“For adults aged 18–64 years, the recommended minimum level of activity for health benefits is 150 minutes of moderate intensity physical activity or 75 minutes of vigorous intensity physical activity, or an equivalent combination of both, each week.” (Australian Institute of Health and Welfare. Australia’s health 2016. Canberra: AIHW; 2016.)

WITH the federal government Medicare Benefits Scheme Review in full swing, it is important to recognise some pertinent facts in its review with all stakeholders.

In 2013–14, $2.2 billion, or 1.4% of the $155 billion total health expenditure, went to public health activities, which included prevention and health promotion. This has been declining since it peaked in 2007–8, when it stood at 2.2% of the total health expenditure. It is disappointing that no extra funding was allocated to preventive health measures in the 2017 federal Budget.

Chronic diseases are the leading cause of ill health, disability and death in Australia. In 2014–15, half of all Australians had at least one of the major chronic diseases, including cancer, cardiovascular disease, diabetes, and mental health and musculoskeletal disorders. The rate was higher in lower socio-economic areas, regional and remote areas and Indigenous communities. This growing burden of chronic disease is in part responsible for driving an increased demand for services and rising health expenditure.

Physical inactivity is one of the major risk factors for chronic disease. In addition, physical inactivity, measured by poor cardiorespiratory fitness, has a greater contribution to all-cause mortality than the negative effects of obesity, diabetes and smoking combined.

In 2014–15, around half (45%) of Australians aged 18–64 years undertook insufficient physical activity each week, with rates of inactivity higher in women and Indigenous populations.

Regular physical activity, defined as 150 minutes of moderate intensity exercise per week, performed over 5 or more days of the week, may help reduce the risk of developing chronic diseases, such as heart disease, stroke, dementia, diabetes and some forms of cancer, by at least 30%. There is also increasing evidence that regular physical activity is effective in the early management of mental illnesses such as depression. Regular physical activity represents an incredibly powerful weapon in the fight against chronic disease, more powerful than many medications listed on the Pharmaceutical Benefits Scheme. Indeed, exercise therapy has been shown to be a safe way to improve functional capacity and reduce disability in those with chronic disease, and should be recommended as part of their management plan.

A recent 2017 report from the Australian Institute of Health and Welfare, Impact of overweight and obesity as a risk factor for chronic conditions: Australian Burden of Disease Study, showed that a loss of about 3 kg body weight for overweight or obese individuals, may reduce the incidence of obesity-related chronic disease in 2020 by 14%. Addressing contributing factors, such as poor dietary practices and physical inactivity, may help achieve this.

Thus, there is compelling evidence that improving compliance with the current national physical activity guidelines is important in the prevention and treatment of chronic disease.

Every single organ system is responsive to physical activity, and given its potential positive impact, a strong argument could be made for an exercise history to be an essential component of any medical consultation. Indeed, the “exercise vital sign” defined as the number of minutes of moderately intense physical activity accrued by someone in the previous week has been proposed as just as important a vital sign as heart rate and blood pressure.

Medical professionals have many opportunities to undertake physical activity counselling. Ann Gates, associate editor at the British Journal of Sports Medicine, wrote in 2016 that: “A qualified doctor, nurse, midwife or allied health professional may see half a million patients during their professional career; this has enormous potential for advocacy and the promotion of physical activity.”

A recent study by the University of Sydney and Exercise and Sports Science Australia, however, showed that physical activity counselling is not universally taught at the undergraduate level across all Australian medical schools. While most provide some training about the importance of physical activity, just under half of the medical schools surveyed felt that the level of physical activity training was insufficient to prepare their students to provide physical activity counselling to their future patients. This is an indictment on the current undergraduate curriculum.

The medical community must work together with a multidisciplinary “united front” to effectively implement physical activity programs with a focus on increasing compliance.

Rather than waiting until disease takes hold and then throwing costly medications, interventions and surgery at the problem, public funding would be better spent on educating patients regarding their condition, helping them understand the context and any pain associated with it, and then formulating an informed, shared management plan with appropriate referrals to effectively manage and prevent recurrence.

The government must work together closely with the bodies that promote, teach and deliver sport and exercise medicine to provide an effective and efficient prevention program through enabling exercise and physical activity for all Australians.

The federal government commitment to prevention is grossly inadequate and short-sighted. By not making physical activity a priority for all, the government continues to place the health of its greatest asset, its community, at risk of chronic disease.

The Australasian College of Sport and Exercise Physicians will continue to uphold and advance world leading training and practice of clinicians in the specialty of sport and exercise medicine. In addition to managing sporting injuries, general musculoskeletal problems and illnesses that affect individuals who exercise, we are perfectly positioned to lead and promote the incorporation of exercise and physical activity into the daily lives of all members of the community whether healthy or unwell.

We will continue to work closely with all levels of government, our medical and allied health colleagues, our peak sporting bodies and teams, as well as the greater community to keep us all active and most importantly, healthy.

Dr Adam Castricum is a sport and exercise physician and president of the Australasian College of Sport and Exercise Physicians.


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6 thoughts on “Commitment to prevention “grossly inadequate”

  1. Christine Morris says:

    The fact that prevention can’t seem to have any kind of sustainability is nonesense. There is evidence to show what works and yet we still focus on the downstream elements. Tragic really!

  2. Richard Middleton says:

    Some of the problems associated with getting regular exercise .. in no particular order.
    1) Mental inertia. Getting going to get going to the gym.
    2) Getting to the gym through all the traffic and exercise clad yummies in their civilian Urban Assault Vehicles.
    3) Being embarrassed at the gym in front of all those sleek lycra compressed, power dressed Adonis and Athena look a likes.
    4) Cost of the gym and the seemingly compulsory lyrca compressing, power dressing exercise fashion and surgically attached water bottle and music player.
    5) Fear of jeers if you wear above to go and get a post workout double decaf, soy flat white (no sugar).
    6) Other physical problems as getting older and more worn out, which limit the ability to do “burpees”, “star jumps” and throw cast iron “kettles” about the place. Or even walk very far.
    7) Cost of buying home gym gear that will actually last and not collapse under your weight as it increases due to increasing consumption of comfort calories.
    8) Fear of the scales failing to recognise the time spent getting rid of grams.

    I find an old pair of shorts and a pair of plimsolls are adequate to do 30 minutes on a stationary bike with intermittent HIIT. It is only the cats who can laugh at me.

  3. Anonymous says:

    Many people in disadvantaged areas:
    – live in areas unsuitable to walk around
    – have knee/hip OA or other conditions so can’t walk/jog
    – have no private transport
    – are not inclined to stand outside in all weather waiting for an unreliable hourly bus service to a gym/pool
    – cannot afford regular gym or pool visits anyway

    So banging on about exercise is pointless.
    We need more creative solutions e.g. subsidised daily community minibus transport to a pool/gym with tailored program, designed to also provide an enjoyable and supportive social experience.
    Local subsidised exercise/dance classes, including for people with physical limitations

  4. Ross Cairns says:

    Great article Adam. This message needs to be pushed by all of us every day to every patient.
    With reference to the other posters; exercise does have its difficulties but simply walking in 10 minute increments is enough to provide significant health benefits. Or do some body weight resistance exercises at home with no gym required. Walking has been shown to improve the pain in hip/knee OA and should not be considered a limitation for most.

    The vast majority of the Australian population have access to free facilities such as the ocean, parks, cycle paths and pavements. The main barrier is motivation and as health practitioners we need to practice motivating patients. Fortunately, if you don’t know how to address these barriers, Sports and Exercise medicine physicians are experts in dealing with these issues and will happily assist!

  5. Anonymous says:

    I dislike exercise for the sake of exercise. I park about 1.4 km from work and walk the rest – there is a very steep hill in the way, I do it every day, no excuses. If it rains I use an umbrella. I don’t have a hospital parking permit. From my perspective the best way to exercise is to build it in to one’s daily routine so it becomes as automatic as brushing one’s teeth.

  6. Anonymous says:

    Hi Adam,
    Great article!
    Preventative exercise is so much more fun than the cure or outcome of a disease.
    We all need to take responsibility for our health, and support from the wider community will encourage everyone to get onboard.
    I hope your message travels far & wide, and all who read it, encourage patients, family, friends, & workmates, to make P. E a priority.

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