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Health benefits of exercise

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Sarah Maidment

on 7 September 2012

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Transcript of Health benefits of exercise

Do your patients have symptoms of exercise deficiency?
Low mood
Poor self esteem
Weight gain
Sallow skin
Poor sleep
Muscle wasting
Constipation
Falls
Cognitive decline Side effects Exercise is medicine and we need to do all we can to get our patients to take it What is the single best thing we can do for our patients’ health? The extent of the problem 40% adult men and 28% adult women meet CMO’s recommended activity levels for health
27 million adults in England are not active enough to benefit their health
Inactive lifestyles in England are twice as prevalent as smoking, hypertension and hypercholesterolaemia
90% British children predicted to be obese by 2050 Inactivity 38% more days in hospital
5.5% more GP visits
13% more specialist services
12% more nurse visits
Billions spent on drug bills
Total cost of >£1billion to NHS Health inequalities Activity levels:
Higher in men of all ages
Decline with increasing age for both genders
Lower for black/minority ethnic groups
Lower in low-income household groups than high-income groups If exercise were a medicine would you prescribe it for your patients? Physically active:
live longer, healthier lives
Unfit, sedentary:
Develop chronic diseases prematurely
Die at younger age Health benefits 35% reduced risk in CVD, CHD and Stroke
35% reduced risk in Type 2 Diabetes
35% reduced risk in hip fracture
80% reduced risk in disability from osteoarthritis
30% reduced risk of colon cancer
20% reduced risk in breast cancer
Reduced risk of Alzheimer's Disease
30% reduced risk of death comparing most active with least active Physical inactivity - significant, independent risk factor for long-term health conditions In a Practice of 10,000 patients, about 6,600 will require exercise Hip fracture 160 women, half prescribed exercise, half control group; followed up for 7.1 years
Exercise group:
Fractures: 17 women = 0.05/1000/year
0 hip fractures
Death rate = 0.003/1000/year
Control group:
Fractures: 23 = 0.08/1000/year
5 hip fractures
Death rate = 0.03/1000/year
80% of women would rather be dead than experience loss of independence that results from hip fracture and admission to nursing home Diabetes Patients with impaired GTT developing diabetes - relative risk reduction for developing diabetes:
Exercise: 51%
Diet: 33%
Diet and exercise: 51%
Antidiabetic drugs: 30%
Orlistat: 56%
Exercise delays onset of diabetes for average of 3.6 years No better measurement of longevity than min/week engaged in activity Dose Low Dose
elderly and those recovering from any illness
No previous encounter
Can be used to treat metabolic conditions
Moderate Dose
Most treatments fall in this range
High Dose
Only under trained supervision
Unless already taking regular dose Low dose: no known side effects
Moderate dose: preventable, minor musculoskeletal problems
High dose: musculoskeletal damage, immune deficiency, metabolic disturbance, collapse
Build up slowly and review Cost per QALY Cost of Statin supplement up to £17,000
Cost of Smoking Cessation up to £9515
Cost of Exercise up to £440

NICE recommend that a drug or intervention that costs up to £30,000 per QALY is justified

68 patients can be treated with exercise for one intervention, costing £30,000 Patients resistant to taking insulin/chemotherapy / invasive surgical procedures yet follow doctor’s orders in belief that they will be helped
Doctors can be effective in behaviour change (reduced smoking rates from 50% to 20%) Why me? Exercise is Medicine!
Assess exercise habits at every clinical visit:
every patient, every visit, every treatment
Record physical activity as a “vital sign”:
On average how many days per week do you engage in moderate or greater physical activity?
On those days how many minutes do you engage in activity at this level? Adults <150 min
Children <420 min/week
Flag as not meeting recommended amounts of physical activity to improve health
Advise on importance of being more active and offer counselling and support to increase exercise
Make sure they understand the health risks associated with inactivity 30 min/day, five times a week
Stretching and balance exercises twice a week
Build up gradually The advice Should be fun!
Endurance, strength, flexibility, balance
Variety:
Brisk walking
Walk in the park
Cycling
Gym
Swimming Shopping
Housework
Cleaning
Gardening
Climbing stairs Exercise prescription most likely to be followed when connected to disease they are dealing with:
How exercise can improve blood pressure or lower blood sugar so that they might not require insulin The advice "If we had a pill that conferred all the proven benefits of exercise, physicians would prescribe it to every patient and our healthcare system would find a way to make sure every patient had access to this wonder drug." Children and adolescents (5-16yr)
60 min mod-vigorous activity per day
Include vigorous aerobic activity to improve bone density and muscle strength
Adults:
>150 min moderate intensity aerobic activity per week
Or >75 min vigorous intensity aerobic activity per week
+ resistance exercises Recommended levels The Health Benefits of Exercise Exercise should be fun! Thank you!
Any questions? Conflict of interest: this presentation is being delivered by a serious cyclist!! Gillies et al BMJ 2007; 334:19
Li G. Lancet 2008; 371:1783-89 Salkeld et al 2000 BMJ Korpelainen et al Arch Intern Med. 2010;170(17):1548-1556 Other useful resources Find out about:
local exercise facilities
exercise groups
exercise referral schemes
Provide patient leaflets GPPAQ - GP physical activity questionnaire
PAR-Q - physical activity readiness questionnaire
PARmed-X - physical activity medical examination Let's get moving campaign
www.nhs.uk/change4life
Exercise promotion in Primary Care: InnovAiT (2011) 4 (10): 569-580
British Journal of Sports Medicine
Arthritis Research UK: "Hands On" Issue 12 - Sport and Exercise Medicine "Exercise Works" http://www.exercise-works.org/ Dr Sarah Maidment - GPVTS ST2, Oxford Deanery With thanks to Ann Gates (@exerciseworks) for ideas and suggestions "I have prescribed regular exercise to help you to control your blood sugar.
The best medical evidence has shown that exercising for 30 minutes a day will help to prevent you from developing diabetes and may help to minimise the need for medications.

Regular exercise is fun. It is also a great medicine.

Here is an "Exercise Works!" booklet that includes some exercises that you can try at home. It also provides information on how to exercise safely and effectively.

When I see you next time, we can discuss how the regular exercise has benefited your health. This is like me reviewing how your medicines have worked.

Try and get 30 minutes of fun aerobic exercise, on at least 5 days a week and include some strength, flexibility and balance exercises twice a week." What to say??
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