Increasing Physical Activity in Primary Care

Andrew Murray GP and Scottish Government

Increasing Physical Activity in Primary Care

Andrew Murray GP and Scottish Government

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Trends in male life expectancy: ScotlandTrends in male life expectancy: Scotland

Richest 20%

Poorest 20%

Albert Einstein

• Insanity

• “is doing the same thing over and over again and expecting different results”

SMOKADIABESITY

Risk Factors- mortality Blair et al BJSM 2009

Elderly Population less active

• Scotland (males)25-34yo- 63% active

65-74yo- 24% active

75yo plus- 13% active

Female population even worse

Risk reduction associated with physical activity- preaching to the converted!!

Chronic condition Risk reductionAll cause mortality 30% risk reductionCVD, stroke 20-35% reductionDiabetes 30-40% reductionHip fractures 36-68% reductionColon cancer 30% reductionBreast cancer 20% reductionLoss of function 30% reductionDepression/dementia 20-30% reduction

MYTHBUSTING

• Too old to exercise

• Too Fat to exercise• I’m diabetic, have OA, COPD,

high BP, etc etc

• Regular physical activity actually helps treat these conditions

Persistence hunting

Investments that work1. Whole of school programmes- early input to produce active ageing!!2. Transport policies and systems that prioritise walking, cycling and public transport3. Urban design that provides for equitable and safe access for recreational physical

activity

4. Physical activity and NCD prevention integrated into primary health care systems

5. Public education, including mass media to raise awareness and change social norms on physical activity

6. Community-wide programs that mobilize and integrate community engagement and resources

7. Sports systems and programs that promote ‘sport for all’ and encourage participation across the life span.

NHS- how we deliver

• Embed it into the NHS- make it normal

• Education- integrate into CPD, workforce development, post and undergraduate curriculums

• Health promoting Health Service

CMO guidelines

• Known by 13% GP’s,• 9% PN, • 7% HV

• 30 mins 5x per weeks (or 150 mins total) moderate exercise- adults

• 60 mins daily for kids

Embed it into the Primary Care• Ask the question??

• “How many days a week do you do physical activity, and for how long” ??150 mins

• Assess• Advice• (Intervention)• Direct to resources

Primary Care pathway

• Feasibility study Jan 2013• Roll out when success proved• Applicable to secondary care, and other

professional groups also• Announced by Ms Robison in parliament

Brief interventions in Primary Care

• Physical Activity £20-440

• Smoking £8-9000

• Statin >£10k

Education

• 40% of med schools teach CMO guidelines• Share information• Guidelines• Grand rounds• 23 and a half hours

Outcome aims

• 50% adults active by 2022

• 80% children• Increase life expectancy

by 5 years in 10 years• Decrease health

inequalities• Less spend on scripts,

appointments

Life expectancy trendsLife expectancy: Scotland & other Western European Countries, 1851-2005

Source: Human Mortality Database

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

1851

-185

3

1855

-185

7

1859

-186

1

1863

-186

5

1867

-186

9

1871

-187

3

1875

-187

7

1879

-188

1

1883

-188

5

1887

-188

9

1891

-189

3

1895

-189

7

1899

-190

1

1903

-190

5

1907

-190

9

1911

-191

3

1915

-191

7

1919

-192

1

1923

-192

5

1927

-192

9

1931

-193

3

1935

-193

7

1939

-194

1

1943

-194

5

1947

-194

9

1951

-195

3

1955

-195

7

1959

-196

1

1963

-196

5

1967

-196

9

1971

-197

3

1975

-197

7

1979

-198

1

1983

-198

5

1987

-198

9

1991

-199

3

1995

-199

7

1999

-200

1

2003

-200

5

Portugal

Scotland

Life expectancy trends

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

Resources

• http://www.fyss.se/fyss-in-english/chapters-in-fyss/ Physical Activity in the Treatment of disease

• 23 and a half hours• Active Scotland• Take Life On• @docandrewmurray @scotgovhealth