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Exercise is Medicine

Exercise is Medicine



"Exercise is Medicine" seminar presented by Dr John Searle OBE, Prof Alfonso Jimenez and Ben Jones at Leisure Industry Week 2011

"Exercise is Medicine" seminar presented by Dr John Searle OBE, Prof Alfonso Jimenez and Ben Jones at Leisure Industry Week 2011



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    Exercise is Medicine Exercise is Medicine Presentation Transcript

    • “Exercise is Medicine”
      Sponsored by:
    • Coming up?
      Dr. John Searle OBE Prof. Alfonso Jimenez Ben Jones
      Sponsored by:
    • Panel Discussion
      • Exercise is Medicine - Can it be done?
      • Case studies
      What lessons do we take back to our business?
      Sponsored by:
    • What can exercise do in chronic disease?
      John Searle
      Chief Medical Officer, FIA
      and Personal Trainer
      Sponsored by:
    • Exercise in disease prevention
      Coronary artery disease / stroke
      Obesity and type 2 diabetes
      Some cancers
      Sponsored by:
    • Exercise in disease prevention
      Healthy & independent older age
      Sponsored by:
    • Physical activity and seniors’ health care needs
      Canadian study 2010:
      24,281 65+ over 1 year
      Mean number of health visits:
      Active = 8 Inactive = 11
      Active have shorter hospital stays and faster illness recovery times
      Sponsored by:
    • Physical activity levels for health
      Evidence based guidance:
      ACSM 2011
      BASES 2010
      Start Active, Stay Active 2011
      Sponsored by:
    • Exercise in chronic disease
      Nice Guidelines: non-specific
      ACSM’s Exercise Management for Persons with Chronic Disease (2009)
      Swedish National Institute of Health, Physical Activity in the Prevention and Treatment of Disease (2010)
      Sponsored by:
    • Which diseases are we talking about?
      Osteoarthritis (OA)
      Rheumatoid arthritis (RA)
      Ankylosing spondylitis
      Coronary artery disease
      Obesity & type 2 DM
      Parkinson’s disease
      Multiple sclerosis
      Breast and bowel cancer
      Sponsored by:
    • Review article
      Kujala UM, Evidence of the effects of exercise therapy in the treatment of chronic disease.
      Br J Sports Med 2009; 43: 550-555.
      Sponsored by:
    • But it was not always like this!
      Sponsored by:
    • REST!
      Sponsored by:
    • Rheumatoid arthritis
      Sponsored by:
    • Appendicitis
      Sponsored by:
    • Objectives
      To achieve:
      An active life style & a sustainable increase in physical activity
      Improvement in symptoms
      Reduction in the rate of disease progression
      Sponsored by:
    • But is it risky?
      Greater risk not to exercise
      Graded progression
      Supervision and monitoring
      Proper precautions
      Sponsored by:
    • Does it work?
      Cardiovascular disease
      Rheumatoid arthritis
      Sponsored by:
    • Coronary artery disease
      National Exercise Referral Scheme in Wales (2010)
      Increased levels of physical activity at 12 months
      Positive effects on depression and anxiety
      Cost effective
      Sponsored by:
    • Rheumatoid arthritis
      Synovial joints symmetrically
      Pain & stiffness
      Decreased activity –loss of muscle
      Sponsored by:
    • What does exercise achieve in RA?
      Literature summary:
      Increases aerobic capacity
      Increase in muscle strength and lean body mass
      Increase in exercise endurance
      Weight control
      Improved quality of life
      Sponsored by:
    • And it really does work!
      Sponsored by:
    • But at a price
      Sponsored by:
    • Depression: exercise and mental health
      Mental Health Foundation:
      less tension, stress and mental fatigue
      a natural energy boost
      improved sleep
      a sense of achievement
      focus in life and motivation
      less anger or frustration
      a healthy appetite
      better social life
      having fun.
      Sponsored by:
    • Cancer: case study
      82 year old man
      Previously well, played golf twice a week
      December 2010 cancer in the mouth
      6 months aggressive chemotherapy
      Serious weight loss, lethargy, loss of appetite
      Sponsored by:
    • Cancer: case study
      Exercise programme at home, June 2011
      Gradual increase in daily walking
      Resistance bands – progression
      Stretching and motor skills
      Healthy eating
      Lass week: 18 holes of golf
      Sponsored by:
    • So what?
      Exercise plays a vital in role as part of the management of chronic disease
      But how do you do it?
      Sponsored by:
    • The Importance of Measurement in Exercise ReferralBen Jones, Blue skies Fitness
      Sponsored by:
    • Overview
      The business of exercise referral
      VARTEC – a reminder
      Deciding what to measure
      Sponsored by:
    • Not so NICE
      NICE recommendation 2006:
      …insufficient evidence to recommend the use of exercise referral schemes other than as part of research studies where effectiveness can be evaluated…
      Sponsored by:
    • The business of exercise referral
      Public money
      typically PCT/LA funded
      Establishing what represents ROI
      Desired outcomes
      Key Performance Indicators
      The need to measure & monitor
      Sponsored by:
    • VARTEC
      Time efficient
      Equipment considerations
      Cost comparison
      Sponsored by:
    • Validity
      Does the measurement pass the Ronseal test?
      Who’s responsibility is it to measure the effectiveness of an ER scheme?
      Financial impact
      Clinical effectiveness
      Anthropological risk factors
      Lifestyle risk factors
      Sponsored by:
    • Accuracy/Reliability
      Determined by a number of factors that need to be controlled adequately in an exercise referral scheme
      Equipment quality
      Equipment consistency
      Equipment maintenance
      Suitability of environment
      Standardised testing protocol used
      Consistency of person testing
      Record keeping & confidentiality
      Sponsored by:
    • Time/Equipment/Cost
      All come down to the same issue
      Tests must be efficient and cost-effective to deliver without sacrificing validity or accuracy of measurements
      Does this answer the ‘who’ question?
      Clinical tests must be conducted by GP/Specialist
      Anthropological tests/questionnaires can be administered by appropriately trained fitness professionals
      Sponsored by:
    • What to measure
      Decision starts with the Validity question – why are we measuring?
      Requires us to first answer the question – Who are we measuring for?
      Fitness Professional
      Greater medical/scientific community? The future? All of us?
      Sponsored by:
    • What to measure for the patient
      Patient wants to know…
      Is exercise worth the time & effort?!
      How can we influence them to conclude ‘yes’
      Demonstrate reduced pain/signs/symptoms?
      Demonstrate reduction in disease markers? – clinical
      Demonstrate improvement in general health? – both
      Demonstrate personal achievement/improved functional fitness
      Sponsored by:
    • What to measure - fitness professional
      Is the exercise programme effective?
      How can we determine yes/no?
      How well have they adhered to it?
      Has the patient progressed toward their individual goals?
      Does the patient have a measurable improvement in function?
      Does the patient have a measurable improvement in health?
      Is the programme sustainable for the patient?
      Do they have a robust action plan to continue to be active?
      Sponsored by:
    • What to measure for the Doctor
      Has the patient’s chronic condition improved or shown slowed progress?
      Have signs/symptoms or risk factors of other conditions reduced?
      Are patients more active than baseline at 6, 12, 24+ months?
      Sponsored by:
    • What to measure for the Doctor
      How can we determine yes/no?
      Improved clinical markers
      Improved signs or symptoms of comorbidities
      Improved predictors of risk for comorbidities
      Increase in long term moderate-vigorous PA behaviour
      Sponsored by:
    • What to measure for commissioners
      The easier it is to demonstrate ROI the better…
      Challenge – we don’t have direct access to the data that shows this:
      Decrease in frequency of visits to GP and other NHS services
      Reduced dosages of medications
      Reduced need for surgical interventions
      Co-morbid conditions prevented
      Sponsored by:
    • What to measure for commissioners
      Anthropological predictors of chronic conditions
      Psychological/QOL questionnaires
      Long-term follow-up of patient’s activity levels (questionnaires)
      Sponsored by:
    • What to measure - future development
      As much as possible, in a standardised format that can be compared in a meaningful way across schemes to evaluate effectiveness
      To allow controlled adaptation and comparison of scheme variables and development of increasingly effective & targeted exercise referral services
      Sponsored by:
    • Final thought
      We may believe that exercise referral schemes are beneficial but there is a lack of evidence to support this
      Unless we begin to evidence these benefits financial pressures will continue to force scheme closures
      Sponsored by: