How can we increase interest in physical activity interventions?
The Faculty of Sport and Exercise Medicine (FSEM) UK is taking a lead in developing the role of medics in using specific exercise for the treatment of a range of conditions, as well as promoting more general physical activity for prevention and general health improvement. Lay Adviser, Jason Feavers looks at physical activity interventions, how receptive medics without a Sport and Exercise Medicine (SEM) background are and what can be done to increase interest.
Back in November 2012, NICE were considering a quality outcome framework (QOF) for physical activity monitoring and intervention. This was featured in an article in Pulse. For me the most interesting part was the GPs’ comments at the end of the article.
“GPs should ensure all their patients wash behind their ears in the morning and wear clean socks. Whatever happened to patients taking responsibility for their own lives.”
“What utter dribble from NICE. You won’t cure a patient’s laziness by lecturing them. People either exercise or they don’t.”
“Tosh. If I wanted to be doing this I would work in a gym.”
Other comments talked about GPs being quite sporty but not having time to do enough activity to meet CMO guidelines, therefore how can they expect patients to do this.
So how can medics be encouraged and motivated to give exercise guidance? Increasing awareness of exercise effectiveness (particularly around treatment), understanding behaviour change (brief interventions and when additional support is appropriate) and having the means to signpost people to appropriate pathways is key.
Increased awareness of exercise prescription. The FSEM’s work to introduce SEM training into the undergraduate curriculum for medical schools is a really positive step. As is the launch of the FSEM (UK) Guide to Exercise Prescription in Health and Disease. When I taught part of a Self Selected Component (SSC) to 3rd and 4th year undergraduate students at Hull York Medical School, very few gave much thought to the physiological changes brought about by exercise, never mind having an understanding of processes such as endothelium-derived nitric oxide production. I feel it’s incredibly important that this type of learning is included in undergraduate medical school training.
Understanding behaviour change. In my opinion, by far the most important aspect of behavior change for medics to be aware of is Prochaska & DiClemente’s Transtheoretical Model. This enables an understanding of the patient’s readiness to change which can be used to determine the most appropriate intervention.
Getting involved in physical activity interventions. For clinicians who recognise the value of specific exercise interventions for medical conditions, but don’t have the time or training to prescribe exercise, many Exercise Referral schemes exist across the UK. These enable healthcare professionals to refer patients to schemes where the exercise programme is carried out by specifically trained exercise referral instructors.
There are also some great examples of schemes that have been set up to increase general physical activity levels. Many of these have been developed combining the skills and knowledge of medical professionals, third sector and public sector.
Dr William Bird set up the first Health Walk scheme in the 1990‘s. More recently he launched Beat the Street, a physical activity challenge using ‘beat boxes’ at locations around a community and a card similar to an Oyster card that can be used to swipe in and out to show where participants have walked. 60,000 people have taken part in the scheme in 3 years. 18% of inactive people were lifted into activity. The proportion of people achieving Department of Health physical activity guidelines increased from 35% to 45% and this was sustained after 3 months.
In York I have been involved in two pilot schemes (still in early stages) set up by local GP practices. Evaluation of these programmes will be available later in the year:
Get Priory Pedaling is an innovative bike loan scheme to enable patients at Priory Medical Group to take up cycling. Within my role at City of York Council we were able to access some funding for 10 loan bikes and provide access to a programme of led cycle rides at various locations. Participants are encouraged to record details of journeys made by bike (each bike has a cycle computer) and can access group challenges using smart phone app Strava.
A patient participation group at Elvington Practice in York had an idea for a Healthy Living Group. I assisted with helping to add some structure to the sessions, a programme of speakers and ways of evaluating outcomes. The GP practice are providing data on outcomes around GP visits and hospital admissions.
If medical schools introduce Sportand Exercise Medicine training at undergraduate level, this would increase interest in Exercise Medicine and physical inactivity levels.At the very least is would give future doctors the confidence and knowledge to talk to patients about exercise and physical activity. Medics should also be encouraged to work as stakeholders in promoting and setting up schemes that are best suited to their local communities or patient groups. Physical inactivity is now one of the largest national health threats in the UK, however it’s at a local level that we can start to see real change.