Fit for the future
The health benefits of physical activity in managing and preventing chronic conditions have been highlighted in a recent Health Select Committee report. Awareness among healthcare professionals is low, but nurse-led projects are popular and effective, with one project ‘transforming’ cancer survivors’ lives.
That is the core message of a Health Select Committee report looking at the impact of physical activity and diet on health. Published in March, the report points to ‘compelling evidence’ that physical activity has ‘huge health benefits totally independent of a person’s weight’ (
The report highlights recent research, which suggests that increasing physical activity could have a greater effect on reducing mortality risk than losing weight. The MPs also cite evidence that regular physical activity helps prevent and manage more than 20 chronic conditions, including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions.
They call on the NHS, local authorities and the government to work together to tackle poor diet and physical inactivity. In particular, physical activity should be a ‘key health priority’.
The British Heart Foundation says that about one in five cases of coronary heart disease in developed countries is due to physical inactivity.
Inactivity is believed to be the main cause of more than one quarter of cases of type 2 diabetes worldwide, says the World Health Organization.
Cancer Research UK says keeping active could prevent about 3,400 cases of cancer in the UK a year. For example, the risks of breast and colon cancer decrease by 20-40% with physical activity.
The Stroke Association says regular moderate exercise can reduce the risk of stroke by 27%.
‘The extraordinary benefits of exercise in improving physical and mental health should be made clear and accessible to everyone, whatever their current level of fitness,’ said committee chair Sarah Wollaston.
The MPs’ report echoes NHS England’s Five Year Forward View, which calls for ‘a radical upgrade in prevention and public health’, and criticises the NHS for spending more on bariatric surgery than on intensive lifestyle intervention programmes.
The need for healthcare staff to focus on physical activity is also underlined in a National Institute for Health and Care Excellence quality standard, published in March (
Some NHS staff have already got the message. Diane Singleton, lead nurse for older people at Liverpool Community Health NHS Trust, won Nursing Standard’s Patient’s Choice Award in 2012 for her pioneering Liveability service, which offers a range of activities to encourage people to be active for life. The service’s fitness classes for the over fifties attract hundreds of people each week.
It has operated for more than a decade, but the service remains unusual, says Ms Singleton. ‘I look for similar services, but don’t find them. Prevention is key. We need more investment in services like ours.’
For cancer patients, physical activity can be particularly challenging. Of the two million cancer survivors in the UK, around 1.6 million are not physically active to the recommended levels, estimates Macmillan Cancer Support. The charity launched the Move More campaign in 2011 to promote physical activity as a routine part of cancer care after its research suggested that more than half of doctors and nurses working in this area spoke to few of their patients about the benefits of being active.
Four years on, Macmillan’s physical activity programme lead, Jo Foster, believes that only some of the messages are getting through. ‘The evidence of the benefits of physical activity for cancer survivors is still not particularly well known,’ she says. ‘Healthcare professionals are busy, pressurised and may feel it is not part of their role.’
Yet their involvement is crucial, with research showing that cancer survivors are more likely to become more active if the advice comes from a healthcare professional.
To find out what the barriers might be, Macmillan interviewed allied healthcare professionals and clinical nurse specialists. ‘Many told us that they didn’t feel confident in talking about lifestyle issues,’ says Ms Foster. ‘They didn’t know how to raise the subject and felt they lacked the necessary skills.’
Macmillan is now developing an intervention for healthcare professionals, based on a conversation lasting 30-60 seconds. Currently being tested by practice nurses, the initial training was delivered by a patient with advanced cancer, who has since died. ‘We’ve had a hugely positive response from the nurses. This has brought home what the benefits of physical activity are for their patients and the major role nurses can play,’ says Ms Foster.
Since Move More was launched, about 80 projects have been set up in the UK to encourage people who have or have had cancer to become and stay active, with nurses taking much of the lead.
‘Even for patients who were active beforehand, activity significantly declines with a cancer diagnosis,’ says Ms Foster. ‘The impact of treatment can lead to fatigue, so you feel less like doing anything and it becomes a vicious circle. But there are benefits for everyone, at every stage of cancer. The most important thing that people say to us is that exercise gives them their life back.’
One of the projects is a partnership between Luton and Dunstable University Hospital NHS Trust, the sports and leisure trust Active Luton and Macmillan, which has provided three years of funding, ending next year. Patients are referred to one of two specially trained fitness instructors, who develop a personalised plan that takes into account their treatment and any limitations they may have.
Activities are based on personal preferences. For example, if a patient played football when they were younger, they may be encouraged to take up walking football, in which the game is played at a slower pace. Other options include gym sessions, golf or joining a walking group. The first 12 sessions are free, and patients are monitored and assessed at the end. ‘The real sign of its success is that most people carry on when their free sessions have ended,’ says Macmillan lead nurse Jan Chalkley.
While the programme can help to tackle any weight gain as a side effect of some treatments, for Ms Chalkley it is more to do with helping patients feel better about themselves. ‘We realised that often patients get to the end of their treatment and feel a bit bereft,’ she says. ‘They can feel low and lacking in confidence.’
A Macmillan survey showed that more than 70% of patients struggle with physical side effects between one year and ten years after treatment.
‘Physical activity motivates people to get back out there,’ says Ms Chalkley. ‘And the effects can be dramatic. It transforms them. I see them afterwards and some are like different people, to the extent that sometimes I don’t recognise them. It is like a cloud has been lifted’.