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Regular exercise is beneficial in the primary prevention of disease, and more widely recognised in the secondary prevention of diseases such as colon cancer1 and type 2 diabetes.2–7 All-cause mortality in a standard population over a 5 year period in men has been shown to be reduced by 44% in those taking regular exercise.8
The Department of Health (DH) therefore recommends that an adult undertakes at least 30 minutes of moderate exercise (3–6 metabolic equivalents (METs9) at least 5 times/week. This recommendation has been corroborated by international bodies, and investigated in relation to disease prevention.10–12
Randomised controlled trials have shown that similar benefits, equivalent to exercising for 30 minutes daily in one bout, can be achieved through shorter bouts of 10–15 minutes duration, to a total of a minimum 30 minutes daily.13–15
However, despite the importance of exercise, a study in 2004 found that only 31% of adults in the UK meet the recommended 30 minutes of moderate exercise at least 5 times/week. Within the 16–24 year group this was 43%, and within the 25–34 year group, 44%.16 This rising level of inactivity4 reflects the changing values of society, available facilities and the pressures of modern-day living.
In order to combat this rise in inactivity, doctors are recommended to give patients advice with regards to exercise, but are we practicing what we preach? This is important as there is good evidence that doctors who exercise are more likely to counsel their patients to exercise.17 20
To our knowledge, this is the first study specifically targeting UK junior doctors to evaluate the amount of exercise done according to the DH recommendations, and to compare it with the UK average. We hypothesise that doctors with on-site exercise facilities are more likely to meet DH recommendations than those without, and that those that met the recommendations as medical students, continue to do so as doctors.
Study design and source of data
This was a cross-sectional study looking at 61e junior doctors randomly recruited from two district general hospitals: 30 from Bedford Hospital and 31 from West Middlesex hospital. Of the two hospitals, only Bedford hospital has an on-site gym. Candidates were predominantly foundation year and specialty trainees of either medical or surgical specialties.
The survey obtained information about age, gender, specialty, training grade, smoking and alcohol consumption, weight and height. In the section on personal exercise habits, doctors were asked to indicate the frequency (never, 1–3, 4–5, 5–7, 7+ times per week), duration (0–10, 10–20, 20–30, 30–40, 40+ minutes per session) and intensity (mild (no change in breathing or heart rate), moderate (some rise in breathing/heart rate and mild sweat beading) or intense (heavy perspiration and shortness of breath)) of exercise.
The body mass index (BMI) was calculated (weight (kg) divided by height (m2)) with standard deviation (SD) as error margin. Those that exercised for at least 30 minutes at least 5 times per week, with at least moderate intensity, were deemed to have met DH recommendations.
All continuous data were analysed statistically using the Student t test. Categorical data were analysed with the Fisher exact probability test. The McNemar test was used to compare the amount of exercise done by the same cohort of doctors before and after medical-school graduation. Significance was set a p<0.05. All the national figures for comparison were taken from the Department of Health Survey 2006.
Of the 61 doctors, 32 were female and 29 were male; 31 from medical specialty and 30 from surgical specialties. None had health problems affecting their ability to exercise. The mean age of the participants was 27.4 and the majority were in foundation-year training (FYT 77%, ST1-3 14.8%, ST3+ 8.2%). The mean male BMI was 25.3 (SD 3.7) and female BMI 21.8 (2.3) (table 1). The national average BMI is 26.8 for men and 26.1 for women in the corresponding age group.
The percentages of smokers (6%) and ex-smokers (11%) wer lower than the national average (23% and 24%, respectively) (p<0.05), and 7% drank more than the DH guideline of 14 units for women and 21 units for men per week.
Only 21% (13/61) of the candidates met the DH recommendations for exercise, which is much lower than the national average of 44% (p<0.001) (fig 1). Of the 21% that did meet the recommendations, most, surprisingly, were from the hospital without an on-site gym (10/31), compared with those who did have an on-site gym (3/30) (p<0.05). It is worth noting that 33% of the candidates at Bedford hospital were unaware of the existence of the on-site gym.
In stark contrast, 64% of the same cohort met DH recommendations as medical students, but of this 64%, only 23% did so as doctors (p<0.0001). Of the 79% (48/61) of the candidates that did not meet recommendations, 58% said they lacked time, 29% lacked motivation and 13% said it was due to lack of facilities (fig 2). Interestingly, of the 35 candidates (57% of the total) who had gym subscription, either to the on-site gym at Bedford hospital or elsewhere, only 3 met the DH exercise recommendation. Of the 32 candidates who intended to do exercise but did not, 66% lacked time, 31% lacked motivation and 3% lacked facilities.
This questionnaire-based study, targeted at young UK medical doctors, has shown that those sampled are healthier than the general UK population in terms of BMI, smoking and alcohol consumption, but significantly less so in terms of exercise.
Importantly, a significantly higher number met DH recommendation as medical students, much higher than the national average. The majority blamed lack of time due to work commitments and commutes, and a significant proportion blamed lack of motivation and tiredness after work for this decrease in exercise after their transition to working in the National Health service. Of those who knew of the existence of the on-site gym, or who had a subscription to an external gym, similar numbers blamed lack of time and motivation. Therefore, even doctors with the intention to exercise encounter work-imposed limitations. This study has shown that having any type of gym access, be it on or off site, does not increase the number of doctors meeting the DH recommendations.
The last section of the questionnaire gave an open commentary box, allowing participants to suggest what would improve their concordance with the DH recommendations. A large number suggested health promotion within the workplace, either in the form of allocated time within working hours for attendance at an organised exercise class, or involvement in team sports within the hospital. Given the fact that a third of doctors at Bedford Hospital were completely unaware that they had on-site gym facilities, and the voiced complaints of the medical staff in the survey, it is evident that the workplace has not made awareness of exercise and general health amongst its medical staff a priority. This is very important, not only for the doctors’ own health, but also for the health of their patients. Numerous studies have shown that students and consultant-equivalent doctors who exercise are more likely to counsel their patients to exercise too.17–20 It has also been shown that increased personal disclosure of exercise habits by doctors,19 as well as the amount of time spent counselling20 increases patient belief and compliance with exercise recommendations.
Previous studies have specifically asked the question whether the situation could be ameliorated by somehow incorporating exercise into physician’s lives.17 Our trainees suggest the same.
This study specifically sampled trainees in order to assess whether we are breeding a cohort of doctors who will counsel their patients appropriately. It is quite apparent that current training is failing the trainees sampled, and is likely to adversely affect the way they counsel patients in the future.
The study was limited by its population, which comprised UK trainees at only two hospitals, although the response rate was 100% Consultants and GPs were not included, thus the mean age is very young. Counselling practices could not be assessed due to limited and inconsistent counselling opportunities throughout training.
Competing interests: None.
Funding: This study complied with the Declaration of Helsinki.
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