The Atlas of Shared Learning

Case study

Introduction of the exercise instructor role to support mobility and independence for elderly residents in a dementia care setting

Leading change

A senior support worker at a Belong Wigan care village led a project to introduce an exercise instructor role, after identifying best practice in this area. Belong is a charitable non-profit making care organisation whose ethos is ‘To support older people to live their own lives through the creation of vibrant village communities’. The project has increased residents independence and improved residents experience of care within the village.

Where to look

Belong run five established villages and two new villages within the UK and model their services around the resident, ensuring they are at the heart of everything that is done. Each village runs a number of services, including independent living apartments, households for people that require more care as well as ‘Belong at Home’ which is a community nursing and care service.  Belong also provide experience days for new residents or those considering using their services.

The Senior support Worker in collaboration with the physiotherapy lead identified that residents who have had a fall, often subsequently have reduced mobility, reduced confidence and often experienced a reduction in pre-fall activity.

Belong as an organisation believe in supporting residents to achieve their full potential and live as active a life as possible, the village model incorporates a residents’ gym within the village complex. Positive results and clear benefits of utilising a gym were demonstrated at other Belong Villages, including increased mobility, increased physical activity in everyday life and a reduction in the number of falls, which culminated in Macclesfield Belong service winning the global ‘Excellence in Ageing Services Award’ (IAHSA) for best gym model in 2013.

What to change

Belong Wigan had support from the Lead Exercise Instructor who assisted with exercise programme design but Wigan care staff had to deliver the exercise on a regular basis. Equipment was minimal and care staff had limited time and expertise to deliver the service effectively. Research evidence base suggests that individualised exercise plans and structured interventions increases confidence, and physical strength reducing the risk of falls as well as reduce the risk of injury when falls occur. (NHS 2018)

Unwarranted variation was evident across the five established Belong villages because provision of gym equipment varied and dedicated qualified exercise instructor time was not uniform across their network. Exercise provision was not standardised, this meant that some residents weren’t receiving a consistent offer in regards to support. Residents with specific long term conditions that required ongoing assistance and dedicated input from staff and medical professionals lacked a robust individualised plan for residents exercise therapies to follow. Post-operative, Stroke and Parkinson’s residents who had access to community physiotherapy and other NHS services needed more support to achieve attainable goals. Long waiting periods for NHS services meant that critical time periods following surgery, falls or stroke could not be met to achieve the resident’s full potential.

Care staff at Belong Wigan identified that introduction of a qualified exercise instructor, ready to deliver regular exercise plans, would improve the quality of service and outcomes for residents at their site. To facilitate the introduction of this new service an exercise instructor role was developed.

How to change

The Lead Exercise instructor supported roll out of an education programme to potential exercise instructors across the villages care staff. The new exercise instructor role, once integrated into the needs of the residents, began to develop exercise/activity plans in collaboration with residents and provide assessments of those residents who have had a fall to see how they can be supported to maintain optimum mobility, strength and confidence. The senior care staff working closely with the lead exercise instructor developed the systems and service needed at the Wigan village to ensure residents have access to falls prevention classes, individualised exercise plans and support via the trained exercise staff. Additional equipment was also brought in to support activities.

Working closely with NHS services and by developing a good professional relationship across service boundaries has enabled the care staff at Wigan Belong to provide a comprehensive and seamless service so that their residents can enjoy a better quality of life and improved outcomes through: increased mobility, core strength development, increased physical activity and emotional welling by gaining confidence in their own mobility.

The exercise instructors provide education, offer support and encouragement to each individual to participate in exercise as well as being a resource for staff.  With full access to medical information and multi-disciplinary team, the exercise instructor designs bespoke individual exercise programmes in collaboration with residents and these are monitored and updated in accordance with the resident’s progress and changing health needs. The exercise instructor also works closely with resident’s families to support the development of exercise plans and support any risk assessments and specific support needs.

Adding value

Outcome based measures were used to monitor improvements in core strength and ability to walk, as well as adjustment to individuals plans as they develop their confidence.

Better outcomes – The introduction of the new exercise instructor service and role has led to residents reporting an increased quality of life. Belong have identified less of a demand on carers as less residents require hoisting, as they can mobilise independently using aids. Wigan Belong has also identified: increased mobility, a reduction in pressure ulcer risks, an increase in resident satisfaction and a reduction in urinary tract infections (UTIs) and deep vein thrombosis (DVT’s), although data for this isn’t currently available. However, as an electronic person-centred software programme (PCS) is being used to record care support and wellbeing of residents data regarding falls, pressure ulcers and nutrition and hydration will be available in the future.

Better experience – The new service and role has been well received by residents especially in cases of residents with limited social interactions. A digital virtual reality system has allowed residents to visits locations they have been to on holidays and provides emotional wellbeing also. Example of feedback from residents has included:

“Since attending this gym I have found great improvement in my mobility and hope to continue to do so, from a very grateful 96 year old lady”

Relatives have also welcomed the initiative, reporting

“Since the beginning of the year when the gym opened, my mother’s mobility and strength has significantly improved. She looks forward to her sessions and the exercise instructors help her to achieve her goals.”

Better use of resources – In one specific example a resident was able to be discharged from the local NHS falls team as progress with the exercise instructor was making such a significant difference, making more efficient use of NHS resources.

The new role and service has resulted in better outcomes and experiences for the residents using the service and has in a number of cases proved to be cost effective approach to providing person centred exercise and mobility support.

The use of a digital Virtual Reality system helps the exercise instructor track the movement and muscle imbalance of residents in order to recommend an effective falls prevention program and exercise plan.

Challenges and lessons learnt for implementation

Investment in staff is important as in this programme of work the exercise instructors previous experience of working senior support worker helped immensely. Working daily shifts in the Belong environment gives a unique perspective and allows the exercise instructor to gain knowledge of both the residents and the care home environment before progressing onto exercise plans.

Offering every resident an equal opportunity in targeted individual exercise plans is important no matter what their ability or situation

The next steps for this service are to improve the evidence base of service inputs to tangible outcomes and to roll the service out to those residents with cognitive impairments such as dementia and their families.


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