Dr Farrah Jawad is a registrar in Sport and Exercise Medicine. She currently works at the Institute of Sport, Exercise and Health in London and co-ordinates the British Journal of Sports Medicine Trainee Perspective blog which can be accessed via http://blogs.bmj.com/bjsm/ . She tweets at @FJSEM
Part of the problem with designing such curricula is that they are packed to the rafters because there is so much to cover; there is always a feeling that one topic has to come out in order to fit another topic in. Perhaps the way to solve this is for lecturers to incorporate physical activity in each of their lectures on various diseases; the effects of physical activity are far-reaching. Physical activity is beneficial in a number of diseases and normal physiological states, including: fibromyalgia and chronic pain syndromes, osteoarthritis, pregnancy, obesity, mild to moderate depression, diabetes mellitus types I and II, cardiovascular disease, chronic obstructive pulmonary disease.
Being more physically active does not mean being sporty, and does not require special equipment or expensive gym memberships. People can make even the smallest changes to their lifestyle – taking the stairs instead of the lift, getting off the bus a stop earlier and walking, for example – which can help to contribute to an overall increased level of physical activity.
The UK Physical Activity Guidelines advice for adults (19-65) states:
- Aim to be active daily. Activity should add up to over 150 minutes per week by participating, in at least 30 minutes of moderate intensity physical activity on 5 or more days a week, or in multiple bouts of 10 minutes or more.
- Comparable benefits can be achieved through vigorous activity of 75 minutes a week or in a combination of moderate and vigorous activity.
- Adults should also undertake physical activity to improve muscle strength on at least two days a week.
- All adults should minimise extended sedentary (sitting) periods.
The guidance for children aged 5 to 18 is that they should participate in a minimum of 60 minutes a day and up to several hours every day of moderate to vigorous intensity physical activity. Three days a week should include vigorous intensity activities that strengthen muscle and bone. This age group should also minimise the amount of time spent being sedentary (sitting) for extended periods. For under 5s capable of walking, they should spend a minimum of 180 minutes a day playing and being active, and those that cannot should be encouraged to play in safe environments and minimise time spent sitting or restrained.
One way you can bring exercise into the consultation is by asking “The Exercise Vital Sign”:“On average how many days/ week do you engage in moderate or greater physical activity (like a brisk walk)?”, then, “On those days, how many minutes do you engage in activity at this level?”
This helps to start the discussion about physical activity and being less sedentary with patients. It is important to extol the virtues of the different types of exercise as they have different positive effects, for example, aerobic exercise for cardiovascular fitness and muscular strength for mobility and falls prevention. When tailoring advice regarding a specific programme of exercise for a patient, you can discuss the FITT principles:
- Frequency – How many times a week to do the activity
- Intensity – How hard to exert oneself during the activity
- Type – The type of activity agreed with the patient
- Time – How long the patient might participate in the activity in minutes
The FITT principles can help a clinician make sure all the bases are covered when discussing exercise prescription. One example of how the FITT principles can be applied is if a patient, when prompted about any particular activity they might like to do more of, mentions walking, the clinician may then suggest that the patient walks at a moderate intensity, so they feel slightly sweaty and short of breath, for 30 minutes a day, five times a week as a goal. But that they might start with a lower intensity, time and frequency initially so that they can build up their fitness in time.
In summary, exercise can be a cheap and effective way of reducing morbidity and mortality, and we need to address potential barriers to exercise and the reduction of sedentary behaviour. Even a short discussion with patients on the benefits of exercise is a start. Active children grow up to be active adults and so intervening at a young age is important. The Active Movement project (www.activemovement.co.uk) aims to do this by integrating low level activity into the normal day of schoolchildren.
As clinicians, it is good to lead by example. On Sunday 26th June 2016, why not walk, jog or run the Institute of Sport, Exercise and Health’s 5 or 10K race in Regent’s Park? (http://www.iseh.co.uk/events/iseh-5k-and-10k-run-2016). Perhaps I will see you there!
Some useful links:
- Motivate 2 Move – http://gpcpd.walesdeanery.org/index.php/welcome-to-motivate-2-move
- Walk 4 Life – http://www.walk4life.info/
- BMJ Learning Module on the Importance of Physical Activity – http://learning.bmj.com/learning/home.html
- Prescription 4 Exercise – http://prescription4exercise.com/
- Active Movement – activemovement.co.uk, Twitter – @imanactivemover
- British Journal of Sports Medicine blog post on an Active Movement conference, November 2015 – http://blogs.bmj.com/bjsm/2015/12/03/these-booties-are-made-for-walking-active-movement-innovation-in-combatting-childrens-inactivity-and-obesity/
- Institute of Sport, Exercise and Health – iseh.co.uk