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Healthy Exercise and Lifestyle Programme (HELP) by dfhrf555fcg

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Healthy Exercise and Lifestyle Programme (HELP)

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									     Healthy Exercise and

  Lifestyle Programme (HELP)
      (Exercise Referral System)




     Information Booklet

            July 2007

Contact: Sue Collins 0191 5297202
e-mail: sue.collins@suntpct.nhs.uk
HELP is a joint initiative between Sunderland Teaching Primary Care Trust and Sunderland Community and
Cultural Services Department. It was established initially as Personal Exercise on Prescription (PEP) in the
Washington area in 1995 and went City Wide as HELP in October 2004.

The aim of the programme is:

   to work with General Practitioners and other Health Professionals to provide members of the
    community who are inactive, have specific health conditions or are socially excluded with the
    opportunity to safely increase their physical activity levels thereby promoting a healthy lifestyle

Objectives
   to promote and encourage the integration of exercise and raised physical activity levels into lifestyle
    patterns
   to elicit the co-operation of health care professionals in referring to the scheme and to make them
    aware of the benefits of exercise for certain conditions
   to provide participants with the knowledge and confidence to become independent exercises upon
    completion of the programme
   to network with community based leisure operations to provide maximum opportunities for patients
    referred to engage in appropriate physical activity
   to determine the benefits of the scheme as perceived by referring agents as well as patients
   to market a high quality service and to offer safe, effective and appropriate physical activity to those
    referred

Are there any benefits of being active?

The table below identifies some of the benefits associated with regular physical activity, together with some
of the consequences and personal costs of a sedentary lifestyle.

               Benefits of regular activity:                             Health risks of inactivity:

        better health                                                   premature death
        improved fitness                                                heart disease
        better posture and balance                                      obesity
        increased confidence                                            high blood pressure
        weight control                                                  type II diabetes
        stronger muscles and bones                                      osteoporosis
        feeling more energetic                                          stroke
        relaxation and reduced stress                                   depression
        continued independent living in later life                      colon cancer


The process is as follows:

   potential participants are identified by their GP, Practice Nurse, Consultant, Dietician, Physiotherapist,
    members of the Cardiac Rehabilitation team etc.
   a referral form is completed detailing relevant medical history and sent to the venue of their choice
   the Lifestyle Officer risk stratifies the individual and passes those classed as low risk to the Wellness
    Referral Consultant for processing. The Lifestyle Officer arranges an initial appointment for those
    classed as moderate and high risk for exercise.
   if the referral is appropriate the individual will be enrolled onto the programme for 15 weeks.
   during this time participants can access a variety of activities at a reduced rate.
HELP uses the established model of exercise on referral incorporating a client centred approach, see below for
diagrammatical representation.



                                      ‘HELP Referral Model’
         GP/ health                      EvaluatIon
        professional                                                               Development of
                                                                                    Programme

    Suitable candidates:
    based on referral protocol                                                   Individually-tailored
    inclusion criteria                Exercise specialist                        exercise programme:
                                      (client centered programme)                menu based programme
                                                                                 incorporating supervised and
                                                                                 independent activities.



Inclusion criteria:

Suitable candidates may include individuals (aged over 16) with at least two specific risk factors for
disease, see checklist 1 for additional details on inclusion criteria. Individuals should be thinking about
becoming more active, but need support in starting an exercise programme.

Exclusion Criteria
There may be a number of reasons why individuals may not access the programme; for a full list of
contraindications see checklist 1.

     IMPORTANT NOTICE: HELP is not available to people who live outside the Sunderland area.

Participant benefits include:

    a personalised activity plan to suit their needs
    specialised activity classes including HeartSmart, Line Dancing, Aquafit
    community activities such as health walks and Wellness Easy Line sessions
    supervised gym sessions
    access to other health enhancing programmes including smoking cessation, individual or group weight
     management and healthy eating
    re-assessments and ongoing support and advice
    the knowledge, skills and confidence needed to continue with the programme independently

Wellness Centres offering exercise referral:

The following table outlines the current supervised gym sessions offered by the NHS Specialist Exercise
Practitioners (Lifestyle Officer):
         Wellness Centre                      Contact No.                     Days                      Times
            Bunny Hill                       0191 520 5222           Wednesday and Friday           9am – 12noon
             Crowtree                        0191 553 2565
                                                   or                Tuesday and Thursday             1pm – 4pm
                                             0191 553 2585
             Houghton                       0191 553 6470                   Tuesday              9am – 12noon 1pm -
                                                                            Thursday                    4pm
               Puma                          0191 553 5901            Monday Wednesday              9am – 12noon
                                                                                                     1pm – 4pm
           Washington                        0191 2193410                  Monday                    1pm – 4pm
                                                   or                      Tuesday,                 9am – 12noon
                                             0191 219 3422            Thursday and Friday
             Seaburn                         0191 529 3800                   Monday                  1pm – 4pm
                                                                             Friday                 9am – 12noon

The following supervised gym sessions are offered by Wellness Referral Consultants:

        Wellness Centre                      Contact No.                      Days                      Times
            Bunny Hill                      0191 520 5222                  Monday                    1pm – 4pm
                                                                          Wednesday                  2pm – 4pm
                                                                            Friday                  9am – 12noon
            Crowtree                        0191 553 2565
                                                                          Tuesday and
                                                  or                                                  1pm – 4pm
                                                                           Thursday
                                            0191 553 2585
            Houghton                        0191 553 6470                   Tuesday              9am – 12noon 1pm -
                                                                            Thursday                    4pm
              Puma                          0191 553 5901             Monday Wednesday              9am – 12noon
                                                                                                     1pm – 4pm
           Washington                       0191 2193410                  Tuesday and                 1pm – 4pm
                                                  or                      Wednesday
                                            0191 219 3422                  Thursday                 9am – 12noon
             Seaburn                        0191 529 3800                   Monday                   1pm – 4pm
                                                                            Friday                  9am – 12noon
       Raich Carter Centre                  0191 553 2333             Monday Wednesday               1pm – 4pm
                                                                         and Friday                 9am – 12noon


Pricing structure:
All activities are heavily subsidised by partner agencies, see checklist 2 for current pricing structure.

What happens at the end of the course?
Upon completion of the programme individuals are invited to attend a re-test appointment to assess
progress and explore ways of continuing their active lifestyle.

All centres off reduced rates to those who have completed the programme successfully see checklist 2 for
details.
Key targets/milestones met 2006 - 2007
To tackle the ‘Improving Health and Social Care through Promotion of Wellness’ priority within the City’s
Community Strategy, a series of stretch targets have been articulated within the Local Public Service
Agreement 2nd Generation (LPSA 2G). The LPSA 2G targets have been developed and agreed between
the City of Sunderland and the STPCT and have been endorsed by the City’s Local Strategic Partnership.

Indicator: Increase life expectancy* and improve quality of life by encouraging people (16+) who are
currently overweight or obese, to participate in a structured physical exercise regime and thus reduce their
body mass index (BMI).
Performance expected with the LPSA at 31 March 2008
         1225 people completing HELP, 1072 DALYS gained

This target is well on the way to being achieved with 939 people completing the programme (77% of 2008
target) and 773 DALYs gained (72% of the 2008 target).

Target – 1450 people accessing HELP.

Target achieved, with a 17.3% increase, during the reporting period there were 2068 people referred to the
programme of which 1702 (82%) attended an initial assessment with the Lifestyle Officer, another 227
(11%) were classed as low risk and passed to Wellness Staff, the other 7% (n=139) were no shows.

Aim – target inactive individuals or those with specific health conditions and offer an individual
exercise programme to safely increase their physical activity levels.

This initiative has successfully targeted individuals who would benefit their health by becoming more active,
attracting a large percentage of older people, with a wide range of medical conditions.

Of the 1702 people referred there were 427 (27%) individuals referred with four or more conditions, 598
(38%) with three, 320 (20%) with 2 co-morbidities, and 233 (15%) with a single condition identified.

                                                                                    NUMBER           %
   Vascular                                    Angina                                     91           5.3
                                               CABG / PCI                                 44           2.6
                                               Heart attack                               97           5.7
                                               Heart problem                             329          19.3
                                               Stroke                                     31           1.8
                                                                            TOTAL        592          34.8

   Muscle / Bone /Joint Problem                Back Problem                                 89         5.2
                                               Bone / Jt problem                           729        42.8
                                               Fibromyalgia                                 14         0.8
                                               Osteoarthritis                              100         5.9
                                               Osteoporosis                                 23         1.4
                                                                            TOTAL          955        56.1

   Breathing Problems                          Chronic Asthma                              186        10.9
                                               Other respiratory problems                   29         1.7
                                                                            TOTAL          215        12.6

   Metabolic                                   Diabetes - Type I                            19         1.1
                                               Diabetes - Type II                          242        14.2
                                               Pre-diabetes                                 11         0.6
                                                                            TOTAL          272        16.0
   Mental Health                              Stress / anxiety                             37         2.2
                                              Depression                                   57         3.3
                                                                         TOTAL             94         5.5

   CHD Risk Factors                           CHD prevention                               25         1.5
   (weight can also be included in this
   category)                                  Increased blood pressure                    547        32.1
                                              Increased cholesterol                        93         5.5
                                                                         TOTAL            665        39.1

   Weight                                     Obese                                       164         9.6
                                              Overweight                                  170        10.0
                                                                         TOTAL            334        19.6

   Miscellaneous                              Epilepsy                                     26         1.5
                                              Falls prevention                             17         1.0
                                              Recovering from Surgery                      53         3.1
                                              Sedentary / unfit                            48         2.8
                                                                         TOTAL            144         8.5


Objective – to promote and encourage the integration of exercise and raised physical activity levels
into lifestyle patterns

Of the 1702 people attending the initial assessment 939 (55%) completed the programme – this figure only
includes those individuals who attended the initial and end of programme (re-test) appointments. There
were 330 (20%) currently exercising (partway through their programme), and 433 (25%) classed as
dropouts. It is worth noting that this figure includes those individuals who completed the scheme but failed
to attend the re-test appointment and those individuals who only required initial advice and signposting to
appropriate community activities.

Self-reported activity levels increased for all individuals completing the programme, with 77% (n=721) being
classified as taking 30 minutes of moderate activity on at least 5 days per week.

Objective – to elicit the co-operation of health care professionals in referring to the scheme and to
make them aware of the benefits of exercise for certain conditions

HELP programme currently accepts referrals from 125 GP’s and Practice Nurses from 44 practices across
the City. In addition, referrals are receive from the Cardiac Rehabilitation Team, Specialist Nurses,
Physiotherapy (acute and community), the Mental Health Unity, Dietetics (acute and community), Occupational
Therapy, Rheumatology, Endocrinology and Gynaecology departments.

Objective – to provide participants with the confidence to become independent exercisers upon
completion of the programme

Of the 939 people who completed the programme 79% indicated they would continue to exercise, following
a similar programme to when they were on the scheme e.g. gym, swimming and walking, the other 21%
suggested that they would continue to exercise independently.

Of those who dropped out 48% (n=208) indicated that they had increased their activity level and were
exercising on a regular basis. Water-based activities (swimming, aquafit) were the main activity of choice at
41% (n=85), while 29% (n=60) suggested they were walking regularly, other activities were varied and
included joining a private health club, playing golf, and attending local exercise classes.

Year-on-year in-house evaluation indicates that patients’ confidence and self-esteem increases while on the
programme. Post interviews suggest that patients attribute their new-found confidence to participating in
HELP. An external evaluation was undertaken by the Sunderland University as part of the successful
Neighbourhood Renewal Funding bid ‘Activate your Health’, copies are available upon request.

Objective – to network with community based leisure operations to provide maximum opportunities
for patients referred to engage in appropriate physical activity

Linking with the Community Wellness Initiative allows HELP participants increased activity opportunities
within the community, during and after completing the programme.

Objective – to determine the benefits of the scheme as perceived by referring agents as well as
patients

Feedback from referring agents is positive, with 85% indicating that the quality of information they receive is
very good. In response to the question regarding their overall perceptions of the programme, 30% thought
the scheme was very good and 70% suggested it was excellent. Comments included:

“This programme has been very well received by our patients, it has been particularly popular with the over
50’s – an age group where regular exercise can make a real difference to their health”
“I think this is an excellent and worthwhile scheme, feedback from my patients is excellent”
“I have seen a lot of benefits for people that have been motivated to attend”
“My patients are very enthusiastic about the programme”
“Very beneficial and of genuine therapeutic use”
“Please keep up the good work”

Objective – to market a high quality service offering safe and effective exercise to those referred.

HELP is in line with the Governments National Quality Assurance Framework for exercise on referral
systems. All Lifestyle Officers (LOs) are on the Register of Exercise Professionals as Advanced Level 3
instructors, participants receive an individualised programme of activity tailored to their needs and health
conditions.

Of those completing the programme 96% said they think the scheme is a good idea and had been beneficial
for them. Many positive comments were received, including:

“It makes you feel safe having someone to show you the equipment and make sure you don’t overdo it”
“It’s good for everyone, even if you’ve got a severe heart problem or blood pressure, or things like that”
'It has surprised me how much I enjoy going to the gym, thanks to all the staff for the care and attention I
received. I feel fitter than I have for a long time and more mobile”
“In my opinion the scheme is excellent, I’m definably continuing with my programme”'
“I feel much better both physically and mentally”

General – HELP has been very successful in engaging local people, particularly those from areas of
deprivation – see appendix 1 for map, and attracting individuals who do not meet the recommended 30
minute of moderate activity on most days of the week, or those who have would not normally attend a
leisure centre. The programmes success is largely due to the friendly and welcoming environment it
provides, the individual support and coaching people receive and the fact that it responds to the individuals
needs, offering personal health plans.
Appendix 1: Geographical spread of referrals to HELP (2006-07) overlaid on deprivation map




                                                                         Most deprived 5%
                                                                         Most deprived 5%
                                                                          5 % to 9 %
                                                                          5 % to   9%
                                                                         10% to 19%
                                                                         10 %     19 %
                                                                         10 % to 19 %
                                                                         20% to 29%
                                                                         20       29
                                                                         20 % to 29 %
                                                                         30% to 49%
                                                                         30 %     49 %
                                                                         30 % to 49 %
                                                                         50% to 100%
                                                                         50 %    100 %
                                                                         50 % to 100 %




NB: The HELP referral system was only established in Bunny Hill mid May 2006

								
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