physical inactivity is one major factor leading to an increased prevalence of obesity and the health burden it confers in young people3-5. walk

Barriers to maintaining physical health: understanding differences across culture, gender and age

It is necessary to identify and address the barriers to physical activity for people living in the Middle East and other developing regions to reduce the effects of this public health burden. Obesity is taking a particular toll on Arab women, with 45.3% of Qatari and 44% of Saudi Arabian women being obese, nearly double the rate of obese men in those countries6. Over the last three decades there has been a big shift in diet in the Middle East, with Western food, some of which is high in calories, fat and sugar, increasing in popularity, particularly as more women are entering the workforce and fast food is replacing traditional home-cooked food.6 The opportunities to exercise in public are extremely limited for women living in many Middle Eastern countries due to cultural factors such as accepted dress codes and modest conduct. The fuller figure is seen as a desirable trait in women in the Middle East, being considered a thing of beauty and higher social standing.

One study on schoolchildren in Iran explored the barriers to physical activity. Researchers found that studying was prioritized over physical activity. The students described a lack of safe and easy-access places to partake in physical activity and reported a lack of encouragement from their parents to engage in physical activity, with a greater emphasis on studying7. The authors noted an inverse association between children’s activity level and the level of the parents’ education7. There was also inadequate public knowledge of how to integrate physical activity into routine daily life7.

UAE: Lack of visible active living, and health promotion initiatives for change

On a recent trip to Dubai I was struck at how much it had changed since I had last visited in 1994; it has become so much more urbanised, more populated and appears to be thriving in economic terms. I was struck by how few people could be seen walking, cycling or running in public, so different from where I live in London. The summers in the UAE are hot and dry – too hot perhaps to do anything but swim outdoors at that time of year. An ice rink and indoor snow resort have been opened in Dubai and in summer months, indoor leisure centres may be the best way for people to get the exercise they need. Dubai seems very safe, even for the young, and it was a surprise not to see more children playing outdoors. I have been interested at looking into some of the public health measures which have been set up in the Middle East in order to combat the problems of lack of physical activity and obesity in the region. In the UAE, two Imperial College London Diabetes Centres have been set up in Abu Dhabi and Al Ain (since 2006 and 2012 respectively).

Walk for Life: A Diabetes Prevention Initiative

Since 2006, the Imperial College London Diabetes Centre in Abu Dhabi (and later the Al Ain centre), has developed a public health initiative which is intended to reach all levels of UAE society using four “pillars”: Walk for Life, Play for Life, Eat for Life and Cook for Life. The Walk for Life is an annual 5K walkathon for the community, which took place last November and saw 20,000 people participate. The aim is to inspire people to walk, build walking communities and encourage healthy lifestyles. Social media, email marketing, public relations, radio, newspapers and magazines advertised it. Friday sermons across approximately 2000 mosques also mentioned the event8. During the event, 633 people took part in a survey to explore their knowledge about the benefits of exercise and their motivations for taking part in Walk for Life. Of those surveyed, 70% said they were aware that a regular walk helps to reduce the risk of diabetes and 70% declared they were interested in forming their own walking groups, requesting more information8. The Walk for Life is due to take place again this year on 14th November 2014.

Play, Eat, and Cook for Life

Play for Life involves a football tournament organised for corporate employees in Dubai. The campaign also supported the Family Development Foundation’s Women’s Fitness Challenge which was spread over 12 weeks and was aimed at educating women in the emirate’s Mirfa region on how to balance work and exercise with a busy lifestyle. Eat for Life promotes a balanced diet to schoolchildren and Cook for Life aims to inspire families to cook healthy meals at home. Cook for Life’s message is delivered by a television programme watched by millions of viewers.

Steps in the Right Direction

Clearly, in the UAE at least, public health initiatives are underway to tackle the burgeoning problem of obesity and non-communicable diseases. Their focus is on addressing people’s lack of physical activity and poor diet choices. I am not presently aware of any other similar initiatives across the Middle East but I hope that they exist. If they do not, perhaps the good example set by the UAE may inspire other nations in the region to follow suit in order to protect the health and welfare of their people.


Dr Farrah Jawad is an ST3 in Sport and Exercise Medicine at the Hammersmith Hospital in London.  She is particularly interested in the public health aspect of Sport and Exercise Medicine and dance-related musculoskeletal injuries.

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

  1. Ng, SW, Zaghloul S, Ali HI et al. The prevalence and trends of overweight, obesity and nutrition-related non-communicable diseases in the Arabian Gulf States. Obes Rev. 2011 Jan; 12 (1): 1-13.
  2. World Health Organisation Global Status Report on Noncommunicable Diseases 2010.
  3.  Dishman RK, Motl RW, Sallis JF, Dunn AL, Birnbaum AS, Welk GJ, et al. Self-management strategies mediate self-efficacy and physical activity. Am J Prev Med. 2005;29(1):10–8.
  4. Makinen TE, Borodulin K, Tammelin TH, Rahko-nen O, Laatikainen T, Prattala R. The effects of adolescence sports and exercise on adulthood leisure-time physical activity in educational groups.Int J BehavNutr Phys Act. 2010;7:27.
  5.  Lee IM, Sesso HD, Paffenbarger RS., Jr Physical activity and coronary heart disease risk in men: does the duration of exercise episodes predict risk? Circulation. 2000;102(9):981–6.
  6. Sarant, L. The hidden obesity toll on women in Arab states. Accessed on 24th May 2014.
  7. Kelishadi R, et al. Barriers to Physical Activity in a representative sample of Children and Adolescents in Isfahan, Iran. Int J Prev Med 2010 Spring; 1(2):131-137.
  8. Walk 2013 Overview: Celebrating 70,000,000 steps, a document produced by Imperial College London Diabetes Centre, 2014.

Exercise Referral Schemes in Primary Care: Where does Sport and Exercise Medicine stand?

16 Mar, 14 | by BJSM

By Dr. Amir Pakravan and Dr. Amanda Jones

Exercise referral schemes (ERS) are often known as specific referrals made by primary care professionals to a third party for individual advice, and a tailored physical activity or exercise programme aimed at achieving health benefits through increased level of physical activity.[1, 2]

Primary care is uniquely placed to promote physical activity at a number of levels and ERS is one of many different ways by which Primary Care professionals can promote physical activity.[2-5] This is usually offered to selected individuals who are deemed to achieve specific health benefits from such tailored programmes.

swimmin in waterConsidering huge direct and indirect healthcare cost of physical inactivity which with conservative estimates is in excess of £900 million per year for England,[6] physical activity is now one of Public Health Outcome indicators. However, many of the other outcome measures of this framework such as people’s weight, over 65s falls sufferers, smoking levels, diabetes, self-reported wellbeing, and death from heart disease and stroke are also directly or indirectly influenced by population’s levels of physical activity.[7]

There is an obvious paucity of sufficient scientifically robust evidence for effectiveness of exercise referral schemes in absolute health risk reduction and economic efficiency, and despite some evidence for improvement of levels of physical activity in ERS participants, there are major questions about significance and sustainability of this increase and whether this would be an efficient use of resources particularly when counselling, advice, and walking have also been shown to provide similar benefits.[1, 2, 8-11]

Previous guidelines by the National Institute for Health and Care Excellence (NICE) restricted endorsement of any ERS by healthcare professionals only to those schemes evaluating a number of measures as part of a designed and controlled research project.[4] Nonetheless, with more than 600 currently active ERSs in the UK, these guidelines have clearly not affected increasing popularity of these schemes. This may in part be due to a lack of controlled trials, but may also reflect a fundamental difference between available evidence and the real feel and health or social benefits experienced on the ground which may have not been sufficiently documented by providers and participants of the schemes.

NICE guidelines on ERS are currently under review and due to involvement with an ongoing project looking into ERSs in Suffolk, one of the authors had the opportunity to sit in one of the NICE Public Health Advisory Committee (PHAC) meetings as a public attendee.

Discussions in the meeting further confirmed the notion that despite significant uncertainties in health and economic effectiveness of ERS, the guidelines needed to change to reflect and help refine current practices whilst encouraging further research. It was acknowledged that one of the main obstacles in strengthening evidence base for effectiveness of ERS is a clear lack of appropriate data sets.

The significant variability of schemes on offer makes it even more difficult to agree on a precise definition for ERS; however it appears the scope of future NICE guidelines may well be restricted to general physically inactive individuals without a specific medical diagnosis. This is in contrast to the majority of current schemes where, as opposed to healthy lifestyle service providers, only specific health and medical conditions are included on the exercise referral programme. The key question appears to be whether an ERS is primarily a specific and targeted health intervention with specific outcome measures, hence the term, “Referral”, or only another way of promoting physical activity in general which in turn is expected to lead to general health benefits.

What was noticeable though, was an absence of a representation from Sport and Exercise Medicine (SEM) on the discussion panel and a lack of acknowledgement of potentially significant role this specialty can play in all aspects of the design, implementation, delivery, and ongoing assessment of the service.  Involvement of SEM specialists with the right skill sets and experience alongside Public Health, Primary Care, Research scientists and service providers can potentially result in a more efficient model where selection and injury or medical risks are minimised, appropriate data sets are collected to a high standard, participant motivation is maintained, and further effective health and behavioural interventions and follow up are made possible.

This is obviously open to debate and it is only through active involvement of the SEM community with the process that possible alternative models can be identified.

In view of the Fresh Approach in Practice document published by the Faculty of Sport and Exercise Medicine,[12] it is prudent that the specialty establishes its role in the wider provision of health and exercise services to general population through active participation in guidelines and policy making processes, and further involvement with implementation of such policies.

NICE draft guidelines on ERS will be published on March 19th for a 6-week period of public consultation,[13] and SEM practitioners are encouraged to take part in the process as stakeholders and to raise awareness about the numerous ways in which this specialty can contribute to addressing the current myriad of challenges and shortcomings (go to NICE website for more information).


1)     Pavey TG, Taylor AH, Fox KR, et al. Effect of exercise referral schemes in primary care on physical activity and improving health outcomes: systematic review and meta-analysis. BMJ. 2011 Nov 4;343.

2)     Isaacs AJ, Critchley JA, Tai SS, et al. Exercise Evaluation Randomised Trial (EXERT): a randomised trial comparing GP referral for leisure centre-based exercise, community-based walking and advice only. Health Technol Assess. 2007 Mar;11(10):1-165.

3)     National Institute for Health and Care Excellence website. Accessed Feb 2014. Physical activity overview.

4)     National Institute for Health and Care Excellence. NICE public health guidance 2: Four commonly used methods to increase Physical Activity. Mar 2006.

5)     Department of Health. Exercise Referral Systems: A National Quality Assurance Framework. London 2001.

6)     Sport England website accessed Feb 2014. PCT table (cost of physical inactivity).

7)     Public Health England. Public Health Outcomes Framework: quarterly data update. Feb 2014.

8)     Pavey TG, Anokye N, Taylor AH, et al. The clinical effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation. Health Technol Assess. 2011 Dec;15(44):i-xii.

9)     Orrow G, Kinmonth AL, Sanderson S, et al. Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials. BMJ. 2012 Mar 26;344.

10)  Williams NH, Hendry M, France B, et al. Effectiveness of exercise-referral schemes to promote physical activity in adults: systematic review. Brit Jour Gen Prac. 2007 Dec: 979-86.

11)  Hanson CL, Allin LJ, Ellis JG, et al. An evaluation of the efficacy of the exercise on referral scheme in Northumberland, UK: association with physical activity and predictors of engagement. A naturalistic observation study. BMJ Open 2013;3:e002849.

12)  The Faculty of Sport and Exercise Medicine UK. Sport & Exercise Medicine: A Fresh Approach in Practice. A National Health Service Information Document.

13)  National Institute for Health and Care Excellence website accessed Feb 2014.


Dr Amir Pakravan is a Sport and Exercise Medicine Registrar with experience within elite sports and pre-hospital care, and is currently running a project under Public Health Suffolk looking into Exercise Referral Schemes.

Dr Amanda Jones is Assistant Director of Public Health, and Lead Consultant for Health Protection and Health Improvement in Suffolk.

Move Now, never mind the weather

13 Feb, 14 | by BJSM

By Dr. Domhnall MacAuley

snow walkingSnow. Hardly surprising. Its part of Canadian life. But, as a sports med doc arriving in Ottawa, what struck me most was the number of people walking, skating and jogging. It may have been minus 25, before wind chill, but that didn’t seem to be a deterrent. There were hundreds of skaters on the Rideau Canal day or night, young and old, relaxing, exercising, and even commuting to work. And, joggers on the bank clad in hats, gloves and balaclavas. Promoting physical activity is a tough call but perhaps weather is not as great a barrier as we think.

Getting people active was the sub plot of a major sports medicine conference in Edinburgh last week . Sir Harry Burns, the visionary chief medical officer for Scotland was a keynote speaker, highlighting how seriously the Scottish public health commitment to physical activity: One of the few countries world-wide with a national physical activity strategy. The health benefits of exercise are undisputed. But, he raised an interesting new perspective- how physical activity might help the diverging life expectancy trajectories between rich and poor. He cited the lifestyle fatalism of some poorer communities- if I die, I die. But, exercise offers some control over health outcomes – enabling people in deprived areas to influence their own well being. How to do it? Rather than the traditional, research to implementation model, he encouraged a quality improvement strategy- measure and re-measure, and starting now. Quoting Don Berwick “some is not a number, soon is not a time”.

“We are the first generation that has to deliberately exercise.” quoted Steve Blair, the doyen of international exercise epidemiologists, from Jerry Morris the physical activity research pioneer (of the seminal bus conductors vs drivers study). And, our lives have become so mechanised, automated, and labour saving, that almost all physical work has been eliminated. One of the most interesting figures, from his own research, showed a mortality advantage of fit overweight men over normal weight unfit men. And, he also cited work showing that being overweight might be good for you (Read more HERE) and statistically debunked the myth of the “obesity epidemic”. He was scathing about the sugar fascists saying the evidence on sugar was not as awful as we are led to believe. Its fitness and activity that really count, His message: ignore any research on obesity and health outcome that doesn’t measure physical activity.

And, just this week, my colleague at CMAJ, Kirsten Patrick, published an editorial entitled Move Now addressing some of the issues raised in research showing that owing household devices, such as televisions, cars, computers, increased the likelihood of obesity and diabetes, mediated in part by effects on physical activity, sitting time and dietary energy intake (Read article HERE). And, highlighting the risk that increasing ownership of household devices may be a greater risk in developing countries. Perhaps our changing world should carry a health warning.

***************************                                                                                                                                                                                                                         Domhnall MacAuley is a Consultant-Associate Editor at Canadian Medical Association Journal (CMAJ), Professor at University of Ulster and Sports Medicine Specialist, Family Doctor at Hillhead Family Practice, and has had various Editorial roles at BMJ              

Move Eat Treat Health Summit November 27, 2013 – Creating a proactive healthcare service: Only a few days left for early bird registration

30 Oct, 13 | by Karim Khan

Move Eat Treat logo

As health and fitness enthusiasts, we instinctively know that lifestyle problems cause the vast majority of chronic disease. We also know the growing burden of chronic disease in the Western world could be largely prevented through simple but powerful changes in behaviour, such as better food and more physical activity.

However, most healthcare professionals are not taught how to advise patients on healthy lifestyles. This is a wasted opportunity, as people are often most open to the idea of changing their behaviour when confronted by a medical problem. The Move Eat Treat campaign was founded to help increase the availability of education about lifestyle for healthcare professionals in the UK.

Move Eat Treat is a nationwide prize-winning campaign promotes the importance of preventative medicine in the UK. Its primary goal is to make lifestyle advice a core theme in healthcare education, enabling medical professionals to help people to live healthier, happier lives.

The date for the very first Move Eat Treat Health Summit has now been announced. On 27th of November 2013, Move Eat Treat will host a conference in London at the Institute of Sport, Exercise and Health. The aim of this summit is to generate ideas, consensus and momentum to improve the current state of education for healthcare professionals in respect of physical activity, nutrition and behavioural change techniques. To do this, we need to bring together people who share the common goal of improving health through proactive healthcare.

Delegates at the Summit will include leaders from the world of medical education, clinical practice, exercise medicine, nutritional experts, and fitness professionals. Here is your opportunity to be a part of the group driving the next steps towards a fitter, healthier Britain.

The key areas of discussion will be physical activity & exercise, nutrition, medical education, public health, primary care, and behaviour change. Discussions in each of these areas will be led by experts in those fields and participation will be open to all delegates. We want to hear your views and we very much hope to see you there.

The event is supported by prominent groups such as the Physical Activity Research Group (PARG) at University College London and individuals including Dr Richard Budgett, CMO of the London 2012 Olympic games: “I’m pleased to support the excellent initiative of Move Eat Treat, which tackles by consensus the three most important areas of public health. This is exactly the type of initiative that will carry forward the flame of promotion of health for everyone”.

For more information about the event visit:

The early bird registration runs until November 8th.

Exercise Medicine In Wales – Gathering momentum in pursuit of an active nation

7 Oct, 13 | by Karim Khan

By Dr Rhodri Martin (@rhodmartin) and Bryn Savill (@BrynSavill)

Wales – An inactive nation

The physical inactivity pandemic is none more evident than here in Wales. The Welsh Health Survey 2012 reports that 71 percent of the population are not doing at least 30 minutes of moderate intensity physical activity, on five or more days a week. Considering the inaccuracy of self reported physical activity we can safely assume that the levels of inactivity are indeed far greater than those published 1. Furthermore, and even more worrying, is that in 2007 Wales topped the European chart for having the most unfit schoolchildren2. This is truly a worrying statistic, and one that requires immediate action to rectify given the dramatic impact this will have on the health of the future population3.

SONY DSCCardiff Exercise Medicine Symposium 2013 (@CardiffExMed)

Despite these depressing statistics, there is however, much reason for optimism. There is a very proactive physical activity movement here in Wales, with individuals focused on reversing the downward trend in physical activity levels. This was exemplified by the recent inaugural Cardiff Exercise Medicine Symposium. Policy makers, healthcare professionals, academics, exercise professionals and students from all over the world looked at ways in which we can address the physical activity pandemic, as well as novel ways in which we can use exercise in the treatment of disease.

Eminent international speakers inspired over 250 delegates, instigating lively debates and exchanges of ideas and experiences from around the world. The symposium brought together academic researchers with health and exercise professionals and provided a platform to help drive forward exercise medicine, and in particular excellence in this new specialty here in Wales.

Despite its small geographical size, Wales is extremely fortunate to have a wealth of expertise in Exercise Medicine. During the ‘Exercise Medicine in Wales session’ we had speakers from several of the leading Welsh Universities highlighting their exercise related research. The application of their work via enthused healthcare and exercise professionals here in Wales will help drive this specialty forward both nationally and internationally.

Delegate breakdown from the Cardiff Exercise Medicine Symposium 2013:


  • 31% Sport Scientists
  • 26 % Students (medical, physiotherapy and sport science)
  • 25% Exercise Specialist (including Cardiac Rehabilitation, Fitness Instructors, Exercise Referral etc.)
  • 16% Physiotherapists
  • 14% Doctors
  • 6% GPs.

Where is Wales leading the way in Exercise Medicine?

Wales has huge potential to drive forward excellence in the speciality of exercise medicine. We already have an established National Exercise Referral Scheme in Wales that delivers exercise interventions throughout the country. Devolution has provided the Welsh Assembly Government with an opportunity to focus on physical inactivity via the legislative route and we should hopefully see the approval of an Active Travel Bill in October 2013, which will ensure that local authorities continuously improve routes for pedestrians and cyclists and consider their needs during new developments. Furthermore, there has been a significant drive to improve physical activity education at both an undergraduate and a postgraduate level in Wales. Undergraduate medical education curricula in Wales now incorporate physical activity, and at postgraduate level a new online resource has been created as an education tool for healthcare professionals.

Wales Exercise Medicine Symposium 2014

In 2014 we hope to build on the strong foundations laid down at Cardiff in 2013 and we look forward to welcoming you all to Wales for the 2014 symposium. Stay tuned for more information.


1. Dyrstad SM, Hansen BH, Holme IM, Anderssen SA.Comparison of Self-reported versus Accelerometer-Measured Physical Activity. Med Sci Sports Exerc. 2013 June 20 (Epub ahead of Print)

2. Tomkinson GR, Olds TS (eds): Pediatric Fitness. Secular Trends and Geographic Variability. Med Sport Sci. Basel, Karger, 2007, vol 50, pp 104-128

3. Blair SN, Kohl HW, III, Paffenbarger RS, Jr, Clark DG, Cooper KH, Gibbons LW. Physical Fitness and All-Cause Mortality: A Prospective Study of Healthy Men and Women. JAMA. 1989;262(17):2395-2401.


Bryn Savill and Rhodri Martin were co-organisers of Cardiff Exercise Medicine Symposium 2013

Are you a clinician/public health decision maker looking for the best Physical Activity and Public Health Course? The ‘Russ Pate / Steve Blair plus more’ course – Park City, Utah, Sept 10-18, 2013

21 Mar, 13 | by Karim Khan


Park City, Utah: Photo via Wikipedia

From my 30-year experience in the field of sport and exercise medicine, I know that the best course for clinicians wanting to change the physical activity landscape through work in the community, (i.e., via workplaces, NGOs, local government, big government or other public health settings is what we respectfully refer to as the Pate/Blair course sponsored by the University of South Carolina Prevention Research Center and the Centers for Disease Control and Prevention.

The leads for this course (Professors Pate and Blair – who really need no introduction) have confirmed that Bess Marcus, Abby King, David Buchner, Barb Ainsworth (all USA), Neville Owen (Aus)  & Canada’s Mark Tremblay will be working with participants in this course. Numbers are limited  which gives you a chance to meet one-on-one with the professor whose work is most relevant to your work.

This once-in a career event transforms a participant’s professional career. You go from ‘wanting to make a difference’ to having the tools to know what to do and having the network of faculty and leading colleagues from across the US and the world to help you.

This year’s opportunity is from September 10-18, 2013 in Park City, Utah.  Apply now so that you can write a good application letter. There are two courses one for clinicians and one for researchers.

1. Practitioner’s Course on Community Interventions

This 6-day course targets those who are involved or interested in promoting physical activity through community-based initiatives. Topics include: public health models for physical activity promotion, needs assessment, best practice intervention strategies, and program evaluation.  The course culminates with a Community Workshop in which participants visit a local area and discuss strategies for improving access to physical activity in that community.


Course participants, 2012

“In my line of work, I don’t hear much about data, and don’t spend time with the data that I do have.  I learned about evidence-based decision making; where to find such documentation, and how to use it in my work.  I saw examples of how research can be used to further the work on the obesity and lack of physical activity areas, and how to continue to partner with those in the health and wellness field to make a difference.  Lastly I learned that there are lots of good people doing good work, and that only by working together and sharing information will any of us succeed.  It was an amazing experience.”

Sue Goodwin, Recreation Division Director at Seattle Parks Department and former Practitioner’s Course participant.

2. Researchers Course: This 8-day Postgraduate Course targets postdoctoral (post PhD) personnel. It will help you develop research competencies in various topics related to physical activity and public health. Ideal if you are hunting for an Assistant Professor positions or in the early stage of your academic career. Learn how to write successful grants and execute studies successfully from the world’s best.

For more information, or to apply, please visit our website at or

contact Janna Borden at (803) 576-6050 or

BJSM blog homepage


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