We must push back immediately and lobby to have physical activity – with its proven health benefits – reinstated on the QOF

The campaign to present exercise as medicine has been delivered a blow with the removal of physical activity from the QOF (Quality and Outcomes Framework) – see p10.

There was huge excitement in the sector when, in April 2013, physical activity was added to the QOF – a voluntary scheme that rewards GPs for patient care – for the treatment of hypertension. This had been a primary policy objective for ukactive and the hope was, as CEO David Stalker said at the time, that it would be “just the beginning of an opportunity to embed physical activity across a wider range of indicators for the management of chronic conditions”.

In the months since that decision, the scientific argument for viewing exercise as medicine has only strengthened. Let’s take just one example: a report published in the October issue of the BMJ – a title which has as its strapline ‘Helping doctors make better decisions’ – which showed that exercise can be as effective as many frequently prescribed drugs in treating some leading causes of death.

The report analysed 305 previous studies to compare the effectiveness of drugs versus exercise in lessening mortality among people with one of four diseases: heart disease, stroke, diabetes or chronic heart failure. For the first three conditions, the risk of death was the same – or lower – if patients exercised than if they took drugs. Only in cases of chronic heart failure were drugs noticeably more effective than exercise.

And it’s not as though we were lacking evidence before that: statistics commonly quoted within the fitness industry include the fact that chronic inactivity shortens a person’s lifespan by up to five years and is responsible for 17 per cent of premature deaths in the UK (The Lancet); that 37,000 deaths in England could be prevented each year if everyone were sufficiently active (Public Health England); and that physical activity is the fourth leading risk factor for mortality around the world (WHO).

Yet in spite of these – and many more – proven health benefits, physical activity will be removed from the slimmed-down QOF which comes into effect in April. Why?

Some GPs have blamed bureaucracy, seeing QOF as a time-consuming, box-ticking exercise. But the fact remains that, even in a slimmed-down QOF, interventions that are proven to work should remain in place. All of which suggests that GPs remain unaware and unconvinced of the benefits of exercise.

We’ve made some inroads: ukactive’s Let’s Get Moving initiative, for example – which places exercise professionals within GP surgeries as part of an integrated team (see HCM May 13, p22) – has been praised by leading health charity The Kings Fund.

Meanwhile, establishments such as the Institute of Lifestyle Medicine in the US (see HCM Sept 13, p80) are pushing the education agenda – something the UK must mirror, as without opening GPs’ minds to exercise, our efforts will continue to hit a brick wall. Driving awareness and understanding will be key.

But above and beyond all of this, we as a sector must push back immediately and lobby to have physical activity – with its proven health benefits – reinstated on the QOF.