NHSU CHAINs Learning _amp; Sharing Event on Obesity_ 17th February by dffhrtcv3


									NHSU CHAINs Learning &
 Sharing Event on Obesity
       17th February 2005
  Exercise on Prescription

          Miranda Thurston
   Centre for Public Health
 University College Chester
l   The Exercise on Prescription model.
l   Exercise on prescription: What can we learn
    from evaluation?
l   EoP: an effective tool for the management of
l   ‘Good practice’ in EoP?
The Exercise on Prescription
l   The original model
    l   A primary care intervention making use of local
        community based leisure facilities, which provide
        structured and supported exercise programmes,
        to which general practitioners and sometimes
        other health professionals can refer their patients.
    l   One of the first schemes to emerge was the Oasis
        Scheme in East Sussex in the early 1980s.
The development of the
traditional EoP model
l   Variations on a theme ….green gyms,
    integrated into healthy living centres …..
l   Number of schemes ….. possibly 1000 in
    England (Riddoch, 2002) up from 200
    reported in 1997 (Fox) but also proliferated
    globally (NZ, USA, for example).
l   Key objective: behaviour change, specifically,
    to encourage long term adherence to
    exercise, amongst those who have
    disengaged from being physically active.
Exercise on Prescription: what
can we learn from evaluation?
l   Problems with methodology and little long term
    follow up (Iliffe et al, 1994).
l   The changing focus of evaluation …..
    l   Evidence of impact: physical and physiological outcomes
        measured objectively.
    l   Evidence of impact: social and psychological outcomes
        measured objectively (for example using the SF36).
    l   Attendance, attrition rates and adherence.
    l   Qualitative work with attenders and non-attenders to
        explore perceptions of the scheme and reasons for
    l   Views of health professionals of the scheme.
Key messages from evaluation
l   Those who are most at risk are least likely to adhere (Taylor, Doust and
    Webborn, 1998).
l   Evidence of small but positive effects, particularly in relation to social
    and psychological variables (Riddoch, 1998), particularly for those who
    attended 75% or more sessions (Jones et al, 2001).
l   Not necessarily effective in relation to increasing long term physical
    activity (Riddoch, 1998; Lawler and Hanratty, 2001; Stahl et al, 2002),
    the critical indicator of success.
l   Those referred generally held positive views about exercise and its
    benefits but were concerned about whether they would enjoy it and how
    painful it would be (Jones et al, 2001).
l   Self-reported changes in lifestyle and improvements in perceptions of
    health for attenders (Jones et al, 2001).
l   Those who completed 75% or more sessions were most likely to have
    sustained the changes at 12 months but getting started was reported as
    ‘hard’. (Jones et al, 2001).
Understanding attrition rates
l   50% of patients who are referred fail to start an EoP
    scheme (Jones and Harris, 1998 cited in Chambers
    et al, 2000).
l   Of those who start, only about 70% are still
    attending at 3 months (Fox et al, 1997) and 20% at
    6 months (Smith and Iliffe, 1997, cited in Chambers,
l   Figures for adherence levels range from 15-70% of
    individuals completing at least 75% of a 10 or 12
    week programme (Shakey, 1997).
l   Percentage of non-attenders highest for those who
    were referred for overweight (Jones et al, 2001).
Understanding attrition rates
l   The factors that influence attendance on the scheme are likely to
    be similar to those that influence physical activity behaviour once
    the intervention is over.
    l Those who had a partner were significantly more likely to
       complete more sessions than those who did not (Jones,
       Thurston, Kirby, 2001).
    l Attenders commented on the social aspects of the programme
       (Jones et al, 2001; Baker, 2000); Hope et al, 1999; Lord and
       Green, 1995).
    l Non-attenders report experiencing health problems which
       prevent them from going to sessions (Jones et al, 2001).
    l Those who had been referred for being overweight reported
       finding exercise very hard and had difficulty keeping up with
       others (Jones et al, 2001).
    l Older people were often worried about exercising (Jones et al,
EoP: an effective tool for the
management of obesity?
l   Health professionals reluctant to raise weight issues with patients (DoH,
    2004); fewer overweight people referred to scheme than some other
    categories (Jones et al, 2001).
l   GPs positive about the psychosocial aspects of EoP but sceptical about the
    medical impact (Jones et al, 2001).
l   Overweight and obese patients lack confidence about their physical
    abilities, have low self-esteem, may feel humiliated in social settings,
    particularly where there is an expectation that they are required to ‘perform’
    (DoH, 2004).
l   Flexibility, tailoring interests to activities, skills and capabilities,
    accommodating group preferences, using activities that can easily be
    incorporated into everyday life are likely to increase participation in physical
    activity (Roberts, 1999).
l   Bind people into social networks where physical activity is customary
    (Roberts and Brodie, 1992).
l   Enjoyment, satisfaction, social interaction, learning skills ……… (Thurston
    and Green, 2004).
Good practice in EoP…..?
l   How can we devise schemes and strategies
    that bind people into satisfying physical
l   What is the role of primary care in such
l   Who are the key professionals?
l   What skills and capabilities are required?

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