GENGHIS KHAN MARATHON 2017 DONE

Some like it hot, but they would have been disappointed by the mountains of Mongolia which hosted the Genghis Khan Marathon in temperatures of minus 32 Celsius.  The task was to navigate through a frozen river network, before enjoying traditional Mongolian and Scottish festivities.  Nowhere can beat Mongolia for the sense of space, and remoteness, almost immediately this grabs you as we drove out of the capital Ulan Bataar.

There were multiple purposes to my visit, first among them was to further experience the charm and culture of Mongolia, which I enjoy more every time I come.  The advantage of small race groups allow a genuine insight into daily life in temperatures that often dip below minus 40 in winter.

As the horn signified the start of the race, conditions were perfect. Minus 32, and very little wind was certainly a good deal more pleasant than a windy minus 40 might have.  I set off at around 3 hour pace, but quickly realised that underfoot conditions (either snowy on the trail, or very slippy on the ice river) meant I wouldn’t be under last year’s time of 3hrs 7 mins.

There were certainly more husky dogs and yaks than humans on the way round, and fortunately no sign of wolves.  The ice occasionally splintered a little beneath my feet, making me a little nervous until pop- though the ice my right foot went, plunging into the frozen river. Instinctively I pulled it straight out my heart racing.  Wet feet at minus 32 is no joke.  I waited to feel the wet and the cold, but it never came.  The gaiters on top of my Merrell All Out Terra Ice had stopped anything coming through.

Race Director, and Honorary Consul of Scotland to Mongolia Dave Scott (Sandbaggers UK), was there to greet competitors at the finish.  I finished ahead of Chris from England who had avoided wet feet.  A special mention should be given to Audrey McIntosh who finished the marathon having the week before ran in the extreme heat of the Namib desert.  Dave had some innovative recovery food lined up.  Haggis, as well as traditional Mongolian delicacies such as goat and potatoes could well be ideal for recovering for the rigors of a race. It is actually not bad from a technical perspective, with carbohydrates as well as protein.

 

 

 

 

 

 

From the north, we head back to Ulan Bataar- at least I don’t have to run back this year!

 

MINUS FORTY IN MONGOLIA MARK 2

Very few places excite taxi drivers, but Mongolia seems to do that to everybody.  Pavel was chock full of questions, of a place that at this time of year is one of extreme beauty, temperatures and terrain.This time last year, I was running from the reputed birthplace of Genghis Khan to the modern day capital of Ulan Bataar, thinking it was much easier to run in the extreme cold, than it was to drive.  Temperatures had dipped to minus 45, and the driver had the blowtorch out to unfreeze the radiator and the diesel tank.  Interesting.

In addition to the longer run, last year I took place in the inaugural Genghis Khan Ice Marathon.  There is something very special about running on a frozen system in Outer Mongolia, with a yurt as the base camp, and the howls of huskies ringing in our ears. Eleven hardy competitors took to the start line, and only two got a touch of frostbite in temperatures of minus 35 (it was a beautiful clear day).  The question I get asked most is what I wear.  In short I use lots of thin layers, including two pairs of gloves, and a special ice shoe with studs in the bottom (Merrell All Out Terra Ice).

So this year, I am joining Sandbaggers at the World’s Coldest Burns Supper, followed by the Genghis Khan Ice Marathon mark 2.  We will have the opportunity to catch up with old friends, and to update on the various Yamaa trust projects that are ongoing.

It will not be boring, and it will not be warm.

NATIONAL ADVENTURE AWARD WIN!

I am totally honoured to have been nominated for, and subsequently won a National Adventure Award 2016.  The National Adventure Awards are a real highlight of the year, bringing together adventurers from the 4 corners of the British Isles to celebrate what everyone has got up to in the last year, and throw ideas around for the next year.

With the certificate

With the certificate

There were some wins for incredible efforts from Sarah Outen MBE circumnavigating the world, Jamie Ramsay who completed an epic run from Vancouver to Buenos Aires, and Ash Dykes who took on Madagascar and all it’s summits.  Closer to home, a team para-climbed the notorious Eiger, while a team also swam to the rocky outcrops of St Kilda.  In one word, amazing.

So in this context it was a huge honour to scoop the “charitable achievements” category.  I have always enjoyed adventure, and had the opportunity to support some fantastic causes including the Yamaa Trust, Scottish Association for Mental Health, African Palliative Care Association and Riding for the Diabled through various runs and climbs.

Thanks to DigitalPict and Rich Alexanader for the photos and video

Thanks to DigitalPict and Rich Alexanader for the photos and video

To be honest though, although I have done a fair bit of running over the years, the vast majority of the hard work in raising awareness and money for charities and social enterprises has been done by others.  Although I have loved contributing and actually get far more out of this than any charity does from me, the folks that should take the credit should definitely include all my family especially the Murrays, Reeves, Linds, Morrisons and Murdochs, and great friends too many to name, but to share a few Dave Scott, Donnie Campbell, Ross Lawrie, Arnaud Le Marie, Colin McPhail, Jenna Anians, Steve Reid John Graham and Shona Thomson.  Well over 2000 people have donated an incredibly generous total of over £160,000, so thanks a tonne to everyone for that, and for raising awareness, donating prizes, collecting medical equipment/ trainers, baking cakes, giving talks, sharing posts, taking photos, marshalling events, and generally being brilliant.

Some partners I work with have been hugely generous.  Many companies have put their hand in their pocket while others have gone beyond the call of duty.  Sandbaggers have ploughed huge resources not only into the expeditions, but also in setting up social enterprises, deaf schools, and supplying hospitals in remote parts of the world including Outer Mongolia, and Namibia.  The University of Edinburgh and the Royal College of Physicians and Surgeons of Glasgow have collected vital medical supplies.  Merrell have sent over 100 of pairs of new trainers and athletic equipment in direct response to requests from East Africa to support local foundations.

So essentially it is a great honour to have been awarded a National Adventure Award, but it would only be fair to say that most of the credit is deserved by many other people. I hope we can continue learning from and supporting these projects together, and wish I had more time to do a little more.

The other nominees in this category have all achieved a tremendous amount, and are worth having a read about and supporting if you can

African Palliative Care Association UK

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Karl Hinnett

–  Wooden Spoon– Arctic Rugby

–  The Archies Mountain Challenge

–  Airdrieonians Trust

–  SAMH

–  Stephen Hill

–  Jamie Ramsay

 

THE COLD COURSE. GOLF AT MINUS 40 IN MONGOLIA

 

Golf_finalGreenGolf has been played for centuries, and is played by 55 million people, in 206 countries worldwide.  A little known fact is that a study from Sweden showed that the average golfer lives 5 years longer than those that don’t play, regardless of age, gender, and earnings.

But while conditions in Scotland were tough for professionals at the Old Course in St Andrew’s leading to the British Open finishing a day late, they were positively clement compared to what awaited us in Mongolia. The Genghis Khan Country Club is elaborately named, and hosts one of 4 golf courses in Mongolia. However it was not golf as we know it, with temperatures dipping to -40, where celcius and farenheight meet and the greens were completely frozen just as we hoped.

Driving Range and clubhouseAfter a few rapid practice swings, with the Terelj Gorge and the Khenti mountains as a backdrop we set off  to play. Standard equipment would not work in these conditions, so we were grateful to Titleist for the bright yellow golf balls, and winter beanies, and to Footjoy for their winter gloves.  These have now been tested in the coldest conditions and helped us enormously.  Nevertheless preferred lies were in operation as the balls frequently lodged in the snow, and the ball travelled a shorter distance possibly due to the extreme sub-zero temperatures.  A new form of golf has emerged called speedgolf- a combination of golf and playing as quickly as possible, which is pretty much what we did to counter the conditions.

Paul_TitleistPaul Dunstan, an associate championship director with the European Tour golf played the best round of the day, including chipping in off a TV camera, taking the crown from David Scott who had come out on top at Wild Golf Namibia, where golf was played in temperatures of +40 degrees, in the world’s largest bunker, the Namib desert. Future events are tentatively planned for the Himalaya, and the Salt flats of Bolivia.

JUST PUT YOU MARATHON YOURSELF ON THE START LINE- THE LOCH RANNOCH

The finish line for a marathon is always one that requires considerable work to get there. I knew that reaching the finish at Loch Rannoch, having had the opportunity to run around the Loch in it’s full autumn glory would be extremely worthwhile, but I could not even think about the finish standing on the start line.

Loch Rannoch- thanks Jimbo Ramsay for the snap

My nose was sufficiently blocked that I simply could not breathe out of it. My pulse rate was a good 30 beats a minute faster than normal. Due to a minor packing issue I had not got any of my running kit with me, and had had to dive into the supermarket to pick up some food, and the other things I would need. I had slept very poorly due to an over-excited baby daughter and an early start.

The feeling of not wanting to put one foot in front of the other is familiar to me.  I often get it when it is raining outside, or I have not had a decent sleep. I usually combat it by putting some music on if these factors are at play, but in this case, chatting to a few friends that had done the course before and declared it a belter enthused me sufficiently to set off.

Scotland is a country like no other in terms of the way that light shifts depending on the season and time of day. The trees looked like a technicolour dreamcoat, partly draped in a variety of autumn shades.  Making a series of disgusting noises due to blocked sinuses, I set off up the road, leaving the eventual winner Lee to set the early pace. Running at a comfortable rate, and having no expectations allowed me to enjoy the colours, and the tremendous support of all the marshalls, and spectators.  I am pretty sure I snorted out a greater volume of bogeys than  volume of fluid I took in- drinking and eating pretty much needed me to stop.

The Loch Rannoch marathon has been absent from the calendar for 20 years. It is fantastic that it is back. Both this, and the Loch Katrine marathon offer fabulous courses, and excellent organisation. It is difficult not to enjoy a scenic run in such a setting.  The finish was a treat for me, the first that my daughter Nina had attended. As I rounded the final corner, there she was in her buggy, asleep on the job!  On a gently undulating course, I was pleased to finish in 2hrs 50, good enough for 2nd place overall although well behind Lee.   The added bonus was that in the absence of my usual trainers I had my shoes (Merrell All Out Terra Trail) for the Genghis Khan Ice Marathon in the car so wore them instead.  Perhaps more aggressive than my usual road shoes (All Out Rush) they were comfy and got the job done well.

Loch Rannoch finish with Nina

In terms of what is next, the big one is heading out to Mongolia in January. Ahead of this I will be doing a load of running and may pick up a race or two.

 

UK PARLIAMENT RECOGNISES MAJOR ACTION NEEDED ON PHYSICAL INACTIVITY

I remember when en route running to the Sahara desert feeling a little ashamed. I had been a doctor for about 6 years, but ironically (given that I had just a 4300km run to the Moroccan desert) had not grasped just how good exercise is for health.  I had not been communicating this to my patients prior to this time

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Simply put regular exercise gets the happy hormones going and makes you happier. It also helps prevent and treat about 40 major diseases like type 2 diabetes, heart attacks and dementia (although athlete’s foot is more likely).

Worldwide (with a few honourable exceptions including Western Australia and Brazil, policy makers have been burying their head in the sand and hoping that the problem of physical inactivity would go away. This is consigning our children to a darker economic future than is necessary (type 2 diabetes costs the UK NHS £1million per hour) and stopping people be as happy and healthy as is possible.

So the report produced by the UK Parliament Health Committee is welcome, and highlights that major action is needed. I do think in Scotland more has been done, but we need to increase the pace and scale of what is happening.

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/activity-diet-health-substantive/

http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/845/845.pdf

Here are a few really useful concrete recommendations from the Scottish Academy of Royal Colleges on what the NHS could do, which I contributed to in my role with the Royal College of Physicians and Surgeons of Glasgow.

http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf

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BLOG- KEY KIT FOR RUNNING THE DESERT

Running with the seals (DigitalPict Photography)

It would be a lie to say that the running is the easy bit, but the most common questions I get asked after running say the Namib, the Sahara, or in the Namib desert is around kit, and specifically being a doctor, around medical kit.  Here are the lightweight things that I carry, and maybe of help during for example to Marathon des Sables or other races and events like this.

  • Footwear

Running day after day in the desert, your feet swell up.  I use a pair of shoes ½ a size bigger than my standard shoes.  For a lightweight shoe that is comfy and has a bit of grip, I use the Merrell All Out Rush

  • Sandgaiters

Having worked at many desert ultras as well as raced them, if you are racing on sand, do not leave home without sandgaiters. These prevent sand getting in your shoes and causing blisters.  The best on the market by far are “Sandbaggers Gaiters” made with parachute silk.  Stitch these into your shoes rather than glueing, as the glue will melt in the heat.

  • Clothing

The key thing is to have clothing (including socks) that are lightweight and wicks moisture away from the skin keeping blisters and overheating down to a dull roar. Some clothing has the additional bonus of sun protection. I use the Merrell clothing range which suits me perfectly

 

  • Sunscreen

Do not skimp on this. Buy high factor sunscreen that stays where it is when you sweat, and only needs applied once or twice a day. P20 has never failed me, while Himalaya is great also

High in the dunes (DigitalPict photography)

  • Blister Kit

The largest study of blisters in ultra-runners showed 85% of competitiors got blisters. This number would probably be even higher in the desert. So take some Sterets to clean the skin, some sterile needles to pop the blisters, (pop at the lowest point, squeeze fluid out, and leave to dry until the morning), and zinc oxide tape to put over the blisters in the morning to prevent them getting worse

  • Vaseline

Stick small amounts of this in the areas you are vulnerable to getting chafing

  • Hand Sanitiser Gel, and toilet paper

Use the hand sanitiser as directed, to cut down the prospects of getting diarrhoea nad vomiting, one of the most common causes of medical withdrawal from races.  Drink bottled water, and avoid foods that look dodgy.

  • Med Kit

Paracetamol, 2 tablets 4 times a day is good for pain.  NSAIDs (anti-inflammatory meds like brufen and voltarol) should not be taken for endurance running. There is a risk of stomach ulcer, kidney failure and other badness. Lyprinol likely has anti-inflammatory actions and I take (batch tested) version of this to combat this.  Immodium/ loperamide is worth carrying in case diarrhoea and vomiting does occur

  • Fuel

Like a car, if the human body is out of fuel, it will not go anywhere.  Small amounts of carbohydrate taken regularly in any race longer than an hour boost performance. I use Science in Sport gels, and carbohydrate and electrolyte powder, whilst post exercise REGO helps by providing carbohydrate to replace used up stores, and protein to repair damaged muscles

  • Ear plugs

These and eye masks help sleep on flights, as well as in noisy tents. Well worth the 6 grams

Sandbaggers gaitersRunning with the Seals
All Images by DigitalPict Photography

BLOG- SHARED LESSONS WITH THE TOPNAAR TRIBE

A huge part of travel and adventure for me is about learning.  Trips to Kenya have helped me understand more about what leads to elite performance in running, whilst Mongolia brought it home to me that happiness is more important than having things.

Utusib clinic

Namibia has a few of the same challenges as parts of Scotland (including a remote and rural locations), and is doing a great job of increasing life expectancy at more than half a year, every year at the moment.  We all also wanted to know more about the oldest desert in the world, and it’s stories and traditions.

We also had the chance to share some vital medical diagnostic equipment donated by the Royal College of Physicians and Surgeons of Glasgow, shoes and athletic equipment donated by Merrell UK, and cycling enthusiasts, and other gifts from Bert Jukes and his team.  Chief Kooitjee of the Topnaar tribe, his top team and the local medical team, as well as the Mayor of Walvis Bay and the divisional Health Minister shared pearls of wisdom, as well the challenges they face with us.  This is the start of a relationship, that with the support of many in Namibia and back home can achieve lasting change.

Royal College Physicians and Surgeons Medical Supplies

Both the athletic  equipment, and medical equipment was extremely well received.  In fact we were honoured to receive the first Topnaar Tribal Appreciation Award given to those outside Namibia- a huge honour.  We had some great discussions about the value of sport and physical activity both in the community and nationally, and thoughts on how this can be achieved.  The numerous pairs of trainers, and huge amount of clothing from Merrell and others will help support the Topnaar schools and athletics groups, whilst they had a highly impressive cycle team that will benefit from donations received.

football shirts and Merrell shoes

 

 

 

 

 

 

 

We really enjoyed hearing about training and education opportunities for the local health care workers, and discussions are ongoing as to how this can be further assisted.  The clinics we saw had fantastic staff, that the donations from the Royal College of Physicians and Surgeons of Glasgow, and many other groups and individuals drew praise from, while the Health Minister present also expressed her delight at the help received, and opportunities for the future.

For us, to have the chance to eat, sing, and dance, as well as learn and share with new friends from Namibia was a highlight of the trip- and we are so grateful for the generosity of others in helping us with this

Children and Topnaar bike team

PHYSICAL INACTIVITY POISED TO BE TAKEN AS SERIOUSLY AS SMOKING

A group of FIFTEEN, of the leading medical organisations in Scotland, have produced a report calling for the NHS to take major action on physical inactivity, and urging a series of sensible, concrete, and wide ranging actions.

The Scottish Government have welcomed the report, and will look at the recommendations which I think will lead to lasting change and improvement. Credit to the Scottish Academy of Medical Royal Colleges for this, I think the agreed actions are so sensible and likely to make a difference, I have shared the whole report below, with a link to a BBC news item about the report

http://www.bbc.co.uk/news/uk-scotland-31018497

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“We will work with a range of partners to fully integrate PHYSICAL ACTIVITY FOR HEALTH into Health and Social Care and increase physical activity in Scotland”

 

Specifically, during 2015-2016, collectively and individually, all Scottish Academy members pledge to work with key stakeholders to:

  • Fully embed physical activity for health into primary care
  • Fully embed physical activity for health into secondary care
  • Prioritise physical activity for health in Health and Social Care integration and in social care
  • Integrate physical activity for health into health education
  • Increase physical activity in the health and social care workforce and workplace
  • Mobilise health and policy leaders to prioritise increasing physical activity
  • Ensure that our ‘Pledge’ is prioritised, reported upon and reviewed throughout 2015-2016

On behalf of the Scottish Academy

5.3 million deaths a year

The Role of Health and Social Care in Increasing Physical Activity: A Position Statement by the Scottish Academy of Medical Royal Colleges and Faculties

 

1. Background

The World Health Organisation (WHO) has identified a lack of physical activity as the fourth leading risk factor for global mortality, directly implicated in 6% of deaths worldwide1. It is increasingly accepted in Scotland that as a society, and as health care professionals we have both a responsibility and an opportunity to create health, and prevent disease, in parallel to treating illness.  Publications such as the Five Year Forward View2, 20/20 vision3, and the Christie Commission4 agree that increased prioritisation of effective, person-centred preventative medicine is required to allow people to live longer, healthier lives in their communities.

 

2. Why increase physical activity?

Regular physical activity has comprehensive health and wellness benefits across the lifespan providing increased life expectancy, better physical and mental health outcomes, and better quality of life. Physical inactivity is one of the major public health challenges of the 21st Century, with significant portions of the UK and global adult population currently failing to meet WHO minimum guidelines on physical activity5. Positive progress has been made, and must be sustained in relation to smoking, obesity and the harmful use of alcohol.  However, a significant increase in the pace and scale of efforts to improvephysical activity levels is required if we are to achieve the Scottish Government’s aim for “Scotland to be a world leader in the promotion of physical activity”6.

 

3. How can we work together to increase physical activity?

Increasing population-wide participation in physical activity is possible, with encouraging increases in child and adult physical activity levels seen in recent Scottish data coinciding with increased effort and partnership working in Scotland.

The National Physical Activity Improvement Programme is offering a system of improvement that is based on testing and learning. Making significant and meaningful improvements requires change. The Scottish Academy will support and develop actions that will increase physical activity in Scotland, measure results and spread approaches to get inactive people active across Scotland.

There is no single solution to increasing physical activity. The Lancet “Physical Activity” Series published in 2012 emphasised that in order to realise greater uptake of physical activity behaviour, it is imperative to extend focused efforts beyond just the health sector7.  Similarly, evidence from the WHO sponsored Investments that Work for Physical Activity8 and Toronto Charter for Physical Activity9 informed the Scottish Government’s Physical Activity Implementation Plan, which in turn calls for a comprehensive, cross-sector approach at individual, community, local, national, and international levels8,10,11. The Scottish Academy believes that partners working in education, transport and the environment, workplace settings, sport and active recreation, and communications as well as in health and social care have a key role to play.

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Environment: Scotland’s built and natural environments will permit and promote increased levels of physical activity.

Workplace settings: Employers will make it easier for people to be more physically active as part of everyday working lives.

NHS and Social Care: NHS and care services will promote and help achieve recommended levels of physical activity.

Education settings: All places of learning in Scotland will promote increased physical activity.

Sport and active recreation: Everyone in Scotland will be more active in their leisure time.

Communications: The people of Scotland will understand and appreciate the benefits of physical activity, and know where and how to be active10.

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4. The Role of Health and Social Care

The Scottish Academy and member Colleges and Faculties recognise the value of increasing physical activity and wish to actively promote this through a number of routes; from high level policy making to those who deliver clinical front line services. It is recognised that having a collaborative approach involving all key stakeholders across sectors and supporting work already done by networks such as the Health Promoting Health Service (HPHS) is the strongest way to ensure effective progress.

Fundamentally, we have an opportunity to support policy makers and use the best available evidence to integrate preventative medicine into health care systems.

Increasing physical activity must be given equal priority to smoking cessation and addressing harmful use of alcohol. The Scottish Academy advocates a minimum of 150 minutes physical activity per week for adults, 60 minutes per day for school age children, and will work towards:

a)    Fully embedding physical activity for health into primary care

Ensure primary care staff (including general practitioners, practice nurses, health visitors, pharmacists and physiotherapists) are adequately educated to assess physical activity levels, provide education on the recommended minimum levels of physical activity for health, offer brief advice and brief intervention, and signpost to community resources.

 

Objectives:

  1. By end 2015 all primary care practitioners must have received information about the “physical activity primary care pathway”
  2. By end 2016 60% primary care practitioners should know the UK CMO recommendations (i.e. 150 minutes moderate physical activity per week) (up from the current 13%; NHS Health Scotland, unpublished data).
  3. By end 2016, every primary care practice should have mechanisms to deliver brief advice and brief interventions for physical inactivity in the same manner and to as many patients as it does for smoking and alcohol.
  4. By end 2018, there should be clear methodology in how to incentivise the achievement of physical activity goals (e.g. one method could be remuneration equal to harmful use of alcohol in primary care contracts (Quality and Outcomes Framework (QOF), Enhanced Services or equivalent)).

 

Key resources:

b)    Fully embedding physical activity for health into secondary care

Ensure secondary care staff are adequately educated and comfortable to assess physical activity levels, provide education on the recommended minimum levels of physical activity for health, offer brief advice and brief intervention, and signpost to community resources fully supporting the aims of the Health Promoting Health Service.

 

Objectives:

  1. By end 2015, every outpatient department will have been sent a copy of “23.5 hours”, and encouraged to play it in waiting areas.
  2. By mid 2016, every clerking document should contain questions about physical activity level and diet, in addition to current questions relating to smoking and alcohol.
  3. By end 2016, every health board should be delivering the Scot-PASQ or equivalent to all patients in secondary care at some point during their inpatient stay (physical activity pathway for secondary care).
  4. By end 2018, every patient leaving hospital should receive brief advice or brief intervention (when indicated as appropriate on the Scot-PASQ) on physical activity and signposting to supportive resources by a health professional.

 

Key resources:

  • Secondary care pathway
  • Every Step Counts
  • Raising the issue of physical activity (available e-Learning)

(The above all at http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvement/hphs/nhs-physical-activity-promotion.aspx)

  • Exercise on prescription book (available 2015).

c)     Fully embedding physical activity for health into social care

Ensure social care staff including care workers and home visitors are adequately educated and comfortable assessing physical activity levels, providing education on the recommended minimum levels of physical activity for health, offeringbrief advice and brief interventions, and signposting to community resources.

 

Objectives:

  1. The Scottish Academy fully endorses the Active and Healthy Ageing: Action Plan for Scotland12 document and actions, and will support delivery of these actions where needed throughout 2015/16.
  2. By end 2016 every person entering care will have an appropriate assessment of physical activity using Scot-PASQ or equivalent, and receive brief advice or brief intervention when indicated (unless inappropriate).

 

Key resources:

(http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvement/hphs/nhs-physical-activity-promotion.aspx.)

d)    Integrating physical activity for health into health education

UK CMO recommendations, assessment of physical activity levels, techniques for encouraging health behaviour change, knowledge of both the benefits of physical activity and the dangers of physical inactivity in relation to life expectancy, physical and mental health outcomes should be integrated into undergraduate health care professional curricula, postgraduate training and examinations, as well as continued professional development (CPD).

 

Objectives:

  1. By end 2015 UK CMO recommendations relating to physical activity and training in health behaviour change should be integrated into the medical undergraduate curriculum in all five Scottish medical schools.
  2. Physical activity should play a significant part in each Member College and Faculty’s educational events.
  3. By end 2016 UK CMO recommendations relating to physical activity and training in health behaviour change should be integrated into every other health care undergraduate curriculum in Scotland.

 

Key Resources:

e)    Mobilising health leaders to prioritise increasing physical activity

Healthcare leaders in policy, the Medical Royal Colleges, medical education, health boards, hospitals and departments must renew their focus on tackling physical inactivity. Key partners should work collaboratively to embed physical activity for health into primary care, secondary care, and medical education; supporting innovation, measuring progress and driving improvement. Increasing knowledge of the required levels of physical activity amongst the general public is imperative.  The exemplary leadership shown by the AHP Directors Group and the AHP Physical Activity Pledge is fully supported by the Scottish Academy.

 

Objectives:

  1. By end 2016 the recommendations of any Chief Executive Letters (CEL) relating to the HPHS, physical inactivity and health inequalities must be delivered, in addition to the recommendations in this paper.
  2. By end of 2017, NHS Boards should demonstrate evidence of providing consultants with appropriate Supporting Professional Activities (SPA) sessional timeto advocate physical activity and enable them to shape and deliver services to increase physical activity, where relevant.

 

Key Resources:

  • Joint communication and recommendations strategy (early 2015)
  • 2015 Chief Executive letters (early 2015)
  • AHP Pledge (http://www.paha.org.uk/Announcement/ahp-directors-physical-activity-pledge )

f)      Increasing physical activity in the health and social care workforce

Promote the values of the Healthy Working Lives initiative and the HPHS programmes and encourage healthcare workers to increase their physical activity levels by work based lifestyle changes.

 

Objectives:

  1. By end 2015, (and reviewed annually thereafter), NHS Estates and Facilities should maximise the use of the NHS outdoor estate as a health promoting asset by encouraging and enabling staff, visitors and patients to engage in green exercise and active travel opportunities to, from and within NHS grounds.
  2. By end 2015 every hospital in Scotland should establish, and clearly signpost, walking routes for staff, patients and relatives, and each health board should offer robust reports on the Health Promoting Health Service. Every hospital should have educational content and resources prominently displayed
  3. By end 2015, all health boards should promote and provide resource and support staff physical activity challenges in the workplace.

 

Key Resources:

Conclusions and next steps

Collaborative and cross-sectoral work has led to Scotland being one of few countries worldwide demonstrating an (albeit modest) increase in physical activity levels. Significant mismatches are present between current, and best practice in relation to physical activity.  Key drivers and workstreams within health and social care exist that should facilitate concrete SMART actions and enable projects to deliver improvements.  Health and Social Care integration offers an opportunity for joint boards to prioritise the key interventions needed to increase physical activity.

The Scottish Academy of Medical Royal Colleges and Faculties is committed to working with a range of partners including NHS Health Scotland, HPHS, medical educationalists, health boards, British Medical Association, clinical leads, and Scottish Government to apply these evidence informed interventions consistently.  This will enable Scotland to achieve the desired step-change in physical activity levels and provide person centred, clinically effective and cost effective care to our patients13,14.

This document will be reviewed by the Scottish Academy at the end of 2015/start of 2016 to ensure adequate progress and delivery of objectives.

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References

  1. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: World Health Organization; 2009.who.int/healthinfo/global_burden_disease/en/ (Accessed 11/2014)
  2. Stevens S. Five year forward view. NHS England. 2014. england.nhs.uk/2014/08/15/5yfv/ (Accessed 11/2014)
  3. The Scottish Government. 20/20 vision. The Scottish Government, 2011. scotland.gov.uk/Topics/Health/Policy/2020-Vision (Accessed 11/2014)
  4. Christie C. The Future Delivery of Public Services. The Christie Commission, 2011. scotland.gov.uk/Publications/2011/06/27154527/18 (Accessed 11/2014)
  5. Department of Health. Start Active, Stay Active’ is a report on physical activity for health from the four home countries’ Chief Medical Officers. 2011
  6. Appendix A: CEL (1) 2012 Implementation Guidance (Year 1). Available from http://elearning.healthscotland.com/pluginfile.php/30237/mod_resource/content/0/Hospital_Health_Improvement_Governance_Framework/Appendix_A-_Implementation_Guidance.pdf (Accessed 11/2014)
  7. Lancet Series on Physical Activity: The Lancet, Vol 380, July 21 2012
  8. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:8;70 9- 7 12.
  9. Global Advocacy Council for Physical Activity (GAPA), International Society for Physical Activity and Health. The Toronto Charter for Physical Activity: A Global Call for Action. May 20 2010. Available at globalpa.org.uk
  10. The Scottish Government. Physical Activity Implementation Plan: A More Active Scotland. The Scottish Government. February 2014. Available at scotland.gov.uk/Resource/0044/00444577.pdf (Accessed 11/2014)
  11. Burns H. Annual Report of the Chief Medical Officer 2011. The Scottish Government. 2012.
  12. Joint Improvement Team. Active and Healthy Ageing: Action Plan for Scotland 2014-2016. Scottish Government. 2014.
  13. Keel A. Annual Report of the Chief Medical Officer 2013- Medical Leadership in Scotland. The Scottish Government. 2014
  14. Gray P. NHS Scotland Chief Executive Annual Report 2013/2014. The Scottish Government. 2014.

 

 

 

INCREASING PHYSICAL ACTIVITY

We know instinctively that exercise is good for health.  Our parents and doctors have probably told us so but this week highlighted the increased evidence that increasing physical activity for ourselves, our friends and family, and for the population in general will drive a huge increase in health and happiness. Surely no bad thing. 


PA_capsule

The study that hit the news this week looked at what kills people in Europe, and found that 7.5% of deaths (that’s TWICE the number of obesity related deaths) are directly attributable to physical inactivity.  The story was widely covered, here’s an example from the BBC who headlined the story

http://www.bbc.co.uk/news/health-30812439  . The case for regular exercise is open and shut, with memorable and huge studies (Lancet 2012) labelling physical inactivity “pandemic”, killing 5.3 million worldwide, and Steve Blair and Karim Khan teaming up to show that when you measure low fitness (as people tend to falsely overestimate the amount of exercise they do, it may kill more than the dreaded “smokadiabesity” – that is the combination of smoking, type 2 diabetes and obesity.

smokadiabesity

http://blogs.bmj.com/bjsm/2011/06/17/suffering-from-smokadiabesity-physical-activity-can-lower-your-risk-of-death/

So the argument is compelling.

The aim of “getting more people more active more often” is clear.

What can we do about it?

Fortunately most of the world’s top boffins in this area got together and worked out what worked, and what was cost effective in increasing physical activity.  It was clear that everyone can make a contribution, by being active yourself, helping friends, work colleagues or family sit less and move more, or by increasing physical activity in your community or even country through roles in communications, transport and the environment, urban design, sport, education, and health and social care.  In my opinion, this has been THE most important document ever produced on physical activity, as it offers a route map to guide people working in their workplace, community, local area or nationally.  I recommend keeping a copy yourself, and sharing a copy of “Investments that Work for Physical Activity” widely.

investmentsthatwork

http://bjsm.bmj.com/content/46/10/709.full

7investments

Global experts like Nanette Mutrie, Karim Khan, Heather MacKay and Fiona Bull were generous with their time and helped us in Scotland.  This led to a National Implementation Plan for Physical Activity

http://www.scotland.gov.uk/Publications/2014/02/8239 as well as guidance for local and community planning.  This use of experts, and investing time and resources in the things that work as well as the hard work and expertise of many many brilliant people on the ground likely contributed to an increase in physical activity in both children and adults in Scotland. It is early and fragile data, but let’s celebrate a quick win.  It is great for Scotland. Increased physical activity gets our children better marks at school, makes them happier on average and prevents and they are 30% less likely to suffer an early death.

But good is the enemy of better. Physical inactivity still kills 2500 Scots (Chief Medical Officer report) a year, and 5.3 million (The Lancet).  What is required is co-ordinated action across the areas highlighted in “Investments that Work for Physical Activity”, and “National Implementation Plan for Physical Activity”.  Some of the big things are being done, for example 97% of children in primary school in Scotland now get 2 hrs of PE (up from 50% in the 90’s), and many of our inner city roads will have 20mile per hour speed limits soon making our streets safer and more conducive to walking and being outside.

As a doctor, I have been looking at what Health and Social Care can do to help increase physical activity. Our health service is one of the best, and safest in the world, and whilst many health professionals do help patients understand the benefits of physical activity, and offer brief advice and solutions, this simply is not happening as frequently as it does for smoking or alcohol, and in general the consensus is we should be aiming to move towards a service that promotes healthy lifestyles and creates health, as well as effectively treating disease.  To highlight the scale of the issue, only 2 of the 5 Scottish medical schools asked in 2012 said they taught the CMO guidelines on physical activity, whilst a group of the UK’s leading doctors ranked physical inactivity as the smallest contributor to death out of 6 risk factors, when evidence suggests it is 2nd or 3rd.  Nurses, doctors and health professionals ask a set of “clerking” questions when a patient is admitted to hospital. Despite the fact physical inactivity kills more than gallstones, varicose veins, thyroid disorder and high cholesterol combined, it is rarely included in these documents, whilst the others almost universally are.

 

The great news for health professionals is that we can move this forward together.  And our patients can help us.   There have already been huge contributions in Scotland in the area below from groups like the Allied Health Professionals Directors Group, Going for Gold, the University of West of Scotland, Scottish Government, National Education Scotland, NHS Health Scotland and Royal Colleges including the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons Edinburgh.

 

Together we can

 

-Embed physical activity for health into primary care

-Embed physical activity for health into hospital and secondary care

-Embed physical activity into social care

-Increase teaching on physical activity in health professional education

-Be active and promote activity in the NHS workforce

-Show leadership, and spread awareness of how we can increase physical activity

Even last week one of the major colleges produced a position statement confirming their commitment to promoting and taking action on physical inactivity. It is a bold statement that I was delighted to contribute to

http://files.rcp.sg/filestore/1501120337_54b3e20d5eca0/Physical%20activity%20position%20statement.pdf

The great news is that there seems to be a real sense of collaboration to get things done.  The Scottish Academy of Colleges contain many of the great and the good of Scottish Medicine and have made clear their commitment to supporting and leading change.  They will outline actions that can be taken to achieve real and lasting change in a position statement in the next month or so, whilst our acting Chief Medical Officer Dr Aileen Keel is a real champion for physical activity and health promotion, and both her report  http://www.scotland.gov.uk/Publications/2014/12/1569 and the NHS Chief Executive report talk about the opportunity we can, and must grasp.

So 2015 promises much. Internationally there are some fantastic initiatives that will help increase physical activity. In Scotland and in particular in health and social care there seems to be a tangible chance of real progress, that can lead to an increase in gross national happiness and a healthier more active nation.

5.3 million deaths a year