Doctors urged to do more to promote the 'miracle cure' of regular exercise

http://www.theguardian.com/society/2015/feb/13/doctors-promote-miracle-cure-regular-exercise

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Doctors should give clear messages to patients about the benefits of 30 minutes of exercise five times a week – which can be a “miracle cure”, according to a report.

Medical practitioners are being urged not to avoid awkward conversations about lifestyle, as a report from the Academy of Medical Royal Colleges says regular exercise is often more effective than pills.

“Don’t be preachy or reprimand,” the report, written for the academy by Scarlett McNally, an orthopaedic surgeon, advises doctors. “Don’t assume or imply that a patient is lazy.”

Doctors should also practise what they preach. “Be a role model! Try cycling to work once a week and using the stairs when you can,” it says.

The report, entitled “The miracle cure and the role of the doctor in promoting it”, points to evidence that exercise prevents a whole range of diseases. “Regular exercise can prevent dementia, type-2 diabetes, some cancers, depression, heart disease and other serious common conditions – reducing the risk of each by at least 30%. This is better than many drugs,” it says.

Regular exercise can cut an individual’s risk of breast cancer by 25% and the risk of bowel cancer by 45%. It can reduce the chances of ever getting dementia or having a stroke by 30%, says the report. It also cuts the risk of high blood pressure or type-2 diabetes by 50%.

Only half the population takes enough exercise and in the over-65s that drops to less than a third. Nearly half of all adults are sedentary for more than five hours a day, driving or sitting in front of a computer or TV screen. In 1949, 34% of miles travelled were by bike. Now that is just 1-2%.

“We’ve got to change what we think of as normal, because what we are seeing in our hospitals and surgeries up and down the country is that normal has become not enough exercise,” writes Scarlett McNally. “Too many of my patients are paying the price for that with broken bones and years of ill health that could have been avoided by being more active.”

If people became more active, it could make a big difference to the finances of the NHS. The budget is currently £120 billion and 70% is spent on people with chronic conditions that could have been avoided or alleviated by greater activity, says the report.

On a personal level, said McNally, inactivity may be easier to tackle than the three other big preventable causes of disease – smoking, alcohol and poor diet – because people don’t have to give something up. Instead, they can do something positive for themselves. One idea is to get a dog. People who regularly walk a dog are 34% more likely to get sufficient exercise than others. Other options are dancing, swimming and walking. The activity should be vigorous enough to increase the heart rate slightly and get a bit sweaty.

“It is not about going to the gym or wearing Lycra but going up stairs and going for a short walk today and a longer one tomorrow,” said McNally. “Thirty minutes – that’s all you need. It is the people who do the least physical exercise who have the most to gain.”

Two recent reports have recently illustrated the lack of focus on activity, according to Prof Dame Sue Bailey, president of the academy, who wrote the report’s foreword. One from King’s College London found that 80% of obese patients had never discussed their weight with their GP. The other, a Europe-wide, 12-year study from Cambridge University, found that inactivity caused twice as many deaths as obesity alone.

GPs should talk to all their patients about their activity levels, not just those who are overweight, or have high blood pressure or cholesterol, said McNally. They are uniquely placed to motivate, help and support their patients in the one-to-one consultation. “Quite a lot of doctors don’t realise they are quite good at this,” she said. “There are some suggestions that doctors are almost too sympathetic – they are taught to empathise and sympathise and treat the condition in front of them. We need a paradigm shift.”

The Royal College of GPs, however, said its members would need more resources if they are to advise patients on getting active. “Simply telling patients what to do is not enough – long-term behaviour change is very hard and requires ongoing support and access to help over time,” said its chair Dr Maureen Baker. “We need more resources in general practice and more GPs so that we can spend more time with our patients on preventing them getting ill, as well as caring for them when they are ill.”

Profe John Wass, public health lead at the Royal College of Physicians, said hospital doctors had “a key responsibility to try to incorporate messages about the impact exercise can have when talking to our patients – as the benefits are plain to see. We must also move away from the idea that exercise is only for a specific short-term purpose but impress the advantages that a lifelong appreciation of physical activity can bring.”

• This article was amended on 13 February 2015 to clarify a statement about levels of exercise among the general population and over-65s.