a paradigm shift in physical activity interventions British Association of Sports and Exercise Medicine May 2014

Ann GatesFounder, Exercise Works!

inactivity is the 4th biggest global killer

pre-science

normal science

modeldrift

modelcrisis

modelrevolution

paradigmshift

The Kuhn Cycle

preventable deaths

why a paradigm shift?

37,000 patient deaths/year from inactivity

“names and faces in every clinic waiting room”

http://www.bmj.com/content/348/bmj.g2804

…medicine needs YOU!

• leadership on ‘exercise as a medicine’

• your influence

• physical activity ‘champion advocates’

• helping patients use physical activity to manage disease

Royal College of Physicians. Action on obesity: comprehensive care for all. Report of a working party. London: RCP, 2013.

• ONLY 1 in 3 doctors give exercise advice during routine consultations CDC 2012

• 56% of adults having had a cardiac event don’t attend cardiac rehab Cardiac Rehabilitation Statistics 2013

• 65% cancer survivors don’t exercise Macmillan Cancer report 2011

• by age 74 years 58% men and 78% women CAN’T walk for 30 mins or more! BHF 2012 statistics

• an inactive person spends 38% more days in hospital than an active person DOH 2011

WARNING…iceberg moment!

“hurdle” problems!

• knowledge and training

• time

• success in changing patient behaviour

how?

Br J Sports Med 2012;46:625-631 doi:10.1136/bjsports-2011-090734

“no exercuses!”

shift the paradigm…

work with what you have…..

• Train every health professional• Provide brief intervention• Support and signpost EVERY patient• Monitor exercise medicine effects!• Record in notes

exercise medicine is a “life saver”

change the paradigm of the consult…

our services and care pathwaysprovide: safe and effective, exercise support, every consult

“

“All Parliamentary Commission on Physical Activity 2014: “teachable moments”

make every

contact count!

672,973 brief physical activity

opportunities every NHS day

every patient

=

A LOT of physical activity

advice, every consult!

if……every TRAINED health professional x over 1 million NHS patients/36 hours

inspiring to change…

how, who, when and where• exercise advice, every patient, every opportunity• everyone MECC 2011, PH44 2013

• exercise as a ‘vital sign’ R. Sallis, Br J Sports Med 2011

• ‘teachable moments’ APC physical activity 2014

helping every patient, feel like an Olympianduring your consultation…!

Fun, exercise prescription and…

how?

One strategy may be to add ‘45 seconds’ of advice

 

‘I want you to start an exercise plan in the treatment of [insert disease condition]. 

When I see you for review of your health problems and medication, I will

also be reviewing the effectiveness of regular exercise in helping you to

manage your disease/condition’

NICE guidance 2013

training for brief intervention

how? knowledge works!

• training• practice• expertise and capabilities

Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013;347:f5577

how?know the clinical red flags

8 ABSOLUTE contra-indications

patient considerations

clinical precautions

disease specific issues

“teachable moments”

cradle…..

FACT: children under 17, in the UK : 95% of those diagnosed with type 2 diabetes were overweight and 83% obese

exercise referral program improved physical activity

inactive individuals decreased

from 75% to 53%reduced costs for inactivity by 22%

…to grave

change the consult conversation!• AVOID using FITT language• use “try” or “choose”• use “effort” • talk about “short bouts of exercise”

make it disease specific

• obesity, type 2 diabetes, COPD, Parkinson’s Disease,

cancer, asthma, osteoporosis, falls prevention……

NICE guidance 2013 , BHF 2012

how? give follow ups and lifelong support!

• gain confidence

• evidence base• what works for YOUR patients?• use prescription tools• identify opportunities for patients

how? use new clinical tools…

NICE guidance 2013

. http://www.cdc.gov/socialmedia/tools/guidelines/pdf/socialmediatoolkit_bm.pdf

how? use social media to reach prospective patients

what paradigms really mean for patient care…

after results!

every patient, every consult,disease specific exercise advice, and follow up!

iceberg drift turns into paradigm shift……

• Arial 18pt• Arial 18pt professionals• patient education and support• exercise advice, every patient, every opportunity

• when and where• every health consult• In hospitals, out patients, clinics, home visits• the viral use of social media

Exercise-Works-Ltd

@exerciseworks

exerciseworks

All content and concepts intellectual copyright to Exercise Works! www.exercise-works.org 2013, 2014.

Acknowledgements and disclosures

• Professor Karim Khan, Dr Jim House, Dr Richard Weiler, Mr Ian Ritchie, Jim Dawton Design, REPSUK, British Nordic Walking

• Dr Brian Johnson, Professor Tahir Masud, Dr Chris Oliver, NASA, NIA, and all the great clinicians who trained me at the Royal Derby Hospitals, Derby, UK, PCTs, and Trent Strategic Health Authority

• a passionate, physical activity advocate for every patient, every consult!

• founder and director of Exercise Works!

• member of the World Heart Federation (WHF) • Emerging Leaders Programme 2014

resources

• FYSS Physical Activity in Disease Prevention and Disease Treatment

• http://www.rcplondon.ac.uk/sites/default/files/documents/exercise-for-life-final_0.pdf

• Ann Gates ISBN: 1121850928 Copyright year: 2013, Patient Exercise Sheets, 1st Edition

• http://www.exercise-for-health.com/

• http://gpcpd.walesdeanery.org/index.php/uk-physical-activity-guidelines

• http://www.exercise-works.org/store/

• http://www.humankinetics.com/products/all-products/acsms-exercise-management-for-persons-wchrnc-diseasesdisab-3rd

• http://www.acsm.org/access-public-information/position-stands

• http://www.nhs.uk/Livewell/fitness/Pages/physical-activity-guidelines-for-adults.aspx

• http://www.healthscotland.com/physical-activity.aspx

• http://gpcpd.walesdeanery.org/index.php/uk-physical-activity-guidelines