Hello and welcome back to my weekly wellbeing round-up! This week’s post from the world of wellbeing focusses on what we should be doing more of, what we could be doing less of, and where the evidence isn’t quite so clear. Sufficiently intrigued? Good…let’s dive in!
I thought I’d start with a nice easy one. No surprises here. Sport England have published their first activity survey for children and young people (2017-18). It reveals that one in three children in England does fewer than 30 minutes of physical activity a day – half the amount recommended by government guidelines (60 minutes a day, 30 in and 30 out of school). Girls are less likely to be as active as boys, with 13 to 16-year-olds the least active age group. This correlates with the findings of this study which looked at the dropping levels of physical activity by age, identifying a key age of 11 after which physical activity may drop off more sharply.
This week the Health Survey for England (2017) was published by NHS Digital. The scale of the challenge we face individually and collectively is sobering. Five key risk factors for health were identified as physical inactivity, obesity, drinking more than 14 units a week of alcohol, smoking and eating less than five portions of fruit or vegetables a day. Headline stats include:
- 68% adults are overweight or obese
- Children who have obese parents are three times more likely to be obese than children of healthy weight parents.
- Less than 20% of children eat five portions of fruit and veg a day
- 19% of adults had three or more out of the five risk factors for health
- 90% of adults had one or more of the five risk factors for health
So when and how should we address this challenge and who is responsible for doing so? My answers are as early as possible and everyone. As humans, we are made to move. Before we had chairs we walked, we ran, we stood, we squatted and we sat on the floor…something that now seems “unnatural” to many of us. In my opinion, to sit still should be seen as an unnatural exception to the norm, necessary for a few hours of the day only for certain work and social activities that can’t be easily done standing or on the go. When parents are worried about their ill child, one of the most common things they will say is that their child is quiet, sitting on the couch and not moving around freely like they normally do. It’s a sign something is wrong. When kids go to school, they are expected to sit still in a chair for hours at a time and get told off if they move around.
Clearly I’m being deliberately provocative here, but I’m trying to make the point that to address the considerable challenges we have largely made for ourselves as a society in pursuit of a life of convenience, we need to flip this situation on its head and establish a new norm. As parents, we should not just be encouraging our children to spend more of their time physically active but modelling it too them as well. If we tell our kids to turn off the games console and “do something”, as we sit slumped on the couch, we should be unsurprised if they are unconvinced.
We need to choose to live lives that at times are a bit less convenient. This could be choosing to walk up and down the stairs more at home or at work, not taking the lift, walking or cycling to the shops/school/work, getting off a stop or two early from the tube or bus, taking short breaks to walk around and stretch our legs at work, using standing desks or having standing meetings. I can guarantee it would make the latter considerably shorter and more focussed! This year I’m going to get a standing desk for work and offer my patients the choice of standing or sitting when we consult. A number of my colleagues have already done this and found that it works well for them and their patients.
It may be that you feel some of these options are realistic and some not…that’s fine, we are all individuals in unique situations at home and at work and there are always simple opportunities for us to become more active. Interestingly, one of the common findings from looking at the world’s blue zones (where people have unusually long life expectancy and good health) is that the communities are generally active but in a modest and gentle way – walking for an hour a day, for example. There aren’t many gym-bunnies or HITT practitioners amongst the centenarians of Okinawa.
Statins for primary prevention.
I need to make a confession. When NICE dropped the threshold for recommending prescribing a statin for primary prevention (preventing heart disease or stroke in people who have not yet had one) from a risk score of 20% to 10% in 2014, I felt profoundly uneasy. To put this simply, GP’s were effectively being advised to treat every man over 60 and every woman over 70 as being diseased and statin-deficient, requiring a drug to lower their cholesterol. This felt instinctively wrong to me.
According to the NNT (numbers needed to treat) website, taking statins to prevent these things happening does not make you less likely to die as a result. 217 people need to take statins for one person to avoid a (non-fatal) heart attack and 313 people need to take statins for one person to avoid a (non-fatal) stroke. For every 21 people who take statins, one will experience muscle pain and damage and for every 204 people who take statins, one will develop diabetes. As a result of all of this, I do have conversations with my patients about the NICE guidelines, the issue of medicalising the ageing process, and the risks and benefits of statins for primary prevention. I offer them the drugs. The majority decline and we usually agree to them making some lifestyle changes and to have the conversation again in a few years’ time.
The findings of this study into the use of statins for primary prevention, published in the BMJ, suggest that the current NICE threshold for offering treatment is too low. For men and women over 70, benefit seems to occur in those with a risk score > 20%, and for people in their forties, benefit seems to occur from a risk score of 14% or more for men and 17% or more for women. I am greatly encouraged by this. It’s always nice to have some actual evidence to back up gut-based practice!
Arthroscopies for meniscal (knee) problems
This study looked at exercise therapy vs arthroscopy (inserting a camera inside the knee joint) for degenerative knee problems in middle-aged patients. The conclusion was that exercise was at least as good a treatment option as surgery. My question would therefore be – why would anyone opt for an invasive hospital procedure with the associated risks of complications including infection? It does of course does depend appropriate advice and support being given re exercise. Just like physical activity is available on prescription in the community, it needs to be taken seriously by hospital specialists, motivated primarily by the best outcomes and least risk for their patients. It’s important that all health professionals in whatever setting, community or hospital, are either knowledgeable about what advice to give or can signpost to someone else who can.
As promised this week, I’m finishing off with something a little less clear cut. Regular readers of this blog know that I’m a big fan of sleep and have made some changes to my lifestyle as a result of learning more about it. If you haven’t read it yet, I recommend for your christmas stocking the excellent Why We Sleep by Matt Walker. One of the questions that my patients and colleagues often ask me is – how much sleep do we need? This study looked into sleep duration and associations with death and major cardiovascular events. Six to eight hours per day was associated with the lowest risk of deaths and major cardiovascular events. Daytime napping was associated with increased risks of major cardiovascular events and deaths in those with more than six hours of nighttime sleep but not in those sleeping less than six hours. My interpretation of this is if you are sleep deprived a nap is a good thing, whereas excessive daytime sleepiness in people who are already sleeping quite a lot at night may indicate possible underlying health issues causing these symptoms. This would also potentially explain why increased risk was also associated with sleeping more than nine hours at night.
That’s almost all for this week. I wanted to finish with some podcast recommendations for you. I cycled an hour each way to work one day this week and one of the great things about that (other than the benefits to my wellbeing, of course!) was that I got to catch up on my listening and fill my brain up a bit more. They have both inspired me in the writing of this week’s post.
My first recommendation is TED Radio Hour, the Fountain of Youth. It’s all about the secrets of ageing and longevity and what we can learn from studying the blue zones.
My second recommendation is episode 39 of Dr Rangan Chatterjee’s Feel Better Live More Podcast, entitled How to Stay Pain Free with the Foot Collective. It’s all about how we are made to move, and should do so as naturally as possible. It’s about much than just feet!
I hope you have enjoyed reading this episode of the weekly wellbeing round-up as much as I have putting it together. It will, of course, return. Until next week, take care of yourself!
Dr Richard Pile