Exercise Referral Schemes for may not be the answer to the obesity crisis

Despite being widespread in the UK as a popular way of promoting physical activity in primary care, it is questionable whether Exercise Referral Schemes actually work.

Their effectiveness and cost effectiveness have been called into question in systematic reviews (Campbell et al., 2015Pavey et al., 2011). These uncertainties have been acknowledged by NICE in their most recent guidance on Exercise Referral Schemes (2014), which makes their choice to continue to recommend these schemes puzzling, to say the least.

And they are costing around £100 million a year – money that could be far better allocated and achieve significant results, improving the health of our nation.

Recent research from Northumbria University (Kelly et al., 2016) is particularly damning. Of the 6894 people who were referred to the South Tyneside Exercise Referral Scheme between 2009 and 2014, 37.8% dropped out in the first 6 weeks. Less than half were left at the end of the 12-week scheme. And those who need it most, those with the highest risk of developing preventable diseases, are among those most likely to dropout.

Although the research only looked at one area, South Tyneside, we’d hazard to guess that the results would be similar everywhere in the UK.

It’s crucial to understand that these sport-based schemes are unlikely to engage the disengaged – clearly evidenced by the high dropout rate and highlighted as one of two main issues Oliver and colleagues (2016) in their recent critique of Exercise Referral Schemes.

Without doubt, physical activity is critical in the battle against obesity and other preventable diseases. But the current focus on prescription and compulsion has to change if we’re going to succeed. We have to empower people to take personal responsibility for their health and their lives by giving them the motivation and understanding to make authentic, self-endorsed lifestyle change.

This issue reaches far beyond Exercise Referral Schemes. Most countries advocate a minimum amount of physical activity, usually along the lines of doing at least 150-minutes of moderate to vigorous intensity exercise per week. And it this sole focus on exercise that needs to change.

There are many other kinds of physical activity that are demonstrably important to our health and wellbeing, including the amount of time we spend sedentary and the total number of calories we burn every day. So, in fact, there are a multitude of physical activity options to choose from. We can all choose activities that fit into our life and that we enjoy – after all, we are all more likely to stick with something we like!

KiActiv® is a clinically proven behavioural medicine platform that uses personalised physical activity in a free-living environment for the prevention and treatment of chronic disease. It is focused on promoting free-living physical activity, which is accessible to everyone. Significantly,  it appeals to those disengaged by exercise and sport, who tend to be most at risk of disease. It creates a flexible service that moves physical activity beyond its traditional settings and makes it part of your every day life.

The Lancet calls for the world to get serious about physical activity

Ahead of the Rio 2016 Olympic Games, the second Lancet Series on physical activity has been launched, providing a stark warning of the staggering human and financial cost of physical inactivity, and the limited progress that’s been made in the 4-years since the London 2012 Olympics.

By far the most publicised finding across the 4-paper series was that from Professor Ulf Ekelund and colleagues, who found that a combination of high levels of sitting and low levels of activity carry the highest risk of death. Those who sat for over eight hours but were physically active for an hour or more a day had a much lower risk of premature death than people who sat less but were also less active.

The headlines tended to take the findings a little too literally, with the Daily Mail telling readers that “adults who sit down for at least eight hours every day must do at least an hour’s daily exercise to undo all the harm.”

The research doesn’t prove that exercise undoes the damage resulting from sedentary behaviour. What it does do is highlight the multidimensional nature of physical activity and provides more evidence to help us understand how the two of the dimensions interact.

The researchers looked back at  14 studies that had already been published and at 2 unpublished studies that had relevant data and applied a standardised protocol to allow them to directly compare the data from 1,005,791 people. Including such a large number of people is a major strength of this study, but it is not without limitations – the data came from people’s estimate of their own sedentary behaviour, television watching and physical activity, which brings into question its accuracy.

The 1,005,791 people were grouped according to the time they spent sitting down each day and their weekly activity. The authors then calculated this risk of death from any cause for people in each possible combination of activity and sitting time, comparing each group to those who were most active and least sedentary.

It’s clear that increased sitting time is associated with increased risk of dying from any cause, but people with high levels of physical activity (about 60-75 minutes of moderate intensity activity a day) seem to have no increased risk of death, even if they sit for more than 8-hours a day – this is where the media got their headlines from.

It’s also worth noting that within each category of sitting time, those with higher levels of physical activity had a lower risk of death. So, whilst the optimum lifestyle would include both high levels of physical activity and as little sitting time as possible, any improvement to either dimension is likely to benefit your health.

It’s time for the world to get serious about optimising physical activity. While there has been progress in terms of policy since 2012 – in 2015, over 90% of countries had a physical activity policy – this hasn’t been translated into increased levels of physical activity, which remain low. Inactive lifestyles are condemning too many people to preventable diseases and an early death (physical inactivity is associated with more than 5 million deaths per year), not to mention the staggering INT$67.5 billion economic cost of physical inactivity worldwide.

We need to act now and deliver effective solutions at scale.

Many strategies to improve physical activity compel or prescribe and the lack of personalisation has failed to deliver successful behaviour change, in the context of individual disease risk or management. We know that physical activity is a behavioural medicine and free-living physical activity is most powerful when it’s personalised. If you want to learn more about the power of personalised data, I devoted a whole blog to it that you can read here.

Why you should aim to do 1000-minutes of physical activity a week if you’re using an activity monitor

Huge numbers of people are choosing to use new technologies to track their physical activity in an effort to meet the 150-minutes per week of physical activity at a moderate-to-vigorous intensity the government recommend. But, many are being lead to believe that they vastly exceed these recommendations, when, in fact, they aren’t doing enough activity to benefit their health.

This is because the guidelines weren’t designed to be used with new technologies.

The 150-minute target was originally suggested on top of a baseline of, so called, normal lifestyle activities. But uncertainty around what this actually means, and the desire for a simple recommendation for public health, has meant that any reference to this baseline isn’t mentioned. So, the perceived target has become simply 150-minutes of moderate-to-vigorous activity a week.

This causes a problem when people monitor almost every minute of their day with an activity tracker and this so-far unknown baseline is actually measured.

According to newly available research from our partners at the University of Bath, we should be aiming for around 1000-minutes of moderate-to-vigorous activity every week.

The researchers analysed free-living physical activity data from 305 men and women who had participated in research studies at the University between 2006 and 2014 that included wearing one of two highly accurate activity monitors. To make sure the data gave a true picture of each person’s lifestyle, they only included those who had collected data for at least 90% of a full 7-day period during their time as a participant. Interestingly, all of the participants met the 150-minute target set by the government, including those who said they were inactive.

The data showed that to achieve a personalised calorie burn target advocated by the World Health Organisation, people needed to do around 1000-minutes a week of moderate-to-vigorous intensity physical activity.

It is this research that forms that foundation of the physical activity guides used in KiActiv®.

We aren’t suggesting that everyone needs to find 1000 more minutes of activity every week. This new target includes all activities that make up our day, both normal lifestyle activities and the additional activity needed to gain the numerous health benefits associated with an active lifestyle.

KiActiv® motivates, engages and improves understanding, empowering self-management and successful behaviour change. This means that everyone can achieve their optimum free-living physical activity and the associated health benefits.

You can read the full research study here.

Every hour you sit can increase your diabetes risk by more than a fifth, according to new research

The more we sit down, the greater our risk we of developing type-2 diabetes, with researchers finding that every extra hour spent sedentary increased the odds of type-2 diabetes by 22%. Crucially, they found that the damage couldn’t be undone by intense exercise.

In the study, published this month in the journal Diabetologia, 2,497 Danish men and women with an average age of 60 wore an accelerometer on their thigh for 8 consecutive days to accurately and objectively measure the daily amount participants spent in different postures (sitting or lying, standing and stepping). Participants were given a standard glucose tolerance test after an overnight fast to determine the diabetes status – over half of the participants (55.9%) had normal glucose metabolism, 15.5% and impaired glucose metabolism and 28.6% had type 2 diabetes.

In Britain, we spend about 9-hours a day sedentary – a trend replicated in the new study. Although the participants with diabetes had the most sedentary time, they were only sedentary for up to 26-minutes more than those without diabetes. That’s the equivalent to getting up from your desk for 3 or 4 minutes each hour of your eight hour working day – about the time it takes to walk to the kitchen to get a drink. And, just think how many minutes you could knock off your sedentary time if you stood up and paced back-and-forth behind your desk every time you made a phone call.

Leading a physically active lifestyle is known to reduce your risk of developing type-2 diabetes, but there’s more to physical activity than the 150-minutes of moderate or 75-minutes of vigorous activity a week recommended in the government guidelines. This is why we take a multidimensional view of physically activity, to make sure we are looking at all the different dimensions of physical activity that impact your health. And, this is the reason our use of personalised physical activity in a free-living environment has been included in an NHS Innovation Test Bed – the Diabetes Digital Coach, led by our partners at the West of England Academic Health Sciences Network.

Simply put, we need to be more active and sit less every day to give us the best chance of avoiding type-2 diabetes. Break up sedentary time with something active, like walking to see your colleague instead of sending them an email, not only will this reduce your sedentary time, it’ll also increase your daily active minutes. Also, you could try going for a 10-minute walk at lunch or getting off the bus a stop early and walking the rest of the way to increase your moderate bouts. It all about finding the activities that you enjoy, that fit into your lifestyle and that “count” for you.

Physical Activity is the most important weapon in the fight against obesity

Have you resolved to lose weight in 2016? Make sure physical activity is included in your plan.

Weight loss can be a minefield, with the supposedly expert opinion on the “best” diet to shed the pounds changing on an almost daily basis. In fact, the most effective diet to follow is one you can stick with. And, whilst calorie intake is obviously important in weight management, new research suggests that calorie counting isn’t the key to fighting obesity – Physical Activity is.

Researchers from McMaster University in Canada found that leading a physically active lifestyle can blunt the genetic effects of FTO – a major contributor to obesity – by up to 75%.

Participants were asked how long they spent doing 41 different types of physical activity. Importantly, free-living activities like gardening, taking the stairs and walking around the office were included in the list alongside more traditional structured exercise like strength training, cycling and team sports.

So, whether your goal is to lose weight or keep healthy, physical activity is the key. The important thing is to discover what activity “counts” for you. Then the choice is yours – you can decide how you want to be active. Chances are you’re already doing at least one thing every day that counts as activity – for some people it’s walking the dog or to the corner shop to buy the morning paper, for others it’s a game of squash or a Zumba class, it might even be something that seems small and insignificant like taking the stairs.

Whatever you choose, make physical activity part of your lifestyle to improve your health in 2016 and for many more years to come.

Get up every half an hour for your health

Sitting down all day is far too easy to do – sitting driving the car or on public transport, working at a computer, and watching TV make up the majority of the day for far too many of us. Even those of us who fit in 30-minutes of exercise and 8-hours sleep on most days tend to sit down the hours that are left.

All this sitting is damaging our health.

New research from the University of Ottawa Heart Institute in Canada has added to the growing body of evidence showing that the more we sit down, the more damage we are doing to our health. The researchers looked at the association between markers of health and sedentary time in 278 patients with coronary artery disease. All the patients had already been through a cardiac rehabilitation programme which aimed to teach them how to improve their physical activity levels in the long term. Despite learning how to lead an active lifestyle, on average the patients spent almost 8-hours a day sedentary – the more sedentary they were the higher their BMI and the lower their fitness, putting them at risk of another cardiac event.

These researchers suggested that everyone should get up and move every half an hour – reducing our sedentary time may be just as important as increasing activity, we need to do both.

Following this advice wouldn’t just reduce your risk of cardiovascular problems. Breaking sedentary time with 5-minutes of either walking or standing has recently been shown to reduce the risk of type-2 diabetes.

So, take the advice of the researchers and monitor your activity patterns to see when you’re sedentary for too long – then you can decide how to break your sedentary. It could be as simple as walking to get a small glass of water every half an hour (try going to the kitchen that’s furthest away from your desk) or standing up during the TV adverts.

Fitness in young adults predicts cardiovascular disease and death in later life

Physical activity is often thought of as no more than a method of weight management, but its benefits extend far beyond burning calories – it can add years to your life and life to those years, reducing the risk of numerous chronic diseases.

While physical activity has long been associated with a reduced risk of cardiovascular disease in middle-aged and older adults, a new study offers fresh evidence that fitness in young adulthood provides protection against cardiovascular problems developing in the future.

As part of this large study, published online in the JAMA Internal Medicine, 4872 men and women aged between 18 and 30 years underwent a treadmill exercise test at baseline, which a sub-set of 2472 participants did again 7 years later. Median follow-up time was almost 27-years, during which the researchers monitored patients for obesity, hardening in the coronary arteries, heart muscle weakness, and incidents related to cardiovascular disease, such as strokes and heart attacks.

Every additional minute of baseline treadmill test duration was linked with a 15% lower risk of death and 12% lower risk of cardiovascular disease by the end of the follow-up period. Among those that did the second treadmill test, every 1-minute reduction in test duration was linked with a 20% increase in risk of cardiovascular events and 21% risk of death.

The fact that none of the other more traditional risk factors measured, including obesity, smoking, hypertension, and high cholesterol didn’t change the outcome highlights the importance of thinking about physical activity as a mere tool for weight loss.

In an editorial that accompanied the study, Dr David Chiriboga and Dr Ira Ockene of the University of Massachusetts Medical School wrote that “the findings offer a substantive confirmation of the importance of physical activity in cardiorespiratory fitness in the prevention of cardiovascular disease.” In further communication, Dr Ockene highlights the need for multidimensional physical activity, saying “I spend a lot of time talking to folks not just about literal exercise but also about the extraordinary value of day-today activity,” adding that we should “also understand the importance of limiting sedentary time”

The power of multidimensional physical activity as a diagnostic tool isn’t limited to cardiovascular diseases. In fact, physical activity is fundamental to the prevention and treatment of numerous diseases, including type-2 diabetes, hypertension, high cholesterol, obesity, some cancers, osteoporosis, and dementia. Being physically active is the single best thing you can do for your health, now and in the future.

The KiActiv HealthCheck accurately evaluates the current physical activity of anyone in relation to their health, delivering a meaningful measure of individual physical activity levels and the associated future disease risks. By delivering actionable behavioural insights, the KiActiv HealthCheck can help improve your understanding of current health status and what you need to do to improve your health and lower disease risk.

Move more to improve your memory

We are pretty evangelical about the power of physical activity for preventing and treating the lifestyle diseases that plague modern society. And rightly so, there is so much scientific evidence in support of physical activity as a powerful medicine that we should all be taking.

A new study, published online in the Journal of the International Neuropsychological Society, has added to the growing evidence-base finding that staying physically active could improve our quality of life by prolonging an independent lifestyle and delaying cognitive decline as we get older.

The researchers from Boston University School of Medicine compared 29 young adults (ages 18-31) and 31 older adults (ages 55-82). All of the participants wore an accelerometer to objectively measure their daily physical activity, as well as completing neuropsychological testing to assess their memory, planning and problem-solving abilities.

The results showed that, older adults were more physically active had better memory performance. The researchers believe that these findings show that the positive effects of physical activity extend to improved long-term memory, which is the type of memory most negatively impacted by aging and neurodegenerative dementias such as Alzheimer’s disease. Around 800,000 people in the UK are currently living with dementia and that number continues to increase. We can help stop this number growing simply by moving more each day.

Importantly, the authors point out that staying physically active can take a variety of forms from formal exercise programs to small changes, such as walking or taking the stairs. In other words, physical activity is multidimensional, we just need to find out what activities work for us. And that’s where KiActiv comes in, empowering you to optimise your physical activity using the activities that “count” for you.

Conflicting headlines just add to the confusion around Physical Activity

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.

Confused?

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!

Does Physical Activity slow the aging process?

Almost any amount of Physical Activity may slow aging at a cellular level, and middle age may be a critical time to prevent your body from aging, at least according to one common measure of cell aging – telomere length.

Telomeres are combinations of DNA and protein that protect the ends of chromosomes and help them remain stable. As we get older telomeres fray and become shorter and our cells begin to age and die more quickly. Shorter telomeres have become associated with numerous aging-related diseases including cardiovascular disease, stroke, obesity, osteoporosis, diabetes, vascular dementia, and many forms of cancer. Recent science suggests that Physical Activity may slow the fraying of telomeres, helping to maintain telomere length and slow cell aging.

A new study, published in the journal Medicine and Science in Sports and Exercise, looked at the interactions of Physical Activity and telomere length among 6503 American men and women, ranging in age from 20 to 84.

The researchers categorised the participants into four groups, based on how they had responded to questions about their Physical Activity. Participants scored a point if they had engaged in each of the following four types of Physical Activity in the past month: moderate-intensity activity, vigorous-intensity activity, muscle-strengthening activities, or walking or cycling for transport. The points tally was then compared to the participant’s telomere length.

For every point scored from any of the four types of Physical Activity, risk of having unusually short telomeres decreased significantly.

Specifically, participants who engaged in a single activity, earning them one point, were about 3% less likely to have short telomeres than someone who did no Physical Activity. Those who did two types of Physical Activity were 24% less likely to have short telomeres, three types were 29% less likely and those reporting four types of Physical Activity were 59% less likely to have short telomeres.

These associations were strongest amongst participants aged 40-65 years, suggesting middle age may be a key time to start or maintain a Physically Active lifestyle and maintain your telomere length.

Although this study doesn’t show that Physical Activity causes changes in telomere length, it does show us that people who are active do have longer telomeres than those who aren’t. It also can’t tell us exactly how much activity we need to do to maintain the length of our telomeres. But, the message is clear – Physical Activity is good for our cells and the more we do in greater variety is likely to be even better.

Physical Activity has many dimensions, each known to have clear biological and health benefits. The personalised multidimensional physical activity profiles visualised in the KiActiv system, created by our partners at the University of Bath, give you a unique insight into your body and your lifestyle. They enhance understanding and inspire confidence to change and optimise your individual physical activity, so you choose what types of Physical Activity you want to do to improve your health and even slow the aging process.