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Introducing #PEPA16

Ann @exerciseworks and Rachael @physiopedia introduce the #PEPA16 Physiotherapy, Exercise and Physical Activity FREE, massive, open, online course.

Register for the course here and we look forward to welcoming everyone to a summer of learning!

Course starts 4th July 2016 and runs for 6 weeks.



6 things I wish my physiotherapists knew. Blog by @stickmancrips for #PEPA16

Blog by Hannah Ensor @stickmancrips and more of her excellent insights can be found here.

This blog is a result of the very enthusiastic twitter chat on Monday 13 June 2016 that introduced me to #PEPA16.The chat was Physiotherapists as leaders in physical activity #PEPA16 tweetchat 13 June 2016 (see the full transcript here).

Out of this chat has come a list of 6 things I wish my physiotherapists had known when treating me - someone with a connective tissue disorder and an autonomic dysfunction, but probably applicable to many other conditions too:

1. Being told I need to exercise more in order to manage my condition is beyond horrible.


Because I used to do a lot of exercise -cycling, sports etc, but was stopped by my symptoms. I missed exercise and was no longer capable of it. It made me feel even more guilty about not being able to do the things I once could. Even more helpless.


2. Changing the definition of exercise can help get round this - but it would be better to use a different word. This allows the patient change their definition when they are ready.

Exercise is not only running and jumping. It is moving. My current definition is "Moving with control and purpose." Moving deliberately and without flop. Housework counts if it's done with control - but not if it's done in zombie flop mode. So why not talk about controlled movement instead? (be careful about just using 'movement' - for someone with hypermobility like me, flopping around has minimal benefit and a high risk of injury. It can also be confusing to be told that all movement will help, when we move throughout the day and it isn't helping! For me movement must be controlled in order to be helpful).

3. Be inventive, creative and ingenious.

If you are going to encourage me to be active, be armed with ideas that are within my grasp. If I'm housebound and barely managing basic self-care tasks, then adding 'go to the gym' or 'spend an hour doing physio exercises' into my task list is a bit silly. Looking at ways to turn these basic tasks into productive activity might be the way forward - teeth brushed in an exhausted-leaning-against-the-sink way isn't active - but what if we switched to sitting down to brush the teeth? Working on sitting upright without leaning for that short activity.

What about making a cup of tea while standing with poise and using all our muscles? It's surprisingly difficult and surprisingly effective. And surprisingly rewarding. I can still remember the first time I did that - the sense of achievement in managing it without joints slipping was incredible.

(Note: I easily stop using various muscles, and exercises that help them wake up are really useful).

And while I still can't do the hoovering from standing due to the combined instability of feet, ankles, knees, pelvis and spine - by wearing a pair of kneepads I can do it from my knees - therefore giving my hips and core a good workout without straining my lower limbs.

4. Sitting down doesn't have to be the enemy.

I was amused to see that during the part of the chat about how active the physios were themselves, there were many comments about sitting at the computer for too long - and most solutions were to keep standing up or have walking meetings in order to be active. Now I agree that getting up can be good, but sitting doesn't have to be passive.

And for many people with mobility problems, finding ways to be active whilst sitting might be the best place to start.

You can chair dance while working. You can sit up using muscles instead of leaning.

Or sit/bounce/dance on a gym ball or wobble cushion.

You can explore the movement in your spine.

On a swivel office chair, you can swing your knees while keeping your shoulders steady.

And if there's a wheelchair sports club anywhere near - the possibility for sitting activity is huge! (you don't need to be a wheelchair user to enjoy wheelchair based sport).

Similarly lying down can be active too. Even without any formal exercises. Several years ago when at my worst I learned to exercise lying down. Gently moving my spine while lying down. Rolling over in bed with deliberate and controlled movements rather than flop (I'm hypermobile so I have an impressive capacity for flop!) Gently engaging muscles without even moving the limb also helped me in those early days of finding ways to become more active, and is something I still use on high-fatigue days.

Little, often, and within my power. That is what active needs to be.  Not long, boring, repetitive exercise lists. It is easier to be motivated about a formal exercise routine when you have already experienced benefits of being active.

Over time my 'active' has evolved - what started out as half-tensing muscles when lying down and progressed to making a cup of tea with gymnast level movement awareness, and doing some tailored exercises to music (more of a dance than 'physio'), has become contemporary dance, lots of controlled movement throughout the day, a much better level of condition management, and a store of formal exercises that I dip into when a joint plays up.

6. Use the expertise of patient led charities.

If you haven't lived it, you will never truly know the impact of the suggestions you give.

I have been given exercises that have worsened my condition (common in people with hypermobility syndromes) so I have good reason to treat your advice with caution. Especially if you haven't already made it clear that not coping with an exercise isn't a failure, but an indication that we need to tweak our approach.

A patient led organisation that encourages self-management and exercise can encourage activity from a place that does know the challenges. That has had injuries from exercise, that has had crushing fatigue for days from pushing too hard. A patient can talk through how they have coped with these constructively in ways that professionals can't; because it is lived and it is real.

I have helped out in a number of The Hypermobility Syndromes Association's events, giving a talks about self-management - including my journey to becoming more active, and it has had a really positive effect - giving people a new perspective on exercise and activity and some tools to help themselves. And I'm not the only one - so don't be afraid to enlist patient led charities and patients themselves to help encourage activity.


Blog moderated by Ann Gates @exerciseworks. Post blog comment: This was an introduction to the #PEPA16 Physiotherapy, Exercise and Physical Activity course which is free and open to all. Details of the course can be found here. Exercise Works always recommends that patients are supported to exercise within their abilities and to their expectations of fun, social opportunities. They should be partners in and lead on the opportunities to access physical activity as part of their daily life.



Join us this August for the #WeActiveChallenge 2016 via @BJSM_BMJ and @exerciseworks

In 2015 we wrote a pivotal blog for the UK We Communities professionals. You can read the complete transcript of that 2015 blog by Ann Gates below.

Fast forward to 2016, and join the second #WeActiveChallenge for 2016, described here by a phenomenal British Journal of Sports Medicine blog by @NaomiMcVey. The challenge starts in August 2016. Please join us and share the health around the world!

Transcript of the We Communities blog by Ann Gates, July 2016:

The role of Allied Health Professionals (AHPs) in the prevention and treatment of non-communicable diseases (NCDs) has never been more critical 1.

The health burden of illness, pain, health inequalities, disability and death from Great Britain’s top 3 main causes of disease: cardiovascular disease, cancer, and respiratory disease, are the nation’s biggest concerns for the future.2 These tomorrows, are dependent on providing personalised patient care and in managing the overall health economy. We already see the loss of 37,000 lives through physical inactivity alone3yet the evidence for physical activity,exercise, sport and active leisure pursuits in preventing and helping to treat these diseases is strong4. In fact, physical activity advice is a core aspect of Public Health England’s vision for the framework of personalised care for all patients.5 This provides the opportunity for all nurses, midwives and AHP’s to provide brief intervention on physical activity,and make an immediate and potentially lifelong difference to patient health outcomes.

So what do we know, and what are the barriers and enablers to making every contact count for physical activity advice?

We know from previous studies (mainly with doctors, but transferable to other professions) that knowledge, training and limited time within the patient contact, are key barriers.6 We also know that the National Institute of Health and Care Excellence (NICE) produced specific guidance (PH44, 2013)7on physical activity advice in primary care: suggesting 5 key actions7 for the NHS workforce to overcome these barriers. So the barriers become implementing all these policies, into daily, clinical practice. But to do that, safely and effectively, our workforce needs to be trained to provide these “teachable moments”. 

The NHS workforce needs to know the evidence for the prevention and treatment of disease, with physical activity. And t­­­­hey need to be confident, competent and capable of engaging patients within that brief intervention. And here lies the biggest barrier….

The knowledge that exercise works is critical. Doctors, nurses and AHPs that are trained in physical activity advice, can “move mountains” when it comes to ensuring best patient care- for example, an oncology physiotherapist would have no problem in supporting patients through chemotherapy side effects,using exercise training as a treatment. But what if a dietitian, pharmacist,occupational therapist, or other allied health professional could also support,intervene and sustain that advice, within that patient’s personalised health plan? How much more powerful would our workforce be if they all were trained to provide basic physical activity advice, every contact? How much more consistent could that vital intervention be, in supporting patients with physical activity,as a medicine, to life long health?

So the role of doctors, nurses and AHP’s in physical activity advice needs to be implemented at scale, supported with training and knowledge transfer. We need an “all [trained] hands on deck” approach to help promote and protect the health of our patients. And we need a workforce “fit” for the future.

And talking of “fit”, I mean fit in two senses:

  1. Able to provide “fit for purpose”personalised care with physical activity advice
  2. Able to provide an NHS workforce that is as physically and mentally fit, and healthy, as we can be, to enable us to provide lifestyle advice that is effective and adhered to.

With this in mind, the @WeAHPs #AHPsActive, is a great initiative to encourage the NHS workforce to become active, and maintain their own health, through regular exercise.

It works. It’s fun. And a bit of @WeDocs @WeNurses interdisciplinary competition would certainly drive the health of the NHS workforce forwards?!

But most of all, I passionately believe it helps us, as AHPs, to provide the best possible “health”care……..for our patients of tomorrow. 

1  World Health Organisation. Global action plan for the prevention and control of NCDs 2013 2020. http://apps.who.int/iris/bitstream/10665/94384/1/9789241506236_eng.pdf?ua=1 

3 Network of Public Health Observatories. Health Impact of Physical Inactivity http://www.apho.org.uk/resource/view.aspx?RID=123459 Public Health England, 2013.  

4 Exercise for life: Physical activity in health and disease Recommendations of the Sport and Exercise Medicine Committee Working Party of the Royal College of Physicians. Royal College of Physicians 2012. http://www.apho.org.uk/resource/view.aspx?RID=123459

6  Primary care providers' perceptions of physical activity counselling in a clinical setting: a systematic review. Emily T Hébert, Margaret O Caughy, Kerem Shuval.Br J Sports Med 2012;46:9 625-631 http://bjsm.bmj.com/content/46/9/625.abstract?etoc

7 Physical activity: brief advice for adults in primary care. National Institute of Healthand Care Excellence [PH44]. 2013. https://www.nice.org.uk/guidance/ph44

8 All-Party Commission. (2014)  ‘Tackling Physical Inactivity; A Co-ordinatedApproach.’  Available Onlinehttp://parliamentarycommissiononphysicalactivity.files.wordpress.com/2014/04/apcopa-final.pdf

Blog moderated by Ann Gates, CEO Exercise Works!