Podcast transcript

General Introduction

You are listening to the Four Ways Forward podcast. A podcast exploring how physical activity can help people live healthier, longer and more independent lives. You may be using physical activity to improve your mental health, improving your joint health, skin health. It just seeps into so many areas. A podcast where we hear from health experts on the importance of movement for our health and the health of the NHS.

Tara Dillon, CEO of sense for the Chartered Institute for the management Sport and Physical Activity

Hello and welcome to this podcast one in a series of podcasts designed to support healthcare professionals and empower you in understanding your role in four ways forward. Welcome and thanks for joining. So today’s podcast is discussing the importance of being physically active and moving more and specifically how important that is for you both personally but also professionally and improving better patient outcomes.

So you couldn’t get two better experts to talk about this subject if we tried. So welcome to our guest speakers, Dr Hussain, who is a lifestyle doctor, he’s also the RCGP Lifestyle and Physical activity lead. And is occasionally, as seen on TV, a bit of a celeb.

Dr Hussain Al Zubaidi, RCGP Lifestyle and Physical activity lead

Thanks for doing this today. Thank you for having me, Tara.

Tara:

We also have the brilliant Hayley Lever who is the CEO of the Greater Manchester Moving Active Partnership, who, worked tirelessly over the is getting the people of Manchester moving more and, initiating some brilliant initiatives on integrating physical activity and health. Welcome, Hayley.

And my name is Tara Dillon. You’re probably wondering, you know, I was, I’m the CEO of sense for the Chartered Institute for the management Sport and Physical Activity. So we’re the professional body for the physical activity workforce. I’ve been in the sector for 38 years, and I’ve seen first-hand the power of physical activity integrated into health.

And I’m really looking forward to sharing some of those stories with, the guest speakers today. So why is physical activity so important? If I, if I were to quote an NHS CEO, so to speak, at a conference a few years ago, he said, I’m coming to, you know, he’s saying he said that if physical activity were a pill, it would and should out-sell all pharma products, which I thought was a brilliant quote, and I’ve hung off that for quite some years. So you say, where is the evidence and impact of the importance of physical activity?

Hussain:

Thank you, Tara. And I suspect, he or she was very much correct because, you know, when we look at physical activity, one of the key stand out things is the breadth of impacts that you have.

It’s not just specific few conditions where we know that both increasing activity levels and reducing sedentary time has benefit. But it’s over to 21, 22 different chronic conditions. And so that can really be its strength because you may be using physical activity to improve your mental health. But at the same time, you’re having compound benefits improving your joint health, your skin health, also improving your cardiovascular health and spiritual health.

It just seeps into so many different areas. And just to give you some sort of key standouts, if you think about some of the key conditions that we’re currently, tackling within the health service, we know that regular movement can cut the risk of chronic diseases like type two diabetes and cardiovascular illness by up to 30%, and it’s linked with a 20% reduction in all-cause mortality.

So the term all-cause mortality is essentially the risk of dying from any cause. And so that’s really significant. And you’ll be hard pressed to find a procedure, injection or pill that will have those kind of results. And beyond physical health, we know physical activity is a proven antidepressant. So if we compare it directly against, antidepressants and we look at, for example, doses of, of 75 minutes across a whole week, we know that reduces your risk of depression by 18%.

And we’ve looked and we know that there are some aspects we understand in terms of the release of chemicals like endocannabinoids, as well as endorphins and endogenous opioids. The actuals of your body are generating painkillers itself. That’s where we see its benefits when it comes to mental health, as well as chronic pain and all of these gains, they don’t just happen in isolation.

You know, when we model an active lifestyle ourselves, you know, our credibility in advising this to patients is through the roof. And, you know, studies have shown that healthcare professionals that are able to maintain a healthy level of physical activity are far more likely to be effective, inspiring and encouraging their patients to take on more physical activity.

Tara:

That’s great. He’s saying brilliant. Thank you so much. I mean, the evidence is overwhelming, right? So what if we can tackle dispelling some of the myths a bit here? Because what you’ve just outlined is extraordinary, right? The power of it, the power of physical activity and some people who will be listening to this will be thinking, well, I just don’t know how.

Well, what do I access, you know, how do I suddenly, as a healthcare professional who doesn’t really move very much because I’m a busy person and I have commitments and all the rest of it, I’m going to have to join a gym They’re fantastic places, but that’s not the only place to become physically active.

I tell people to take the dog for a walk even if they haven’t got a dog. I mean the power and impact of that. If you haven’t been active is extraordinary. I hope we dispel the myths and I and also say, you know, think some healthcare professionals are really quite, nervous about prescribing movement and activity, particularly in cardiac patients, for example, you know, there’s this fear that if I refer you to a sports club or a gym or just to go for a walk, you might suddenly have a serious cardiac event. What would what would you advise healthcare professionals in that respect?

Hussain:

Yeah, really good set of questions there. You know, starting off in terms of starting their own journey, I would say it’s actually the best place for them to consider kind of what they can do. If they do feel like they aren’t getting as much movement as they’d like, or maybe as much as what is recommended by the chief medical officers physical activity guidelines, then that’s sort of the best place to start when it even comes to supporting your patient, because at the end of the day, we want to be able to encourage and have conversations with our patients that we’ve also had to navigate.

Just speaking from my own personal experience, you know, having those discussions with myself and seeking support and advice from those around me to increase my activity levels from what was very sedentary. It helped teach me the kind of sort of tools that I would need to start that journey. And sometimes we miss a few steps, and we jump along the line to where we want to get, rather than thinking about what the steps and stages I need to go through to improve my confidence, knowledge and skills around movement.

And so I’d highly recommend people look beyond what is sometimes glamorized as a sort of ideal movement. Let’s say completing a marathon or, you know, going to the gym or whatever has been kind of idolised as sort of the perfect movement to just consider how moving the body makes them feel. Because often when you’re starting off, there’ll be some movements that you don’t like that feel difficult, that lead to a lot of fatigue that you then struggle to balance up, but that your other, commitments.

But then there be other movements that actually do the opposite, maybe the lighter or shorter. Maybe they involve music, for example, dancing or community or being outside in nature, which you love. And so try to make that sort of first step in getting more active, as desirable as possible, often speak to my patients. And I say, if you don’t feel 6 or 7 out of ten at least confident that you will maintain this movement going forwards, then it’s not the right thing to try and tackle.

Like you said, we need to adapt it. We need to think about it differently. Just to give you an example, you know, had one patient that wanted to start walking more, but very much didn’t enjoy doing it on their own, and they were quite isolated. Unfortunately, the wife died a few years previously and they just didn’t feel connected any more with the community.

So he didn’t get motivated walking on his own. But then he also struggled with not having a close network that he could reach out to go on walks. And so we I encouraged him to go to Park Walk. So, the same events that happened at Park Run, where you can walk at these things, and he’s been able to develop a community because he volunteers as the park walker.

So he gets to talk and integrate with other people, his community, who he then goes on walks at other points in the week. And so it’s just thinking about whether it’s yourself or the patient or colleague that’s working in health care as well. How can you reduce the friction, the first bit of movement and decide based on your preferences and needs rather than what you think is kind of ideal?

Tara

So I mentioned, at the beginning Four Ways Forward. This is NHS England’s but around integrating physical activity and wellbeing. Obviously there are four ways forward. The first one is about empowering healthcare professionals. The second one is we’ve touched on integrating physical activity into clinical pathways, which I think we’ll come on to shortly, but also supporting the NHS workforce.

An innovating through partnership, you know, so, Hayley, how do we support NHS staff in that journey to wellness? Because as I said earlier, if a health care professional suggests that movement is good for a patient, the impact is enormous.

Hayley ever, CEO of the Greater Manchester Moving Active Partnership:

Where my mind’s going to is back in, the pandemic, actually, when we were talking to our role here is to support and lead and connect people within Greater Manchester, within our place.

And back in the pandemic, we were developing the new data moving strategy online. Everything was online. And it came about kind of by accident. And we started with a question to reach, you know, to each room, which was how does movement matter to you for your family in your work? And, and that very, very simple question, which was supposed to be a warm up, just to get people connecting in the room and in breakout rooms became the absolute foundational questions for everything we’ve done since. What was very striking during that period is that it didn’t matter who people were, which sector they were from, what their role was. Everybody could access that question. How does movement matter to you, your family, your community, your work? And so building that conversation from the ground up was really important to help us understand how we best support people to play their role.

We’ve had, the benefit of valuation research is embedded in this work, over the years. And one of the things that’s really quite striking is that when someone’s got a personal belief in the importance of movement, then they’re more likely to feel confident in advocating that for this. But we have to support them because they might be a clinician or somebody working in the health system who’s a massive advocate and champion of this, but they can’t connect to someone that then, you know, and they haven’t got the tools to have conversations that connect and understand the person that they’re meeting with.

You know, it’s important that, our work is to develop that belief in people, support people to have a meaningful relationship, a positive relationship with movement, physical activity themselves such that they can support others in terms of sort of how you how you help that happen at scale. It’s about telling stories and sustains them so beautifully.

Is that what then? That’s what spreads and grows.

Tara:

100% agree. It it’s a cultural shift, right? This this mindset is key. I mentioned earlier about gyms and, sports clubs and stuff like that. But just from my perspective. But some people I speak to in, in health care are sometimes a bit nervous about referring a patient or advising a patient to join a gym or a club because they’re not quite sure how qualified the physical activity professional is.

So I think it’s probably my job to dispel that myth. You know, the physical activity workforce is around 600,000 people working in the physical activity workforce. But the size of the motor trade, it’s very well established. And in sport, you know, there’s about 3 million volunteers. You know, there’s it is a huge, huge workforce.

And as the CEO of the professional body for, for the workforce, you know, just wanted to give some assurance to the listeners in the podcast today is that we’re actually set up a bit like your Royal Colleges set up in the same way that RCGP is or RCN. And insofar as we have professional standards and the professional body, the Chartered Institute is the custodian of those standards. So it talks about the minimum knowledge, skills and behaviours required to be a coach, a lifestyle coach or a personal trainer. Gym group, sports coach, etc. they’re very robust. They’re delivered by quality insured training provider partners. And individuals become members of the professional body. They can gain chartered status. So you can be absolutely assured of the professionalism of the incredible physical activity workforce.

I think what we’ll talk about in a second is this we’ll get some anecdotes, we’ll get some case study, you know, where we know it works. I was talking to a friend of mine at the weekend who works in a in a in a breast clinic in a in a local hospital. And it’s just brilliant to hear and see that physical activity is being used, really powerfully in, in rehab and pre rehabilitation.

So pre having cancer patients for example do you have any case studies you can share in that respect?

Hussain:

Yeah, like so many case studies of where, you know movement and physical activity have improved health and it often improves things that the patient had no idea was, something that it could potentially do. And I’ll use one example.

I’ll change his name, obviously just for anonymity, but let’s take Paul. And Paul was a gentleman that when I first met him, he was about 8 or 9 weeks post discharged from hospital. This was during the right, in the sense of the Covid pandemic, where he was in ICU for a number of weeks, and in fact, his family were told that at one point, highly likely he was not going to make it is absolutely heartbreaking.

But he came to my consultation room, and he said they mentioned that one of the reasons why I developed such a severe response in reaction to Covid was, unfortunately, my background, health, you know, he was struggling significantly with his weight. His Cardiorespiratory fitness was very poor, unfortunately, and he wanted to have a discussion about how we can go about changing that.

And I’ll be totally honest, you know, when I was first thinking and going about this, I still felt relatively overwhelmed with the task at hand because there were a number of issues and barriers and problems in the way and I was slightly sort of, what do I do first? Where do we go? The tip that I learned from that experience, which is the healthcare professional, does not need to have the answers.

You do not need to provide the exact plan by which he’s going to mastermind this turnaround in his lifestyle and health, instead of just giving generic advice to Paul in this case, you need to focus on how can we create an environment in this consultation over a short space of time, over the next few minutes, where you can empower the patient to start feeling confident in generating their own ideas and plans, and you can make them feel good about it, and you can help them realise what those changes that they want to make is going to affect their health.

So I quickly switched it ranks. I had no idea what Paul should be doing first if I was being honest. I said, Paul, you know, what do you think? Where do you think we should go from here? And he started talking about different things that he wanted to try, and he’d highlight why they hadn’t worked in the past.

And, and he mentioned that because of his weight, his joints always hurt very significantly suffered with osteoarthritis due to that. And we talked and it sort of the conversation eventually just steered to swimming. And he felt that, you know, and swam for over 20 years. But when he did swim last, which was over in university, he actually really enjoyed it.

So, we discussed the local swimming group that occurs at the Everyone Active gym near us, where they allow patients with long term conditions to access the pool for free for 12 weeks, and then after that, they have 12 weeks at reduced membership, called the social prescribing membership, and then they go on to full membership after that. And that was the beginning of his journey, and he started swimming.

And it took a bit of time. And eventually that swimming, he got more confident. His breathing starts to improve. He started walking with us and many months and years down the line, he was making significant progress. And in fact, one of the things that we often do is we track our patient’s activity to keep them motivated on an app called Strava.

And I notice on Paul’s Strava that he was starting to do a lot of walks in Leeds. I’m based in Leamington and that’s over two hours away and I like the next walk. I said, Paul, yeah, I noticed that you’re in Leeds a lot and he goes, yeah, I moved to Leeds about nine months ago and I was like, what do you mean you’ve moved to Leeds?

So you’ve been coming to the walk and the swim like every week for the last, you know, two years. And he goes, yeah, I kept coming because yes, my health is improving. Yes. My weight was dropping. Yes, my breathing’s better. But the benefit I got most out of physical activity was the friends I made and the confidence they gave me.

You know, I started having conversations at work, telling them what I needed in order to live a happy and healthier life. I started having better conversations with my family, and they understand me better and I understand them better. I’ve got a much better relationship with my daughter. The benefits he valued most were the things that made him feel better, that made him think he was a better dad and a better employee.

And that is the key message that I want to get across there is that movement is not this simple thing that makes your heart pump faster and you’re breathing better. It has benefits across the board.

Tara:

Yeah. What a fantastic case study done. Who said. And I think a lot of people, will understand the benefits. But many people, particularly in the, in the professional world, like to know about evaluation and research.

And do you have any case studies you can share with us on research and evaluation? Because I know you guys have done quite a bit.

Hayley:

Yeah. I mean, there’s a lot I think what I’m struck by is and this is very much of improvement over the last few years is that we have got collectively, we have got evidence and research and evaluation to help us understand all of this.

You know, in terms of why does it matter what works, how do you do it? You know, what’s important and how you do it. So I think in this moment it feels like we’ve got we’ve got great evidence. What we really need to understand is what’s the real question that someone’s asking and needs to understand. Who is it for?

So this is a strategic, you know, I need to make the case at my health board. You know, or is it? I need to be able to support an individual who’s sitting in front of me to understand the evidence base and it goes back to story and translation. I think, for me is understanding the evidence and evaluate, you know, the evidence that’s available to us and then working out how to connect that and how to use it well to support the work.

And the evidence and evaluation and learning at an individual level, right up to a national level now and everything in between, you know, so we can explore what matters in terms of language, what matters in terms of how we go about things. It can help people to understand the return on investment or what they might commission, or how they might deliver a project or a programme.

It might help to, support and influence in government to understand at a governmental level what are the conditions that we need to create around this work? The, the skill is in is in that connecting between what is the actual question, what’s the problem I’m trying to solve here? And then which data, which evidence, which research is going to help me to, to develop, you know, whether it’s making the case or helping some to understand or whether it’s helping someone to do that job in the neighbourhoods, our job is very much in that kind of connecting, translating thing.

Tara:

I would imagine there’s a lot of people listening today who work in health care. Probably sat there thinking, I too want to feel the benefits of that. I would like my mental well-being to be better and be part of a community, and do something with people that are like minded, rather than go out there on my own and try and do it.

But there’s there are other tools as well. Aren’t that who’s saying that that couldn’t support the NHS workforce, but more familiar to the NHS and not so much on the physical activity side. What’s available to people?

Hussain:

Yeah, there’s a lot more information and tools, for example, digital tools out there, which is making the job of encouraging physical activity for patients easier, in my view, and more effective.

So, if we think about the NHS active ten app, this helps to really break down and sort of chunk up and explain what and why we have that of 150 minutes per week guideline. And of course, there’s, you know, well-known guides and apps like couch to five K. But for those that do want to take on running, we have things like Couch to Fitness, which is a Sport England funded program by the Our parks group, which has a number of different ways of getting active, whether it be outside the window.

So these can be good to help build encouragement and help people progress. Now clinicians can use these tools by either signposting or directly, you know, engaging patients through them and showing them kind of how they work. And also, let’s not underestimate the power that these apps have in motivating people. But we also have more and more useful resources out there for patients.

And for example, We Are Undefeatable, which is a campaign set up by the Richmond Group of health charities in the UK. They have resources for both healthcare professionals and patients, and it’s definitely my go-to, whether it comes to having displays within the waiting room at Primary Care Center to having resources that clinicians can either text out or print off to give to patients, these can help us.

They can give us that structure and confidence when it comes to discussing these kinds of things. And more and more now we’re seeing healthcare professionals being empowered through education. So there’s more resources out there. For example, the Royal College has developed for GPS is a framework for those to build experience and training in the role of lifestyle medicine, of which physical activity is a key pillar of.

So we’re seeing training being delivered to equip them with that knowledge. And then hopefully with time we’ll see confidence increase. Because what we’ve seen from some of the work that we are undefeatable have done is that patients really value healthcare professionals’ opinion and advice when it comes to physical activity. But unfortunately, the healthcare professionals don’t always feel confident and empowered to have those discussions.

So we’re hoping that whether it be training, whether it be resources, tools and also key statements like this, you know, the Four Ways Forward here for harnessing the benefits of physical activity. This can be all part of the process where we can see that shift of incorporating more physical activity, conversations and discussions within healthcare consultations.

Tara:

Just quickly also – what’s the RCGP, Physical Activity Charter?

Hussain:

The Royal College of GP’s active Practice charter is a pledge which essentially practices all primary care networks, or clusters to those in the devolved nations, can sign up by showing evidence that they’ve completed five key criteria.

The other is about increasing physical activity for staff and patients. And the final bit is about partnering with a local physical activity provider. We have now over 500 active practices, which is fantastic. And over the last year we’ve seen the biggest growth in that challenge this year since its launch, which is fantastic. So, what do we want to achieve with it?

Well, obviously we want to start practices on that journey of embedding physical activity into the work that they do. We also want to use that as a, as a sign, the fact that primary care, care about physical activity, that they want to get behind this movement and they want to encourage for more change, to allow them to do this better and more.

So the more practices that we can get signing up to this, the more we can show that, look, primary care engaged. They want to get involved. Let’s support them. Let’s make this job easier.

Tara:

It’s fantastic initiative and thanks for sharing that so concisely. So mean that I mean that’s just one practical step for healthcare professionals, isn’t it, that other any others that you could that you could share?

Because if I were listening today, I would be thinking, okay, I need to get involved here. This isn’t rocket science particularly. The benefits are obvious, and we’ve heard some fantastic anecdotes and. Okay, so listen, both of you all kind of get involved.

Hussain:

Well, it depends where you are. Your first step could be if you want to just increase your own physical activity levels, that’s you getting involved in my opinion, we know that that will help you become more confident in doing the same. When you’re engaging your colleagues and patients, you may want to explore some of the resources we’ve touched on before. Consider training and upskilling yourself in the area. I’d highly recommend whether you’re in secondary or primary care, to contact your active partnership. So active partnerships if you’re based in England, 43 different regions where they support their local area to increase physical activity and help them overcome a number of areas and inequalities that may be existing.  In Wales they are developing their own active partnerships as well, and in Scotland, a number of the regions have within the councils departments which are around trying to increase that. So definitely engage with your community, engage with your physical activity sector and see what can be done. Start off small, then over time, naturally things will come about where you can access them.

But if you don’t know each other, if you don’t communicate with each other, nothing will ever happen. And my final tip is have conversations about it in your teams. Discuss it often. There will be a few people that are really passionate about it. Maybe they can lead this. They may not be senior in terms of their leadership level, but their passion will help drive this.

And you can give this as a side project, a quality improvement task. We always have to show evidence of developing and this could be the personal development plan. So yeah, do sometimes look outside of the box as to who can support in terms of the role or position and yet upskill yourself.

Tara:

Any tips from you Hayley. Any resources or tools that the listeners could, could access to engage with this?

Hayley:

Yeah, I think the key is what I in was saying. No, it’s about conversation isn’t it. And connecting to this agenda personally. And this is right where you started. And I think I would also reflect I recognise we haven’t touched on this, but people working in the health system and in very, very different contexts and roles, you know, you might be in a row where you want to be all day.

You might be working shifts, you might be in an office-based job, desk job. And I think it’s also got to be adaptable. We’ve got to, you know, understand people’s context and conditions and then and then support people in that way. So I think starting conversations, you know, at home in your community, in your, in your job is the is the key.

And don’t yeah. Don’t wait for it to kind of happen top down I think it’s a movement for movement. Everyone’s got a role in the contribution to play, and it can be as simple as starting a different kind of conversation with a colleague. As the saying was talking earlier about the way that the primary care system is connected with the health system and is connected with Park Run and the swimming pool and all the rest, that’s where the real change happens.

And imagine, like if we can create the conditions for that in every neighbourhood across, you know, across the UK

Tara:

Thanks Hayley, and you know to his signs point about active partnerships and you’re a great example in Greater Manchester. You know we work for sport and physical activity works with health in in in so many places.

So, our work for example putting gym in in Hussein’s neck of the woods, you know, we’ve convened local skills boards and, and around every single board there is a there is an IOC team will be there is a local authority there in primary care is represented. Well. There’s an active partnership. There are employers and employees of sport, and there are leisure operators, fitness, sports clubs, you name it.

They’re all around the table and education is around the table as well. And they’re all talking about local priorities and saying I in my area slips, trips and falls in my area, diabetes in my area, you know, tackling obesity and the efficiency of it in local outcomes through collaboration and partnerships is extraordinary. Right? So, if there’s a listener here who’s going up there and you oversaw the budget, again, look no further.

Honestly, that integrating physical activity into health will save you an absolute fortune. But I think, you know, if there’s a takeaway from today for you as a professional, just moving more is so good with your own physical and mental health. You’re busy people. You’re under some pressure. And you’re going to stay busy and under pressure if we can’t prevent people from overwhelming you.

So this is such an obvious conversation to be having. So, listen, Hussain Hayley, thank you so much for such an insightful, energetic, innovative session today. I hope the listeners took loads away. And for those of you who haven’t heard, the other said, this is one of a series of podcasts available to support you. The NHS workforce.

So yes, it’s all around the Four Ways Forward I talked about. Thank you for listening. Do during the next podcast and we’ll see you again soon. Thank you for listening to the Four Ways Forward podcast produced by NHS horizons for NHS England.

Publication reference: PRN02315