Maswell Park Health Centre 31st January 2012 Dr William

Transcript Maswell Park Health Centre 31st January 2012 Dr William

Inactivity: What’s all the Fuss

“Physical inactivity is the fourth leading cause of death worldwide”

In the UK 17% of deaths are caused by inactivity

Attributable fractions (%) for all-cause deaths in 40 842 (3333 deaths) men and 12 943 (491 deaths) women in the Aerobics Center Longitudinal Study.

1 0,9 0,8 0,7 0,6 0,5 0,4 0,3 0,2 0,1 0

The most impact is from Inactive to doing something

Learning Points

1. Physical Inactivity is 4 th leading cause of death 2. Only 30% of the UK population are active enough for their health 3. Low fitness is the most important risk factor to combat in primary care 4. Getting people who are inactive to doing something has the greatest benefits © 2014 Intelligent Health

Causes of Stress and Free Radicals

People Place Purpose Chronic Stress

Chronic Stress

Physical Inactivity

Chronic Inflammation

• Low grade long term inflammation is the fundamental root cause of: – Diabetes – Cardiovascular Disease – Cancers – Dementia (secondary to visceral fat) – Depression and Anxiety – Arthritis and many other conditions © 2014 Intelligent Health

People

Stress Hormones Physical Inactivity And other poor health behaviours Mitochondrial damage / Inflammation Mitochondria as a key component of the stress response.

Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No 5 2007 Depression Cancers Cardiovascular Diabetes Dementia

How Does Physical Activity Work?

1) Anti-inflammatory 2) Anti-aging

Visceral fat reduction with exercise

Fat loss after 13 weeks of walking 60 mins a day and no weight loss

Lean Obese Type 2 Diabetes

Anti-Inflammatory - Fat

Anti-inflammatory - Muscles

• Contracting Muscles Release powerful Anti inflammatories called Myokines that increase 100 fold after exercise.

Learning Points

5. Chronic inflammation is the foundation of most long term conditions 6. Physical activity is a powerful anti inflammatory through 2 mechanisms; 7. reducing visceral fat and 8. by releasing Myokines from exercising muscle © 2014 Intelligent Health

Physical activity creates more healthy mitochondria and slows the effect of aging

Sedentary

Oxidative Phosphorylation

Reactive Oxidative Species Anti-Oxidants Mitochondrial DNA

Mitochondria

Anti-oxidants

Physically Active

Reactive Oxidative Species Oxidative Phosphorylation

Mitochondrial DNA

Mitochondria

Learning Points

9. Mitochondria determine life expectancy and are key to healthy aging 10.When inactive mitochondria release free radicals that can destroy both the mitochondria and the cell itself.

Bone Density

Joints

Physical Activity increases the strength and thickness of articular cartilage and prevents deterioration of the joint.

The Brain

Natural Killer Cells

These cells target viruses and cancer cells and are released during physical activity. Their levels subside after about six hours.

Learning Points

12. PA retains bone density 13. Inactivity leads to degradation of the articular cartilage 14. PA reduces the risk of developing depression, dementia and anxiety 15.PA strengthens the endothelium and reduces existing atheroma 16. PA boosts Natural Killer Cells © 2014 Intelligent Health

Physical Activity and Diabetes

Risk of cardiovascular disease mortality by cardiorespiratory fitness and body mass index categories, 2316 men with type 2 diabetes at baseline, 179 deaths.

Blair S N Br J Sports Med 2009;43:1-2

Physical Activity and Diabetes

Blair S N Br J Sports Med 2009;43:1-2

Physical Activity abolishes the increased CVD risk in Diabetes

Follow up of 53,973 Norwegian Men 1750 deaths from CVD > 3 hours vs < 3 hours a week of PA

3 2,5 2 1,5 1 0,5 0 <3 hrs a week no Diabetes <3 hrs a week with Diabetes >3 hrs a week with Diabetes >3 hrs a week no Diabetes Børge Moe Eivin Eilertsen Tom I.L. Nilsen Diabetes Care March 2013 vol. 36 no. 3 690-695 © 2014 Intelligent Health

Cancer and Physical Activity

Breast cancer

24% reduced risk of disease recurrence 1. Advice is therefore to increase activity even during chemo/Rx therapy

Prostate cancer

90 minutes of brisk walking a week can reduce the risk of all cause mortality by up to 50% 2

Colon cancer

Can improve survival by about 25% 3 .

[1] Ibrahim, E., & Al-Homaidh, A. (2010). Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Medical Oncology. doi:10.1007/s12032-010-9536-x.

[2]Kenfield SA (2010) Physical activity and mortality in prostate cancer (In regular vigorous physical activity found to have survival benefits for prostate cancer patients AACR frontier in cancer prevention research conference by Tuma R). Oncol Times 32: 29–33 [3] Meyerhardt JA, Heseltine D, Niedzwiecki D, Hollis D, Saltz LB, Mayer RJ, Schilsky RL, Fuchs CS (2005) The impact of physical activity on patients with stage III colon cancer: findings from intergroup trial CALGB 89803. Proc Am Soc Clin Oncol 24: 3534.

Coronary Stent Vs 12 months of exercise 20 mins a day 71% event free Medical Cost $7000 More readmissions Circulation. 2004 Mar 23;109(11):1371-8. Epub 2004 Mar 8 80% event free Medical Cost $3400 © 2014 Intelligent Health

The Heath Burden of Inactivity in Suffolk

Suffolk County

Number Deaths (39-79) Diabetes (Prevalence) CHD (Emergency admissions) Breast Cancer (New Cases) Bowel Cancer Stroke Cost (total for Suffolk for 1 year) 2747 30,789 1,495 487 402 Cost (per 100,000) Number reduced if 100% population becomes active 490 4,130 165 99 80 © 2012 Intelligent Health/NHS London Cost due to inactivity 2,620,537 £7,602,313 £854,605 £1,085,154 £1,884,081 £14,046,686 £1,894,165

Health Benefits of Physical Activity Those patients who are inactive have:

1.Estimates of the number of people in England who attain or exceed vigorous intensity exercise by walking at 3 mph Paul Kelly, Marie Murphy, Pekka Oja, Elaine M. Murtagh, Charlie Foster Journal of Sports Sciences Vol. 29,Iss. 15 2011 2.Stanaway FF et al How fast does the Grim Reaper walk? Receiver operating characteristics curve analysis in healthy men aged 70 and over:BMJ. 2011; 343: d7679.

Walk!

• • • • • 5.4 million adults in England (20%) would take vigorous exercise by walking at a speed of 3mph 1 .

Walking at 3mph demonstrates minimum fitness of 6 METS.

Australian men 2 age >70 measured walking speed at usual pace. Walking speed of 2 mph was most predictive of mortality over 5 years No men walking at speeds of 3 mph were caught by Grim Reaper.

Screening Question

1) “In the past week how many days have you done a total of 30 minutes or more of physical activity, which was enough to raise your breathing rate? This may include sport, exercise, brisk walking or cycling?” 2) GPPAQ

Outcome

Inactive Moderately Inactive Moderately Active Active

Read Code

138X 138Y 138a 138b

The basics of all Behaviour change

Dissatisfaction •The first stage is an understanding that the status quo is damaging Life could be better •…and then that life could be a lot better to reverse this damage Feeling helped •This is the feeling that there is support and help available Make it easy © 2014 Intelligent Health

Exploring Decisional Balance

Ask questions in order 1 – 4 Not Changing Changing

Good

1. Advantages of Status Quo

Not So Good

2. Downside of Status Quo 4. Advantages of changing 3. Downside of changing

Brief Intervention (basics)

• • • • Motivation to change cannot be imposed.

Ambivalence = “I would like to change... but” It is the patient’s task not the health professional’s to sort out this ambivalence. Direct persuasion is not an effective method for resolving ambivalence.

Brief Intervention

O pen Ended Questions A ffirmations R eflections S ummarising

Importance Confidence Ruler

“On a scale of 1-10, how important is it to you right now to (be more physically active)?

What number would you give yourself?” “On a scale of 1-10, how confident are you right now that you could xxxxxxxxxx if you wanted to? What number would you give yourself?”

Not at all Confident/Important Very Confident/Important

1 2 3 4 5 6 7 8 9 10

What works in Changing Behaviour

1 • • • • • • • • Goal Setting Self Monitoring Frequent and Prolonged Contact Feedback and Reinforcement Incentives Problem Solving Preventing Relapse Motivational Interviewing 1 REF: Artininian N et al, Interventions to Promote Physical Activity and Dietry Lifestyle Changes for Cardiovascular Risk Factor Reduction in Adults: A Scientific Statement From the American Heart Association Circulation 2010, 122:406-441

Reality Check

• • • • • • • 270,000 inactive people aged 40-79 in Suffolk Decide to reach 67500 (25%) in one year Each one has two appointments (135,000) That’s 2800 a week and 562 a day.

If everyone uses organised sessions just once a week then there would need to be 67,500.

Work

The Active Community

7 Best Buys in Physical Activity

Br JSportsMed 2012;46:709–712 1. School programme to integrate physical activity.

2. Transport policies that favour walking and cycling.

3. Urban design to promote activity for everyone 4. Physical activity and embedded in Healthcare.

Suffolk: The Most Active County

• • • • • • • A clear vision and a common metric Training of healthcare providers Training of sports and physical activity providers Interventions to reduce the health inequalities gap. “PA is a means to an end rather an end in itself” Create scale A strong clear leadership to implement this strategy.

PA is a means to an end

Beat the Street (Local)

• • • • • • Sensors placed at bus stops, shops, schools and surgeries in Caversham (population 30,000).

13,000 cards distributed by: Schools, GPs, Work.

Beat the Street (Local)

400,500 swipes 50,000 miles walked / cycled £6000 raised for books 20% of whole population participating All schools, all GPs, most businesses participated

Reasons to take part in Beat the Street

Taking part in a local community… Easy to do / would be walking anyway Helping local education / schools /… Saving money on travel Getting children involved /… Spending more time with family and… The possibility of winning a prize /… Travelling in a more environmentally… Doing something positive for my… Getting more exercise for myself or… Having fun Winning points for Caversham or a… 0% 1% 3% 3% 4% 7% 10% 18% 18% 19% 20% 30% 45% 30% 40% 50% 52% 60% 70% 86% 80% 90% 100% © 2012 Intelligent Health

COMMUNITY ENGAGEMENT

• All GP Practices will be distributing cards and information and targeting specific groups.

• All Primary schools have been invited • Local media will be contacted • Reading Sports organisations “Beat the Street was a success for the whole school community and we are really pleased to have the opportunity to join in again. We know that the details have been modified and made even more exciting for the children and we can't wait to get started.” John Cosgrove, Head of Christ the King, Whitley 51

WHERE?

130 beat boxes 1 at every school 8-10 in Town Centre

Community Prescription

Summary

• • • • • Inactivity is as important as smoking Don’t use weight loss as an indicator of being successfully active.

Maswell Park Health Centre 31st January 2012 Dr William

Transcript Maswell Park Health Centre 31st January 2012 Dr William

Inactivity: What’s all the Fuss

In the UK 17% of deaths are caused by inactivity

The most impact is from Inactive to doing something

Learning Points

People Place Purpose Chronic Stress

Chronic Stress

Chronic Inflammation

People

How Does Physical Activity Work?

1) Anti-inflammatory 2) Anti-aging

Visceral fat reduction with exercise

Anti-Inflammatory - Fat

Anti-inflammatory - Muscles

Learning Points

Physical activity creates more healthy mitochondria and slows the effect of aging

Sedentary

Mitochondria

Physically Active

Mitochondria

Learning Points

Bone Density

Joints

The Brain

Natural Killer Cells

Learning Points

Physical Activity and Diabetes

Physical Activity and Diabetes

Physical Activity abolishes the increased CVD risk in Diabetes

Cancer and Physical Activity

The Heath Burden of Inactivity in Suffolk

Health Benefits of Physical Activity Those patients who are inactive have:

Walk!

Screening Question

The basics of all Behaviour change

Exploring Decisional Balance

Brief Intervention (basics)

Brief Intervention

Importance Confidence Ruler

What works in Changing Behaviour

Reality Check

The Active Community

7 Best Buys in Physical Activity

Suffolk: The Most Active County

PA is a means to an end

Beat the Street (Local)

Beat the Street (Local)

Reasons to take part in Beat the Street

Community Prescription

Summary

Directory