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;

I did my PhD on this subject and found that most students and practitioners wold welcome more "exercise" education #physiotalk
— Grainne ODonoghue (@odonogr) January 12, 2015

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.

physiotherapy/services cannot achieve the required duration of evidence based programmes/required adherence to ex. #physiotalk
— Bex Townley (@BexTownley) January 12, 2015

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.  

How become Exercise experts #physiotalk strengthen the undergraduate curriculum @MelroseStewart1
— Ann Green (@AGreenCovPhysio) January 12, 2015

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!

@annalowephysio @physiotalk A structured CPD pathway maybe by the @CSP so we're covering all key aspects of ET enduring key competencies met
— Gareth Liversidge (@gazliverphysio) January 12, 2015

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).  

@DaveNicholls3 @annalowephysio physios often set people up for failure by prescribing exercise that people won't do. #physiotalk
— Paul Westwood (@TriathlonPhysio) January 12, 2015

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!