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A paradigm shift for exercise medicine BASEM 2014 Copyright @exerciseworks


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A call to action to all health professionals to prescribe exercise to every patient, every consult!

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A paradigm shift for exercise medicine BASEM 2014 Copyright @exerciseworks

  1. 1. a paradigm shift in physical activity interventions British Association of Sports and Exercise Medicine May 2014 Ann Gates Founder, Exercise Works!
  2. 2. inactivity is the 4th biggest global killer pre-science normal science model drift model crisis model revolution paradigm shift The Kuhn Cycle
  3. 3. preventable deaths why a paradigm shift? 37,000 patient deaths/year from inactivity “names and faces in every clinic waiting room”
  4. 4.
  5. 5. …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.
  6. 6. • 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!
  7. 7. “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
  8. 8. “no exercuses!”
  9. 9. shift the paradigm… work with what you have…..
  10. 10. • 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”
  11. 11. change the paradigm of the consult… our services and care pathways provide: safe and effective, exercise support, every consult “ “ All Parliamentary Commission on Physical Activity 2014: “teachable moments” make every contact count!
  12. 12. 672,973 brief physical activity opportunities every NHS day every patient
  13. 13. = A LOT of physical activity advice, every consult! if…… every TRAINED health professional x over 1 million NHS patients/36 hours
  14. 14. 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
  15. 15. helping every patient, feel like an Olympian during your consultation…! Fun, exercise prescription and…
  16. 16. 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
  17. 17. how? knowledge works! • training • practice • expertise and capabilities Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study BMJ 2013;347:f5577
  18. 18. how? know the clinical red flags 8 ABSOLUTE contra-indications patient considerations clinical precautions disease specific issues
  19. 19. “teachable moments” cradle….. FACT: children under 17, in the UK : 95% of those diagnosed with type 2 diabetes were overweight and 83% obese
  20. 20. exercise referral program improved physical activity inactive individuals decreased from 75% to 53% reduced costs for inactivity by 22% …to grave
  21. 21. 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!
  22. 22. • gain confidence • evidence base • what works for YOUR patients? • use prescription tools • identify opportunities for patients how? use new clinical tools… NICE guidance 2013 
  23. 23. . how? use social media to reach prospective patients
  24. 24. what paradigms really mean for patient care… after results!
  25. 25. every patient, every consult, disease specific exercise advice, and follow up! iceberg drift turns into paradigm shift……
  26. 26. • 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! 2013, 2014.
  27. 27. 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
  28. 28. resources • FYSS Physical Activity in Disease Prevention and Disease Treatment • • Ann Gates ISBN: 1121850928 Copyright year: 2013, Patient Exercise Sheets, 1st Edition • • • • • • • •