Why is increasing physical activity important?

Inactivity accounts for at least 2,500 deaths each year in Scotland and for almost 1 in 10 deaths worldwide. It is considered to be the second biggest risk factor for mortality, behind high blood pressure. Increased physical fitness would reduce premature death by 30% and can help prevent and treat more than 20 chronic diseases. Getting Scotland fit could increase an individual's life expectancy by almost a year.

Furthermore, physical activity offsets much of the health problems of obesity - releasing cash and improving health outcomes at scale. Scotland was one of the first countries to introduce a national physical strategy in 2003. 'Let´s Make Scotland More Active' provides a broad framework of objectives and priorities for the promotion of all physical activity in Scotland, not just cycling.

What is 'physical activity'?

Physical activity is a general term used to describe any movement of the body that uses energy. This deliberately broad definition means that virtually all types of activity can be beneficial including: exercise, sport, play, dance and ´active living´ such as walking, cycling for transport, housework, gardening and work.

How much you should be doing?

There is UK consensus on the amount and type of physical activity recommended to improve and maintain health. The recommendations differ across age groups because people have different needs at different life stages. Adults should aim to be active daily. Over a week, this should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least 5 days a week

The benefits

Increasing physical activity is an evidence-based way to:

a) increase life expectancy,
b) decrease health inequalities, and
c) achieve tangible cash savings not just for the NHS but also across a range of sectors.

For example, increasing levels of physical activity amongst the workforce can increase motivation and reduce sick absences by 26%, potentially saving over £500 million. Its positive impact is more extensive; regular physical activity improves marks at school, as well as quality of life, and health outcomes for our children. It can reduce anti-social and criminal behaviour. Extensive evidence confirms that a reasonable level of cardio-respiratory fitness – that achieved by 30 minutes of brisk walking on 5 days each week – can reduce the risk of many illnesses shown in the table below.

In 2012 in Scotland, 39% of adults aged 16 and over met the physical activity recommendations with men more likely to do so than women (45% compared with 33%). 73% of children (76% of boys and 70% of girls) meet the physical activity recommendations including school-based activity.

Adult activity levels are related to income and area deprivation, with those living in the highest income households more likely to meet the recommended activity levels, and those in the most deprived areas least likely to meet them.

Interventions

At present, a brief advice intervention from a health professional is the main way of encouraging physical activity. It is highly cost effective but is, in itself, inadequate to deliver a step change in population uptake. Those with the greatest need are often the least likely to respond to such advice.

The Toronto Charter on Physical Activity was a WHO (World Health Organisation) sponsored effort to bring together all the evidence-based interventions that have been shown to work across society. Recommendations include action in the following areas:

Education: Making physical activity in the early years, for school-age children and students normal.

Transport and the environment: Transport policies and systems that prioritise walking, cycling and public transport.

Urban design and infrastructure: Providing safe and equitable access for recreation and physical activity across the life course.

The Workplace: Promoting policies and an environment that encourage regular physical activity and other health promoting behaviours.

The NHS and Care: Embedding assessment and advice about physical activity as a routine part of the NHS and care.

Training professionals: Integrating physical activity into undergraduate and postgraduate curriculums, CPD and workforce development.

Sport and recreation: Sport systems and programmes that promote “sport for all” and encourage participation across the life-span.

Communications/Public education: Systematic, consistent public education, including mass media, to raise awareness of the benefits, and change social norms physical activity.

Action is needed across all, not just one or two of these areas if Scotland is to achieve the transformation necessary.

The economic benefits of enhanced physical fitness

The National Institute for Health and Clinical Excellence (NICE) established that brief advice/interventions for physical activity cost between £20 and £440 per quality adjusted life year (QALY) when compared with no intervention. This is significantly below the £30,000 threshold for cost-effectiveness and therefore indicates exceptional value for money.

Switzerland, which has attributed a similar number of deaths each year as Scotland to physical activity, has estimated that it causes 1.4 million cases of illness annually and costs the economy a sum in the region of 1 billion Swiss francs. This suggests that annual costs to Scotland are in the region of £660 million. Moderate expenditure on enhancing physical fitness is likely to save considerable sums, as well as enhancing significantly quality adjusted life expectancy.

'Preventing Overweight and Obesity in Scotland: A Route Map Towards Healthy Weight'

Scotland has one of the highest levels of obesity in the world with over a million adults and over 150,000 children obese. This level of obesity is predicted to worsen with adult obesity levels reaching over 40% by 2030. Overweight and obesity brings with it a risk of disease and a cost to society that will directly impact on our ability to achieve sustainable economic growth. This situation is avoidable.

Energy expenditure is one of four main strands within the 'Obesity Route Map'. Particular reference is made to increasing opportunities for and uptake of walking, cycling and other physical activity in our daily lives and minimising sedentary behaviour. The Preventing Overweight and Obesity in Scotland: A routemap towards healthy weight is aimed at decision-makers in central and local government who can influence and enable the range and scale of actions required to address Scotland´s growing obesity epidemic.

Bibliography

Chief Medical Office Annual Report 2011 -  Transforming Scotland's Health

Chris Oliver is a Consultant Orthopaedic Trauma Surgeon in Edinburgh. He is Chairman of the Cyclists' Touring Club for Scotland. Follow on Twitter @cyclingsurgeon