By Professor Greg Whyte OBE, Chair of the ukactive Scientific Advisory Board and Professor of Applied Sport and Exercise Science at Liverpool John Moore’s University
In a week when the global incidence of COVID-19 topped 50 million cases, with 1.25 million deaths, it is clear that we must focus on prevention to bring an end to this pandemic. Lockdown 2.0 is the Government’s response to prevent the spread of the virus, however, it is often the simplest advice that is the most effective in reducing infection rates: washing/sanitising hands regularly; avoiding contact with eyes, nose and mouth; and socially distancing (‘Hands-Face-Space’) are central to the success of any prevention programme.
Further to this guidance, our growing knowledge of COVID-19 has shone a spotlight on the importance of health in reducing the risk of infection and reducing the severity of symptoms if infected (see my previous ukactive blog, Exercise: The wonder drug).
Unfortunately, once infected, COVID-19 is a complex virus that has a negative impact on a large number of body systems (ie heart, lungs, kidneys, liver), and can lead to a long recovery process of more than eight weeks for one in 20 COVID sufferers, a condition called ‘long COVID’.
Recovery from long COVID is likely to be complex and protracted for many. Central to the rehabilitation process will be the role of the fitness sector in providing the facilities and expertise required for physical therapy to overcome the negative impact of COVID-19 on physical function, including the loss of muscle mass, strength, aerobic capacity, and mobility, to name but a few.
Following news of a vaccine breakthrough for COVID-19 this week, it should also be noted that physical activity plays an important role in increasing the efficacy of vaccines, and therefore is vital to provide any new vaccine with the best possible chance of success.
But, COVID-19 is not the only disease where the fitness sector plays an essential role. The vast majority of prehabilitation and rehabilitation for a range of diseases is currently provided by the fitness sector, including cancer, cardiac, pulmonary, and neuro. Without access to these facilities and the expertise provided by the fitness sector, many of these patients will go unsupported in the hour of their greatest need.
Macmillan recently reported 50,000 undiagnosed cases of cancer during the first lockdown, a figure that is projected to break 100,000 by next year. But the damage caused by lockdown does not end with missed diagnosis, because the closure of gyms and leisure facilities also has an impact.
According to Anthony Crozier and the PAEx team at Liverpool John Moore’s University, 66% of our nation’s cancer prehabilitation and rehabilitation support services are delivered at leisure centres, with 69% of provision funded through local authorities and the third sector. In addition, 73% of functional assessments and 80% of exercise to support these interventions are delivered by Level 4 instructors from the sector. If we are to avoid a future healthcare catastrophe, we must recognise the fitness sector as an essential service.
Lockdown 2.0 is different to the first lockdown, further exacerbating the health challenges we face. The annual seasonal flu outbreak has begun, which places additional stress on our healthcare system, and further highlights the need for a focussed prevention and health promotion approach.
“In a typical flu season about 7,000 people a year in the UK die of seasonal flu. And, in a bad flu year, which often goes quite unremarked, it can be north of 20,000 people dying.” – Professor Chris Whitty, BMJ, 2020
Following months of negotiation with Number 10, SAGE, DCMS, and PHE, an agreement was reached that the exhaustive guidance to the fitness sector would provide a COVID-safe environment. In response, the fitness sector rose to the challenge and spent millions of pounds in redesigning spaces to deliver the guidelines, and ukactive collected data to demonstrate the safety of the sector.
Aggregated data from 1,900 facilities following 50 million visits reported a rate 2.88 cases per 100,000 visits (cases by date reported as of 20 October; compared with 150 per 100,000 in the general population), demonstrating the effectiveness of the COVID-safe guidelines. It is clear, from the science, that fitness facilities have an outstanding safety record. Furthermore, the sector has a robust, rapid and effective track and trace system to support the protection of the population.
“The fitness and leisure sector has set the benchmark for the responsible monitoring and reporting of COVID-19 cases in the UK, and the latest findings continue to show successful adherence to the Government’s guidelines.” – Huw Edwards, CEO, ukactive
In addition to its outstanding safety record, the fitness sector takes its responsibility for public health seriously, and is currently working on upskilling its workforce to provide specialist support for COVID-19 patients, as well as all other diseased states that require physical therapy as part of their prehabilitation and rehabilitation.
I am currently working with a group of national and international specialists on a project (iCARDIO) to create a new accreditation framework for ‘Clinical Exercise Physiologists’, something that will be required to ensure the sector is recognised by the health sector, and provide essential services for patients across the disease spectrum.
If we are to protect our health service, which is reportedly at breaking point, and effectively deal with COVID-19 and avoid a future healthcare catastrophe, we must recognise the fitness and leisure sector as an essential service in the prevention and treatment of disease, as well as enhancing the health of the nation, and keep these valuable facilities open.
The BMJ Interview: Chris Whitty, England’s Chief Medical Officer, on COVID-19. BMJ 2020;371:m4235.