Focusing on Physical Activity Can Help Avoid Unnecessary Later Life Social Care Expenses Interview with:
Dr. Scarlett McNally

Consultant Orthopaedic Surgeo
Eastbourne D.G.H. What is the background for this study? What are the main findings?

Response: There are vast differences between older people in their abilities and their number of medical conditions. Many people confuse ageing with loss of fitness. Ageing has specific effects (reduction in hearing and skin elasticity for example) but the loss of fitness is not inevitable. Genetics contributes only 20% to diseases. There is abundant evidence that adults who take up physical activity improve their fitness up to the level of someone a decade younger, with improvements in ‘up and go’ times. Physical activity can reduce the severity of most conditions, such as heart disease or the risk of onset or recurrence of many cancers. Inactivity is one of the top four risk factors for most long-term conditions. There is a dose-effect curve. Dementia, disability and frailty can be prevented, reduced or delayed.

The need for social care is based on an individual’s abilities; for example, being unable to get to the toilet in time may increase the need for care from twice daily care givers to needing residential care or live-in care, which increases costs five-fold.

Hospitals contribute to people reducing their mobility, with the ‘deconditioning syndrome’ of bed rest, with 60% of in-patients reducing their mobility.

The total cost of social care in the UK is up to £100 billion, so even modest changes would reduce the cost of social care by several billion pounds a year. What should clinicians and patients take away from your report?

Response: The prevailing culture that fitness in not for middle-aged and older people needs to change. Physical activity needs to be fitted in, at a minimum level of 150 minutes per week at moderate intensity (slightly out of breath). That is 20 minutes per day; additional twice-weekly strength and balance training reduces the risk of falls.

Environments need to change, with more open spaces and modifications that allow active travel, such as cycle lanes, to become normal.

Friends and family need to support others to become more active. This will reduce suffering and reduce costs.

Health professionals should promote exercise like a medicine. What recommendations do you have for future research as a result of this study?

Response: We do not recommend further research since the evidence is overwhelming. What is needed is for individuals, families, health systems and local and central governments to identify the barriers to people being active and put in place practicalities, environments and support. Is there anything else you would like to add?

Response: If exercise were a drug, it would be the miracle cure.

Disclosures: No funding was involved in this study. SM is an elected council member of the Royal College of Surgeons of England. MM is president of Cera, a social care provider. MG writes books promoting physical activity among older people. Thank you for your contribution to the community.

Citation: BMJ

Focus on physical activity can help avoid unnecessary social care
Scarlett McNally, consultant orthopaedic surgeon, Eastbourne District General Hospital, Eastbourne BN21 2UD, UK
David Nunan, senior researcher, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
Anna Dixon, chief executive, Centre for Ageing Better, London, UK
Mahiben Maruthappu, health executive, Cera, London, UK
Kenny Butler, Health & Wellbeing Lead, UKactive, London, UK
Muir Gray, public health doctor, Oxford University Hospitals NHS Trust, Oxford, UK

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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Last Updated on October 27, 2017 by Marie Benz MD FAAD