Pharmacy magazine – fitness and wellbeing – April 2019 issue

 

Finding routes to fitness

Physical activity can make a huge difference to our health and wellbeing, but despite many public health campaigns we continue to get fatter and inactive. How can pharmacy help customers step up to the plate? By Sasa Jankovic

 

Despite living in a FitBit age in which many of us are ever more enthusiastic about taking up a range of sports, the most recent Health Survey for England revealed 64 per cent of adults are overweight or obese, and figures from Public Health England (PHE) show we are around 20% less active than we were in 1961. Shockingly, in some communities only one in ten adults are active enough to stay healthy, and if current trends continue we will be 35% less active by 2030.

 

Unsurprisingly, this inability to get moving is having dire consequences for our health. According to PHE, physical inactivity directly contributes to one in six deaths in the UK, the same number as smoking. So why are we falling short? It seems there are several social, cultural and economic reasons: technology has taken over in the home and at work so fewer of us have physical jobs and we sit for long periods in front of a computer or television, as well as relying on cars and other motorised transport rather than walking or cycling as a means of getting around.

 

The result of this is that almost 20% of adults aged 25-34 are classified as inactive – meaning they take part in less than 30 minutes of physical activity per week, and this figure gets worse as we age – resulting in over 50% of those over 75 being inactive.

 

Although these figures may make it looks as if it is mainly older people who are most in need of physical activity, DW Fitness First, the UK’s second largest gym operator, says every age group is guilty of not being as active as they should: “The current government guidelines for physical activity recommend that we perform at least 150 minutes of moderate aerobic activity per week, including two days of strength training, but statistics provided by UK Active reveal that only 34% of men and 24% of women aged 19-65 currently meet these guidelines.”

 

In addition, PHE says those who are regularly engaging with healthcare professionals (which equates to those with or at risk of developing health conditions) are far more likely to be inactive – a vicious circle.

 

The benefits of moving

Fortunately, there is plenty of data that you can share with customers about the benefits that physical activity can make to both physical and mental wellbeing.

 

Although weight loss is the result that most people relate to taking up a more active lifestyle, DW Fitness First says there are “endless benefits, both physical and mental, to keeping on top of your fitness”.

 

PHE stresses that people who have a physically active lifestyle have a 20-35% lower risk of cardiovascular disease, coronary heart disease and stroke compared to those who have a sedentary lifestyle. Regular physical activity is also associated with a reduced risk of diabetes, osteoporosis, and colon/breast cancer, and with improved mental health, and in older adults physical activity is linked to increased functional capacities.

 

Physical activity also releases endorphins that relieve stress and fight depression, plus DW Fitness First adds that “regular fitness routines are a fantastic way to build confidence, as you can see exactly what you’re capable of and how far you’ve progressed”.

 

And the benefits don’t stop there. According to PHE, being active plays a key role in brain development in early childhood and is also good for longer-term educational attainment. Increased energy levels boost workplace productivity and reduce sickness absence, and it claims an active population can even reduce levels of crime and antisocial behaviour.

 

Pharmacy on board

All this data isn’t new, so if we know this, why isn’t everyone exercising? A common reason is not knowing where to start, or finding a program that’s easy to stick with, which gives pharmacy teams plenty of opportunity to step in with advice and encouragement.

 

“Community pharmacy, with its open front door, is a great location for supporting people by promoting the benefits of exercise”, says sports scientist Paul Moloney. “As a location that is frequented by members of the public with co-morbidities and disease states that would be of most benefit to an increase in exercise, the two are very much interlinked. A community pharmacist negates the need for an appointment and can also target the demographic that possibly can't afford a personal trainer or gym membership. The pharmacy may also have an existing relationship with patients, so the advice would be a logical add on to your other services.”

 

For example, staff can suggest customers incorporate small, regular changes like walking and cycling into their lifestyle, instead of aiming to see exercise as just something they have to go to a gym for. They are more likely to sustain these small changes and over the long term the health benefits will pay off.

 

You can also help customers increase their physical activity levels via the Five As system (Ask, Assess, Advise, Assist and Arrange) which is sometimes used in smoking cessation but can be adapted for physical activity: Ask about the patient's current levels of physical activity; Assess their fitness and capabilities; Advise about appropriate exercise and the risks involved; Assist in helping them find places to get involved; and Arrange any necessary referrals.

 

For your tech-savvy customers, fitness trackers and other health apps can be another useful tool. According to a survey of 1,076 UK adults carried out by LaptopsDirect.co.uk, more than 1 in 3 (37%) of those who have challenged themselves to get fitter during 2019 believe that their choice of tech products is helping them reach their goals.

 

Wearable fitness trackers (34%) and smart watches (26%) were cited to be the most helpful technology according to those surveyed, with meal planning smartphone apps (19%), closely followed by heart rate monitors (12%), and calorie counting smartphone apps (9%) ranked as the next most useful tech to help with their fitness goals.

 

If you want to go the extra mile and add to your own knowledge of how best to advise your customers to get active, PHE has developed a national Moving Healthcare Professionals programme with Sport England to support healthcare professionals develop the knowledge, skills and confidence to embed physical activity within clinical care. This includes the PHE Physical Activity Clinical Champions programme, which has a national network of more than 40 healthcare professionals who have already delivered free peer-to-peer training to over 22,000 practicing healthcare professionals on physical activity and how to incorporate this advice in practice. To find out more or to book a session contact physicalactivity@phe.gov.uk

 

Common sports injuries

Once you’ve encouraged your customers to get moving, this opens up further scope to advise them on avoiding and managing common sports injuries. Although you should remind them to consult their GP or, if necessary, go to A&E if they are worried or in serious pain, less serious problems may be treated effectively at home with OTC medicines and medical devices.

 

Sprains and strains

Most sprains and strains can usually be treated with self-care such as the PRICE technique of protection, rest, ice, compression and elevation, and should improve within six to eight weeks – although severe muscle strains may take longer.

 

Topical NSAID products which offer an anti-inflammatory action together with pain relief are another option to help with muscle and joint aches and pains arising from sports injuries.

 

While painkillers can be used to help ease any discomfort, you should advise your customers to see their GP if they are in severe pain or if their injury is not improving or getting worse.

 

Joint health

Joints injury can occur when a joint is taken outside of its comfortable range of motion, so stronger stabiliser muscles and increased flexibility lessen the likelihood or severity of an injury. Maintaining a healthy weight can also be beneficial on joints. One study claimed that losing about a pound of weight delivers almost a four pound reduction in knee joint load for each step.

 

Blisters

Though painful, most blisters heal on their own unless they become infected, but can be easily prevented in the first place by covering tender spots with a friction-resistant dressing or plaster. If they do occur then specialist blister plasters claim to aid rapid healing by absorbing the fluid, protecting skin from bacteria and helping relieve the pain of friction and pressure.

 

However, it is worth reminding any of your athletic customers who have diabetes to be particularly vigilant when checking for blisters, as their foot injuries take longer to heal due to poorer blood circulation.

 

Sports nutrition

While it is important to follow a varied and balanced diet and healthy lifestyle, some people believe that sports nutrition products and supplements have a role to play in boosting their performance and recovery, and helping them avoid injury.

 

This used to be a market that was mainly targeted at professional athletes, but Dr Emma Derbyshire, public health nutritionist and advisor to The Health Food Supplements Information Service (www.hsis.org) says this has changed.

 

“Sports nutrition emerged in the United States in the 1940s as a niche interest of bodybuilders as a way to obtain optimal nutrition in a convenient format, but things began to change with the growing awareness of the role that exercise can play in supporting a healthy lifestyle. As more and more people started going to the gym or for a morning run, demand for nutritional products that could help them run further, lift more, swim better or recover faster began to grow. Sports nutrition is no longer confined to simply serving body builders and is now used to allow all active people to consume the nutrition they need at the right time in the most convenient format, in conjunction with a nutritious diet.”

 

If this sounds like it reflects some of your customer base then it could be worth considering stocking a few key products, particularly as Derbyshire says the sports nutrition market is growing. With products including vitamins and minerals, protein powders and protein bars, branched chain amino acids, creatine supplements, fats such as omega-3s, conjugated linoleic acid (CLA) and medium chain triglycerides (MCTs), and sports drinks, she says: “The UK sports nutrition market reached £799m in 2017 – up 13% on 2016 and more than double the £350m recorded in 2012.

 

“More than 10 million people in the UK belong to a gym and events such as triathlons with running, cycling and swimming are increasing in popularity, [so] many active individuals may wish to seek advice on healthy eating, nutrition and supplements to help them excel in their regular activity or sport and pharmacies could become a key resource both stocking and providing information on these products.”

 

What to stock

Derbyshire’s advice about what to stock includes:

• Vitamins and minerals – Active physical exercise is linked with nutritional deficiencies such as vitamins A, C, iron, zinc and calcium, particularly in young athletes whose nutritional needs are increased because of growth.[1]
  Prolonged bouts of heavy exercise are associated with lowered immune function. Adequate intakes of iron and zinc and vitamins A, D, E, B6 and B12 are important to maintain a healthy immune function.[2]
  Trace minerals. Athletes tend to have lower serum zinc concentrations suggesting their zinc requirements are higher.[3] Serum selenium concentrations may also be lower in athletes.[4] Iron levels may be low especially in women of reproductive age. Requirements for specific nutrients can vary by type of sport. For example, zinc and copper requirements may be higher when the activity has a big impact on muscle mass.[5]
  Vitamin C may aid recovery in athletes by mopping up free radicals and increasing collagen synthesis. It is likely best to stick to doses not exceeding 200mg daily.[6] One study in 20 athletes found vitamin C supplementation could increase exercise performance in those with low levels of vitamin C.[7] Vitamin C has also been found to be effective at preventing colds when consumed regularly by athletes training in subarctic conditions.[8]
  Glucosamine may protect the joints in athletes. Research shows a protective effect of glucosamine on joints in soccer players and bicycle racers[9] through improving cartilage metabolism. [10]
  Omega-3 fatty acids. DHA and EPA have an anti-inflammatory action. Adequate amounts of these compounds in the body tissues may facilitate healing after sports injury.[11] Oily fish (the main dietary source of DHA and EPA) intake is lower than recommended suggesting the need to consider a supplement.
  Protein supplements. Protein supplements are frequently consumed by athletes and active adults to achieve greater gains in muscle mass and strength and improve physical performance. Some evidence shows that protein supplementation does increase muscle mass and endurance, but has little impact on muscle damage and recovery. The focus should be on obtaining protein from the diet.
   

Appropriate advice

As with anything you sell, there are things to bear in mind when it comes to stocking sports nutrition products and supplements.

 

“The range needs to be carefully selected as there are a lot of products”, says Moloney, “so I would suggest reputable brands being stocked. The other part which pharmacists and their team need to consider is if you are advising elite athletes you need to be aware of the UK Anti-doping policies and advice on supplements.”

 

And elite athletes aren’t the only group who need specific advice. “A vegan diet in particular creates challenges for planning a nutritious diet for an athlete or active person”, says Derbyshire. She recommends vegans who are exercising need to make sure they are “consuming enough energy (calories) and protein; vitamin B12, iron, zinc, calcium, iodine and vitamin D, and there is a lack of long chain omega-3 fatty acids (EPA and DHA) in most plant-based foods[12]”.

 

If you are ready to increase your offering with sports nutrition products and advice, Moloney says the time is now: “Community pharmacists, with their knowledge of nutrition and supplements, are ideally placed to be the 'go to' for sports nutrition advice as it naturally compliments their skillset and expertise. Consumers would benefit highly, I believe, from the enhanced advice they could receive from a pharmacist as opposed to online purchases or 'pop up' unregulated nutrition shops.”

 

With around 1.2 million health-related visits to a community pharmacy every day, the messages that you and your team give to your customers about their physical activity and how to raise it could have a big impact on their activity levels. We know that people are living longer than ever before, so early intervention is needed to make sure physical activity is as accessible and its benefits and importance are as well understood as possible, because it is one of the simplest ways to prevent ill health for all of us.

 

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Box:

For more information about recommended weekly amounts of activity, go to

http://www.nhs.uk/Livewell/fitness/Pages/Activelifestyle.aspx

 

Moving Healthcare Professionals

https://www.sportengland.org/our-work/health-and-inactivity/moving-healthcare-professionals/

 

UK Anti-Doping

https://www.ukad.org.uk

 

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[1] https://www.ncbi.nlm.nih.gov/pubmed/27754418
[2] https://www.ncbi.nlm.nih.gov/pubmed/26634839
[3] https://www.ncbi.nlm.nih.gov/pubmed/29164533
[4] https://www.ncbi.nlm.nih.gov/pubmed/29623649
[5] https://www.ncbi.nlm.nih.gov/pubmed/24509996
[6] https://www.ncbi.nlm.nih.gov/pubmed/22777327
[7] https://www.ncbi.nlm.nih.gov/pubmed/25526969
[8] https://www.ncbi.nlm.nih.gov/pubmed/19432914
[9] https://www.ncbi.nlm.nih.gov/pubmed/23358550
[10] https://www.ncbi.nlm.nih.gov/pubmed/30132529
[11] https://www.ncbi.nlm.nih.gov/pubmed/26400437
[12] https://www.ncbi.nlm.nih.gov/pubmed/28924423