Heart Foundation Policy Consensus Forum

FRIDAY 11 SEPTEMBER 2015

AMA VICE PRESIDENT DR STEPHEN PARNIS

**Check Against Delivery

I acknowledge the traditional owners of the land on which we meet, and pay my respects to their elders, past and present.

May I say congratulations to the Heart Foundation for bringing together so many stakeholders to focus on the need for a National Action Plan on Physical Activity.

It’s always good to have these events at Parliament House, to give issues such as this the prominence they deserve.

As the peak body for the medical profession, the AMA is acutely aware of the enormous range of benefits, health and otherwise, that are achieved by participation in physical activity.

As a society, we have spent well over a century seeking to progress by making life easier for ourselves.

That is, making the daily activities of our lives less onerous.

While that has resulted in many benefits, it has also led to the modern-day reality that Australians are far too sedentary, to the extent that it is harmful to our health.

The AMA supports the Heart Foundation’s efforts to ‘Move More, Sit Less.’

I spoke at the Heart Foundation breakfast earlier this year, which launched this campaign, and I welcome today’s opportunity to move to the next logical step - a call to action, principally for a National Physical Activity Strategy backed by determined support and effective resources.

For any strategy to be effective here, it must provide practical, prioritised answers, so politicians and other leaders are clear about what needs to be implemented.

Today, I will discuss opportunities to increase activity among children, opportunities to increase physical activity in the workplace, opportunities to engage in active transport, and opportunities to increase physical activity in local communities.  

I will also speak about the important role that doctors need to play, to encourage physical activity as a routine part of medical care.

We have a role in increasing both the awareness and understanding of the benefits of activity, and in boosting participation rates at every opportunity.

While a National Physical Activity Plan warrants dedicated funding, some of the examples we will hear about today can be delivered at low or no cost to Government.  

It has to be said that increasing physical activity does not always imply an increase in government, corporate, or individual expenditure.

What it does require is an investment by government in terms of leadership and policy prioritisation.

Some of initiatives raised today will fall into the domain of State and Local government, but we must have national leadership – national leadership to coordinate and implement the Action Plan.

We need this leadership because we are witnessing changes to the way Australians live their lives.

The high rates of sedentary behaviour have reached the point where it is having a significant and widespread effect on public health.

Between 60 and 70 per cent of Australians have sufficiently low levels of physical activity that their health is put at risk. This, in turn, imposes serious burdens upon our health system.

And it is not confined to Australia.

The World Health Organisation has identified that inadequate physical activity is the fourth leading risk factor for global mortality, after hypertension, tobacco use, and diabetes.

Increasing physical activity by just 10 per cent could lead to cost savings of $258 million, and 37 per cent of those savings would be in the health sector.

Importantly, the biggest gains are to be made by those who are the most sedentary. Even a small change to a more active lifestyle can lead to tremendous improvements in health outcomes.

Walking for half an hour a day, five days a week, may increase life expectancy by up to three years via the reduced impact of cardiovascular disease.

My clinical work is as an Emergency Physician, and my daily experience in the ED only confirms many of these points to me.

I see many frail elderly people with conditions such as confusion, dementia, and trauma from falls.

But I also see many men and women in their 80s and 90s who are fully independent, leading rich, busy lives.

If I am to discern a common feature among the well elderly, it is their determination to be as physically active as possible.

These are the same people who have shorter hospital admissions, and recover more promptly from surgery. In short, they are more resilient, and it is not accidental. I find these people inspirational.

The flipside of that coin is seeing patients in Emergency who end up in hospital with conditions that can be linked to inactivity and poor lifestyle choices.

In many cases, these patients have also been advised – by other health professionals or by friends and family – that it is time to make changes to their lifestyle.

But there is something about a ride in an ambulance and lying on a trolley in an emergency department that seems to crystallise the importance of embracing a healthier lifestyle.

I try to take these opportunities to encourage change for the better.

Unfortunately, some people don’t realise the importance of healthy lifestyle until it’s too late.

It takes things like major heart attack, a debilitating stroke, the diagnosis of advanced cancer, which I see on a regular basis, to turn the lights on.

When significant health events occur, they usually result in major and long term changes to that person’s life.

This can be in the form of lifelong medication regimes, onerous medical and surgical treatment, diminished independence, and even social isolation.

But, as we so often say, prevention is better than cure.

When it comes to advice about a healthier lifestyle and engaging in physical activity, it often comes from a general practitioner.

It is entirely appropriate for most people to speak to their GP before engaging in any new program of physical activity.

Because GPs often know the details of their patients’ lives and health, their cultural backgrounds and their interests, they are able to provide the right advice and support to encourage their patients not only to be physically active, but how best to sustain this activity.

GPs should have the local knowledge to be able to provide the links to local opportunities and activities in their area. 

I recently met with a group of GPs in Western Sydney, who are seeking to extend opportunities for healthy activity to a new level for their community.

They have proposed the use of Google maps as a platform to provide more information about physical activity opportunities in any given local area.

We at the AMA are helping to facilitate this engagement.

I would now like to turn to public campaigning.

There are examples where investment in public education and awareness has led to increased participation rates in physical activity.

But there are just as many where the impact has been questionable at best.

In 2015, we have to be smarter in the way we do these things.

We must invest in campaigns that are appropriately targeted by age group and demographic, using all media platforms. The messages must be easily understood, and include ready-made solutions.

We also need cultural change.

As long as physical activity is viewed in the same way as ‘eating your vegetables’, it will continue to be perceived as an obligation or a chore.

Activities that involve being physically active need to be seen in a much more positive light.

They need to be seen as opportunities - opportunities to socialise and spend time with family and friends, opportunities to engage with the natural environment, and opportunities to care for and nurture yourself.

Exercise is not a spectator sport.

One of the benefits of a national physical activity Action Plan will be to untangle physical activity from the issue of being overweight or obese.

If we continue to talk about obesity and physical activity at the same time, we risk sending a mixed message.

GPs mustn’t shy away from addressing this issue.

Physical activity is an important part of weight management, but the health benefits of physical activity are about so much more.  

Being active has a vital role in disease prevention, in chronic disease management, and fostering improved mental health.

These benefits are tangible and meaningful, and must be presented in this way.

We need to let people know that they can reduce their chances of developing certain conditions or diseases by participating in the recommended levels of physical activity.

The data says it all.

Widespread and effective participation in physical activity across the population could lead to a 50 per cent reduction in the incidence of hypertension, type 2 diabetes, osteoarthritis, and major fractures.

A 45 per cent reduction in bowel cancer.

A 40 per cent reduction in the incidence of heart disease, osteoporosis, low back pain, and falls in the elderly.

A 30 per cent reduction in stroke, depression, and dementia.

And a 25 per cent reduction in breast cancer.

It’s time to have a genuine discussion about what constitutes physical activity.

Physical activity to improve your health doesn’t have to be gruelling, sweaty, and unenjoyable.

It doesn’t have to test your willpower, or leave you physically sore.

It doesn’t have to be competitive, nor does it have to be done in isolation.

While some people do enjoy more intense physical endeavours, there’s a strong evidence-base for promoting less intense activities that also convey equally healthy benefits.

The obvious one is walking.

We’ve done a good job of promoting walking as health promotion and prevention, but there are also options that people might not associate with the words ‘exercise’.

These include dancing, tai chi, and gardening.

We also have to be realistic in our advice around physical activity.

The constant advertising about gym membership and those late-night adverts for ‘wonder’ exercise machines must be countered with basic information and advice about how to undertake regular activities that improve the cardiac and respiratory function.

For example, there are useful guides online showing how to begin exercising and how to increase on a daily or gradual way until you’ve achieved the correct level of physical activity.

Too often, those most in need of activity get discouraged when faced with the prospect of being ‘active’. 

And all too often, those in need are discouraged by what they perceive as the costs involved with physical activity.

One of the biggest costs is time.

We live in a society that is increasingly time poor, where busy people find it difficult to squeeze something else into their day.  

Long working hours, long commutes to and from work, picking up and dropping off children at school and child care leave many feeling like that extra 30 minutes per day is unachievable.

The other impediment is the financial cost.

As I mentioned earlier, there are options for physical activity that are free or are low cost, but the reality is that many activities do have a cost – and sometimes these are quite significant.  

Annual gym or club memberships can run into the thousands. Sports equipment is expensive.

Name brand joggers cost hundreds of dollars – and then there’s the lycra, the wireless head phones, and the fitness trackers that are all heavily promoted in the health and wellness space.

You don’t need all of this stuff, but the fact that it is associated with physical activity can act as a barrier to participation.

Another issue relates to parents.

Some Mums and Dads invest so much of their time and money into their children’s activities that they neglect their own need to pursue physical activity.

This is a problem, as children often model themselves on their parent’s behaviour. 

What might seem to be a selfless act may inadvertently be sending the wrong message.

So, what do we need to do?  

One area that I am particularly interested in is the encouragement of physical activity in the workplace.

For so many of us, our workplaces and work practices are an incredibly important part of lives. They profoundly influence our physical and mental health.

When measures are introduced to encourage a more physically active environment, everyone wins.

Examples such as bicycle storage, shower facilities, standing desks and walking meetings provide opportunities for increased participation.

Measures such as these may be easier to implement in larger workplaces. But small business can’t be left out of this.

Small business is a significant employer in Australia, and implementing these types of changes and the flexibility required to encourage physical activity may be more difficult for smaller businesses.

This doesn’t mean that it is impossible, but we should be talking with organisations like COSBOA – the Council of Small Business Australia – about how best to support small business in facilitating employee activities.

The benefits are clearly worth it.  

We know that employees who are physically active generally have improved engagement, motivation and morale, and less sick leave.

They tend to have improved productivity levels.

These are the types of attributes small businesses rely on – they are the attributes that all businesses rely on – so it makes sense to look at ways to encourage employees to facilitate increased workplace physical activity.

We also need to include active transport measures as a priority in all transport and infrastructure policies.

Many countries have developed innovative ways to provide and promote active transport, and in turn reap the benefits.  We should be examining these.

Australia certainly has some important transport considerations.

In a big country and with sprawling cities, we often experience long commuting distances.

We are also subject to weather variation that can border on extreme, but we can certainly consider some of the proven models and adapt these policies to our needs.

There are cities with exceptionally good bicycle access, covered walking areas, public exercise facilities, and even car free days.

These measures not only improve health through the reduction in air pollution, they create a more active environment where commuters walk or ride, rather than drive.

As well as having a dedicated focus on active transport we need to encourage all authorities to consider the principles of good urban design to create more active communities.

For example, cities and large towns need walking and cycling paths, playing fields and other green spaces, along with street lighting, localised shopping centres, and better public transport options.

This is a developing trend in Manhattan, New York - one of the most urbanised places on earth.

We need to recognise the systemic barriers to physical activity.

Lack of access to public transport, or the need for longer trips to use facilities, adversely impacts on participation.

Not surprisingly, it is often the outer suburbs of our major cities where we find the greatest dependence on cars, and the lowest rates of physical activity.

Another barrier includes recognising parental concerns about their children’s safety, whether that be just outside playing with friends, or whether they are walking or riding a bike to school.

Concerns about safety also extend to adults.  

Given the busy lives many of us lead, the reality of walking, running, or cycling during dusk, dawn or even in the dark, can make many stop and consider their own personal safety.

Cities and towns need safe and secure places to encourage the population to be active.

The provision of appropriate lighting, security, and high volume usage are known to address some of these safety concerns.  

I now turn to the social determinants of health, recognising that, for many people, sedentary behaviour and other so-called ‘lifestyle choices’ are more of a reflection of inequality at a number of levels.

There are very real barriers to participation.

Many Australians have such low levels of health literacy that they find it difficult to understand basic aspects of their health and the provision of health care.

This uncertainty extends to understanding the tangible benefits from engaging in physical activity.

Outer - and often more disadvantaged - suburbs are also less likely to have the same access to sporting and recreational facilities that are available for those people living in more affluent suburbs that are closer to town or city centres.  

I said earlier that, as health professionals, we have a major role in encouraging, and indeed prescribing, physical activity in our patients.

I believe it is time for us to be more definitive and opportunistic, recognising that it can be a difficult conversation to be had.

As doctors, we should be highlighting the very real costs involved in sedentary behaviour - health and medication costs, compromised independence, and poorer quality of life.

A prescription for physical activity must be taken seriously, and considered to be an essential part of medical care.

It is a part of illness prevention as well as disease mitigation, and numerous examples make this point across the human lifespan.

For toddlers and children, regular physical activity is essential for normal development of fine and gross motor skills.

At the other end of the spectrum, active elderly people are less likely to endure cognitive decline or suffer from falls or depression – essentially because of the benefits of exercise.

So we need to tailor physical activity to every individual, and consider their needs, preferences, and capabilities. 

We need to be pragmatic, finding and investing time and money into options that work.

For me, a 46 year old man with a young family, limited spare time and a history of back problems, this means commuting to the hospital on a bike, and doing a little bit of gym work to build up muscle and bone strength.

I am mindful that as medical practitioners we should be role models – practising what we preach.

In conclusion, can I reiterate that the benefits of healthy amounts of physical activity, and the avoidance of a sedentary lifestyle, are profound.

In an era where we all hope and expect to live long and independent lives, it is clear that we must do more to be more active.

More as individuals to fit physical activity into our daily lives …

More as employers and employees to make our workplaces conducive to physical activity …

More as doctors and teachers to promote health literacy and exercise as a basic part of health care, growth, and development …

More as State and Local governments to ensure our communities have the resources, settings, and incentives they need to lead active lives …

And more as the Australian Government to provide the national leadership we need to develop and coordinate a National Physical Activity Strategy.

11 September 2015

CONTACT:        John Flannery                     02 6270 5477 / 0419 494 761

                       Odette Visser                      02 6270 5412 / 0427 209 753

Follow the AMA Media on Twitter: http://twitter.com/ama_media

Follow the AMA President on Twitter: http://twitter.com/amapresident

Follow Australian Medicine on Twitter:  https://twitter.com/amaausmed

Like the AMA on Facebook https://www.facebook.com/AustralianMedicalAssociation