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. 

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  . 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’ reaches epidemic proportions. But low fitness still kills more Americans than smoking, diabetes and obesity combined!

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.
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 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
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 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