For goodness' sake walk!

Monday, 29 July 2013

In his presentation of the Inaugural Jerry Morris Oration for the Heart Foundation on 26 July, Adrian Bauman gave a fascinating and powerful description of the importance to health of physical activity.

In 1953 Jerry Morris published the first evidence on the effect of the lack of physical activity on heart disease. The study compared the working lives and heart health of the drivers of double-decker buses with that of their conductors. Because of their constant movement up and down the stairs, the conductors were shown to be at less risk of heart disease. Adrian Bauman has been leading the way in Australia and internationally to have the benefits of physical activity recognised by the general public, health practitioners and policy makers.

More in sorrow than anger, Professor Bauman reported on the failure of governments and the health sector to recognise the huge benefits to be gained from increased physical activity. (The Heart Foundation, it has to be said, has been an exception to the general rule of agencies failing to give appropriate attention to physical activity.)

Physical inactivity causes as much damage to health in developed countries as smoking. That is the (astonishing) take home message.

Professor Bauman explained that the relatively slow rate of adoption of measures that would stimulate increased physical activity has a number of causes. For one thing, the picture is more clouded than it need be because all kinds of data series on the issue are available. There needs to be more focus on universally applied and consistent evidence - collected about the same metric and in the same way.

For another, doing what needs to be done to increase physical activity involves many sectors and industries: transport systems, urban and civic design, workplace adjustment - not just the health sector. (This is one of the reasons why - although challenging enough - it is easier for governments to take on the tobacco industry: powerful but monolithic; a single entity that most are prepared to accept as inimical to good health.)

The health sector itself is not without responsibility however. Professor Bauman reported that GPs have become much more practised or compliant at giving anti-smoking messages than advice about the need for and benefits of physical activity. (The failure of efforts to have the health benefits of physical activity widely accepted is so great that doctors don't even feel it necessary to exaggerate the extent to which they report providing messages on the subject!)

But there is good news. The greatest health benefits are reaped by those who adjust their lifestyle to move from no physical activity to some. So all of us who need to should start walking. (We Australians are already doing less than the Canadians and the Norwegians - and consider the climatic challenges they face!)

Also, compared with lifestyle actions to stop smoking or lose weight, increased physical activity acts faster to improve health.

Professor Bauman warned against mythologising data such as that relating to the apparent danger of increased hours of sitting. He said the jury is still out on that complex issue and he counselled more walking as the unequivocal message.

Professor Bauman spent some time early in his career as a rural GP and, in conversation after the Oration, he demonstrated his appreciation of the particular challenges of encouraging more physical activity in remote areas. In more remote and sparsely populated areas it's not about 'going to the gym in lycra', visiting the skate park or walking to the supermarket. But it's vital nevertheless and the Alliance looks forward to the possibility of gaining more insights into how to best promote and achieve increased physical activity in rural and remote areas from Professor Bauman's work and leadership.

Surprising though it may seem, people in rural and remote areas are reported as being more sedentary than their city cousins. This is a worry - unless it's just that the data available to us suffers from some of those classification difficulties ('exercise' cf 'sport and recreation' cf 'physical activity') that Professor Bauman warned us about.

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