EXERCISE REFERRAL 1 HEA recommendations for design and implementation

• The main aim of a scheme should be to achieve a behaviour change that will result in long-term participation in an active lifestyle – physical activity only confers health benefits during the stages of life when an active lifestyle is adopted

• Promote the message of 30 minutes of moderate activity five times a week

• Promote non-facility based activities such as walking and cycling – exercise that doesn’t require constant supervision and is cheap for the patient

• Offer a variety of activities that will appeal to different people

• Encourage patients to engage in less obvious forms of exercise such as gardening and take these activities into account in activity evaluations

• Target the elderly sedentary patients as they not only experience more significant benefits but are also the most cost-effective group to target – exercise can have a significant positive effect on osteoporosis even at age 50+

• It is important that training for, and the organisation of schemes are based on an accepted theoretical model of behaviour

• Training of exercise specialists is crucial to the success of schemes – both in caring for individuals with medical conditions and in achieving behaviour change through motivational techniques

• GPs are an important component of the support network that enables patients to adopt and maintain the lifestyle changes

2 HEA recommendations for the evaluation of schemes

• Do not undervalue the social and psychological benefits of schemes – this is often is quoted as the most successful element of projects

• Include psycho-social measurements in addition to the physical activity participation in evaluations

• While physical activity is an important outcome measure, assessment of mediators of physical activity (e.g. self-efficacy, State of Change) are a good indicator for patients on their way to behaviour change

• Physical activity is difficult to measure so it is critical that valid and reliable questionnaires are used

• As the ultimate goal is lifelong changes in activity – long term follow-up is essential to assess meaningful health gain

Be realistic

• Major changes in large numbers of people are unlikely but small changes in a large number are meaningful

• Accept that studies which seek significant behavioural changes such as exercising every day or stopping smoking show considerably lower rates of success

• Where there’s a will, there’s a way – if properly organised it is possible that 25-30% of a target group will participate – the OASIS project in Hailsham, Sussex has achieved an adherence rate of between 40-60% over the last four years

The National Quality

Assurance Framework Shortly after publication of the HEA review came the consultation version of the DOH-commissioned National Quality Assurance Framework designed to provide national guidelines on the

SportEX 21

development, running and evaluation of exercise referral schemes.

The document has been produced jointly by the British Association of Sport and Exercise Sciences (BASES), the governing body of sport and exercise science

and Exercise England (formerly The Exercise Association), governing body of the fitness profession.

The framework focuses closely on the practical application of guidelines and includes suggested templates for GP referrals, informed consent and activity planning.

The guidelines include

advice on: • The selection of patients • How to assess physical activity both before and during the programme

• What exercise to recommend • How to promote long-term physical activity and provide the necessary support

• The competencies required from those involved in the schemes • Medico-legal aspects of referral

The issue of responsibility of patient care is one of the most important factors in the success or failure of schemes. This is partly because it is an issue of trust between the referring medical practitioners and scheme staff.

If GPs don’t feel confident in accepting responsibility for the patients with medical conditions referred to the scheme then the success of the scheme is likely to be seriously compromised.

The framework suggests guidelines for the referral-specific competencies required from each of the professional groups involved. These include GPs, community nurses, physiotherapists, operational managers, commissioning managers and the exercise specialists.