Health secretary urges GPs to be “creative” in prescribing exerciseBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b3364 (Published 17 August 2009) Cite this as: BMJ 2009;339:b3364
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Re: ‘Health Secretary urges GPs’ to be “creative” in Prescribing exercise’ BMJ 22 August 2009 Volume 339 page 417.
The recently announced renewed government interest in increasing the
nation’s physical activity is to be applauded. The benefits of physical
activity in preventing cardiovascular disease (CVD) have been apparent for
over half a century since the initial observation that physically active
London bus conductors were less likely to develop coronary heart disease
than their sedentary bus driver colleagues (1). Since then evidence has
continued to accumulate demonstrating that physically active men and women
reduce their risk of CVD by between one third and one half compared to
their sedentary counterparts (2). The relative risk of CVD associated
with a sedentary lifestyle is similar to that associated with cigarette
smoking, hypertension or hypercholesterolaemia (2) and clearly represents
an ideal target for CVD risk reduction in the population. However, the
capacity of physical activity interventions to prevent CVD events has yet
to be born out in outcome studies and in addition, a sustained increase in
physical activity following a brief intervention remains the holy grail.
The United Kingdom Health Development Agency in their evidence briefing
for brief interventions aimed at increasing physical activity levels (3),
concluded that at the present time there is some evidence suggesting that
a single episode of brief tailored advice with some follow-up can increase
physical activity but possibly only in the short term. Given this lack of
evidence it is unsurprising that the provision of lifestyle advice yields
few rewards in the Quality and Outcomes Framework (QOF) (4). Previous
government initiatives in primary care to increase physical activity
include ‘exercise on prescription’. A National Institute for Health and
Clinical Excellence (NICE) review found that exercise on prescription
schemes result in only short term increases in exercise levels (<_12 weeks="weeks" _5.="_5." this="this" latest="latest" initiative="initiative" seems="seems" at="at" odds="odds" with="with" the="the" department="department" of="of" healths="healths" previous="previous" advice="advice" to="to" primary="primary" care="care" trusts="trusts" _6="_6" only="only" endorse="endorse" interventions="interventions" when="when" they="they" are="are" part="part" a="a" properly="properly" designed="designed" and="and" controlled="controlled" research="research" study="study" determine="determine" effectiveness="effectiveness" as="as" recommended="recommended" by="by" nice.="nice." p="p"/>Despite much government focus on improving the health of the population in
recent years, public perceptions of what constitutes a healthy lifestyle
and which behaviours are unhealthy remain poor with between a half and two
thirds of the population citing television and magazines as their main
sources of health promotion information (7). Of those who have received
healthy lifestyle advice from primary care services, few are able to
accurately recall what they have been told (8).
Whilst there is convincing epidemiological and physiological evidence of
the cardiovascular protective effects of physical activity in adults,
disappointingly intervention studies have yet to demonstrate that
interventions designed to increase physical activity can result in a
reduction in CVD or an improvement in CVD risk factors or indeed a
sustained increase in physical activity levels. It seems unlikely
therefore, that the recently announced government recommendation to
provide brief physical activity advice in primary care will have any
meaningful benefit on the health of the population.
It may therefore be more appropriate for our elected government ministers
to implement legislative changes that coerce the population into
increasing their activity for example, banning traffic from city centres
and providing more cycle lanes, rather than handing the baton to primary
care to improve performance in European league tables, a mission in which
they will almost certainly fail.
1. Morris J, Heady J, Raffle P, Roberts C, Parks J. Coronary heart-
disease and physical activity of work. Lancet. 1953;265(6795):1053-7.
2. Gill J, Malkova D. Physical activity, fitness and cardiovascular
disease risk in adults: interactions with insulin resistance and obesity.
Clinical Science. 2006;110:409-25.
3. Hillsdon M, Foster C, Cavill N, Crombie H, Naidoo B: The
effectiveness of public health interventions for increasing physical
activity among adults: a review of reviews. 2005:1-40 London, Health
Development Agency [online] Available at;
4. Quality and Outcomes Framework guidance for GMS Contract 2009/10
[online] Available at;
5. Four commonly used methods to increase physical activity: brief
interventions in primary care, exercise referral schemes, pedometers and
community-based exercise programmes for walking and cycling. March 2006
[online] Available at; http://www.nice.org.uk/phi002 (accessed 31/8/09).
6. Department of Health statement on Exercise Referral, March 2007
[online] Available at;
7. Duaso M, Cheung P. Health promotion and lifestyle advice in a
general practice: what do patients think? Journal of Advanced Nursing.
8. Little P, Slocock L, Griffin S, Pillinger J. Who is targeted for
lifestyle advice? A cross-sectional survey in two general practices.
British Journal of General Practice. 1999;49(447):806-10.
Competing interests: No competing interests
Re: ‘Health Secretary urges GPs’ to be “creative” in Prescribing
BMJ 22 August 2009 Volume 339 page 417.
I was interested in reading this item of news BMJ, 22 August Vol 339
page 417 by Roger Dobson where he states that. ‘The Department of Health
through its secretary Mr Burnham has unveiled plans to get the country
dancing, cycling, swimming and walking its way up the league table from
21st position among 32 countries in Europe to a target of fourth place
within a decade’. I applaud this idea but it has taken over 24 years
since I tried to promote physical activity from a rural GP practice.
I was the General Practitioner who promoted physical activity from
the surgery and the results were published in 1985 (1). “Can General
practitioners influence exercise habits? A controlled trial”. The Royal
College of General Practitioners (2) published (1986), “Prescribing
Exercise from General Practice”.
I developed the “Healthy Village” which was recognised as a first by
the World Health Organisation in 1998. (3) The concept used the community
as a resource for health by providing physical activities through local
organisations including those promoting dancing, swimming, walking and
The Pioneer Health centre in Peckham, (4) the phf.org. through Dr
Scott Williamson and Innes Pearce provided facilities within pram walking
distance of the centre and provided physical activities for all ages
including, dancing, swimming as well as healthy eating, and combined these
with an annual family health check from 1936.
General Practitioners continue to promote physical activity. Healthy
Living Centres started by the Labour Government in 1997 some continue
today. The community can provide facilities and promote physical activity
though Primary Care.
retired General Practitioner
No competing interest,
1 Campbell M, Browne D and Waters W, Can General Practitioners influence
exercise habits? A controlled trial BMJ 1985 290; 1044-1066
2 Derek Browne, Medical Annual Ed D Pereira Gray RCGP 1986, 115-128
3 Derek Browne, Occasional Paper 71, 1995 RCGP Healthy Villages 30-32
4 the phf.org.
Competing interests: No competing interests