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• Sports and exercise medicine education: extending the call to action to the UK
  Ellen L Voute, Dr Jai Mathur
  Published on: 4 November 2020

• Published on: 4 November 2020

  Sports and exercise medicine education: extending the call to action to the UK

  • Ellen L Voute, Medical Student The University of Edinburgh
  • Other Contributors:
    • Dr Jai Mathur, FY1

  We read with great interest the article by Asif et al. (1), and applaud their call to action for education and research in sports and exercise medicine in the USA. We want to extend this call to action to the UK medical education system, where a similar need for physical activity (PA) promotion and development of sports and exercise medicine is needed.

  Similar to the USA, there is poor adherence to PA guidelines in the UK population with only 66% of adults engaging in ≥150 minutes of moderate PA per week, the minimum amount found to produce health benefits (2). PA is associated with many positive health outcomes such as enhanced psychological well-being, cancer prevention and increased brain and cardiovascular health, showing it is an essential and valid way to better the health of the population (3). Furthermore, physical inactivity is associated with 16.9% of all-cause mortality in the UK, affirming the need to control and reverse the inactivity epidemic (4).
  The public view doctors as a respectable source of information, which when coupled with the regular contact they have with the community places them as an invaluable resource for PA promotion in the UK (5). However, in their article, Asif et al. (1) describe how doctors in the USA have not been adequately prepared to provide advice and counselling on PA. It is evident that this inadequacy also applies to doctors in the UK. In 2012, the mean number of hours spent teaching PA science and promotion in UK...

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  We read with great interest the article by Asif et al. (1), and applaud their call to action for education and research in sports and exercise medicine in the USA. We want to extend this call to action to the UK medical education system, where a similar need for physical activity (PA) promotion and development of sports and exercise medicine is needed.

  Similar to the USA, there is poor adherence to PA guidelines in the UK population with only 66% of adults engaging in ≥150 minutes of moderate PA per week, the minimum amount found to produce health benefits (2). PA is associated with many positive health outcomes such as enhanced psychological well-being, cancer prevention and increased brain and cardiovascular health, showing it is an essential and valid way to better the health of the population (3). Furthermore, physical inactivity is associated with 16.9% of all-cause mortality in the UK, affirming the need to control and reverse the inactivity epidemic (4).
  The public view doctors as a respectable source of information, which when coupled with the regular contact they have with the community places them as an invaluable resource for PA promotion in the UK (5). However, in their article, Asif et al. (1) describe how doctors in the USA have not been adequately prepared to provide advice and counselling on PA. It is evident that this inadequacy also applies to doctors in the UK. In 2012, the mean number of hours spent teaching PA science and promotion in UK medical schools was just 4.2 across the whole curriculum, compared to 109 hours spent teaching pharmacology (6). Since then, PA teaching within medical school curricula has slightly improved, but there is still a profound lack of knowledge within student populations. Only 14.9% of medical students at the University of Edinburgh could correctly recall the UK adult PA guidelines and a meagre 10% felt they were adequately trained to give PA advice (7). In addition to the lack of effective PA teaching throughout medical school, there were only 9 training places for sports and exercise medicine within the NHS in 2015 - none of which were in Scotland, Northern Ireland or Wales (8). This is a speciality which has the potential to play a monumental role in safe exercise prescriptions and in the prevention of non-communicable diseases, but the scarcity of training in sport and exercise medicine is creating a barrier for the effective practice and PA promotion of our future doctors.

  We want to extend and expand upon the call to action put forward by Asif et al. (1) to create change within medical school curricula in the UK:

  • Develop and implement physical activity/exercise medicine education curricula in all UK medical schools and increase the number of training places for sports and exercise medicine within the NHS. Comprehensive core exercise medicine and chronic disease modules have been designed for use by medical schools in the UK, but these need to be more widely utilised and embedded within curricula.

  • Build upon and improve research to identify clinical models to promote PA in practice. Research is already taking place for the effective prescription of exercise for the improvement of various conditions. However, there is still vast amounts of work to be done to make this evidence more robust and extend it to be applicable to more population groups. Psychology should be used to construct interventions which appeal to patients, and ensure adherence is maintained (9).

  • Define and expand local, regional and national partnerships that cultivate community resources to promote physical activity/exercise medicine, especially for under-represented minority and medically underserved populations. Social prescribing is a relatively new scheme within the NHS that provides a pathway for healthcare professionals to refer patients to a ‘link worker’. This is a worker that works with local community groups to deliver valuable services to people to improve their health and well-being such as healthy cookery classes, volunteering, exercise groups and art activities - creating a holistic approach to healthcare. The effective partnership between social prescribing and PA promotion in the community is unequivocal, confirming the benefits for its incorporation into medical education curricula.

  • Encourage medical students and doctors to be more active. It is known that more active healthcare professionals promote PA more often, with this relationship beginning right from the start of medical school (10).

  The benefits of PA for health have been well established but the levels of activity in the UK population still remain low. The implementation of this call to action to improve sports and exercise medicine education within the medical education system in the UK will allow us as healthcare professionals to lead the campaign to enhance and improve the health of millions of people.

  References
  1. Asif IM, Drezner JA. Sports and exercise medicine education in the USA: Call to action [Internet]. Vol. 54, British Journal of Sports Medicine. BMJ Publishing Group; 2020 [cited 2020 Oct 22]. p. 195–6. Available from: https://www.
  2. Scottish Government. The Scottish Health Survey. Scottish Heal Surv. 2018;1.
  3. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Scientific Report. US Dep Heal Hum Serv [Internet]. 2018 [cited 2019 Nov 19];1–779. Available from: https://health.gov/paguidelines/second-edition/report/pdf/PAG_Advisory_C...
  4. Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT, et al. Effect of physical inactivity on major non-communicable diseases worldwide: An analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219–29.
  5. Devine P. Northern Ireland Life and Times Survey 2008 [Internet]. 2008 [cited 2020 Jan 15]. Available from: www.ark.ac.uk/nilt
  6. Weiler R, Chew S, Coombs N, Hamer M, Stamatakis E. Physical activity education in the undergraduate curricula of all UK medical schools: are tomorrow’s doctors equipped to follow clinical guidelines? Br J Sports Med [Internet]. 2012 Nov 1 [cited 2020 Oct 22];46(14):1024–6. Available from: http://old.rcplondon.ac.uk/
  7. Osborne SA, Adams JM, Fawkner S, Kelly P, Murray AD, Oliver CW. Tomorrow’s doctors want more teaching and training on physical activity for health. Br J Sports Med [Internet]. 2017 Apr 1 [cited 2020 Oct 22];51(8):624–5. Available from: http://blogs.bmj.com/bjsm/2016/03/27/6726/
  8. West LR, Griffin S. Sport and exercise medicine in the UK: What juniors should know to get ahead [Internet]. Vol. 51, British Journal of Sports Medicine. BMJ Publishing Group; 2017 [cited 2020 Oct 22]. p. 1567–9. Available from: http://www.fsem.ac.uk/
  9. Biddle SJH, Mutrie N, Gorely T. Psychology of Physical Activity: Determinants, Well-being and Interventions. 3rd ed. Abingdon: Taylor & Francis Group; 2015.
  10. Lobelo F, Duperly J, Frank E. Physical activity habits of doctors and medical students influence their counselling practices. Br J Sports Med. 2009 Feb;43(2):89–92.

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  Conflict of Interest:
  None declared.

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