Physical activity who cares? Leicestershire and Rutland Sport The 10 years celebration

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1 Physical activity who cares? Leicestershire and Rutland Sport The 10 years celebration 5 th November 2014 Dr William Bird MB,BS MBE 2012 Intelligent Health/NHS London

2 Contributors to Overall Health Status; The power of Health Behaviours Genetics 20% Environmental 50% 10% 20% Medical Care Health Behaviours 2012 Intelligent Health/NHS London

3 Causes of Stress and Free Radicals People Isolation Place Danger Purpose Rejection Fear and Chronic Stress

4 Chronic Stress Physical Inactivity Stults-Kolehmainen MA, Sinha R The effects of stress on physical activity and exercise. Sports Med Jan;44(1):

5 Mortality due to Inactivity 2012 Intelligent Health/NHS London

6 Attributable fractions (%) for all-cause deaths in (3333 deaths) men and (491 deaths) women in the Aerobics Center Longitudinal Study Blair S N Br J Sports Med 2009;43:1-2 Attributable Fraction % Cardiorespiratory Fitness Obesity Smoking Hypertension High Cholesterol Diabetes Axis Title Men Women 2014 Intelligent Health

7 CCG and Public Health Budget Central Manchester 000 s North Manchester 1000 s 2012 Intelligent Health/NHS London South Manchester 000 s Public Health (Covering all three CCGs) 000 s Population 211, , , ,000 GP Practices Total Allocation 282, , ,675 41,738 Secondary care 134, , ,984 Greater Manchester Collaboratively Commissioned Services 18,715 19,174 15,332 Mental Health 36,335 37,091 24,017 Community Services 27,533 27,307 26,209 Prescribing 27,432 33,513 27,996 Other

8 The Heath Burden of Inactivity in Leicester Leicester Number Number reduced if 100% population becomes active Deaths (39-79) 1, Diabetes (Prevalence) CHD (Emergency admissions) Breast Cancer (New Cases) Cost due to inactivity 16, , ,693, ,965 Bowel Cancer ,498 Stroke X X 653,880 Cost (total for Leicester on Trent for 1 year) 5,888, Intelligent Health/NHS London

9 Cost Benefit COMMUNITY PRESCRIPTION (referring to Sport) 1.2% population (2347) Total cost of intervention 247, patients with pre-diabetes reaching Government Guidelines for physical activity Metric 2 years 5 years Total QALY s Gained Benefit-cost ratio (including healthcare cost savings and the value of health gains) Net present value (including healthcare cost savings and the value of health gains) , ,407 Benefit-cost ratio (including only productivity gains) Intelligent Health Net present value of productivity gains 281,607 1,011,766

10 What do CCGs really want Savings Savings Savings Schemes to reach target groups. Who not how many 1-5 year Return on investment Willing to take risks but rigorous evaluation is absolutely key 2012 Intelligent Health/NHS London

11 Chronic Inflammation Low grade long term inflammation is the fundamental root cause of: Diabetes Cardiovascular Disease Cancers Dementia (secondary to visceral fat) Depression and Anxiety Arthritis and many other conditions 2014 Intelligent Health

12 Visceral fat reduction with exercise 0 Fat loss after 13 weeks of walking 60 mins a day and no weight loss Lean Obese Type 2 Diabetes -5 % Loss of Fat Axis Title S/C Fat Viseral Fat Lee S et al. J Appl Physiol 2005;99: Intelligent Health

13 Anti-Inflammatory - Fat 2014 Intelligent Health

14 Anti-inflammatory - Muscles Contracting Muscles Release powerful Antiinflammatories called Myokines that increase 100 fold after exercise. they also Reduce insulin resistance and mediate 75% of glucose uptake Burn more calories at rest than fat Protect joints 2012 Intelligent Health/NHS London

15 Sedentary Oxidative Phosphorylation Reactive Oxidative Inner membrane Species Anti-Oxidants Mitochondrial DNA Mitochondria

16 Physically Active Oxidative Phosphorylation Reactive Oxidative Species Anti-oxidants Mitochondrial DNA Mitochondria 2014 Intelligent Health

17 People Purpose Chronic Place Stress Stress Hormones Physical Inactivity And other poor health behaviours Mitochondrial damage and telomere shortening which leads to inflammation Mitochondria as a key component of the stress response. Manoli et al. Trends in Endocrinology and Metabolism Vol 18 No Depression Cancers Cardiovascular Diabetes Dementia

18 Lets get Bob active 2012 Intelligent Health/NHS London

19 Bob, Why don t you get off the bus a stop early?

20 Bob, why don t you try Betty s keep fit on a Tuesday

21 Bob you really should take the stairs instead of the lift

22 .and have you tried cycling to the shops?

23 But Bob already walks 3 miles to Liverpool s home game But to Bob that is not exercise 2012 Intelligent Health/NHS London

24 Building the Infrastructure Inter-sectorial Partnership Leadership Local Activity Plan Economic LEP Political Commitment Workforce Capacity Monitoring and Evaluation Targets

25 Delivering the Action Media Community Natural Environment Sport Worksite Primary Care Schools Urban Design

26 Necessary Components of Local Action on Physical Activity Partnerships Workforce Leadership Political Commitments R and D Resources $ LocalAction Plan National Targets Monitoring and Evaluation INFRASTRUCTURE Media and Social Marketing Campaigns ACTIONS Community Natural Environment (parks, rivers, nature, coastal) Schools Work place Urban Environment Primary Health care Sports Transport / Movement Networks PROGRAMS POLICIES PLACES

27 How can LRS go further? Create a clear vision and a common metric Develop interventions to reduce the health inequalities. PA is a means to an end rather an end in itself Create scale Keep it very local Train healthcare, teachers and employers Have a strong clear leadership. Provide rigorous monitoring and evaluation 2012 Intelligent Health/NHS London

28 Don t isolate Physical Activity 2012 Intelligent Health/NHS London

29 The Active Community Work GP Park Home Street School Sport 2013 Intelligent Health

30 Activate the whole community i.e create scale and depth 2012 Intelligent Health/NHS London

31 Activate communities within communities 2013 Intelligent Health

32 The 6 Key attributes to a successful activity scheme 1. Is it targeting the inactive population? (Baseline measures of who) 2. Is it getting them more active? <12 weeks 3. Is it keeping them active? >12 weeks 4. Is success measurable? (metrics, time) 5. Is it sustainable? (People skills funding) 6. Is it scalable?

33 Community-wide programs 2012 Intelligent Health/NHS London

34 Reading Population 155, Intelligent Health/NHS London

35 Beat the Street (Reading) Total Miles 244,537 Total number of raw swipes: 514,198 Total number of Cards and Fobs used: 15,074 Total number of children 8,416 Total number of adults : 6, Intelligent Health/NHS London

36 Heat Map of Usage of Beat Boxes 2013 Intelligent Health

37 Reasons to take part in Beat the Street Looking Better Winning Prizes Saving money on travel Having Time for Myself 10% 14% 11% 14% 15% 15% 14% 21% Doing Something Good for he Spending Time with Family and 34% 33% 44% 49% Thurrock Reading Having fun 53% 62% Getting Fit Feeling More Healthy 46% 46% 59% 61% 0% 10% 20% 30% 40% 50% 60% 70%

38 Changes in Physical Activity achieving 30 mins of activity 5 days a week P <0.05 P< Reading Before After 3 months 2014 Intelligent Health

39 Physical Activity and Sport as a means to an end A stronger community Increased inter-generational connections Increased volunteering More family based events and activities 2012 Intelligent Health/NHS London A better place to live and work More use of parks and green space More cafes and open squares A Stronger local economy More successful local businesses More productive employees

40 Summary Physical Activity is fundamental to human health and survival Health is all about the who Physical Activity must be seen as the gateway to a better life i.e. a means to an end It requires strong partnerships and leadership particular from the health sector..think of Bob 2013 Intelligent Health

41 Thank You

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