A call to action to all health professionals to prescribe exercise to every patient, every consult!

1. a paradigm shift
in physical activity
interventions
British Association of Sports and Exercise Medicine May 2014
Ann Gates
Founder, Exercise Works!

2. inactivity is the
4th biggest global killer
pre-science
normal
science
model
drift
model
crisis
model
revolution
paradigm
shift
The Kuhn Cycle

3. preventable deaths
why a paradigm shift?
37,000 patient deaths/year from inactivity
“names and faces in every clinic waiting room”

4. http://www.bmj.com/content/348/bmj.g2804

5. …medicine needs YOU!
• leadership on ‘exercise as a medicine’
• your influence
• physical activity ‘champion advocates’
• helping patients use physical activity to manage disease
Royal College of Physicians. Action on obesity: comprehensive care for all. Report of a working party. London: RCP, 2013.

6. • ONLY 1 in 3 doctors give exercise advice during routine consultations CDC 2012
• 56% of adults having had a cardiac event don’t attend cardiac
rehab Cardiac Rehabilitation Statistics 2013
• 65% cancer survivors don’t exercise Macmillan Cancer report 2011
• by age 74 years 58% men and 78% women CAN’T walk for 30 mins
or more! BHF 2012 statistics
• an inactive person spends 38% more days in hospital than
an active person DOH 2011
WARNING…iceberg moment!

7. “hurdle” problems!
• knowledge and training
• time
• success in changing patient behaviour
how?
Br J Sports Med 2012;46:625-631 doi:10.1136/bjsports-2011-090734

8. “no exercuses!”

9. shift the paradigm…
work with what you have…..

10. • Train every health professional
• Provide brief intervention
• Support and signpost EVERY patient
• Monitor exercise medicine effects!
• Record in notes
exercise medicine is a “life saver”

11. change the
paradigm of the
consult…
our services and care
pathways
provide:
safe and effective,
exercise support,
every consult
“
“
All Parliamentary Commission on Physical Activity 2014: “teachable moments”
make
every contact
count!

12. 672,973
brief physical activity opportunities
every NHS day
every patient

13. =
A LOT of
physical activity advice,
every consult!
if……
every TRAINED health professional x over 1 million NHS patients/36 hours

14. inspiring to change…
how, who, when and where
• exercise advice, every patient, every opportunity
• everyone MECC 2011, PH44 2013
• exercise as a ‘vital sign’ R. Sallis, Br J Sports Med 2011
• ‘teachable moments’APC physical activity 2014

15. helping every patient,
feel like an Olympian
during your consultation…!
Fun, exercise prescription and…

16. how?
One strategy may be to add ‘45 seconds’ of advice
‘I want you to start an exercise plan in the treatment of [insert disease condition].
When I see you for review of your health problems and medication, I will
also be reviewing the effectiveness of regular exercise in helping you to
manage your disease/condition’
NICE guidance 2013 
training for brief
intervention

17. how?
knowledge works!
• training
• practice
• expertise and capabilities
Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013;347:f5577

18. how?
know the clinical red flags
8 ABSOLUTE contra-indications
patient considerations
clinical precautions
disease specific issues

20. “teachable moments”
cradle…..
FACT: children under 17, in the UK : 95% of those diagnosed with type 2 diabetes were overweight and 83% obese

21. exercise referral program improved physical activity
inactive individuals decreased
from 75% to 53%
reduced costs for inactivity by 22%
…to grave

22. change the consult conversation!
• AVOID using FITT language
• use “try” or “choose”
• use “effort”
• talk about “short bouts of exercise”
make it disease specific
• obesity, type 2 diabetes, COPD, Parkinson’s Disease,
cancer, asthma, osteoporosis, falls prevention……
NICE guidance 2013 , BHF 2012
how?
give follow ups and lifelong
support!

23. • gain confidence
• evidence base
• what works for YOUR patients?
• use prescription tools
• identify opportunities for patients
how?
use new clinical tools…
NICE guidance 2013 

25. . http://www.cdc.gov/socialmedia/tools/guidelines/pdf/socialmediatoolkit_bm.pdf
how?
use social media to reach
prospective patients

26. what paradigms really mean for
patient care…
after results!

27. every patient,
every consult,
disease specific exercise
advice,
and follow up!
iceberg drift turns into paradigm shift……

28. • Arial 18pt
• Arial 18pt professionals
• patient education and support
• exercise advice, every patient, every opportunity
• when and where
• every health consult
• In hospitals, out patients, clinics, home visits
• the viral use of social media
Exercise-Works-Ltd
@exerciseworks
exerciseworks
All content and concepts intellectual copyright to Exercise Works! www.exercise-works.org 2013, 2014.

29. Acknowledgements and disclosures
• Professor Karim Khan, Dr Jim House, Dr Richard Weiler, Mr Ian Ritchie,
Jim Dawton Design, REPSUK, British Nordic Walking
• Dr Brian Johnson, Professor Tahir Masud, Dr Chris Oliver, NASA, NIA, and
all the great clinicians who trained me at the Royal Derby Hospitals,
Derby, UK, PCTs, and Trent Strategic Health Authority
• a passionate, physical activity advocate for every patient, every consult!
• founder and director of Exercise Works!
• member of the World Heart Federation (WHF)
• Emerging Leaders Programme 2014

30. resources
• FYSS Physical Activity in Disease Prevention and Disease Treatment
• http://www.rcplondon.ac.uk/sites/default/files/documents/exercise-for-life-final_0.pdf
• Ann Gates ISBN: 1121850928 Copyright year: 2013, Patient Exercise Sheets, 1st Edition
• http://www.exercise-for-health.com/
• http://gpcpd.walesdeanery.org/index.php/uk-physical-activity-guidelines
• http://www.exercise-works.org/store/
• http://www.humankinetics.com/products/all-products/acsms-exercise-management-for-persons-wchrnc-diseasesdisab-3rd
• http://www.acsm.org/access-public-information/position-stands
• http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx
• http://www.healthscotland.com/physical-activity.aspx
• http://gpcpd.walesdeanery.org/index.php/uk-physical-activity-guidelines