Why getting active matters

Physical activity

Getting – and staying - active is critical in the primary and secondary prevention of over 20 chronic conditions, but approximately 34% of men and 42% of women in the UK are not active enough for good health. Physical inactivity is understood to be responsible for 1 in every 6 UK deaths and up to 40% of long-term conditions could be prevented if everyone met the UK Chief Medical Officer’s physical activity recommendations.

Of particular concern are the 27% of the population classified as ‘inactive’, meaning they do less than 30 minutes of moderate intensity physical activity (such as walking) per week. 33% of children do less than half the recommended physical activity for their age. Inactive people are at high risk of developing long-term health conditions, a situation that is worsened by the fact that when they develop illness they generally become even less active. In children and young people physical activity plays an important role in preventing the onset of mental health illness and improves the physical and mental wellbeing in children with long-term conditions.

The cost to the health service is £0.9 billion annually, with the estimated cost to the UK being £7.4 billion. The impact of physical activity on our health is significant, yet we are expected to be 35% less active in 2030 than we were in 1960 based on current trends.

The evidence is clear – physical inactivity is a major risk factor for ill-health and physical activity is protective and preventative for all of us – young, old, well or with long-term conditions. The very modest risks are far outweighed by the benefits, and GPs and their teams are ideally placed to lead by example in their communities, and have conversations about physical activity with all of their patients.

Key reference: Physical activity: applying All Our Health

Sedentary behaviour - a risk factor in itself

Perhaps the question we’re asked the most is, ‘why is there a requirement in the Active Practice Charter to reduce sedentary behaviour as well as increase physical activity – surely they’re one and the same?’ 

Sedentary behaviour and inactivity are linked – but the science, and the national guidelines, encourage us to think about them as separate and additive risk factors. Breaking up long periods of sitting down is particularly relevant for those of us who work long hours in an office, over and above getting your daily ‘dose’ of physical activity, hence its presence in the Active Practice Charter. Over to Dr Richard Mayne, an academic GP with an interest in sedentary behaviour, to explain more in the next section.

Why does sedentary behaviour matter?

Humans were not made to sit behind desks. We were made to move. Did you know there is a dose-response relationship between sedentary time and mortality? Unfortunately, the more time we spend being sedentary, the higher our risk of death – it is a separate and additive risk factor to being less active.

The effect of sedentary behaviour (sitting or lying in a state of low energy expenditure) on mortality was first discovered by the epidemiologist Jeremy Morris in post-World War Two London. Morris and his colleagues found that (sedentary) bus drivers had higher rates of mortality from cardiovascular disease than their (physically active) bus conductor colleagues. The main reason for this was postulated to be due to their differences in sedentary behaviour and physical activity during the working day, as they had very similar lifestyles outside of work. 

Scary reading for us GPs at the coalface of the NHS, working behind desks all day long! Are we the sedentary bus drivers compared to our more physically active, bus conductor hospital colleagues?

Many working adults in the UK spend 9 hours or more sitting down every day. Children and retired people from lower socioeconomic groups are more likely to be sedentary compared to their better off counterparts, as well as those who already have a chronic condition. As primary care practitioners, looking out for this prevalent risk factor and providing advice and aspiration – particularly in these groups – could have powerful consequences.

What can we in primary care do?

As primary care professionals, with our high levels of patient contact and opportunities for health promotion, we can and should be at the forefront of this culture-change, sitting less and moving more in order to live longer, happier and healthier lives, as well as encouraging our patients to do likewise.

Moving more helps people feel better, due to chemical changes in the brain as effective as any antidepressant. People are much more likely to change their behaviour if they believe they will see immediate benefits. Behavioural change psychology dictates that the focus should be on the here and now. Telling people that “moving more will make you feel better today,” is much more effective than saying “exercising for thirty minutes five times a week will reduce your risk of a heart attack in thirty years’ time.”

In 2020, the World Health Organization (WHO) released their ‘Guidelines on physical activity and sedentary behaviour’. These include specific guidance for people of all ages and abilities, but the key take home message is for everyone to be less sedentary as well as being more physically active. In some cases it might be most effective for us to move away from ‘prescribing exercise’ and simply encourage people to move more, because any movement is better than no movement. 

Over to you!

Some ways for us, as GPs, to sit less and move more during the working day include:

• walking to the waiting room to greet patients
• walking to meetings
• getting a sit-stand desk to try ‘active consulting’ (where you conduct phone consultations while standing up or walking around the consulting room)
• active breaks (such as going for a short walk at lunchtime, time permitting).

And of course, sign up to the Active Practice Charter – to advertise to the world that your practice means it when it comes to increasing physical activity AND reducing sedentary behaviour!