Physical inactivity is a leading cause of worldwide morbidity and mortality. The use of physical activity (PA) promotion in clinical settings by doctors is supported by the National Institute for Health and Clinical Excellence guidelines in primary care. Thirty-nine different disease-specific clinical guidelines also support PA and exercise promotion, usually as a primary treatment and management recommendation, covering a wide range of diseases and conditions. 

The vast majority of the population in England live largely sedentary lives when measured objectively, ie. well below levels recommended for basic health benefits, placing them at a greater risk of developing or having been diagnosed with chronic disease. PA promotion is therefore applicable to most of the population and patients, and a recent systematic review of randomised controlled trials, assessing promotion of PA to sedentary adults recruited in primary care, demonstrated significantly increased PA levels at 12 months. 

Approximately one in four people in England say they would be more active if they were advised to do so by a GP or nurse, and yet 54% of patients reported not even being provided with advice on diet and exercise by their GP. 

It is not entirely clear why this paradox exists and why clinical practice is seemingly not following evidence-based guidance and national policy initiatives to the detriment of individual and population health. Explanations of the ‘Cinderella’ status of physical activity in healthcare and public health propose that doctors are neither trained, experienced or confident to provide PA promotion effectively to their patients in accordance with a growing number of clinical and public health guidelines. 

Almost 30 years ago it was recognised that PA education within medical schools was required to support increasing evidence that PA promotion was important in the management, treatment and prevention of disease and also in the promotion of health. 

However, little is known about the PA content of medical school curricula. The aim of this study, therefore, was to assess the provision of PA teaching content in the curricula of all medical schools in the UK. 

A questionnaire designed to assess the content, form and timing of key aspects of education on PA promotion according to current national guidelines was sent to the 31 medical schools in the UK.¹ The questionnaire quantified the amount, number of years and total time devoted to teaching PA within the full undergraduate curriculum of each medical school. 

A 100% response rate was achieved. Response rates for individual questions varied. Five medical schools (16.1% of responders and 93.5% responded) did not include any specific PA teaching within their curricula. Four medical schools (15.4% of responders and 83.9% responded) taught PA within all five years of the curricula and the average year of this teaching was 2.3 years (SD 1.5, 83.9% responded). 

The average number of hours devoted to teaching PA throughout the entire curricula was 4.2 (SD 2.6), however, this question was only answered by 12 schools (38.7%). Only 15 (55.6% of responders and 87.1% responded) medical schools teach the current chief medical officer (CMO) guidance for PA. 

Two common themes emerging from free text responses in relation to teaching PA were that the curriculum was ‘integrated’ (12 mentions by eight schools) and that it was ‘difficult to quantify/assess’ (five mentions by four schools) the teaching of physical activity within these curricula. 

Delivery of PA teaching is varied across UK medical schools, but overall was sparse or nonexistent. Increasingly integrated curricula make PA teaching difficult to quantify and introduce into existing and established curricula based on ‘traditional’ medical specialties. 

There is widespread omission of basic teaching elements, such as the CMO recommendations and guidance on PA, which has been endorsed by all four UK departments of health. There is an urgent need for PA teaching to have dedicated time at medical schools, to equip tomorrow’s doctors with the basic knowledge, confidence and skills to promote PA and follow numerous clinical guidelines that support PA promotion. This will need to be supported with behavioural change skills, which are fundamental to the delivery of most aspects of preventive medicine and clinical communication.

Reference

1. Weiler R, Chew S, Coombs N et al, Br J Sports Med 2012 [Epub ahead of print]