PhysioUpdate 23rd May 2023

Health ministers in England are inviting physiotherapists and other interested parties to submit evidence on how six key health conditions – musculoskeletal (MSK) disorders, chronic respiratory diseases, cancer, cardiovascular diseases including stroke and diabetes, dementia and mental ill health – should be tackled in the future.

Health and social care secretary Steve Barclay said: ‘Patients often live with more than one major condition, so it’s vital that we do all we can to understand how best to manage their care.

‘I encourage patients, carers and healthcare professionals to contribute to our call for evidence so we can ensure our major conditions strategy is as targeted and patient-focused as possible.’

Six-week deadline to respond

The call for evidence, which was launched on 17 May, will inform strategy on how best to prevent, diagnose and manage conditions that are said to ‘put the most strain on the NHS’. One person in four is affected by at least two of the major long-term conditions, and a new strategy will focus on both treatment and prevention.

As well as encouraging individuals with one or more of the conditions outlined to respond, the call for evidence is extended to carers, and those working in NHS bodies, local government, the voluntary and community sector, and wider industry. They are particularly keen to receive views how the government and the NHS can improve working relationships with other organisations and sectors.

Lung conditions are the third biggest killer in the UK, but historically haven’t received the attention they deserve, so the major conditions strategy is a big opportunity to change that [Sarah Woolnough, Asthma + Lung UK]

The government’s aim is to improve care and outcomes for those living with multiple conditions and an increasing complexity of need. It will seek to reduce care and treatment that are too narrowly focused on specific diseases or organs in the body and consider how to treat people as a whole.

Examples of the issues include

• half of people with a heart or lung condition have an MSK disorder, such as back pain
• people with diabetes are twice as likely to have depression
• nine patients in 10 with dementia have another long-term condition

Charities welcome call for evidence

Sarah Woolnough, Asthma + Lung UK’s chief executive, said: ‘It’s encouraging to see the government taking action on respiratory diseases, such as asthma and chronic obstructive pulmonary disease. Lung conditions are the third biggest killer in the UK, but historically haven’t received the attention they deserve, so the major conditions strategy is a big opportunity to change that.'

She added: ‘Therefore, we want everyone with a lung condition or who works in respiratory health to come forward and have their say.’

Samantha Benham-Hermetz, director of policy and public affairs at Alzheimer’s Research UK, said: ‘Since the previous dementia strategy expired in 2020, the number of people living with the condition in the UK, and the challenges they face every day, have only continued to grow. Thanks to progress in research, we’re on the cusp of a new era in dementia, with two new treatments for early Alzheimer’s disease showing promise in the last six months, and revolutionary new ways to diagnose it on the horizon.’

The call for evidence is open for six weeks and will close on 27 June.

Background

Earlier calls for evidence on cancer, and mental health and wellbeing both attracted more than 5,000 responses from individuals and organisations.

Researchers have warned that patients with rheumatic and musculoskeletal (MSK) conditions are vulnerable to using opioids on a long-term basis. They say that up to one person with rheumatoid arthritis or fibromyalgia in three who takes these drugs for the first time are potentially at risk.

The view is outlined in a research letter that was published online today (17 May) in the Annals of the Rheumatic Diseases. The first author is Yun-Ting Huang, who is based at the Centre for Epidemiology Versus Arthritis at the University of Manchester.

To assess the proportion of patients transitioning to long-term use among those newly started on an opioid, Dr Huang and her colleagues drew on the anonymised medical records of 841,047 adults whose details had been entered into the Clinical Practice Research Datalink (CPRD), a nationally representative UK-wide primary care research database. 

Some 12,260 of them had been diagnosed with rheumatoid arthritis, 5,195 with psoriatic arthritis, 3,046 with axial spondyloarthritis, 3,081 with systemic lupus erythematosus (SLE), 796,276 with osteoarthritis, and 21,189 with fibromyalgia. 

Regular aerobic exercise – often termed ‘cardio’, is linked to a significantly lower risk of death from flu or pneumonia, even at weekly levels below those recommended.

That is the finding of a US-based research team whose article appears online in the British Journal of Sports Medicine today (17 May). The first author is Bryant Webber, from the Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia.

But there may be a level above which the effects plateau or – in the case of muscle strengthening activities – become potentially harmful, the findings suggest. 

Large US survey results

Dr Webber and his colleagues therefore wanted to find out if specific types and amounts of physical activity might be associated with this reduced risk. They drew on the responses of 577,909 adults who had taken part in the US nationally representative National Health Interview Survey (NHIS) between 1998 and 2018. 

Respondents were asked how often they spent 10 or more minutes in vigorous intensity and light or moderate intensity aerobic activities, and they were asked how often they did muscle strengthening activities. Individuals were then categorised according to how well they met recommended aerobic activity plus muscle strengthening weekly targets: not meeting either; meeting the aerobic activity target; meeting the muscle-strengthening target; and meeting both targets.

Five levels of physical activity were defined: below 10, 10-149, 150–300, 301–600 and more than 600 mins/week of moderate to vigorous physical activity; and less than two, two, three, four-six and seven or more sessions/week of muscle strengthening activities.

Half the respondents (50.5 per cent) didn’t meet either weekly target. How well they did so differed significantly according to sociodemographic and lifestyle factors, underlying health conditions, and whether they had been vaccinated against flu and/or pneumonia.

A third (34 per cent) were aerobically inactive, and more than three quarters (78 per cent) reported fewer than two weekly sessions of muscle strengthening activities. During an average monitoring period of nine years, 81,431 participants died; 1,516 of these deaths were attributed to flu and pneumonia.

Those who met both recommended weekly physical activity targets had nearly half (48 per cent) the risk of dying from flu or pneumonia as their peers who met neither, after accounting for potentially influential factors. 

Efforts to reduce influenza and pneumonia mortality among adults might focus on decreasing the prevalence of aerobic inactivity and increasing the prevalence of achieving 2 episodes/week of muscle-strengthening activity [Bryant Webber et al]

Meeting only the aerobic activity target was associated with a 36 per cent lower risk, after accounting for potentially influential factors, while meeting only the muscle strengthening target wasn’t associated with any significant difference in risk.

Health benefits and aerobic physical activity 

In terms of quantity, clocking up 10–149, 150–300, and 301–600 mins/week of aerobic physical activity was associated with, respectively, 21 per cent, 41 per cent, and 50 per cent lower risks, compared with none. But no additional benefit was seen above 600 weekly minutes. 

‘Although [10-150 mins/week] is often labelled "insufficient" because it falls below the recommended duration, it may confer health benefits relative to physical inactivity,’ Dr Webber and his colleagues note.

When it came to muscle strengthening activities, compared with fewer than two weekly sessions, meeting the weekly target of two was associated with a 47 per cent lower risk, but seven or more sessions were associated with a 41 per cent higher risk.

Muscle-strengthening activities may help

‘While beyond the scope of this study, plausible explanations [for this dichotomy] range from inaccurate responses (such as reporting occupational physical activity, which may not confer the same protective effect as leisure-time physical activity) to haemodynamic ramifications of frequent, high-intensity [muscle strengthening activity],’ explain the researchers.

As an observational study, cause, cannot be established, added to which the researchers acknowledge various limitations. For example, the study relied on personal recall and at one point in time; the NHIS survey captured only leisure time physical activity in bouts of 10 or more minutes, nor did it distinguish between light and moderate intensity activities.

Nevertheless, the researchers conclude: ‘Efforts to reduce influenza and pneumonia mortality among adults might focus on decreasing the prevalence of aerobic inactivity and increasing the prevalence of achieving 2 episodes/week of muscle-strengthening activity.’

Factfile

Adults are advised to clock up at least 150 minutes/week of moderate intensity, or 75 minutes of vigorous intensity, aerobic physical activity, or an equivalent combination, plus muscle strengthening activity of moderate or greater intensity at least twice a week.

Aerobic exercise, which includes brisk/speed walking, swimming, running, and stair climbing, is sustained, increasing heart rate and working up a sweat. Muscle strengthening activities include the use of weights and resistance bands; exercises such as squats, lunges, and press-ups (calisthenics); and heavy gardening.

As well as helping to maintain good health and ward off serious illness, regular physical activity may also protect against death from flu or pneumonia, the evidence indicates.

To access the full version of the article – titled Research: Leisure- time physical activity and mortality from influenza and pneumonia: a cohort study of 577 909 US adults doi 10.1136/bjsports-2022-106644 – click 

Two studies that aim to improve rehabilitation after arm fractures have received a £2 million funding boost from the National Institute for Health and Care Research (NIHR). The REACH and WISE trials both investigate new physiotherapy approaches to rehabilitation, enabling patients to carry out progressive exercise programmes at home.

David Keene, an associate professor in trauma and orthopaedics at the University of Exeter, is the chief investigator on both the REACH and WISE trials. REACH is a collaboration venture involving researchers from the universities of Exeter, Oxford and Bristol. The trial, which focuses on rehabilitation after shoulder fractures, has been awarded £1.7 million from NIHR’s Health Technology Assessment programme.

The aim of the REACH trial – which is led by Dr Keene and Professor Matthew Costa from the University of Oxford – is to discover the best rehabilitation approach to support people in the wake of a shoulder fracture.