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Rapid response to:

Opinion Dissecting Health

Scarlett McNally: Exercise can do wonders for social care

BMJ 2022; 379 doi: (Published 26 October 2022) Cite this as: BMJ 2022;379:o2538

Rapid Response:

Physical activity can do wonders for the nation's health.

Dear Editor
We agree with McNally, urgent and radical solutions are needed for the crisis in social care and the NHS, and the promotion of physical activity is one element that should be part of a comprehensive long-term strategy.(1) Funding, workforce shortages and the welfare of staff are other crucial issues that need addressing.(2,3)

Research studies over many decades now confirm the wide-ranging health benefits of regular physical activity and a recent BMA report listed physical, mental, social, environmental and societal benefits.(4-8) It is clear that regular physical activity reduces the risk of morbidity and mortality from several chronic diseases and it is also recommended in secondary and tertiary prevention of some noncommunicable diseases.

There are considerable inequalities in relation to levels of physical activity and include those linked to age, disability, economics, race and gender. They are the result of a variety of social, cultural and environmental factors that can and must be addressed.(8)

Women’s sport for example has been ignored and underfunded for decades. However, organisations such as the Women’s Sport Trust have been very successful in tackling this important public health issue.(9) They have increased media coverage and helped to improve funding for women’s sport. But much more needs to be done to encourage women and girls to take up different sports and other physical activities.

Children and young people need to understand that physical activity is beneficial to health and mental and emotional wellbeing. Children with higher levels of emotional, behavioural, social, and school wellbeing, on average, have higher levels of academic achievement and are more engaged in school, both concurrently and in later years.(10) Physical education in school, including those associated with leisure and participation in the community, can support this outcome for all children.(11)

We are pleased that members of the House of Lords and House of Commons have debated the benefits of physical activity, concerns about lack of participation at grassroots level and actions that need to be undertaken.(12,13) However, overall physical activity is not currently being prioritised in government policymaking.

In schools there is a lack of protection for physical activity in the curriculum and in some areas playing fields have been sold off. There is also low spending on active travel and budget cuts have been made for open spaces and recreation facilities by local authorities. Swimmers across the UK have lost access to more than 60 public pools in the last three years.(14) This is of concern as swimming is a great form of exercise for almost everybody regardless of age, health or ability.

An important goal for the government should be to integrate physical activity into the way people live their lives so that the active choices become the easier ones.(15) We need to enable people to participate in sport and to lead active lifestyles regardless of ability, age, and background. This will require changes to the physical and social environments.(15) Leisure facilities, swimming pools, parks and other outdoor spaces need to be maintained. Similarly, transport and housing policies will need to facilitate physical activity and active travel.

We believe that a country-wide increase in physical activity could be used as a positive way to help reduce health inequalities and improve mental, as well as physical health. Dramatic benefits could be achieved for a number of important conditions including dementia, type 2 diabetes, some cancers, depression, heart disease and frailty and infirmity. In addition, with the increasing cost of the NHS and social care, perhaps now is the time to boost spending on the promotion of physical activity in order to try and mitigate some major future costs.(1,6,16)

1) McNally S. Scarlett McNally: Exercise can do wonders for social care BMJ 2022; 379 :o2538 doi:10.1136/bmj.o2538

2) Watson M C, Tilford S. Maintaining and promoting health in care homes BMJ 2022; 376 :o183 doi:10.1136/bmj.o183

3) Allen L, Williamson S, Berry E and Alderwick H. The cost of caring: poverty and deprivation among residential care workers in the UK. London: The Health Foundation, 2022.

4) 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.

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

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

7) McNally SA. Exercise: the miracle cure for surgeons to fix the NHS and social care. Bull R Coll Surg Engl 2020; 102: 28–33.

8) Watson M C, Lloyd J. Physical activity: manifold benefits for health and wellbeing BMJ 2022; 376 :o815 doi:10.1136/bmj.o815

9) Women’s Sport Trust. Raising the visibility & increasing the impact of women’s sport. [viewed 28th October 2022].

10) Childhood Wellbeing Research Centre. The Impact of Pupil Behaviour and Wellbeing on Educational Outcomes. London: Childhood Wellbeing Research Centre, 2012.

11) Lloyd J. Compassion through development of physical and mental health and well-being. In, Towards the Compassionate School. Ed. Maurice Irfan Coles. London: Trentham Books/IOE Press, 2015.

12) House of Lords. A national plan for sport, health and wellbeing. HL Paper 113. London: House of Lords, 2021.

13) Hansard: Westminster. Physical Education. Parliamentary Debates. Hansard Volume 711, 153WH-170WH, 23 March 2022. [viewed 28th October 2022].

14) BBC. Swimming pools: Concern as closures across the UK revealed. [viewed 28th October 2022].

15) Watson M C, Lloyd J. Seismic shift in policy needed to increase physical activity BMJ 2015; 350 :h3486 doi:10.1136/bmj.h3486

16) McNally S, Nunan D, Dixon A, Maruthappu M, Butler K, Gray M et al. Focus on physical activity can help avoid unnecessary social care. BMJ 2017; 359 :j4609 doi:10.1136/bmj.j4609

Competing interests: No competing interests

03 November 2022
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, 2nd Floor, Fairbank House, 27 Ashley Road, Altrincham, Cheshire, WA14 2DP