CSP Congress

Making exercise a normal part of health care

Pie in the sky?John Searle

Chief Medical Officer, Fitness Industry Association

Where am I coming from?

• NHS consultant• RA diagnosed in my mid-fifties• Key role of exercise• Personal trainer• CMO - FIA working with

• Health professionals and DH• Fitness sector

Fitness sector’s objective

To establish exercise as a normal part of healthcare

• in the prevention of disease• as part of the treatment of disease• in the promotion of healthy and

independent old age

WHY?

• What is the biggest threat to the nation’s wellbeing?

Threats to the nation’s wellbeing

• Terrorism• Climate change• Economic instability• Diseases of Western affluence• Ageing population

Obesity

2010• Men 24%• Women 25%• Children 16%2050• Men 60%• Women 50%• Children 25%

Heart disease

• Annual: 275,00 heart attack annually

• Deaths: 120,00

• UK death rates highest in the world

Heart disease

• Annual: 275,00 heart attack annually

• Deaths: 120,00

• UK death rates highest in the world

Strokes

• 110,000 annually

• Third biggest killer

Type 2 diabetes

• 2,000,000 cases in the UK• heart attack• stroke• hypertension• kidney failure• peripheral vascular disease

Falls

• 30% of 65+ have a fall

• 50% are recurrent

Dementia

• 820,000in UK

• 1:3 >65 will suffer from some form of dementia

• £23 billion: annual cost of care

Depression

40,000,000 prescriptions for depression each year in the UK

Older people

• 2010: 9.7m 65+(16% population)

• 2015: 14m 65+

• 60% of hospital bed days.

The state of the nation

A sedentary, overweight population,costing billions of pounds every year, heading for dementia and nursing homes.

Do we want to go there?

Slow, mass suicide

But we have the answer

‘the benefits of regular physical activity on health, longevity and wellbeing easily surpass the effectiveness of any drugs or other medical treatment.’

John Dryden:1631-1700

By chance our learned fathers earned their food,Toil strained the nerve and purified the blood.But we, their sons, a pampered race of men Are limited to three score years and ten.Better to hunt in fields for health unsought Than fee the doctor for a nauseous draft.The wise for cure on exercise depend;God never made his work for man to mend.

Exercise

• Reduces the risk of developing these diseases

• Is a key component in their management

• Promotes a healthy and independent old age

Coronary artery disease

Aerobic exercise:150’ moderate intensity / 75’ high

intensity exercise per week

20-30% reduction in risk of CV disease

(Hamer and Chida 2008)

Exercise and disease risk reduction

• CV disease +++• Type 2 diabetes +++• Obesity +++• PM breast cancer ++• Colon cancer +• Depression ++• Cognitive impairment +

O’Donovan G et al (2010)

Exercise as part of treatment

BJSEM August 2009• CV disease: CAD, HF, BP+, cholesterol +• COPD• Asthma• OA and RA• Type 2 DM• Parkinsons’s• MS

Exercise in older age

‘Among those >65 years, physical activity is strongly associated with reduced health resources and costs’

(Woolcott JC et al 2010)

What can we do?

• Culture change among health professionals

• Engagement between health and fitness professionals

• Move the fitness industry from cosmetics to health

Culture change among health professionals

Our own health and fitness

Health professionals

Why are we an unhealthy bunch?• Increasing work loads• Constrained resources• Loss of control• Stress

• weariness• no time• poor nutrition

Culture change among health professionals

• our own health and fitness• education - evidence base• rewards• make it easier to

recommend/prescribe exercise

Engagement between health and fitness professionals

CSP/FIA Joint Working Group

• referral guidelines between each other

• referral advice for GPs

• joint educational opportunities

Engagement between health and fitness professionals

Joint Consultative Forum between thefitness sector and the Medical RoyalColleges• best practice guidance for using exercise in the

treatment of chronic disease• advice to doctors, fitness professionals and the

DH

Engagement between health and fitness professionals

Local contacts - the changing contextof GP commissioning and public healthboards

Move the fitness industry from cosmetics to health

How has the fitness industry developed?

Industry development

1960’s and 70’s

Industry developmentIndustry development

1980’s

Industry development

1990’ & 2000’s

- equipment

Industry development

1990’ & 2000’s

‘looking good feeling great’

Fitness Industry 2010+

Health agenda• disease prevention• disease treatment• healthy and independent old age

• through clubs and community hubs

Making a start

Who is missing?