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Physical Activity for the Management and Prevention of Long T erm Conditions Michelle Turner DSN and GPN Physical Activity Clinical Champions 2022 LIVE WEBINAR 2 Learning Outcomes By the end of the session you will be able to: • Demonstrate knowledge of the UK Chief Medical Officers’ (CMOs) guidelines for physical activity; • Describe population physical activity levels at national and local levels; • Explain the benefits of physical activity for the management and prevention of long term conditions; • Apply this knowledge in your clinical care of patients through routine brief advice on physical activity. 3 Plan for the Session 1. Setting the scene 2. Key concepts in physical activity 3. Benefits of physical activity 4. Supporting people to become more active Knowledge and skills of healthcare professionals 4 •Survey of 1,000 GPs found 80% not familiar with national guidelines •Survey of 552 physiotherapists showed only one in six (16%) knew all elements of guidelines Chatterjee et al. (2017) British Journal of General Practice; Lowe et al. (2018) BMJ Open. How active are we? In England... 5 Active Lives Survey November 2019/20 6 Scale of the Problem Decreasing activity levels • Adults are at least 20% less active than in 1960s, and estimates suggest that by 2030 we will be 35% less active. Physical activity contributes to the prevention of: • 1 in 6 UK deaths • 19% – 66% of many long-term conditions • Reduced risk of functional limitation, including activities of daily living, by 50% in older adults Estimated annual cost to UK……. £7.4 billion Everybody Active Everyday (2016) Services – USA; Ossa D & Hutton J (2002); Murray et al. (2013) Lancet; Scarborough et al. (2011) Journal of Public Healthnt of Health & Human 7 Top five risk factors for non-communicable diseases, high income countries WHO (2009) Global health risks: mortality and burden of disease attributable to selected major risks 8 How inactive are we? Globally…. Guthold et al. (2018) Lancet Global Health 9 Regional Data Region Inactive (<30 mins per week) 25.3 North West North East 24.6 Yorkshire and 24.2 the Humber 23.8 London 23.4 East Midlands West Midlands 22.9 East of England 22.0 20.1 South East 19.1 South West Active Lives Survey (Nov 19-20) Fingertips tool – profile for Physical Activity 10 Physical activity across policies and guidance 11 Plan for the Session 1. Setting the scene 2. Key concepts in physical activity 3. Benefits of physical activity 4. Supporting people to become more active 12 What is Physical Activity? Health matters: physical activity - prevention and management of long-term conditions Jan 2020physical activity should an adult aim to undertake each week? 30 60 90 120 150 UK Chief Medical Officers’ guidelines 14 •Muscle-strengthening activity on at least two days a week •150 minutes of moderate intensity activity Or 75 minutes of vigorous intensity activity Or a combination of both •Minimise sedentary time and break up periods of inactivity •For older adults (65+) - Balance and flexibility activities at least two days a week Every minute counts. Some is good, more is better! UK Chief Medical Officers (2019) 15 Strength & Balance Skelton & Mavroeidi (2018) Journal of Frailty, Sarcopenia and Falls. Sedentary 16 behaviour Around 20 million adults in the UK are physically inactive. Sitting or lying awake is an independent risk factor for health by disrupting metabolism (muscle, lipid, glucose) and circulation. The annual healthcare cost of physical inactivity in the UK is around £1.2 billion Many adults spend >7 hours per day sedentary (increasing with age or limiting illness) Just two minutes walking has a physiological effect. UK Chief Medical Officers’ recommend: Minimise time sedentary and where possible break up periods of inactivity. A Br16ish Heart Foundation Physical Inactivity Report (2017)17 Who gains the most? 18 Dose-response curve of physical activity and health benefits Greatest gains are in those who go from doing nothing to doing something. UK CMOs’ Physical Activity Guidelines (2019) 19 Intensity of physical activity As the intensity increases, heart rate, respiratory rate and energy consumption do likewise UK Chief Medical Officers (2019) 20 Plan for the Session 1. Setting the scene 2. Key concepts in physical activity 3. Benefits of physical activity 4. Supporting people to become more active 21 Physical activity reduces mortality and morbidity Physical Activity Guidance – applying All Our Health (2019) 22 How is physical activity protective? Physical activity Muscle Visceral fat Anti-inflammatory myokines Systemic Inflammation Ku22ner et al. (2010) Arthritis Care Research 23 Visceral fat for the same BMI The Missing Risk: MRI and MRS Phenotyping of Abdominal Adiposity and Ectopic Fat. Obesity (2012) Stefan Häring et al. (2013) Lancet Diab Endocrinol. with permission from Elsevier 24 The wider well-being benefits of physical activity Sport England (2017) Sport Outcomes evidence review, summary of the review and findings 25 Activity across the lifecourse Centre for Ageing Better – Raising the Bar on Strength and Balance (2019) 26 In-patient settings 95% of hospital time (up to 23hr/ day) spent in bed and associated with: • De-conditioning / Risk of daily living disability • Declines in muscle strength and cognition • Higher risk of hospital re-admission • Reduced quality of life In-patient physical activity associated with: • Decreased length of stay • Improved fitness Sedentary behaviour in hospitalised older people: a scoping review protocol (2020) 27 Plan for the Session 1Setting the scene 2Key concepts in physical activity 3Benefits of physical activity 4Supporting people to become more active How much do people with a long-term health condition want 28 to be active? I am happy with the amount of physical activity I do, and do not want to do more I am unhappy with the amount of physical activity I do, and do want to do more Richmond Group of Charities (2016)What is the main barrier to physical activity for people with a long term condition? Lack of motivation Breathlessness before, during or after physical activity Pain before, during or after physical activity Feeling embarrassed Cost What are the perceived barriers for people with 30 LTCs Reassure and empower! % selecting each option as one of the top three barriers to physical activity Richmond Group of Charities (2016) Clinical tips 31 Have physical activity conversations in consultations. Make every contact count! Very brief advice can be effective, especially related to long-term conditions. ‘Moderate intensity’ activity differs by individual – Make it achievable! Physical activity conversations can be 1, 5 or more minutes Use the Moving Medicines website for support offering tailored brief advise on physical activity across a range of clinical specialties. 31 32 Consensus Statement A new consensus statement, led by the Faculty of Sport and Exercise Medicine UK and developed through review of the scientific evidence and expert clinical and patient consensus, has concluded that the benefits of physical activity far outweigh the risks for people living with long-term health conditions. The consensus statements are based on a rapid review of the evidence and have been developed through an academically rigorous consensus process by Healthcare Professionals, for Healthcare Professionals. They have been specifically designed to support health professionals to have evidence based collaborative person centred conversations to help empower people to move more on their own terms to benefit their health and happiness. https://movingmedicine.ac.uk/riskconsensus/ 33 The power of healthcare professional advice 3 A’s of brief advice 34 ‘One of the things we can do to stay and feel healthy is to be active. How physically active are you?’ Ask or more physical activity? Does this add up to 150 minutes?’ minutes Discover your patients ideas and perspective Assess ‘Are you interested in being more physically active?’can benefit you?’ ‘How confident do you feel about increasing you physical activity level?’ Plan and set goals ‘What goals would you like to set?’ Advise ‘How will you monitor your progress? situation.pecific suggestions applicable to your patients goals and Based on Haseler C et al. (2019) British Medical Journal Motivational Interviewing principles 35 R esist the urge to dictate the conversation U nderstand the individual’s reasons for change L isten – the solutions lie within the individual E mpower the individual so they have the ability to change Hall et all. Motivational interviewing techniques – facilitating behaviour change in the general practice setting (2012) 36 Understanding risk * * Elevated level of risk for those symptomatic with cardiac, metabolic or renal disease American College of Sports Medicine (2018) Exercise per-participation Health Screening Recommendations. 37 Local Opportunities 43 Active Partnerships across ‘Swim England’s Poolfinder tool makes it easier for England, using the power of sport people to find the right swimming pool for them, and physical activity to transform using live timetable data, details on learning to swim and a wider range of accessibility features.’ lives. parkrun organise free, weekly, 5km GP practices can sign up to become an Walking for Health is England’s timed runs around the world. They Active Practice. They must demonstrate largest network of health walks are open to everyone, free, and are evidence of boosting physical activity for with over 360 active walking safe and easy to take part in. patients and staff, and of partnering with schemes local physical activity providers. Key Resources 38 Evidence-based resources Guidance E-learning for Health Health Education England UK CMOs guidance and infographics Moving Medicine Prescribing movement NICE guidance All Our Health Health Education England National public campaigns We are UndefeatABLE 15 UK Health Charities Motivate 2 Move Health Education & Improvement Wales Royal Colleges/Professional bodies Better Health NHS Love Activity, Hate Exercise? Chartered Society of RCGP Active Practice Charter Physiotherapy RCGP toolkit One You / Change4Life / Active 10 Public Health England Recent Publications Returning to physical activity after Covid-19 British Medical Couch to 5K NHS Moving Healthcare Professionals Sport England Journal Physical activity: understanding and addressing inequalities Uniting the Movement Sport England 39 Spread the word If you have enjoyed the session today, please tell your colleagues how to access their FREE online training course by following these easy steps: 1. Contact physicalactivity@phe.gov.uk and ask for your local Physical Activity Clinical Champion contact 2. Arrange a suitable time 3. Ensure your session will meet the minimum criteria • At least 1 hour in length • At least 12 - 15 healthcare professionals / trainees are able to attendWould you like to find out more about physical activity? The Physical Activity Clinical Champion training is one element of the Moving Healthcare Professional Programme. If you would like to be added to a distribution list to be kept informed about other parts of the programme and policy updates around physical activity, please contact physicalactivity@phe.gov.uk Physical Activity Clinical Champions 2022 LIVE WEBINARAbout the Office Health Improvement & Disparities (OHID) About Sport England Sport England is a public body and invests up to £300 million National Lottery and The Office for Health Improvement and Disparities (OHID) will work government money each year in projects and programmes that help people get across the Department of Health and Social Care (DHSC), the rest of active and play sport. government, the healthcare system, local government and industry to It wants everyone in England, regardless of age, background, or level of ability, to be creative about how we shift our focus towards preventing ill health,eel able to engage in sport and physical activity. That’s why a lot of its work is in particular in the places and communities where there are the most specifically focused on helping people who do no, or very little, physical activity and significant disparities. groups who are typically less active - like women, disabled people and people on lower incomes. As part of DHSC, OHID brings together expert advice, analysis and evidence with policy development and implementation to shape and HEAD OFFICE drive health improvement and equalities priorities for government 21 Bloomsbury Street, London, Office for Health Improvement and Disparities, WC1B 3HF Department of Health and Social Care www.sportengland.org Twitter: @Sport_England 39 Victoria Street, Facebook: https://www.facebook.com/sportengland London, SW1H 0EU Follow us on Twitt@OHID www.gov.uk/government/organisations/office-for-health-improvement-and-dis parities/ With thanks to the National Centre for Sport and Exercise Medicine 41
