Writing for The Conversation Professor Dylan Thompson, Director of Research at the University of Bath and Chief Investigator on the MiPact Study, explains just how complex physical activity is and why multidimensional physical activity profiles are crucial for the accurate evaluation of an individual’s physical activity.
Physical activity is great for our health. We keep hearing this mantra, the evidence is overwhelming and yet we are in the midst of an inactivity epidemic!
A vast number of people are suffering from preventable conditions and, most of the time and in most cases, are being treated with drugs that don’t work well. In many cases, providing an effective physical activity intervention could reduce or remove the need for these drugs, their negative side effects and their price tag.
Dr Chris van Tulleken has decided enough is enough and taken to BBC prime time TV to have his say.
As anyone who watched The Doctor Who Gave Up Drugs will know, Dr Chris van Tulleken worked with patients in a GP surgery in east London to offer drug-free treatments instead of their prescriptions. He prescribed physical activity with some astonishing results.
Thousands of patients at the surgery were taking drugs to reduce their risk of heart attack or stroke and as part of his experiment he began working with a group who wanted to stop. They were prescribed a 30-minute brisk walk, five times a week for eight weeks. Those who adhered improved their blood sugar levels more than would be expected when taking a new drug (much to the surprise of the initially skeptical nurse). They also had massively improved moods, better sleep and reduced aches. The surgery continues to supports the walking group (the number of patients in the group is growing) and the patients in the original walking group have stayed off their statins. The programme also documents the success achieved by patients suffering from depression and chronic pain, who were weaned off their drugs with the help of different physical activity interventions.
Prior to establishing the walking group Dr van Tulleken clearly identified that, in the current health system, exercise is just something that people are told to do. This paternalistic view is ineffective, but even in a supported walking programme there are still limitations. Whilst patient adherence to the programme was not mentioned, motivation and engagement was shown to be an issue and the human resource needed to remedy this is not insignificant. Health care professionals simply don’t have enough time to engage, motivate and empower every patient. Let’s not forget that there were thousands of others at the surgery who could have benefited from a physical activity intervention and multiples of that across the country. What if there was a clinically proven and scalable programme for delivering sustainable physical activity behaviour change – wouldn’t that be great? One that provided digital support, encouraged family participation, and appealed to people with no interest in exercise – even better.
It is important to also understand that walking, be it in a group or on your own, isn’t the only type of activity that benefits health – there are different ways to harness the benefits of physical activity because it has multiple independent biologically-important dimensions. Focusing on one dimension alone, like walking, creates a danger of developing a false picture of activity. The personalised multidimensional physical activity profiles visualised in the KiActiv® system are crucial for the accurate evaluation of an individual’s physical activity and the creation of bespoke strategies for successful change. Through this we have evidenced an enhanced understanding and inspired confidence to change and optimise individuals’ physical activity for a longer, healthier life.
We share Dr Chris van Tulleken’s vision for a health service, rather than “prescription service”, which can offer effective lifestyle solutions alongside or instead of drugs. The power of physical activity is there for everyone to see, and through our years of R&D we’ve developed a programme that can be prescribed just like a drug to prevent and treat a number of chronic diseases. KiActiv® programmes combine the latest technologies with cutting edge academic understanding to empower self-management and support self-endorsed lifestyle change. This not only moves us away from paternalistic healthcare, away from the culture of telling or compelling, but by getting people to take responsibility for their health and lowering the burden on GPs, emergency care and hospitals we can also have a huge impact on the costs.
At the 46th Annual Meeting of the World Economic Forum in Davos today (22nd January), NHS Chief Executive, Simon Stevens, announced the first wave of NHS Innovation ‘Test Beds’. These collaborations between the NHS and innovators aim to harness technology to address some of the most complex issues facing patients and the health service.
Ki are proud to be part of one of these – the Diabetes Digital Coach, led by the West of England Academic Health Science Network (WEAHSN) – and are very excited to demonstrate how the use of personalised physical activity in a free-living environment can improve diabetes management. You can find out more about our partnership with the WEAHSN here.
Today’s announcement coincides with a report by the Public Accounts Committee criticising the Department of Health and the NHS in England for being “too slow” to act in the prevention and treatment of diabetes.
More than 3 million people in England currently diagnosed with diabetes and this number continues to grow by almost 5% every year, as does the number of diabetes-related complications that need treatment. And with the cost of diabetes currently standing at £5.5 billion a year, something needs to be done and it needs to be done now.
The Diabetes Digital Coach is perfectly placed to meet this need – enabling people with diabetes to take control of their own health, significantly benefiting patients and cutting healthcare costs.
Physical activity is fundamental to the prevention and treatment of Type 2 diabetes – research shows that it should be prescribed by a healthcare professional at initial diagnosis, before medications (Nathan et al., 2009), and continue throughout the management of the condition (Duclos et al., 2015; Andrews et al., 2011).
KiActiv® powers the effective prescription of free-living physical activity for the prevention and treatment of disease. Our digital medicine is natural, safe and accessible to everyone. As part of the Diabetes Digital Coach, KiActiv® will enable individuals to self-manage their condition more effectively and empower sustainable physical activity behaviour change through improved access, engagement, motivation, and understanding.
Nathan, D.M., Buse, J.B., Davidson, M.B., Ferrannini, E., Holman, R.R., Sherwin, R., Zinman, B. (2009). Medical management of hypoglycaemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy. Diabetes Care, 32(1), 193-203.
Duclos, M., Dejager, S., Postel-Vinay, N., di Nicola, S., Quére, S., and Fiquet, B. (2015). Physical activity in patients with type 2 diabetes and hypertension – insights into motivations and barriers from the MOBILE study. Vascular Health and Risk Managment, 11, 361-371.
Andrews, R.C., Cooper, A.R., Montgomery, A.A., Norcross, A.J., Peters, T.J., Sharp, D.J., Jackson,N., Fitzsimons, K., Bright, J., Coulman, K., England, C.Y., Gorton, J., McLenaghan, A., Paxton, E., Polet, A., Thompson, C., and Dayan, C.M. (2011). Diet or diet plus physical activity versus usual care in patients with newly diagnosed type 2 diabetes: the Early ACTID randomised controlled trial. Lancet, 378, 129-139.
A simple question deserves a simple answer. Unfortunately, in the case of the amount of Physical Activity we should be doing to stay healthy, this is a difficult thing to do. This situation isn’t helped by the continued publication of confusing and conflicting headlines.
Let’s take the past week or so as an example; two headlines sat side-by-side in a popular online UK newspaper one telling us that 30-minutes of brisk walking five times a week is better than going to the gym for losing weight and the other saying that we should be doing double or even quadruple the recommended 150-minutes of moderate to vigorous intensity exercise each week if we want to keep our hearts healthy. Putting aside the limitations of both studies for a moment, we can probably say that both of these headlines have an element of truth.
Well, the first thing to do is to change the way you think about Physical Activity. Stop thinking only about the 30-minutes of exercise you do five times a week to meet the government guidelines, think instead about everything that makes you move. Physical Activity has many dimensions, each known to have clear biological and health benefits – from the amount of time you spend sedentary each day to your daily calorie burn, not forgetting the time you spend doing moderate-to-vigorous intensity activity each week. They all have a part to play in keeping you healthy.
Most research focuses on structured exercise, just like the report from The London School of Economics which was reported in a number of newspapers to show brisk walking is better than the gym for weight loss. The study didn’t actually compare the effects of the different types of activity directly, so we can’t say for sure which one was best or if one is truly better than the other. In fact, this was a cross-sectional study; it only looked at activity at one time point, so can’t make any conclusions about weight loss over time.
It will come as no surprise that people who did more activity of any kind had the lowest body mass index (BMI) and waist measurements. These effects were strongest in women and in people over the age of 50. Men who walked briskly for 30-minutes five days a week had a BMI on average one unit less than those who didn’t do this amount; the difference was 1.8 units for women. The equivalent amount of sport or exercise, heavy manual work, or heavy housework (for women only) were also linked with a lower BMI, it was just that the difference was smaller.
In fact, to get the most bang for your buck in terms of body weight, another recent study suggests we need to be active for at least 150-minutes a week and stand up for most of the day. The research published this month in the Mayo Clinic Proceedings showed that achieving this amount of activity gave some benefit, but standing up and being active gave additional benefit – the more time people spent standing the lower their odds of obesity and metabolic syndrome.
But remember, the outcome researchers are looking at is really important. These two studies both focused on measures of obesity, whereas the other study I mentioned earlier wanted to know about heart failure – two very different, although undeniably related outcomes (being overweight can increase your risk of heart problems). The amount of activity we need to do probably depends on what we are trying to achieve.
So, what should we do?
Simply put, we should sit less and move more. Research tells us that the more we move, the lower our risk of developing any number of preventable diseases. Importantly, it likely doesn’t matter what specific activity we choose to do, just as long as it increases our calorie burn at least three times our resting rate (i.e. is at least moderate-intensity for us). Chances are we are all doing at least one thing each day that meets this criterion – we just need to find out what that activity is for us – it could be anything from walking the dog or playing with the kids to 18-holes of golf or a Spinning class. We should also spend less time sitting or standing still – moving more will help with this.
The personalised multidimensional physical activity profiles visualised in the KiActiv system, created by our partners at the University of Bath, enhance understanding and inspire confidence to change and optimise your individual physical activity to benefit your health – one size doesn’t fit all!
“Couch potatoes rejoice! Sitting for long periods is NOT bad for your health, study claims”, declared a very eye-catching headline in the Daily Mail this week. But sitting is bad for your health, we know it is, and the science agrees, even the authors of the study agree.
The new study, published in the International Journal of Epidemiology, looked at the association between different types of sitting time (work, TV, non-TV leisure-time, leisure-time and total sitting) and death from all causes in men and women working white-collar jobs on Whitehall in London. In this group of people, none of the different types of sitting time were associated with early death. But, they sat less and did more activity than people who have taken part in other studies where sitting for too long has been associated with poor health. So, they may not have sat down enough to limit their lifespan or they may have been protected, at least to some extent, by their physical activity.
This study didn’t look at whether the time the men and women spent sitting down was associated with the preventable diseases that research has previously shown to been linked with this behaviour, like type-2 diabetes, cardiovascular diseases, obesity, and even some types of cancer. So, although being sedentary may not reduce the years in your life, it can reduce the life in your years.
The authors of the study quite rightly, warn us that “policy makers should be cautious about recommending reductions in sitting time as a stand-alone public health intervention.” We agree, physical activity is multidimensional – sedentary time is just one of those dimensions. To reduce your risk of developing numerous preventable diseases you also need to include more physical activity into your day.
What’s more, sedentary time is more than just sitting down. Dr Mevyn Hillsdon, one of the co-authors of the new study, is quoted as saying that “Any stationary posture where energy expenditure is low may be detrimental to health, be it sitting or standing.” We agree and that’s why every minute that your calorie burn isn’t high enough to reach the threshold for light activity is included in the sedentary time dimension in all of the KiActiv solutions.
Leading a more physically active lifestyle can help prevent you developing numerous diseases in the future. Just remember that a physical active lifestyle comes in many different forms, that’s because physical activity is multidimensional. The key is to understand what your lifestyle looks like now and find what activities “count” for you, something as simple as fidgeting may increase your calorie burn to mean you’re not sedentary, but you may need to do more, like pacing around when you’re on the phone. Just don’t stay still for too long and include activity that you enjoy every day.
It’s becoming more and more apparent that sitting down is killing us.
Science is beginning to reveal the true extent of the damage our sedentary lifestyles are doing to our health. Evidence suggests that the more than seven hours the average Brit spends sitting every day could be exacting a serious toll on our bodies, increasing our risk of developing preventable diseases like heart disease, stroke, type 2 diabetes, obesity, hypertension, osteoporosis, and backache, as well as anxiety and depression. More recently, researchers have added both cancer and non-fatty liver disease to this ever-expanding list.
For many years, doctors thought that all these problems were the result of too little time spent exercising. And, public health messages reflected this thinking, with the government telling us we should all do 150-minutes of moderate activity each week – they suggest we achieve this by doing 30-mins on most days. But what about the other 23 and a half hours a day?
Whilst being physically active is critical, it can’t make up for the damaging effects of sitting too much. That’s because a sedentary body and a standing body use energy in completely different ways, so these two behaviours, or dimensions, have independent effects on our bodies. Indeed, there are multiple independent biologically-important dimensions of physical activity and it’s these that make up the personalised multidimensional physical activity profiles developed by our partners at the University of Bath and visualised in the KiActiv solutions.
We it comes to sedentary time, we need a change in culture. Although TV watching is an obvious target – going out for a walk instead of watching TV in the evenings would definitely decrease sedentary time by an hour or two. But what about the 8-hours or more adults spend sitting behind a desk each day – decreasing this would have a much bigger impact. Children spend at least 6-hours at school each day being taught that sitting still at a desk is good – is it any wonder we carry this behaviour into adulthood. Standing up at your desk and moving around the office or classroom may seem like an oddity now, but hopefully it will be the norm in the future.
This type of culture change will take time, but we can all make changes in our own lives today, we just need to know what our current lifestyle looks like. KiActiv solutions put the data from your lifestyle in context, not only telling about your activity, but also your sedentary behaviour. Once you know when you’re sedentary and exactly how long you’re sedentary for, you can choose how you what to do to decrease your sedentary and improve your health.
Try breaking up your sitting time by moving around for 5-minutes every hour or so. You might want to hold walking meetings, get your coffee from a kitchen that’s further away or even on another floor (taking the stairs up and back down, of course), or even just fidget more – the choice is yours, just sit less and move more.
Millions of pounds are being wasted each year on unnecessary treatments for heart attacks and strokes, according to leading cardiologists.
Writing in the Postgraduate Medical Journal, Dr Aseem Malhotra and colleagues give a number of examples of patients being given expensive treatments that haven’t actually been proven to work. Not only are these unnecessary treatments costing the NHS at least £2.4billion a year overall, they also mean patients having serious operations that they don’t actually need.
Wouldn’t it be better to use this money to prevent people ever getting these preventable diseases?
Even in prevention, money is being spent unnecessarily mass-medicating healthy people. A year ago the threshold for prescription of statins to at risk patients was lowered to include those judged to have a 10-20% risk of developing cardiovascular disease in the next 10-years. Statins are now prescribed to around 10 million people in Britain. Not only do drug prescriptions cost money, doctor’s are of the opinion that healthy people given statins are more likely to suffer side-effects than gain benefits. Frighteningly, statins have been linked with an increased risk of developing type-2 diabetes – a disease that already affects over 3.3 million people in the UK and has been predicted to bankrupt the NHS.
So, what would happen if doctors prescribed physical activity instead of statins?
Aside from the massive cost-saving effect this would have, people would become healthier overall. They would significantly reduce their risk of numerous preventable diseases, including cardiovascular disease, type-2 diabetes, and the dislipidemia that would have resulted in a prescription for statins.
Physical activity is the single most important thing we can all do for our health – it gives you the most “bang for your buck”, impacting on more diseases than any single pill the doctor could prescribe. And, even better, physical activity is medicine without side effects, just benefits.
It’s important to recognise that physical activity is as individual as you are – the activity that “counts” isn’t the same for everyone. The right activity for you could be anything from walking to buy the paper in the morning, cycling or walking as part of your daily commute, playing with the kids, or doing the gardening, to more structured exercise like going to the gym, playing football, or running. Even something as small as getting up for 5-minutes every hour can have huge health benefits. Understanding your activity is the key, that’s why we created KiActiv System.
You could live up to 7-years longer if you walked briskly for 20- to 25-minutes every day, the delegates at the European Society of Cardiology Congress heard on Sunday. And it doesn’t matter how old you are – other research shows that people who start exercising in their 70’s also benefit.
Last month, we talked about a large Swedish study that showed similar results. In that study, as little as 20-minutes a day of walking or cycling was associated with a 21% lower risk of developing heart failure. Both studies suggest 20-minutes as the minimum amount we should be doing each day, not the optimum. You may also have read our blog back in August talking about research that showed that more is better when it comes to preventing an early death, at least up to 300-minutes a week. Start with 20-minutes and increase your activity at your own pace.
The research showed that different types of activity – aerobic, high intensity and strength – all have a positive impact on markers of aging. Although aerobic and high intensity activity were better than strength training at increasing telomerase activity, which helps to repair DNA as gets old.
This highlights that we don’t all need to be doing the same thing when it comes to physical activity to gain similar benefits – one size doesn’t fit all!
It’s time to change the way we think about Physical Activity – it is not just exercise. It has multiple dimensions that we can take advantage of to gain the innumerable health benefits. So, each of us can choose what we want to do to optimise our physical activity and harness all of its protective properties. The key is to find out what “counts” for us. It’s likely you’re already doing at least one thing every day that counts for you. It could be anything from walking to the bus stop or playing with the kids, to playing 9 holes of golf or a daily run. That’s why we visualise personalised multidimensional physical activity profiles in the KiActiv System. They enhance understanding, inspire confidence to change and optimise your individual physical activity – it’s your life, you choose how to optimise your physical activity and improve your health.
Can the Daily Mail’s attention grabbing headline “Not doing enough housework is ‘making women fat’, study claims” be right?
Putting aside the obvious connotations, they have a point – but it’s not just housework and it’s not just women. Modern life is energy-saving; we now use a vacuum cleaner instead of sweeping or scrubbing the floor; we drive to the supermarket instead of walking around the local shops to buy our food; we take the escalator instead of walking up the stairs; we sit at a desk for at least 8-hours a day, and the list goes on. All this energy-saving technology has meant our daily calorie burn has decreased and obesity levels have risen.
Whilst obesity is on the increase our calorie intake has actually decreased over the past 30-years by about 20%, according to research from the Institute of Fiscal Studies. The researchers found that, we are eating out more, snacking more and spending more on food, but we are filling our shopping baskets with healthier options. So, although our calorie intake has decreased, our calorie burn must have decreased even more.
Researcher Melanie Lührmann suggests “we are probably ill-advised to just look at food consumption as the main factor explaining obesity. Both physical activity and calories are important.”
Exercise is only one way to increase your daily calorie burn and if you enjoy it, keep it up! But, don’t forget about the other 23.5hours of your day – assuming you sleep for 8-hours, as well as your 30-minute workout you have another 930 minutes to burn extra calories (or 960 minutes if you don’t like exercise). Put it this way, if you burnt half a calorie more every minute you’re awake, you would burn almost 500 extra calories even if you don’t exercise. If you didn’t change what you were eating, you should see a weight loss of about 1lb a week.
It’s all about finding ways to move more throughout your day, just like your grandparents did. And that goes for all of us, not just women.
According to the result of a recent large-scale study, if you work 55-hours a work or more you are putting your health at risk, increasing your chances of having and even dying from a stroke and, to a slightly lesser extent, getting coronary heart disease.
The researchers looked at the results from twenty-five published and unpublished studies, in a systematic review and meta-analysis. The results come from a large number of people from across the UK, Europe, USA, and Australia making them more robust and believable; 603,828 men and women contributed to the analysis for coronary heart disease risk and 528,908 for stroke.
They found that people who worked for 55 hours or more increased their risk of developing coronary heart disease by a modest, but significant, 13% in comparison to people working the standard 35 to 40-hour week. More frightening, working 55 hours or more increased the risk of having a stroke by 33%. In fact, stroke risk increased gradually as working hours increased above standard; working just a few hours more (41-48 hours) increased risk by 10% and working 49-54 hours by 27%.
Stress was obviously implicated in the association between working long hours and disease risk, but the researchers made it clear that sitting still for such a long time can also be blamed. Not forgetting that working 11-hours a day doesn’t leave much time for physical activity. So, workaholics are increasing their risk by being both sedentary and inactive – add in high stress levels and it’s no wonder the research found the risk they did.
Increasing activity and decreasing sedentary time will have a huge impact on your risk of a number of preventable diseases, not just coronary heart disease and stroke. Simply getting up from your desk and walking around for 5-minutes every hour can make a big difference, even if you work a standard 40-hour week – you could pace around when you’re talking on the phone, walk to a kitchen that’s a bit further away from your desk to get your coffee, or fill up a small glass of water so you have to fill-up more frequently. If you do this each hour for 8-hours (40-hour week) you could reduce your sedentary time (and increase your activity) by 40-minutes a day or just under 3.5 hours in a working week. The numbers are even better for those working a 55-hour week, adding up to 55-minutes a day or over 4.5 hours in the working week.
And it is the multitude of health benefits that can be achieved through physical activity that has been partly responsible for over 50’s spending more than £1.5billion a year to keep fit, according to a study by the insurance company RIAS.
You don’t need to wait until you’re 50 to take advantage of the benefits of increasing your physical activity and decreasing the time you spend sitting or standing still – start today. The key is to understand what activities “count” for you. You are probably doing something every day that would help you achieve the levels needed to benefit health – you just need to find out what it is for you. It might be your active commute, lunchtime walk, a round of golf, or simply popping to the shops for a pint of milk.
The KiActiv system will show you what your lifestyle means in the context of the many dimensions of physical activity and give you the tools you need to optimise your lifestyle and health, now and for the future.