Can running save the NHS?
The national health service’s 70th birthday last year was the perfect opportunity to reflect on this unique institution. From a commemorative service at Westminster Abbey to milestone parkruns across the country, everyone seemed keen to join the party. It was yet another reminder of the special place it holds in the nation’s heart, as poignant as the NHS segment in the opening ceremony of the London 2012 Olympics. Who can forget the rollerskating nurses and child ‘patients’ bouncing on hospital beds?
While we rightly celebrate the past, the future looks far from rosy. As the UK’s population increases and we live longer, we demand more from a health service that already deals with one million patients every 36 hours. Factor in the health problems caused by sedentary lifestyles fuelled by poor diets and the result is no surprise: an NHS under – ultimately – unbearable strain as more and more is asked of it. According to a report by the Institute of Fiscal Studies and Health Foundation, it now costs £149 billion a year to operate our health service. It is the fifth-biggest employer in the world, behind the likes of the US Department of Defense and China’s People’s Liberation Army.
One way to reduce the mind-boggling cost of running the NHS is for each of us to take preventive action. The healthier and fitter we are, the less we will need to rely on the safety net of the NHS. Lifestyle changes can dramatically improve many aspects of our health, and getting more exercise is a key and relatively simple change that nearly everyone can make. Currently, more than 20 million people in the UK are classed as physically inactive, meaning they don’t hit the recommended weekly activity target(s) of 150 minutes of moderate aerobic exercise or 75 minutes of more vigorous activity. Lowering that figure that would make a huge difference to the health of the nation and the NHS balance sheet.
‘Regular physical activity, such as running, can help reduce the risk of key preventable illnesses that are driving demand on NHS services, such as type 2 diabetes, cardiovascular disease, depression and some cancers,’ says Dr Mike Brannan, national lead for physical activity at Public Health England. ‘Getting active can begin with a simple 10-minute brisk daily walk, or starting our free Couch to 5K programme app.’
We’ll explore how running, as one of the most accessible and effective forms of exercise, could play a crucial role in easing the burden on the NHS and reducing the number of premature deaths in this country.
Cancer
Imagine watching the entire field of the London Marathon stream past you nine times over. That would be roughly 360,000 people, which is equal to the number diagnosed each year with cancer in the UK. Roughly one in three of us will develop the disease at some stage, with half of all cases affecting the breast, prostate, bowel or lung. Cancer Research UK (CRUK) says cancer kills almost 164,00 people in the UK every year.
Cancer services also cost the NHS £5bn a year and this enormous amount leads to much-publicised tough policy decisions about which forms of treatment can be made available to patients.
The picture isn’t all bleak, however. People diagnosed with cancer today have, on average, a 53 per cent chance of surviving for five or more years. Survival rates for prostate cancer, for example, have tripled in the past 40 years. But our odds of getting cancer in the first place could be slashed further if we took more responsibility for our health.
CRUK believes 38 per cent of all cancers can be prevented through lifestyle changes such as stopping smoking, improving diet and, crucially, exercising more. According to CRUK estimates, this could prevent 135,000 annual cancer deaths.
Georgina Wiley, a specialist nurse adviser for Macmillan Cancer Support, and a keen runner, says there’s ample evidence that regular exercise cuts the risk of some cancers: ‘For breast cancer, being active can alter the hormone levels, the chemical messages that are carried around our body,’ she says. ‘Cancer starts when cells divide and multiply
and it’s thought that oestrogen encourages cells to divide more frequently. But running reduces these oestrogen levels and helps prevent breast cancer.
‘With bowel cancer, exercise encourages the quicker movement of food through our bodies, reducing the time harmful chemicals remain in our bowel, cutting our cancer risk,’ says Wiley.
Aside from its role in prevention, running may also boost survival chances for those with the disease. ‘Being active before, during and after cancer treatment can reduce the fatigue from cancer and strengthen muscles, joints and bones. It can also help with anxiety and depression,’ says Wiley.
Dr Rebecca Robinson, a consultant in sports and exercise medicine, and an oncologist at Sheffield’s Weston Park Hospital, agrees: ‘There’s some exciting work showing that exercise may prevent cancer and benefit recovery post-treatment,’ says Robinson, who’s also a GB endurance runner. ‘In terms of prevention, exercise can reduce inflammation in the body, which can be a driver for certain cancers. We already have good evidence that exercising – including running – can help those with breast, colon, lung and endometrial cancers. Some research suggests exercise might stimulate the immune system in a very positive way.’
There is a huge body of research out there to back the role of exercise in reducing cancer risk and boosting survival rates. In 2017, a Danish study suggested exercise can prevent cancer spreading by slowing down its progress, making it easier to treat. Adrenaline is released during intensive workouts such as running and scientists believe this can cut the risk of developing breast cancer by 25 per cent. Similarly, the World Cancer Research Fund found that exercise reduced breast cancer risk in postmenopausal women by 10 per cent.
Such is the weight of scientific research that last year the Clinical Oncology Society of Australia called for exercise to be a fundamental part of cancer treatment following indisputable evidence that it can help with recovery from several cancers. It prescribed at least 150 minutes of exercise a week, with a jog/run being part of the regime. While this development was a first, the Australian example will surely soon be followed by other countries in the world.
One way of getting those exercise minutes could be by taking part in 5K Your Way. The event was launched in Nottingham last June by multiple Ironman winner Lucy Gossage – who’s also an oncologist at the City Hospital – and international runner Gemma Hillier Moses. It’s a monthly event, hosted at more than 25 parkruns for those affected by cancer.
‘There’s strong evidence that we should get every single cancer patient talking about doing some exercise, whatever their level,’ says Dr Gossage. ‘Some of our runners say it’s a way of connecting with others dealing with cancer. For others, it’s introducing exercise, which can be so helpful. We had a chap recently who ran it for the first time since undergoing chemo. After crossing the line, he said “I feel so alive!”’
Obesity
One February day back in 2012, Elaine Wyllie, head teacher at St Ninian’s School in Stirling, encouraged her pupils to go for a run around the school grounds. The run – which became known as the Daily Mile – quickly became part of the school’s regular timetable.
Seven years later, over 8,000 schools across the UK and around the world have embraced the routine of a 15-minute daily outdoor run at a comfortable pace. The aim was – and is – to get children running every day to help them become fitter and healthier, and reduce rates of childhood obesity.
Currently, 26.2 per cent of adults in England are classified as obese (a body mass index of 30-39.9) – with an additional 35.2 per cent being over-weight. According to the Organisation for Economic Cooperation and Development (OECD), which promotes global health as part of its brief, this makes the UK the most obese nation in Western Europe.
And, worryingly, this slide towards obesity often begins with the young. Ten per cent
of children starting primary school in England are obese, a figure that doubles by the time they leave. According to Public Health England, nearly a third of secondary school pupils are either overweight or obese.
This paints a disturbing picture of the future, as increasing obesity levels are already straining stretched NHS services. The latest figures show an 18 per cent annual increase in the number of patients admitted to NHS hospitals for obesity and related conditions. There were around 617,000 such admissions in 2016-17, according to NHS Digital. Further evidence from Public Health England shows that obesity is responsible for around 30,000 deaths each year, depriving a person of, on average, nine years of life.
In 2014-15, the NHS spent an estimated £6.1 billion on overweight and obesity-related ill health, a figure that’s projected to rise to £9.7 billion by 2050. However, the wider costs
to society from the knock-on effects of obesity are thought to be more than £27 billion, according to Public Health England.
This is a health and public policy time bomb, but Dr Alison Innerd, senior lecturer in physical activity and exercise science at Teesside University, already sees signs that running is playing a part in easing the crisis. ‘Running’s not for everyone, but parkrun and social running groups are attracting what we call “hard to reach” people, including women and younger people who wouldn’t normally be interested in exercise,’ she says. ‘By offering a social side while getting fit, weight loss can naturally follow rather than being the sole focus of why people decide to run.’
Of course exercise, and specifically running, is not the only factor at play here. Numerous recent studies have identified both insufficient activity and poor diet as the causes of the obesity surge, with statistics from NHS Digital showing that a fifth of men and a quarter of women are now classed as inactive.
More evidence that we need to move comes from a study at Queen’s University Belfast published in March this year. It concluded that sitting or lying down for long periods (more than six hours a day) could cause about 70,000 deaths in the UK and cost the NHS at least £700 million a year in treatment.
The value of exercise in reducing obesity and boosting health is emphasised by David Stensel, professor of exercise metabolism at Loughborough University: ‘There’s quite a lot of debate about exercise versus diet in controlling weight,’ he says. ‘Even as an advocate of exercise, I would say diet is possibly more important for weight – you can’t outrun a bad diet. But you can clearly see the benefits of combining this with even relatively modest amounts of exercise.
‘Using MRI scans, we’ve shown that those who regularly exercise will reduce the visceral fat, which builds up in the abdominal cavity before wrapping around important organs like the liver, pancreas and intestines; this can lead to type 2 diabetes and heart disease. As a keen runner, I believe running’s an excellent way of cutting visceral and overall excess fat in people who are overweight.’
Mental Health
When researchers from the psychology department at Harvard University, US, examined the ways in which aerobic exercise affects our emotional well-being, their conclusions would not have surprised many seasoned runners.
The study involved 80 volunteers. Lab tests were used to stir up their emotions, some of which increased their anxiety or lowered their mood. They were then randomly assigned
to either a stretching session or a 30-minute run. The researchers found that after completing their activity, the runners were better at processing their negative thoughts than those who stretched.
The 2017 study is one of many to focus on physical activity as an aid to our emotional well-being and Professor Craig Mahoney, a sports psychologist at the University of the West of Scotland, is a strong believer that what happens in our head can be affected by what we do with our body. ‘Running at an appropriate level has been proven to release the hormone endorphin, which produces a mood-enhancing effect,’ says Mahoney. ‘It has also been shown to provide relief from anxiety and improvement in self-esteem. As well as exercise decreasing the stress hormones such as cortisol, it increases the release of adrenaline, serotonin, oxytocin and dopamine, which are referred to as the body’s “happy chemicals”.’
As the stigma around mental health has lessened somewhat, more people are now opening up about their emotional well-being. The charity Mind says that one in four of us will experience a mental health issue at some point. Often this can manifest as anxiety, depression or both. Obsessive-compulsive disorder, phobias, panic disorders and post-traumatic stress disorder are also becoming increasingly common.
While it’s undoubtedly a positive development, the fact that more people are now seeking help has come at a cost, with the bill for mental health services in the last financial year reaching £11.9 billion. Meanwhile, a 2108 OECD report showed that mental illness costs approximately £94 billion annually when treatment, social care costs and loss to the economy are included. In January this year, the Government unveiled its 10-year plan for the NHS, pledging an extra £2.3 billion in mental health by 2024, thereby helping a further
two million people.
But to ease the NHS burden, alternatives to prescribing drugs have already been introduced. One of those has been advocated by Allan Bednar, the therapies’ lead for Turning Point, a national social enterprise with more than 300 UK locations, who says some of its 77,000 clients have found running beneficial.
‘Rumination is one of the problems that can lead to both depression and anxiety,’ says Bednar. ‘It’s when you go over and over a problem in your head without resolving it. But running outside means you become less introspective and instead look around you more. This can stop the cycle of brooding over negative thoughts.’
England Athletics has also recognised the positive link between running and good mental health, teaming up with Mind to launch #RunAndTalk, a programme already involving 23,600 people (a third of whom had a mental illness). It encourages those who have never run before, or are returning to it, to join one of its empathetic running groups.
Psychotherapist William Pullen, author of Run for Your Life: Mindful Running for a Happy Life, encourages his clients to run, too. ‘There are many reasons why running is good for mental health, with some less obvious than you might think,’ he says. ‘For example, a run through a forest will mean you absorb phytoncides – chemicals that plants and trees naturally produce to protect themselves – which have been shown to decrease anxiety, depression, anger and stress.’
He believes the body is ‘primed for adventure, exploration and hunting’, adding, ‘We’re built to be free and [to have] that sense of freedom every runner knows is the perfect antidote to most forms of mental distress.’
Diabetes
This is the 21st-century health epidemic that many believe is threatening to overwhelm the NHS. The number of newly diagnosed cases of type 2 diabetes – when the pancreas doesn’t produce enough insulin or the cells don’t react to it, raising blood sugar levels – is soaring.
The charity Diabetes UK says that in the past 20 years, cases of type 2 diabetes (T2D) here have almost doubled, from 1.9 million to 3.7 million, and could reach 5.5 million by 2030. One person is diagnosed with T2D every three minutes and it is estimated that one in 10 people aged over 40 have it. With more than one million people thought to have undiagnosed T2D, and a further 12.3 million at risk of developing it, the word ‘epidemic’ doesn’t sound like hyperbole.
T2D costs the NHS more than £9 billion a year. It’s believed that at any time, one in six hospital beds is occupied by someone with diabetes and diabetes medication alone costs the NHS £1 billion a year – there were 55 million prescriptions last year, up 70 per cent in the last 10 years.
Although not exclusively caused by lifestyle choices, there’s a proven link between T2D and rising obesity rates. And lifestyle changes can often prevent T2D in people with pre-diabetes (when blood sugar levels are higher than normal but not high enough that diabetes develops). It’s also possible to reverse the condition the same way. Diet and exercise are key and running is an ideal way to achieve this, say experts.
‘There are a number of risk factors for type 2 diabetes, including age and ethnicity, but being overweight is the most significant,’ says Douglas Twenefour, deputy head of care at Diabetes UK, who advocates running as a way to deal with T2D. ‘People can take steps to manage or reduce this with diet and exercise. Although nobody is expecting you to become a marathon runner overnight, running regularly will help the body and either prevent or manage diabetes.’
Twenefour says running can help people with T2D use what insulin their body does produce more effectively. ‘Running can benefit your glucose levels for 48-72 hours after exercising by making your muscles more insulin sensitive,’ he says. ‘Staying in range can prevent complications such as sight loss, kidney disease and lower leg amputations caused by nerve damage.’
Dr Paddy English, diabetes consultant at Plymouth’s Derriford Hospital, agrees that running can help address rising T2D levels. ‘When you’re active, you need less insulin to keep your blood glucose level stable,’ he says. ‘In simple terms, exercise takes the strain off the pancreas and so lowers the amount of meds you need. That’s good for you and the NHS budget.’
Exercise can also contribute to weight loss, making it easier to control the condition. ‘Relatively small shifts in weight and activity have a huge impact,’ adds English. ‘Reducing body weight by 3.5 kilos by modifying the diet and increasing activity can cut T2D development in those with impaired glucose tolerance by 58 per cent.
‘It means that a regular run or even a brisk walk could prevent T2D in many people who are on the cusp of developing it.’ This view was backed by a recent University College London study review, which looked at 26 existing T2D studies before coming to a similar conclusion. It found that doing the recommended 150 minutes of weekly exercise reduced the risk of developing T2D by 26 per cent, and that risk fell further for those who exercised more.
This approach is shared by Southport GP Simon Tobin, who ‘prescribes’ running to T2D and other patients he believes could benefit. Many now prefer regular parkruns to a lifetime of pills and this could play a huge part in keeping the NHS running, too.
Heart Disease
With around seven million people in the UK living with heart and circulatory disease, it’s easy to see why this area of healthcare costs the NHS almost £9 billion a year. And, of course, the costs go way beyond the financial: according to the British Heart Foundation, every day an average of 420 people die from cardiovascular disease (CVD) – the collective name given to an array of conditions that affect the heart and blood vessels. That’s a quarter of all deaths in the UK. This is often due to coronary heart disease (when the arteries narrow and may eventually block, owing to fatty deposits or plaques), leading to heart failure, heart attacks and strokes.
Of the 170,000 annual deaths in the UK caused by heart and circulatory disease, 42,000 are classed as premature because the person who died was under 75. Add to this those who survive a heart attack or a stroke but need emergency treatment and aftercare, and it’s clear NHS spending is only heading one way. But experts believe we can chip away at these grim statistics simply by being more active.
‘If we could put exercise like running into a pill, it would be the most popular one on the shelf because it provides a host of benefits,’ says Dr Dan Augustine, consultant cardiologist and sports cardiologist at the Royal United Hospital Bath. ‘There’s good evidence to show that an increase in your exercise capacity reduces your cardiovascular risk and mortality. It also reduces the risk of coronary artery disease, lowers blood pressure and helps maintain a normal weight. All of this helps improve your lipid profile, reducing ‘bad’ cholesterol and improving ‘good’ cholesterol. Having a poor lipid profile is one of the risk factors for heart attacks and strokes. Exercise has multi-system benefits, so increasing the amount we do will help us achieve these benefits.’
There are caveats. ‘We know that people in their 40s onwards who have exercised over a lifetime at higher intensities are at increased risk of developing an irregular heart rhythm called atrial fibrillation,’ adds Augustine, a keen runner. ‘There have been studies showing that older endurance athletes have more heart- muscle scarring – fibrosis – on heart MRI scans and further studies are needed to see what the significance of this is, if any. Studies have also shown that older endurance athletes had more furring of their heart arteries compared with age-matched controls. However, importantly, the plaque seen in athletes is calcified, more benign and thought to be less likely to rupture and cause cardiovascular events than the softer mixed plaques seen in the control groups. Overall, the benefits of exercise far outweigh the downsides. Anything done to reduce sedentary behaviour will cut cardiovascular risk.’
A major US study involving 55,000 people by Iowa State University’s Department of Kinesiology found that runners had a 24-40 per cent reduced risk of dying young. Interestingly, the study found that no other activity had the same positive impact on health as running, with every hour of running potentially increasing life expectancy by seven hours. And it gets better. Runners could expect to live three years longer than non-runners. Even those who already have coronary disease can benefit by running for less than 80 minutes a week.
Lead author Professor Duck-Chul Lee said even those who do a high mileages won’t cause any damage to their heart. ‘We still didn’t find a significant harmful effect of running too much on mortality, including cardiovascular mortality,’ says Lee. ‘You might not get further benefits, but you will not harm yourself.’
Obviously, running in isolation isn’t the cure-all for every modern health condition, but all of this research and expert insight adds up to a compelling argument that getting more people out there pounding the UK’s pavements, trails and park paths could be a valuable prescription for an ailing health service. Can running really save the NHS? We believe that it can, if enough people lace up their running shoes. And, more importantly, if you’re one of them, it can add many healthy years to your life, too.
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