The Case For Physical ActivityKim Ferrier

Lead Physiotherapist, GCWMS

November, 2013

The plan!

• Inactivity• Physical activity

advice and recommendations

• Physical activity strategy

• Barriers/Solutions

Hippocrates (400 BC)(“father of medicine”)

“Eating alone will not keep a man well; he must also exercise. For food and exercise, while possessing opposite qualities, yet work together to produce health”

CHARTERED SOCIETY OF PHYSIOTHERAPY SURVEY

2,042 ADULTS REVEALED,

• 17% WOULD RATHER VISIT THEIR INLAWS OR WATCH PAINT DRY THAN EXERCISE

• 40% ENJOYED EXERCISE

• 43% RECOGNISED THE NEED FOR EXERCISE EVEN IF THEY DID NOT ENJOY IT

Optimum research on behalf of CSP. www.netdoctor.co.uk

The Impact of inactivity?

• In 2008, the World Health Organisation ( WHO)

estimated that 3.2 million deaths per year could be attributed to low physical

activity levels. (17% of premature deaths in the UK)

• Being inactive shortens lifespan by 3-5 years

(Lancet, 2012)

Costs of inactivity?

• Physical inactivity is the 4th leading risk factor for global mortality (6% of deaths globally).

Start active, Stay active, 2011

• Physical inactivity increases the risk of developing coronary heart disease two fold.

Cardiac rehabilitation 57, SIGN guidelines

• The estimated direct cost of physical inactivity to the UK is £1.06 billion.

Start active, stay active, 2011

Modern day Gym?where most people get their exercise

Watson, R. and Benelam, B. (2012), Physical activity: the latest on its contribution to energy balance and health. Nutrition Bulletin, 37: 78–85.

doi: 10.1111/j.1467-3010.2011.01953.x

Sedentary Behaviour

sedentary adjective 1. characterized by or requiring a sitting posture: a sedentary

occupation. 2. accustomed to sit or rest a great deal or to take little exercise. 3. Chiefly Zoology . a. abiding in one place; not migratory. b. pertaining to animals that move about little or are permanently attached

to something, as a barnacle.

• In Scotland, reported sedentary leisure time was similar for men and women - 5.5/5.4 weekdays and 6.1/5.1 mean hours at weekends. This varied with age.

(Scottish Health Survey, 2012)

If current trends continue...• it is estimated that by 2020 the average British citizen is

expected to become so sedentary they will expend only 25% more energy per day then if they spent the whole day sleeping.... (Walking works, 2013).

Sedentary behaviour and NutritionStuart Biddle, Professor of Physical Activity & Health, Loughborough University

• Walking, sitting or lying <1.6 Mets

• Studies show clear associations between sedentary behaviour (usual screen time, and often TV viewing) and elements of a less healthy diet including –

• lower fruit and vegetable consumption

• higher consumption of energy-dense snacks, drinks and fast foods

• higher total energy intake

• Strength of associations: small-to-moderate

Steady decline in walking

• 1975: 255 miles/year = 255,500 kcals • 2003: 192 miles/year = 192,00 kcals• Loss of 63,000 kcals per year (= 18lbs of

fat)• Loss of 173 kcals/day • Add 175 kcals/day lost at work since

1960

• 345 kcals/day lost but not from lack of sport or exercise

Fox and Hilston 2007, Obesity reviews Sup 1. 115-121.

Exercise the “F. I.T. T.” way

F = frequency

I = intensity

T = time

T = type

Number of bouts of physical activity per week

How much exertion/energy used

The length of time in which an activity

or activity is performed

What specific activity

Rating of Perceived Exertion

6 no exertion at all7 extremely light89 very light1011 light1213 somewhat hard

(moderate)1415 Hard (>6METS)1617 very hard1819 extremely hard20 maximal exertion

0 no exertion at all0.5 extremely weak (just

noticeable)1 Very weak (light)2 Weak (light)

3 Moderate (3-6 METS)

4

5 Strong

6

7 Very strong

8

9

10 Extremely strong

*

Warm Up

To prepare the muscular, nervous, cardiac, respiratory and vascular systems for the main workout

• Minimum 15 minutes (ACPICR, 2003)

• 10 - 11 RPE original scale • (> or = 3 modified scale)

Other Purposes of Warm up

• Welcome apprehension

• Motivate • Reinforce good

posture/ exercise technique and safety

Cool down

• 10 minutes of movements of diminishing intensity and stretching

risk of hypotension, arrhythmias, angina

• baroreceptor reflex

Scotland’s physical activity strategy

Scotland's strategy 2022 targetRecommended levels of physical activity

50% of adults will be achieving 5x 30mins (moderate activity)

&

80% of children will be achieving 1 hour per day

(At least moderate activity)

Need to increase physical activity by 1% per year across population

Scottish Health Survey, 2012

The proportions of men and women aged 16 and over meeting the physical activity

recommendations is 62%67% men

58% womenThere were considerable differences in the proportions meeting the recommendations

by age.

SOME of the benefits of regular physical activity

• 30% reduction in all cause mortality• 20-35% lower risk of CVD, CHD and stroke• 30-40% lower risk of metabolic syndrome and

type 2 diabetes• Consistent effect on achieving weight

maintenance (< 3% change in weight)• Risk reduction of hip fracture 36-68%, 30% less

falls• 30% lower risk of colon cancer and 20% lower

risk of breast cancer

MOOD!

• The Royal College of Psychiatrists recommends exercise as a treatment for depression in adults.

• SIGN national clinical guideline for non-pharmaceutical management of depression states that structured exercise programmes may be an option for depressed people.

Scottish Health Survey 2012

• Active adults 30% less likely to feel distressed and are 30% more likely to experience enhanced wellbeing than inactive adults.

Walking works, 2013

Start Active, Stay ActiveA report on physical activity for health from the 4 home

countries’ Chief Medical Officers, July 2011

• New UK guidelines tailored to 4 specific age groups

• Children under 5 • Children and young people aged 5-18 • Adults aged 19-64 • Adults aged 65 and over

(Based on WHO guidance, 2010)

Start Active, Stay ActiveAdults age 19-64

• Should be active daily • 150 minutes, moderate intensity, bouts of 10 minutes

– one way to approach this is 30 minutes 5/7• Alternatively, comparable benefits can be achieved

through 75 minutes of vigorous activity spread across the week, or a combination of moderate and vigorous activity

• Adults should undertake physical activity to improve muscle strength on 2/7

• Adults should minimise sedentary time

Physical activity advice for adults

• 45-60 minutes of moderate intensity activity per day to prevent the development of obesity.

• People who have been obese and have managed to lose weight may need to do 60-90 minutes' activity a day in order to avoid regaining weight.

At least 5 a week. A report from the CMO. 2004.

SIGN 115: Management of Obesity Physical Activity RecommendationsOverweight and obese individuals should be

prescribed a volume of physical activity equal to approximately 1,800-2,500 kcal/week.

This corresponds to approximately 225-300 min/week of moderate intensity physical activity (which may be achieved through five sessions of 45-60 minutes per week, or lesser amounts of vigorous physical activity).

SIGN 115: Management of Obesity, 2009

Advocate overweight or obese individuals should be supported to undertake increased physical activity

as part of a weight management program.(1)

Prescription of activity alone is not effective – prescription only results in significantly greater

weight loss when participants received additional support i.e. family members, monetary incentives.

Question?

What % of Britons would exercise if their life depended on it?

38%What % of Britons find exercise fun?

4%Data: British Heart Foundation survey (17 Sept 2007), conducted by YouGov, N = 2100

Most common barriers…

• Pain!• Lack of motivation –

“poor health” isn’t necessarily a driver

• Past experience• Self confidence/self

esteem• PCOS/Cardiac/DM/PF• Social circumstances • Fatigue (sleep apnoea?)

Where to start?

sedentary behaviour

• Increase opportunistic behaviour

• Initiate structured activity plan

• Increase frequency of activity program

• Increase duration of activity program

• Increase intensity of activity program

Solutions??

• Buddy systems• Motivational interviewing

– Incentive V’s confidence = adherence to goal

• Reward scheme• Telephone/email support• Tailored exercise

programme suited to level of ability to gain confidence and self esteem

Doctors to lead by example???

• The % of physicians who engage in the recommended amount of exercise is only 25%.

• Doctors who exercise on a regular basis are more likely to recommend healthy lifestyle habits to their patients compared with physically inactive physicians.

(American Journal of Health Promotion, May/June 2011, Vol 25, No 5).

• A face to face pole of 167 London GP’s in 2012 found that not a single one of them knew the CMO recommendations.

(Intelligent health, Long term conditions: My best move project report, 2012 – Walking works).

Health Survey for England, 2012

“It appears to have been no significant change in levels of physical activity since they were last measured in 2008, suggesting that to date there is no sign of the hoped for physical activity legacy of the 2012 Olympics and Paralympics”

2014 Commonwealth Games

‘Once in generation’ opportunity.

• Encourages people in Scotland to become more physically active in run up to 2014 Games and beyond.

• A cultural shift to improve the nations health.

• “Active nation” is a key programme within the Games Legacy Plan.

Contact details

• Kim Ferrier, Lead Physiotherapist• Glasgow & Clyde Weight Management Service

Mansionhouse Unit,

100 Mansionhouse Road,

Glasgow, G41 3DX• Telephone: 0141 201 6115/6361• E-mail kim.ferrier@ggc.scot.nhs.uk• www.nhsggc.org.uk/gcwms

References1. SIGN. SIGN Management of Obesity. A National Clinical

Guideline Draft. 20092. NICE. NICE Guideline on Management of Obesity. 20063. Sattar, N, Lean M. Management: Part 1 Behavioural change, diet

and activity. 2006. BMJ, 333, 740-743.4. Foresight-Tackling obesities, future choices, Project report 2nd

edition Government Office for science.2008.5. Scottish Health Survey, 2011, September, Volume 1, Chapter 6,

Physical activity.6. Start Active, Stay Active, Department of health, physical activity,

health improvement and protection, 2011.7. Walking works – overview Ramblers and Macmillian Cancer

Support.8. Scottish Health Survey, 2012, September, Volume 1, Main report,

Chapter 6, Physical activity.