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Supporting activity for long term health

The message that activity is good for your health is very hard to avoid these days. Activity is beneficial for physical health, mental health and resilience, which leads to higher chance of social contact, less chance of loneliness, and more chance of maintaining a steady job, says Alex Thompson.

It’s well known that if you have a long term condition being more active will help you to manage the condition more effectively and stop progression, leading on to other benefits such as lower medication use, less pain, and increased overall quality of life. What an opportunity! Let’s all get more active and just see the effects on us as individuals, the NHS and society. Let’s go – job done, problem solved.

Back on earth, however, we know, as individuals, as patients, as clinicians, as policy makers, that for people to become more active it is actually really difficult, especially when you have one or more long term condition. 66 per cent of adults are classed as inactive with only 50% walking at least five times a week. People with Musculoskeletal (MSK) long term conditions, e.g. back pain or arthritis, say that exercise is not for them and people with long term conditions regularly come across negative messages about being active.

This is reflected in what I’ve seen many times in clinical practice; people who feel unable to engage in activity full stop, or encounter pain flare ups that inhibit their ability to be active. This can lead to conditions such as frailty, causing less resilience and less ability to bounce back after mental or physical illnesses, or Type 2 diabetes.

As a case in point, meet Jeff. He is a 72 year old who I met in an acute hospitals orthopaedic clinic appointment. He had successfully managed his low back pain for years but had a flare up of pain, so he stopped his usual twice weekly bowling, stopped walking the dog, and his garden was getting overgrown as he couldn’t do it. In this time, Jeff also found his painkillers were making him constipated and dizzy, so he felt less like being active. This went on for a while, eventually he ended up having a scan which showed he had some areas on his spine that were not in pristine condition; clinical advice at the time meant that Jeff became more cautious about activity.

In practice, I have also seen different healthcare professionals advise different treatments about activity, and if it’s safe to be active or not, resulting in confusion for patients as to whether or not to be active.

So what actually is a good ‘pathway’ to support someone like Jeff?

In health and social care the question of what the support offer is for activity needs serious consideration. For the public and service users across the system I would propose they ask what the offer is and what support comes with it. Furthermore – how is the transition from inactivity to activity supported? How does that transition stick? And how are bumps in the road, such as pain flare ups, supported?

This is a good time to pick back up with Jeff. Clinicians seeing Jeff were trained in shared decision making and motivational interviewing techniques. A personalised care plan was worked out jointly between Jeff and the clinician. This included having access to co-located, evidence based, supported activity programmes run by activity coordinators; in this instance, health and activity services working together in a leisure centre. The programme also had education and management techniques as core components. Jeff got back to his bowling twice a week and stopped needing to take strong painkillers, walked the dog again and could do his garden.

What if?

If Jeff had had this intervention earlier the value to him would have been increased and he would have got back to his regular activities sooner. The value to health care would have been seen by avoiding out-patient hospital appointments, the repetitive trips to the GP about medication, and perhaps not needing the supported programme. It is perhaps difficult to realise actual cash savings, but the opportunities that supporting Jeff, and people with similar problems earlier would, for example, decrease the need for orthopaedic consultations and allow for reallocation to other areas of the system.

Even when the support offer is there it is still difficult for people to become more active. But the more people do, the more health benefits will be realised and the impact of people’s long term conditions will not keep them from their garden whilst adding some efficiency into the system.

Alex Thompson

Alex is the topic lead in the NHS RightCare pathways programme. He qualified as a physiotherapist in 2001 from the University of Nottingham. He has worked in acute and community trusts in a variety of senior clinical and leadership roles, acquiring an MSc and other post-graduate qualifications. He has developed system strategy to enable activity and prevention pathways for people with chronic MSK pain and led implementation of this strategy. He has led other innovative improvements including virtual clinics and advancing physiotherapy practice. He has led successful programmes to increase research capability and capacity in Allied Health Professionals. He is currently undertaking a PhD Fellowship at Sheffield Hallam University evaluating optimal transitions to activity in people with MSK pain.

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