Physical inactivity is associated with earlier mortality — the evidence is incontrovertible

We commend BJGP for publishing and bringing much needed attention to the opinions of Mike Fitzpatrick on the perceptions of physical activity promotion within the healthcare sector in this country.¹

There is, however, nothing virtuous, propagandist, patronising, and infantile about physical inactivity being the fourth leading risk factor for global mortality responsible for 6% of worldwide deaths and a major contributing factor to 60% of global non-communicable diseases.² There is a clear causal relationship between the amount of movement people do and all-cause mortality.³

Behaviour change psychology permeates all aspects of medicine and it is interesting to note that, despite widespread acceptance of pharmaceutical medications by doctors, enormous pharmaceutical advertising expenditure, and a large proportion of medical education being devoted to pharmacology, only 30–50% of patients change their behaviour sufficiently to consume prescribed medication at advised therapeutic doses.⁴ Changes to medical education are urgently needed to include greater emphasis on behaviour change techniques for they underpin much of what we do in clinical practice, and are effectively used to modify physical inactivity behaviour in primary care.^5,6

Dr Fitzpatrick insinuates that coordinated public health strategies involving health professionals and physical activity promotion have ‘no proven value in relation to health’. We congratulate Fitzpatrick on promoting lifestyle promotion at his clinic, according to the NHS Information Centre, last year his own surgery achieved 100% incentivised payments from QOF for lifestyle promotion indicators. Brief interventions in primary care achieve similar concordance with physical activity to prescribed medication,^7,8 so lifestyle recommendations are in fact of very great value in relation to health with far wider collateral benefits.^9,10,11

Physical activity promotion and lifestyle advice are included as the first treatment recommendation in 39 different sets of clinical guidelines in the UK because evidence supports that physical activity can be used to treat the same diseases that physical inactivity causes (and improve quality of life, mental health, productivity, and academic achievement).¹²

Medical ethics, medico-legal duties of care, and perhaps even moral responsibility also underpin the need for physical activity promotion, to the extent that General Medical Council Good Medical Practice obligations, state that ‘You should encourage patients and the public to take an interest in their health and to take action to improve and maintain it. This may include advising patients on the effects of their life choices on their health and well-being …’.¹³

As a start, some simple tips assisting doctors with physical activity promotion in primary care was recently published in the BMJ.¹⁴