Exercise Is Medicine – One We Need Everyday

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Move more, eat less.’ Sounds simple, doesn’t it? In the media, we often hear this phrase said in relation to tips and advice for healthier living, and weight loss. In reality, that sort of broad thinking is neither simple nor helpful, as it doesn’t contain any specific guidance for any individual to follow. How MUCH more movement? How MUCH less food? It’s not a one-size fits all. It never has been, and never will be, no matter what the latest diet trend or fitness craze is.

Let me ask you a question. What does exercise mean to YOU? Take a second to reflect on that. Is it walking, or running? Maybe you play a sport, or love going to boxing or spinning or zumba with friends? Do you lift weights? Or is the concept of ‘exercise’ both scary and alien to you, something you ‘should do’ but struggle to find the time, or the motivation?

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There is NO judgement for whatever you answer to this question. I ask because physical activity is a modifiable lifestyle factor that, as a doctor, I am beyond passionate about promoting. If you follow me on social media, or you’ve followed this blog for a while, you might have read my first article on this topic – Exercise As Medicine – A Prescription for Lifestyle Change. In it, I talked about my interest in this area, and I told you guys about a small research project I was under-taking with a friend/fellow doctor and a couple of the senior physiotherapists at the hospital where I work. We did a small survey of twenty of my fellow junior doctors, to assess their knowledge and awareness of national physical activity guidelines, and the concept of ‘exercise prescribing‘ – i.e. that your doctor might, on a basic level, be able to advise you on and prescribe exercise, similarly to how you get prescriptions for medications. We then organised two interactive lectures, taught by our senior physiotherapists, which educated the doctors on existing physical activity guidelines, as well as some case based discussions.

FYI: Anything I discuss below that you’re keen for a reference/study I’ve looked at for, just ask!

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Because I’m a total nerd (you knew that already though), and because I’m pretty set on  public health and preventive medicine as my career path, I decided to put our results together into a little abstract, and submitted it to the Irish Royal College of Physicians Public Health Summer Conference, which was held in Dublin in May. I’ve been to the summer and winter conferences last year, to learn and explore this area, and I loved it. I told myself, after the winter meeting in 2017 that I would make sure I had my own (however small) project to present at the 2018 summer conference. And happily, the Faculty accepted my submission for both a poster and oral presentation! So I created a poster of our project (see below), and I presented a ‘Two Minute Magic’ Power-Point to a room of public health specialists and trainees. You guys showed such interest in our project that I wanted to follow up my first article with this, to tell you about my interest in this area, and what we did!

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Here’s the thing. In the Western world, we are just not moving our butts enough. We live in a society where day to day life is geared towards largely sedentary lifestyles – many of us drive to work, to sit at desks all day, to arrive back home to assume a similar seat position, either at the computer or the television. That is of course not true of everyone or every profession – as a doctor, I’m basically on my feet all day at work, for example. And many of us do our bit to counter-act this sedentary living with exercise before, during or after work. Standing desks are growing in popularity, and company wellness and exercise initiatives are increasingly common. All the same, as a population, we are not doing enough. And I don’t think us doctors, as healthcare professionals, are doing enough right now to promote a change in this lifestyle factor among our patients. Physical inactivity has reached pandemic levels, according to a 2012 series on Physical Activity published by the Lancet, and it was been identified in this series as the fourth leading cause of death worldwide (after hypertension (high blood pressure), smoking, and hyperglycaemia (or high blood sugar, a pre-disposing state to type 2 diabetes mellitus). Think about that. A totally preventable, easy modifiable risk factor for mortality that we can so easily address – yet we aren’t. You may have heard of the term ‘non-communicable diseases‘ – this refers to chronic diseases such as heart disease, obesity, type 2 diabetes mellitus, and cancer, for example. Physical inactivity is a major risk factor for the development of these illnesses, which are a huge burden on our healthcare systems. In Ireland, the 2016 Healthy Ireland Survey revealed only 32% of the Irish population were felt to be sufficiently active. Not even a third of us. Our National Physical Activity guidelines advise that we should be active at a moderate intensity (by moderate, we usually say ‘you should be able to talk but not sing’) for 30 minutes a day, five days per week, or 150 minutes per week. If you think about it, given that there are 24 hours in a day, that’s actually a tiny amount of time. It’s very feasible, and to be honest, I would change that to 30 minutes a day, seven days a week. Minimum.

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On an international level, we can refer to the World Health Organisation Guidelines, which are the same as our Irish guidelines above, as well as the more detailed American College of Sports Medicine guidelines, which I prefer, and I’ve included here:

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I prefer these because they include the importance of regular resistance training, the benefits of which I’ve spoken about in a previous blog post on Gym Intimidation. As a starting point with patients, I think the WHO and Irish guidelines are fantastic, and my preferred mode of activity I like to address is walking. Why? Multiple reasons. It’s free, it’s accessible to pretty much everyone, and it can be fit into any part of your day. Getting up a half an hour earlier, especially during the summer mornings, to do a brisk walk before you head to work – ideal. The hardest part is not snoozing your alarm! Or bringing your walking shoes to work, and taking a half hour or even twenty minutes on your lunch break to get those steps in. Longer evenings are also perfect for a stroll – and this is a great time to get family and/or friends to go with you! I’m also a big fan of advising people to invest in a simple pair of headphones, because if you find walking boring, listening to music, Podcasts (a personal favourite of mine) or audiobooks can be a total game-changer. If 30 minutes all in one go seems too much, then split it up! Ten to fifteen minutes, 3 times a day. If that was a tablet your doctor told you to take for blood pressure, you wouldn’t think twice about it.

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That takes me to my second point in this article, and the whole reason for our research project, which is the knowledge and awareness among doctors of exercise guidelines, and promoting the prioritisation of education on this topic, so that we can be empowered to address it with our patients. Older studies I looked at while doing this project showed very very small numbers of medical schools including physical activity education in their curricula – for example, a studies from the early 2000s showed only 13% of US medical schools incorporated aspects of physical activity in their under-graduate programmes, while in the UK and Ireland, only 13 of 28 medical schools surveyed including aspects of sports and exercise medicine in their teaching. From personal experience in Ireland, at an under and post graduate level, preventive medicine as whole is not an area I saw prioritised during my medical education. I loved my college years, and speak very highly of the training I’ve received to date – but historically the teaching we receive in this area of health has lagged behind the rest.

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In our small study, most doctors were unaware of any existing physical activity guidelines, and reflecting that, most did not feel confident with their existing knowledge to advise their patients on exercise. A positive finding was that most had referred their patients to allied healthcare professionals such as physiotherapy to improve physical activity as part of patient management. An important thing to note also is that I work in acute hospital medicine right now, not in community general practice, so our findings will reflect that too. It was also a really small study, but a decent proportion of junior doctors at my level (senior house officer) took part.

So. Here’s where I’ll finish – with two take home points:

  1. We are not active enough, both nationally and globally. Improving physical activity levels of the population has got to be a public health priority, the same way campaigns for smoking cessation and healthy eating are. And in this country, it already is, but it needs more voices behind it. Because simple positive changes we make as individuals to improve our activity levels have MASSIVE results – those 30 minutes a day can literally be life changing in the long run, and trust me, you WILL feel the physical and mental benefits of it.
  2. We need to prioritise education on physical activity guidelines and the concept of exercise prescribing at under and post graduate medical level. This is essential, to equip us doctors of the present and the future to address this key lifestyle factor with our patients.

And that’s a wrap. For now.  I would LOVE your feedback on this post guys – I’m aware and delighted that many of you following my blog are also healthcare professionals, and would be grateful for your thoughts and comments! Either have your say here, send me a DM or find me on social media – I’m @theirishbalance on Instagram/Twitter/Facebook!

Ciara 🙂 x

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