Commitment to prevention “grossly inadequate”

“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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