Should exercise be given as an NHS prescription?

Covid has changed the way we view health and the role of the NHS. But how genuine is government chat around transitioning to a preventative health society, and what role should fitness professionals be playing in helping with those new priorities?

A few years ago, I qualified as a level three PT. As well as being able to lead group fitness classes and do individual sessions, that certified me to take on patients who’ve been prescribed exercise by their GP as part of a treatment plan.

There are thousands of us in the UK – people who could reasonably help to revolutionise health and fitness without burdening the NHS or public resources too dramatically. And yet, do you know anyone who’s actually been prescribed a PT session? It tends to feel as though fitness and nutrition are wellbeing or self-care concerns as opposed to fundamental aspects of health. 

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Recent news suggests that it’s not just gym memberships or running partners that could be available for free. A study by University College London is trialling surfing, rollerskating and gardening to see whether sports and outdoor activities can make young people less anxious and depressed.

It comes at a time when these activities are less accessible than ever thanks to the cost of living crisis. But it’s also an interesting way to take the pressure off NHS services as they buckle under the weight of backlogs and increased illnesses after Covid. 

A healthy society surely thrives on preventative medicine: good food, decent movement and balanced wellbeing. But as a society – we’re seem to still be getting that all wrong.

Gyms are expensive, organic food is exorbitant (and only getting more and more expensive) and it seems logical to assume that the reason we don’t have a long-term pill-free solution to lowering cholesterol yet is because it’s cheaper to prescribe a lifetime of statins. Whose job, then, is it to keep us healthy – and what role should politicians, fitness professionals and we as individuals play in the pursuit of health?

The NHS is there to save our lives, not help us live them

We’re lucky in this country to have access to free-at-the-point-of-access healthcare, whether that’s popping to the GP for a blood test or getting glued back together in A&E. It’s there to save lives and to treat illnesses. It prescribes and occasionally refers – and nowhere is that more prevalent than in women’s health. 

Those of us who have been to the NHS complaining of amenorrhea (no periods), for example, will know only too well how prescriptive rather than preventative help can be, with appointments often ending with prescriptions for the pill rather than any in-depth investigations into mental health, disordered eating, hormonal imbalance or exercise obsession.

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The pandemic, however, may just have forced the government to reconsider the way in which healthcare has become a reactive tool in this country. In 2021, health and social care secretary Sajid Javid set up the Office for Health Improvement and Disparities (OHID) in order to put prevention at the heart of healthcare. Its aim, apparently, is to coordinate a programme across the NHS, local and central government and within communities to improve the public’s health. 

In a statement, Javid said: “This body marks a new era of preventative healthcare to help people live healthier, happier and longer lives… and will reduce pressure on our NHS and care services.”

A large part of that, he claims, will involve acting on “wider factors that affect people’s health, such as work, housing and education” which the OHID says accounts for around 80% of a person’s long-term health. Its interesting, then, that despite actively aiming to help “people across the country… live in better health for longer” by going after the “biggest preventable killers” like tobacco, obesity, alcohol and recreational drugs (which “cost the taxpayer billions of pounds each year”), there’s no mention of fitness or food in the press release – two things we know play huge roles in obesity management and mental health.

Should gyms and PTs be influencing healthcare policy?

Someone who is keen to press home the potential for preventative medicine through fitness is Laura Hoggins, PT and director of The Foundry. While firmly believing that we all have to be accountable for our own health, she believes that “society needs to do a better job of educating people on sustainable practices”.

“The healthcare system (God bless the NHS!) is set up to provide solutions to problems, to prescribe medicine or practice for illness. The fitness industry is actually the sector that can help keep people away from needing the NHS,” she tells Stylist.

While active PT prescriptions may still be a way off, Hoggins sees her role as a PT as “prescribing movement, selecting the dose and appraising the frequency”. Given that a sedentary lifestyle has been linked to all causes of mortality including cardiovascular disease, obesity, diabetes, cancer, and depression, it seems amazing that movement isn’t front and centre of the government’s healthcare plans.

Hoggins says: “Imagine if exercise was taken daily like a paracetamol to manage someone’s joint pain or headache. We all have the responsibility in our respective scopes of practice to encourage people to be active and to prioritise our health.” Because of that, she believes that the government should do more to educate our population.

Another person who believes that PTs hold a lot of power when it comes to preventative health measures is FIIT trainer Nesrine Dally. “I do think that PTs should play a more important role within society,” she explains. “Many health diseases can be reversed or even prevented with regular exercise and healthy eating habits. 

“We often want a quick fix, a pill to fix our joint or back pain, but we don’t realise that exercise in most cases is the best long term solution. The most important role of a PT is education.”

PTs and gyms are there to support and empower clients to form life-long habits. The NHS simply isn’t equipped to do that.  

Has the media warped our idea of ‘good health’?

Of course, we can’t lay all the responsibility and blame in Westminster. It’s hard to deny that the media hasn’t played a huge role in making fitness exclusionary – whether that’s been only giving airtime to slim whitefitness influencers or talking about fitness solely in the context of weight loss.

“We’ve got to educate people about how fitness can be a part of their daily lives, not just something we have to do, a torture to fit in with societal norms,” Hoggins insists. 

From a business point of view, that means not getting stuck in this idea of the ‘ideal’ fitness customer: “(Gyms shouldn’t just be) going after the disposable income – everyone has a right to have access to exercise, to feel safe while participating, to feel included,” continues Hoggins. “It is everyone’s responsibility to understand how movement can help them be better at life.”

Changing the fitness industry to get prescriptions out to everyone

That’s not to say that gyms like The Foundry don’t have power. They operate as physical, talking and community therapy and it’s that commitment to the holistic benefits of fitness that mean that despite being a commercial enterprise with bills to pay, they offer cheap classes on ClassPass and free community sessions. 

After two years of the pandemic, Dally believes that we’re only just waking up to the power of movement for mental health and overall wellbeing but that the industry still has a lot of work to do to make those benefits accessible for all.

Apps like FIIT have allowed many of us to get top-tier training from our living rooms, box bedrooms and local parks. “We need to do more to make movement accessible in every way possible,” Dally says. “The more people who have access to fitness, the healthier we will become as a society, and of course, this means less dependency on the NHS.”

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One can’t help but think that many gyms and PTs are punching way above their stations with the offerings they have. There are plenty of fitness insiders doing their best to democratise good health, mobility and strength – even if PTs like me feel woefully underqualified to intervene in someone’s healthcare programme (because as with anything, practice makes perfect).

And it’s clear that the powers that be care increasingly about prevention and not just intervention when it comes to health. But without a genuine investment into those grassroot fitness facilities or subsidised apps, it’s hard to see health as a priority. 

As Dally concludes, this isn’t a niche interest but something that “we should all be putting our energy into: getting more people moving!”

Looking to get more active? Hop over to the Strong Women Training Club where you’ll find workouts, training plans and plenty of fitness advice. 

Illustration by Ella Byworth.

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