HOME NATIONS 100KM CHAMPIONSHIPS 2015

Only 90km to go!

There are many reasons we run. It might be to keep fit, it might be to get the happy hormones going, and in addition I often use running to go somewhere new and for the buzz of competition.

The Anglo-Celtic Plate/ Home Nations 100km Championships 2015 was the chance to pull on a Scotland vest, work as part of a team, and test yourself against the clock, and the other Home Nations athletes. In 2014, the race had taken part in Kent, England where Scotland came 2nd in the team competition, and I ran 7-22, for 2nd in the Scottish Champs and 5th in the UK individually. Last year I felt as if I still had a quicker time in me, having had a hamstring issue, and it being a hot day.

But 2015 has been good to me, with Jennie and I having been joined by baby Nina, an expedition to Namibia, illness, and a hectic work schedule meaning – in short that I was absolutely miles short of the training I needed to do to be truly competitive this year.

This being the case, and having not raced in 2015 I had no idea how quickly to set off, in the picturesque village of Redwick, Wales. I set off with the group on 7 hour pace, some of the guys that I had run with last year, but with my lack of training and windy conditions after 12 km I backed right off, recognising this would be a 1 way ticket to destruction. So I ran the 100km pretty much solo, being wonderfully supported at each aid station by Scottish Athletics Val MacAuley, Craig Stewart, Lorna McMillan, and Noanie Heffron.

Ross Houston

 

Heading towards the finish, I knew that Scotland team mate Ross Houston had won the event in 6-43, the fastest time in the world this year- truly remarkable given he ran solo and with the windy conditions. Despite being almost an hour behind Ross, I was pleased to get the job done in 7-41, enough for 2nd in the Scottish Championships (having overtaken Grant Jeans at around halfway), and 6th in the Home Nations Champs.  Although my time was down on last year, due to various factors it was the absolute best I could do on the day, feeling I was having to dig deeper than a JCB for the last 20-30km. Grant MacDonald, a good friend who remarkably had fully recovered from a brain haemorrhage last year (not at the race) took 3rd in the Scottish Champs, and brought us home for 2nd in the team competition. England brought 5 very strong athletes, and there was no catching them.

The even better news for Scotland was in the ladies competition where Rosie Bell (2nd Overall in less than 9 hours), Charlotte Black, and Keziah Higgins clinched the title.

Triumphant Scotland Women's Team

A huge thanks first of all to Jennie and Nina for allowing me to do some training, despite the fact I am at work and abroad quite a bit. I’m looking forward to taking my girls on holiday next week. Also to my coach Donnie Campbell, Scottish Athletics endurance manager Adrian Stott for their sage advice and motivation, and to our fantastic support crew led by Val in Wales. A massive thanks also to Merrell UK, and my other sponsors for their unwavering support, and excellent equipment.

I am not sure where I will race next, but it will not be for at least 5 weeks. I feel like the tin man this morning.  Challenge wise, we have also found an absolutely outrageous possibility for early 2016, where access by vehicles is very difficult, but local packs of huskies are able to provide a support infrastructure.  More to follow.

Andrew

Merrell UK

UK PARLIAMENT RECOGNISES MAJOR ACTION NEEDED ON PHYSICAL INACTIVITY

I remember when en route running to the Sahara desert feeling a little ashamed. I had been a doctor for about 6 years, but ironically (given that I had just a 4300km run to the Moroccan desert) had not grasped just how good exercise is for health.  I had not been communicating this to my patients prior to this time

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Simply put regular exercise gets the happy hormones going and makes you happier. It also helps prevent and treat about 40 major diseases like type 2 diabetes, heart attacks and dementia (although athlete’s foot is more likely).

Worldwide (with a few honourable exceptions including Western Australia and Brazil, policy makers have been burying their head in the sand and hoping that the problem of physical inactivity would go away. This is consigning our children to a darker economic future than is necessary (type 2 diabetes costs the UK NHS £1million per hour) and stopping people be as happy and healthy as is possible.

So the report produced by the UK Parliament Health Committee is welcome, and highlights that major action is needed. I do think in Scotland more has been done, but we need to increase the pace and scale of what is happening.

http://www.parliament.uk/business/committees/committees-a-z/commons-select/health-committee/news/activity-diet-health-substantive/

http://www.publications.parliament.uk/pa/cm201415/cmselect/cmhealth/845/845.pdf

Here are a few really useful concrete recommendations from the Scottish Academy of Royal Colleges on what the NHS could do, which I contributed to in my role with the Royal College of Physicians and Surgeons of Glasgow.

http://www.rcpsych.ac.uk/pdf/SA%20Position%20Statement.pdf

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BLOG- KEY KIT FOR RUNNING THE DESERT

Running with the seals (DigitalPict Photography)

It would be a lie to say that the running is the easy bit, but the most common questions I get asked after running say the Namib, the Sahara, or in the Namib desert is around kit, and specifically being a doctor, around medical kit.  Here are the lightweight things that I carry, and maybe of help during for example to Marathon des Sables or other races and events like this.

  • Footwear

Running day after day in the desert, your feet swell up.  I use a pair of shoes ½ a size bigger than my standard shoes.  For a lightweight shoe that is comfy and has a bit of grip, I use the Merrell All Out Rush

  • Sandgaiters

Having worked at many desert ultras as well as raced them, if you are racing on sand, do not leave home without sandgaiters. These prevent sand getting in your shoes and causing blisters.  The best on the market by far are “Sandbaggers Gaiters” made with parachute silk.  Stitch these into your shoes rather than glueing, as the glue will melt in the heat.

  • Clothing

The key thing is to have clothing (including socks) that are lightweight and wicks moisture away from the skin keeping blisters and overheating down to a dull roar. Some clothing has the additional bonus of sun protection. I use the Merrell clothing range which suits me perfectly

 

  • Sunscreen

Do not skimp on this. Buy high factor sunscreen that stays where it is when you sweat, and only needs applied once or twice a day. P20 has never failed me, while Himalaya is great also

High in the dunes (DigitalPict photography)

  • Blister Kit

The largest study of blisters in ultra-runners showed 85% of competitiors got blisters. This number would probably be even higher in the desert. So take some Sterets to clean the skin, some sterile needles to pop the blisters, (pop at the lowest point, squeeze fluid out, and leave to dry until the morning), and zinc oxide tape to put over the blisters in the morning to prevent them getting worse

  • Vaseline

Stick small amounts of this in the areas you are vulnerable to getting chafing

  • Hand Sanitiser Gel, and toilet paper

Use the hand sanitiser as directed, to cut down the prospects of getting diarrhoea nad vomiting, one of the most common causes of medical withdrawal from races.  Drink bottled water, and avoid foods that look dodgy.

  • Med Kit

Paracetamol, 2 tablets 4 times a day is good for pain.  NSAIDs (anti-inflammatory meds like brufen and voltarol) should not be taken for endurance running. There is a risk of stomach ulcer, kidney failure and other badness. Lyprinol likely has anti-inflammatory actions and I take (batch tested) version of this to combat this.  Immodium/ loperamide is worth carrying in case diarrhoea and vomiting does occur

  • Fuel

Like a car, if the human body is out of fuel, it will not go anywhere.  Small amounts of carbohydrate taken regularly in any race longer than an hour boost performance. I use Science in Sport gels, and carbohydrate and electrolyte powder, whilst post exercise REGO helps by providing carbohydrate to replace used up stores, and protein to repair damaged muscles

  • Ear plugs

These and eye masks help sleep on flights, as well as in noisy tents. Well worth the 6 grams

Sandbaggers gaitersRunning with the Seals
All Images by DigitalPict Photography

BLOG- SHARED LESSONS WITH THE TOPNAAR TRIBE

A huge part of travel and adventure for me is about learning.  Trips to Kenya have helped me understand more about what leads to elite performance in running, whilst Mongolia brought it home to me that happiness is more important than having things.

Utusib clinic

Namibia has a few of the same challenges as parts of Scotland (including a remote and rural locations), and is doing a great job of increasing life expectancy at more than half a year, every year at the moment.  We all also wanted to know more about the oldest desert in the world, and it’s stories and traditions.

We also had the chance to share some vital medical diagnostic equipment donated by the Royal College of Physicians and Surgeons of Glasgow, shoes and athletic equipment donated by Merrell UK, and cycling enthusiasts, and other gifts from Bert Jukes and his team.  Chief Kooitjee of the Topnaar tribe, his top team and the local medical team, as well as the Mayor of Walvis Bay and the divisional Health Minister shared pearls of wisdom, as well the challenges they face with us.  This is the start of a relationship, that with the support of many in Namibia and back home can achieve lasting change.

Royal College Physicians and Surgeons Medical Supplies

Both the athletic  equipment, and medical equipment was extremely well received.  In fact we were honoured to receive the first Topnaar Tribal Appreciation Award given to those outside Namibia- a huge honour.  We had some great discussions about the value of sport and physical activity both in the community and nationally, and thoughts on how this can be achieved.  The numerous pairs of trainers, and huge amount of clothing from Merrell and others will help support the Topnaar schools and athletics groups, whilst they had a highly impressive cycle team that will benefit from donations received.

football shirts and Merrell shoes

 

 

 

 

 

 

 

We really enjoyed hearing about training and education opportunities for the local health care workers, and discussions are ongoing as to how this can be further assisted.  The clinics we saw had fantastic staff, that the donations from the Royal College of Physicians and Surgeons of Glasgow, and many other groups and individuals drew praise from, while the Health Minister present also expressed her delight at the help received, and opportunities for the future.

For us, to have the chance to eat, sing, and dance, as well as learn and share with new friends from Namibia was a highlight of the trip- and we are so grateful for the generosity of others in helping us with this

Children and Topnaar bike team

BLOG- RUNNING ACROSS THE NAMIB- PART 2 OF 2

Genuine challenges are always a roller coaster of emotion.  Both Donnie and I reflected upon what it would take to get us to the finish.  The first 3 days had proved we could have absolutely every confidence in our support crew.  Their route finding had been superb and we had been kept well stocked up on food, sun cream and anything else 2 men traversing the Namib desert could ever want.  We probably needed to conserve a bit more energy, by covering good distance, but running slower, and we needed not to think too far ahead.  Breaking the challenge down 10km by 10km, and day by day would keep anxiety about the scale of the challenge down.

chameleon

In good spirits we set off again through the dunes on day 4, trying to avoid having to go over every dune by hitting the cols, and using the sand valleys between the dunes where possible.  This made progress a lot easier.  Having run in deserts including the Sahara and the Gobi, I must admit I had not expected the Namib to be so hard.  It is partly the size of the dunes, but also the fact that everything in the Namib desert is sand, and heavy sand to run through.  Running races like the Gobi Challenge, the Sahara Race, and Marathon des Sables usually at least half of the course is a more runnable hard sand, or rocky terrain but this just wasn’t. But after a few days our bodies were settling into it, and we knew that the second half of the challenge would feature some beach that although sandy is a good deal easier than dunes.  I felt after day 4 we had at least a 50/50 chance of getting it done>

 

A suprising feature of the Namib is the plethora of wildlife.  This is due to it being coastal, and although it on average receives the least rain of any desert, a fog in the morning from the sea sometimes rolls over bringing moisture.  The next 3 days allowed us opportunities to run past seal colonies (we even went for a swim with the seals), as well as spotting chameleons, giant spiders, antelopes and the tracks of hyena’s and sidewinder snakes on incursions inland. There was also the bizarre sights of various shipwrecks, some well inland, for example the well preserved carcass of the Edward Bohlen, a 1907 ship marooned in the desert showing that the desert is alive and moving week by week and year by year.

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With covering these distances there were issues.  Donnie and I both ate a fair bit of the sand blowing in our face, Donnie had sand in his eyes, and my back totally seized up one day leading to an uncomfortable time at the end of day 5 unable to move for half an hour.  But we were getting there, and thanks to the expert route finding of our Namibia hosts we thought we could emerge from the desert a day early, on day 9 rather than 10, allowing an extra day for community work.

 

So with the hammer down we progressed over salt flats, dunes, and the coast on day 8.  As we were within 100km of Walvis bay, flamingos greeted us regularly, and on another occasion we were hemmed in by 300kg of Oryx, a huge antelope with massive straight horns that have been known to kill lions. That evening was one for celebration.

Dune Running

We had only 55km to do on the last day, over manageable terrain, which we knew would be a formality. So relaxed were we that we staged an impromptu game of golf over the sand dunes before setting off.  With sand valleys of 300 metres, good scoring proved difficult, but it was a grand warm up for tanking the last leg into civilisation.  Apart from our tight knit group, we had seen no humans at all during our time in the desert, so seeing Chief Kooitjee and members of the local Topnaar tribe welcoming us to Walvis bay was special.  Any finish line is great, but one with a pint of beer and the promise of a shower is even better.  It was a great moment that we shared, expeditions like this are just not possible without expert help, and having Jurgens, Hein, Len, Paul, Wossy, Percy and Luciano, as well as Dave, and our fantastic documentary team Brian and Gayle of LittleBigShot productions, and Jonny Graham of DigitalPict the expeditions professional photographer.  Donnie deserved more beer than me.  He had put up with my whining about my back and various ailments and stayed strong throughout.  When he was asked by a newspaper if he had thought of giving up he simply said “I was in the marines. So no”.

At the end of the Namib Desert

The 2 days after allowed opportunities to share experiences and assist locally with community work. More about that in the next blog, but we did also raise a glass to Bert Jukes, who both through himself and Lyprinol UK had unswervingly supported the expedition, and to Merrell UK, who as ever had supplied top quality kit not only to myself but to support local athletic projects.

BLOG- RUNNING ACROSS THE NAMIB- PART 1 OF 2

3 months ago legendary Scottish Expedition organiser David Scott (of Sandbaggers) sent myself and Donnie Campbell 3 pictures and a short email. “Run Across the Namib desert- some parts have not even been explored properly, here are some photos, sore feet and adventure awaits”. The pictures showed variously the desert night sky, a sea of massive sand dunes, and a ship wreck marooned in the middle of the desert. Pictures trump 1000 words. It looked incredible. Sold.

Shipwreck

Shipwreck in the dunes

By far the hardest part of an adventure is the planning. Funding and support for the expedition was quickly secured from Scottish entrepreneur Bert Jukes of Lyprinol UK, a great believer in pushing boundaries and breaking new ground. Special permits were required to access the desert, and applications made to tribal chiefs to secure access to parts of the park rich in diamonds that have not been accessed.  Accurately planning a route would be impossible, but knowing roughly where we were going, and what to take would be key.  Dave and his Namibian partners took care of the majority of this, but each email looking at vehicles, equipment and logistics had my mind drifting to the dunes.

 

Flying into Luderitz is an amazing experience in itself. Sand stretches as far as the eye can see, dunes rearing up to 400 metres high bringing home the severity of the conditions we would face. Getting off the plane, it was roasting hot, and we talked nervously awaiting our bags.

blisters

Dave, had brought on board Live the Journey, a quality Southern African outfit that knew this area better than anyone else, having received expert assistance from members of the Topnaar tribe, and it was highly reassuring meeting the team in country.

Setting off directly towards the dunes got the butterflies going in the stomach.  Dave had warned us that the desert can kill you in a day if you let it, and the heat even at 0830 was oppressive. The first day took us 62km over unexplored diamond areas, swooping over ridges, and battering through sand under the watchful eye of the local wildlife including jackals and Gembok.  The following day was another long shift what felt like wading through heavy sand for another 60+km day, ending high in a dune system with a view of the sea and abandoned mining quarters.  The view was stunning, and I should have been elated, but I was not. My “tank” already felt more empty than it should have done, feeling more like having run 110km a day.  My hip flexor was tight, and my left big toe was already just one big blister.  Another 8 days like this seemed impossible.

 

But time brings perspective, and experience is a great teacher. I recalled being in hefty trouble during previous events, having Achilles tendons that looked like sticks of rhubarb 5 days into running from John O’Groats to the Sahara, and starting the “7 ultras of 7 continents in under a week” with heavy blisters having competed in the Antarctic Ice Marathon hours before.  All I could do was to do the right things consistently, and expect things to improve. If they didn’t, they didn’t.

Day 3 as Dave had promised was a straight path though some of the highest dunes in the world. Significant forward progress takes time, over the most aggressive of the dunes, the maximum we could crank out was 3km and hour, and the support trucks were frequently having to tow each other out.  But move forward we did, and the excitement of the sheer scale of the landscape dulled the pain temporarily as we camped for the first day in the Devil’s Workshop at the end of day 3

PRESS RELEASE- RUNNERS COMPLETE EPIC NAMIBIAN DESERT CROSSING

UK runners Dr Andrew Murray and Donnie Campbell have successfully completed a  first – running across the Namib desert from Luderitz to Walvis Bay, Namibia.  The challenge was set three months ago by Scottish Expedition organiser David Scott, and supported by Lyprinol UK.  The record breaking run crossed the highest sand dunes in the world including the formidable ‘Devil’s Workshop’, in punishing conditions with the pair running over 50km every single day, completing 504.1km in total almost entirely on punishing heavy sand, and crossing the finish line on day 9 of the expedition, at 1430 on 10th February 2015. The pair are no strangers to racing in extreme conditions, with Murray having completed an epic 4295 km run from north Scotland to the Sahara desert, and won races at the North Pole, Antartica and Outer Mongolia amongst others, while Campbell, a former Royal Marine Commando completed a 184 mile run from Glasgow to Skye without sleeping.

Near the start at Luderitz

Speaking from Walvis Bay, Aberdonian Dr Murray 34, of Merrell UK said

“The Namib desert is, hands down both the most spectacular and gruelling place I’ve run in.  Every step through the sand was energy sapping, and my feet are destroyed with blisters.  We were in hefty trouble even after 2 days, but our support team and the incredible views got us to the finish. There were times every day I felt like stopping, but taking on many 300 metre dunes, passing shipwrecks miles inland, and seeing the suprising plethora of wildlife were particular highlights.  We don’t advise everyone to run through the Namib, but would like to promote the value of exercise. Even 30 minutes of walking 5 times a week helps you live on average 7 years longer.”

Edinburgh resident Donnie Campbell, 30, added

Running 500 odd km though the Namib desert was extremely tough and we could not have done it without the expertise of our expedition leaders David Scott, Bert Jukes and the support and superb local knowledge from the team in Namibia.  Their route selection was incredible considering no one has ever driven parts of the route never mind ran it, so this was a huge them effort to deliver Andrew and myself to Walvis Bay a bit battered, bruised and tired but still in one piece. We even ran through abandoned diamond mines, although my fiancee Rachael will be disappointed to learn I couldn’t find a big one ahead of our wedding next month!”

David Scott, from Glasgow added

“Three months ago I challenged Donnie and Andrew to deliver a World first – to run from Luderitz to Walvis Bay across the mighty Namib Desert, supported by a joint Scottish, South African and Namibian safety team.  As expedition organiser I was faced with huge logistical and safety concerns which we tackled as team and overcame to a successful and, more importantly safe conclusion.   The physical demands we placed on the guys were immense and throughout the challenge we were never certain we would emerge successful.  Apart from seeing the guys cross over the finish line my lasting memory will surely be having the privilege of tackling terrain through special concession areas which had never been driven (or run) over before.   We are indebted to Bert Jukes and Lyprinol for believing in this expedition, and supporting it from the outset.  I am also indebted to our excellent African partners Live the Journey
Near the Finish pictures
and the Topnaar tribe for allowing us to pass through their stunning desert.’

Following the run, the team are now engaged in some community work and the sharing of medical and athletic equipment, and education in the Kuiseb river region with Chief Kooitjie and the local Topnaar Tribe, the custodians of the Namib desert work supported by the Royal College of Physicians and Surgeons of Glasgow, Lyprinol, and Merrell UK.

 

PHYSICAL INACTIVITY POISED TO BE TAKEN AS SERIOUSLY AS SMOKING

A group of FIFTEEN, of the leading medical organisations in Scotland, have produced a report calling for the NHS to take major action on physical inactivity, and urging a series of sensible, concrete, and wide ranging actions.

The Scottish Government have welcomed the report, and will look at the recommendations which I think will lead to lasting change and improvement. Credit to the Scottish Academy of Medical Royal Colleges for this, I think the agreed actions are so sensible and likely to make a difference, I have shared the whole report below, with a link to a BBC news item about the report

http://www.bbc.co.uk/news/uk-scotland-31018497

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“We will work with a range of partners to fully integrate PHYSICAL ACTIVITY FOR HEALTH into Health and Social Care and increase physical activity in Scotland”

 

Specifically, during 2015-2016, collectively and individually, all Scottish Academy members pledge to work with key stakeholders to:

  • Fully embed physical activity for health into primary care
  • Fully embed physical activity for health into secondary care
  • Prioritise physical activity for health in Health and Social Care integration and in social care
  • Integrate physical activity for health into health education
  • Increase physical activity in the health and social care workforce and workplace
  • Mobilise health and policy leaders to prioritise increasing physical activity
  • Ensure that our ‘Pledge’ is prioritised, reported upon and reviewed throughout 2015-2016

On behalf of the Scottish Academy

5.3 million deaths a year

The Role of Health and Social Care in Increasing Physical Activity: A Position Statement by the Scottish Academy of Medical Royal Colleges and Faculties

 

1. Background

The World Health Organisation (WHO) has identified a lack of physical activity as the fourth leading risk factor for global mortality, directly implicated in 6% of deaths worldwide1. It is increasingly accepted in Scotland that as a society, and as health care professionals we have both a responsibility and an opportunity to create health, and prevent disease, in parallel to treating illness.  Publications such as the Five Year Forward View2, 20/20 vision3, and the Christie Commission4 agree that increased prioritisation of effective, person-centred preventative medicine is required to allow people to live longer, healthier lives in their communities.

 

2. Why increase physical activity?

Regular physical activity has comprehensive health and wellness benefits across the lifespan providing increased life expectancy, better physical and mental health outcomes, and better quality of life. Physical inactivity is one of the major public health challenges of the 21st Century, with significant portions of the UK and global adult population currently failing to meet WHO minimum guidelines on physical activity5. Positive progress has been made, and must be sustained in relation to smoking, obesity and the harmful use of alcohol.  However, a significant increase in the pace and scale of efforts to improvephysical activity levels is required if we are to achieve the Scottish Government’s aim for “Scotland to be a world leader in the promotion of physical activity”6.

 

3. How can we work together to increase physical activity?

Increasing population-wide participation in physical activity is possible, with encouraging increases in child and adult physical activity levels seen in recent Scottish data coinciding with increased effort and partnership working in Scotland.

The National Physical Activity Improvement Programme is offering a system of improvement that is based on testing and learning. Making significant and meaningful improvements requires change. The Scottish Academy will support and develop actions that will increase physical activity in Scotland, measure results and spread approaches to get inactive people active across Scotland.

There is no single solution to increasing physical activity. The Lancet “Physical Activity” Series published in 2012 emphasised that in order to realise greater uptake of physical activity behaviour, it is imperative to extend focused efforts beyond just the health sector7.  Similarly, evidence from the WHO sponsored Investments that Work for Physical Activity8 and Toronto Charter for Physical Activity9 informed the Scottish Government’s Physical Activity Implementation Plan, which in turn calls for a comprehensive, cross-sector approach at individual, community, local, national, and international levels8,10,11. The Scottish Academy believes that partners working in education, transport and the environment, workplace settings, sport and active recreation, and communications as well as in health and social care have a key role to play.

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Environment: Scotland’s built and natural environments will permit and promote increased levels of physical activity.

Workplace settings: Employers will make it easier for people to be more physically active as part of everyday working lives.

NHS and Social Care: NHS and care services will promote and help achieve recommended levels of physical activity.

Education settings: All places of learning in Scotland will promote increased physical activity.

Sport and active recreation: Everyone in Scotland will be more active in their leisure time.

Communications: The people of Scotland will understand and appreciate the benefits of physical activity, and know where and how to be active10.

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4. The Role of Health and Social Care

The Scottish Academy and member Colleges and Faculties recognise the value of increasing physical activity and wish to actively promote this through a number of routes; from high level policy making to those who deliver clinical front line services. It is recognised that having a collaborative approach involving all key stakeholders across sectors and supporting work already done by networks such as the Health Promoting Health Service (HPHS) is the strongest way to ensure effective progress.

Fundamentally, we have an opportunity to support policy makers and use the best available evidence to integrate preventative medicine into health care systems.

Increasing physical activity must be given equal priority to smoking cessation and addressing harmful use of alcohol. The Scottish Academy advocates a minimum of 150 minutes physical activity per week for adults, 60 minutes per day for school age children, and will work towards:

a)    Fully embedding physical activity for health into primary care

Ensure primary care staff (including general practitioners, practice nurses, health visitors, pharmacists and physiotherapists) are adequately educated to assess physical activity levels, provide education on the recommended minimum levels of physical activity for health, offer brief advice and brief intervention, and signpost to community resources.

 

Objectives:

  1. By end 2015 all primary care practitioners must have received information about the “physical activity primary care pathway”
  2. By end 2016 60% primary care practitioners should know the UK CMO recommendations (i.e. 150 minutes moderate physical activity per week) (up from the current 13%; NHS Health Scotland, unpublished data).
  3. By end 2016, every primary care practice should have mechanisms to deliver brief advice and brief interventions for physical inactivity in the same manner and to as many patients as it does for smoking and alcohol.
  4. By end 2018, there should be clear methodology in how to incentivise the achievement of physical activity goals (e.g. one method could be remuneration equal to harmful use of alcohol in primary care contracts (Quality and Outcomes Framework (QOF), Enhanced Services or equivalent)).

 

Key resources:

b)    Fully embedding physical activity for health into secondary care

Ensure secondary care staff are adequately educated and comfortable to assess physical activity levels, provide education on the recommended minimum levels of physical activity for health, offer brief advice and brief intervention, and signpost to community resources fully supporting the aims of the Health Promoting Health Service.

 

Objectives:

  1. By end 2015, every outpatient department will have been sent a copy of “23.5 hours”, and encouraged to play it in waiting areas.
  2. By mid 2016, every clerking document should contain questions about physical activity level and diet, in addition to current questions relating to smoking and alcohol.
  3. By end 2016, every health board should be delivering the Scot-PASQ or equivalent to all patients in secondary care at some point during their inpatient stay (physical activity pathway for secondary care).
  4. By end 2018, every patient leaving hospital should receive brief advice or brief intervention (when indicated as appropriate on the Scot-PASQ) on physical activity and signposting to supportive resources by a health professional.

 

Key resources:

  • Secondary care pathway
  • Every Step Counts
  • Raising the issue of physical activity (available e-Learning)

(The above all at http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvement/hphs/nhs-physical-activity-promotion.aspx)

  • Exercise on prescription book (available 2015).

c)     Fully embedding physical activity for health into social care

Ensure social care staff including care workers and home visitors are adequately educated and comfortable assessing physical activity levels, providing education on the recommended minimum levels of physical activity for health, offeringbrief advice and brief interventions, and signposting to community resources.

 

Objectives:

  1. The Scottish Academy fully endorses the Active and Healthy Ageing: Action Plan for Scotland12 document and actions, and will support delivery of these actions where needed throughout 2015/16.
  2. By end 2016 every person entering care will have an appropriate assessment of physical activity using Scot-PASQ or equivalent, and receive brief advice or brief intervention when indicated (unless inappropriate).

 

Key resources:

(http://www.knowledge.scot.nhs.uk/home/portals-and-topics/health-improvement/hphs/nhs-physical-activity-promotion.aspx.)

d)    Integrating physical activity for health into health education

UK CMO recommendations, assessment of physical activity levels, techniques for encouraging health behaviour change, knowledge of both the benefits of physical activity and the dangers of physical inactivity in relation to life expectancy, physical and mental health outcomes should be integrated into undergraduate health care professional curricula, postgraduate training and examinations, as well as continued professional development (CPD).

 

Objectives:

  1. By end 2015 UK CMO recommendations relating to physical activity and training in health behaviour change should be integrated into the medical undergraduate curriculum in all five Scottish medical schools.
  2. Physical activity should play a significant part in each Member College and Faculty’s educational events.
  3. By end 2016 UK CMO recommendations relating to physical activity and training in health behaviour change should be integrated into every other health care undergraduate curriculum in Scotland.

 

Key Resources:

e)    Mobilising health leaders to prioritise increasing physical activity

Healthcare leaders in policy, the Medical Royal Colleges, medical education, health boards, hospitals and departments must renew their focus on tackling physical inactivity. Key partners should work collaboratively to embed physical activity for health into primary care, secondary care, and medical education; supporting innovation, measuring progress and driving improvement. Increasing knowledge of the required levels of physical activity amongst the general public is imperative.  The exemplary leadership shown by the AHP Directors Group and the AHP Physical Activity Pledge is fully supported by the Scottish Academy.

 

Objectives:

  1. By end 2016 the recommendations of any Chief Executive Letters (CEL) relating to the HPHS, physical inactivity and health inequalities must be delivered, in addition to the recommendations in this paper.
  2. By end of 2017, NHS Boards should demonstrate evidence of providing consultants with appropriate Supporting Professional Activities (SPA) sessional timeto advocate physical activity and enable them to shape and deliver services to increase physical activity, where relevant.

 

Key Resources:

  • Joint communication and recommendations strategy (early 2015)
  • 2015 Chief Executive letters (early 2015)
  • AHP Pledge (http://www.paha.org.uk/Announcement/ahp-directors-physical-activity-pledge )

f)      Increasing physical activity in the health and social care workforce

Promote the values of the Healthy Working Lives initiative and the HPHS programmes and encourage healthcare workers to increase their physical activity levels by work based lifestyle changes.

 

Objectives:

  1. By end 2015, (and reviewed annually thereafter), NHS Estates and Facilities should maximise the use of the NHS outdoor estate as a health promoting asset by encouraging and enabling staff, visitors and patients to engage in green exercise and active travel opportunities to, from and within NHS grounds.
  2. By end 2015 every hospital in Scotland should establish, and clearly signpost, walking routes for staff, patients and relatives, and each health board should offer robust reports on the Health Promoting Health Service. Every hospital should have educational content and resources prominently displayed
  3. By end 2015, all health boards should promote and provide resource and support staff physical activity challenges in the workplace.

 

Key Resources:

Conclusions and next steps

Collaborative and cross-sectoral work has led to Scotland being one of few countries worldwide demonstrating an (albeit modest) increase in physical activity levels. Significant mismatches are present between current, and best practice in relation to physical activity.  Key drivers and workstreams within health and social care exist that should facilitate concrete SMART actions and enable projects to deliver improvements.  Health and Social Care integration offers an opportunity for joint boards to prioritise the key interventions needed to increase physical activity.

The Scottish Academy of Medical Royal Colleges and Faculties is committed to working with a range of partners including NHS Health Scotland, HPHS, medical educationalists, health boards, British Medical Association, clinical leads, and Scottish Government to apply these evidence informed interventions consistently.  This will enable Scotland to achieve the desired step-change in physical activity levels and provide person centred, clinically effective and cost effective care to our patients13,14.

This document will be reviewed by the Scottish Academy at the end of 2015/start of 2016 to ensure adequate progress and delivery of objectives.

sitting disease

References

  1. World Health Organization. Global health risks: mortality and burden of disease attributable to selected major risks. Geneva, Switzerland: World Health Organization; 2009.who.int/healthinfo/global_burden_disease/en/ (Accessed 11/2014)
  2. Stevens S. Five year forward view. NHS England. 2014. england.nhs.uk/2014/08/15/5yfv/ (Accessed 11/2014)
  3. The Scottish Government. 20/20 vision. The Scottish Government, 2011. scotland.gov.uk/Topics/Health/Policy/2020-Vision (Accessed 11/2014)
  4. Christie C. The Future Delivery of Public Services. The Christie Commission, 2011. scotland.gov.uk/Publications/2011/06/27154527/18 (Accessed 11/2014)
  5. Department of Health. Start Active, Stay Active’ is a report on physical activity for health from the four home countries’ Chief Medical Officers. 2011
  6. Appendix A: CEL (1) 2012 Implementation Guidance (Year 1). Available from http://elearning.healthscotland.com/pluginfile.php/30237/mod_resource/content/0/Hospital_Health_Improvement_Governance_Framework/Appendix_A-_Implementation_Guidance.pdf (Accessed 11/2014)
  7. Lancet Series on Physical Activity: The Lancet, Vol 380, July 21 2012
  8. Global Advocacy for Physical Activity (GAPA) the Advocacy Council of the International Society for Physical Activity and Health (ISPAH). NCD Prevention: Investments that Work for Physical Activity. Br J Sports Med 2012;46:8;70 9- 7 12.
  9. Global Advocacy Council for Physical Activity (GAPA), International Society for Physical Activity and Health. The Toronto Charter for Physical Activity: A Global Call for Action. May 20 2010. Available at globalpa.org.uk
  10. The Scottish Government. Physical Activity Implementation Plan: A More Active Scotland. The Scottish Government. February 2014. Available at scotland.gov.uk/Resource/0044/00444577.pdf (Accessed 11/2014)
  11. Burns H. Annual Report of the Chief Medical Officer 2011. The Scottish Government. 2012.
  12. Joint Improvement Team. Active and Healthy Ageing: Action Plan for Scotland 2014-2016. Scottish Government. 2014.
  13. Keel A. Annual Report of the Chief Medical Officer 2013- Medical Leadership in Scotland. The Scottish Government. 2014
  14. Gray P. NHS Scotland Chief Executive Annual Report 2013/2014. The Scottish Government. 2014.

 

 

 

INCREASING PHYSICAL ACTIVITY

We know instinctively that exercise is good for health.  Our parents and doctors have probably told us so but this week highlighted the increased evidence that increasing physical activity for ourselves, our friends and family, and for the population in general will drive a huge increase in health and happiness. Surely no bad thing. 


PA_capsule

The study that hit the news this week looked at what kills people in Europe, and found that 7.5% of deaths (that’s TWICE the number of obesity related deaths) are directly attributable to physical inactivity.  The story was widely covered, here’s an example from the BBC who headlined the story

http://www.bbc.co.uk/news/health-30812439  . The case for regular exercise is open and shut, with memorable and huge studies (Lancet 2012) labelling physical inactivity “pandemic”, killing 5.3 million worldwide, and Steve Blair and Karim Khan teaming up to show that when you measure low fitness (as people tend to falsely overestimate the amount of exercise they do, it may kill more than the dreaded “smokadiabesity” – that is the combination of smoking, type 2 diabetes and obesity.

smokadiabesity

http://blogs.bmj.com/bjsm/2011/06/17/suffering-from-smokadiabesity-physical-activity-can-lower-your-risk-of-death/

So the argument is compelling.

The aim of “getting more people more active more often” is clear.

What can we do about it?

Fortunately most of the world’s top boffins in this area got together and worked out what worked, and what was cost effective in increasing physical activity.  It was clear that everyone can make a contribution, by being active yourself, helping friends, work colleagues or family sit less and move more, or by increasing physical activity in your community or even country through roles in communications, transport and the environment, urban design, sport, education, and health and social care.  In my opinion, this has been THE most important document ever produced on physical activity, as it offers a route map to guide people working in their workplace, community, local area or nationally.  I recommend keeping a copy yourself, and sharing a copy of “Investments that Work for Physical Activity” widely.

investmentsthatwork

http://bjsm.bmj.com/content/46/10/709.full

7investments

Global experts like Nanette Mutrie, Karim Khan, Heather MacKay and Fiona Bull were generous with their time and helped us in Scotland.  This led to a National Implementation Plan for Physical Activity

http://www.scotland.gov.uk/Publications/2014/02/8239 as well as guidance for local and community planning.  This use of experts, and investing time and resources in the things that work as well as the hard work and expertise of many many brilliant people on the ground likely contributed to an increase in physical activity in both children and adults in Scotland. It is early and fragile data, but let’s celebrate a quick win.  It is great for Scotland. Increased physical activity gets our children better marks at school, makes them happier on average and prevents and they are 30% less likely to suffer an early death.

But good is the enemy of better. Physical inactivity still kills 2500 Scots (Chief Medical Officer report) a year, and 5.3 million (The Lancet).  What is required is co-ordinated action across the areas highlighted in “Investments that Work for Physical Activity”, and “National Implementation Plan for Physical Activity”.  Some of the big things are being done, for example 97% of children in primary school in Scotland now get 2 hrs of PE (up from 50% in the 90’s), and many of our inner city roads will have 20mile per hour speed limits soon making our streets safer and more conducive to walking and being outside.

As a doctor, I have been looking at what Health and Social Care can do to help increase physical activity. Our health service is one of the best, and safest in the world, and whilst many health professionals do help patients understand the benefits of physical activity, and offer brief advice and solutions, this simply is not happening as frequently as it does for smoking or alcohol, and in general the consensus is we should be aiming to move towards a service that promotes healthy lifestyles and creates health, as well as effectively treating disease.  To highlight the scale of the issue, only 2 of the 5 Scottish medical schools asked in 2012 said they taught the CMO guidelines on physical activity, whilst a group of the UK’s leading doctors ranked physical inactivity as the smallest contributor to death out of 6 risk factors, when evidence suggests it is 2nd or 3rd.  Nurses, doctors and health professionals ask a set of “clerking” questions when a patient is admitted to hospital. Despite the fact physical inactivity kills more than gallstones, varicose veins, thyroid disorder and high cholesterol combined, it is rarely included in these documents, whilst the others almost universally are.

 

The great news for health professionals is that we can move this forward together.  And our patients can help us.   There have already been huge contributions in Scotland in the area below from groups like the Allied Health Professionals Directors Group, Going for Gold, the University of West of Scotland, Scottish Government, National Education Scotland, NHS Health Scotland and Royal Colleges including the Royal College of Physicians and Surgeons of Glasgow and the Royal College of Surgeons Edinburgh.

 

Together we can

 

-Embed physical activity for health into primary care

-Embed physical activity for health into hospital and secondary care

-Embed physical activity into social care

-Increase teaching on physical activity in health professional education

-Be active and promote activity in the NHS workforce

-Show leadership, and spread awareness of how we can increase physical activity

Even last week one of the major colleges produced a position statement confirming their commitment to promoting and taking action on physical inactivity. It is a bold statement that I was delighted to contribute to

http://files.rcp.sg/filestore/1501120337_54b3e20d5eca0/Physical%20activity%20position%20statement.pdf

The great news is that there seems to be a real sense of collaboration to get things done.  The Scottish Academy of Colleges contain many of the great and the good of Scottish Medicine and have made clear their commitment to supporting and leading change.  They will outline actions that can be taken to achieve real and lasting change in a position statement in the next month or so, whilst our acting Chief Medical Officer Dr Aileen Keel is a real champion for physical activity and health promotion, and both her report  http://www.scotland.gov.uk/Publications/2014/12/1569 and the NHS Chief Executive report talk about the opportunity we can, and must grasp.

So 2015 promises much. Internationally there are some fantastic initiatives that will help increase physical activity. In Scotland and in particular in health and social care there seems to be a tangible chance of real progress, that can lead to an increase in gross national happiness and a healthier more active nation.

5.3 million deaths a year

NGUGI, ONE OF WORLD’S GREATEST MIDDLE DISTANCE RUNNERS, AMONG SPEAKERS AT EDINBURGH SPORTS MEDICINE EVENT

17 October 2014

Below is some information from SportScotland about an event I am excited about being involved with on Monday.  Please follow the links and come along. John Ngugi and Euan Burton are absolutely top athletes and people with stories worth sharing.

‘Being your Best’ is the theme of an event being organised by the Fitness Assessment and Sports Injuries Clinic (FASIC), based at the University of Edinburgh on Monday (20 October). It’s a theme as applicable to school-aged children making their first steps in a sport to top Scottish athletes who already benefit from individually tailored programmes through the likes of the sportscotland institute of sport.

With John Ngugi and athletes in Kenya

With John Ngugi and athletes in Kenya

John Ngugi, 1988 Olympic 5000m gold medallist and 5 x World Champion is one of the three guest speakers on the evening.  Revered in his homeland of Kenya, Ngugi is regarded as one of the greatest middle distance runners of all time.  In what promises to be a fascinating talk, he will share his thoughts on ‘what it takes to win Olympic gold.’ The FASIC event is supporting the John Ngugi Foundation, an organisation that aims to help young athletes in Kenya.

 

From a Scottish perspective, keynote speakers will include Scottish judoka and 2014 Commonwealth Games gold medallist Euan Burton and Dr Andrew Murray.  The latter is an ultra-distance runner and a sport and exercise medicine consultant to the sportscotland institute of sport.

 

Speaking ahead of the event, John Ngugi commented: “What does it take to become an Olympic Champion?  Why have Kenyan runners won so many golds and broken so many records? My motto is train hard, fight easy and believe.  If you train hard you will be successful but belief is also vital to be your best. I look forward to sharing my insights and those from my country when I come to Scotland. I also look forward to hearing from experts at the sportscotland institute of sport and Edinburgh University and taking these ideas back to Kenya.  In particular, I am honoured to be opening the Scottish Running Clinic at the University.”

 

Success looks like this

Murray, who recently ran Scotland’s ten highest Munro’s in under 24 hours, has previously visited Kenya to gain insights to the factors that help the East African country produce so many world-class track middle and long distance athletes.

 

On Monday Murray will offer insights to how ‘science and medicine can improve performance’ while Burton will recall his experience of preparing for and competing at the 2014 Commonwealth Games.

 

Murray commented: “On Monday we’ll hear from two incredible athletes. John Ngugi, both physiologically and in terms of medals won, is amongst the greatest athletes the world has known. He was a real pioneer for Kenya, a country that in world terms remains the most successful nation in middle and long distance running.

 

“Euan Burton’s (2014) Commonwealth Games gold winning performance was one of the iconic moments of the summer. As a coach and part of the sportscotland institute of sport, he contributed to what is the single greatest and most concentrated production line of medals in Scottish Commonwealth Games history, with 93% of the judo athletes in Team Scotland winning medals. As an athlete and as part of the team behind the team his insights promise to be fascinating.”

 

Event information

The “Being Your Best” event will be held within the Anatomy Lecture Theatre, University of Edinburgh from 630pm-830pm on Monday 20 October.

Tickets for the event are £10 each and are available through the EventBrite site: http://www.eventbrite.co.uk/e/being-your-best-tickets-12887580099

See also: https://www.facebook.com/events/705318129504561

www.johnngugifoundation.net

 

Notes to the editor

For interview requests with John Ngugi, in the first instance please contact: Malcolm Anderson – Mob: 07956098281 /malcolm.anderson@runningacrossborders.org

 

For comment from Dr Andrew Murray please contact Dr Murray directly on: docandrewmurray@googlemail.com

Issued on behalf of sportscotland and organised by 3×1 Public Relations, Tel: 0131 225 7700.

The event has been staged through help with FASIC University of Edinburgh, Running Across Borders, Purple Reign, the John Ngugi Foundation, Edinburgh Sports and Exercise Medicine Society, Merrell UK, Footworks, Judo Scotland and Sportscotland

Scottish Running Clinic