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Physical Activity
and Primary Care
Overlaps and
Opportunities
Sponsored by:
Contents
Foreword: Dr Ewan Hamnett ..........................................................................................
This report marks a seminal time in the health landscape of the UK, and a significant
opportunity for leisure and activity...
3 4
The Primary Care landscape:
what role does Physical Activity have to play?
This report, ‘Physical Activity and Primary...
3 4
NHS England
NHS England is an independent body, at arm’s length to the government. Its main role is to improve health ...
Commissioning landscape - what’s new?
The introduction of a majority Conservative Government after the General Election 20...
3 4
The future of Public Health
In the month following the May 2015 General Election, the Chancellor announced that the 20...
3 4
The leisure centre as the community hub:
how operators can look to plant roots across communities
The idea of the leis...
3 413 14
The wellbeing workforce:
the role of leisure professionals in primary care
As part of any move towards engaging i...
Kenny Butler, Health and Wellbeing Manager
ukactive - Let’s Get Moving programme
The Let’s Get Moving (LGM) programme, pow...
Dr Ewan Hamnett
Physical Activity Champion for Birmingham
Dr Ewan Hamnett is a former GP and currently works on the Health...
3 419 20
Premier Training International
Public Health Intervention with Hertfordshire YMCA
This healthy partnership involv...
Rich Millard
Partnership Director, Places for People Leisure
Places for People Leisure recognises that its impact upon the...
3 423 24
Places for People Leisure
Joint Services - Maltby Leisure Centre, Rotherham
Places for People Leisure recognises ...
Erica Tillinghast
Global Education Manager, Precor
Developing an exercise referral scheme and engaging with GP’s and other...
3 427 28
Precor
Hengrove Park Leisure Centre, Bristol
Moving Forward
“I’ve come to realise that keeping moving and being m...
3 429 30
Precor
Leisure at Cheltenham
Leisure Centre, Cheltenham
Taking the Treadmill One Step at a Time
For 32-year-old W...
331
Case Study
I believe fitness is key to living the life I desire
“I took exercise for granted before but it has played ...
ukactive, 4th
& 5th
Floor, 26 Bedford Row, London WC1R 4HE
T: 020 7400 8600 | E: info@ukactive.org.uk | www.ukactive.com
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Physical activity and Primary Care Overlaps and Opportunities Report

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The Primary Care landscape:
what role does Physical Activity have to play?

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Physical activity and Primary Care Overlaps and Opportunities Report

  1. 1. Physical Activity and Primary Care Overlaps and Opportunities Sponsored by:
  2. 2. Contents Foreword: Dr Ewan Hamnett .............................................................................................................................................................. 1 Foreword: Justin Smith .......................................................................................................................................................................... 2 Introduction ................................................................................................................................................................................................... 3 Glossary ............................................................................................................................................................................................................ 5 Commissioning landscape .................................................................................................................................................................. 7 Future of public health and new models of care ................................................................................................................... 9 The community hub ................................................................................................................................................................................ 11 Wellbeing workforce ............................................................................................................................................................................. 13 Guidance and case studies ............................................................................................................................................................. 15
  3. 3. This report marks a seminal time in the health landscape of the UK, and a significant opportunity for leisure and activity providers to play a role in the provision of physical activity interventions to positively impact the health of millions. As a former GP, I have witnessed first-hand that the nation is currently facing a tipping point. The health inequalities that present themselves are not going to improve without innovative thinking and solutions. We have one of the most obese and inactive populations in the world, and the NHS is creaking trying to deal with this. The impact of getting people more active should not be underestimated. To ensure that the health service remains free at the point of use, we need to take health out of the NHS, to where it belongs - in the community. We need to enable the population to live lifestyles that are sustainable. Our reliance on the NHS and the current culture of treating, rather than preventing, illness must change if we are to manage the complex and varied demands that our health service faces. This report offers valuable guidance for leisure and activity providers on how to engage with health and care providers, to develop ways of working that will reduce the worrying health inequalities that are developing in the UK, and to combat the sedentary lifestyles that could see our vital health service reduced to something that can only serve those who are able to pay. It is often the poorest in society that fail to meet the minimum recommended levels of physical activity, which is seriously impacting their health in both the short and long term. Leisure and activity providers must be conscious of the large section of society that are disengaged from activity, who would likely see the most benefit to both their physical and mental health from doing more exercise - in doing so correctly, operators can un-tap countless opportunities for development and expansion, both through or outside of traditional public funding routes. Across the spectrum of stakeholders with a responsibility for this issue, be it the government, local authorities, leisure operators or primary care providers, what must be understood is that activity is a medical necessity. It should no longer be seen a lifestyle choice primarily at the fingertips of middle or upper-income consumers. Leisure operators need to work with, and not against, local authorities, primary care providers and public health teams to provide programmes to fill these activity-gaps. In my role as Physical Activity Champion for Birmingham I see endless overlooked opportunities for collaboration, which is why I am contributing to this report, and am committed to working with ukactive and its partners to achieve our joint goal of getting more people, more active, more often. Dr Ewan Hamnett Physical Activity Champion for Birmingham and elected member of ukactive’s Board for wider Physical Activity promotion Foreword: Dr Ewan Hamnett 1 As a leading equipment provider, Precor works with a diverse range of leisure and activity providers, from local authorities and public sector operators, to private and boutique gyms. We understand that the private sector does not necessarily share the same policy goals as Government, so aligning activity and approach between public and private sector is not always easy. However, we believe the potential in this area is enormous. There is a huge call for leisure and activity providers to become more involved in the health setting, and with that comes real opportunities to drive commercial value and hit a number of Primary Business Objectives (PBOs). So what are the benefits of engaging with primary care? There is mutual benefit to be gained on both sides; Primary Care can benefit from the expertise of an operator’s staff as well as facilities to help more people get active, whilst operators and providers can benefit from new audiences and diversification. One of the key issues facing leisure and activity providers is diversification in a difficult market. We understand attracting new users and increasing footfall can be challenging, and primary care can potentially open doors. Investing in a programme with primary care professionals will likely bring about higher activity levels in a section of the population that are currently inactive and therefore not likely to be gym members. Gyms, although popular with many, are often not appealing to the least active, with some reluctant to visit as they perceive it to be an intimidating environment, not suitable to their needs and perhaps beyond their budget. However, once users gain confidence to get active and have seen the myriad benefits that exercise can have - through physical activity interventions such as walking groups or motivational interviewing - they are far more likely to become gym users, or members, themselves, and view it as a worthwhile investment. This will lead to positive outcomes for both an operator’s attraction and retention rates. Another area of value to be had from engaging with local health outcomes is the upskilling of staff in areas such as motivational interviewing and condition-specific knowledge. Leisure and activity providers could benefit from a more highly skilled workforce, greater understanding and expertise on wider health issues and subsequent improved staff retention. There is also the small matter of the health of the nation; we are officially the laziest nation in Europe! Precor supports this report in order to support our customers, partners, and all relevant stakeholders in getting more people, more active, more often. Justin Smith Head of UK, Precor Foreword: Justin Smith 2
  4. 4. 3 4 The Primary Care landscape: what role does Physical Activity have to play? This report, ‘Physical Activity and Primary Care: Overlaps and Opportunities’ aims to provide leisure and activity providers with a succinct overview of the primary care landscape and the opportunities available to engage in this field. Building upon last year’s ‘5 Step Guide to Public Health Commissioning’, this report will provide practical guidance for leisure and activity providers as to how they can work with GP surgeries, local authorities, public health teams and Clinical Commissioning Groups (CCG’s) among others, in the provision of activity programmes - both to increase commercial value and play a more prominent role in improving the health of communities. Primary care provides the first point of contact in the health care system, with the main source of primary health care being the general practice. Around 90 per cent of people’s contact with the NHS takes place in the primary care setting1 . Primary care is operated by NHS England, and Clinical Commissioning Groups, which sit under the NHS, are the deliverers of primary care services. Introduction 3 Primary health care involves providing treatment for common illnesses, the management of long term illnesses such as diabetes and heart disease and the prevention of future ill-health through advice, immunisation and screening programmes. Primary care is well placed to promote physical activity for several reasons: a large proportion of the general population consult their general practitioner every year; health promotion is an integral part of the primary care consultation; patients with chronic disease, such as diabetes, or risk factors, such as hypertension, are reviewed regularly; and simple screening questionnaires have been developed to record physical activity in primary care consultations3 . Physical activity can be promoted in primary care in lots of different ways, including brief interventions, delivery of advice, provision of written materials, community-based walking and cycling programmes as well as referral to an exercise programme. As we will discuss throughout this report, exercise on referral is a major player in the commissioning of physical activity interventions, however it is far from the only option available. In order for operators to broaden their reach and access new markets we need to look beyond the traditional model, and perhaps take a more holistic, wellbeing approach to leisure services. Offering what the consumer wants and providing personalised services is fundamental to getting more people active. Traditionally the significant time and costs associated with local authority procurements may have acted as a deterrent to some providers. However this report will endeavour to simplify the process, and provide practical guidance on overcoming such challenges and providing effective services either with or without government funding. Working with primary care is at the heart of self-interest for operators, and represents a multitude of opportunities irrespective of funding accessibility and traditional routes. It is in a provider’s interest to invest in this area and makes business sense, so the question we should now be asking is; what are you waiting for? In order to provide meaningful advice for leisure and activity providers, this report gathers unique insight from a range of stakeholders, each with a different area of expertise in the physical activity and health fields, including; Precor, Places for People Leisure, Premier Training International, ukactive’s Let’s Get Moving team, and former-GP Dr Ewan Hamnett. The report will also highlight good practice by way of case studies from the above organisations - how they did it and how you can too. 4 Parliament Department of Health Community health services Secondary care NHS EnglandPublic Health England Patients and public receive services Clinical commissioning groups Public Health departments based in local authorities GPs and other primary care contractors 3 ‘Promoting physical activity in primary care’, Nefyn H Williams, 7th November 2011, BMJ 2011;343:d6615 http://www.bmj.com/content/343/bmj.d6615 4 ‘Effectiveness of physical activity promotion based in primary care: systematic review and meta-analysis of randomised controlled trials’, G Orrow et al, 26th March 2012, BMJ 2012;344:e1389 http://www.bmj.com/content/344/bmj.e1389 5 ‘Four commonly used methods to increase physical activity’, NICE guidelines [PH2], NICE, March 2006, https://www.nice.org.uk/guidance/ph2 1 Figure 1 - Primary Care, Health & Social Care Information Centre, http://www.hscic.gov.uk/primary-care 2 ‘The new structure of the NHS in England’, Holly Holder and Ruth Thorlby, Nuffield Trust, 1st April 2013 http://www.nuffieldtrust.org.uk/talks/slideshows/new-structure-nhs-england
  5. 5. 3 4 NHS England NHS England is an independent body, at arm’s length to the government. Its main role is to improve health outcomes for people in England. It: • oversees the operation of clinical commissioning groups (CCGs) • allocates resources to CCGs • commissions primary care and specialist services Clinical Commissioning Groups (CCGs) Clinical commissioning groups replaced primary care trusts (PCTs) on April 1st 2013. CCGs are clinically led statutory NHS bodies responsible for the planning and commissioning of healthcare services for their local area. They are responsible for about 60% of the NHS budget and commission most secondary care services such as: • planned hospital care • rehabilitative care • urgent and emergency care (including out-of-hours) • most community health services • mental health and learning disability services CCGs can commission any service provider that meets NHS standards and costs. These can be NHS hospitals, social enterprises, charities or private sector providers. However, they must be assured of the quality of services they commission, taking into account both National Institute for Health and Care Excellence (NICE) guidelines and the Care Quality Commission’s (CQC) data about service providers. More information on NICE can be found later in this report. Health and Wellbeing Boards Every “upper tier” local authority has established a health and wellbeing board (HWB) to act as a forum for local commissioners across the NHS, social care, public health and other services. The Health and Social Care Act 2012 establishes health and wellbeing boards as a forum where key leaders from the health and care system work together to improve the health and wellbeing of their local population and reduce health inequalities. 5 Public Health England Public Health England (PHE) provides national leadership and expert services to support public health, and also works with local government and the NHS to respond to emergencies. PHE: • co-ordinates a national public health service and delivers some elements of this • builds an evidence base to support local public health services • supports the public to make healthier choices • provides leadership to the public health delivery system • supports the development of the public health workforce 6 Glossary This NHS glossary will provide a brief overview of some of the key bodies referred to throughout the report, and their role in the health system6 . For more information on the key bodies to be aware of and an overview of the commissioning structure please see the ‘5 Step Guide to Public Health Commissioning’ report, available from Precor. 6 ‘Understanding the new NHS’, NHS England, June 2014, http://www.nhs.uk/NHSEngland/thenhs/about/Documents/simple-nhs-guide.pdf
  6. 6. Commissioning landscape - what’s new? The introduction of a majority Conservative Government after the General Election 2015 means that the commissioning landscape remains broadly the same as that introduced during the previous Parliament; Predominantly, commissioning is managed locally, via the 211 Clinical Commissioning Groups (CCGs). CCGs commission all hospital activity and some community services. The majority of public health services, such as obesity and weight management, are also commissioned locally by Public Health England and local authorities. All other services including primary care and specialised services are commissioned nationally by NHS England. However, according to the Faculty of Medical Leadership and Management, these arrangements are set to change from 2015/16, as primary care and some aspects of specialised services will be co-commissioned by both NHS England and CCGs8 . 3 47 8 The below diagram demonstrates, in simple terms, the flow of funding within the Department of Health. (Figures are based on HM Treasury Spending Review 2010). Highlighted on the above diagram is the total funding for primary care from 2013/2014. This is a key area of interest for operators in this context, but there is lots of overlap between funding streams here, as CCG’s work in conjunction with local authorities, and funding could also be drawn from public health or community services, for example. Reforms to the commissioning system that took place with the reformed Health and Social Care Act, enacted in 2013 under the Coalition Government, have given local authorities new responsibilities and ring-fenced funding. As a result, leisure and activity providers have more involvement, responsibility and opportunities to be involved in improving local health outcomes than ever before. NHS England CCGs - 211 Public Health England Local Authorities Commissioning Support Units Strategic Clinical Networks Secondary Care Mental Health Services Community Services Maternity Services Public Health Services Specialised Services Primary Care Armed Forces Care Public Health 7a Health and Justice 13 Billion 12 Billion 50 Million by NHS England 2.3 Billion 0.5 Billion 50 MillionfromCCGs 64 Billion Total NHS Spend in 2013/14 7 Figure 2 - ‘The role of culture and leisure in improving health and wellbeing’, Produced by the Chief Cultural & Leisure Officers Association on behalf of the National Leisure & Culture Forum, March 2014, http://www.cloa.org.uk/images/stories/Print_version_-_The_role_of_culture_and_sport_in_improving_health_and_well-being.pdf 8 ‘Commissioning: What’s the big deal?’ Adlington K, Finn R, Ghafur S, Smith CR, Zarkali A, On behalf of the National Medical Director’s Clinical Fellows 2014-15, Faculty of Medical Leadership and Management, http://www.nhs.uk/NHSEngland/thenhs/about/Documents/Commissioning-FINAL-2015.pdf 9 Figure 3 - Refer to footnote 7 Centrally managed projects & services Arms Length Body funding Public health spending Nationally commissioned services Locally commissioned services Clinical Commissioning Groups £64 Billion NHS England £96 Billion Department of Health £107 Billion HM Treasury How the money flows... (All figures based on HM Treasury Spending Review 2010)
  7. 7. 3 4 The future of Public Health In the month following the May 2015 General Election, the Chancellor announced that the 2015/16 public health grant to local authorities would be reduced by £200 million. This could have a substantial impact on the amount of funding available for community physical activity programmes and interventions from local authorities - which could pose a challenge to independent and private operators looking to engage in this area, as funding may be less accessible, as well as public sector leisure providers who will see their budgets squeezed. Despite these austerity measures, ukactive’s previous work has shown that local authorities across the country nearly doubled the amount of public health grant funding they allocated to tackling physical inactivity between 2013/14 and 2014/15, a shift from around 2% to 4% on average10 . This could demonstrate that, given the increased focus and priority the physical activity agenda has begun to receive from government over recent months and years - local authorities may choose to allocate more money, as a proportion of their budgets, to physical activity interventions as opposed to other areas of public health. Furthermore, as can be seen from the commissioning structure outlined above, funding for primary care itself is not impacted by public health funding, additionally Clinical Commissioning Groups and Health and Wellbeing Boards will become increasingly important in commissioning physical activity solutions to health problems in the future. At the same time, devolution, which will see local authorities making more of their own decisions around the health and social care needs of their residents, has begun in Greater Manchester, with a historic devolution settlement with Government made in November 2014. This model of devolution, representing more than 2.8m people, involves a directly-elected mayor, with powers over transport, housing and planning, among other things, being transferred to the region. Bosses behind the region’s £6bn NHS devolution plans have pledged that NHS and council public health chiefs are to work more closely with residents in a move to slash health inequalities across the region, under a radical bid to put people power at the heart of public health11 . The new Government looks set to continue on this path, with Greater Manchester acting as a blueprint for other major cities. Devolution could thus bring greater opportunities for more co-ordinated and joined up care regionally, through the harmonization of local authorities, the NHS and communities. This is why it is vital for operators to start engaging with relevant stakeholders now, to maximise the future opportunities that will be available to them. The recent Department for Culture, Media and Sport (DCMS) consultation paper on ‘A New Strategy for Sport’ asks for insight into ways the Government can improve joined up working with other bodies, highlighting key areas of shared responsibility12 . Public-private partnerships are a means of fuelling economic growth, and this consultation suggests the Government could be increasingly reliant upon the private sector to provide community-based services, as cuts to local budgets continue to deepen. The private sector delivers an enormous number of sporting opportunities, almost always with no public funding attached or linked, and without the role of the private sector, millions fewer people would be able to participate in sport and physical activity on a regular basis. Similarly, local authorities play a vital role in sporting provision outside of what is funded by central government, particularly through the provision of leisure facilities, gyms and swimming pools in local areas. The Government is currently welcoming views into the role of the private sector in delivering public policy objectives in sport through their consultation13 . 9 New models of care At a time when the NHS is reaching crisis-point, there is increasing requirement for new models of care to be developed in order meet the needs of the demanding population of the future. NHS England recognises that the traditional divide between primary care, community services, and hospitals is increasingly a barrier to the personalised and coordinated health services patients need, and has acknowledged that they will increasingly need to dissolve these traditional boundaries. Long term and lifestyle-related conditions, such as diabetes, are now a central task of the NHS, and caring for these conditions requires a partnership with patients over the long term rather than providing single, unconnected ‘episodes’ of care14 . To take a specific example; the DCMS states that sport and physical activity will be a core part of the government’s campaign to reduce and prevent diabetes, and they have further welcomed views on how physical activity can play a more significant and effective role to combat obesity, diabetes and other physical health conditions. The Government has also recognised the positive impact of physical activity on the many forms of dementia, and pledges to continue to build on the excellent work of initiatives like the ‘Dementia Friends’ campaign, which has gone such a long way towards raising awareness of this condition within communities15 . As a result, as we see a continued rise in lifestyle-related long-term conditions, the role that physical activity has to play in the prevention and treatment of these will only increase, and the demand for leisure and activity providers to deliver more tailored and specialised services will rise. This is especially applicable to the four major Non- Communicable Disease areas, which are as follows; • Cardiovascular disease • Type-2 diabetes • Cancers • Chronic lung disease As well as these four broad areas, dedicated physical activity interventions can also have substantial positive impacts on a large number of other health issues, including; • Dementia • Strokes • Joint pain (such as osteoarthritis) • As well as many mental health issues, including depression. With the significant role it has to play in both preventing and treating so many of the above conditions, physical activity will, out of necessity, become much more embedded in any future longer-term models of care. The rise of long-term lifestyle-related conditions combined with new models of care, funding, devolution, a joined-up approach, and all of the things mentioned above, mean that the future holds an ever-increasing range of opportunities for leisure and activity providers to fill the void left by government in the provision of services to improve the health of communities. 10 ThefutureofPublicHealth&newmodelsofcare 10 ‘Steps to Solving Inactivity’, ukactive, 2014 11 ‘New Greater Manchester devolution deal urges everyone to take charge of their own health’, Dean Kirby, Manchester Evening News, 10th July 2015, http://www.manchestereveningnews.co.uk/news/health/new-greater-manchester-devolution-deal-9625749 12 ‘A New Strategy for Sport: Consultation Paper’, Department for Culture, Media and Sport, August 2015, https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/450712/1619-F_Sports_Strategy_ACCESSIBLE.pdf 13 Refer to footnote 11 14 The NHS Five Year Forward View, NHS England, 23rd October 2014, http://www.england.nhs.uk/ourwork/futurenhs/5yfv-ch3/ 15 Refer to footnote 11
  8. 8. 3 4 The leisure centre as the community hub: how operators can look to plant roots across communities The idea of the leisure centre as the ‘community hub’ focuses on operators planting roots within several areas and remits of the local authority - beyond the gym itself - including in the GP surgery, as well as community centres and parks and so on. To begin with, physical activity venues need to become welcoming for all in order to increase participation, as too many people are currently not even taking the first step towards becoming more physically active16 . One important part of this is to engage with specific target groups in the community, such as pre and post-natal groups, babies and children, older people’s activities, and disadvantaged people. This would see diversification and attraction of new types of members beyond the traditional gym membership base, consisting broadly of those already engaged in exercise. For example, providing walking groups for older people represents an opportunity to engage with a currently widely inactive population, and getting them engaged in an activity they can be comfortable with in the first instance is the initial step towards the adoption of a healthier lifestyle, which could later lead to secondary spend opportunities in the leisure centre. It is crucial that operators work in partnership with local authorities, public and third sector organisations in order to develop wider and more sustainable involvement across several remits of the community. Some local health boards and primary care trusts have developed a more integrated system for the promotion of physical activity, which offer a range of activity opportunities for local populations, such as led-walks, green-exercise, exercise referral schemes and/or specialist condition-specific whole exercise classes17 . Sport England provides some advice on how to develop a community ‘sports hub’ and some of the elements this may include in its ‘Developing Sustainable Sports Facilities’ toolkit. These are very much dependant on size, location and organisation, but should include a wide range of partners and could incorporate some of the following ideas; • A private-sector operated gym could be housed within the same building as public sector led facilities such as a pool, sports hall, pitches etc. • The centre could incorporate other elements such as a dedicated community space, a crèche, library or social services for example, or even commercial rental opportunities18 . 11 Exercise on referral and NICE guidance for physical activity interventions The UK has seen a marked expansion in exercise referral schemes over the past two decades, but there have been some concerns that these might not produce sustained changes in physical activity beyond the typical programme length of 12 weeks. In fact, the UK National Institute for Health and Clinical Excellence (NICE) has advised that exercise referral schemes should not be commissioned in primary care outside of well-designed research studies19 . Despite this dismissal, exercise referral schemes remain popular, especially as they can offer many benefits aside from simply raising activity levels; such as helping people to socialise, providing a means of getting involved with the community and providing affordable access to facilities- factors which are not considered by NICE20 . NICE admit that physical activity programmes offered as part of many exercise referral schemes - and the reasons why people are referred to them - vary considerably. NICE is unable to differentiate between the effectiveness of different types of scheme, which highlights broad limitations to the guidance. In addition, the absence of NICE guidelines on other physical activity interventions - outside of exercise on referral - is because they have not been considered, it does not reflect a judgement on their effectiveness21 . Therefore it appears impossible to wholly reject the effectiveness of exercise on referral. Exercise referral schemes in their many different guises are still a valid option for a lot of commissioners due to widespread continued belief that such programmes have value and can indeed bring about behaviour change in many users when designed effectively. The lack of evidence to back up the efficacy of exercise referral programmes simply demonstrates a vast gap in the market for schemes with a research based-background, as well as the potential for alternative schemes to be developed to improve upon more traditional exercise referral programmes. If an operator can prove the efficacy and effectiveness of its own programmes through a well-designed measurement and tracking system to sit alongside delivery, then such a programme would have enormous potential for wider pick-up. An example of one way that an operator could ensure they are measuring the impact of their programmes would be to track member workouts. For those on any kind of exercise referral programme or similar scheme, this would provide evidence that participants are improving their fitness and health over time, and could also demonstrate retention rates. For example, Precor’s Preva system can record such data and enable it to be exported and sent directly to GP’s. Please also see page 26 for more information on tracking and measurement. Evidence is crucial in the tendering and commissioning of health and community services and it is important not to underestimate the significance of research and evidence in the process of winning contracts and commissioning services. This is something that admittedly may require a more long-term approach and initial investment into a monitoring or tracking system, but it has the potential to bring about tangible long-term reward. 12 The community hub 16 Refer to footnote 11 17 ‘A Toolkit for the Design, Implementation & Evaluation of Exercise Referral Schemes: A guide to training and qualifications’, BHF National Centre for Physical Activity and Health, http://www.bhfactive.org.uk/sites/Exercise-Referral-Toolkit/downloads/s9-exercise-referral-qualifications-and-training-guide.pdf 18 ‘Developing Sustainable Sports Facilities: A toolkit for the development of a Sustainable Community Sports Hub’, Sport England, 2008, http://www.sportengland.org/media/122050/document-15-sustainable-community-sports-hub-toolkit-.pdf 19 ‘Exercise referral schemes to promote physical activity’ NICE guidelines [PH54], NICE, September 2014, https://www.nice.org.uk/guidance/ph54/chapter/what-is-this-guideline-about 20 Refer to footnote 19 21 Refer to footnote 19
  9. 9. 3 413 14 The wellbeing workforce: the role of leisure professionals in primary care As part of any move towards engaging in this area, it is vital to also discuss the roles available for leisure professionals and their remit in a primary care setting. There is lots of scope within the sector to cultivate a ‘wellbeing workforce’, but in order to do so leisure professionals must be trained to deliver effectively in these areas. An assessment of how equipped the existing workforce is to deliver in a primary care setting is required; however there is currently widespread dissatisfaction with workforce standards throughout the physical activity sector. The Government recognises the need to ensure that people working in sport, including staff of gyms and leisure centres, are all aware of and can articulate the health benefits of physical activity. Crucially, they also need to understand the varying needs of different groups in the community22 . This also means it will be increasingly important for the physical activity sector to work with the health sector to break down barriers and improve understanding between leisure professionals and health professionals, who have traditionally spoken different languages. The same applies to Directors of Public Health, GPs and other health professionals, to ensure they too are well versed in the benefits of physical activity and are able to make a persuasive case both to funders and to patients23 . If leisure professionals are well equipped in these areas it could help boost both attraction and secondary spend for providers, as exercise professionals could identify further opportunities to address specific exercise needs more acutely. In terms of the specific qualifications required by exercise professionals for much of the work in this area, most schemes require an instructor to be Level 3 qualified or higher on the Register of Exercise Professionals (REPs). For example, ukactive’s Let’s Get Moving programme only uses qualified instructors who are registered on REPs with the Level 3 exercise referral category of registration. The use of exercise instructors who are not Level 3 qualified and not registered on REPs does not represent national policy24 . For those working on an exercise referral scheme their role would include designing, monitoring, adapting and implementing physical activity programmes for individual clients with a range of medical conditions25 . According to the BHF National Centre for physical activity and health - due to the current shortage of appropriately qualified staff - some schemes may offer referred clients the opportunity to participate in activities that are led by instructors who do not hold a recognised exercise referral qualification. For example, many schemes offer yoga, tai chi, dance, swimming, walking, which are delivered by instructors who may or may not be qualified in exercise referral. However, given that clients’ physical activity needs and preferences are diverse, such activities are valuable options on the menu26 . Furthermore, due to the increasing prevalence of long-term medical conditions it is likely that exercise referral professionals are now dealing with a wider range of conditions than when exercise referral schemes first began. Given this reality, exercise professionals need to be able to access more in-depth Level 3 training/CPD opportunities for the wider range of conditions which they encounter27 . It would be mutually beneficial for exercise referral coordinators to work in partnership with training providers to gather data about the gaps that exist in the skills, knowledge and attitudes of qualified exercise referral instructors to best meet the needs of their local scheme. This could be done relatively simply by operators through carrying out an internal audit of staff, alternatively a third party such as ukactive could help facilitate this. This would enable training providers to offer appropriate learning opportunities to fill the gaps identified and ensure that there is sufficient continuing professional development training available28 . With improved training and standards, there is increasing scope for exercise professionals to work on structured exercise programmes designed for managing a specific health condition, such as osteoarthritis or a respiratory disorder, or for rehabilitation following recovery from a specific illness, for example a heart attack or stroke. Wellbeing workforce 22 Refer to footnote 11 23 Refer to footnote 11 24 Refer to footnote 20 25, 26, 27 & 28 Refer to footnote 17
  10. 10. Kenny Butler, Health and Wellbeing Manager ukactive - Let’s Get Moving programme The Let’s Get Moving (LGM) programme, powered by ukactive, is a model that demonstrates how to take an already tried and tested physical activity programme and scale it up using operator know-how and a primary care audience. Let’s Get Moving is unique in a few ways; it is scalable, does not require GPs time (it takes their practice administration only minutes to extract patient data, identifying those who would benefit from one-to-one sessions with an exercise professional), and uses motivational interviewing (MI) as a key component of the intervention by specially trained exercise professionals. It is designed to guide completely inactive adults towards becoming more active by creating a pathway for sustainable involvement in physical activity - sustainable because it is a life change, not an exercise prescription - it has longevity. The benefits are immense and it acts as a primary, secondary and tertiary prevention tool helping with numerous health conditions such as heart disease, hypertension and type-2 diabetes. The Let’s Get Moving team see first-hand the genuine potential for such programmes to answer the problems of strained NHS budgets and GP time, as well as declining activity rates, which are affecting and will continue to affect physical activity operators. While Let’s get Moving receives funding from the government, Nesta and Sport England, the model that it uses is certainly one that could be used and developed by leisure and activity providers with an interest in working more closely with Clinical Commissioning Groups (CCGs), to make a direct impact on the health of communities. The exercise professionals and operators involved will have the opportunity to widen their respective client base whilst simultaneously having a positive impact on the communities surrounding them. Investing in a programme with primary care professionals will likely bring about higher activity levels in a section of the population that have previously been highly inactive and therefore not likely to be gym users or members. Gyms are often not appealing to the least active, with some people reluctant to use them as they don’t feel them to be suitable to their needs, and are perhaps beyond their budget. Recent data from the LGM programme shows an increase of 75% in vigorous physical activity levels in participants after 12 weeks. This should be meaningful for operators looking to attract new members, as once users are more confident to get active and have seen the myriad of benefits that it can have, they are far more likely to become users of leisure facilities and see them as a worthwhile investment. ukactive strongly believes that if there were more exercise schemes to refer to, GPs would use them. However, many operators lack the knowledge of how to go about navigating the complex world of health commissioning, and there needs to be clearer opportunities to engage with primary care practitioners so that arrangements that are beneficial for both sides can arise. Every region and CCG is different, and the challenge is to correctly gauge its culture and establish good relationships; those who do will reap great benefits in the long run. The first step for operators is to be in the same room as primary care providers and commissioners to allow the conversations to begin. Our experience with LGM has shown success to be the engagement of the triad of Clinical Commissioning Groups, Local Authorities and individual GP practices. There are a number of entry-routes for operators here, which are often highly dependent on region and local authority, but can include attending events such as GP shutdowns - when a surgery closes for a short period of time in order to invite local stakeholders in to meet and discuss local health needs - these take place in a number of GP surgeries, and would require research into practices in your area. It also is useful to have an awareness of opportunities in your local area to be part of open health consultations and attend consortiums; NHS England runs an online ‘Consultation Hub’ where open consultations on certain issues are posted. ukactive may be able to advise and assist with tender opportunities, and we also recommend working in partnership with other bodies when submitting tender applications, as legacy is key. The ability to utilise existing assets in the community, and to ensure there is activity provision to meet demand. Increasing direct referrals to local programmes will assist with sustained life-long participation and the legacy for a sustained model for any local authority and CCG. Any operators who are keen to be pioneers in this area should think about where and with whom they might wish to start the process of developing a scheme that will tackle physical inactivity in a way that operators have not done in the past. How operators, who have the personnel and the facilities in place, can work through primary care pathways represents a massive opportunity, and one that CCGs across the country must take up. The real benefits such partnerships could have for both sectors mean that it is vital that operators and CCGs open their doors for such conversations to take place. Guidance and top tips for operators 3 415 16 Parliament Primary Care Community Venue Community Venue A new joined-up physical activity approach...
  11. 11. Dr Ewan Hamnett Physical Activity Champion for Birmingham Dr Ewan Hamnett is a former GP and currently works on the Health and Wellbeing Board for Birmingham in a ‘Physical Activity Champion’ role. He will offer his personal insight, opinions and advice as to the role the physical activity sector has to play in the health arena. “The key is to present lifestyle and activity choices that are preferable to the current car and house-based choices. This will require a bigger menu than your standard local leisure centre offering. We need to look at wellbeing in the broader sense to include whatever makes people feel better about themselves. ’Activity’ should be a diverse menu to include music, dance, volunteering, conservation etc. We should encourage leisure operators to be imaginative in the range of services they offer, as this report endeavours to do, and start to think about pairing with 3rd sector organisations, whilst being cognicent of local services provided by councils and local public health priorities. Leisure operators need to engage more directly with NHS providers. For example, directly approaching Clinical Commissioning Groups (CCGs) with business cases. Diabetes and prediabetes represent a wonderful opportunity to develop links with the NHS. The combined cohort is probably in excess of 12 million patients. Moving this group into an active lifestyle combined with evidenced based dietary information on carbohydrate reduction has the potential for very significant health savings. Different leisure operators might need to link together to offer diverse programmes for a particular locality and also need to shed any kind of ‘Is s/he fit enough to exercise at our gym?’ mentality. “Activity is a medical necessity not a lifestyle choice.” There is also potential to engage the hospital sector. Coronary and pulmonary rehabilitation programmes spring to mind. Most of these are currently hospital based with little signposting to sustainable lifelong activity. Finally, the leisure industry must move towards a much higher level of knowledge for its workers at the coal face. The science behind the 150 minutes of moderate activity is poorly understood by not only the public but also some of the medical profession. Furthermore, the confusion that exists in the space between activity and obesity needs to be cleared. It should be well known that it is much better to be fat and active than thin and sedentary. Activity is a medical necessity not a lifestyle choice.” 3 417 18 Julian Berriman Research&DevelopmentDirector,PremierTrainingInternational Premier Training International is a leading health and fitness industry training provider, with an interest in the development a health and well-being workforce both within and outside the sector. This guidance will thus outline the key skills and understandings required to promote active healthy lifestyles, and explore who these skills may be applicable to. Some of the key areas for training and development in for the health and wellbeing workforce might include: • Understanding the public health environment - including the role of local authorities, CCGs, Health and Wellbeing Boards • Working with communities to promote and support active, healthy lifestyles - the transfer of responsibility from central to local and placing communities at the heart of public health should be reflected in the role of the health and well-being workforce, who should be trained to understand the health needs of their particular community. • Behaviour change - Many of the barriers to engaging in a more active and healthy lifestyle are psychological or behavioural in nature. Through techniques such as motivational interviewing and other behaviour change skills, individuals or groups can be encouraged to make healthier lifestyle choices. • Supportive signposting - if an individual’s needs fall outside of one’s own role boundaries it is essential to be able to signpost them towards other professionals and services who can offer support to meet their needs. • Measurement and the evidence base - the workforce should understand the importance of evidencing impact in terms of health outcomes, in order to demonstrate the effectiveness of programmes. • Data protection and information governance - if engaging with the medical community there is a significant increase in the responsibilities associated with moving information. Premier Training International also offers a variety of advanced skills course, in order for exercise professionals to specialise in condition-specific or targeted population areas, including some of the following; • Diploma in Exercise Referral • Award in Designing Pre and Post-Natal Exercise Programmes • Postural Assessment and Corrective Exercise Instructor Training • DNAFit Fitness Genetics Training • Fit For Sport ‘Fitness for Children’ • Certificate in Promoting Community Health and Well-being Premier Training International views such skills as fundamental for the health and well-being workforce of the future- whether working in a health and fitness facility, within the community or out of GP surgeries. These skills would not only be applicable to the existing health and fitness workforce but can also be invaluable to any individuals with a role to play in encouraging active healthy lifestyles. The Herts YMCA case study featured later in this report is an excellent example of this as the majority of participants were drawn from outside the health and fitness industry. Operators must consider the need to train their own workforce in the skills listed above, but also the need to set up community networks and work with health and well-being champions within communities. In this way, centres will truly become community hubs; we will broaden the reach of health and well-being and build the foundations of active healthy lifestyles that will support a healthy nation and ultimately the health and fitness industry as a whole.
  12. 12. 3 419 20 Premier Training International Public Health Intervention with Hertfordshire YMCA This healthy partnership involves the joint working of a third sector organisation (YMCA) with a commercial sector, training company (Premier Training) and a public sector body (Public Health Hertfordshire). The ultimate rationale for the partnership was to deliver advice on health improvement and behaviour change to the most vulnerable and in need groups. Aims and objectives of the partnership The objective of the partnerships was to develop and deliver a bespoke Certificate in Promoting Community Health and Well-being to targeted community champions, already working with vulnerable groups within our communities, thus creating a network of Community Health Agents. The programme will measure, monitor and report on these interactions post-course to offer interventions to service users in the community on five key areas: Smoking, alcohol, diet & exercise, behavioural/lifestyle management and mental health awareness. The focal community areas were: • Community Centres & Community Gyms • Hostels • Charity Support Groups • Day Centres & Disability Groups • Children’s Centres • Job Centres • BME Groups • Faith Groups • Carer Groups & Organisations Aims • Effectivesign-postingtothemanyservicesandprovisionslocallywhichaddresshealth&wellbeingimprovement • To address Hertfordshire’s stated Health & Wellbeing Priorities • To ultimately help to reduce risk factors created by leading an unhealthy lifestyle How • Community based delivery with established groups, providing mentors and sign-posters to address the 5 key issues outlined above - both on a 1-2-1 or group basis. • Advising on behavioural interventions before long term health problems arise • Training those already working with the target groups, in a tailored Level 2 Certificate in Promoting Community Health & Well-being (Cert.PCHWB) • Monitoring and evaluating key performance indicators of engagement and nature of intervention. How is the partnership funded and is this sustainable? The project was funded by Public Health for a delivery of 4 courses located across Hertfordshire. There was some in-kind funding from YMCA West & Central Herts for venue hire and project management. Premier Training utilised other funding from the Innovation Code. There was no cost to the students or their employers, as we did not want cost to become a barrier to participation, plus the target market were charitable or third sector organisations. It was envisaged that achieving all outcomes and KPIs would lead to public health commissioning of further courses and in this way produce a sustainable delivery and funding model. Working in partnership to deliver the programme successfully The partnership working has consisted of a third sector organisation (YMCA) with a forward-thinking commercial sector, training company (Premier Training) and a public sector body (Public Health Hertfordshire). This training course was delivered under the Innovation Code which allows training providers to draw down SFA funding to work with employers to develop a course of training before it becomes an officially accredited qualification. Through working with the YMCA in this case PTI were able to adapt the delivery of this course to groups drawn from the community but without a background in health and fitness. This adaptation illustrates the potential to broaden the reach of the health and fitness sector toward recruiting new champions of active healthy lifestyles often drawn from the very groups we are trying to reach. YMCA also communicated with Public Health Hertfordshire in order to secure funding and to feedback on course outcomes while PTI liaised with the Awarding organisation Active IQ in order to access Innovation Code funding. Evidence of the impact of the partnership: how it has/will get more people, more active, more often? All course participants uploaded any interventions they had with their service users for 6 weeks post course. There were a total of 240 interventions. Headline statistics were as follows: Did you sign-post to a suitable service? Yes: 48% Not required: 54% From your intervention, do you believe that you had a positive impact on the service user’s health behaviour? Yes: 76% No: 2% Not sure: 22% Case Study
  13. 13. Rich Millard Partnership Director, Places for People Leisure Places for People Leisure recognises that its impact upon the health and wellbeing of a community cannot be fulfilled by a traditional approach to leisure centre design and management. First of all, there is a difference between a local and national approach, dependent on the size of operator and scope of the programme. An organisation must make a strategic commitment internally to health and wellbeing, such as hiring a Health and Wellbeing Manager, which was one of the first steps Places for People took. It is also important to clarify what health and wellbeing means to your organisation, and ensure that everyone is on the same page about this, as it is a concept that varies in its interpretation. On a local basis, every area is different and it is crucial to understand your local demographic. Each local authority has a Joint Strategic Needs Assessment (JSNA) specific to the area, and it is important to have an understanding of this. The JSNA is a fundamental part of the planning and commissioning cycle at a local level, and requires local authorities to consider the needs of their local populations and how they respond with effective commissioning of services to properly meet those needs. The needs of populations span the NHS and local authorities, for example the joined up provision of stroke care services, and coordinated approaches to obesity and physical activity29 . As well as having an awareness of the objectives of your local Health and Wellbeing Board it is also useful to know if the Board features someone working in a ‘Physical Activity Champion’ role, that you may be able to network with or potentially lobby, or perhaps a prominent GP that is particularly engaged in the physical activity agenda. It may also be a good idea for look out for opportunities to attend educational events such as seminars and public health conferences, both national and regional, in order to grasp a better understanding of the landscape, as well as providing the opportunity to network. For Places for People, local authority teams play a vital role in all health and wellbeing approaches, and it is essential to have buy-in from them. Each local authority lists their corporate objectives on their website; these tend to discuss specific objectives around improving the health of their local communities, so this may be another good area to look into in order to better understand local need. In all conversations with such bodies it is useful to understand that there is not a one- size-fits-all approach, you must be a good listener and open to observation. In terms of staff, Places for People have a robust health and wellbeing workforce - among the largest in the UK - with around 300 staff delivering health and wellbeing services. They recognise that when it comes to the health and wellbeing workforce, soft skills are often just as, if not more crucial than technical ability in terms of motivating inactive populations. For example, the ability to encourage behaviour change derives primarily from soft skills such as excellent communication, a positive and friendly nature and motivational interviewing skills. Places for People also have an extensive apprenticeship scheme, through which a lot of their internal health and wellbeing workforce is developed, and they are leaders in the sector for workforce development. The entire Health and Wellbeing workforce is educated to a Level 3 standard, which ensures PfP’s programmes are NICE compliant. In order for other leisure and activity providers to develop successful workforce development programmes of their own, it would be useful to speak directly to a training provider. Similar to many of the other contributors to this report, Places for People recognise the importance of tracking and measuring impact in order to prove the effectiveness of programmes to local authorities, CCGs and Health and Wellbeing Boards. For example, one method that Places for People use is the ‘SWIMTAG’, which is available for members to use at certain sites and for Swim4Health participants for free. It counts lengths, calories, stroke rate and more in order to record progress and improvement. The SWIMTAG wristband automatically uploads participant’s results to personalised SWIMTAG online accounts. We would recommend other leisure and activity providers to look into methods such as this, and reach out to technology and equipment providers in order to find the best tracking and measuring methods to suit your programme. As mentioned previously, leisure centre layout is also vital. The atmosphere needs to be welcoming and friendly in order to encourage those who would otherwise be reluctant to enter the gym environment as they find it intimidating; such as those with weight or body image issues, or mental health problems. As featured in the case study on page 23, PfP have expertise in incorporating a variety of other services into their leisure centres in order to form community hubs, such as hosting Slimming World or Weight Watchers classes, smoking cessation programmes, dementia friendly centres and so on. Finally, Places for People use the New Economics Foundations ‘Five Ways to Wellbeing’ model, which outlines a set of evidence-based actions to improve personal wellbeing. They are: Connect, Be Active, Take Notice, Keep Learning and Give. This model can be utilised in lots of different ways, for example to develop organisational strategy, to measure impact, to assess need, for staff development, and to help people to incorporate more wellbeing-promoting activities into their lives. It may be a good idea to incorporate a model/pathway like this into your own organisation in order to ensure everyone is clear on the purpose and objectives of health and wellbeing programmes. 3 421 22 29 ‘Joint Strategic Needs Assessment’, Health & Social Care Information Centre, http://www.hscic.gov.uk/jsna
  14. 14. 3 423 24 Places for People Leisure Joint Services - Maltby Leisure Centre, Rotherham Places for People Leisure recognises that its impact upon the health and wellbeing of a community cannot be fulfilled by a traditional approach to leisure centre design and management. In a pioneering partnership, Maltby Leisure Centre was one of four new facilities developed as part of a £34 million PFI project by Places for People Leisure (PfPL) for Rotherham Metropolitan Borough Council. This project was one of the UK’s largest leisure PFI schemes. Completed in two phases between 2008 and 2010, the Centre includes a six court sports hall, 25m swimming pool and teaching pool, fitness suite, aerobics studio and café. However, to equip it so that it can properly and distinctly operate as a ‘Health Hub’, there are also private consultation rooms, multiple meeting rooms and a service centre with two GP surgeries and pharmacy. The building is a new approach to leisure centre design, housing a number of agencies concerned with health and wellbeing under one roof. Since July 2013, PfPL’s health and wellbeing team have operated three exercise referral schemes at Maltby Leisure Centre, Rotherham Leisure Complex and since March 2014 at Aston Leisure Centre. This includes Shape-Up, Mend and MoreLife as part of the Healthy Weight Framework in Rotherham. Having our own dedicated team also ensures outreach is undertaken to promote the service and gain high volumes of referrals. Referrals are gained through strong links with health professionals including the School Nursing Service, schools, health professionals, British Heart Foundation, Youth Services, Public Health Rotherham and from GP’s across Rotherham and within Maltby Leisure Centre itself. The team are members of the Obesity Strategy Group, a partnership of key agencies in the Rotherham Health and Wellbeing Framework. Membership of this group ensures the smooth transition of referrals between tiers and that customers are triaged correctly. As part of the commissioned framework, Rotherham has achieved excellent outcomes over the past five years meeting NHS KPI’s. All our programmes are NICE compliant. The team includes on-site nutritionists and physical activity specialists with expert knowledge and qualifications including Register of Exercise Professionals qualifications (REPS). The Contract Health and Wellbeing Manager oversees all health and wellbeing services and ensures the team stay up-to-date with industry updates and best practice along with continuous professional development. Case Study
  15. 15. Erica Tillinghast Global Education Manager, Precor Developing an exercise referral scheme and engaging with GP’s and other healthcare professionals can present a massive opportunity for leisure and activity providers. However, showing you are able to provide the right environment and expertise for this specialist group is vital, as the hardest part is motivating those referred to ensure they visit the gym regularly and commit to getting themselves fitter and healthier. Precor’s Global Education Manager, Erica Tillinghast, provides some top tips on how to demonstrate to healthcare professionals the engagement level your facility will have with referral clients ensuring that they follow guidance, improve their fitness and are ultimately retained as long-term members: Invest in the right equipment There are a number of ways operators can maximise opportunities. Investing in equipment that is easy to use is vital to ensure users don’t get scared off and never come back. Alargeproportionofreferralmembersmaynothaveusedagymbefore,soremember: • A one on one assessment is key, as this helps assess their personal goals are and how they work in conjunction with their current fitness level. • Take time to explain how to use the different settings on the equipment and show them how their favourite workout can be saved each time for ease of use by using Precor’s Preva networked fitness. • If there are issues relating to impact veer them toward the Adaptive Motion Trainer (AMT) so they can benefit from a great upper and lower body workout without inflicting any impact on the joints. Gym layout and ambiance Flow of gym and clear welcoming areas are important to ensure members feel comfortable within their surroundings, so getting the equipment layout right and using space effectively is crucial. Precor’s four-step ActivDesign concept makes space work harder by designing the area based on the latest market trends and IHRSA and ACSM research, alongside insights from worldwide shopping giants. All elements are taken into account from flow-through, zoning and equipment choice and layout, to colours, light and even floor finishes. Operators also receive in- club training and launch support, as well as on-going evaluation. A good gym environment shouldn’t be filled with as many products as possible. It’s important to retain referral clients and research shows that 38% of members stay because of the variety of equipment, and users are more likely to become repeat customers if the right type of equipment is provided within a well thought-out space. Measuring goals and recording progress Monitoring and measuring goals keeps members engaged and helps motivate them, as well as being essential to the whole referral process in providing data back to GPs and healthcare professionals. Precor’s Preva Personal Accounts enable members to set personal workout goals each week. They can choose targets that are relevant to them - distance, calories or duration - and select an individual long-term focus, for example losing weight or toning up. As well as working closely with PT’s, referral members can measure their own progress with a weekly goal summary which alerts them if they’re on or off target, and automatically recalculates any remaining workouts so they still reach their goal. Users can also track their lifetime totals, so they can see the calories burnt, distance travelled and time they’ve spent exercising. Milestone badges are shown to constantly give exercisers something to strive for and help keep them motivated and engaged and members can save their ‘favourite’ last session making it easy for them the next time they log in. PT’s are always looking for ways to encourage members and by using the Preva Exerciser Activity Report they can see individual member activity and usage on the cardio equipment - such as what days and time they generally come in or whether they have set a personal goal - allowing them to assess how well they are doing with their workouts while on the referral scheme and beyond. The Exerciser Activity Report can also be exported and provided to healthcare stakeholders who are monitoring activity and success. “...research shows that 38% of members stay because of the variety of equipment...” 25 26
  16. 16. 3 427 28 Precor Hengrove Park Leisure Centre, Bristol Moving Forward “I’ve come to realise that keeping moving and being mobile are more important the older you get, but at the same time I need the exercise routine to fit in with my daily routine in order for me to be motivated to do it,” says 55-year-old Ann Grayburn from Bristol. Having seen what being overweight and a lack of mobility did to her once active father - he couldn’t even walk up the road without becoming exhausted - and having recently lost her brother, Ann was conscious that she needed to become more focussed on keeping fit and maintaining muscle strength, in order to stay healthy and keep off the extra pounds. A professional musician Ann plays the viola in several orchestras and teaches piano. I believe tomorrow will be even better because of what I do today “It’s important for me to enjoy what I’m doing, which is why before joining the gym I would swim and occasionally ride horses,” she states. However, playing the viola and the occasional fall off a horse led to a shoulder and neck injury and she became less active and put on weight. Ann joined Hengrove Park Leisure Centre in Bristol, which showcases a 173-station gym, featuring state of the art Precor equipment, along with a 50m Olympic swimming pool, and embarked on a six-month fitness journey with a Precor film crew monitoring her progress. I believe the human body is an amazing thing Kurtis Walters, Fitness Suite Manager at Hengrove Park Leisure Centre comments: “While Ann wanted to lose some weight, her main approach to keeping fit was to enhance and increase mobility in order to maintain a healthy lifestyle and sustain a reasonable weight. To achieve this we created a regime that covered both cardiovascular and strength exercises using high intensity interval training (HIIT) programmes on Precor’s award-winning Adaptive Motion Trainer (AMT) so that she could change up the routine and use it in a variety of ways (running, walking, stepping), along with time spent on Precor’s recumbent bike and the rowing machines. “The Precor strength machines were used to build up her strength and muscle tone and she quickly progressed to using heavier weights and more repetitions.” Ann comments: “Having Kurtis there monitoring my progress was a real boost to my confidence and gave me the encouragement to do well.” Over the six month journey Ann lost around three stone in weight. “I noticed that as I became fitter little things changed, such as carrying heavy shopping bags became easier, and I’ve come to the realisation that exercising is a continual process. The film crew may not be around any longer but Kurtis still encourages me and the journey continues.” “The Precor strength machines were used to build up her strength and muscle tone...” I believe fitness is key to living the life I desire With a lot going on in her life, time management plays a key role in when and how often she gets to the gym. Ann concludes: “Making fitness part of my life has now become a priority and while I may not be able to visit the gym as often as I would like, and sometimes life gets in the way, I now consider what other activities I can cut back on so that I can keep exercising. It’s about fitting it in to make sure you continue to benefit from the results and stay healthy.” Case Study Name: Ann Grayburn Age: 55 years old Occupation: Musician Member at Hengrove Park Leisure Centre, Bristol To view Ann’s story and watch the accompanying video, please scan the below code:
  17. 17. 3 429 30 Precor Leisure at Cheltenham Leisure Centre, Cheltenham Taking the Treadmill One Step at a Time For 32-year-old Will Wood every day brings a new challenge, and just being able to walk is a huge accomplishment. That is why running on the treadmill, and even thinking about competing in a 10k run, is a success he is extremely proud of. Just over two years ago Wood was found by his car having a fit and was diagnosed with a subarachnoid haemorrhage - commonly known as a bleed on the brain. The prognosis was that he would never use the left side of his body again and, along with severe memory loss, impairment of planning abilities and impacting his confidence, effectively meant he had to learn to walk again from scratch. Rehabilitation was a large part of the healing process, but when Wood could walk again, albeit with a pronounced limp, he felt he wanted to continue to achieve more. He says: “The biggest thing was to reduce my limp because I felt like it made me stand out from everyone else.” A moderate exerciser before the bleed; going for the occasional jog, doing some weights and push-ups in the evening and having just completed a 10k run, exercise played a crucial part in Wood’s recovery. He joined Leisure at Cheltenham and embarked on his fitness journey. I believe in the power of the human spirit Believing in his recovery, being determined to succeed and wanting to inspire and provide hope to people, Will allowed Precor to follow his progress over a six-month period and the results are amazing. His first day in the gym was a real boost to his confidence. He states: “It felt brilliant and while I was working out I felt like everyone else again. It was as if my bleed had never happened.” Starting off slowly by using the Precor recumbent bike and an arm ergometer, along with a circuit of air-pressure resistant stations to gently strength and condition the muscles, Wood began to improve, and by the third month had progressed to the Precor treadmill. Just walking on the treadmill was a feat, but he was elated when he managed to walk a mile, and then promptly gave himself the goal of being able to run on the machine. I desire a life without limits Wood uses an analogy from his job as a sports journalist, and comments: “If you have a goal then you have something to aim towards, if you don’t shoot then you won’t score.” Chris Davis, Fitness Suite Supervisor at Leisure at Cheltenham observes: “What I noticed about Will immediately was his tenacity and drive to progress with each and every session, sometimes perhaps even well before he was ready. “A great example of his eagerness to conquer the Precor treadmill independently is when he became focussed on building speed to get back to running as soon as possible. An inspirational and equally amusing moment, even though I had strongly advised a gradual build up and to use the treadmill under supervision, was to find Will jogging away by himself. Albeit slightly unsteady, but jogging nonetheless! It was the realisation that weeks of what Will found to be a frustratingly simple but equally valuable strength regime had given him the stability and confidence to fulfil one of his most important gym related goals.” By month five Wood was running on the treadmill and continued using Preva to plan his workout. Given his inability to plan journeys or retain directions he found Preva a key component of his gym activity. He found it easy to use and the simplicity of being able to save his favourite work-out and get going at the push of a button gave him the motivation to succeed. Over the six months of filming Wood noticed he could not only run for longer, from just a few minutes to over 45 minutes, but had also got to the point in his exercise schedule where he could do some light free-weights to strengthen the rest of his body. Today he’s committed to his fitness regime and gives himself jobs and shopping trips to make sure he continues to exercise throughout the day. Having reduced his limp significantly, so that it’s almost imperceptible, being able to run on the treadmill and even walking to work, Wood is well on the way to a full recovery and has a lot to look forward to. He comments: “Being back at work as a sports journalist, if only for six hours a week, is a huge accomplishment as it’s a big part of my life and I cannot wait to show my bleed that it has not beaten me. Apart from the fact that I can actually walk again, the most positive aspect of my fitness journey has been strengthening my walking by using the treadmill, so that I feel and look like everyone else. “...the most positive aspect of my fitness journey has been strengthening my walking by using the treadmill, so that I feel and look like everyone else.” Case Study Name: Will Wood Age: 32 years old Occupation: Sports Journalist Member at Leisure at Cheltenham Leisure Centre, Cheltenham
  18. 18. 331 Case Study I believe fitness is key to living the life I desire “I took exercise for granted before but it has played such a major part in my recovery especially as there was so much at stake. The Precor treadmill is a vital piece of equipment that I will carry on using as it represents the fact that I couldn’t even walk, was told I would never move my left hand side again, but now I can run! It was so easy to use and great that I could watch or listen to music or TV, which helped the time to pass easier and took my mind off the fact that I was exercising. I believe tomorrow will be even better because of what I do today “My goal for the future is to continue to go to the gym three times a week and use the treadmill in order to train for another charity run, either a 10k or a marathon to support Headway, the national brain injury charity that has assisted and helped me to get back to normality. Not only has exercising given me the use of my body back again, but it has restored my confidence and I’m looking forward to fit and healthy times ahead.” “If you have a goal then you have something to aim towards, if you don’t shoot then you won’t score.” To view Will’s story and watch the accompanying video, please scan the below code:
  19. 19. ukactive, 4th & 5th Floor, 26 Bedford Row, London WC1R 4HE T: 020 7400 8600 | E: info@ukactive.org.uk | www.ukactive.com

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