Prescribing physical activity as an alternative way of treating physical and mental health problems: interview with Marita Friberg

To support EU Member States in reaching the Sustainable Developmental Goals, the European Commission has established the new expert group “Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases”. The Group sets Public Health priorities and coordinates implementation of evidence-based best practice interventions in other countries. We conducted an interview with Marita Friberg from the Public Health Agency of Sweden, who presented a best practice example on prescribing physical activity for physical and mental health problems, which planned to be implemented in 10 other member states.

PB: Thank you, Marita, for agreeing to participate in this interview. Could you please give us a short summary of your best practice example on prescribing physical activity? How did your project become part the best practice examples?

MF: Our project was suggested by the Steering Group as a best practice example. We developed a method in Sweden (prescribing physical activity), which has been scientifically evaluated and is proven to be as good as medical treatment (to address physical and mental health problems). Prescribing physical activity is used in healthcare, and follows the medical treatment process: the prescriber has to be registered, the process has to be followed-up and documented in a systematic way. The prescriber could be a doctor, a nurse or a physiotherapist. These are the key figures of the method. The evidence-based handbook presents prescriptions for different diagnoses. The treatment is individualised, happening in a dialog with the patient and based on each person’s capacity and motivation.

GB: What can you do if people do not want or cannot afford to buy a membership for a sports facility?

MF: The recommendations in the guidebook only indicate the dosage, not a particular activity. For example, strength-training three times a week or aerobic training four times a week. Then, in dialog with the patient, we discuss what is most convenient, and we try to find the physical activity which suits the person the best. The dialogue is central and essential to the implementation of the best practice. If the cost for gym is too expensive, then you can find other options, such as using your own bodyweight or working out at home. We talk about how you can integrate physical activity in your everyday life. For example, if you are going to your workplace or visit friends, walking, getting off the bus earlier or cycling, all of those would be an option to increase physical activity. Or taking the stairs instead of the elevator. The majority of patients receive prescribed walking. It is not about the exercise itself, it is about physical activity.

PB: …but what if I don’t want to do it alone?

MF: Then the healthcare can inform you of physical activity providers and groups in your area. In some regions, there are even health coaches. If you visit your doctor, she/he can recommend you talk with a health coach, who is usually a trainer or physiotherapist, and the coach can help you further.

PB: In Belgium, GPs have more or less 15 minutes to see a patient. How can this dialogue fit in such a short timeframe?

This is also a problem in most of the countries we have been talking to, because only the doctors are allowed to prescribe. In Sweden, we are using special trained nurses, because doctors often have limited time for a dialogue.  It is cost-effective to use nurses. However, it is important to have doctors on board because they meet the patient and they can suggest the patient to talk to the nurses. Doctors can be the door openers, but they do not have to be the person who has the dialog with the patients.

GB: What is your experience about working with people from lower socioeconomic background? Studies show a social gradient in physical activity.

MF: This is an important issue we have to work on. Also, the adherence to the prescription. We are struggling in Sweden, because prescription for physical activity is an offer that patients can accept or decline. This group more often declines the prescription for physical activity and prefers taking medication. We have to include them somehow, otherwise only those who are motivated will participate in our project. This will increase the inequality gap. So, this it is a future lesson to learn, how can we work with these vulnerable groups.

PB: What do you think would be the struggle to share and implement this project in other countries? The healthcare systems might be completely different.

MF: That is why we need a feasibility study at the beginning of the project. We try to be realistic: it is not going to be implemented on national level. We start small. We will work with actual health professionals on local level, who talk to patients and who want to implement our project. Parallel on the structural level, we need to raise awareness in stakeholder workshops, and show how our method could be integrated in the health care system.

PB: What should be the role of the Steering Group on Prevention and Promotion?

MF: I think the Steering Group has started this project, as they see how important it is. We have 10 participating member states at the moment and about 5-6, who want to join. But, we have a limited budget and limited time. We can start the European implementation in this first project, but the Steering Group has to acknowledge that it will need further support, as you are not going to solve this problem with a three years project. While we start with these 10 participating countries, other countries might see the benefits and would like to join. It is important that we can introduce this method to them as well.

PB and GB: Thank you for your time. We really look forward at seeing how this project will be implemented.

This interview was conducted by Young Gasteiners Petronille Bogaert and Gerg? Baranyi

European Patient’s Rights Day

Today marks the 6th European Patients’ Rights Day and this years theme is: “Active Ageing citizens at the center of EU health policy”. Active Citizens Network  is organizing events on 15th and 16th of May in Brussels to bring attention to active ageing of European citizens.

Due to demographic transition the number of citizens above 65 is rapidly increasing. According to WHO Europe, median age of Europeans is already the highest in the world, and the proportion of people aged 65 and older is forecast to increase from 14% in 2010 to 25% in 2050. If you want to find out how the demographic transition developed during the last 50 years, watch this video.

With increasing age, people are at high risk of chronic diseases, mental illness and require more health care. However, they should not be seen as burden to the health care system and society due to their increasing needs and care. Empowering ageing citizens, ensuring access to health related information, implementing their rights and encouraging a healthy lifestyle has a vice versa effect for the whole population.

European institutions, patient organizations, healthcare representatives and national and/or regional health care departments should come together and discuss: How ageing patients can actively be involved, exchange of knowledge and best practices and how rights of ageing people can be secured.

Having access to health information, care and treatment is a right that should be secured at every stage of life.

“Shaken not stirred” to be replaced by a Heineken

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On the 16th of April a report was published that the alcohol industry will launch a first imitative to self –regulated advertising to combat abuses across media. Under the Responsible Marketing Pact Europe’s eight largest alcohol manufactures including Bacardi, Heineken, Carlsberg and Pernod Ricard have agreed to work with the World Federation of Advertisers (WFA), the European Commission and national authorities to protect underage consumers from advertisements in social media such as Facebook or movies. Under the pact a common standard will be established, ads may only be placed in media where at least 70% of the audience is expected to be above the legal purchase age. Standards, implementation and compliance will we monitored by Accenture and national self-regulatory organisations.

Despina Spanou health department strategy chief said: We want it [the alcohol industry] to show that self-regulation can deliver results, but they need to demonstrate that it can work,” adding that Commission President José Manuel Barroso had personally indicated a preference for more rigorous health warning labels, this according to an interview with EurActiv.

Coincidently, one day (17th April) later it was announced that Heineken will be the new sponsor (approximately worth $45 million) of the upcoming James Bond movie. The famous Martini “shaken not stirred” will be exchanged for a Heineken beer. In most EU countries the legal age limit to watch the actions of James Bond on the big screen is 12 or 16 years.

It has to show whether the Responsible Marketing Pact will have a positive effect on the health of consumers or is just an action of showing good will regarding the forthcoming review of the EU alcohol strategy, to be expected beginning 2013.


The World is Thirsty because We are Hungry

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What would we do without water? We use it to brush our teeth, to take a relaxing bath, to cook or simply to drink. But are the highest amounts of water really used for personal hygiene, sanitation and drinking? According to the UN Water website each of us drinks from 2 to 4 litres of water every day, however most of the water we ‘drink’ is embedded in the food we eat: producing 1 kilo of beef for example consumes 15,000 litres of water while 1 kilo of wheat ’drinks up’ 1,500 litres.

On the 22nd of March we celebrate World Water Day, to bring attention to the importance of clean water, access to it for everyone and the sustainable management of it. The theme of this year’s day is “Water and Food Security”. This year the event is being organized by the Food and Agriculture Organization of the United Nations. The official event will therefore take place in Rome, two sessions will be held and various speakers are sharing their views on this years topic. Next to the morning and afternoon session and exhibition can be visited.

Worldwide various events are being organized, ranging from student debates, awareness walks, trash clean up of rivers and lakes, concerts and exhibitions. What will you do to raise awareness and ensure the safety of water in food for 9 billion people in 2050?

How do you try to save water and be sustainable?

Celebrate one extra chromosome – World Down Syndrome Day

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Watch the video to learn more about 68 countries, promoting the inclusion of people with Down syndrome.

Today is the 7th World Down Syndrome Day (WDSD) and this year for the first time it will be officially guarded by the United Nations. But what is Down syndrome? It is a genetic defect, causing a person to have an extra copy of one chromosome. Three different types of Down syndrome exist:  regular trisomy 21, translocation and mosaic. The genetic defect changes the balance of the body and affects physical and intellectual features.
On this day worldwide people who have Down syndrome and the people in their lives are celebrated. Events and activities are organized to raise awareness of what it means to live with Down syndrome and to educate people.

Here are some beautiful examples:
In Kosovo the World Down Syndrome event already took place on 16th of March 2012. Activists organized a solidarity march to raise awareness, to educate and to show citizens that people with the syndrome are ready to be fully integrated as equal members of society. At the end of the march, in front of the National Theatre of Kosova, balloons were released that were held by participants throughout the walk. In South Africa the Upside Down syndrome support group for parents will be holding a family picnic. In the UK a young boy called Logan will make and decorated over 100 cakes for his school, to celebrate the day, all cake toppers are made of the WDSD logo.

On the 21st of March World Down Syndrome International will announce awards for volunteers, scientists and professionals for outstanding performances. Candidates can be individuals or groups, who have been nominated by any member or member organisation.


Let’s celebrate the World Down Syndrome Day together!