MEDICAL MATTERS

It’s all very well but is it

practical? FIA Chief Medical Officer John Searle looks at this month’s topic

T

he new Professional and Operational Standards in Exercise Referral have been out for consultation during the summer. One of the concerns that has been expressed is that the

bar has been set too high and the Standards are just not practical. Putting them into practice will be time consuming and increase costs. As Chair of the group which put the Standards together my response is, ‘If we believe that exercise really can benefit people with chronic disease should we not be providing the most safe and effective service we can?’

The background to the new Standards is important. First, our own sector has been working hard to improve the standards of fitness instructors. The latest National Occupational Standards for our training institutions have raised the bar at all levels of qualification. The latest SkillsActive/REPs Professional Practice Unit for exercise referral puts exercise referral instructors on a par with health professionals. Secondly, one of the hard things for our sector to swallow has been the serious lack of evidence that our current exercise referral schemes are effective. Apart from the findings of the National Exercise Referral Scheme in Wales (NERS), there is no evidence that exercise referral schemes result in a sustained increase in physical activity for patients. And NERS looked mainly at patients with cardiovascular risk factors. This is despite the fact that there is very good disease specific evidence that exercise programmes decrease symptoms and improve activity levels for many chronic illnesses. Thirdly, the British Heart Foundation National Centre for Physical Activity Exercise Referral Toolkit which was published in 2010, while identifying many areas of good practice also pointed out that there are areas of confusion.

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It is against this background that the Joint Consultative Forum of Medical Royal Colleges, the Fitness Sector and the Chartered Society of Physiotherapy have produced the new Professional and Operational Standards in Exercise Referral which will be published towards the end of the year. They set out clearly the referral process from doctors and other health professionals to exercise referral services, a risk stratification method, how to assess patients and the basic principles of an exercise programme to produce a sustainable increase in physical activity. Of course, the new standards cannot be implemented overnight. It will take time. But it is crucial that we move steadily towards that if doctors and NHS commissioners are to have the confidence that the services we offer really can benefit patients.

The REPs Journal 2011;22(Septembet):26