Take your medicine
Why GPs can now prescribe cycling
In an ever-widening area around a Northamptonshire reservoir, there has been “a dynamic flash in different coloured Primark sports gear” – a description that, location aside, could apply to any of the thousands of people who have rediscovered cycling during lockdown. In this case it is, in his own words, Chris Heaton-Harris, the government minister responsible for cycling. Like many others who’ve dusted off an ageing bike and rediscovered a love of cycling, Heaton-Harris has reaped its health benefits of regular riding – benefits he is keen to help others enjoy.
The MP for Daventry is a former greengrocer who took up the cycling post, along with the portfolio for rail and Crossrail, in July 2019. A year later, he presided over a raft of active travel announcements from Downing Street, including a review of the Highway Code to help those cycling and walking, new design standards for cycling infrastructure, free cycle training and bike maintenance vouchers, action on cycle theft, and cycling-on-prescription iniatives– with £2bn set aside to deliver these measures, along with physical cycling routes.
Lockdown sparked a massive growth in cycling, as people stuck at home sought a daily means of exercise.Sundays were particularly busy, with more than a 300 per cent increase in cycling levels in England, according to recent government figures. Weekday levels also consistently rose above 100 per cent, even as people headed back to work as lockdown restrictions lifted. Now the government is attempting to maintain that momentum – keeping people off public transport and out of private cars. and on bikes for everyday trips instead – by instructing councils to provide emergency cycle infrastructure, as well as incentivising lapsed cyclists to get back in the saddle.
In addition to his eagerness for physical cycling infrastructure to be built during his tenure, Heaton-Harris is also keen on helping people become healthier through cycling. He says: “The social prescribing bit, encouraging GPs to prescribe cycling and getting people to be able to access bikes through their local surgeries - I genuinely think that’s got the potential to change a huge number of people’s lives for the better.”
Heaton-Harris was among those who took up road cycling in a “big way” during lockdown. He got his bike fixed up – “I’ve basically got a new bike. Just got the same old seat and the same frame” – and downloaded Strava, competing with himself on segments. He even lost a couple of pounds of weight, by cycling “religiously every day” during Covid-19 restrictions.
However, not everyone has access to a bike, funds to buy one, or the confidence to cycle – let alone routes near their homes and workplaces that they feel safe cycling on. The government’s cycling-onprescription initiative will be aimed at areas in the UK with some of the poorest health outcomes – places where people have shorter life expectancy and high levels of inactivity-related diseases, such as obesity, diabetes and some cancers.
Doctors will prescribe cycling on a pilot basis to begin with, in areas with poor health and low physical activity levels, with a stock of bikes available to be borrowed. There will also be moral support in the form of cycle training, and access to cycling groups and peer support. Patients will be allowed to keep the bikes, if they use them enough, while interventions could be connected to new cycle infrastructure the government has announced it will build, too.
These programmes can be effective, if done well. A cycling-on-prescription programme in Yorkshire – called Cycle for Health and delivered by the national cycling charity, Cycling UK – offered people with long-term conditions a 12-week
“Like many during lockdown, cycling minister Chris HeatonHarris has reaped the health benefits of regular cycling”
programme of cycle skills training. Participants reported transformations in how they felt, physically and mentally; six weeks after the programme finished, more than a third were still cycling on average more than two hours per week. Previously, 82 per cent weren’t getting the recommended 15 minutes of exercise a week, with almost a third exercising for less than 30 minutes a week. Immediately afterwards, 73 per cent were.
James Scott, Cycling UK’s Director of Behaviour Change, supports cycling-on-prescription initiatives, but warns they need to be done well. “Giving doctors the opportunity to prescribe cycling shows a modern approach to medicine which acknowledges some health solutions require a range of interventions beyond the purely pharmaceutical or surgical.”
Scott adds that people embarking on cycling prescription programmes, such as the charity’s Cycle for Health, have shown clear physical and mental wellbeing benefits. “People are happier and healthier, all because they’ve had the support and training which comes through tailored health intervention programmes centred around cycling.”
In Scotland, those living in the most deprived areas are four times more likely to die early than those in the least deprived areas. Here, regular cycling can be transformative. According to a Glasgow University study, people who cycle to work have a 45 per cent lower risk of developing cancer, a 46 per cent lower risk of heart disease and a 41 per cent lower risk of premature death, compared to those commuting by car or public transport. It’s not just commuting cycling that reaps benefits, though. The greatest health benefits happen when people who get no exercise start doing a little.
It’s a big ask, though – and one that requires investment. While £2bn sounds like a lot of money to deliver these lofty goals, it doesn’t go far when you’re talking about creating a cycling revolution.
“For a cycling prescription to have any benefit, just as you would with antibiotics, you need a planned course for the medicine,” says Scott. “You need a multi-week programme that will build up patients’ confidence, fitness and skills on the bike – and in some cases even provide the bike itself – all of which should hopefully lead to long-term health solutions, as they realise they can make cycling part of their transport and leisure lifestyle choices.”
We know exercise is good for us, and that Boris Johnson is intent on improving the health of the nation following his brush with Covid-19. It’s not just coronavirus inspiring government to act on active travel. It’s the knowledge that, further down the line, the country faces another looming health crisis – a physical inactivity crisis.
“Giving doctors the opportunity to prescribe cycling shows a modern approach to medicine”