The document discusses the role of exercise in the management and prevention of chronic diseases, highlighting its benefits in disease progression, recovery, and overall health. It emphasizes the importance of exercise referral schemes and the need for measurement to demonstrate their effectiveness and return on investment. Case studies and guidelines illustrate how physical activity contributes to improved health outcomes across various chronic conditions.

1. “Exercise is Medicine”Sponsored by:

2. Coming up?Dr. John Searle OBE Prof. Alfonso Jimenez Ben JonesSponsored by:

3. Panel DiscussionExercise is Medicine - Can it be done?

4. Case studiesWhat lessons do we take back to our business?Sponsored by:

5. What can exercise do in chronic disease?John SearleChief Medical Officer, FIAand Personal TrainerSponsored by:

6. Exercise in disease preventionCoronary artery disease / strokeObesity and type 2 diabetesDementiaDepressionSome cancersOsteoporosisSponsored by:

7. Exercise in disease preventionHealthy & independent older ageSponsored by:

8. Physical activity and seniors’ health care needsCanadian study 2010:24,281 65+ over 1 yearMean number of health visits: Active = 8 Inactive = 11Active have shorter hospital stays and faster illness recovery timesSponsored by:

9. Physical activity levels for healthEvidence based guidance:ACSM 2011BASES 2010Start Active, Stay Active 2011Sponsored by:

10. Exercise in chronic diseaseRecommendations:Nice Guidelines: non-specificACSM’s Exercise Management for Persons with Chronic Disease (2009)Swedish National Institute of Health, Physical Activity in the Prevention and Treatment of Disease (2010)Sponsored by:

11. Which diseases are we talking about?Osteoarthritis (OA)Rheumatoid arthritis (RA)Ankylosing spondylitisFibromyalgiaCoronary artery diseaseHypertensionStrokeObesity & type 2 DMAsthmaCOPDParkinson’s diseaseMultiple sclerosisBreast and bowel cancerDepressionSponsored by:

12. Review articleKujala UM, Evidence of the effects of exercise therapy in the treatment of chronic disease. Br J Sports Med 2009; 43: 550-555.Sponsored by:

13. But it was not always like this!Sponsored by:

14. REST!Sponsored by:

15. Rheumatoid arthritisSponsored by:

16. AppendicitisSponsored by:

17. ObjectivesTo achieve:An active life style & a sustainable increase in physical activityImprovement in symptomsReduction in the rate of disease progressionSponsored by:

18. But is it risky?Greater risk not to exerciseGraded progressionSupervision and monitoringProper precautionsSponsored by:

19. Does it work?Cardiovascular diseaseRheumatoid arthritisDepressionSponsored by:

20. Coronary artery diseaseNational Exercise Referral Scheme in Wales (2010)Increased levels of physical activity at 12 monthsPositive effects on depression and anxietyCost effectiveSponsored by:

21. Rheumatoid arthritisSynovial joints symmetricallyPain & stiffnessFatigueDecreased activity –loss of muscleSponsored by:

22. What does exercise achieve in RA?Literature summary:Increases aerobic capacityIncrease in muscle strength and lean body massIncrease in exercise enduranceWeight controlImproved quality of lifeSponsored by:

23. And it really does work!Sponsored by:

24. But at a priceSponsored by:

25. Depression: exercise and mental healthMental Health Foundation:less tension, stress and mental fatiguea natural energy boostimproved sleepa sense of achievementfocus in life and motivationless anger or frustrationa healthy appetitebetter social lifehaving fun.Sponsored by:

26. Cancer: case study82 year old manPreviously well, played golf twice a weekDecember 2010 cancer in the mouth6 months aggressive chemotherapySerious weight loss, lethargy, loss of appetiteSponsored by:

27. Cancer: case studyExercise programme at home, June 2011Gradual increase in daily walkingResistance bands – progressionStretching and motor skillsHealthy eatingLass week: 18 holes of golfSponsored by:

28. So what?Exercise plays a vital in role as part of the management of chronic diseaseBut how do you do it?Sponsored by:

29. The Importance of Measurement in Exercise ReferralBen Jones, Blue skies FitnessSponsored by:

30. OverviewThe business of exercise referralVARTEC – a reminderDeciding what to measureSponsored by:

31. Not so NICENICE recommendation 2006:…insufficient evidence to recommend the use of exercise referral schemes other than as part of research studies where effectiveness can be evaluated…Sponsored by:

32. The business of exercise referralPublic money typically PCT/LA fundedEstablishing what represents ROIDesired outcomesKey Performance IndicatorsThe need to measure & monitorSponsored by:

33. VARTECValidityAccuracyReliabilityTime efficientEquipment considerationsCost comparisonSponsored by:

34. ValidityDoes the measurement pass the Ronseal test?Who’s responsibility is it to measure the effectiveness of an ER scheme?Financial impactClinical effectivenessAnthropological risk factorsLifestyle risk factorsPsychological/QOLSponsored by:

35. Accuracy/ReliabilityDetermined by a number of factors that need to be controlled adequately in an exercise referral schemeEquipment qualityEquipment consistencyEquipment maintenanceSuitability of environmentStandardised testing protocol usedConsistency of person testingRecord keeping & confidentialitySponsored by:

36. Time/Equipment/CostAll come down to the same issueTests must be efficient and cost-effective to deliver without sacrificing validity or accuracy of measurementsDoes this answer the ‘who’ question?Clinical tests must be conducted by GP/SpecialistAnthropological tests/questionnaires can be administered by appropriately trained fitness professionalsSponsored by:

37. What to measureDecision starts with the Validity question – why are we measuring?Requires us to first answer the question – Who are we measuring for?PatientFitness ProfessionalDoctorCommissionerGreater medical/scientific community? The future? All of us?Sponsored by:

38. What to measure for the patientPatient wants to know…Is exercise worth the time & effort?!How can we influence them to conclude ‘yes’Demonstrate reduced pain/signs/symptoms?Demonstrate reduction in disease markers? – clinicalDemonstrate improvement in general health? – bothDemonstrate personal achievement/improved functional fitnessSponsored by:

39. What to measure - fitness professionalIs the exercise programme effective?How can we determine yes/no?How well have they adhered to it?Has the patient progressed toward their individual goals?Does the patient have a measurable improvement in function?Does the patient have a measurable improvement in health?Is the programme sustainable for the patient?Do they have a robust action plan to continue to be active?Sponsored by:

40. What to measure for the DoctorHas the patient’s chronic condition improved or shown slowed progress?Have signs/symptoms or risk factors of other conditions reduced?Are patients more active than baseline at 6, 12, 24+ months?Sponsored by:

41. What to measure for the DoctorHow can we determine yes/no?Improved clinical markersImproved signs or symptoms of comorbiditiesImproved predictors of risk for comorbiditiesIncrease in long term moderate-vigorous PA behaviourSponsored by:

42. What to measure for commissionersThe easier it is to demonstrate ROI the better…Challenge – we don’t have direct access to the data that shows this:Decrease in frequency of visits to GP and other NHS servicesReduced dosages of medicationsReduced need for surgical interventionsCo-morbid conditions preventedSponsored by:

43. What to measure for commissionersAttendance/adherenceAnthropological predictors of chronic conditionsPsychological/QOL questionnairesLong-term follow-up of patient’s activity levels (questionnaires)Sponsored by:

44. What to measure - future developmentAs much as possible, in a standardised format that can be compared in a meaningful way across schemes to evaluate effectivenessWhy?To allow controlled adaptation and comparison of scheme variables and development of increasingly effective & targeted exercise referral servicesSponsored by: