The Royal College of General Practitioners has made physical activity and lifestyle a clinical priority for GPs. Dr Zoe Williams, one of the project’s clinical champions – and a former TV Gladiator – tells Kate Cracknell how this will work, and why it’s so important

You’re a practising GP, but you’re also a TV doctor. With this access to the public ear, what are the key messages you try to get across?
Hippocrates had it bang on when he said: “If we could give every individual the right amount of nourishment and exercise – not too little and not too much – we would have found the safest way to health.”

I try to remind people that our health is predominantly in our own hands. Though we’re privileged to have access to the wonders of modern day medicine, this is no substitute for healthy lifestyle – both diet and exercise – when it comes to disease prevention, disease treatment and general happiness and wellbeing.

You collaborate with PHE on its ‘Everybody Active, Every Day’ framework. How can that framework be translated into a compelling message that gets people moving?
One in six deaths are caused by inactivity, which we categorise as doing less than 30 minutes of moderate intensity physical activity each day. That’s as many deaths as are caused by smoking!

Rebranding ‘exercise’ as ‘physical activity’ and discussing how walking, cycling and even everyday chores can count makes being active seem much more achievable. Breaking physical activity down into 10-minute bursts can be more acceptable to people too, especially when they’re starting out, rather than aiming to be active for 30 minutes at a time. #10minutebursts

How do we drive the preventative healthcare agenda when there’s still such a heavy a reliance on drugs?
Drugs aren’t going anywhere and that’s a good thing – there’s certainly a place for them in our healthcare system. However, I firmly believe that lifestyle advice should exist wherever there’s a drug that could be prescribed.

At each patient contact where a drug is discussed, prescribed or issued, healthcare professionals should also be delivering brief advice about lifestyle, be it physical activity, diet, alcohol, smoking or stress control.

The NHS has adopted the ‘Make Every Contact Count’ (MECC) approach, as have many other organisations including local authorities and those in the health and fitness industry. MECC is an approach to behaviour change that uses the millions of day-to-day interactions organisations and individuals have with other people to support them in making positive changes to their physical and mental health and wellbeing. You can find more information here: www.health-club.co.uk/mecc

How important is physical activity in delivering your vision of preventative healthcare?
Physical activity is at the epicentre of health and wellness and is often the first step for individuals in their journey towards a healthier life. Becoming more active can have immediate, as well as longer term, improvement in symptoms, mood and wellbeing. It’s also been shown to reduce the likelihood of other harmful lifestyle choices, such as smoking.

The RCGP has made physical activity and lifestyle a clinical priority for GPs over the next three years.

What does that mean in practice?
The overall aims are to provide the primary care workforce with focused, reliable, evidence-based information to prevent and manage lifestyle-related diseases.

This will be achieved though research into the barriers that prevent GPs from promoting physical activity – we will review current literature and guidance to ensure GPs have access to a set of agreed, evidence-based guidance and tools. There will also be health promotion and disease prevention strategies, and new materials developed for patients and commissioners.

We’ll seek to involve GPs in decision-making around how best to implement changes. In fact, one our first tasks will be engaging with GPs via a questionnaire.

How else can we overcome GPs’ reluctance to promote physical activity to patients?
Public Health England – as part of its ‘Everybody Active, Every Day’ strategy – provides a free training package to GPs, as well as to hospital doctors, nurses and midwives. I’m one of a team of GP clinical champions delivering this training, which is available across England.

For further information about the PHE clinical champions, or to book a training session, please email: [email protected]

How do you inspire your own patients to get active?
Sometimes it’s as simple as ‘giving them permission’ to do so. Some patients just need to hear that being active is safe and a good thing to do.

It may seem obvious to some of us, but a diagnosis such as hypertension can, for some, lead to a lack of confidence and concerns that exercise may not be safe. This can be exacerbated if they’re asked to complete forms which highlight certain conditions, such as high blood pressure, as potentially meaning it’s unsafe for them to exercise. I’ve experienced patients being completely put off and alienated from exercise due to this.

Explaining that physical activity actually forms an important part of managing their medical condition can have a hugely positive impact. I also find out what the patients’ own motivations are, as well as what they enjoy or have enjoyed in the past. Finally, I help them break down whatever barriers are standing in their way by adopting a motivational interview style in my consultation with them.

Is there a role for gyms?
Of course. Fitness centres have the facilities, the staff/expertise and the experience to help people be more active. GPs see far too much of the same people – and these are precisely the people fitness professionals should be seeing more of.

Working in partnership will be key to redressing this balance – and I’ve seen good examples of such partnerships where the gym offering has been taken into the GP surgery. This can help patients overcome the fear of ‘the gym’ and helps GPs become more engaged and involved.

Walking groups initiated from the gym or GP surgeries are another great way to introduce inactive people to exercise – and to fitness professionals.

How much of a credibility issue is there – will GPs ever see fitness providers as true partners?
There may be a general perception that there are credibility issues when it comes to the regulation of the fitness industry and the variation in training of fitness professionals. Exercise and dietary advice can vary and conflict from professional to professional. However, in my experience, GPs are happy to refer patients into ‘exercise on referral’ schemes run by REPs Level 4-qualified professionals.

I recognise that building stronger links between GPs and local physical activity initiatives and providers is key, especially with the current enthusiasm from the health and fitness sector to work with those who are inactive or affected by disease. However, it’s important that messages being shared with patients – from both healthcare professionals and fitness professionals – are consistent. We need to look at ways to ensure this is delivered moving forwards.