Intended for healthcare professionals

Rapid response to:


Physical activity: government must tackle “stark inequalities,” says BMA

BMJ 2019; 367 doi: (Published 23 October 2019) Cite this as: BMJ 2019;367:l6168

Rapid Response:

“Best Buy in Public Health”: Physical Activity.

The BMA is right to call for urgent changes to improve low levels of physical activity and we fully agree that sufficient effective national action is now required to reduce disparities.(1,2) In line with the Ottawa Charter for Health Promotion, what is needed is policy actions aimed at improving social, economic and environmental factors that support physical activity, combined with individually focused approaches.(3,4)

The current case for promoting physical activity is strong.(5-9) Regular exercise can bring dramatic health benefits: generally promoting health; preventing many serious and common conditions; and improving the health of those with certain chronic conditions.(2,7) There is now evidence for a wide range of conditions including; cardiovascular health, obesity, diabetes, dementia, osteoporosis and falls in the elderly.(2,7)

The BMA report quite rightly highlights the considerable inequalities in the levels of physical activity that people undertake and these include ones in relation to age, disability, ethnic group and gender.(2) The physical environment and social barriers (both real and perceived), need to be changed so that individuals are more likely to take part in activities.

Schools can encourage participation through structured activity in the curriculum including physical education and sport, but also those other physical leisure activities available in school and in the community should be promoted.(10,11) 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.(12)

One organisation that has been working hard to use the power of sport to accelerate gender equality and stimulate social change is the Women’s Sport Trust.(13) Since its inception this charity has helped to increase positive media coverage of a diverse group of female athletes and this is likely to encourage more to participate in a range of sports. They are also working to improve the funding landscape. However, in relation to women, much more still needs to be done in a range of settings including schools, workplaces and hospitals.(9,14)

There are many NHS staff who could be involved in promoting and supporting physical activity, and doctors could play leading roles in the fight against sedentary lifestyles.(5,7,15) They are unique in being trusted and often see individuals at critical times. On a one-to-one level they can use their many contacts with patients to encourage activity that is appropriate to the individual’s needs.(15) Also, as members of groups, employers, and leaders in communities doctors could act as advocates for change both in relation to the population and the environment.

A key recommendation in the BMA report and one that we fully endorse is that the NHS should act as an “anchor institution to encourage and facilitate active travel and set an example for other employers.”(2) If this was undertaken, we believe that there would be health dividends for many including staff, patients and other community members.

However, we do need a paradigm shift in the way we think about hospitals. Instead of having hospitals mainly focused on providing services for patients that are sick we need to develop their positive health promoting roles and public health staff have the potential to support and develop health promoting hospitals.(16)

Other settings also have key roles to play in promoting physical activity.(2,9,17) But despite the potential health, economic and societal benefits, physical activity is not being given the priority it deserves.(2,14) There needs to be increased investment in environments to make walking and cycling more attractive as this is likely to help to reduce inequalities.(2,18) Local government should be given the resources to develop recreation facilities and open spaces. In addition, capacity in local authority public health departments needs to be improved so that specialists can actively promote physical activity in different settings.(14,19-21)

In 1994, Jerry Morris described exercise as “Best Buy in Public Health” because of its manifold benefits.(22) We think it is now time to take heed of the history of physical activity, health and medicine(22-24) as well as current evidence.(5,7,9) The Institute of Health Promotion and Education recommends that the government needs to invest now in getting people more active particularly in deprived areas as this will dramatically improve the nation’s health as well as making some savings for the NHS.

1) Mahase E. Physical activity: government must tackle “stark inequalities,” says BMA. BMJ 2019;367:l6168

2) BMA. Get a move on: steps to increase physical activity levels in the UK. Oct 2019.

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

4) Thompson, S. R., Watson, M C. and Tilford, S. (2018) The Ottawa Charter 30years on: still an important standard for health promotion. International Journal of Health Promotion and Education. 56(2), 73-84

5) 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.

6) 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.

7) 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.

8) Public Health England (2016). Health matters: getting every adult active every day. [Online]. Available at:

9) World Health Organization. Global action plan on physical activity 2018–2030: more active people for a healthier world. Geneva: World Health Organization, 2018.

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

11) Lloyd J, Watson M. IHPE Position Statement: PSHE. Lichfield: IHPE, 2019.

12) Parry W. Education Committee. Written evidence submitted by Will Parry, Department of Quantitative Social Science, Institute of Education, University of London. 2013 [viewed 22nd October 2019]. Available from:

13) Women’s Sport Trust. What do we do? 2019 [viewed 24 October 2019]. Available from:

14) Watson M C and Lloyd J. Seismic shift in policy needed to increase physical activity. BMJ 2015;350:h3486

15) Haseler C, Crooke R and Haseler T. Promoting physical activity to patients. BMJ 2019;366:l5230

16) Watson, M. Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.

17) NICE (2019). Physical activity: encouraging activity in the community. [Online]. Available at:

18) Geffen, R. (2016). Cycling and Walking Investment Strategy worthless without meaningful funding, say cycling groups. [Online]. Available at: 2016-03-27/cycling-walking-investment-strategy-worthless-without-meaningfulfundi

19) BMA. Public health and healthcare delivery task and finish group: final report. Jan 2015.

20) Watson M C and Lloyd J, 2016. Need for increased investment in public health BMJ 2016;352:i761.

21) Watson M C and Thompson S. Government must get serious about prevention. BMJ 2018;360:k1279.

22) Morris J. Exercise in the prevention of coronary heart disease. Today’s best
buy in public health. Med Sci Sports Exerc 1994; 26: 807–14.

23) MacAuley D. A history of physical activity, health and medicine. Journal of the Royal Society of Medicine 1994. 87:32-35.

24) Yang D. Prescribing ‘Guiding and Pulling’: The institutionalisation of therapeutic exercise in Sui China (581–618 CE). PhD thesis. London: University College London, 2018.

Competing interests: No competing interests

26 October 2019
Michael Craig Watson
Trustee, Institute of Health Promotion and Education.
Dr John Lloyd, Honorary Vice President, Institute of Health Promotion and Education.
Institute of Health Promotion and Education, PO Box 7409, Lichfield WS14 4LS, UK.