Transcript Maswell Park Health Centre 31st January 2012 Dr William

Dr William Bird MBE, MRCGP
CEO Intelligent Health GP
Everybody More
Active Every Day
12 March 2015
Oxfordshire
Mortality due to Inactivity
© 2012 Intelligent Health/NHS London
More lives are saved by getting people fit
Blair S N Br J Sports Med 2009;43:1-2
18
16
Attributable Fraction %
14
12
10
8
6
4
2
0
Cardiorespiratory
Fitness
Obesity
Smoking
Hypertension
High Cholesterol
Diabetes
Axis Title
Men
Women
© 2014 Intelligent Health
Fear and Chronic
Stress
People
Isolation
•
© 2015 Intelligent Health
Place
Danger
Many people living in poorer
areas are lonely have little
regard to their environment
and have no purpose
Purpose
Rejection
Chronic Stress
Physical
Inactivity
•
© 2015 Intelligent Health
Visceral Fat
Visceral fat increases
all cause mortality
OR 1.83 (1.23 to 2.73)
10% weight loss leads
to 35% visceral fat
weight loss
Janssen I, Ross R.. Int J Obes Relat
Metab Disord. 1999;23:1035– 46.
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Kuk, Jennifer L et al. Obesity;2006;14:
336-341.
Anti-Inflammatory - Fat
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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
0
% Loss of Fat
-5
-10
-15
-20
-25
Axis Title
S/C Fat
Viseral Fat
Lee S et al. J Appl Physiol 2005;99:1220-1225
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Free Radicals
and death of
a cell
Physical
Activity Stress
and
inflammation
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Sedentary High fat diet and Stress
Oxidative Phosphorylation
Inner membrane
Reactive Oxidative
Species
Anti-Oxidants
Mitochondrial DNA
Mitochondria
Manoli et al.Trends in Endocrinology and Metabolism Vol 18 No 5 2007
McIntosh L et al. Neurotoxicology 17.3-4 (1995): 873-882.
•
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Physically Active, low fat and not
stressed
Oxidative Phosphorylation
Anti-oxidants
Mitochondrial DNA
Mitochondria
•
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© 2012 Intelligent Health/NHS London
Telomeres get shorter
Epel, Elissa, et al. "Can meditation slow rate of
cellular aging? Cognitive stress, mindfulness,
and telomeres." Annals of the New York
Academy of Sciences 1172.1 (2009): 34-53.
•
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© 2012 Intelligent Health/NHS London
Telomere shortening
Epel, Elissa S. "Psychological and metabolic
stress: a recipe for accelerated cellular aging."
Hormones (Athens) 8.1 (2009): 7-22.
Senescence: The end of the cell.
Hezel, Aram F., Nabeel Bardeesy, and Richard S. Maser. "Telomere induced senescence:
end game signaling." Current molecular medicine 5.2 (2005): 145-152.
People
Chronic
Stress
Purpose
Place
Inactivity and over
eating leading to
Visceral Fat
Stress Hormones
Mitochondrial damage and telomere shortening
which leads to inflammation
Depression
Cancers
Cardiovascular
Diabetes
Dementia
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
Joints
Physical Activity increases
the strength and
thickness of articular
cartilage and prevents
deterioration of the joint.
Patients with OA must
continue to be active to
increase function and
reduce pain
© 2014 Intelligent Health
The Hippocampus enlarges with exercise
by 20% in both children and elderly
© 2012 Intelligent Health/NHS London
Natural
Killer Cells
These cells target viruses
and cancer cells and are
released during physical
activity. Their levels
subside after about six
hours.
© 2012 Intelligent Health/NHS London
Cancer and Physical Activity
Breast cancer
24% reduced risk of disease recurrence1. Advice is therefore
to increase activity even during chemo/Rx therapy
[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.
© 2014 Intelligent Health
Physical Activity and Diabetes
Follow up of 53,973 Norwegian Men (recruited 1995).
Adjusted for weight
1750 deaths from CVD in 2008
> 3 hours vs < 3 hours a week of PA
2.81 (1.93-4.07)
Børge Moe
Eivin Eilertsen
Tom I.L. Nilsen
0.89 (0.481.63)
1
0.78 (0.63-0.96)
<3 hrs a week no
Diabetes
<3 hrs a week
with Diabetes
>3 hrs a week
with Diabetes
Diabetes Care
March 2013
vol. 36 no. 3
690-695
>3 hrs a week no
Diabetes
© 2012 Intelligent Health/NHS London
Lets get Bob active
© 2012 Intelligent Health/NHS London
“Bob, Why don’t you get off the bus a
stop early?”
“Bob you really should take the stairs
instead of the lift”
“ ….and have you tried cycling to the
shops?”
But Bob already walks 3 miles to
Liverpool’s home game
But to Bob that is not exercise
© 2012 Intelligent Health/NHS London
PA: The means to an end
Don’t isolate Physical Activity
© 2012 Intelligent Health/NHS
London
The Active Community
Work
Home
GP
Street
Park
School
Sport
© 2013 Intelligent Health
Activate the whole community i.e
create scale and depth
© 2012 Intelligent Health/NHS
London
Activate communities within
communities
© 2013 Intelligent Health
20 July 2015
© 2015 Intelligent Health
Beat the
Street in Terni,
Italy February
2015
35
Beat the Street (Reading)
•
•
•
•
•
Total Miles 244,537
Total number of raw swipes: 514,198
Total number of Cards and Fobs used: 15,074
Total number of Fobs (and school cards) : 8,416
Total number of Cards : 6,658
© 2012 Intelligent Health/NHS London
Heat Map of Usage of Beat Boxes
© 2013 Intelligent Health
Distribution of users of BB02 by groups
Increased Physical Activity
Matched Pairs of achieving 30 mins of activity 5 days a week
50
45
P<0.05
P <0.05
40
35
30
25
20
15
10
5
0
Reading
Thurrock
Before
After
Building the Infrastructure
Inter-sectorial
Partnership
Leadership
Local Activity
Plan
Funding
Political
Commitment
Workforce
Capacity
Monitoring and
Evaluation
Targets
Delivering the Action
Media
Community
Natural
Environment
Sport
Worksite
Primary Care
Schools
Urban
Design
Workforce
Political
Commitments
National
Targets
R and D
Resources £
Monitoring and
Evaluation
Media and Social Marketing Campaigns
Community
Schools
Natural
Environment
(parks, rivers, nature,
coastal)
Work
place
Urban
Environment
Primary
Health
care
Sports
Transport / Movement
Networks
ACTIONS
PLACES
Local Action
Plan
POLICIES
Leadership
PROGRAMS
Partnerships
INFRASTRUCTURE
Necessary Components of Local Action on Physical Activity
Summary
• Physical Activity is fundamental to human
health and survival
• To change the status quo requires a revolution
of thinking with walking at the centre
• Physical Activity must be seen as the gateway
to a better life i.e. a means to an end
• It requires strong partnerships and leadership
particular from the health sector
• …..think of Bob
© 2013 Intelligent Health
Thank You
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