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The Built Environment 
Dr Mike Loosemore 
Consultant Sport and exercise Medicine. ISEH. UCLH. 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Health benefits of physical activity 
Regular physical activity at the correct intensity: 
•Reduces the risk of heart disease by 40% 
•Lowers the risk of stroke by 27% 
•Reduces the incidence of diabetes by almost 50% 
•Reduces the incidence of high blood pressure, by almost 50% 
•Can reduce mortality and the risk of recurrent breast cancer by almost 50% 
•Can lower the risk of colon cancer by over 60% 
•Can reduce the risk of developing of Alzheimer’s disease by one-third 
•Can decrease depression as effectively as Prozac or behavioural therapy 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
A frightening effect 
Obesity 
Smoker 
Hyper- 
tension 
High Cholesterol 
Diabetes 
Low Fitness 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
The perils of inactivity 
Active Movement 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Inactivity 
Effect of physical inactivity on major non-communicable 
diseases worldwide: an analysis of 
burden of disease and life expectancy 
The Lancet, Volume 380, Issue 9838, Pages 219 - 229, 21 July 2012 
doi:10.1016/S0140-6736(12)61031-9 
I-Min Lee Eric J Shiroma Felipe Lobelo Pekka Puska Steven N Blair Peter T Katzmarzyk, for the 
Lancet Physical Activity Series Working Group† 
Faculty of Sport and Exercise Medicine UK 
Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Endurance Hunting 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Are we less physically active? 
•Compared to 1980: 
–the UK now travels 25% less on foot and by bicycle 
–watches twice as much television 
–half as many young people play extra-curricular sport 
–half as many work in physically active employment 
–daily life also involves a range of labour saving devices, including washing machines, dishwashers, lifts, car-washes and ride-on lawnmowers. 
Foresight Obesity Report, 2007 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Trends in manual & non-manual occupations among 
E nglish adults . The Health S urvey for E ngland 
35 
45 
55 
65 
1 991 1 993 1 994 1 997 1 998 1 999 2003 2004 
Per cent 
Manual Jobs Non-Manual Jobs 
Faculty of Sport and Exercise Medicine UK 
Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
The genetic paradox 
Endurance v Energy conservation 
Active Movement 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Sedentary Behavior 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Non-Vigorous PA and Mortality Risk 
All Cause Mortality Relative Risk 
Non-Vigorous Physical Activity, MET-Hrs/week 
Woodcock Int J Epi; 2010 
2.5 hours/wk decreased mortality by 19% 
7 hours/wk decreased mortality by 24% 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Breaking the Geriatric Curve 
NEJM, April 1998 
Age 
High-Risk Lifestyle (inactivity, smoking, obesity) 
‘Deficient 
Survival’ 
Our ultimate goal 
Active Movement 
Low-Risk Lifestyle (active, non-smoker) 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Br J Sports Med2012;46:709-712 doi:10.1136/bjsm.2012.091485 
Review 
NON COMMUNICABLE DISEASE PREVENTION 
Investments that Work for Physical Activity 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
1.‘Whole-of-school’ programs 
2. Active Transport 
3. Urban Design 
4. Integration into Primary Care 
5. Public education 
6.Whole-of- community 
7.Sport for all 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
1. ‘Whole-of-school’ programs 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
2. Active Transport 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
3. Urban Design 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
3. Urban Design
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise 
3. Urban Design
Effect of increasing active travel in urban England and Wales on costs to the National Health Service 
•James Jarrett, James Woodcock, Ulla K Griffi ths, Zaid Chalabi, Phil Edwards, Ian Roberts, Andy Haines 
•Lancet 2012; 379: 2198–205 
Within 20 years, reductions in the prevalences of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer because of increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
4. Integration into Primary Care 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
5. Public education 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
6. Whole-of-community 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
7. Sport for all 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
7. Sport for all 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Inactivity 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Inactivity 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Conclusion 
• Physical inactivity is the major risk factor for morbidity and mortality. 
–There is a linear relationship between physical activity and health status. 
–Changing the Built Environment is crucial. 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
Thank You 
@doctorloosemore 
Mikmike.loosemore@eis2win.co.uk 
mike@activemovement.co.uk 
Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise

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Mike Loosemore Presentation - Active by Design

  • 1. The Built Environment Dr Mike Loosemore Consultant Sport and exercise Medicine. ISEH. UCLH. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 2. Health benefits of physical activity Regular physical activity at the correct intensity: •Reduces the risk of heart disease by 40% •Lowers the risk of stroke by 27% •Reduces the incidence of diabetes by almost 50% •Reduces the incidence of high blood pressure, by almost 50% •Can reduce mortality and the risk of recurrent breast cancer by almost 50% •Can lower the risk of colon cancer by over 60% •Can reduce the risk of developing of Alzheimer’s disease by one-third •Can decrease depression as effectively as Prozac or behavioural therapy Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 3. A frightening effect Obesity Smoker Hyper- tension High Cholesterol Diabetes Low Fitness Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 4. The perils of inactivity Active Movement Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 5. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 6.
  • 7.
  • 8. Inactivity Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy The Lancet, Volume 380, Issue 9838, Pages 219 - 229, 21 July 2012 doi:10.1016/S0140-6736(12)61031-9 I-Min Lee Eric J Shiroma Felipe Lobelo Pekka Puska Steven N Blair Peter T Katzmarzyk, for the Lancet Physical Activity Series Working Group† Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 9. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 10. Endurance Hunting Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 11.
  • 12. Are we less physically active? •Compared to 1980: –the UK now travels 25% less on foot and by bicycle –watches twice as much television –half as many young people play extra-curricular sport –half as many work in physically active employment –daily life also involves a range of labour saving devices, including washing machines, dishwashers, lifts, car-washes and ride-on lawnmowers. Foresight Obesity Report, 2007 Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 13. Trends in manual & non-manual occupations among E nglish adults . The Health S urvey for E ngland 35 45 55 65 1 991 1 993 1 994 1 997 1 998 1 999 2003 2004 Per cent Manual Jobs Non-Manual Jobs Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 14. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 15. The genetic paradox Endurance v Energy conservation Active Movement Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 16. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 17. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 18. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 19. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 20. Sedentary Behavior Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 21. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 22. Non-Vigorous PA and Mortality Risk All Cause Mortality Relative Risk Non-Vigorous Physical Activity, MET-Hrs/week Woodcock Int J Epi; 2010 2.5 hours/wk decreased mortality by 19% 7 hours/wk decreased mortality by 24% Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 23. Breaking the Geriatric Curve NEJM, April 1998 Age High-Risk Lifestyle (inactivity, smoking, obesity) ‘Deficient Survival’ Our ultimate goal Active Movement Low-Risk Lifestyle (active, non-smoker) Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 24. Br J Sports Med2012;46:709-712 doi:10.1136/bjsm.2012.091485 Review NON COMMUNICABLE DISEASE PREVENTION Investments that Work for Physical Activity Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 25. 1.‘Whole-of-school’ programs 2. Active Transport 3. Urban Design 4. Integration into Primary Care 5. Public education 6.Whole-of- community 7.Sport for all Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 26. 1. ‘Whole-of-school’ programs Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 27. 2. Active Transport Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 28. 3. Urban Design Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 30. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise 3. Urban Design
  • 31. Effect of increasing active travel in urban England and Wales on costs to the National Health Service •James Jarrett, James Woodcock, Ulla K Griffi ths, Zaid Chalabi, Phil Edwards, Ian Roberts, Andy Haines •Lancet 2012; 379: 2198–205 Within 20 years, reductions in the prevalences of type 2 diabetes, dementia, ischaemic heart disease, cerebrovascular disease, and cancer because of increased physical activity would lead to savings of roughly UK£17 billion (in 2010 prices) Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 32. 4. Integration into Primary Care Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 33. 5. Public education Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 34. 6. Whole-of-community Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 35. 7. Sport for all Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 36. 7. Sport for all Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 37. Inactivity Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 38. Inactivity Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 39. Conclusion • Physical inactivity is the major risk factor for morbidity and mortality. –There is a linear relationship between physical activity and health status. –Changing the Built Environment is crucial. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 40. Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise
  • 41. Thank You @doctorloosemore Mikmike.loosemore@eis2win.co.uk mike@activemovement.co.uk Faculty of Sport and Exercise Medicine UK Health through Sport and Exercise