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

Wednesday 14 January 2015

Exercise, at the heart of Physiotherapy? (Tweetchat debrief)

On Monday 12th January Physiotalk hosted the first tweetchat of 2015.  My colleague Rachel Young (@youngphysio) and I (@annalowephysio) were guest hosts for the session.  Rachel & I chose this topic because we are both passionate about exercise and about Physiotherapy and we share concern that the two things seem to be on divergent paths.

The Tweetchat was fast and furious; my head is still spinning!  The analytics suggest that there were 756 tweets from 88 participants and I have to say, at times I didn't have a clue what was going on! Participants were varied; it was great to see that physio students were represented along with physios from all specialisms and from across the globe.  We were also joined by Osteopaths and Speech and Language Therapists whose tweets added a different perspective.

The aim of this blog post is to organise the information from the Tweetchat and to highlight & expand upon some of the key discussions.  I've added peoples' Twitter handles so that you can find and follow them if you wish.  I've mentioned a number of contributors and embedded tweets, I hope that I have represented your views accurately.

Question 1: Are we actually any good at prescribing exercise?

First off, there were a few calls to unpack what we mean by exercise prescription, this is a valid point and something I'd love to do but probably not over Twitter, apologies for ignoring these tweets!

Mel Stewart (@melrosestewart1) suggested that there is variety in knowledge and skills and that some standards might be useful, this was reinforced by Mandy Dunbar (@physiodunbar) who felt that minimum standards for Universities might be helpful.

The general feeling seemed to be that we are perfectly positioned to lead on exercise but that we seem to have lost some of our skills in this area.  Zara Hansen (@cbtskills) suggested that this might be due to the scope and breadth of practice expanding.  Lack of knowledge of strength training principles and lack of expertise with use of gym equipment were highlighted as issues.  Grainne O'Donoghue (@odonogr) raised the issue of confidence and shared findings from her PhD;


Alan Taylor (@tayloralanj) posted a list of 10 reasons why we should be leading on exercise this stimulated a great discussion.  Dave Nicholls (@davenicholls3) added in our ability to cope with co-morbidities and I'd also add our ability to acknowledge and balance risk, we are less risk averse than some other exercise professionals and we understand that there is a risk inherent in doing nothing.  

Question 2: What do we need to do to become better at exercise prescription?

Rachel Young (@youngphysio) suggested that we might have become "functional to a fault", whilst function is our main driver, in order to restore function we need people to engage with exercise and sometimes function takes all the fun away.  One of the key things that came through was that exercise needs to be fun; I think we have work to do on our ability to sell exercise!

Other factors that were identified as important in engaging patients were;

  • making it realistic, less can be more, there was talk of no more than 3 exercises,
  • making it easy for patients, seeing them in their own environment,
  • adopting a flexible approach,
  • giving patients choice, acknowledging patients' preferences,
  • encouraging honesty about what's achievable,
  • planning for relapse,
  • tailoring, no more bog-standard photocopies, no more 3x10 for everyone.

Bex Townley (@bextownley) raised an important point below and went on to highlight the importance of partnertship working with other professionals to meet patients' needs.

Mike  Stewart (@knowpainmike) drew our attention to the issue of behaviour change (see previous blog post) and I agree, it is the essence of what we do. 

Question 3: How do we become recognised as exercise experts?

One of the key things to come out of the tweets related to this question was the need to value exercise as an intervention in its own right.  It's not just an adjunct, it's not something that we just tell people to do at home, it's not what we spend the last 2 minutes of an appointment doing.  We need to walk the walk and that means making exercise central to our interventions and that will convey our belief in its value to patients.

Another discussion that cropped up was the idea of exercising with patients, I love this idea, what a great way to raise our profile and show patients how much we value exercise. There were lots of calls to "get out of our treatment rooms" and exercise with patients in the best environment for them.  Does anyone run general exercise classes for patients and NHS staff?  Do any departments run physical activity challenges that staff and patients can participate in?   
There were a number of tweets suggesting that we need to strengthen UG curricula if we want to be recognised as exercise experts, again this comes back to the point about minimum standards and whether this would help curriculum design.  

There was a suggestion that adding basic fitness qualifications into UG courses might help and this was followed with a short discussion about the HEIs that have embedded vocational qualifications into their courses.

Access to exercise-related CPD that is accessible, affordable and high-quality was identified as a factor.  Gareth Liversidge (@gazliverphysio) made the following suggestion, I'm going to have a think about this one, what a great idea!

Rachael Lowe (@RachaelLowe) also suggested running an open on-line course through Physiopedia as one way of improving knowledge and confidence.  

Question 4: What essential exercise prescription skills should be taught at UG?

It was suggested that students need to understand the importance of being realistic (fewer exercises performed well).  



Tweeters felt that students need to be exposed to underpinning principles of exercise training including FITT principle, measurement of intensity and principles of strength training.  I would add to this that I think students need to be taught about normal response to exercise before considering pathology.

Other key skills identified were using appropriate means of imparting information, written, text, online, phone call etc.  An understanding of behaviour change theory and practice was also considered essential.

This discussion came back to the point of valuing exercise, if Educators value exercise students are far more likely to value exercise too.

To conclude.....
All in all it was a really stimulating Tweetchat, loads of great ideas and such enthusiasm!  I came away with a renewed sense of just how much exercise unites our profession.  There are lots of opportunities for us to secure and develop our practice in this area and there are certainly a lot of passionate physios who are out there making it happen!