The Case For Physical
Activity
Kim 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 Nutrition
Stuart 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-tomoderate
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
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
T = type
What specific activity
Rating of Perceived
Exertion
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
no exertion at all
extremely light
very light
light
somewhat hard (moderate)
Hard (>6METS)
very hard
extremely hard
maximal exertion
0
0.5
1
2
3
4
5
6
7
8
9
10
*
no exertion at all
extremely weak (just
noticeable)
Very weak (light)
Weak (light)
Moderate (3-6 METS)
Strong
Very strong
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 target
Recommended 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% women
There 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 nonpharmaceutical 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 Active
A 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 Active
Adults 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 6090 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 Recommendations
Overweight 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
References
1.
2.
3.
4.
5.
6.
7.
8.
SIGN. SIGN Management of Obesity. A National Clinical
Guideline Draft. 2009
NICE. NICE Guideline on Management of Obesity. 2006
Sattar, N, Lean M. Management: Part 1 Behavioural change, diet
and activity. 2006. BMJ, 333, 740-743.
Foresight-Tackling obesities, future choices, Project report 2nd
edition Government Office for science.2008.
Scottish Health Survey, 2011, September, Volume 1, Chapter 6,
Physical activity.
Start Active, Stay Active, Department of health, physical activity,
health improvement and protection, 2011.
Walking works – overview Ramblers and Macmillian Cancer
Support.
Scottish Health Survey, 2012, September, Volume 1, Main report,
Chapter 6, Physical activity.