Exercise is crucial for health. Yet in the UK less than one in ten men, and less than one in twenty women, do enough of it. The Saturday programme at the 2014 Exercise and Medicine conference explored developments in behavioural science, clinical practice and public policy that can encourage people to exercise more.
The day began with Professor Steven Blair from South Carolina University, one of the leading epidemiologists in exercise medicine. His presentation about energy balance and obesity detailed the complex relationship between food and energy balance, and the more linear relationship between energy expenditure and energy balance. This includes the ‘diet dilemma’: if we reduce our food intake, we also reduce our metabolic rate, so not eating as much doesn’t always lead to weight loss. And when we start eating normally again, because our metabolism has slowed down, we tend to get fatter.
The answer, according to Professor Blair, is to concentrate on energy expenditure – exercise – because it’s clear that activity has been manufactured out of our environment, as shown by the American housewife survey, which showed a huge reduction in women’s weekly energy expenditure, whereas our calorie intake has not gone up greatly in that time. Which suggests that the current obesity epidemic is due to a reduction in activity rather than eating too much.
Exercise: how do we make the change?
Maneesh Sethi from Pavlock spoke about ways to change behaviour and how long it takes. His research, conducted at Stanford University in the USA, showed that a simple behaviour change like putting on a car seat belt takes about thirty days to implement if done daily; more complex behaviour change can take up to ninety days.
He suggested a ‘small steps approach’ to change in behaviour. For example if you want to get someone to go to the gym every day, the shift from their current lifestyle might be too great. So he recommended starting by asking them to pack their gym bag every day. And if you do that for a week, you get a treat. Then after you’ve done that for a while, you’d take your gym bag, go outside your front door, close and lock your front door. And then the next one would be to go, pack your bag, close the door, drive to the gym and go into the gym. And then once you’re doing that regularly you start working out in the gym.
Of course some people, when they pack their gym bag or lock themselves out of the house with their gym bag, will think “Well, I might as well go to the gym and do some physical activity”, Mr Sethi said. He defined a successful behaviour change as something you feel more comfortable with doing than with not doing; if you go regularly to the gym regularly enough, you feel more comfortable going to the gym and training than you do if you don’t, as with wearing a seat belt.
Public policy to promote exercise: what works?
Mike Brennan from the National Physical Activity Implementation Framework, Public Health England, reported on Government understanding of the level of disease and associated cost caused by physical inactivity. In the UK, activity levels are much worse than France, the Netherlands and the USA, leading to a higher rate of mortality due to physical inactivity .
For example, over ten per cent of all deaths in the UK from coronary heart disease are as a result of lack of physical activity. The overall cost to the UK across all conditions is estimated at up to £10 billion a year – equivalent to around one tenth of NHS England’s budget.
Implementation, Brennan says, requires commitment from the very top of government, through local clinicians and businesses to individual citizens. Professor Myra Nimmo from the ISEH’s sister National Centre for Sport and Exercise Medicine at Loughborough University, spoke about the Centre’s research into increasing physical activity in the UK’s population.
Delivering culturally sensitive activity programmes
In the conference’s final session, GP and ex-TV Gladiator Zoe WIlliams gave delegates an insight into the issues faced in implementing exercise programmes within diverse local communities. To be successful, these programmes need to be sensitive to both potential language barriers and cultural ideas around physical activity. She recommended establishing local ‘exercise champions’ to work with local communities.
Commenting on the conference, ISEH consultant Dr Mike Loosemore said: “Once people realise that every tiny little bit of activity they do really matters, it is much easier for them to take steps to become more healthy. When they come to park the car at the supermarket, they’ll think ‘Why bother going round and round in circles burning up carbon to park close to the entrance when I can park a hundred metres away, get a massive parking space, and then I’m going to get that extra hundred metre walk which is good for me when hopefully through being more active you get healthier and you’re able to be even more active”.
“Thirty per cent of the population are doing less than thirty minutes of physical activity a week. Half that are doing virtually no physical activity a week; they’re the ones we want to target because they’re the ones that are at the highest risk.”
The second annual Exercise Medicine Conference was held on 20 and 21 June 2014 at the Royal Society of Medicine in London, and was sponsored by Technogym. The conference was introduced by Dr Mike Loosemore, Lead Consultant in Sport and Exercise Medicine at the ISEH and Lead Sports Physician for the South of England at the English Institute for Sport. Mike also co-owns Active Movement, which promotes healthy lifestyles in the workplace.
Read highlights of day one’s morning and afternoon sessions at the conference.