Dr William Bird MBE, MRCGP 28 April 2015 Making the ... · PDF file"Making the Natural Health...

"Making the Natural Health

Service Work”

Stoke on Trent28 April 2015

Dr William Bird MBE, MRCGP

28 April 2015

© 2015 Intelligent Health

We were

designed to

be

connected

to nature

The Story

Yet 54% of the world’s population live in cities

Is this disconnection the underlying cause of the epidemics of obesity and other chronic diseases?Do we need healthy landscapes?

80 seconds ago

Mankind has evolved wellIf we take an hour to equal 1000 years then four days is 100,000 years; the time from the origin of mankind to today.

4 Days ago

10 hours ago 4 hours ago 9 minutes ago

4000 yrs civilisation10,000 yrs ago

Agriculture

Technology

100,000 yrs ago

Hunter gatherers

industrialisation

Fear and Chronic

Stress

PeopleLoneliness

PlaceHostile

PurposeRejection

Between 2007 and

2011 only 28% of

Americans said

that their stress

levels improved. American Psychological

Association 2012

• © 2015 Intelligent Health

Does lack of nature cause chronic stress?

...and if so,

who is most

vulnerable?


The Effect of Trees on Cognitive

Performance

-3

-2

-1

0

1

2

3

4

5

6

7

Digit Span Backward Test

No Tree Min Awareness

Mod Awareness Heightened Awareness

P=<0.001Lin, Ying-Hsuan, et al. "Does awareness effect

the restorative function and perception of street

trees?." Cognitive Science 5 (2014): 906.

Exposure to Neighbourhood Green Space and

Mental Health:

© 2015 Intelligent Health Beyer, Kirsten MM, et al. Int.J of environmental research and public health 11.3 (2014): 3453-3472.

Normalized

Difference

Vegetation Index

(NDVI)


Association Between Trees,

Vegetation, Depression and Stress


Place: Green space

moderates the effect

of stressful events

in children

Nearby Nature

A Buffer of Life Stress

among Rural Children

NM Wells, GW Evans

Environment and

Behavior May

2003vol. 35 no.

3 311-33

High Nature

Low Nature

0

2

4

6

8

10

12

14

Low Medium High

Psycho

log

ical S

tre

ss

Stressful events

High Nature Low Nature

1

1.2

1.4

1.6

1.8

2

2.2

No green Little green Some green More green Very green

In

cid

enc

e R

ate R

atio

Exposure to Green

Highest Income

Middle Income

Lowest Income

Linear (Highest Income)

Linear (Middle Income)

Linear (Lowest Income)

Place: Green space reduces Health Inequalities Mitchell, R. and Popham, F.

(2008) Effect of exposure to natural environment on health inequalities: an observational population study. The Lancet 372(9650):pp. 1655-1660.

Stress and inflammation

Visceral Fat

Chronic Stress increases risk to Visceral Fat

Aschbacher, Kirstin, et al. "Chronic stress increases vulnerability to diet-related abdominal fat, oxidative stress, and metabolic risk." Psychoneuroendocrinology 46 (2014): 14-22.


Visceral fat increases all cause mortality

OR 1.83 (1.23 to 2.73)

Kuk, Jennifer L et al. Obesity;2006;14: 336-341.

10% weight loss leads to 35% visceral fat weight loss

Janssen I, Ross R.. Int J Obes RelatMetab Disord. 1999;23:1035– 46.

Visceral Fat

Anti-Inflammatory - Fat



Chronic Stress

Physical

Inactivity

Visceral fat reduction with exercise

-25

-20

-15

-10

-5

0

Lean Obese Type 2 Diabetes

% L

oss

of

Fat

Axis Title

Fat loss after 13 weeks of walking 60 mins a day and no weight loss

S/C Fat Viseral Fat


Lee S et al. J Appl Physiol 2005;99:1220-1225


Brain Derived Neuro-trophic Factor

• Opposes Neuro-generative processes• Reduces Type 2 Diabetes in Mice• Increases Connectivity between Neurones• Improves Mitochondrial function in the

brain

Noakes T Spedding M: Olympics: Run for Your Life Nature 487, 295–296 (19 July 2012)

PA is Fundamental to Human Survival

Mortality due to Inactivity


More lives are saved by getting people fit

0

2

4

6

8

10

12

14

16

18

CardiorespiratoryFitness

Obesity Smoking Hypertension High Cholesterol Diabetes

Att

rib

uta

ble

Fra

ctio

n %

Axis Title

Men Women


Blair S N Br J Sports Med 2009;43:1-2

Sedentary High fat diet and Stress

Mitochondrial DNA

Reactive Oxidative Species

Anti-Oxidants

Mitochondria

Oxidative PhosphorylationInner membrane


Manoli et al.Trends in Endocrinology and Metabolism Vol 18 No 5 2007McIntosh L et al. Neurotoxicology 17.3-4 (1995): 873-882.

Physically Active, low fat and not

stressed

Mitochondrial DNA

Oxidative Phosphorylation

Anti-oxidants

Mitochondria


“The mitochondria is like a dynamo it has to keep moving”

Prof Mike MurphyMRC Mitochondrial Biology Unit Cambridge University


But with the weight of a 40 pound car battery


Telomeres get shorter


Epel, Elissa, et al. "Can meditation slow rate of cellular aging? Cognitive stress, mindfulness, and telomeres." Annals of the New York Academy of Sciences 1172.1 (2009): 34-53.


Telomere shortening

Epel, Elissa S. "Psychological and metabolic stress: a recipe for accelerated cellular aging." Hormones (Athens) 8.1 (2009): 7-22.

Hezel, Aram F., Nabeel Bardeesy, and Richard S. Maser. "Telomere induced senescence: end game signaling." Current molecular medicine 5.2 (2005): 145-152.

Senescence. The end of the cell.

1) People 2) Purpose

6) Poor Health Behaviour

Smoking Drinking Inactivity

5) Chronic Stress

7) Mitochondrial dysfunction, 8) Chronic Inflammation and 9) Telomere Shortening

10) Long Term Conditions (diabetes, CV disease, cancer, arthritis, COPD, mental health, dementia)

4) Resilience Stressors

2) Place

www.walkingforhealth.org.uk

• Europe’s largest walking scheme

• About 175,000 walks a year in 650 schemes (England only)

• 1.8 million contacts a year

• About 10,000 active volunteer walk leaders

http://www.walkingforhealth.org.uk/

Green Gym Vs Aerobics

Comparison of heart-rate response

during two sessions of activity

0

50

100

150

200

Time Minutes

Heart Rate

Green Gym

Step aerobicsV Reynolds 1999

OCHRAD

Community Prescription

Beat the Street

Is

MeasurableDevelops

PartnershipsEnhances

Communities



The key purpose of Beat

the Street is to connect

people to place. In

Reading 15,000

residents will go to

parks that they had

never visited before

Days in the past week of 30 minutes or

more of physical activity (Reading)


3 months after BTS

finished 53% of

participants met

activity guidelines

compared to 35% at

the start


Walking briskly

uses 3.5 METS

and can cover 3

miles an hour.

Walking is good

exercise

and it is free!

An exercise

class uses

3.5 METS

for 1 hour.

Walking 244,000

miles is the

equivalent of 3500

exercise classes

with 20 people in

each one.

Beat the Street Reading 2015

202 beat boxes

1. Boxes 0.5 km apart

2. Join a team : school,

community group,

workplace

3. Walk/Cycle/Run, tap, get

points

4. Tap two boxes within 1

hour to get 10 points

5. Points go to team total

6. Top teams win cash

prizes for

school/community

group/charity

Data from one Beat Box

22/05/2015

40

Physical Activity as a means to an end

A better place to live and work (place)

More open parks and green space

More cafes and open squares to wander aimlessly


A stronger community (People)

Increased inter-generational connectionsIncreased volunteering

More family based events and activities

A stronger local economy (Purpose)

More successful local businesses More productive employees

Nature a means to an end

A better place to live and work (place)

More open parks and green space

More cafes and open squares to wander aimlessly


A stronger community (People)

Increased inter-generational connectionsIncreased volunteering

More family based events and activities

A stronger local economy (Purpose)

More successful local businesses More productive employees

So what is the future

• Long term conditions will soon leave the NHS financially unsustainable.

• On its own the NHS can treat these conditions

• But only with others can it prevent them.

• The natural environment is delicate but is our natural habitat (shared by many other species).

• The future of healthcare is using the natural health service.

• Nature to people and people to nature.


[email protected]

On Earth’s partall days start beautifullypatiently it revolves and revolves with its treesand oceans and lakesdeserts and volcanoesthe two of us and the rest of youand all the animals

Petur Gunnarssonone

Dr William Bird MBE, MRCGP 28 April 2015 Making the ... · PDF file"Making the Natural Health...

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