“Exercise is Medicine”<br />Sponsored by: <br />
Coming up?<br />Dr. John Searle OBE         Prof. Alfonso Jimenez         Ben Jones<br />Sponsored by: <br />
Panel Discussion<br /><ul><li>Exercise is Medicine - Can it be done?
Case studies</li></ul>What lessons do we take back to our business?<br />Sponsored by: <br />
What can exercise do in chronic disease?<br />John Searle<br />Chief Medical Officer, FIA<br />and Personal Trainer<br />S...
Exercise in disease prevention<br />Coronary artery disease / stroke<br />Obesity and type 2 diabetes<br />Dementia<br />D...
Exercise in disease prevention<br />Healthy & independent older age<br />Sponsored by: <br />
Physical activity and seniors’ health care needs<br />Canadian study 2010:<br />24,281 65+ over  1 year<br />Mean number o...
Physical activity levels for health<br />Evidence based guidance:<br />ACSM 2011<br />BASES 2010<br />Start Active, Stay A...
Exercise in chronic disease<br />Recommendations:<br />Nice Guidelines: non-specific<br />ACSM’s Exercise Management for P...
Which diseases are we talking about?<br />Osteoarthritis (OA)<br />Rheumatoid arthritis (RA)<br />Ankylosing spondylitis<b...
Review article<br />Kujala UM, Evidence of the effects of exercise therapy  in the treatment of chronic disease. <br />Br ...
But it was not always like this!<br />Sponsored by: <br />
REST!<br />Sponsored by: <br />
Rheumatoid arthritis<br />Sponsored by: <br />
Appendicitis<br />Sponsored by: <br />
Objectives<br />To achieve:<br />An active life style & a sustainable increase in physical activity<br />Improvement in sy...
But is it risky?<br />Greater risk not to exercise<br />Graded progression<br />Supervision and monitoring<br />Proper pre...
Does it work?<br />Cardiovascular disease<br />Rheumatoid arthritis<br />Depression<br />Sponsored by: <br />
Coronary artery disease<br />National Exercise Referral Scheme in Wales (2010)<br />Increased levels of physical activity ...
Rheumatoid arthritis<br />Synovial joints symmetrically<br />Pain & stiffness<br />Fatigue<br />Decreased activity –loss o...
What does exercise achieve in RA?<br />Literature summary:<br />Increases aerobic capacity<br />Increase in muscle strengt...
And it really does work!<br />Sponsored by: <br />
But at a price<br />Sponsored by: <br />
Depression: exercise and mental health<br />Mental Health Foundation:<br />less tension, stress and mental fatigue<br />a ...
Cancer: case study<br />82 year old man<br />Previously well, played golf twice a week<br />December 2010 cancer in the mo...
Cancer: case study<br />Exercise programme at home, June 2011<br />Gradual increase in daily walking<br />Resistance bands...
So what?<br />Exercise plays a vital in role as part of the management of chronic disease<br />But how do you do it?<br />...
The Importance of Measurement in Exercise ReferralBen Jones, Blue skies Fitness<br />Sponsored by: <br />
Overview<br />The business of exercise referral<br />VARTEC – a reminder<br />Deciding what to measure<br />Sponsored by: ...
Not so NICE<br />NICE recommendation 2006:<br />…insufficient evidence to recommend the use of exercise referral schemes o...
The business of exercise referral<br />Public money<br /> typically PCT/LA funded<br />Establishing what represents ROI<br...
VARTEC<br />Validity<br />Accuracy<br />Reliability<br />Time efficient<br />Equipment considerations<br />Cost comparison...
Validity<br />Does the measurement pass the Ronseal test?<br />Who’s responsibility is it to measure the effectiveness of ...
Accuracy/Reliability<br />Determined by a number of factors that need to be controlled adequately in an exercise referral ...
Time/Equipment/Cost<br />All come down to the same issue<br />Tests must be efficient and cost-effective to deliver withou...
What to measure<br />Decision starts with the Validity question – why are we measuring?<br />Requires us to first answer t...
What to measure for the patient<br />Patient wants to know…<br />Is exercise worth the time & effort?!<br />How can we inf...
What to measure - fitness professional<br />Is the exercise programme effective?<br />How can we determine yes/no?<br />Ho...
What to measure for the Doctor<br />Has the patient’s chronic condition improved or shown slowed progress?<br />Have signs...
What to measure for the Doctor<br />How can we determine yes/no?<br />Improved clinical markers<br />Improved signs or sym...
What to measure for commissioners<br />The easier it is to demonstrate ROI the better…<br />Challenge – we don’t have dire...
What to measure for commissioners<br />Attendance/adherence<br />Anthropological predictors of chronic conditions<br />Psy...
What to measure - future development<br />As much as possible, in a standardised format that can be compared in a meaningf...
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Exercise is Medicine

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"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

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

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