// MORE ACTION, LESS RHETORIC: reclaiming Australia’s health and fitness

Medical exercise specialist Dr William Sukala believes that enough has been said about increasing public fitness levels, and that more needs to be done. Here he discusses the health issues facing Australia – and what the fitness industry can do about them.

Network
Bill, you’ve carved out a niche for yourself in the industry as a medical exercise specialist focused mainly on obesity, diabetes, heart disease and related metabolic conditions. Why should fitness professionals care about special population groups now more than ever?

WS
I still see a defined gap between the medical field and fitness industry that desperately needs to be bridged. As I look at the fitness industry around the world, I see a heavy emphasis on standard fitness training for the apparently healthy population, but comparatively less focus on individuals with medical limitations. This is particularly relevant for the Australian fitness industry because recent estimates show that 61 per cent of the Australian population is either overweight or obese. Add in the fact that the older demographic is the fastest growing subset of the population and you’ve got a perfect storm brewing for a public health disaster (the beginning of which is already evident). Because people with medical issues can, and do, join fitness facilities, I believe there is a tremendous opportunity to both improve health and grow the special populations niche within the industry.

Network
Where does the fitness industry fit into this? Do you think the medical establishment, tertiary institutions, and government health organisations are doing enough to fight the obesity epidemic?

WS
This is precisely where I see a need for the fitness industry to rise to the challenge. Clinicians, academics, and government bureaucrats around the world are great at producing research, making recommendations, and creating position stands on health issues, but I believe they’re out of touch and bogged down in red tape when it comes to creating and implementing programs that will effect real change. In short, we have an active army of fitness professionals who are out there on the front lines and can be rapidly mobilised to make a direct impact on the obesity epidemic today. However, on a positive note, I have seen an increase in attendees at my medical exercise seminars, which seems to reflect a growing awareness and interest in this niche area.

Network
You’ve previously said that most people intuitively know what they need to do to improve their health, but they still don’t do anything about it. What do you mean?

WS
I’m convinced government health agencies are throwing good money after bad by telling people what they ‘should’ be doing. Health statistics clearly show a steadily rising number of deaths, which I think underscores the fact that this approach is completely misguided. Stand on a street corner in any major city around the world and ask 100 random people if they should eat less, move more, and quit smoking and, invariably, 99 will say ‘yes’. People don’t need more information – they got the message ages ago. Instead, we need to get into peoples’ minds and give them a ‘check up from the neck up.’

I think what Fiona Cosgrove (wellnesscoachingaustralia.com.au) is doing in Australia with motivational interviewing is absolutely spot on because this approach encourages people to come up with their own solutions for change, finding values-based reasons to improve their health. I believe community-level obesity programs, which include motivational interviewing, self-efficacy enhancement, and low barriers to entry (i.e., reasonable price, hours of operation, welcoming environment) are likely to have the greatest impact. Taking it a step further, I see tremendous opportunities in the workplace, where interventions are needed to get workers out of their chairs and into standing workstations!

Network
Speaking of sitting, you’ve recently been focusing on the emerging science of ‘inactivity physiology’ and its impact on obesity. What is this, and what does it mean for fitness professionals?

I’ve spoken extensively on the topic of inactivity physiology to fitness and medical professionals the world over and it always raises a curious eyebrow. Inactivity physiology examines the defined negative health effects of today’s excessively sedentary lifestyle. Sadly, society appears to be completely backwards: where many thousands of years ago we sat down to take a break due to our active survival lifestyle, now we have to stand up to take a break! Government health agencies tell us that we need to do a minimum 30 minutes of moderate to vigorous activity at least five times per week, but after subtracting an eight-hour sleep it’s how we spend the remaining 15½ waking hours of the day that really makes a difference. An Australian study of over 4,000 subjects found that those who met the activity guidelines but remained sedentary at other times of the day virtually counteracted the potential health benefits of that activity. The study participants with the highest television viewing times had increased health risks such as higher waist circumferences, systolic blood pressure, blood sugar, and impaired blood lipid profiles. Other studies using objective measures for measuring activity habits (i.e., accelerometers, inclinometers) have shown that only a very small percentage of the population actually do the recommended amount of activity.

From a practical standpoint, we’ve all had clients who, despite all good efforts, either fail to lose weight or slowly continue to gain. The reason for this may stem from clients inadvertently saving energy or eating imperceptibly larger meals at other times of the day. Also consider the body’s innate ‘famine buffer’ which adjusts energy expenditure to prevent weight loss. Bearing this in mind, one of the most overlooked aspects of weight control is the effect of non-exercise activity thermogenesis (NEAT), or the energy we ‘waste’ when we’re not doing planned exercise. Adding a cumulative four hours a day of standing time doing light domestic chores over one year can burn the equivalent energy stored in 32 kilograms of body fat! The take home message to clients should be ‘a little bit of something is better than a lot of nothing!’

Network
You’re presenting two sessions at FILEX this year: ‘Safely training clients with high blood pressure’ and ‘Keg vs. 6-pack: research review on belly fat’. What can delegates expect?

WS
My first session will combine lecture and practical components to teach trainers how to take an accurate manual blood pressure reading. I’m amazed at how many trainers rely on automated blood pressure cuffs when, in fact, the machines are quite susceptible to error. A blood pressure reading can tell you a lot about a person if you know what you’re looking for. For example, I once had a client who showed up one day with uncharacteristically low blood pressure and an elevated pulse. After phoning his doctor, I sent him over to the emergency department where they found he was bleeding internally. For this reason, I think it’s important for trainers to understand the physiology behind blood pressure and what the numbers mean from a conceptual standpoint. My aim is to go beyond boring textbook information and breathe some real life into blood pressure.

‘Belly fat’ is now an over-sensationalised catchphrase in the media, with all kinds of belly fat diets, nostrums and pills on the market. The aim of my second session, ‘Keg versus 6-Pack’ is to discuss the latest research on the science behind belly fat, its impact on health status, and the latest evidence on the best exercise regimens to get rid of it.

Dr William Sukala, PhD, BSc Nut, MSc (ExPhys)
A medical exercise specialist, William has over two decades experience in personal training, clinical cardiac rehabilitation, and obesity and diabetes research. He recently completed his doctoral research in obesity and diabetes in indigenous populations. A health writer and presenter, he has also consulted to industry organisations, including Weight Watchers and the American Council on Exercise. William strives to translate his clinical experience and the latest scientific research into useable information for fitness professionals. For more information visit www.williamsukala.com