Millions More Moving is our first policy report on how we can tackle inactivity by supporting people with long-term conditions to move. In this blog series, colleagues working in different areas of health and physical activity will be discussing themes central to the three policy ‘shifts’ the report calls for: leadership and accountability, movement embedded in healthcare, and movement as part of everyday life. - Professor Scarlett McNally, surgeon and Deputy Director of the Centre for Perioperative Care
This is a very personal view of a surgeon and a patient. I have been an Orthopaedic surgeon for 30 years. It is the best job in the world, working with patients and fixing arms and legs. Sadly, about half the fractures we see are preventable, resulting from weak bones and muscles that make falls, fractures, pain and loss of independence more likely. Most traffic ‘accidents’ are also preventable.
I was the lead author for the Academy of Medical Royal Colleges’ report ‘Exercise the miracle cure’, in 2015. This explained, with 200 references, how exercise, at a dose of 150 minutes per week, could reduce the risk of dementia, depression, strokes, diabetes and bowel cancer by at least 30% each, and also improve health for people living with many common conditions. Exercise improves health in several ways, affecting metabolism (controlling sugar levels), inflammation, pain management and patient empowerment. Having strong muscles means being able to get to the toilet and needing fewer carers. The need for social care could be reduced if we focus on physical activity, especially by people in their 50s and 60s.
We now know that the risk of exercise is far less than the risk of being sedentary. For any change (such as starting to exercise), people need to know why and how. The #WeAreUndefeatable campaign showcases people with long-term conditions being active. Options are different for different people. In the excellent resources at www.movingmedicine.ac.uk, the section about ‘condition – perioperative care’ has a guide for healthcare professionals about motivational interviewing – how to talk to people about starting to exercise rapidly.
I am Deputy Director at the Centre for Perioperative Care (CPOC) where we try to improve the pathway for patients having surgery. This approach can reduce complications of surgery by 30% to 80% and length of stay by 1-2 days. 10 – 15% of operations have a complication and 14% of patients regret having had an operation. Complications of surgery are more than four times more likely if someone is frail or physically inactive. The public is set up to fail. We have a too-passive model of how to live and be a patient. Having an operation is a ‘teachable moment’. We have pages on the CPOC website on how to prepare for surgery, including my blog about exercising before surgery – recommending people find an exercise that might work, get started and then do more.
It has been an honour to work with patient charities and the excellent patient representatives at CPOC. I became a patient, with myeloma (blood cancer) and amyloidosis, which gave me a different perspective. My GP told me to go for a walk every day and my treating consultant told me ‘Your heart’s a muscle – you’ve got to use it’. I benefited from getting their “permission”. I bought an electric-cycle and went out every day – never missing a ‘dose’. I got fit enough to be eligible for a stem cell transplant in 2020 and I’m much better now.
I did a challenge for ‘WheelsForWellbeing’ because some people with disabilities may find it easier to cycle than to walk or drive – including me at the time. I have tried to make ‘Active travel’ (walking and cycling) safer and easier – because it gets people exercising and interacting with their community. I write a column about the wider view of health in the British Medical Journal.
We each only get one life. Exercise reduces ill health and costs to patients and society. The future will be better if patient charities and health organisations work together. Environments and expectations must change. I am proud of CPOC’s association with the Richmond Group.
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