Feasibility of “fitness age” as a motivator for positive physical activity behaviour and improved health outcomes in UK primary care
Physical fitness, defined as “a set of attributes that people possess or achieve that relates to the ability to perform physical activity”,1 is a strong risk factor for mortality, morbidity and ill health. This risk is independent of physical activity levels and other well established risk factors (e.g. blood pressure, cholesterol, BMI). A higher fitness level offsets the incidence and impact of chronic disease across the age spectrum, but particularly into older age.2 Moreover, poor performance of simple physical capacity assessments (e.g. grip strength, chair rise and standing balance time) carried out in the home setting by a nurse is associated with a 7-fold increase in mortality risk.3
This raises the prospect of an ideal “fitness age” as an informative concept in risk profiling; akin to the “heart age” metric currently used in practice for cardiovascular risk prediction.4 Heart age has been shown in randomised trials as a plausible motivational tool for the adoption of healthier cardiovascular lifestyles and reduced CVD risk.5 Similarly, informing smokers of their lung age has shown to be a strong motivator for instigating and maintaining positive behaviour changes in UK primary care settings,6 and appears receptive by primary care providers.7 Fitness age may provide a similar cue for motivating individuals towards favourable physical activity and lifestyle behaviours and thus the potential for better health outcomes.
This project will be part of a new research collaboration between groups within the host department, Public Health England and Better Value Healthcare (lead by Sir Muir Gray). This department already has a strong track record in research on brief interventions in primary care. The selected student will work in a priority clinical area to primary care, as well as develop methodological experience in mixed-methods research including systematic reviews, questionnaire/survey and qualitative data collection.
The research team
The studentship will be linked to a number of research active groups within the department (https://www.phc.ox.ac.uk/) including the Centre for Evidence-Based Medicine (http://www.cebm.net/) and the Behavioural Medicine Research Group -TBC (https://www.phc.ox.ac.uk/research/behavioural-medicine). The student will work alongside Dr David Nunan (https://www.phc.ox.ac.uk/team/david-nunan), a departmental lecturer and senior researcher, Dr Kamal Mahtani, (https://www.phc.ox.ac.uk/team/kamal-mahtani), an academic GP and XXX - TBC. Between them they have extensive experience in clinical exercise science, complex systematic reviews and behavioural research methodology, with a strong emphasis on evidence-into-practice. There may also be opportunities to link this work with the RCGP Physical Activity and Lifestyle Clinical Priority, a 3-year programme to promote the uptake of evidence-based physical activity and lifestyle interventions in primary care.
Who should apply?
Candidates will be expected to be familiar with the basics of evidence synthesis, and quantitative and qualitative research methodology as applied to healthcare settings and to hold a good undergraduate degree and a Masters degree in a relevant subject (such as clinical exercise science, public health, evidence-based health care, communications science, behavioural science). The overarching topic for study has been identified but specific questions and research methodology should be identified by the candidate, who should offer a preliminary literature review as part of the application.
- American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins; 9th revised North American ed edition (1 Feb. 2013).
- Willis BL, Gao A, Leonard D, et al. Midlife Fitness and the Development of Chronic Conditions in Later Life. Arch Intern Med. 2012;172:1333-40.
- Cooper R, Heine Strand B, Hardy R, et al. Physical capability in mid-life and survival over 13 years follow-up: British birth cohort study. BMJ. 2014;348:g2219
- NHS Choices. Your NHS health check results and action plan. Accessed on 15.11.2016: (http://www.nhs.uk/conditions/nhs-health-check/pages/your-nhs-health-check-results-and-action-plan.aspx).
- Lopez-Gonzalez et al. Effectiveness of the Heart Age tool for improving modifiable cardiovascular risk factors in a Southern European population: a randomized trial. European Journal of Preventive Cardiology. 2015;22:389-96.
- Parkes G, Greenhalgh T, Griffin M, Dent R. Effect on smoking quit rates of telling patients their lung age: the Step2quit randomized controlled trial. BMJ. 2008;336:598–600.
- Parker D, Eltinge S, Rafferty, C, et al. Primary Care Providers’ Views on Using Lung Age as an Aid to Smoking Cessation Counseling for Patients with Chronic Obstructive Pulmonary Disease. Lung. 2015;193:321-27.