By Ann Gates

(@exerciseworks)

Giving regular exercise advice and support as part of every health care consultation is fast becoming a critical health intervention in the prevention of the ‘tsunami’ of lifestyle diseases such as obesity, diabetes and related cancers. In May 2012 the U.S. Centre for Disease Control together with the Institute of Medicine released a national report detailing recommendations to combat the ‘Weight of the Nation’. The data predicted 42 percent (or 32 million more people) of the American population would be obese by 2030, while 11 percent would be severely obese. The economic costs for the associated health care services: $550 billion. This is an unsustainable cost for most health care systems and countries. This burden of lifestyle diseases and suffering is an unacceptable outcome for 21^st  century medicine.

The ‘Weight of the Nation 2012’ report summarised the key actions as:

1. Integrating physical activity into people’s daily lives
2. Making healthy food and beverage options available everywhere
3. Transforming marketing and messages about nutrition and physical activity
4. Making schools a gateway to healthy weights
5. Galvanizing employers and health care professionals to support healthy lifestyles

Several ‘best practice’ initiatives covering both healthier diets and integrating physical activity are identified. The authors report that physical activity should be a ‘routine and integral part of daily life’.

This provides the ‘call to action’  for health professionals to lead on giving exercise advice and support to patients, relatives and caregivers on why regular exercise helps prevent and treat many lifestyle diseases or ‘non communicable diseases’ (#NCDs). 36 million people, around the world, die from lifestyle diseases each year. They are names and faces in every doctor’s waiting room, every hospital outpatient clinic and everybody’s family. This is a global health issue that needs urgent health professional intervention by every health professional around the world.

Giving physical activity advice to everyone is not as easy as it seems. We know that when doctors give exercise advice to patients that they are more likely to follow that advice (read more here).  We also know that brief intervention during doctor –patient consultations is cost effective.

Exercise advice to patients should include warm up, exercise plan and cool down instructions on how to exercise effectively and safely. A weekly, balanced exercise programme for patients with chronic diseases should include cardiovascular, strength, flexibility and balance exercises. Different diseases often respond better to different types of exercises and physical activities. For example, Nordic walking or ballet has been shown to help improve the symptoms of patients with Parkinson’s disease.

Patients deserve the choice to choose how to incorporate ‘exercise as a medicine’ into their daily lives and in the prevention and management of long term diseases. Health care professionals can use tools like the American Cancer Society’s ‘Make Time-Break Time’ infographic to help patients understand the risks of inactivity and sedentary behaviour to their health during the day. This helps patients to ‘choose’ to increase their activity levels as part of the clinical management of their health condition.

The more health professionals consult with their patients on the benefits of regular exercise and more patients start to realise the benefits to their health, the more likely health care organisations around the world can start to address the obesity and non communicable diseases epidemic in a sustainable way.

This is a call to action to change our clinical practice and implement the concept of exercise as a medicine in the prevention and treatment of chronic diseases. Exercise advice and support should be part of EVERY consultation.

It is also time for sports and exercise professionals, health care professionals and patients to work together to help improve both the weight and health of nations all around the world.

Follow this link to see ‘part 1′ of this blog. It has 292 tweets to date – a BJSM record! Thanks everyone for promoting physical activity.

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Ann Gates BPharm(Hons)  MRPharmS

Personal Trainer, Chronic Disease Exercise Specialist, BACPR Exercise Instructor.

Founder of Exercise Works!

www.exercise-works.org

@exerciseworks

email: ann@exercise-works.org

Given it’s the weekend, BJSM is allowed to have a bit of fun and show the 5-min video of ‘smokadiabesity‘ being introduced to  last week’s Walking Summit in Washington DC. More importantly, Robert Sallis and Doug Van Zoeren provide helpful evidence and compelling stories as to the benefits of walking.

The link for Every Body Walk! is here - the value for all BJSM blog users is that the site has motivational clips, trail maps -  very practical aids to getting people walking. So it fits with BJSM’s ‘implementation’ push – turning research into patient health benefits. We’d love to hear your stories of how you motivated yourself, or others, to benefit from physical activity. Add below the post or email to karim.khan@ubc.ca

ACSM posted the following to members…

Yesterday’s U.N. Side Event on Physical Activity and Noncommunicable Diseases (NCDs) brought together an extraordinary group of world ministers of health, public health professionals, physical activity advocates, scientists, elite athletes and other experts. The focus was on physical activity as a global health opportunity, informing the deliberations of the U.N. High-Level Meeting on Noncommunicable Diseases taking place today and tomorrow.

Live Webcast U.N. Roundtables

The U.N. sessions on NCDs will be webcast live at www.un.org/webcast ( http://www.un.org/webcast ) . Under Live Schedule at right, click on Channel 4 to access the roundtable discussions on NCDs (Monday at 10:00 a.m. and 3:00 p.m. EDT).

Image source: www.fullissue.com

Recent press coverage of BJSM article: Television viewing time and reduced life expectancy: a life table analysis, has sparked debate in popular media. David Aaronovich, from the UK Times, writes: “On Tuesday morning many people in Britain woke up to the news that their televisions were killing them… A curious person would want to know how this transmission of death works…Is it some kind of death ray, emitted by the billions of nasty little pixels on the screen?”

His main issue wasn’t with the credibility of research findings but rather the news coverage’s muddled distinction between causal and associated behaviour risks.

The sensationalist response to Veerman, Healy, and Cobiac et al’s article is not confined to the UK. News headlines from around the globe include:

TV can kill, just like smoking

It’s the threat in the corner of every living room

TV And Lifespan: One Hour’s Viewing Shortens Life By 22 Minutes

New Study Says “Jersey Shore” Can Shorten Life Span (Not Really)

Reporting accuracy aside, as they say in the business – any press is good press. The news coverage successfully calls attention to the risks associated with coming home from your desk job (remember a few weeks ago – we were told that desk jobs are a serious health risk), and sitting for hours in front of the TV.

Since researchers excluded those individuals that exercised in front of the TV, the underlying issue here is the negative health impacts of sedentary behaviour. This is nothing new for our fellow physical activity advocates (see related BJSM warm up on smokadiabesity).

The blast of news coverage also suggests that creative research angles on behavioral health impacts are useful in grabbing the public imagination. It may be considered a less dramatic version of when activists take off their clothes to promote reduction of fossil fuel dependency or anti-fur campaigns (see World Naked Bike Ride and I’d Rather Go Naked Than Wear Fur).

As commendable as this level of commitment to promoting behavior change is, one of our aims at BJSM is to keep our clothes on and let the science speak for itself.

Post script: One news headline DID hit on the crux of the issue:

Want to live longer? Try less TV and more exercise

First – credit to New York Times. Specifically Gretchen Reynolds who provides wise perspectives on sport and exercise medicine. Like this piece about exercise for brain function. Gretchen provides balanced, topical sports medicine coverage – she picks the emerging winners and doesn’t get blinded by fads. She has been on exercise and brain function for a while – if it were a stock, think Apple over recent years or Blackberry during 2000-2005. The NYT’s Tara Parker-Pope is active on Twitter (@NYTimesWell) – definitely good to follow.

Second, the BJSM actively promotes this area of Exercise is Medicine. One review relating resistance training and cognitive benefit will get you started. In the same issue, the paragon of the field, Art Kramer, summarizes aerobic exercise effects.

For more spice and intrigue, consider Leon Flicker’s gentle rebuke to the NIH for their failing to acknowledge the evidence for exercise and brain function in their 2010 consensus statement. An Australian had to lead that push because US researchers want NIH funding – don’t bite the hand that feeds you! But why didn’t the NIH do a better job? Is this a case for Ray Moynihan? (Twitter @RayMoynihan and ‘Selling Sickness’ via Amazon). To spell it out, do major agencies undervalue the benefits of physical activity for health because there is no corporate support? (Omission rather than commission?).

OK – enough for a weekend!
Take home message = exercise for your brain – your heart will thank you for it!

And third, remember that any drug trial that shows a positive effect will have 10 to 100 to 1000 times more marketing budget support than a similar exercise study. So when the evidence is emerging for physical activity benefits – see lead link to New York Times….magnify the headline fonts and the coverage volume by 10 to 100 to 1000 for a fair comparison with anticholinesterases. I’m reaching for my walking shoes and my dumbell!

See link to smokadiabesity epidemic here

Blair. 2009. BJSM, (43) pp1-2

Smoking, diabetes and obesity are  major public health concerns.  At the same time there is little attention given to the health consequences of missing a day (or a lifetime) of physical activity.
Yet low physical fitness kills more Americans than does either smoking, diabetes, or obesity (see Blair). And, when one looks at it carefully, low fitness kills more Americans than smoking, diabetes and obesity in COMBINATION!! (apologies for red but it deserved it!)

As a nation, an unfit America (that’s where these data exist) dies more from low fitness than from ‘smokadiabesity.’ And low fitness is readily curable.  Do personal, and policy, priorities reflect the real killer?

Comment below or send guest comments to karim.khan@ubc.ca

Does our health system reflect this order of importance?

This graph (redrawn from Blair SN, BJSM 2009, pp. 1-2)  compares the population attributable fraction of death for men (left, coloured bar in each set) and women (right, open bar in each set). The low fitness column reflects a greater PAF for deaths than the combined smokadiabesity column.

See also Supercourse for Professor Blair`s 40-slide lecture on this topic

And click here to listen to Professor Blair`s BJSM podcast