Presentation by Dr William Bi

1. StreetGames
National Conference
11th April 2013
Dr William Bird MRCGP MBE
© 2012 Intelligent Health/NHS London

2. © 2012 Intelligent Health/NHS London

3. Attributable fractions (%) for all-cause deaths in 40 842 (3333 deaths) men and 12 943 (491
deaths) women in the Aerobics Center Longitudinal Study.
Blair S N Br J Sports Med 2009;43:1-2
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

4. Attributable fractions (%) for all-cause deaths in 40 842 (3333 deaths) men and 12 943 (491
deaths) women in the Aerobics Center Longitudinal Study.
Blair S N Br J Sports Med 2009;43:1-2
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.

5. 80 seconds ago
Mankind has evolved wellIf we take an hour to equal 1000
years then four days is 100,000
years; the time from the origin of
mankind to today.
4 Days ago
10 hours ago 4 hours ago 9 minutes ago
4000 yrs civilisation
10,000 yrs ago
Agriculture
Technology
100,000 yrs ago
Hunter gatherers
industrialisation

6. People
Wellbeing
Purpose
Place
People

7. Causes of Stress and Free Radicals
Chronic Stress
People Place Purpose

8. 1. Physical activity
plays a key role in
the control of the
body’s response to
physical stress1 and
prevents telomere
shortening2
2. Chronic stress
reduces levels of
physical activity3.
Physical activity
and Stress
1 Rimmele et al Level of PA affects adrenal and
Cardiovascular Reactivity to Psychosocial
Stress: Psychoneuroendocrinology (2009) 43
190-198
2 Puterman E, Lin J, Blackburn E, O'Donovan A,
Adler N, et al. (2010) The Power of Exercise:
Buffering the Effect of Chronic Stress on
Telomere Length. PLoS ONE 5(5): e10837.
doi:10.1371/journal.pone.0010837
3Vitaliano P et al A Path Model of Chronic
Stress, The Metabolic Syndrome and Coronary
Heart Disease Pyschosomatic Medicine
64:418-435 (2002)

9. e
Chronic Stress
Stress
Hormones
Physical
Inactivity

10. e
Chronic Stress
Physical Inactivity

12. People
Purpose PlaceChronic Stress
Stress Hormones
Mitochondrial damage
Physical Inactivity
And other poor health
behaviours
Cancers Cardiovascular Diabetes DementiaDepression
e
Mitochondria as a key component
of the stress response.
Manoli et al. Trends in
Endocrinology and Metabolism
Vol 18 No 5 2007

13. Health Benefits of Physical Activity
Disease Risk reduction Strength of
evidence
Death 20-35% Strong
CHD and Stroke 20-35% Strong
Type 2 Diabetes 35-50% Strong
Colon Cancer 30-50% Strong
Breast Cancer 20% Strong
Hip Fracture 36-68% Moderate
Depression 20-30% Strong
Alzheimer’s Disease 60% Moderate
REF: Department of Health, Start
Active Stay Active 2011
© 2012 Intelligent Health/NHS London

14. Anti-ageing effect
• Increases Reactive Oxidative Species (Free
Radicals)that stimulate the production of
antioxidants in the Mitochondria.
• This is a powerful anti-ageing mechanism
that protects the cell from DNA damage.
• In fact taking anti-oxidants orally interferes
with this mechanism.
© 2012 Intelligent Health/NHS London
• Increases Reactive Oxidative Species (Free
Radicals) that stimulate the production of
antioxidants in the Mitochondria.
• This is a powerful anti-ageing mechanism
that protects the cell from DNA damage.
• In fact taking anti-oxidants orally interferes
with this mechanism

15. Anti-ageing effect
• Increases Reactive Oxidative Species (Free
Radicals)that stimulate the production of
antioxidants in the Mitochondria.
• This is a powerful anti-ageing mechanism
that protects the cell from DNA damage.
• In fact taking anti-oxidants orally interferes
with this mechanism.
© 2012 Intelligent Health/NHS London
• Increases Reactive Oxidative Species (Free
Radicals) that stimulate the production of
antioxidants in the Mitochondria.
• This is a powerful anti-ageing mechanism
that protects the cell from DNA damage.
• In fact taking anti-oxidants orally interferes
with this mechanism

16. Sedentary
Mitochondrial DNA
Reactive Oxidative
Species
Anti-Oxidants
Mitochondria
Oxidative Phosphorylation

17. Physically Active
Mitochondrial DNA
Reactive Oxidative
Species
Oxidative Phosphorylation
Anti-oxidants
Mitochondria

18. How Does Physical Activity Work?
• All Conditions:
– Anti-inflammatory.
• Release Cytokines from muscle
• Improves endothelial function
– Enhances mitochondrial antioxidant
production
– lengthened telomeres
• Cardiovascular:
– Increases Stroke Volume
– Reduces Blood Pressure
– Improves Heamostatic function
(reduced Fibrinogen etc)
– Improves cholesterol ratio
– Halts and can reverse plaque formation
• Cancer
– Reduces sex hormone formation
– Increases Insulin sensitivity
– Increases production of Natural Killer
Cells
© 2012 Intelligent Health/NHS London

19. Health Benefits of Physical Activity
Disease Risk reduction Strength of
evidence
Death 20-35% Strong
CHD and Stroke 20-35% Strong
Type 2 Diabetes 35-50% Strong
Colon Cancer 30-50% Strong
Breast Cancer 20% Strong
Hip Fracture 36-68% Moderate
Depression 20-30% Strong
Alzheimer’s Disease 60% Moderate
REF: Department of Health, Start
Active Stay Active 2011
© 2012 Intelligent Health/NHS London

20. Anti-Inflammatory
Two possible mechanisms:
• the reduction in visceral fat mass;
– Visceral fat increases inflammatory agents and
reduces anti-inflammatory ones creating a
permanent state of Inflammation.
• Increased production anti-inflammatory
cytokines from contracting muscle.
© 2012 Intelligent Health/NHS London
Two possible mechanisms:
• the reduction in visceral fat mass;
– Visceral fat increases inflammatory agents and
reduces anti-inflammatory ones creating a
permanent state of Inflammation.
• Increased production anti-inflammatory
cytokines from contracting muscle.

21. © 2012 Intelligent Health/NHS London

22. © 2012 Intelligent Health/NHS London

23. © 2012 Intelligent Health/NHS London

24. Muscles
© 2012 Intelligent Health/NHS London

25. © 2012 Intelligent Health/NHS London

26. Natural Killer Cells
© 2012 Intelligent Health/NHS London

27. Fitness and Fat
© 2012 Intelligent Health/NHS London

28. Physical Activity and Weight Loss
• To reduce or maintain weight
loss between 120mins and
250mins of moderate activity
are required.
• To achieve significant weight
loss over 250 mins a week of
moderate activity is required.
American College of Sports Medicine Position
Stand. Appropriate physical activity intervention
strategies for weight loss and prevention of
weight regain for adults. Medicine and Science in
Sports and Exercise [2009, 41(2):459-71
© 2012 Intelligent Health/NHS London

29. Risk of cardiovascular disease mortality by cardiorespiratory fitness and body mass index
categories, 2316 men with type 2 diabetes at baseline, 179 deaths.
Blair S N Br J Sports Med 2009;43:1-2
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved. © 2012 Intelligent Health/NHS London

30. Risk of cardiovascular disease mortality by cardiorespiratory fitness and body mass index
categories, 2316 men with type 2 diabetes at baseline, 179 deaths.
Blair S N Br J Sports Med 2009;43:1-2
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
Normal Weight and
Unfit Fat and Fit
© 2012 Intelligent Health/NHS London

31. Cardiorespiratory Fitness and Body Mass Index
as Predictors of Cardiovascular Disease Mortality
Among Men With Diabetes
Timothy S. Church, MD, MPH, PhD; Michael J. LaMonte, PhD; Carolyn E.
Barlow, MS; Steven N. Blair, PED Arch Intern Med. 2005;165:2114-2120
© 2012 Intelligent Health/NHS London
179 CVD deaths during a
mean (SD) follow-up of 15.9
(7.9) years and 36 710
“manyears” of exposure.

32. Cumulative all-cause mortality associated with randomization to dietary weight loss in the
Trial of Nonpharmacologic Intervention in the Elderly (TONE). 1Based on Cox proportional
hazards regression.
Shea M K et al. Am J Clin Nutr 2011;94:839-846
©2011 by American Society for Nutrition

33. CVD Mortality Risk Factors Modified by
Physical Activity

34. In Summary
© 2012 Intelligent Health/NHS London

35. NEW WAY OF RECORDING AND
INCENTIVISING SPORT
© 2012 Intelligent Health/NHS London

36. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition

37. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition
www.beatthestreet.me
The Beat Boxes were
installed around the
school in three
circles. The Beat
Boxes in the outer
circle had three
points, the middle
circle, two points and
the inner circle (the
school) one point.

38. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition
Each Child has an
online consul to see
their progress

39. © Copyright 2012 Intelligent Health | Beat The Street
SCHOOL RANKINGS
1st Laura Secord 58% Vancouver
2nd Lord Kitchener 56% Vancouver
3rd Zenchuan School 42% Shanghai
4th Cleeve Park 35% London
5th Reading Girls 34% Reading
6th Lammas School 29% London
6th George Mitchell 28% London
7th Langley Park 27% London
7th Highdown School 27% Reading
10th Hugh Farringdon 18% Reading
11th Bow School 17% London
12th Bexleyheath Academy 12% London
13th Ravensbourne School 7% London

40. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition
2012 London Reading Vancouver Shanghai
Health Minister
Congratulates the
winning Beat the Street
children.
Houses of Parliament
October 26th 2012

41. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition
London 2012 Canadian
Silver Medallist
Andrew Byrne supports
Laura Secord School

42. Most incentivising components

43. 2012 London Reading Vancouver Shanghai
The Global School
Walking Competition
• Sports providers hold
NFC phones (e.g West
Ham FC)
• Children touch phone
with cards to register
attendance
Get Children into Sport
after Beat The Street

44. © 2012 Intelligent Health/NHS London

45. Mile End Park
© 2012 Intelligent Health/NHS London

46. Thank you
William.bird@intelligenthealth.co.uk
Now Get
Moving