 So, we hear the ID Tech Act show and who are you? I am Professor Greg White and I'm actually a physical activity exercise specialist. Are you a nutritionist? Well, I cover the whole gamut really. So, I'm the director of the Centre for Health and Human Performance in London where we look after all areas of human health and performance from nutrition to biomechanics to physiology to medical. So, it's quite a broad spectrum where we try to enhance people's quality of life as well as their length of life. Is it a company or is it for the government? No, so this is a private company. And really what we're trying to do is actually sort of circumvent traditional healthcare to some extent and actually deliver what is required because it is a very complex picture because it deals with people and people are the most complex things to change. Particularly when it comes to behaviour. So, we do an awful lot around behavioural change. So, what is a bigger factor? Is it the food or is it the physical activity? It's a classic question. Is it consumption or is it expenditure? In other words, is it what we eat or is it the activity that we have? And the very simple answer to that is it's both. What we put in our mouths is very important, both in terms of the quantity but also the nature of it, the quality of it. And so, focusing on things like sugar content for example, simple sugar content is really important when it comes to certain diseases or disease states, things like metabolic syndrome like type 2 diabetes for example. But equally it's also about volume. It's about portion size. It's about number of calories. But balanced against that of course is what we expend, how active we are. And I think the crucial thing about activity is not only does it help in terms of weight management but actually activity is central to all cause mortality, so heart disease, cancer, type 2 diabetes. But it's also about improving mental and emotional health and also physical activity can actually improve social health in terms of social interaction. So for me physical activity is the most important but nonetheless it's part of a whole host of different things that are required. So, how does it help for cancer for example? Physical activity in cancer, the work that I do is actually around optimizing patients who are undergoing therapy. I mean what we know is that people who are more active have a lower prevalence of cancer all told. So in terms of actually prevention, physical activity is a very good preventative strategy. But if you have cancer then you'll have to have treatment. And that treatment is chemotherapy, it's radiotherapy and often it can be surgery. All of those are massive physical insults on the body and the physical capacity of the body to withstand that insult is really very important. What we do is we do a process called prehabilitation. So what we do is we optimize the patient prior to treatment. We also optimize them during treatment to try and ameliorate some of the negative effects of treatment like chemotherapy. And then of course rehabilitation following treatment. So following chemotherapy, following surgery to bring them back to a normal or better quality of life than they had. Because a cancer patient has to go through chemotherapy and also the radiation therapy, right? And those both they kind of destroy all cells kind of so you need to do more physical activity than otherwise to kind of stay strong? Yeah, I mean the thing is that there's a whole host of different interventions, different treatments you have as cancer. But something like chemotherapy for example is cytotoxic, it actually destroys cells. And it's also the newer drugs are now much more selective but in general it's relatively non-selective so it destroys everything. And what you do see is there's a whole host of downstream cascades of chemotherapy, things like sarcopenia, you get reduction in muscle mass which is very important because what that underpins is your functional capacity. So your ability to stand up from the chair, your ability to walk. So some of the things that we do with physical activity is try and dampen, reduce the effect, that cytotoxic effect of chemotherapy on the body. One great example of that is actually in terms of heart failure. What we know is that some chemotherapy is a cardiotoxic. They have a cardiotoxicity which impacts on the heart. Intervene with exercise whilst you're having chemotherapy and you can reduce that toxicity. So there's lots of ways where simple interventions with physical activity can have a very positive effect. Both acutely and chronically. And then for example, a lot of people have arthritis. Do you have any recommendations for what do they need to do? Is it similar kind of stuff? Obviously two different types of arthritis. Rheumatoid arthritis which is an inflammatory autoimmune issue. And you've got osteoarthritis incredibly prevalent in the population particularly as we age. There is only one effective treatment for osteoarthritis and that is exercise. In very simple terms, what you get is you get movement of joints and that movement of joints is what causes pain. If you can stabilize the joint and we do that by improving strength and also improving strength endurance, what you do is you stabilize the joint, you reduce movement, you reduce pain. And so it's incredibly valuable exercise and paradoxically so because you think if I'm in pain I don't want to move. But actually the more you move, the more exercise you do, very focused, very specific you can improve osteoarthritis. But so you are able to, because it hurts a lot on the joints, you can still... Sorry, this one's a good time. Do come along and listen to these informative talks from global organizations. The exhibition theater is now open. Do come along and before the talks from global organizations. Thank you. Sorry, so the joints are hurting, but how do you train the muscles if they have a difficulty moving? It's a very interesting one because obviously you're in pain. So the use of selective analgesics, so using painkillers at the right time can actually enhance the physical activity. So actually taking them before you're physically active is important. To control the pain, to enable you to be more active. The more active you are, the stronger and more stable the joints become, the less the requirement for analgesics in the long term. So what you are doing, you're taking a slightly different approach across time in response to what your requirements are. And I think often what we do with healthcare is we take, it's a one-size-fits-all approach, is that this is what we do, this is the algorithm and so we're just going to go ahead and do it. What we do need to do is actually personalize that and that's a lot of the work that we do is actually about personalizing, customizing it so it's bespoke to the individual so we optimize their health. So do you have like a private clinic or how does it work? Yep. And people sign up and then you help each of them separately? Yep, so I run a private clinic on Harley Street in London called the Centre for Health and Human Performance and what we do is we effectively look after individuals and so what we do which is perhaps slightly different from what a global health service does is we really do individualize our care so that we optimize what we're doing with our clients so that we effectively move to a faster solution for the particular issues that they have. Not an easy process, not a quick process and not necessarily a cheap process but it does deliver results. So how's the cancer is a big issue in society? How's it been, how's the progress in fighting it and is all the solution you think in your field or a solution is some kind of magical drug and a mix of what you do? No, I think, I mean cancer is ubiquitous now. We all are touched by cancer whether we suffer from cancer personally or we know somebody who has or does suffer from cancer and I think what the solution is is it's multi-agency it is the development of new drugs so it is the pharmaceutical industry. Equally for me actually it's much more of a focus on prevention is that what we want to try and do is prevent cancer in the first place for which lifestyle is very important in that so smoking, alcohol consumption, physical activity and diet all of those things which are modifiable those modifiable risk factors really very important so the agencies that are involved in that become a crucial part of prevention but when it comes to treatment what we're trying to do is optimise that treatment so the development of new drugs makes a difference but also when we're using those drugs May I have your attention please? There might be a slight delay to the conference tracks again there might be a slight delay to the conference tracks just stay tuned and I will make the announcement a few minutes before they're about to begin So we get one more announcement Again there's going to be a slight delay to the conference tracks I can just finish that bit anyway so I mean in terms of treatment it is multi-agency it's about the development of new drugs that's clearly important more targeted therapy which addresses the specific cancers and on top of that though it's actually about coping with that treatment so in other words optimising the quality of life during treatment which is a lot of the work that we do through physical activity through nutrition, through lifestyle interventions and then of course it's about the rehabilitation of the patient as well so not just prehabilitation but rehabilitation as well to bring the patient back to a high quality of life not only length of life but the quality of those lives So there's a lot of women that get breast cancer and usually it's a little thing in the beginning right and then how do they optimise their chances not to get what's called reoccurrence of cancer is it stuff you talk about? No it's exactly that I think that's a very interesting point that you raise I mean we know an awful lot about breast cancer what is less well known is the fact that more men die of prostate cancer than women die of breast cancer so there are cancers which have a very high prevalence in certain populations men and women and I think that one of the key things to that is number one is prevention we've just spoken about that the other thing is about early identification what we've done with breast cancer is we've become much more aware of the signs of breast cancer so physical examination has underpinned the early identification add on top of that the development of technology around mammograms is assisted in that process and also then the development of bespoke drugs a bespoke farmer which is targeted therapy things like herceptin for example for her too positive breast cancer have made a massive difference as well but of course that is just one cancer there are lots of different cancers and it requires that targeted approach to deal with those other cancers to make the same sort of strides that we've made in breast cancer possible so a lot of physical activity is very important physical activity is central to health without any shadow of doubt across the lifespan so whether it's from pregnant mothers impacting upon their unborn child through childhood into adolescence into adulthood and particularly into old age physical activity is central to quality of life as well as length of life they come into contact with many people that didn't do any physical activity and then they get breast cancer then suddenly they become huge athletic people I mean it's a really interesting one and we've done an awful lot of work for example around breast cancer where we look at women who get breast cancer and then look at intervening with physical activity in fact changing lifestyles post diagnosis and I think that's a very important thing to remember is that the bottom line is it's not the end of the road it's the beginning of the next chapter and what we can do any positive change in lifestyle will have a positive effect on health no matter when we do that so what we should never do is think it's too late to make a change now is the right time to make that change and we will benefit from that change as we go forward and another big issue in society is the heart issues people have right? so how much do you do with that? I mean cardiovascular disease has always been high on the agenda if not number one on that early mortality agenda coronary artery disease is a particular issue but there are lots of cardiovascular diseases which both limit quality of life and also limit length of life again some of those like coronary artery disease for example are heavily influenced by lifestyle so diet, physical activity, smoking, alcohol all of those things which are modifiable which we can change can all affect cardiovascular disease but we do have control to reduce their impact by changing our behaviors so for me one of the things that I spend my life talking about really is actually about prevention is that if we can modify our lifestyles if we can improve our lifestyles we can reduce the risk of developing a whole host of non-communicable disease and you had for example of the person who got a new heart and then cycled 360 so if you get a heart what's called a operation it's very important or heart transplant or even what's called bypass then people after that they have to do change lifestyle or physical activity it's so important otherwise it could get bad again it's a very important point you make and that is that the intervention of medicine does not have a future benefit is that we are still responsible for our own health and whether we've had bypass surgery whether we've had a stent fitted in a narrowing coronary artery whether we've had a heart transplant the bottom line is that we still need to look after our anatomy and physiology our health resides in our hands and positive behavioral change will make a positive difference to our health now and in for the future and then the huge issue now is more and more diabetes and how bad is that and then that's exactly what you're saying again there are lots of what we call non-communicable diseases so diseases you don't catch which are lifestyle related and because of that they're lifestyle modifiable type 2 diabetes is a very good example of that and of course what we know is that physical inactivity poor diet, obesity are all directly linked to the prevalence of type 2 diabetes does that matter what it does because type 2 diabetes is profoundly bad for your health globally acutely and chronically but also for the economy I mean it costs a huge amount to look after type 2 diabetes so the drain on a healthcare system for what is a lifestyle modifiable it's not necessarily curable but modifiable disease is enormous so again it's about personal responsibility but it's also our job to work on a global responsibility in society to try and enhance that environment and that comes down to legislation around transport around food etc that we all have a role to play in improving the health of the nation so it's government stuff it's government and it's personal to some extent it's very easy it's very easy for us as humans to blame somebody else and so what we can do is we can say well the government should sort that well actually when the government sort it we then call them big brother and so there's a no win situation but I think again what this is the health of the nation is multi agency and it requires everybody from government the heads of government all the way through and most importantly to us as individuals to care for our own health and if those multi agencies can come together to deliver a package which improves health that's where we're trying to get to so for example you say diabetes is a huge cost so what is the actual cost what happens they need to go to the hospital a lot or yeah so I mean the cost of diabetes for example currently in the UK we run around four to five million type 2 diabetics that costs the NHS about a quarter of the total healthcare budget somewhere in the region of about 25 billion pounds a year which is spent on the treatment of type 2 diabetics where it comes in a drug form with things like metformin all the way through to actually hospital admissions and then the downstream events or causes of things like peripheral vascular disease leading to amputations all of those things cost money and have a massive economic burden which of course in a healthcare system that we have in the UK if you take money away from the healthcare budget for one particular disease it reduces the budget availability for other diseases so actually we have a responsibility to care for the whole system so of course all the prevention has to be done is any chance that once people have diabetes they can be fixed from it or it's something you just taste with you no 100% diabetes is curable I mean type 2 diabetes remember the big distinction between type 1 and type 2 but type 2 diabetes we can improve and we can improve and potentially cure and we've actually done it on a TV show where we showed the reversal of type 2 diabetes through diet and physical activity so lifestyle modification it does take work so then that person becomes like normal they become normal so their markers of diabetes return reverse to normal so it is possible how many people have done that? there's a growing understanding of type 2 diabetics that they can actually reverse the condition and in reversing it's not about necessarily curable what you can do is you can reduce medication doses by making lifestyle changes all of that improves quality of life so it is lifestyle modifiable I think what we need to do is actually help people to make those changes to their lifestyle in order that what we can do is help them control type 2 diabetes in the general population so what if you became the minister of health and stuff like that would you is there some way that all these amazing let's say Sainsbury's and Tesco's and all that stuff can be a little bit encouraged to I don't know a little bit more easy for people to understand that exactly what's healthy what's not maybe customizable for every person when you go to the store what's good for you and then also the recipes and all that stuff does that make sense or is it just up to people to figure it out? I think what's interesting for me is why this conference is so important actually technology has a role to play in that customizing of the requirements for an individual in other words creating a bespoke individualized we talk about personalized medicine but actually what we need is personalized lifestyles and I think tech has the opportunity to do that it can be incredibly confusing because of information overload and I think the requirement of tech is to simplify that and also tailor it and personalize it and that really for me is where the future is because if you can make it easy for people to understand easy for people to adopt it's much more likely to be successful so everybody needs the most advanced fitness tracker that has blood pressure sensitivity that has all this other kind of stuff built in maybe it should be like a national priority to make sure everybody gets one the answer to that is no it's not about complexity I think to some extent what the industry what the tech industry has to understand is about simplicity is that what we're talking about is behavioral change it's the most difficult thing to do is to change human behavior and I think the key driver for that particularly when it comes to health is simplicity is that Einstein coined it beautifully and that is that the genius is the ability to explain the complex in simple terms and that's what we've got to do with healthcare that's what we've got to do with quality of life with behavioral change we have to make it simple but on top of that we have to make it accessible so it's not about the most expensive wearable tech because the bottom line is actually that becomes exclusive rather than inclusive what we've got to do is we've got to find solutions which are simple and affordable and then personalize them so they can actually promote and produce behavior change do you partner with rehab resorts, some kind of places where it is good weather for example with good food and physical everyday stuff or should people just be able to do that from London or from you know I think it's an interesting one what there is is this inverse relationship between affluence and health is that actually the poorer you are the more likely you are to be unhealthy so there are higher prevalence of cardiovascular disease type 2 diabetes but you're more likely to be inactive more likely to smoke more likely to drink excessively and so the solution to the solution to the health care problem that we have in society is not about providing expensive complex solutions so going away to the Maldives on a retreat is very lovely if you can afford it and the bottom line is that the vast majority of the population can't afford that it does provide a solution to some what we have to look at is we have to look at not only a multi agency approach but actually a broad base approach which delivers solutions for everybody in society and so do you have constant communications with all the ministers and stuff like that do they consult you or you just work in your company so I work very hard I'm the chair of the research advisory group for a group called UK active who effectively are the lobby group to government on physical activity and so we work very closely with government to try and to try and educate to some extent those in government as to the issues that surround health care in our society but also to provide solutions in other words connect them so connect them to the guys like here today the text is that it's the innovators in our field which are the future of our field and so connecting industrial partners into government to provide solutions for what are very complex issues is part of the way forward to solve the health care issues in society so are you optimistic about what's going on or are there some countries that are amazingly doing something really cool that everybody should copy or am I optimistic it's a very good question I tend to think I'm always optimistic but I think in saying that what you can never underestimate is the size of the problem that we have this is a massive change that is required and I think where you see countries that do it well invariably embedded in their culture and I think what we are trying to do is actually trying to change that cultural reference particularly of western society places like the United States and Great Britain if you can change the cultural approach if you can change people's attitudes then you have a much better chance of changing behaviors and most changing behaviors will lead to positive health outcomes so it is I'm optimistic but it's a very big job and a very complex job actually the life expectancy is kind of not really increasing as it used to and it's kind of going down even because of this issue the children of today are predicted to live shorter lives than their parents that's the first time in human history and I think what that does is that articulates the level of problem that we face and that simply shouldn't happen not with the advances that we have in healthcare, in pharmaceuticals in diagnostics, in tech that should never occur but it comes down to one thing and that is about behavior and how we work incredibly hard if we are to improve the lot of our children and our grandchildren as we move forward Is Japan a good example because they live longer or who's great at this? There are lots of good examples worldwide of longevity so if we look to the Middle East look at places like Japan equally if we move to Europe and we look at places like Greece we often talk ad infinitum but there are good examples of longevity but equally it's not just about length of life it's actually about quality of those years, it's about life in those years not years of life and I think really what we have to focus on is not just about increasing length of life all we have to focus on is improving the quality of life Do you also work with what's it called the girls that are super thin I forgot the anorexics and bulimics is that also a topic? I think the interesting thing is you have to be very careful with messaging and the media has to be very careful about messaging what we have driven through the media is an aesthetically obsessed population where obesity is such a big issue because we talk about size it's about aesthetics of course what that has done to some extent is it's driven a rise in anorexia and bulimia because those people who are susceptible to those messages are actually being affected by them add on top of that if you think about things like pregnancy the messaging around pregnancy to not gain excessive weight has actually led to a lot of underweight pregnant women so some of the message can be counterproductive so I think what we have to be very careful about this is not about hammering this is not about vilifying certain groups in the population I think we have to be much cleverer much smarter about the messages that we're sending out to make sure again that they are bespoke personalised messages to help people improve their own quality of life