150 minutes to save your life

On 19^th July, Public Health England published their bulletin  “Health Matters: getting every adult active every day”.  I thought back to my days as a police force PTI where I introduced free group exercise classes (aside from the mandatory training that officers had to undertake).  These classes, open to all, were 45 minutes long and designed by me to be fun, to burn calories, build muscle mass, and improve CV.  There were other benefits too, sickness absence figures dropped – particularly for those two big hitters – musculoskeletal conditions and depression/stress/anxiety.  There was a general uplift in feeling well and greater social interaction.

Those who attended my classes reported that they slept better, felt calmer yet more energised, their concentration and thought processes improved as did their general physical and mental resilience.  All through attending a 45 minute class three times a week.

Fast forward to 2011 when I was commissioned to design and deliver a Breast Cancer Survivorship Programme aimed at introducing an exercise and dietary management programme for women after diagnosis and treatment of breast cancer that would lead to a lasting beneficial change in health behaviour, weight reduction and improvement in quality of life.   Drawing on the many national and international studies on healthy lifestyle choices and breast cancer, my programme expanded on this body of work by exploring the impact of a specific physical and dietary intervention. Increasingly, evidence suggested that physical rehabilitation could lead to patients returning to normal lifestyle more quickly and that exercise and weight reduction (by following a low fat diet) may have a role in reducing recurrence of breast cancer.  There was also evidence to suggest that exercise may reduce symptoms such as depression, arthralgia, hot flushes, low bone mineral density and other side effects of treatment.

I introduced a four week introductory Nordic walking exercise programme under instructor supervision together with a weight management programme under the care of community dietetics. Throughout the programme, patient/carer and clinician workshops and focus groups were held to ascertain the needs of the patients, and the effect and evaluation of the programme.  At commencement and end of the programme patients were weighed and measured (BMI and waist circumference).  A visual analogue scale was completed in terms of symptoms of arthralgia (bone pain) and hot flushes. A HAD scale to assess psychological status was also completed as were qualitative dietary changes assessed by food frequency questionnaires and/or food diaries before and after intervention. Finally, a patient questionnaire survey assessed satisfaction with the intervention. The cohort of patients either maintained or reduced their BMI over the period of the programme.  One patient in particular, lost a total of 4.5st with greatly improved lymphoedema.   The work with the dietician was particularly appreciated by the patients as this had not been previously available in such depth.  Reduction in medication for conditions such as depression were also reported as were less tangible benefits such as feelings of “a return to society” as opposed to being in “patient mode”.   Participants gained an understanding of the principles of a healthy low fat diet whilst not compromising Vitamin D and Calcium intake.  They felt empowered to self-care in terms of exercise and following a healthy, low fat diet.

So much for organised, structured exercise.  But what we need to emphasise is a change in behaviour, walking instead of taking the bus, using the stairs instead of the elevator, dancing in the kitchen waiting for the kettle to boil!

Currently, the statistics are scary – we are 20% less active now than in the 1960s with a forecast to be 35% less active by 2030; 1 in 4 women and 1 in 5 men are classed as physically inactive.  Emergency admission for hip fractures continues to rise as do conditions relating to obesity, and the diagnosis of depression soars.  Yet 150 minutes of physical activity each week – which can be split into as little as 10 minute slots – can reduce the risk of dementia by 30%, hip fractures by a whopping 68%, depression by 30% and diabetes by 40%.  In fact physical activity can help prevent or manage 20 different chronic conditions.

There are, of course, some great initiatives already in place producing significant results; for example This Girl Can has inspired over 2.8 million women to become more active and One You and Couch to 5k has inspired many to start running.

We cannot let the change in behaviour rest at the GPs door, we need to start making changes at a societal level.  So here, surely, is an area where we should be providing “joined up care” and integrate physical activity into clinical and social care pathways.  The benefits – towards both mental and physical health – are there for the individual, their families, society and the economy. So our Wellbeing Centres need to have an input, as do our Housing Departments, our Transport Departments, our Education Departments as well as our Department of Health.  Start telling that to the Commissioners , start getting them working with their colleagues in these other areas and as a nation we can start saving lives and save the NHS some money.