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Medicolegal neglect? The case for physical activity promotion and Exercise Medicine
  1. Richard Weiler1,
  2. Peter Feldschreiber2,
  3. Emmanuel Stamatakis3
  1. 1Homerton University Hospital NHS Foundation Trust, London, UK
  2. 2Barrister, Medical and Healthcare Law, 4 New Square Chambers, London, UK
  3. 3Department of Epidemiology and Public Health, University College London, London, UK
  1. Correspondence to Richard Weiler, Specialist Registrar in Sport & Exercise Medicine, Homerton University Hospital NHS Foundation Trust, Homerton Row, London E9 6SR, UK; rweiler{at}doctors.org.uk

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Introduction

Whether measured subjectively or objectively, a large proportion of the population are living sedentary and physically inactive lives.1 2 This should be a major public health focus given the overwhelming evidence demonstrating that physical inactivity increases an individual's risk for all-cause mortality and may be one of the leading causes of non-communicable chronic disease in the world, responsible for about 60% of worldwide deaths3,,6 and probably more in developed countries.

Pandemic levels of physical inactivity result in a huge burden of unhealthy consequences within populations and for society, across all socioeconomic classes, all ethnicities and phenotypes.

However, attempts to explain the precise causes of chronic diseases and resultant deaths, for each individual, are very difficult. We are all exposed to multiple risk factors in variable quantities throughout our lives and, currently, these are virtually impossible to measure. Consequently, despite our remarkable growth in the medical field, explanations for precise causes of death remain speculative. To attribute causal status of risk factors for non-communicable disease is fraught with difficulty both clinically and medicolegally. For example, it is baffling that despite scientific progress since Richard Doll's landmark findings 60 years ago, strongly linking smoking with lung cancer,7 causation of smoking and lung cancer has still not been upheld in a court of law.8

Duty of care

Duty of care is a legal obligation imposed on a doctor requiring, via the Bolam test,9 that their actions conform to those of a responsible body of professional opinion, even if others have a different opinion. More recently, the Bolitho v City and Hackney Health Authority case, entitled a judge to choose between two bodies of …

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