Bringing Physical Activity into the Heart of the Community via @KPMedicalP

Guest blog by Dr Jo Wallis of Kiveton Park Medical Practice

Ann has asked me to blog about my experience of trying to bring physical activity into the heart of my general practice community. After the Olympics I was inspired to help get my patients more active to improve their health and wellbeing. Via @Twitter I quickly found @exerciseworks and Ann kindly spent a good deal of time bringing me up to speed on all the research and evidence behind the benefits of physical activity for all patients. She signposted me, and the practice, to a range of national and international ‘movers and shakers’ in the area of exercise as a medicine. 

My 'work in progress' has taken into account all the things I have learned and can be summarised into the following strands.  

1. Workforce wellbeing

Encouraging my colleagues and staff to find ways in the working day to sit less, stand more, and walk more. To support and encourage physical activity amongst the staff and celebrate their achievements. 

2. Exercise IS a medicine

I've started to talk to my patients about physical activity as a matter of routine. I have developed a way to record in Emis-Web current levels of PA as a significant active problem and code my brief interventions. I can export this template to any Emis-Web users who are interested. Please contact me @jowallis100 for further details! 

3. Patient information literature

I have collected a variety of written information leaflets on physical activity covering a full range of ages and health burden. I code the electronic patient record when I back up my brief intervention with an appropriate educational support leaflet.  

4. Local Community Stakeholders

I have introduced myself to local people and businesses with an interest in physical activity. This includes some local Registered Exercise Professionals (REP's) and gym owners in order to work on a joint venture to improve physical activity in our community and break down any barriers which exist between health and the exercise/fitness industry.

I am also creating a bank of local volunteers who will become our walk leaders, Nordic waking leaders and Otago class instructors for the future. We have had one stakeholder’s meeting where we brought everyone together to share ideas and aims. 

5. Local professional stakeholders in Physical Activity

I have made contact with local health workers who are involved in physical activity with patients, in order to work out where the gaps in provision are. We are now working together to develop small projects which 'fill the gaps' and plan to apply jointly for funding. 

Unfortunately my all encompassing bid to the local trust was unsuccessful, so 'Plan B' is to work up smaller bids with other stakeholders. For example...

‘More Life’ for children's weight management; we are improving signposting and referral within the practice to get more children to take up the excellent weight management service at an earlier stage. 

Cardiac rehabilitation programmes; working with Secondary Care Trust's Lead Cardiac nurse and leisure facilities to increase the cardiac rehabilitation provision in the early days post event and to support and encourage ongoing exercise for the rest of the patients life. We are working together to encourage and support physical activity in the community for patients with heart failure.

Working with Local Authorities' Sport & Physical Activity Development Team on lots of projects; Otago in surgery, supporting the links with local gyms and REP's, bringing the 'Active Always' programme into the South of the borough where I practice, training up Otago class leaders, training up walking for health leaders, working to find some funding to support a co-ordinator who will 'case find' and match patients with locally available physical activity (eg on discharge from pulmonary rehabilitation, cardiac rehabilitation, weight management services, Falls service etc)

Preliminary discussions with the local pulmonary rehabilitation team to bring the course into our community and ensure patients have easy access to ongoing physical activity after discharge.

We have a Health Trainer in the surgery once a week and we are working together to increase the physical activity part of her role. She is going to train to be a 'walking for health' leader and thereafter plans to take her cohort of patients out for a walk, perhaps once a month! 

6. Set up Otago classes to run from surgery for our frailer older patients

All clinicians are referring into Otago classes which run in our surgery. We have now filled three classes and are trying to work out how to accommodate the next cohort of enthusiastic patients. The classes are funded by public health and one of our patient volunteers to help.  

 We have sent two representatives from the practice to be trained up to be Otago instructors (funded via public health). 

7. Walking for Health

Walking is so easy and suitable for vast majority of people. So I am developing a group of patient volunteers to train as walk leaders (who will be trained and insured by public health). My aim is to get a walking group leaving the surgery every weekday.  I am going to train up too, and offer 'walk with the doc' sessions from time to time!  

8. NordicWalking

I am working with Catherine Hughes (Director of British Nordic Walking) to find funding to train up some Nordic Walking leaders, who would then lead Nordic Walking groups from the surgery. 

9. Work with Patient Participation Group (PPG)

We have an active PPG who have become involved with the idea of improving opportunities for physical activity in our community. They have taken a special interest in the BHFNC information on physical activity for older adults and are helping to raise the profile of the project. 

10. Create a physical activity suite within the surgery

This will be the area where patients can browse information on the UK Chief Medical Officer guidelines, watch exercise DVD's and be signposted to local opportunities for physical activity. We have invested in some audiovisual equipment which will allow presentations and web access for groups. It is the area where the Otago classes take place and will be the place where walks from the surgery start and finish.

There are tea & coffee making facilities! 

11. Emis-web templates

I have amended all the Qof templates where physical activity has been proven to have benefits (which is most of them!!). I have bolted on my physical activity template as a 'new page' on each existing Qof template. 

12. Lobbying

Lobbying public health and CCG to put more resources into PA (ongoing), talking to anyone, who will listen, about physical activity for health and wellbeing, writing about physical activity in my letters to consultants, seeking support from other local GP's to add weight to the lobbying. 

13. Case studies

I am collecting a series of case studies where my physical activity advice has been the cornerstone of my management. 

14. Working on an official launch for the physical activity project

The PPG are taking a strong role in the official  launch for the Physical Activity project which will be on: 

Wednesday 17th July 2013

at Kiveton Park Medical Practice S26 6QU.

3-6pm; Local stakeholders stands & activities in the surgery and 'Walk with the Doc' sessions. Official opening at 6.15pm.

All twitter friends welcome! 

If anyone has any suggestions to improve the project, or wants more information on coding and templates, please do get in touch: @jowalllis100  or @KPMedicalP

Blog moderated by Ann Gates MRPharmS, Founder of Exercise Works!

4 tips for easily starting to be active and remain active via @SatishKTM

Guest blog by @SatishPandey

4 tips for easily starting to be active and remaining active

 “Get active and stay active” should be one of the most useful mantras we can spread in the world that is spending more lethargic lives and at the same time is living longer than any time in our history. The longer life brings with it problems of non-communicable diseases (NCD).  Lifestyle factors contribute to a very large proportion of these NCDs. What makes this more shocking is the fact that developing countries bear disproportionately higher burden. We might think widespread poverty should make communicable diseases more prevalent in these areas. However, while the developing countries slowly but surely struggle out of the communicable diseases’ grip; they now face a double burden due to the growing threat from the emergence of NCDs.  The most effective way to tackle NCDs is through prevention measures. 

Getting regular adequate exercise is prescribed as one of the more effective preventive measures of NCDs. As easy as it might sound, most people struggle to get even moderate level of exercise regularly.  The list of excuses, both real and contrived, for not ‘being active’ is quite long. We have to help people of all ages to find exercise routine that they find joyful. This simple solution could avert millions of future deaths in our world. 

 Here are four tips that I have found help to “get active and stay active”

Listen to them but do what works best for you

The world is full of free advice. We have a choice to take them or ignore them. We also have a third choice, that we generally don’t realize we have  - hear them out but make up your own mind about what works for you.  The list of options about the range of activities that can help you remain active and healthy is extremely long. The list has become so long not just because it’s full of activities scientifically proven to work but also because different individuals have, over time, tailored their work out patterns to what they best feel most comfortable in.

You will be told you by your ‘concerned’ friends that you need to mix you runs and weights. Some would ask you to also watch your diet. Others would say running on treadmill isn’t very effective. Some might even suggest that the best result is obtained only by doing power exercise.

The fact of the matter is that we can make either one or more of the exercises work for us.  It’s always best to try and get the maximum out of our workouts but for starters, the idea is to comfortably get into a routine (which is my next point) so that we make ‘being active a habit’. The entire idea is to find that one exercise or a combination that makes us feel most happy and at home with. My experience is that only that will get us going and also keep us going. There are lots written about adding variety to our exercise and may be over the long run, we certainly need to but first and foremost, while starting, we need to find that one easy and simple routine that we can do over and over again. We have to remember; we are in this for a long haul and not just for a couple of days.

Develop a routine

Exercise can be addictive. For those, who have already made it an addiction, I would really like to say – great job! It does take a lot of effort to reach a stage where you have made ‘getting active’ a habit you can’t do without. 

For beginners, we have to remember that in our early days we will exercise only if it’s easy enough (but may be stretches us just that wee bit to get the sense of ‘exercising’) – like if the gym is near you, or if the weather is suitable, or if the exercise we do isn’t too testing. The routine of doing it over and over happens only if we find something that isn’t too energy sapping. So, once we have found that something to do, we have to find the right days and the time of the day to do it over and over again. We need to go ahead and find out if its mornings that works the best for us or the evenings or a combination.

It would be too hard to accept ‘I simply don’t have the time for it’ as an answer.  Believe me when I say – “If you want it bad enough, you will find time for it”.  However, it also is true that the routine itself shouldn’t be a source of stress for you.  Once you have developed this routine, you will start feeling good about yourself.  Eventually, you will slowly bring in the variety and more rigor to your exercise as you move ahead but in the beginning, you have to, at least, be a regular regardless of how hard you are exercising.

Talk about your newfound passion

“If you have it, flaunt it!’. This is very true with exercising. Whatever it is that you are doing – running, walking, lifting weights, cardio, Zumba(™) dance – just talk about it.  This is one thing, I believe, that is okay to get on other people’s nerves with. 

I have sensed that the more you let others know what you are up to; you not only inspire them but also create an obligation for you to keep exercising. Now, this obligation may not be the most appropriate reason to for you to exercise but I have found that it still works. So, Tweet away the miles you have run, post pictures on Facebook about the hikes you have done or invite fellow workers from the office to your Zumba™ class. This keeps you excited and keeps you going.

Be happy about it all

Happiness and exercising seem to have such a cyclical relationship- one feeds into the other in such a seamless manner.  So, it should be very natural that you become happier when you have exercised. It lights up your day with a sense of achievement. It makes you less stressed by taking the toxins out of your system and replacing them with the right hormones. It also helps you sleep better. The happiness should allow you to gradually stretch yourself with your exercise routine making you do more. This simple but very strong complimentary relationship of happiness and exercise is something we need to capitalize on. So, carry on exercising, carry a smile on your face as a result and it will help you do more the next morning.

In closing, I think it would safe to say that most of us have, at some point in our lives, started exercising, did our bit for may be a few days to a couple weeks, repeated it on and off but never settled into a more sustained routine. Better results always require better efforts. Our aim should be to invest more time and effort in remaining active over a very long period of time so that not just you, yourself but the whole world can see the positive changes in you.

So, what are you waiting for – ‘get active and more importantly, make sure you remain active!” 

Blog moderated by Ann Gates MRPharmS

Founder of Exercise Works!

Latest @BJSM_BMJ blog via @exerciseworks

Great new blog for the British Journal of Sports Medicine and great video via Fit Behavior.

Finding your Motivation from FitBehavior on Vimeo.

At 63 years old, Bill Center ("The Admiral"), could not get up & down off the floor to play with his grandchildren. Nor could he enjoy traveling, as we was functionally unfit to do so. Sure he hoped to lose weight, feel better, etc....but the real motivation was focused on functionality so he COULD play with his granddaughters, enjoy traveling in retirement...he was motivated to make a lifestyle change.

Via Ann Gates BPharm(Hons) MRPharmS

Founder of Exercise Works! ... and on a mission to help every patient access quality exercise advice from every health professional... globally!