The 1968 version of Oliver Twist in my mind is a classic. Anyone who has seen the film will remember that classic seen where Oliver asks for more:

The evening arrived; the boys took their places. The master, in his cook's uniform, stationed himself at the copper; his pauper assistants ranged themselves behind him; the gruel was served out; and a long grace was said over the short commons. The gruel disappeared; the boys whispered each other, and winked at Oliver; while his next neighbours nudged him. Child as he was, he was desperate with hunger, and reckless with misery. He rose from the table; and advancing to the master, basin and spoon in hand, said: somewhat alarmed at his own temerity:

'Please, sir, I want some more.'

The master was a fat, healthy man; but he turned very pale. He gazed in stupified astonishment on the small rebel for some seconds, and then clung for support to the copper. The assistants were paralysed with wonder; the boys with fear.

'What!' said the master at length, in a faint voice.

'Please, sir,' replied Oliver, 'I want some more.'

The master aimed a blow at Oliver's head with the ladle; pinioned him in his arm; and shrieked aloud for the beadle.

Condensed from Oliver Twist chapter 2

So, upon reading Susi Kriemler, trial in the BMJ on the Effect of school based physical activity programme (KISS) on fitness and adiposity in primary schoolchildren all I could think of was surely we need more of this type of research in our preventive strategies and less of the poly-pill mentality.

In the study children received a programme that included adding two additional physical activity lessons a week, daily short activity breaks, and physical activity homework. Overall, physical activity and fitness improved and led to reduced adiposity in children.

'Mr. Limbkins, I beg your pardon, sir! Oliver Twist has asked for more!

There was a general start. Horror was depicted on every countenance.

'For MORE!' said Mr. Limbkins. 'Compose yourself, Bumble, and answer me distinctly. Do I understand that he asked for more, after he had eaten the supper allotted by the dietary?'

'He did, sir,' replied Bumble.

'That boy will be hung,' said the gentleman in the white waistcoat. 'I know that boy will be hung.'

Condensed from Oliver Twist chapter 2

What do you think will happen if we ask: physical activity research, please sir can we have some more?

Coronary heart disease (CHD), which usually presents as a heart attack (or myocardial infarction, MI) is the most common cause of death and disability both in the UK and globally. The way in which CHD is treated and prevented therefore has huge implications for patients, health professionals and policymakers. Once a person has a heart attack, prevention of further heart attacks, stroke or death, or secondary prevention, is crucial. There is strong evidence for benefit of several drugs and treatments after heart attacks to this end, including aspirin, statins, ACE inhibitors and beta-blockers. Such treatments have undoubtedly saved lives, but studies in the US and the UK, have shown that between 30-60% of MI patients receive appropriate treatment. There are strong arguments for giving more people the right drugs with benefits in terms of mortality and cost-effectiveness. Current NICE guidelines therefore recommend these treatments for all patients following a heart attack.

This week, the British Heart Foundation reported that only 38% of such patients were receiving adequate rehabilitation care. “Cardiac rehab includes advice from dieticians, physiotherapists and psychologists about how to live with the consequences and improve the survival chances following heart attacks, coronary artery bypass operations and angioplasties.” The components of cardiac rehab have benefits individually and together. For example, a review of 46 trials including 9000 patients showed that exercise-based rehabilitation reduces all deaths by 20%, and cardiac deaths by 26%. Some patients are too ill to benefit from cardiac rehabilitation, and others choose not to partake or continue with the rehabilitation programme.

Provision of drug treatment and primary angioplasty programmes has improved more than cardiac rehabilitation, which has remained the poor relation. This is partly because we tend to favour treatment rather than prevention, and pills rather than behaviour changes. To a greater extent than other treatments, cardiac rehabilitation needs the commitment of the patient. However, this does not mean that we cannot be innovative in designing ways of increasing access to this vital aspect of care for patients after MI.