In Australia, 3 in 4 people aged 15+ years are not meeting the physical activity guidelines, while 1 in 2 adults aged 18–64 years spend their day at work mostly sitting. Considering that physical inactivity is linked with adverse mental wellbeing, prolonged sitting also has some detrimental effects on wellbeing. To optimise the benefits of an active lifestyle, we may need to add more physical activity into our daily routine, make walking/bicycling (i.e., active commuting) as a default mode of commuting and limit our sitting time, especially recreational, – perhaps replacing our sitting time with green time activity.

The National Health Survey gives an important – and somewhat bleak – insight into the health and well-being of Australians. The report found about 50% of Australians have a chronic health condition and 81% have at least one long-term health issue.

As expected, the main health conditions impacting us are mental health, back pain, arthritis, asthma, diabetes, heart disease, and stroke. Many of us also have high cholesterol (8.4%), high blood pressure (11.6%), and diabetes (5.3%) which can lead to some of those health problems.

However, we can take immediate steps to limit health impacts from these conditions and today’s report shows Australians have a lot of room for improvement.

Only 4% of us eat enough fruit and vegetables, only 24% do the recommended amount of physical activity, 27% of us drink more than is recommended, and 50% of us work in jobs where we sit all-day. Most concerning is that 65.8% of us are overweight or obese, which greatly increases the likelihood of developing chronic health problems.

There remains inequity in the number of chronic conditions and participation in physical activity according to socioeconomic disadvantage.

Our health and care systems do not have a good way to provide evidence-based non-pharmacological interventions to disadvantaged people. Those who are more advantaged pay for exercise programs and private services such as physiotherapy themselves.  “Almost one in three (28.4%) people living in areas of most disadvantage had two or more chronic conditions, compared to one in eight (16.1%) of those living in areas of least disadvantage” and “Adults living in areas of most disadvantage were more likely to have completed zero minutes of physical activity in the last week than those living in areas of least disadvantage (17.2% compared to 7.8%)”.

There remains room for improvement in physical activity participation in older adults. Our systems need to support older people to be more active. “One in three (33.4%) people aged 65 years or over met the physical activity guidelines in 2022.”

We need to get the message out more about the role of strengthening exercises across the life course and continue to support women to be more active “One in four (26.6%) undertook strength or toning exercises on two or more days in the last week”. We don’t have these data for older adults. “Overall, males were more likely to meet the physical activity guidelines (24.9% compared to 19.9%).”

This report does not cover consequences of the lack of participation in exercises known to prevent falls and enhance physical function i.e., exercises that target balance and strength. Other reports have shown falls to result in 233,000 hospitalisations and over 5800 deaths each year in Australia https://www.aihw.gov.au/reports/injury/falls

The data clearly point to the continued burden of pain and mental health on the lives of Australians. With arthritis, back pain, migraine affecting about 40% of the population, and mental and behavioural conditions about 30%, these conditions were only approached by hay fever (27%) in terms of prevalence, and were unmatched in terms of moderate and profound disability. Back pain was almost twice as common in clients of Veterans’ Affairs than the population average.

These data strengthen the clear call to action to ensure people disabled by chronic pain and mental ill health have access to contemporary and evidence-based models of care that are grounded in education and active self-management strategies, so as to enable and empower consumers towards recovery. Clinical guidelines the world over point recommend these interventions, but not enough Australians are receiving them. The new wave of treatments for chronic back pain that focus on training the brain and the body offer hope for the two in five Australians suffering from chronic pain.

The latest National Health Survey data show that back problems are the 2nd most common long term health condition suffered by Australians. Australia is not different to other countries and we see a similar result in most parts of the world including in low and middle income countries. As well as being common, back pain carries a significant financial burden on health systems and of course the individual. As an example Australians who retire early due to back pain have less financial wealth putting them at greater risk of poverty in their retirement. 
 
One way to reduce disease burden due to back pain is to ensure that Australians get access to the right care for their back pain. The 2022 Clinical Care Standards from the Australian Commission for Safety and Quality in Healthcare and the Chronic Low Back Pain Guidelines from the World Health Organization, released earlier this month, provide useful resources for consumers and clinicians. Preventing back pain makes sense, but much of the usual advice around ergonomics is probably not useful. A better approach is to adopt a healthy lifestyle (healthy diet, healthy weight, avoid smoking, be physically active), much the same as we would advise for optimising heart health, as there is some evidence that this can reduce the risk of developing disabling back problems.

"The significant disparity in life expectancy for people with co-occurring physical and mental health conditions has continued, despite many health system reforms.

We surveyed people across Australia with mental health concerns and their families, carers and supporters to ask about their experiences of being asked about their physical health. Almost all respondents in this survey had seen a health professional of some sort in the previous 12 months, and over two-thirds had seen a mental health professional.

The results indicate that multiple opportunities to prevent the unnecessary and preventable early death of people living with mental ill-health are being missed. Each of these occasions of service represents an opportunity for physical health promotion, screening and care.

However, in most instances, consumers and carers report that mental health professionals did not ask or inquire about the physical health of consumers. The results of this research indicate health professionals are failing to adequately pay attention to the physical health concerns of people living with mental ill-health. This failure is resulting in significant costs to the health and wellbeing of consumers, their carers, and to the Australian health system overall."

It is well known that chronic pain and poor sleep are enormous and growing health problems. Less recognised, however, is the relationship between the two. Poor sleep co-occurs with chronic pain in up to 88% of cases and is often associated with pain severity. Contrary to the traditional view that pain interferes with sleep, emerging work including our own pre-clinical studies, suggests the opposite—poor sleep increases pain. This opens the enticing, yet under-investigated possibility that interventions aimed at sleep could improve pain, and that this effect could be amplified with the addition of other traditional pain therapies such as physical activity.

Our research is currently tackling this issue by testing how sleep and physical activity—two of the most prevalent and rising health issues—contribute to the development of chronic pain and can be modified to prevent this massive problem. The potential implications are huge as chronic pain, poor sleep and inactivity individually affect 30-47% of the population.

The latest National Health Survey reveals a challenging reality: three quarters of Australian adults are not meeting the physical activity guidelines. This is a major issue. Physical activity is crucial for our health and our pain. Millions of Australians live with chronic pain, a condition that can affect every aspect of life, from physical function to mental well-being.

But there is hope. Research shows that exercise can help people with chronic pain to cope with their pain, improve their mood, and enhance their quality of life. However, many people face barriers to exercise, and some people also have misconceptions about pain, such as thinking that it simply always means damage or that movement will always make things worse.

Understanding more about the latest neuroscience of pain may help people overcome these barriers. I have been involved in various projects to make pain science education accessible and engaging for everyone, especially children. For example, I have created some children’s books and TED-Ed videos that explain the science of pain in a simple and fun way. I hope these and other resources will inspire the next generation to learn more about pain and to embrace an increase in daily physical activity. But more importantly, I hope they will encourage people to engage in meaningful activities and participate actively in life in way that they enjoy.