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Recent objective evidence from England and the USA suggests that low physical activity is the most prevalent chronic disease risk factor, with 95% of the adult population not meeting the modest physical activity guidelines.1 2 In the UK, the annual cost of physical inactivity has been estimated at £8.2 billion, whereas the annual cost of smoking has been estimated at £1.5 billion,3 alcohol at £3.0 billion4 and obesity at £4.2 billion.1
However, despite this enormous burden on our public health and finances, the relative importance of physical inactivity as a primary cause of many chronic diseases is largely neglected within modern medicine and by health strategy. Surrogate risk factors for disease, such as hypertension, type II diabetes, obesity and dyslipidaemia, receive ample attention in medical education, have incentivised interventions embedded within primary care and are routinely reviewed during visits to a general practitioner (GP). Yet, despite physical inactivity being the most prevalent modifiable affliction and possibly the greatest chronic disease risk factor,5 it is still not receiving the attention that scientific and clinical evidence would seem to merit.
Primary care opportunities
There is a unique structure to general practice and primary care within the UK National Health Service (NHS). UK GPs, who are usually the first point of contact for patients, have a unique position and opportunity to combat physical inactivity and its numerous associated comorbidities. Through the Quality and Outcomes Framework (QOF), GPs are financially rewarded for achieving healthcare targets. Setting up a new QOF point is relatively very cheap, costing approximately £1 million across the UK, and GPs have proved adept at reaching QOF targets.6 GPs are not trained to give lifestyle modification advice, but last year QOF included physical activity for the first time under a ‘cardiovascular risk assessment and management’ indicator. Specifically, 40–70% …
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