* GTA’s top doctors join forces to encourage cities to plan for built-in exercise Urban planning should encourage walking, cycling and use of public transit to battle chronic disease, public health doctors say.* *By:* Theresa Boyle http://www.thestar.com/authors.boyle_theresa.html Health, Published on Wed May 14 2014

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The top doctors for Toronto, Peel, Hamilton and Simcoe- Muskoka have joined forces to urge all levels of government to change the way communities are planned, to encourage more physical activity.

When it comes to land-use and transportation planning, more consideration must be given to encouraging residents to walk, cycle and use public transit, they told a news conference at Union Station on Wednesday.

“This really is the big public health concern of our time, of our generation. How our communities are shaped, how we move around and the impact it has on the leading causes of death and illness in our society is something that all health organizations are coming to grips with,” said Toronto Medical Officer of Health Dr. David McKeown.

Many communities have been built around the car, contributing to sedentary lifestyles, thy noted.

Chronic conditions such as diabetes, obesity and heart disease are directly related to “having engineered physical activity out of our lives,” said Dr. David Mowat, medical officer of health for Peel.

He pointed out that 10 per cent of an adult’s physical energy expenditure is recreational while 90 per cent is utilitarian, that is, “going about our regular business.”

The solution to getting people move more is to get them to incorporate physical activity into their daily routines, he said.

“This is not about telling people to shape up, exercise more and eat well. That approach has been tried for years and it has failed,” Mowat said.

He cited cycling as an example, noting that those who spend a total of three hours weekly biking to work cut their risk of premature death from all causes by 28 per cent.

Even taking public transit can easily add 30 minutes of activity into one’s day because it can include walking to and from the bus stop and subway and taking stairs. The Canadian Physical Activity Guidelineshttp://www.csep.ca/english/view.asp?x=804 just happen to call for 30 minutes of activity a day.

The group of doctors made three specific recommendations: Invest “many billions of dollars” in public transit. Strengthen provincial policies that support transit and active transportation (walking or cycling to get to a destination). Make transit and active transportation integral to city planning.

The doctors released a report, Improving Health by Designhttp://www.peelregion.ca/health/resources/healthbydesign/pdf/moh-report.pdf, that points out that there are almost 57,000 new cases of diabetes and 7,000 new cases of heart disease annually in the Greater Toronto- Hamilton Area and Simcoe-Muskoka.

About a quarter of both conditions are preventable through physical activity, the report notes.

It estimates that more than 300 premature deaths and over 1,000 cases of diabetes could be prevented annually with improvements in the way communities are designed and with better integration of public transportation. (Estimations are based on a health economic assessment tool from the World Health Organization and a diabetes population risk tool from the Institute for Clinical Evaluative Sciences.)

It goes on to say that physical inactivity and obesity cost the GTHA and Simcoe Muskoka $4 billion annually, including $1.4 billion in direct medical costs. The remainder is related to lost productivity.

“The environment in which we live is the main influence upon our behaviour . . . and changes in the environment are necessary to improve our health. We need to make the healthy choice the easy choice,” Mowat said.