Article Text

Download PDFPDF

Leadership in physical activity: is this the currency of change in the student healthcare curriculum?
  1. Ann Bernadette Gates1,2,
  2. Ian K Ritchie3,
  3. Fiona Moffatt4,
  4. João Breda5
  1. 1 School of Health Sciences, University of Nottingham, Derby, UK
  2. 2 Faculty of Sport, Health and Wellbeing, Plymouth Marjon University, Plymouth, Devon, England
  3. 3 Royal College of Surgeons of Edinburgh, Edinburgh, UK
  4. 4 Physiotherapy and Rehabilitation Sciences, University of Nottingham, Nottingham, UK
  5. 5 World Health Organization Europe, Copenhagen, Denmark
  1. Correspondence to Professor Ann Bernadette Gates, School of Health Sciences, The University of Nottingham, Nottingham NG7 2RD, UK; annbgates{at}

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The state of play in healthcare outcomes

Non-communicable diseases (NCD) are the major healthcare challenge for many societies, including those that are more developed. Physical inactivity and deconditioning are inextricably linked to the present and future health outcomes for patients, communities and nations.

This is a changed environment. Traditionally, Western healthcare was focused on curing disease such as infection and cancers. Now, the NCDs are the bigger problem. For this reason, it is imperative that the next generation of healthcare professionals are able to deliver both prevention and treatment services which emphasise the benefits of physical activity (PA).

To do this they must be equipped with the knowledge and implementation skills to provide care and leadership.1 Indeed, given that this is the first generation of society who are expected to outlive their children, this has to be an immediate and transformational community of practice approach rather than the slower, traditional transactional leadership model.

Physical inactivity and sedentary behaviour are well-known risk factors for the current epidemic of NCDs and the consequent problems of immobility, disability and premature death.2 Therefore, it is essential that healthcare students possess the basic facts and the necessary skills to enable them to deliver the best care to patients.

This means that they must be confident, competent and capable in discussing and recommending PA as an intervention. As a bare minimum, students should be aware of the following four critical points:

  • Insufficient PA is a leading risk factor for death worldwide.

  • Insufficient PA is a key risk factor for NCDs such as cardiovascular disease, cancer and type 2 diabetes.

  • Globally, one in four adults is not active enough.

  • The WHO member states have agreed a target to reduce physical inactivity by 10% by 2025.3

This knowledge should supplement the routine use of the UK Chief Medical Officers’ infographics on PA across the lifespan, along with other peer-reviewed and endorsed resources.

Since physical inactivity is having such a major impact on the health and economies of our populations, it makes sense to ensure that healthcare workers are now able to acquire the knowledge, and communication and leadership skills to deliver solutions that will address these lifestyle and healthcare problems.

The Moving Healthcare Professionals Commission

Commissioned by Public Health England and Sport England, Ann Gates and Ian Ritchie visited a sample of medical schools and approached schools of health in England during 2017 and 2018 to identify whether PA was embedded in the undergraduate curriculum. This programme of visits formed part of the Public Health England and Sport England’s Moving Healthcare Professionals Programme.

The Commission visited 16 of 17 English medical schools and approached 83 schools of health through the UK Council of Deans of Health. These visits resulted in a framework for implementation and profiled 15 examples of best practice in implementation.

Leading change

Connecting with leaders in medical education and meeting healthcare students as part of the commission was successful. It is widely recognised that the curriculum needs to be adapted to meet the demands of our populations now and in the future. Collectively, university staff and students have risen to the challenge and have committed to the principle that PA should be part of the undergraduate curriculum. While it is understood that medical and healthcare curricula are full, with little room for additional material, we must face the challenge of changing those curricula if we are to provide a healthcare workforce fit for the future. In taking on these challenges, many English medical schools provided great examples of implementing the benefits of PA into undergraduate teaching, assessment and examination.

The next stage is to develop consistency and sustainability across these educational approaches so that student learning and skills development for PA brief intervention is delivered to an equitable standard across England.

The report acknowledges that PA knowledge and brief intervention skills training is now being delivered in many English medical schools. See online supplementary files 1 and 2 for the executive report, appendices and medical school visit narratives.

The future health of our patients and populations depends on the realisation that NCDs are a real and present danger. PA is a large part of the solution4 and delivers on 13 of the 17  Sustainable Development Goals (SDGs). Therefore, we must equip our future healthcare professionals now with the knowledge, competencies, capabilities and confidence to prevent, treat and manage NCDs and deliver on the SDGs.5 Furthermore, they must be able to advocate for the environment in which weFurthermore, they must be able to advocate for the environment in which we all live and work to become less passive, more m all live and work to become less passive, more mobile and more receptive to beneficial change.

For these reasons it is essential that PA is delivered as part of the healthcare curriculum.

It is inescapable that prevention and treatment of NCDs by PA should be at the very heart of educating tomorrow’s healthcare professionals.

Supplementary file 1

Supplementary file 2


The authors thank all the deans of medicine and health, faculty staff, students and fellow PA advocates in England for their support for the project and their facilitation of a warm welcome at each of the visits. Thanks and recognition are also due to PHE and Sport England for the commission to teach PA to the healthcare workforce. A special mention is warranted for the UK Council of Deans of Health for leading on the work with HEIs. But lastly, we extend our heartfelt appreciation to all the past and present contributors to the physical activity resources, the #MovementForMovement community of practice team of over 40 authors and nearly 30 peer reviewers. We thank Seven Stones Design for producing the reports, tables, figures and the commission infographic for the PHE reports.



  • Twitter @exerciseworks, @fimo18, @JoaoBreda2

  • Contributors ABG and IKR were the main authors and sole providers of work with the report and supplementary information. FM and JB provided editorial review and strategic advice for the editorial content and style.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors. ABG and IKR were commissioned and funded by PHE and Sport England.

  • Disclaimer JB is a WHO staff member. Views expressed here are his own.

  • Competing interests ABG is a member of the World Heart Federation, Emerging Leaders Programme; Honorary Associate Professor, The University of Nottingham; Honorary Visiting Professor, Plymouth Marjon University; CEO of Exercise-Works! IKR is a retired trauma and orthopaedic surgeon and past president of RCSEd, Chair of Scottish Government Health and Social Care Physical Activity Delivery Group. FM is an assistant professor in the School of Health Sciences, University of Nottingham, and a member of the Swim England Wellbeing Committee. JB is head of WHO European Office for Prevention and Control of Noncommunicable Diseases.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The PHE executive report and appendices (supplements) are only available electronically from Public Health England, Nick Clarke, Programme Manager—Physical Activity Adult Health and Wellbeing Team, Healthy People Division Public Health England, 2nd Floor, Zone C, Skipton House, 80 London Road, London SE1 6LH. Email:

  • Correction notice This article has been updated since it was published Online First. A disclaimer statement for JB has been inserted.