Page 16 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)

SA JOURNAL OF DIABETES & VASCULAR DISEASE
158 VOLUME 9 NUMBER 4 • NOVEMBER 2012
Changing Behaviour
PHYSICAL ACTIVITY: GETTING
PEOPLE MOVING TO PREVENT CVD
S Afr J Diabetes Vasc Dis 2012;
9: 158–160
Susan Mayor
Managing Editor, BJPCN
Fewer than half of men •
and one-quarter of
women currently achieve
recommended physical
activity levels
People who are physically •
active have a 20–35%
lower risk of CVD than
those who are sedentary
Physical activity can •
prevent progression
from impaired glucose
tolerance to type 2
diabetes and reduce
HbA1c in people with
diabetes
Latest UK guidelines •
recommend a total of
150 minutes each week
of moderate intensity
physical activity
Motivational interviewing •
– focusing on the
patient’s priorities – can
help achieve change
Walking is a good option •
to increase physical
activity for many people
KEY POINTS
Originally in Br J Prim Care Nursing
2012
If physical activity could be taken as a tablet, the
dramatic benefits it achieves in reducing cardio-
vascular disease and diabetes as well as many
other conditions mean all of us would be on it. But
many people currently miss out because it takes
more effort to increase physical activity than popping
open a tablet bottle. This article sets out the evidence
for physical inactivity as a major cardiovascular risk
factor and how to put the evidence into practice and
get patients moving.
What would you do about a risk factor that causes
more than one in every 20 deaths worldwide but
which is generally simple and cheap – even free – to
correct? Would you ensure you told every patient all
about it and did your best to help them reduce their
risk?
The risk factor we’re talking about is physical in-
activity, which is the fourth leading risk factor for glo-
bal mortality accounting for 6% of all deaths accord-
ing to figures from the World Health Organisation.
It follows high blood pressure (13%), smoking (9%)
and is equal to high blood glucose (6%) in mortal-
ity rankings. With all the efforts that go into reduc-
ing blood pressure, stopping smoking and lowering
blood glucose, why is physical inactivity often left out
of cardiovascular disease
(CVD) risk factor man-
agement?
“Physical inactiv-
ity tends to be added
as a throwaway com-
ment, even though it’s
a major risk factor,” warns
Cath Robertson, physiotherapist
and trainer in cardiovascular dis-
ease prevention. She thinks this is
because healthcare professionals often
lack training and knowledge about physical activity
and are unsure how to get patients – particularly
those with chronic conditions – to become more ac-
tive. “Lack of confidence and lack of time means that
physical activity just gets left out,” she says.
Dr William Bird, a GP in Reading and consultant to
NHS London on physical activity, agrees that health-
care professionals tend to focus on other CVD risk
factors in health promotion and prevention efforts.
“When I ask healthcare professionals to list risk fac-
tors, physical activity is usually buried at the very
bottom. But looking at your practice population as a
whole, the most significant attributable risk factor for
cardiovascular death is low fitness,” he points out.
He is currently running a programme for NHS Lon-
don training general practices to use physical activ-
ity as a treatment (www.yourpersonalbestcampaign.
co.uk) and lobbying for physical activity to be includ-
ed in QOF, with support from the National Institute for
Health and Clinical Excellence.
There is huge room for improvement. Fewer than
half of men (40%) and around one in four women
(28%) currently achieve recommended levels of physi-
cal activity, according to self-reported surveys, which
tend to over-estimate activity. Physical activity is lower