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Focussing on fitness

Focussing on fitness
22 April 2016

Trying to get patients fit and healthy is easier said than done. But at practices across England local authorities have worked with surgeries and introduced personal trainers to get patients moving

Trying to get patients fit and healthy is easier said than done. But at practices across England local authorities have worked with surgeries and introduced personal trainers to get patients moving

Inactivity is a killer. That much we know.  But persuading people to ditch long-term sedentary habits for regular exercise has long been the Holy Grail for many working in public health.
Prescribing statins has in many cases become the easier option for those with heart disease. But with the NHS under increasing financial stress, this approach is not sustainable in the long run and does nothing to address other escalating health issues caused by an inactive lifestyle, such as type 2 diabetes.
Exercise is cheap and it improves health overall. And now, thanks to the Let’s Get Moving (LGM) programme, run in partnership with ukactive, the not-for-profit health body for the UK activity sector, GP practices, and local authorities, demonstrable success in encouraging people to increase activity is emerging.
LGM focuses exclusively on people who are physically inactive and struggling with their health. Those taking part meet one-to-one with an exercise professional, trained in motivational interviewing, who, crucially, is based at their GP surgery, for up to 12 weeks.
They can be directed to community activities, peer-led group sessions, and offered one-to-one advice and support.
During 2015 more than 1,800 patients attended LGM appointments, an increase of 60% on the previous year. So far it is offered through 29 surgeries in Birmingham, Luton, Bedfordshire, Essex and Kent, supporting thousands of patients to become more active.

Patient access
A Blueprint for an Active Britain (see Resources), published late last year by ukactive’s, and backed by a coalition of health experts including Mike Pringle, president of the Royal College of GPs and former health minister Lord Darzi, recommended that every GP surgery in the country should have access to a trained physical activity professional to help patients work on their cardio-respiratory fitness and improve their mental health.
The LGM scheme is a first step towards this goal, and previously unreleased data from ukactive shows that more than half of participants have recorded an improvement in their physical health.
Statistics tracking more than 600 patients in Luton and Bedfordshire shows an increase in overall physical activity of 79%.
The data, based on the International Physical Activity Questionnaire, which was designed to provide a set of well-developed instruments that can be used internationally to obtain comparable estimates of physical activity, shows that those same patients walked 80% more after 12 weeks on the programme, took 60% extra vigorous exercise, and their level of moderate exercise rose by 48% during that time.
And the cost of this improvement is staggeringly low: The cost per additional quality adjusted life year (QALY), the measure used by the National Institute for Health and Care Excellence (NICE) to establish cost effectiveness of a treatment) for a physical activity intervention is between £20 and £440. As a comparison, statins (a class of lipid-lowering medications) cost between £10,000 and £17,000 per QALY for patients aged 45 to 85, while smoking cessation interventions in the NHS cost between £221 and £9,515 per QALY.

LGM at work
Dr Manpinder Sahota is a GP in Gravesend, Kent. His surgery – Pelham Medical Practice – has recently started referring patients to the LGM programme.
A GP for 17 years, Dr Sahota has seen an increasing number of patients with long-term health problems caused by poor diet and lack of physical activity. With high levels of deprivation, childhood obesity and chronic conditions, Dr Sahota said Gravesend was an ideal test-bed for a physical activity intervention. He says: “Patients do seem to respond and engage with an activity programme if it’s delivered in a GP surgery setting… it’s almost like they’ve been given a prescription, so they’re more likely to do it.”
“People have strong attachments to their GP practice and trust that GPs want the best for them, so it enables us to be more effective. Personal trainers can spend the time talking to patients about how to get moving and doing more activity – the work that GPs would love to do but just don’t have the time,” he adds.
Dr Sahota believes the next step for LGM and similar interventions is to work with patients before their inactivity leads to the long-term conditions that are so debilitating for the patient, and expensive for the NHS.
“My long-term vision is to develop a health and wellbeing centre so I would have programmes like LGM in there permanently on a daily basis, with a gym and facilities which mean that I, as a GP, could refer patients to in-house services.”
The LGM programme began delivery in deprived areas of Kent last September.
Andy Fairhurst, physical activity programme manager for Kent County Council Public Health, who commissioned the programme, says behavioural change, rather than provision of opportunities for physical activity is his highest priority.
“We have parks and leisure centres; there is no lack of sports clubs,” he says. “There is, more or less, opportunity for everyone, within reason.
“What we needed to do was focus on identifying at-risk individuals and changing their behaviour, and the most cost effective way of doing that is to find the most inactive individuals whose health is already at risk from low levels of physical activity.”
The local authority wrote a service specification based on the Department of Health’s commissioning guidance on physical activity, and ukactive’s tender matched the council’s requirements.
Since its introduction last September, Mr Fairhurst says the throughput of the programme has exceeded targets, with around 2,500 brief interventions over the telephone having taken place, and close to 300 people taking up the full motivational interview process.
Personal trainer Paul Coombes, who has worked with around 190 patients through the Let’s Get Moving programme at Kingsbury Court Surgery in Dunstable, Bedfordshire, said a lot of his focus goes into building confidence. While many of the patients referred to him were overweight, they also included patients who had suffered strokes, and those with long-term conditions like diabetes and lung disease.
Paul coached his patients through the 12-week motivational interviewing programme, helped them set personal exercise goals, and signposted them to local physical activity sessions, and he says his clients felt supported to make lifestyle changes.
“Some patients joined local walking groups, others joined gyms or zumba classes, and one man got so into it he ended up being a group leader,” Paul said. One patient who was at risk of having a second stroke told Paul the programme had helped motivate her to visit the gym three times a week, which could prove to be a lifesaver.
The LGM programme in Kent currently operates in two practices, but Mr Fairhurst says the county council is now considering expanding the methodology behind LGM to all health improvement settings. He says: “The concept that this uses – screening for conditions that could be alleviated by lifestyle changes and then delivering motivational interviewing – works for wider health concerns than physical activity.”

Extra support
The LGM model has been adapted and expanded to include some specialist groups.
In Bedfordshire, ukactive has worked with the National Childbirth Trust (NCT) to offer 12 weeks of specialised post-natal support to new mums from a community exercise professional.
LGM’s success has caught the eye of government, and now the Cabinet Office, and social innovation charity Nesta have backed an expansion of the scheme to the voluntary sector, in the shape of a grant of almost £100,000.
The funding will help train volunteers as programme ambassadors and support community exercise professionals to run group activities. The money will also help create local peer support networks to strengthen and sustain the programme.
Dan Jones, director in Nesta’s Innovation Lab, says: “There was already strong evidence that when delivered by professional exercise coaches, the LGM project had a significant impact on levels of physical activity, and thus on health and wellbeing.
“The Centre for Social Action Innovation Fund, a £14 million fund from the Cabinet Office and Nesta to support volunteers working alongside public services, was excited by the opportunity to build peer-to-peer support into this proven model, through volunteer-led exercise groups and online peer support.
“We were particularly interested in how this kind of voluntary support could help sustain increased exercise levels over the longer term.”

Mary-Louise Clews, freelance journalist and consultant.

Blueprint for an Active Britain –

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