Monday, 23 November 2015

Top Ten Physical Activity Resources

I've been meaning to collate a list of on-line Physical Activity (PA) resources and speaking at the Primary Care Rheumatology Society conference in York on Friday has reminded me to get on with it!  This list started as a Top Ten but I keep adding more, it is by no means exhaustive and it isn't in any particular order. It's basically a compilation of some of the free, open-access PA resources that have been particularly useful to me over the last couple of years.

23 1/2 hours

I'm prepared to bet that this is the most informative 10 minutes you'll ever have on physical activity!  If you only access one resource make it this clip!

PA infographic from the CMO

This new infographic reinforces the same basic messages from the 2011 guidelines but in addition to this there is a focus on the message that something/anything is better than nothing. This is particularly important when working with people for whom 150 is not achievable, people with LTCs, for example, can still gain huge health benefits from engaging in regular activity even if it is well short of the amount required for "optimum" health benefits.  The infographic format is more accessible than a report and it would be a good poster to have in waiting rooms etc.

Start Active, Stay Active

This report was published in 2011, it sets out the policy context and gives lots of detail about the extent of physical inactivity.  This was the document that first introduced the CMOs PA guidelines, these were recently updated in the above infographic.

Everybody active, every day: an evidence-based approach to physical activity

This report was published by PHE in 2014, it outlines the key issues and calls for a change in culture around physical activity.  It highlights four key areas in which action is essential to create a more active nation.  These areas are;

  1. Active society
  2. Moving professionals (this includes health & social care)
  3. Active environments 
  4. Moving at scale
This link will take you to some other related resources.

PHE Slidesets on PA

PHE have made these slidesets available online, they have some useful graphs showing levels of inactivity by age, gender, socio-economic status etc.

BMJ Learning Resources

BMJ learning have created a suite of on-line learning modules on physical activity for LTCs. I particularly liked the final module in the list, it shows real understanding of the barriers that clinicians are up against in primary care settings and it makes small, achievable suggestions about ways in which we might promote activity. The modules are free, you just need to create an account which only takes a minute or two.  They take about 30 minutes each to complete and include:

Blueprint for an Active Britain

UK Active recently published this document, it outlines some of the key changes that are required not just in health care but across society in order to make physical activity part of our every day lives.

British Heart Foundation Resources

BHF produce a range of fantastic, accessible resources on physical activity. The two documents that I go back to time and time again are:

Faculty of Sports and Exercise Medicine Resources

The FSEM produced a booklet called Exercise Prescription in Health and Disease, it presents a series of case studies for medical students. It has loads of great content and is presented in a nice, e-booklet style here.

If there are other resources that you think are useful for healthcare professions then drop me a line and I'll add them to the list.

Tuesday, 17 November 2015

BJSM Blog Post

I enjoyed writing a blog post for BJSM about the work we have done with Exercise Works! to enhance the undergraduate Physiotherapy curriculum at Sheffield Hallam University.  The post has been well received and my Twitter feed has gone crazy!  The full article can be read here.

Thank you to BHF for putting the closing sentence on this great back drop & tweeting it!

Thursday, 22 October 2015

Summary of Physio UK Presentation

It was great to present at Physio UK in Liverpool at the weekend.  I was overwhelmed by the response to the session and delighted to see the commitment to health behaviour change and, in particular, to physical activity.

A summary of the presentation can be read here.

Wednesday, 14 October 2015

Physio UK 2015: Future Proofing Resources

This blog post is to accompany my presentation at Physio UK.  I have accessed a lot of fantastic resources in planning the presentation and I thought that discussing these in a bit more detail might make for a useful blog post.

The title of my session is "Future Proofing Physiotherapy: Equipping the future workforce to meet the needs of the changing population" and this is an overview of some of the key resources that have shaped my ideas.

Resources on basic concepts in public health

This book explores the challenges of working in mainstream health care with limited support to address the wider determinants of health.  It is based on US health care and from a doctors perspective but there are real parallels with the challenges that we face in the UK.

The progress that the author makes in addressing some of the issues is incredible, it's a very inspiring book!

There is also a TED talk by the author.

This report published by Arthritis Research UK is a must-read for musculoskeletal physiotherapists.  It outlines the prevalence and incidence of musculoskeletal disorders and the massive cost to individuals, society and the healthcare budget.

It clearly identifies the co-morbidities that tend to accompany MSK conditions and highlights the links between disability, risk of early mortality and MSK conditions.  It explores the potential for interventions that focus on improving general health to be embedded within current MSK care.

Resources on local population health

Joint Strategic Needs Assessments analyse the health needs of the local population.  They inform the commissioning of health services within a local authority.  They underpin the health and well-being strategy (see below).  The key aim of a JSNA is to accurately assess the health needs of a local population with an view to improving it.

Every area will have a JSNA, they can be found on your local government website.
A health and well being strategy is essentially an improvement plan based on the JSNA, it is compiled by the local health and wellbeing board and they are also usually available on the local government website.

For more info on JSNAs and health & wellbeing strategies see this document "Joint Strategic Needs Assessment & joint health and wellbeing strategies explained".

Local health profiles are created by PHE, they are really easy to access you just go to the website and put in a postcode.  The give lots of useful information on local health priorities and show useful deprivation profiles of the area.

Resources on health behaviours

I first read this document last year and I've revisited it many times since, it has really influenced my thinking about the role of the Physiotherapist in addressing health behaviours.

It gives an overview of the prevalence of unhealthy behaviours and the clustering that tends to occur.  It also shows how this is changing over time and the disparity between health behaviours of the most and least deprived.

I will definitely be at David Buck's session at Physio UK!

This document is a really useful implementation guide for MECC, it outlines the resources and the organisational support that are required for successful implementation.

Finally, I went to the BHF conference last month, it was a brilliant experience and all the slides are available on their website. In fact all the resources from the last 6 conferences are there so it's well worth a look.

From the 2015 conference I found Justin Varney's presentation particularly useful in getting insight into a commissioner's perspective on physical activity interventions.

This is just a few of the resources that I have used in the planning of my presentation for Saturday, I have chosen them because they have influenced and developed my thinking on the role of the physiotherapist in public health.  These themes will be explored further in the presentation, the slides will be available on the CSP website after the conference.

Thursday, 24 September 2015

Physiotherapists as Role Models

It was great to see the Role Model article in Frontline this week and really interesting to read Professor Phil Reed's response to the question.

Tuesday, 9 June 2015

Asking Difficult Questions; Shall I, Shan't I?

The role of the physiotherapist in delivering health messages has had a lot of attention recently.  The prevalence of lifestyle diseases alongside rising concern about the sustainability of health and social care systems has brought preventative care into the spotlight.  AHPs make up approximately 6% of the NHS workforce and they have been identified as an untapped public health resource. 

As AHPs find themselves increasingly reflecting on their role in public health we have cause to consider our role in wider health promotion and Physiotalk hosted an interesting tweetchat about this just last night.  I've mentioned in previous blog posts  the huge role that health behaviours are thought to have in contributing to overall health (McGinnis et al 2002).  This challenges us to consider the balance between reactive treatment of the presenting complaint and proactive, preventative care of the whole person.

The Royal Society for Public health & Public Health England recently published a joint report on AHPs & healthy conversations.  In brief, the results from the survey show clear collective ambition amongst AHPs to be recognised for their role in public health.  It also shows that many AHPs frequently initiate healthy conversations with their patients.  This was matched with positive views from the public about the perceived credibility and trustworthiness of the advice AHPs give.

However, a number of barriers to initiating healthy conversations were raised in the report, these include being embarrassed to raise the issue and feeling that it is not appropriate or could be insensitive.  If we are to promote behaviour change we first have to identify risky behaviours and then openly discuss them and this can be awkward for both clinician and patient. We may want to ask about tobacco use, alcohol consumption, weight/nutrition or drug use, in some areas of practice it may be appropriate to ask about risky sexual practice or domestic abuse.

This blog post was published in BMJ recently, it gives an interesting patient perspective; the author asks healthcare professionals to;

Think twice before offering unsolicited advice in the guise of “education,” particularly when your patient is consulting you about something unrelated. If your patients hear the same potted advice during every appointment, it’ll soon lose its impact; and if you insist on bringing up a subject that they find traumatic you could put them off seeking your advice in future.

The author of the blog post had many negative experiences of receiving well intentioned, but poorly delivered, advice.  In contrast to this perspective, a sub-analysis of a large US study explored patients' reactions to being asked questions about smoking, diet/exercise and alcohol during primary care consultations.  The vast majority of participants stated that they felt "very comfortable" answering these questions.  They were then asked how important they thought it was for their care provider to know about these health behaviours and the vast majority considered it to be "very important". 

So, in this study, participants didn't mind being screened for health behaviours and they considered it to be an important process, I think the important thing here is about offering a service and allowing the patient to make an informed choice about whether or not they want it.  This would avoid unwanted, paternalistic advice (as per the above blog post) but would fulfil our moral and professional obligation to promote health.

In contemporary health care, health behaviour change is a key clinical skill and we need to take it seriously.   We need to look at best practice and reflect on our own strengths and weaknesses so that we can plan our development accordingly (as we would with any other important clinical skill). 

As frontline practitioners we have a real opportunity to impact on unhealthy behaviours and there is evidence that this is acceptable, desirable and effective.  We need to move this practice from being opportune and optional to being a core part of our assessment with every new patient.  If we get used to having these conversations then they might not feel quite so "difficult".  If we are to fulfil our potential role as health promoting practitioners I believe that we do have a duty of care to ask......but there is a big difference between asking and telling.



Thursday, 4 June 2015

What does public health mean to you? Frontline Interview

I recently did an interview with Frontline magazine about public health and what it means for physios.

 The full interview can be read here