Intended for healthcare professionals

Observations Yankee Doodling

Why don’t people exercise, even a little?

BMJ 2015; 350 doi: (Published 04 June 2015) Cite this as: BMJ 2015;350:h3024

Re: Why don’t people exercise, even a little?

We agree that there is now considerable and growing evidence that exercise can be used to maintain and promote health. Being physically active can reduce the risk of some cancers, type 2 diabetes, depression, heart disease, and other serious conditions.(1-3) However, the strategies suggested by Kamerow for promoting exercise appear to be narrow compared to the size and importance of this public health challenge.(4) What is needed in this area is a seismic shift in public health activity and, an approach that is in line with the Ottawa Charter for Health Promotion.(5)

There are great inequalities in relation to physical activity and these include ones linked to: disability, age, race, economics and gender. Women's sport for example is often ignored and underfunded. A simple examination of the sports pages of most newspapers provides some evidence. However, organisations such as the Women’s Sport Trust are now seeking to address this. They are trying to provide platforms for diverse role models, increase media coverage, and improve funding for women’s sport.(6)

There are many professional groups who could be involved in promoting physical activity and doctors, especially GPs have potentially pivotal roles to play.(1,7) On a one-to-one basis they can use their many interactions with patients to encourage activity that is suited to the individual’s needs. Also, as leaders in communities, employers, and members of committees such as Health and Wellbeing boards, they could act as advocates for change. However, these roles may not be easy to undertake in some parts of the country - where there are severe shortages of GPs: resources will be needed.(8)

Schools are important settings for promoting health and should work with pupils and their parents/carers to address this concern. This can be done by encouraging children and young people to participate in a range of physical activities and to understand how such activity is beneficial to health and mental well-being.(9) Physical activity must mean not only structured activity in the curriculum through physical education and sport, but also those other physical leisure activities available in school and in the community. Any activity which enables children and young people to be warm and breathless for significant periods of time which they enjoy, and overcomes the barriers to participation brought about by disability, gender, religion and culture, should be valued. Compounded by government education policy, schools still focus too much on traditional team games which include few and exclude so many.(10)

The social and physical environment can have an important impact on physical activity levels.(3,11) The barriers stopping people being active need to be removed so that the healthier option will be the easier option. For example, transport and housing policies need to support physical activity and active travel. (12-14)

There is overwhelming evidence that physical activity can have an influence on health and there are now evidence-based interventions that can support individuals.(1,14) Increasing levels of physical activity in the population demands a multi-sectoral approach, and national plans should comprise of multiple strategies aimed at supporting the individual and creating supportive environments.(3) Government commitment is needed to energize all the different sectors. However, there is also an urgent need for a dramatic increase in action to match this important public health issue.

1) Academy of Medical Royal Colleges. Exercise: The miracle cure and the role of the doctor in promoting it. London: Academy of Medical Royal Colleges, 2015

2) Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity: a systematic review of longitudinal studies. BMC Public Health 2013;13:813.

3) World Health Organization. Global recommendations on physical activity for health. Geneva: World Health Organization, 2010.

4) Kamerow D. Why don’t people exercise, even a little? BMJ 2015;350:h3024

5) World Health Organization. Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.

6) Women’s Sport Trust. What do we do? 2015 [viewed 10 June 2015]. Available from:

7) Royal College of Physicians. Exercise for life: physical activity in health and disease. Recommendations of the Sport and Exercise Medicine Committee Working Party of the Royal College of Physicians London: RCP, 2012.

8) Royal College of General Practitioners. New league table reveals GP shortages across England, as patients set to wait week or more to see family doctor on 67m occasions. 2015 [viewed 10 June 2015]. Available from:

9) NICE. Promoting physical activity for children and young people. NICE guidelines [PH17]. London: NICE, 2009.

10) Parry W. Education Committee. Written evidence submitted by Will Parry, Department of Quantitative Social Science, Institute of Education, University of London. 2013 [viewed 10 June 2015]. Available from:

11) NICE. Physical activity and the environment. NICE guidelines [PH8]. London: NICE, 2008.

12) Active Transport for Healthy Living Coalition. The case for action by the
Active Transport for Healthy Living Coalition. 2014 [viewed 10 June 2015]. Available from:

13) Watson, E and Watson, M, 2012. Re: Put health at the heart of transport policies, says BMA report. BMJ Rapid Response 13th July 2012.

14) Public Health England. Everybody active, every day. What works – the evidence. London: PHE, 2014.

Competing interests: No competing interests

11 June 2015
Michael Craig Watson
Associate Professor of Public Health
Dr John Lloyd (Immediate Past President, Institute of Health Promotion and Education).
University of Nottingham, Faculty of Medicine and Health Sciences, Queen's Medical Centre, Nottingham. NG7 2HA