Some readers, while possibly entertained by Dr Fitzpatrick's tabloid-style column, should wonder how it is possible for his opinions to be published in a peer reviewed journal, based on research he confesses he has not read or is not aware of, therefore not understood and unable to suitably reference. Like his original article,1 he cites his opinions as if they are fact and is unable to refer to any relevant research to justify his views.2
Fitzpatrick's heartfelt extremism on public health matters is very unbalanced and personal. We hope most readers will thankfully not be able to take these opinions seriously. More worryingly, with new NHS GP commissioning, there is now nothing stopping a person with such unjustifiable views from becoming a public health service commissioner.
Fitzpatrick's assumptions about physical activity reflect as much about his own dire educational needs as they do a medical education system that appears to have failed and is still failing him.3,4 There is an enormous body of scientific evidence on the health benefits of physical activity, and he needs to read some of it.5
The first author of this response is also privileged to work in the real world as a GP, but this does not bring childish legitimacy to either his or Dr Fitzpatrick's opinions. If Dr Fitzpatrick's beliefs hang on his semantic understanding and interpretation of words, then he would do well to use the words exercise (structured activities) and physical activity (any bodily movement) appropriately. Sustained increases in physical activity and reductions in sedentary behaviour (in other words, time spent sitting or moving very little) are the behaviour changes that can be influenced with our patients and save much suffering and healthcare resource consumption. Such advice can only be effective when healthcare professionals are better educated in the benefits of physical activity and trained to deliver simple behaviour change techniques. To respond to his points:
It is quite possible that today's older population results from active lives commenced before technological advances and poor diets became habitual, and have lived alongside better health care. Levels of obesity, diabetes, numerous other diseases of inactivity, and poor lifestyles, once only seen in adults, are on a rapid rise in children. Perhaps Dr Fitzpatrick would do better to second guess the health of his patients when today's inactive children have grown up.
Dr Fitzpatrick's interpretation of the current physical activity recommendations is flawed: current guidance supports at least 150 minutes (for adults) of moderate intensity physical activity a week (not a minimum of 30 minutes on 5 days) broken up to a patients choosing, to gain minimum health benefits.6 Equivalent health benefits can be achieved with 75 minutes of more vigorous exercise a week, such as running or playing football. We are unsure how it is possible for a club runner or committed footballer to do less than the equivalent of 75 minutes of running a week, unless Dr Fitzpatrick refers to virtual runners and footballers, in other words, videogamers. Dr Fitzpatrick may be relieved to know that moderate activity may include walking, gardening, housework, and sex. Even Dr Fitzpatrick admits knowing that self-reporting is heinously inaccurate, so his daft bias survey carries no significance and should not grace these pages.
No advocate of physical activity has ever claimed that a GP can transform all couch potatoes into athletes. However, there is evidence that even brief consultations lasting a few minutes or simple pedometer-based programmes delivered through health professionals can lead to substantial increases in patients' activity levels (by ∼30%).7 It stands to reason that any intervention can be more effectively implemented when healthcare professionals are sufficiently educated and trained to deliver it to their patients.
- © British Journal of General Practice 2012