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Sit Less, Get Active! First MOOC to deliver and evaluate physical activity promotion, call to action: sign-up or share

22 Jun, 16 | by BJSM

By Adam Bleakley (Foundation Doctor, NHS Lothian) and Evan Jenkins (Medical Student, University of Edinburgh)

Physical activity is regarded as a global public health priority (Kohl, 2012), and physical inactivity the biggest public health problem of the 21st century (Blair, 2009).

Physical inactivity and sedentariness, “silent killers”, are associated with increased morbidity and reduced life expectancy (Lee et al. 2012, Levine 2015). Despite this, about one third of the global population are inactive (Hallal et al. 2012). In 2012, almost half of England and Scotland’s population did not meet the physical activity guidelines, and physical activity further decreases with age (British Heart Foundation, 2015).

It is imperative to further promote benefits of physical activity, work on strategies that will increase population levels of physical activity and make it an important part of people’s everyday lives.

bike moocSit Less, Get Active MOOC

Here, at the University of Edinburgh (Usher Institute for Population Health Sciences and Informatics, Physical Activity for Health Research Centre, Sports and Exercise and School of Informatics), we are the first to offer a “Sit Less, Get Active” Massive Open Online Course (MOOC), on June 30th, 2016. This new, interactive MOOC promotes and evaluates physical activity.

For those thinking, “what’s a MOOC??”: MOOCs are online courses that can be taken by anyone from any part of the world in their own time as long as you have access to the Internet.

Sign up here (it’s that easy):

Join us on a journey to learn how to sit less and become more active. Use this free course to learn how to monitor your own activity, set physical activity goals and make physical activity a habit- or share it with networks that you think it will benefit. We will present various examples on how to sit less and be more active in various settings such as your neighbourhood, home, work or educational environment, to help you incorporate the ones that fit the best to your lifestyle.

The MOOC is 3 weeks long with a commitment of not more than one hour per week. This course also offers you a unique opportunity to receive weekly physical activity health messages and monthly video reminders for 6 months after the initial 3 week-course as nudges to help you sit less and stay more active.

And if you are a health professional, use knowledge gain through this course to empower your patients to be more physically active. However, if time is the constraint, you can simply “prescribe” the course to your patients.

MOOC_TeamThe core MOOC team includes (in alphabetical order): Dr Graham Baker, Dr Danijela Gasevic, Professor Dragan Gasevic, Dr Andrew Murray, Professor Nanette Mutrie, Professor Chris Oliver, and Helen Ryall. We are grateful to all volunteers and partners who have advised us, endorsed us or worked with us in many capacities such as The Scottish Government, NHS Health Scotland, NHS Health Lothian, Sustrans Scotland, Edinburgh Leisure, SPORTA, Cycling UK, and Queen Margaret University.

How to sign up and share

The course starts on June 30, 2016, and it will run three to four times per year. You can sign up to Sit Less, Get Active MOOC by registering online via link:

Follow us on Twitter @GetActiveMOOC for a daily dose of physical activity promotion. If you have any questions, please contact the Team Lead Dr Danijela Gasevic at And don’t forget, Sit Less and Get more active for your health and happiness!



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

British Heart Foundation. Physical Activity Statistics 2015. Accessed at on June 18 2016

Hallal PC, Andersen LB, Guthold R, Haskell W for the Lancet Physical Activity Series Working Group. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet 2012;380(9838):247-257.

Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S. The pandemic of physical inactivity: global action for public healthThe Lancet, 2012;380(9838):294-305.

Lee I, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzy PT for the Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet 2012, 380(9838):219-229.

Levine JA. Sick of sitting. Diabetologia 2015, 58(8):1751-1758

#WeActiveChallenge: the WeCommunities launch fun, interactive social media campaign to promote activity

13 Jun, 16 | by BJSM

By Naomi McVey @NaomiMcVey

The case for increasing physical activity among the global population is compelling, but achieving this is far more complex. Despite comprehensive guidance from national and international organisations[1][2][3][4], and increasing emphasis on supporting the health of the NHS workforce[5][6][7], the reality of knowing how and where to start, and fitting exercise into busy lives, can be challenging for many people.

livestrong stairsExamples of high profile physical activity campaigns are those that inspire realistic, achievable change. Last year, influenced by our own experiences of juggling work and family life the @WeAHPs team developed a grassroots social media campaign focused on motivating ourselves, colleagues and families to get up and active.


The #AHPsActive campaign launched on twitter in July 2015. People taking part were asked to tweet a picture of them ‘getting active’. Inspired by Sport England’s This Girl Can campaign this was about being fun, realistic and achievable. We simply challenged our colleagues to be healthy role models and do a little more than they did before.

Support for the campaign took us by surprise and a blog from Exercise Works kick-started an online competition pitching allied health professionals head-to-head with nurses in the last two weeks in August. We wanted the #AHPsActive #NursesActive competition to:

  • raise the profile of the importance of peer support and role modelling in physical activity
  • help us practice what we teach as health care professionals
  • motivate, inspire and create a sense of community.rope pull

Activity and reach

raftingWe used twitter analytics to encourage the AHPs v nurses aspect of the competition and also promoted an award for the best photo, with the final decision made by FabNHSStuff.

Between July and September more than 800 people used the #AHPsActive hashtag in over 2500 tweets. In the 2-week competition alone over 1000 people got involved, with a twitter reach of over 7 million people. This included hundreds of photos of healthcare professionals, their teams, friends and families taking part in a huge range of activities around the world. Ice hockey in Finland, mountain climbing, cycling, skateboarding, wall-scaling, skydiving, mud running and much more: the campaign resulted in a vibrant online library of images showing nurses and allied health professionals taking part in physical activity. Smiling, sweaty and having fun.

How much did this cost? Nothing – just the time and enthusiasm of the people organising the campaign and taking part.

The 2016 campaign

This year we are planning to get bigger and better. This summer the campaign will expand across all the WeCommunities.  As a group of nurses, midwives, health visitors, AHPs, doctors, pharmacists, paramedics, finance professionals and commissioners with over 100,000 combined followers we feel well placed to influence the healthcare workforce as peers and colleagues.

Our aims build on those of last year. We know that awareness of physical activity guidelines can be lacking in healthcare professionals and students[8] as well as the general population[9] so we’re planning to promote recommendations as part of the campaign as well as resources to help achieve these. Taking place on twitter, we are asking people to share new and more photos. We’ll be using twitter analytics to encourage competition between the different communities, and with support from Public Health England we’ve teamed up with Virtual Runner UK to provide 500 WeCommunities medals as well. We’ll also develop ways to measure the impact of the campaign.

So, join us and #GetActive this summer and help us role model a healthy lifestyle with the #WeActiveChallenge.


Naomi McVey is a physiotherapist, community lead for the @WeAHPs and @Physiotalk twitter communities, and a fledgling runner.

The WeCommunities are an alliance of over 15 tweetchat communities including nurses, health visitors, midwives, doctors, AHPs and pharmacists. The communities are run by healthcare professionals, as volunteers, who believe passionately that through connecting people and sharing information, ideas and expertise we can improve health and healthcare. 


[1] NICE pathway on physical activity

[2] Department of Health UK Physical Activity guidelines 

[3] Murray etc al (2016) Scotland’s progress in putting policy about physical activity into practice. Br J Sports Med 2016;50:320-321  at

[4] Global recommendations on physical activity for health

[5] Physical activity in the workplace, NICE guideline PH13

[6] Simon Stevens announces major drive to improve health in NHS workplace

[7] White D, 2015. Promoting physical activity within Scottish hospital settings. Br J Sports Med 2015;49:1415-1416  at

[8] Dunlop M and Murray A, 2012. Major limitations in knowledge of physical activity guidelines among UK medical students revealed: implications for the undergraduate medical curriculum, Br J Sports Med 2013;47:718-720 at

[9] Knox E at al., 2013. Lack of knowledge of physical activity guidelines: can physical activity promotion campaigns do better? BMJ Open 2013;3 at

An unlikely candidate, a year as Professor of Physical Activity for Health

27 Apr, 16 | by BJSM

By Prof Chris Oliver

chris oliverAfter losing over 12 stone in weight, cycling across America, becoming a cycle campaigner, writing some policy on active travel and starting a few physical activity projects I became honorary professor physical activity for health at the University of Edinburgh. The “Sit Less, Walk More” message had finally come home to me. I had certainly lost my work life balance and after writing hundreds of numerous papers and passing an alphabet soup of post nominals, I was seriously ill with metabolic syndrome and diabetes. Although I was a successful trauma orthopaedic surgeon at the Royal Infirmary of Edinburgh, my life was collapsing around me. I had a gastric band in 2007 and got physically active, a shopping list of things to do to recover my life and get back to the things I did as a medical student got seriously out of hand. I never expected to get back to expedition whitewater kayaking or to ride 3,415 miles across the USA, this was a surprise. Coming off call in 2013 allowed me to recover from considerable professional burnout, I never should have gone back on call after having my gastric band. After all this, neither did I expect to become a professor or be in the media. I really just wanted to pay back to everyone the second chance at life I had been given. In 2013 the BBC Scotland Adventure Show made a mini-documentary about my weight loss and advocacy roles. I had hit the national media.

Meeting Professor Nanette Mutrie at the Physical Activity for Health Research Centre, University of Edinburgh was a life changing event and in the spring of 2015 I was conferred as honorary professor, a job with no exact role or even title, just to be available! With my somewhat nerd like computer skills I deliberately intended to grow my social media networks as much as possible to enable me to meet and network with as many physical activity advocates as possible. I grew my Twitter, Facebook, LinkedIn, Klout and Wikipedia profiles to engage. Certainly press, TV and radio occurred, often by initial engagement with Twitter. A consistent professional message on the positive aspects of physical activity has grown networks well. I had some professional media training. I had useful engaging radio interviews on BBC Radio Scotland on weight-loss surgery, sugar tax and various aspects of obesity. In January 2016 I featured in a BBC Scotland News documentary, “Car Sick” on the relationship between cars, bicycles, pollution and physical activity. Television seems easier to control than radio call-ins!

My initial university project was to develop the University of Edinburgh Undergraduate Medical Teaching Resource. Engagement with developing the curriculum in Edinburgh has been slow but editorials in the BJSM have helped develop physical activity teaching throughout the United Kingdom. In Edinburgh all medical students will take a six-year undergraduate course with compulsory intercalated BSc, so it’s planned from 2018 to have a course for medical students in physical activity. It would be hoped these doctors would become leaders in physical activity advocacy. We undertook a review of the knowledge of medical student knowledge of the CMO guidelines for physical activity and not surprisingly discovered that 85% of Edinburgh medical students did not know the guidelines, we’ll shortly be publishing a detailed paper. We now have significant plans to redesign and redevelop our university educational resource for physical activity.

I experimented with Lego as a tool to understand the mind maps of physical activity and inspired Nathan Stephens NHS Leadership Fellow at the Royal College of Surgeons of Edinburgh to develop some innovative physical activity infographics One of my students wrote a short blog on physical activity infographics.

I was invited to join the NHS Scotland Health and Social Care Physical Activity Delivery Group, this group delivers the Physical Activity Policy for the Scottish Government. It’s notable that the recent Scottish budget did not deliver any extra funding for active travel and even a 1% transfer of funding from roads to active travel was ignored. Being a member of the Cross Party Group for Cycling at Holyrood I see access to ministers a key for developing good bold physical activity policy. I’ve attended several NHS Scotland physical activity events. I conclude that it would be good to see a Physical Activity Cross Party Group evolve at Holyrood. Government funding needs to be placed in the correct places and not encased in silos. There needs to be an increased “political will” to support physical activity and negate the effects of physical inactivity. We all know the ticking economic time bomb that is being caused by physical inactivity. Senior government policy makers and leading ministers must quickly engage with vigorous physical activity policy, however unpalatable it may seem.

Throughout the year I gave various lectures: I was told to find out about altmetrics and give a lecture to the department. I was doubled billed with the Scottish CMO, Catherine Calderwood to give a “Health and Wellbeing” lecture to a secondary school in Glasgow, I particularly enjoyed this and would hope that one of the pupils one day would perhaps cycle across the USA, perhaps decades away. I presented results of a small survey on cycling and coffee and wrote some more scientific articles on caffeine and coffee. My inaugural institute professorial lecture “How not to be a surgeon, cycling to physical activity” was started with my entrance cycling into the lecture theate on a Brompton bike, a serious example of active travel.

With members of PAHRC we have a multiagency grant submission into investigate the effects of 20mph speed limits on active travel in Edinburgh; walking, cycling and the built environment in Edinburgh, the results are awaited.

There are some great people in PAHRC. Sharing an office with Dr Andrew Murray, the ultramarathon runner has been interesting and we have both worked to promote physical activity as much as we can, however we both have day jobs! With Dr Danijela Gasevic and her team at PAHRC are developing a MOOC, Massive Online Open Course in Physical Activity and Assessment. The MOOC will launch in May 2016 and has over 13,000 people signed up, we are currently signing up about 100 people a day. You can join here, no idea what the final numbers joining will be.

The surgery I currently perform is complex hand and wrist reconstruction surgery. The technical details of the surgery is still so much fun and I spend most of my time now teaching operative surgery. I cannot do surgery forever so a longer term career in physical activity post retirement in the next five years or so looks a great opportunity. The first year has been fun! Thanks Nanette!

Prof Chris Oliver

Honorary Professor Physical Activity for Health, University of Edinburgh


Twitter @CyclingSurgeon



“These booties are made for walking” Active Movement – Innovation in combatting children’s inactivity and obesity

3 Dec, 15 | by BJSM

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

By Dr Farrah Jawad

standing-classroom.jpg.650x0_q70_crop-smartActive Movement is an initiative that focuses on simple behaviour changes to empower people to sit less and move more.  Their aim is to: (i) integrate low level activity into our daily lives, (ii) make movement accessible for all, without requiring special equipment or skills and (iii) remove the perceived barriers that may preclude some people from participating in sport or going to the gym, for example.  The Active Movement team has recently been involved in teaching this concept to nursery and primary school children and plan to extend this to secondary schools.

On Friday 27th November 2015 at the Institute of Sport, Exercise and Health in London, Active Movement held a conference entitled “Innovation in combatting children’s inactivity and obesity.”  Below are some brief educational points from the event:

“Innovation in combatting children’s inactivity and obesity” – Paul Chadwick

  • We cannot change behaviour without first understanding the driver of the behaviour
  • The Behaviour Change Wheel1 has universal applicability to any behaviour and can be a useful tool to facilitate behaviour change
  • Behaviour change requires capability (physical and psychological), motivation and opportunity; for increasing physical activity which might mean safe spaces, cues and reminders to be active, credible role models, and so on.
  • Innovation does not have to mean something completely new, rather we can innovate through what we already know.

“Innovation and collective wellbeing” – Linda Baston-Pitt

  • The early years are a critical period in the establishment of sedentary and active behaviours, so shaping behaviour at a young age is very important.
  • Children’s wellbeing and future development is dependent on having a high parent and staff well-being and an emotionally positive environment.
  • A bottom-up approach may work best – teaching children directly in their schools, in their early years, should help them grow into active, less sedentary adults.

Beat the street logo“A review of Beat the Street – getting more children active within the school and community” – William Bird MBE

  • Exercise has positive effects on executive function and mathematics achievement in children;2,3 we do not have to decide between physical activity and academic achievement as the two go hand in hand.
  • The theme of the Beat the Street initiative was to transform the streets into an activity centre. Children and adults were given smart cards and sensors were put up across the city in Reading, England (approximate population 207,000).  Health messages were avoided, and people were encouraged to travel around the city to touch the sensors with their smart cards in order to gain points to win prizes.  Around 39% of the population took part (approximately 10,000 children and 13,000 adults).
  • Beat the Street participants reported that their biggest reasons for taking part were “feeling healthier,” “getting fit,” and “having fun.”
  • The organisers found that participants were likely to stay active at 3 months (which they defined as achieving 30 minutes physical activity five times a week) and after one year, there also seemed to be retention of physical activity levels.
  • Beat the Street has been rolled out in Thurrock, Norwich and Cambridge and will be coming to further areas in the UK in 2016.

The impact of changing the learning environment to improve health and learning – Stacy Clemes

  • Sedentary behaviour is common and automatic due to our lifestyle. Nearly 2/3 of 9-10 year olds spend 2/3 of the day sitting4.
  • Sedentary behaviour tracks from childhood to adulthood.
  • Sit-to-stand desks in primary schools have been shown to be effective in increasing energy expenditure5,6 and standing and movement during the school day7.
  • A small scale study took place at a primary school in Bradford, England. Baseline data showed that children spent around 9.5 hours a day sitting on their school days (69% of their wake time), and 10.5 hours sitting on non-school days (70% of their wake time).  Around 70% of class time was spent sitting and 71% of after school time was spent sitting.
  • Children were exposed to sit-to-stand desks for an hour each day and after this intervention, time sitting decreased and time spent stepping increased significantly.
  • A comparative study in Melbourne, Australia saw similar effects.
  • The BBC reported on the study in Bradford and you can watch the two minute clip via this link:

Active movement – innovation in behaviour change – Mike Loosemore and Peter Savage

  • Most children are active not as a learned behaviour but instinctively.
  • Active Movement aims to establish low level activity as normal practice by engaging with early years children to integrate movement into the daily routine. There is an emphasis here on activity not being a “bolt-on extra” for busy teachers to try to incorporate into the day but on physical activity being a natural, integrated part of the day.
  • Active Movement has given nursery and primary schools materials on how to increase their physical activity throughout the day and does this with the use of characters as role models (“Sid”, who sits, and “Stan”, who stands). Staff working at the schools were also given material about the benefits of physical activity and how they can increase their own levels of activity, thereby making them into physical activity role models too.

Leyf (London Early Years Foundation) Nurseries – June O’Sullivan MBE

  • Children are the litmus test – if anything is going wrong in our society, it is first evident in children.
  • 25% of British children are overweight by the time they start primary school.
  • 1,000,000 children in the UK go to nursery each day – there is opportunity to intervene by entering into pedagogical conversations with parents, harnessing “Pester Power,” championing outdoor play, good food procurement and cooking skills in order to facilitate positive behaviour change.

The event was a chance to consider different strategies of reducing sedentary behaviour in our communities, emphasising the concept that innovation does not need to be something completely new, rather harnessing what we know already and thinking of simple, effective ways of implementing change that involves whole communities.


  1. Michie, S, van Stralen, M, West, R (2011).  The behaviour change wheel: A new method for characterising and designing behaviour change interventions.  Implementation Science 2011, 6:42  doi:10.1186/1748-5908-6-42
  2. Davis CL, Tomporowski PD, McDowell JE, et al. Exercise Improves Executive Function and Achievement and Alters Brain Activation in Overweight Children: A Randomized Controlled Trial. Health psychology : official journal of the Division of Health Psychology, American Psychological Association. 2011;30(1):91-98. doi:10.1037/a0021766.
  3. Tomporowski PD, Davis CL, Miller PH, Naglieri JA. Exercise and Children’s Intelligence, Cognition, and Academic Achievement. Educational psychology review. 2008;20(2):111-131. doi:10.1007/s10648-007-9057-0.
  4. Steele, Rebekah M., et al. “Targeting sedentary time or moderate-and vigorous-intensity activity: independent relations with adiposity in a population-based sample of 10-y-old British children.” The American journal of clinical nutrition 90.5 (2009): 1185-1192
  5. Benden, M. E., J. J. Congleton, and R. Fink. “An in-situ study of the habits of users that impact office chair design and testing.” Journal of the Human Factors and Ergonomics Society 1.53 (2011): 38-49.
  6. Benden, M, Zhao, H, Jeffrey C (2014). The Evaluation of the Impact of a Stand-Biased Desk on Energy Expenditure and Physical Activity for Elementary School Students.   J. Environ. Res. Public Health 2014, 11(9), 9361-9375; doi:10.3390/ijerph110909361
  7. Lanningham-Foster, L., Foster, R. C., McCrady, S. K., Manohar, C. U., Jensen, T. B., Mitre, N. G., Hill, J. O. and Levine, J. A. (2008), Changing the School Environment to Increase Physical Activity in Children. Obesity, 16: 1849–1853. doi: 10.1038/oby.2008.282

Further reading

Hunter RF, de Silva D, Reynolds V, Bird W, Fox KR. International inter-school competition to encourage children to walk to school: a mixed methods feasibility study. BMC Research Notes. 2015;8:19. doi:10.1186/s13104-014-0959-x.

W J Brown, A E Bauman, N Owen.  Stand up, sit down, keep moving: turning circles in physical activity research?  Br J Sports Med 2009;43:86-88 doi:10.1136/bjsm.2008.055285

Clemes, S, Barber, S, Bingham D (2015).  Reducing children’s classroom sitting time using sit-to-stand desks: findings from pilot studies in UK and Australian primary schools.  J Public Health first published online June 14, 2015 doi:10.1093/pubmed/fdv084

Dr Farrah Jawad is a registrar in Sport and Exercise Medicine in London.  She co-ordinates the BJSM Trainee Perspective blog.

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)

The delegate view of 6th London School of SEM Conference– What lessons were learnt?

1 Apr, 15 | by BJSM

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

By Jonathan Shurlock (@J_Shurlock)

Reading the recent BJSM blog on the 6th annual London Deanery Sports and Exercise Medicine (SEM) Conference written by the event organisers, inspired me to give the delegate view of the important lessons learnt by those in attendance, and add in some links to related BJSM material.

Tales from the ballet: common problems encountered with performing athletes and dancers – Dr Roger Wolman

  • Dancers are often lumped as a single group, however movement patterns vary significantly between forms of dance
  • Injury risk factors – Poor nutrition. The movements desired by dance coaches require demanding biomechanics. Aesthetic requirements of low body weight and knee hyper-flexion
  • Demands – Highly competitive environment means that dancers do not reveal injuries for fear of being held back. Tours are often long, with inadequate rest
  • Support – Limited financial resources, therefore there is inadequate medical and scientific support. The first NHS specialist dance injury clinics were set up in 2012. There is often an on-going battle between dance teachers and sports therapists and a balance must be met to ensure protection of athlete’s health and performance capability

Mental health in sport – Dr Justin Yeoh

  • The true incidence of depression in sport is uncertain, due to limited research. There is a higher incidence in aesthetic sports (e.g. dance, gymnastics)
  • If exercise is effective in the treatment of depression, so why do athletes get depressed? à Athletes are perceived to be superhuman. However, they have the same risk factors as the general population, and a long list of additional risk factors (e.g. recurrent injuries)
  • Athletes will not necessarily discuss their symptoms, so awareness is needed of the common signs, including:
  • Consistent poor or inconsistent performance (reduced work rate, poor motivation)
  • Increased apathy or irritability
  • Medical issues (recurrent illness or injury, excessive fatigue)
  • Stigma and lack of education are still prevalent issues. Good examples of schemes to improve awareness and reduce stigma from PFA, Rugby Union, and Rugby League
  • See recent BJSM blog

Rehabilitation considerations in the older athlete – Mr Bruce Paton

  • Increasing age impacts on oxygen transfer (reduced V02 max), maximum heart rate and muscle physiology (reduced number and size of muscle fibres, and change in muscle fibre types)
  • The V02 max requirement to retain independence is thought to be above 15-18 litres/min/kg
  • A substantial drop in performance is seen with most sports at around 70 years of age, event with chronic exercise
  • Eccentric or isometric loading is very useful for older athletes
  • See previous BJSM blog

The challenges of managing an athlete with a disability – Dr Richard Weiler

  • The general level of evidence for the implementation and effectiveness of prevention strategies and treatments in disability sport is poor
  • “You must unlearn what you have learned” à observe and understand the different abilities that these athletes possess
  • Humour can be critical when working with individuals in disability sport

Keynote; How to increase exercise in sedentary people – Dr William Bird

  • Low cardiorespiratory fitness has a much greater impact on all cause mortality than obesity. (See evidence here)
  • A huge number of deaths from disease such as breast and bowel cancer are attributable to physical inactivity (See evidence here)
  • You cannot isolate physical activity and throw it on top of a busy, stressful life. To promote physical activity, we need to identify patient values and end goals, to provide a gateway to a better life
  • Promotion of physical activity requires changes to infrastructure and strong partnerships and leadership from the health sector
  • See open access article and BJSM podcast

To delivery and beyond: Exercise in pregnancy – Dr Eleanor Tillet

  • Physical activity guidelines are modified during pregnancy (See here)
  • Exercise in pregnancy should be encouraged, as long as you ensure your patient is aware of the following:

–   Contraindications to physical activity during pregnancy

–   Injury risk with increased ROM

–   Avoidance of exercise where there is risk of abdominal trauma

–   The aim during pregnancy is not to gain fitness, but to maintain

Paediatric sports medicine: Top tips for managing the child and adolescent athlete – Dr GB Ajayi

  • Children are not little adults! Their injury risks are not the same as the adult population
  • Increasing height = modified centre of mass = reduced muscular control = increased injury risk (Testosterone mitigates against this)
  • Ossification centres are areas of weakness therefore children can get injuries not often seen in adults (e.g. supracondylar fractures)
  • You need to be aware of the increased risk of acute avulsion injuries and chronic overuse osteochondroses
  • See these systematic reviews (1 & 2) for a good summary of injury considerations in children

How the medical team prepares for an international tournament – Dr Ian Beasley

  • The multidisciplinary team (MDT) is central in tournament preparation. The team must agree realistic aims and plan logistics
  • An emergency action plan is needed at every stage
  • Where is your defibrillator? This should always be immediately accessible, not ‘under the bus’
  • When traveling for competition endemic problems need to be assessed, such as local communicable disease, temperature and humidity
  • During international competition, the host country hosts a meeting of all team medical officers to discuss specifics. This is vital to ensure effective medical care throughout the competition


Jonathan ShurlockBSc (Hons), is a fourth year medical student. He sits on the european College of Sport & Exercise Physicians (ECOSEP) student committee, in addition to the London Sports and Exercise Medicine Committee. He has a passion for clean sport, and as such works as a research assistant at The Centre for Sport and Exercise Science and Medicine (SESAME) in Eastbourne, working on various WADA funded anti-doping projects. His twitter handle is @J_Shurlock.

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.

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.

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.

The challenges of health communication in a modern world of entertainment

22 Jun, 12 | by Karim Khan

Sport and Exercise Medicine: The UK trainee perspective (A twice-monthly series on the BJSM blog)

By Dr Wilby Williamson

Preaching about physical activity and demanding compliance with 150 minutes of activity per week, as I do with my friends and family, often falls on deaf ears.  Changing tack to discuss differences between London’s bus drivers and conductors in the 1950s and challenging my peers to a 2 minute wiggle at least allows me to stay for dinner!  Health communication is certainly a challenge, complicated by perceptions of risk and medical uncertainty.  But as professionals practicing evidence-based medicine, we have signed up to translate evidence and facilitate informed decision making.

Dr Mike Evans (23 and ½ hours) has shown the world that scientific evidence can be the centre fold for our communication. He has set the physical activity public engagement ball rolling; now we need to keep the momentum going, pushing the understanding beyond the pages of our esteemed journals and the feverish eyes of our professional and academic circles.  In the UK there are approximately 40 million regular online users with 50 to 60 percent using YouTube or Facebook on a monthly basis1-3. Dr Evans’ work illuminates both the potential and some of the requirements for successfully engaging these users. Winning favour with our audience is not easy, we go online seeking specific information or to be entertained. As health communicators we may have as little as 15 seconds to hook the online user. The salience, affects, and messengers all being important determinants of gaining influence. See his discussion of what he learned in this exclusive BJSM paper – click here.

Communication campaigns have to acknowledge the distinctions and idiosyncrasies between different media platforms. Consumers may use multiple media sources at any one time and the lines between the offline and online environments are becoming increasingly blurred. 80 percent of twittering is via mobile devices and twitter is one of the fastest growing online platforms with 23% of the UK audience liking the occasional tweet1-4. Aspirations, in the modern world of communications are not only to go viral but to package material for the small screen and seek user generated content as a sign of success. Posts, tweets and uploads all providing measures of reach and engagement. BJSM has been customised for mobile platforms.

The skills required to launch a communications campaign go beyond the repertoire learned in the standard health communication class. Planning for an engagement project starts with getting the right multidisciplinary collaboration, with creativity and online experience being essential.

This summer, I am privileged to be working as one of the health professionals on a creative science and health communication project exploring strategies for public engagement.  Funded by the Wellcome Trust, the Fidget Project is bridging the offline and online worlds of communication. The collaboration is bringing together experience from artistic, online and health & science backgrounds to provide an explanation for the message that we sit too much and need to move more. With the summer of 2012 offering endless entertainment options, encouraging our nations to sit in front of their media devices, can we coax people to consider the benefits of being a ‘frequent breaker’ and embrace adding 22 minutes of (moderate) wiggling to their day? As we tread festival fields, pitch in city centres and navigate the social media world, feel free to join the tour and see how we trend.


  1. UK Online Measurement, UK Online Media Landscape 2011.  
  2. YouGov, Social Media ‘growing up’ in UK Feb 2012
  3. Ofcom, Social Networking : A quantitative and qualitative research report into attitudes, behaviours and use 2008  
  4. The Guardian, Twitter now has 10m users in UK May 2012 



Fidget  is a public engagement project funded via the Wellcome Trust’s Society Awards. The charity, London Arts in Health Forum is directing Fidget in collaboration with the installation artist Michael Pinsky and the online charity Youthnet.

Dr Wilby Williamson is a registrar in Sports and Exercise Medicine on an East of England rotation. He was a visiting researcher with the Physical Activity group at the Medical Research Council’s Diabetes and Obesity Epidemiology Unit. He is currently an associate in preventive medicine with London Arts in Health Forum.

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

Has ‘sedentarism’ — excessive sitting — crossed over to join the conditions that the public is aware of? The new obesity?

22 Jul, 11 | by Karim Khan

The  health problems of office workers who ‘sit too much’ is getting increasing attention not only in medical journals but now also in popular media.


Owen N, Baumen, AE, and Brown, W. 2009. Too much sitting: a novel and important predictor of chronic disease risk? BJSM;43:81-83.

Brown, WJ, Bauman, AE, and Owen N. Stand up, sit down, keep moving: turning circles in physical activity research? BJSM 2009; 43:86-88.

Carr, LJ, Walaska KA, and Marcus BH. 2011. Feasibility of a portable pedal exercise machine for reducing sedentary time in the workplace. BJSM, published online Feb 14, 2011.

Khazan, O. Love My Computer Lifestyle. Hate How It’s Killing Me. Forbeswoman, June 29, 2011.

One recent news article –   NJ court: Desk job, not bad health, led to death – raised the question:  is this a prelude for other hazards of physical inactivity related disorders or just a blip? Cardiac events, diabetes etc…

The trial lawyers have been saying when “smoking bullet” (cause-effect type mechanisms) is combined with lack of choice, its only a matter of time. We’ll see.

While it is clearly over-simplistic to say that ALL sitting is ‘bad,’ there is growing momentum for simple, effective strategies to counteract the health burden of sedentary office culture.

Marckowitz, E. Sitting Is Bad for You: What Can You Do About It at Work? Inc, May 4, 2001.

Don’t forget the short BJSM podcast, Sedentary behaviour and mortality, with Genevieve Healy, one of the pioneers in this field.

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