Physical Activity- a good medicine we can do more to promote
“Health Professionals fail to inform patients about wonder-treatment”. Would this headline be palatable to the general public were it to appear in the media? Would it be fair?
MacAuley, Bauman and Fremont rightly state that it is “extraordinary how long mainstream medicine is taking to accept the importance of physical activity”1. If we are serious about doing the best thing for every patient every time, then surely something with proven efficacy in increasing happiness, helping to prevent and treat over 40 chronic diseases, and significantly increasing life expectancy2 would be a key weapon to not only help treat disease, but also achieve health.
In our view the authors are right to conclude that efforts based within health and social care are necessary, but not sufficient in themselves to produce a tangible increase in population physical activity levels. A co-ordinated, collaborative, cross-sectoral approach is required to secure lasting change and improvement. This requires action and input from colleagues in education, transport, urban design, communications, workforce settings, sport and active recreation as well as health and social care. Parallels can be drawn with the efforts in the UK over the last 60 years to reduce cigarette smoking, where physicians worked with and across many sectors, supported by government in order to achieve change at the cultural and behavioural level. It would be hard to find any doctor who feels that promoting the health benefits of smoking cessation falls beyond their duty to “make the care of your patient your first concern”3. In Scotland, we have benefited from input and knowledge from experts who emphasized that this cross-sectoral approach, taken at national, local, and community levels was required in relation to physical activity. These suggestions were incorporated into “Investments that work for physical activity4” and embraced within Scotland as a route map to guide change.
It is likely that this input, applied systematically is responsible for the most recent Scottish Health Survey5 data showing an, albeit modest, increase in physical activity levels in both adults and children.
Concrete examples of such collaborative efforts already exist: within education where about 96% of primary school children receiving a minimum 2 hours of Physical Education each week, (up from 5% in 2003, and 55% in 2010) whilst in transport 20mph speed limits are increasingly replacing 30mph in cities across Scotland to allow for safer engagement in physical activity and fewer road traffic accidents.
Everyone can make a contribution to increasing physical activity, and the NHS and Social Care are no different. Although further study is required, brief advice and brief intervention can be highly cost effective, at £40-440 per QALY, where the ceiling for cost effectiveness is £30,0006. The authors share the example that only 1 in 6 patients with hypertension or diabetes receive advice regarding physical activity; 2 conditions where this should clearly be part of routine care. As health professionals, it would seem we are not yet collectively taking proportionate responsibility, nevermind disproportionate responsibility.
There is a real opportunity for Health and Social Care to increase its collaborative contribution and for individual clinicians, service leaders and policy makers to take concrete actions7 that can lead to real change and improvement in physical activity levels, happiness, and health for our patients and populations. Furthermore, since physical activity can put a big fat smile on our face, as health professionals perhaps we can facilitate ways for ourselves and NHS staff (the world’s third biggest workforce) to be more active too.
Dr Andrew Murray1,2
Mr Nathan Stephens3
1) Clinical Leadership Fellow, Royal College of Physicians and Surgeons of Glasgow.
2) Centre for Sports and Exercise, University of Edinburgh.
3) Clinical Leadership Fellow, Royal College of Surgeons Edinburgh and NHS Education for Scotland
References
1) MacAuley, Bauman, Fremont. Exercise: not a miracle cure- just good medicine. BMJ 2015;350:h1416
2) Department of Health. “Start Active, Stay Active” - a report on physical activity for health from the four home countries’ Chief Medical Officers. 2011
3) Good medical practice (2013), General Medical Council, http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp
4) 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 Med 2012;46:8;70 9- 7 12.
5) Scottish Government. Scottish Health Survey 2013. Scottish Government. 2014.
6) NICE. Four Commonly used methods to increase physical activity. National Institute for Health and Clinical Excellence. 2006. http://www.nice.org.uk/ nicemedia/pdf/
7) Scottish Academy of Medical Royal Colleges and Faculties. The Role of Health and Social Care in Increasing Physical Activity. Scottish Academy of Medical Royal Colleges and Faculties. 2015 accesed online April 2015 http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf
Competing interests:
No competing interests
14 April 2015
Andrew D Murray
Clinical Leadership Fellow
Nathan Stephens, Clinical Leadership Fellow, Royal College of Surgeons Edinburgh and NHS Education for Scotland
Royal College of Physicians and Surgeons of Glasgow
Rapid Response:
Physical Activity- a good medicine we can do more to promote
“Health Professionals fail to inform patients about wonder-treatment”. Would this headline be palatable to the general public were it to appear in the media? Would it be fair?
MacAuley, Bauman and Fremont rightly state that it is “extraordinary how long mainstream medicine is taking to accept the importance of physical activity”1. If we are serious about doing the best thing for every patient every time, then surely something with proven efficacy in increasing happiness, helping to prevent and treat over 40 chronic diseases, and significantly increasing life expectancy2 would be a key weapon to not only help treat disease, but also achieve health.
In our view the authors are right to conclude that efforts based within health and social care are necessary, but not sufficient in themselves to produce a tangible increase in population physical activity levels. A co-ordinated, collaborative, cross-sectoral approach is required to secure lasting change and improvement. This requires action and input from colleagues in education, transport, urban design, communications, workforce settings, sport and active recreation as well as health and social care. Parallels can be drawn with the efforts in the UK over the last 60 years to reduce cigarette smoking, where physicians worked with and across many sectors, supported by government in order to achieve change at the cultural and behavioural level. It would be hard to find any doctor who feels that promoting the health benefits of smoking cessation falls beyond their duty to “make the care of your patient your first concern”3. In Scotland, we have benefited from input and knowledge from experts who emphasized that this cross-sectoral approach, taken at national, local, and community levels was required in relation to physical activity. These suggestions were incorporated into “Investments that work for physical activity4” and embraced within Scotland as a route map to guide change.
It is likely that this input, applied systematically is responsible for the most recent Scottish Health Survey5 data showing an, albeit modest, increase in physical activity levels in both adults and children.
Concrete examples of such collaborative efforts already exist: within education where about 96% of primary school children receiving a minimum 2 hours of Physical Education each week, (up from 5% in 2003, and 55% in 2010) whilst in transport 20mph speed limits are increasingly replacing 30mph in cities across Scotland to allow for safer engagement in physical activity and fewer road traffic accidents.
Everyone can make a contribution to increasing physical activity, and the NHS and Social Care are no different. Although further study is required, brief advice and brief intervention can be highly cost effective, at £40-440 per QALY, where the ceiling for cost effectiveness is £30,0006. The authors share the example that only 1 in 6 patients with hypertension or diabetes receive advice regarding physical activity; 2 conditions where this should clearly be part of routine care. As health professionals, it would seem we are not yet collectively taking proportionate responsibility, nevermind disproportionate responsibility.
There is a real opportunity for Health and Social Care to increase its collaborative contribution and for individual clinicians, service leaders and policy makers to take concrete actions7 that can lead to real change and improvement in physical activity levels, happiness, and health for our patients and populations. Furthermore, since physical activity can put a big fat smile on our face, as health professionals perhaps we can facilitate ways for ourselves and NHS staff (the world’s third biggest workforce) to be more active too.
Dr Andrew Murray1,2
Mr Nathan Stephens3
1) Clinical Leadership Fellow, Royal College of Physicians and Surgeons of Glasgow.
2) Centre for Sports and Exercise, University of Edinburgh.
3) Clinical Leadership Fellow, Royal College of Surgeons Edinburgh and NHS Education for Scotland
References
1) MacAuley, Bauman, Fremont. Exercise: not a miracle cure- just good medicine. BMJ 2015;350:h1416
2) Department of Health. “Start Active, Stay Active” - a report on physical activity for health from the four home countries’ Chief Medical Officers. 2011
3) Good medical practice (2013), General Medical Council, http://www.gmc-uk.org/guidance/good_medical_practice/duties_of_a_doctor.asp
4) 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 Med 2012;46:8;70 9- 7 12.
5) Scottish Government. Scottish Health Survey 2013. Scottish Government. 2014.
6) NICE. Four Commonly used methods to increase physical activity. National Institute for Health and Clinical Excellence. 2006. http://www.nice.org.uk/ nicemedia/pdf/
7) Scottish Academy of Medical Royal Colleges and Faculties. The Role of Health and Social Care in Increasing Physical Activity. Scottish Academy of Medical Royal Colleges and Faculties. 2015 accesed online April 2015 http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf
Competing interests: No competing interests