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Physical activity promotion in
Primary Care – what works?
Dr Andrew Boyd MRCGP
RCGP Clinical Priority Champion: Physical Activity & Lifestyle
A little about me
2
A
A
How did I end up here?
National shift in approach to physical activity
3
National framework domains,
Everybody Active, Every Day
National Strategy outcomes, Sporting
Future 2015
CMO Infographics
Your words don’t fall on deaf ears!
How does the UK compare with the
following countries for inactivity?
6
A
USA
France
Netherlands
Germany
Australia
Finland
Proportion who are inactive
7 Public Health England (2014) Everybody Active, Every Day; Based on Hallal PC et al. (2012) Global physical activity levels:
surveillance progress, pitfalls, and prospects. The Lancet.
International comparison of physical inactivity (at ages 15 and over)
Note: Comparator = Not meeting any of the following per week: (a) 5 x 30 mins moderate-intensity activity; (b) 3 x 20 mins
vigorous-intensity activity; (c) equivalent combination achieving 600 metabolic equivalent-min.
UK 63.3%
USA 40.5%
Australia 37.9%
Finland 37.8%
France 32.5%
Germany 28.0%
Netherlands 18.2%
0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0%
% Inactive
Physical activity: Who gains the most?
8 Moore et al. (2012) PLOS Medicine
A
150 Minutes
Biggest gain
in years
Physical activity reduces the mortality and
morbidity risk of disease
9
Start Active, Stay Active (2011) based on US Department of Health and
Human Services Physical Activity Guidelines Advisory Committee Report
(2008), Washington DC
A
Disease Risk reduction Strength of evidence
Osteoarthritis disability 22-80% Moderate
Alzheimer’s disease 20-30% Moderate
Hip fracture 36-68% Moderate
Depression 20-30% Moderate
Early death 20-35% Strong
CHD and stroke 20-35% Strong
Type 2 diabetes 35-40% Strong
Colon cancer 30-50% Strong
Breast cancer 20% Strong
Hypertension 33% Strong
Functional limitation, elderly 30% Strong
Prevention of falls 30% Strong
Lies, damn lies, and statistics…
• 25% of the UK adult population ‘inactive’
• >40% of the population ‘not active enough for good health’
• Inactivity 4th biggest risk factor for NCD
• 300million GP & patient consultations per annum
• 75% GP discuss lifestyle ‘often/always’
• So… why isn’t the message getting through?
Barriers – GP perceptions
• Time - 10 minutes to talk about everything!
• Lack of knowledge
• Fear of offending patients
• Perceived lack of services locally
• Reliability of services - who can I trust?
What we learnt…
• Behaviour change takes time – think smoking
• PHE teaching will reach some but not all
• There are HCPs doing great work already
• There is an appetite for this – patients and HCPs
• Genuine concerns re: medicolegal limbo
• One size definitely doesn’t fit all
Solutions - knowledge
• RCGP toolkit – ‘motivate to move’ – disease specific
• Podcasts
• Videos
• Events – regional workshops, conferences, media presence
• Moving Medicine
‘Moving Medicine’
Solutions – advocacy and empowerment
• The Active Practice –the power of the med student
• The case for PA –commissioners
• The case for surgeries
• The case for the PA industry
• The case for the voluntary/third sector
• Universal cross sector medicolegal guidance
• Doctors and HCPs as leaders and activists
Taking a stand!
Stefan et al. (2013) Lancet Diab Endocrinol16
Becoming a local leader
• Look for allies
• Join or start a network
• ‘Lifestyle’ medicine: RCGP, PHE, BSLM, social media
• Grants and bids – charities, CCG, research
• Events - Elevate, UKactive, ISPAH, BSLM conference, FSEM, BASEM
Social Prescribing: a solution?
• GPs can’t do it all – but can sew a seed
• For more complex patients
• In-depth knowledge of local services
• Health sec promise for universal access
• Emerging evidence of efficacy
• Are they including PA in their offer?
Walk Map Learn – a local initiative
The parkrun practice
The future
• Surgeries as health/wellness centres
• PA as the norm not just for weirdos in lycra!
• Embedding in other health priorities – PCC; clusters;resilience
• PA recognised as a good value safe ‘medicine’ for all
• Positive partnerships across sectors nationwide
Resources
• Motivate to Move gpcpd.walesdeanery.org
• Moving Medicine www.fsem.ac.uk
• RCGP Physical Activity Toolkit www.rcgp.org.uk
• Arthritis UK PILs www.arthritisresearchuk.org
• Disease charities – Richmond Group
• One You app www.nhs.uk/oneyou
• NHS Live Well www.nhs.uk/live-well/exercise/
• Chair based www.bhf.org.uk/heart-matters-magazine/activity/chair-
based-exercises
And many many others…
Get in touch
• RCGP Physical Activity & Lifestyle Clinical Priority
andrew.boyd4@nhs.net
• PHE Clinical Champions physicalactivity@phe.gov.uk
• British Society of Lifestyle Medicine bslm.org.uk
Thank you!

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Andrew Boyd

  • 1. Physical activity promotion in Primary Care – what works? Dr Andrew Boyd MRCGP RCGP Clinical Priority Champion: Physical Activity & Lifestyle
  • 2. A little about me 2 A A How did I end up here?
  • 3. National shift in approach to physical activity 3 National framework domains, Everybody Active, Every Day National Strategy outcomes, Sporting Future 2015
  • 5. Your words don’t fall on deaf ears!
  • 6. How does the UK compare with the following countries for inactivity? 6 A USA France Netherlands Germany Australia Finland
  • 7. Proportion who are inactive 7 Public Health England (2014) Everybody Active, Every Day; Based on Hallal PC et al. (2012) Global physical activity levels: surveillance progress, pitfalls, and prospects. The Lancet. International comparison of physical inactivity (at ages 15 and over) Note: Comparator = Not meeting any of the following per week: (a) 5 x 30 mins moderate-intensity activity; (b) 3 x 20 mins vigorous-intensity activity; (c) equivalent combination achieving 600 metabolic equivalent-min. UK 63.3% USA 40.5% Australia 37.9% Finland 37.8% France 32.5% Germany 28.0% Netherlands 18.2% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% % Inactive
  • 8. Physical activity: Who gains the most? 8 Moore et al. (2012) PLOS Medicine A 150 Minutes Biggest gain in years
  • 9. Physical activity reduces the mortality and morbidity risk of disease 9 Start Active, Stay Active (2011) based on US Department of Health and Human Services Physical Activity Guidelines Advisory Committee Report (2008), Washington DC A Disease Risk reduction Strength of evidence Osteoarthritis disability 22-80% Moderate Alzheimer’s disease 20-30% Moderate Hip fracture 36-68% Moderate Depression 20-30% Moderate Early death 20-35% Strong CHD and stroke 20-35% Strong Type 2 diabetes 35-40% Strong Colon cancer 30-50% Strong Breast cancer 20% Strong Hypertension 33% Strong Functional limitation, elderly 30% Strong Prevention of falls 30% Strong
  • 10. Lies, damn lies, and statistics… • 25% of the UK adult population ‘inactive’ • >40% of the population ‘not active enough for good health’ • Inactivity 4th biggest risk factor for NCD • 300million GP & patient consultations per annum • 75% GP discuss lifestyle ‘often/always’ • So… why isn’t the message getting through?
  • 11. Barriers – GP perceptions • Time - 10 minutes to talk about everything! • Lack of knowledge • Fear of offending patients • Perceived lack of services locally • Reliability of services - who can I trust?
  • 12. What we learnt… • Behaviour change takes time – think smoking • PHE teaching will reach some but not all • There are HCPs doing great work already • There is an appetite for this – patients and HCPs • Genuine concerns re: medicolegal limbo • One size definitely doesn’t fit all
  • 13. Solutions - knowledge • RCGP toolkit – ‘motivate to move’ – disease specific • Podcasts • Videos • Events – regional workshops, conferences, media presence • Moving Medicine
  • 15. Solutions – advocacy and empowerment • The Active Practice –the power of the med student • The case for PA –commissioners • The case for surgeries • The case for the PA industry • The case for the voluntary/third sector • Universal cross sector medicolegal guidance • Doctors and HCPs as leaders and activists
  • 16. Taking a stand! Stefan et al. (2013) Lancet Diab Endocrinol16
  • 17. Becoming a local leader • Look for allies • Join or start a network • ‘Lifestyle’ medicine: RCGP, PHE, BSLM, social media • Grants and bids – charities, CCG, research • Events - Elevate, UKactive, ISPAH, BSLM conference, FSEM, BASEM
  • 18. Social Prescribing: a solution? • GPs can’t do it all – but can sew a seed • For more complex patients • In-depth knowledge of local services • Health sec promise for universal access • Emerging evidence of efficacy • Are they including PA in their offer?
  • 19. Walk Map Learn – a local initiative
  • 21. The future • Surgeries as health/wellness centres • PA as the norm not just for weirdos in lycra! • Embedding in other health priorities – PCC; clusters;resilience • PA recognised as a good value safe ‘medicine’ for all • Positive partnerships across sectors nationwide
  • 22. Resources • Motivate to Move gpcpd.walesdeanery.org • Moving Medicine www.fsem.ac.uk • RCGP Physical Activity Toolkit www.rcgp.org.uk • Arthritis UK PILs www.arthritisresearchuk.org • Disease charities – Richmond Group • One You app www.nhs.uk/oneyou • NHS Live Well www.nhs.uk/live-well/exercise/ • Chair based www.bhf.org.uk/heart-matters-magazine/activity/chair- based-exercises And many many others…
  • 23. Get in touch • RCGP Physical Activity & Lifestyle Clinical Priority andrew.boyd4@nhs.net • PHE Clinical Champions physicalactivity@phe.gov.uk • British Society of Lifestyle Medicine bslm.org.uk Thank you!