The Exercise Prescription — ‘BASEM style’

Author Dawn Thompson (left) with her siblings, at the end of a half marathon

Readers of this blog will be familiar with Dawn Thompson, a sports medicine physician in training and one of CJSM’s junior editors.

She is UK-based, and a member of the British Association of Sports and Exercise Medicine (BASEM).  I asked her to give a run-down of the recent BASEM annual conference for the CJSM readership.

What follows is her post from the conference, with a heavy dose of a subject near and dear to our heart — the worldwide physical inactivity epidemic, and how we sports & exercise folks can address this.

From our journal articles to our blog posts, CJSM is committed to putting the ‘exercise’ into the profession of Sports & Exercise Medicine.

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Dawn Thompson

Last month I attended the British Association of Sports and Exercise Medicine Annual Conference – ‘From Plinth to Pitch’. This was an excellently put together series of talks and lectures covering everything from Rio 2016, injury management, the female athlete to even the medical considerations in less mainstream sports of Futsal and disability shooting.

As always with Sports Medicine conferences there was a good mix of medical students, trainees, GPs and Sports and Exercise Medicine (SEM) consultants. The budding SEM doctor got to learn from and meet the experts they aspire to be while the more seasoned attendees got to catch up with old acquaintances and make new ones along the way. The standout session for me was the discussion on physical activity and how you actually get someone to exercise. This is an area close to my heart that made me feel invigorated and inspired enough to choose this topic as the focus of  my newest blog post.

Physical inactivity is the 4^th leading cause of preventable death from non-communicable disease worldwide. Being more active can help prevent and manage conditions such as coronary heart disease, type 2 diabetes, stroke, musculoskeletal conditions, Alzheimer’s, falls in elderly and some cancers (Blair 2005). It also has a positive effect on wellbeing, mood, mental health, sleep, sense of achievement, relaxation and release from daily stress (Kim 2012). These benefits are independent of weight and in fact it has been demonstrated that the risk of mortality in diabetic patients is reduced by 50% in those who are obese but moderately or highly fit compared to those of normal weight who are unfit (Church et al 2005). It seems it is better to be fat but fit, opposed to thin and unfit.

Reducing physical activity also has the potential to save healthcare systems large amounts of money.  Higher levels of physical activity are associated with reduction in duration of hospital stays and the Department of Health estimates that the average cost of physical inactivity for every primary care trust (PCT) in England is £5 million/year.

If you’re not convinced, don’t take my word for it! Doctor Mike Evans produced an excellent video a number of years ago titled ‘23.5 hours’. It is based on the concept that if we can reduce all the mundane aspects of life to just 23 ½ hours a day and find half-an-hour for being active we will reap the rewards. These recommendation coincide with the UK recommended national guidelines for physical activity, which can be summarised as –

• At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week

OR

• 75 minutes (1 hour and 15 minutes) of vigorous-intensity aerobic activity such as running or a game of singles tennis every week

OR

• An equivalent mix of moderate- and vigorous-intensity aerobic activity every week (for example 2 30-minute runs plus 30 minutes of fast walking)

AND

• Muscle-strengthening activities on 2 or more days a week that work all major muscle groups (legs, hips, back, abdomen, chest, shoulders and arms).

This is all very well but how do we actually get people more active? Public Health England produced a strategy in 2014 with some excellent ideas on how this can be achieved including making activity easy, fun and affordable. This document states that the push towards activity should be across all sectors, however I personally feel that one of the first steps in achieving this lies with education and training, not just of patients and the public but of healthcare professionals. Whilst most Sports Medics and many doctors are familiar with the numerous benefits of regular physical activity, studies have shown that only 13% of GPs are aware of the current guidelines on physical activity and only 56% of UK medical schools have physical activity on their curriculum (Weiler 2012, Douglas 2006).

A study I recently co-authored looking at patient experience in 2 general practices in the UK  suggested that only 52% of patients surveyed recalled ever being asked by a doctor about physical activity, with 46% saying they would welcome help from their doctor to become more active (Morton 2016). Considering that the number needed to treat for physical activity is 12 compared to around 50 for smoking cessation, it is interesting that most doctors will discuss smoking with their patients but not physical activity (Williams 2014). Clearly healthcare professionals need to be more proactive in discussing these issues with patients – “making every contact count” – however without appropriate healthcare professional training and support this is unlikely to be successful.

Without something changing, the children of the future are set to be the first generation who will die at a younger age than their parents. As health care professionals and as members of society we have an obligation to try and prevent this by encouraging our patients, our friends,  our family and even ourselves to make physical activity a part of what we do. As Dr Mike Evens says – if the best thing we can do for our health is to spend half an hour a day being active, can we limit our general sitting and sleeping to just 23.5 hours a day?

I know from personal experience that with busy lives and other commitments, this is more difficult to achieve in reality than the simplicity of the concept would suggest. Perhaps as the specialty of Sports and Exercise Medicine evolves, this is a key opportunity for the “E” in SEM to make its mark, as trainees and consultants get involved with shaping the future and working towards a fitter, healthier tomorrow.

References

Blair SN. Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine 2009;43(1):1-2

Douglas F, Torrance N, van Teijlingen E, et al. Primary care staff’s views and experiences related to routinely advising patients about physical activity. A questionnaire survey. BMC Public Health. 2006;6:138

Church TS, LaMonte MJ, Barlow CE, et al. Cardiorespiratory fitness and body mass index as predictors of cardiovascular disease mortality among men with diabetes. Arch Intern Med. 2005;165:2114-20

Kim YS, Park YS, Allegrante JP, et al. Relationship between physical activity and general mental health. Preventive Medicine 2012;55(5):458-63 doi: 10.1016/j.ypmed.2012.08.021[published Online First: Epub Date]|.

Morton S, Thompson D, Wheeler P, Easton G, Majeed A. What do patients really know? An evaluation of patients’ physical activity guideline knowlegde within general practice. London Journal of Primary Care, DOI: 10.1080/17571472.2016.1173939

Thornton J, Fremont P, Khan K, et al. Physical Activity Prescription: A Critical Opportunity to Address a Modifiable Risk Factor for the Prevention and Management of Chronic Disease:  A Position Statement by the Canadian Academy of Sport and Exercise Medicine. Clin Journ Sport Med 2016; 26: 259 – 265.

Weiler R, Chew S, Coombs N, et al. Physical activity education in the undergraduate curricula of all UK medical schools. Are tomorrow’s doctors equipped to follow clinical guidelines? Br J Sports Med. 2012;46:1024-6.

Williams CM, Nathan N, Wolfenden L. Physical activity promotion in primary care has a sustained influence on activity levels of sedentary adults. Br J Sports Med. 2014;48:1069-70