Recondition the nation

Dr Amit Arora is a consultant geriatrician in the North Midlands. In this blog, he discusses promoting movement among our older generation so they can remain active, independent and mobile. This not only improves outcomes, but can also prevent falls and long stays in hospital, with better mental health and wellbeing for both our older patients and our staff.

Since I first wrote a blog here introducing the issue of deconditioning as a clinical syndrome, significant progress has been made across the health and social care sector to recognise the issue of deconditioning as a clinical syndrome. We have also seen a growing awareness about deconditioning across professional organisations and medical literature, which has also resonated with our staff and the public.

Deconditioning syndrome can be defined as the ‘condition of physiological, psychological and functional decline that occurs as a result of complex physical changes’, which happens with prolonged bed rest and the associated loss of muscle strength.

We know half of admitted frail older patients experience functional decline between admission and discharge, and up to 50% of older people can become incontinent within 48 hours of admission. In the first seven days of admission, inpatients have reduced muscle strength by up to 10%, reduced circulation by up to 25% and reduced dignity, quality, confidence, independence and choice.

National and international reports have shown how the pandemic adversely affected the physical, psychological and functional wellbeing of populations, with older people disproportionately affected by deconditioning.

There is evidence to share the findings of the negative impact of lack of movement due to inappropriately prolonged bed rest, so we can now change and establish an increase in activity in all patients – but more specifically, in older patients. There is now an urgent and growing need to shift focus from just avoiding deconditioning and to promote reconditioning.

The findings in favour of activity and exercise for older people confirm how important it is for us to identify effective approaches to behaviour change, to share the best practice and to put in place strategies to prevent deconditioning, at scale and speed.

Two successful campaigns have raised awareness about deconditioning: ‘National Deconditioning Awareness and Prevention Campaign: Sit Up, Get Dressed, Keep Moving’; and ‘EndPJparalysis’.

‘Recondition the Nation’ is in place to promote ‘reconditioning’ approaches with the aim that this initiative will be widely recognised and implemented across the health and social care sector to help all groups, and specifically our older generation, stay active, mobile and healthy.

Between 2021 and 2022, 178 teams took part in (de)Conditioning Games across health and social care in the East of England, to promote activity among their inpatient population. These teams shared good ideas to promote safe, physical activity.

Successful outcomes included:

  • a reduction in falls at Northampton General Hospital and care homes across Essex
  • improved nutritional care in the neuro unit at the Norfolk and Norwich University Hospital
  • in their older people wards, Luton and Dunstable and Cambridge University hospitals reported improved confidence, with no increase in care needs on discharge and improved mental wellbeing and improved mobility.

To continue the success of the games, the Emergency Care Improvement Support Team – supported by NHS England and social care colleagues – launched ‘Recondition the Nation’ in November 2022. The programme aims to:

  1. Improve patient outcomes by prevention of deconditioning.
  2. Improve staff wellbeing by introducing joy in their work.
  3. Improve the health of the nation by introducing wide scale change across health and care sector.

Across all NHS England regions, Wales and beyond, teams have had the freedom to create their own ideas to increase activity and implement the ideas locally. The ideas are there to inspire activity, with daily walks scheduled around the ward ‘running track’; chair-based exercises; and modified exercise classes arranged by organisations such as Move it or Lose it.

All the physical activities and games have been well received by staff and patients, who say that taking part has helped relieve boredom, improved appetite and made people feel happy.

We encourage participation of various teams from hospitals, care homes, councils, communities and any other organisations to help us, guide us and join this movement to improve patient outcomes, improve staff wellbeing and improve the health of the nation.

We welcome you to join us to #ReconditionTheNation. You can see resources and support for your initiatives on the #ReconditionTheNation section of FutureNHS.

Dr Amit Arora is a consultant geriatrician in the North Midlands, Clinical Director for the Emergency Care Improvement Support Team of NHS England and a Vice President (Workforce) for the British Geriatrics Society.

He is the founding Director of the National Frailty Academy and creator of the National Deconditioning Awareness and Prevention campaign and is now leading the national mission to #ReconditionTheNation.