Is there really any point to the NHS app monitoring people’s step count? This is the latest announcement from Health Secretary Victoria Atkins, who wants to use the app as the ‘front door to prevention’ and helping people back into work. It is easily caricatured as a modern-day Norman Tebbit ‘on yer bike’ measure, suggesting to the long-term sick that if only they walk 10,000 steps a day, they’ll get back into a job.

Except perhaps they will. We have a number of problems with our current approach to illness. One of them is that we tend to view everything through a biomedical model when other interventions can be as, if not more, powerful and permanent. Mental health problems are one of the most common reasons for people being out of work, particularly among the youngest cohort of 16-34 year olds. While anti-depressants have a reasonably strong evidence base behind them, so does moderate exercise, including walking.

The main drawback of activity is that people don’t believe in it sufficiently

Enlightened clinicians tend to take a tripartite approach to mental illnesses: medicine, therapy and other activity. The first can have unpleasant side-effects, take a long time to withdraw from (I should know, I’m currently trying to reduce my own very high dose of anti-depressants), and doesn’t always deal with the underlying cause of someone’s complaint. The second is difficult to access, with NHS waiting lists overrun, a shortage of professionals to provide the service, and a quagmire of different therapeutic approaches that are very difficult to navigate on your own. The third is free, and its main side effect seems to be getting in shape and needing to replace your shoes more often.

The main drawback of activity is that people don’t believe in it sufficiently. Studies of the placebo effect have shown that patients are much more likely to improve if the pills they are being given are large, or if they are being treated with a large machine or surgical-looking approach. Walking and other activity just seem too simple, which is presumably why we have an inactivity crisis while also all being obsessed with weird fad diets and spending absurd amounts of money on static bikes.

It’s not just mental health either: any GP or rheumatologist will tell you that the biggest problem they have is getting a patient who will religiously take their painkillers to also do their prescribed physiotherapy exercises every day. We don’t trust in the things we do with our bodies nearly as much as the things we do to them.

If the NHS is keen to use a model where the biomedical approach is less of a priority, then that’s great, but it will only have limited success if there is not the accompanying investment in therapies. When I was acutely unwell with post-traumatic stress disorder, I often spent four or five hours a day walking away from the black dog. I wouldn’t have learned how to manage that illness without regular therapy, though. I wouldn’t have made it back into the workplace without each of those three approaches. If the public doesn’t fully believe in physio for the mind or body, then the same can be said for the government’s approach to therapy: it talks a good game on it, but needs to fully commit to it in order to get results.