Exercise and healthy living is the “miracle treatment” which could go a long way to easing the pressure on Scotland’s crippled NHS. With a growing number of elderly people and a Scottish lifestyle plagued by obesity, alcohol, drug and smoking addiction, hospitals and GP surgeries are facing record demand.
And experts believe that a healthier lifestyle as the population ages is vital to the survival of the NHS in its current form. Dawn Skelton, professor of ageing and health at Glasgow Caledonian University, is among those trying to encourage better habits among patients.
She said: “Physical activity reduces our risk of heart disease, stroke and cancer. It reduces symptoms of disease. It is a miracle treatment but it is just not in a pill.”
A report by the World Health Organization last year said if each individual’s activity levels increased by a few per cent, it could save billions of pounds a year on health services around the world. And Professor Skelton, an exercise physiologist, wholeheartedly agrees.
She sees a lot of ageing patients left chronically ill after simple falls and believes a few simple exercises could reduce hospitalisation drastically. She said: “There are lots of reasons why people could fall but one of the key things is that as we get older all our reserves, our eyesight, our hearing, our balance – all sensory inputs which help us maintain our balance – start to decline in all of us.
“But some of us hit the decline a little bit earlier, maybe to do with sedentary lifestyles or health issues or medication, but if you could improve someone’s strength and balance so that they can correct that trip and stay upright then that makes a big difference to whether somebody actually falls and breaks something.”
Skelton continued: “Falls are massive and at the moment we can see it highlighted with the pressures that are happening with people not able to be discharged. About 75 per cent of all hospital beds are taken up by frailer, older adults who have gone in sometimes as result of a fall but sometimes they fall in hospital.
“Eventually they need some rehab or a care package to support them when they first go home or need to go into a care home because they are unsafe to themselves because they fall so often they become frail.”
But she said exercise can improve strength and balance allowing people to feel more confident to move and, therefore, getting more active. Skelton said: “They won’t necessarily become a non-faller because people can fall at any age but if we can get them back to the point they no longer worry about falling, they just get on with life, that is a huge outcome for them and their families.”
She said about a third of all people who go into care homes do so because of instability and falls, adding: “It’s a big issue considering falls are preventable. It is just people have to work harder. It is not an easy fix.” In 2018, activity guidelines were drawn up by the chief medical officers of the four home nations.
Skelton said: “To lessen the risk of heart disease, cancer, depression, diabetes by being overweight they came up with 150 minutes of exercise a week. Ideally, this should be something which makes us slightly warmer or out of breath. It is something beyond a stroll, something that gives us a little huff and puff.
"It is better to split it up rather than just do two-and-a-half hours on a Saturday and then do nothing the rest of the week. Within that activity, we should do something which challenges our balance and something that makes our muscles warmer or tense at least twice a week. That could be going to the gym and lifting weights but it could also be doing repetitive sits to stands.
“It does worry me about the next couple of generations. Are we going to see more fallers because they are not building up that reserve of strengths and balances?” She said the country now has “a pandemic of rehabilitation needs”.
Skelton added: “Following on from Covid we have such frailty. We need to support everyone who feels less able over the past couple of years to move more. Exercise has the ability to reduce symptoms, reduce your chance of getting something in the future. Almost no disease or condition is affected by exercise, or lack of it, unless it is a neurological condition like motor neurone disease.
“Things like heart disease, any cancer, diabetes, metabolic disease, arthritis are strongly related to a lack of activity as well as things like depression, loneliness and social isolation.”
And she believes those with care packages should be encouraged to move more. A care package should include exercise because it could lead to the person not needing one at all and living completely independently.
The professor said: “What tends to happen is the care goes in and even more is done for them and then they end up in a care home anyway because their muscles can’t support them.” She thinks doctors should ask about activity when they ask about smoking, drinking and a patient’s weight.
A lot of Scots have an unhealthy relationship with food, alcohol, cigarettes and drugs as well as a reluctance to exercise and this lifestyle is being felt sharply at hospital front doors where beds are being taken up with illnesses related to their excesses.
The Scottish Government’s Scottish Health Survey 2021 showed two thirds of Scots adults were overweight, with one third obese as well as one in five children at risk of obesity. The report stated: “Research has shown that more than one in 20 adult cancer cases is linked to excess weight.
“Obesity is linked to a range of co-morbidities including diabetes, cardiovascular disease, hypertension and certain cancers. Risk could be reduced overall even with modest reductions in body mass.”
The report also highlights an association between being overweight and mental health problems such as depression and anxiety, and says there is a link between obesity in midlife and possible dementia later in life.
Smoking is also a significant public health issue in Scotland and a leading cause of preventable ill health, premature death and disability.
A Public Health Scotland report showed in 2019 there were 54,315 hospital admissions where smoking was a primary reason for admission and 104,896 admissions where it was a primary or secondary reason. Drug admissions accounted for 12,474 hospital stays in a year and there were 35,124 alcohol-related admissions.
A National Records for Scotland report also highlighted 1245 alcohol-related deaths, the second year in a row there has been an increase. And there is also a worrying rise in the number of drug deaths in the last two months of 2022.
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