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exercise referral


Holistic: 1-Greatlife addresses exercise, nutrition and the mental challenge of lifestyle change


Case Study 1-Greatlife


programme. Developed over five years as a collaboration between Georgina Jupp’s CK Academy and Basildon-based GP Dr Robert Colby – thereby integrating medical and fitness expertise – it adopts a holistic approach, addressing not only nutrition and exercise but also the intellectual challenge associated with achieving effective lifestyle change. The incorporation of this mental/ motivational aspect, which can be so crucial to overcoming initial barriers, as well as to adherence and ultimately success, is what the 1-Greatlife team believes sets this scheme apart. Addressing a diverse range of


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factors – including stress management, wellbeing management, confi dence building and personal development alongside physical activity and nutritional education – 1-Greatlife caters for the obese/overweight, those with joint pain or mobility problems due to musculoskeletal conditions, and those with mental health conditions such as depression, anxiety and hopelessness around the possibility of making signifi cant lifestyle change.


ACTIVITY LEVELS “FITT” Scores


Introduction course Maintenance course


-Greatlife positions itself not as exercise referral but as an evolving lifestyle modification


Delivered by high-level, specially


trained fi tness professionals – known as ‘lifestyle advisors’ – 1-Greatlife focuses on one-to-one attention and constantly evolving personalised plans based on detailed assessment. But crucially it also focuses on the inter-personal element: forming and maintaining relationships with each patient, providing a ‘warm, accepting and understanding environment’ and seeking to continually increase each patient’s enjoyment of the process. Exercise referral specialists are used


for case management from point of referral, surgery-based one-to-one assessments using shared primary care electronic records, group education via seminars, group functional physical activity sessions, coaching and support resources – and of course the development of the aforementioned ‘therapeutic relationships’.


statistics & savings In 2007, 1-Greatlife won a formal tender by NHS South West Essex (NHS SWE) PCT. Nearly 700 patients have since undergone detailed assessment in surgeries, 600 patients have participated in the 12-week introductory course and 300 patients have taken part in the eight-week maintenance course.


The analysis of 1-Greatlife’s data by NHS SWE


Before After Difference % increase 1.44 3.22


3.13 4.28


1.69 1.06


117.35 32.76


WAIST CIRCUMFERENCE (CMS) Before After Difference % increase 118.98 112.39


Introduction course Maintenance course


EXERCISE TOLERANCE


Introduction course Maintenance course


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Before After Difference % increase 20.79 22.46


25.46 5.92 25.38 3.67


28.46 16.32


Read Health Club Management online at healthclubmanagement.co.uk/digital


115.15 -3.83 111.04 -2.18


-3.22 -1.94


In autumn 2009, NHS SWE


performed a statistical analysis of the scheme’s data, including the following KPIs: activity levels based on FITT scores (frequency, intensity, time – ie duration – and type of physical activity), waist circumference, exercise tolerance (using the ‘sit to stand’ measure) and HAD scores for depression. The FITT, waist and tolerance results can be seen in the table below. In addition, HAD scores decreased by 50 per cent. Not only that, but an independent


source calculated the cost savings, in terms of reduced in-patient spells and outpatient attendances, to be over £300 per patient. Primary care consultations were also reduced: 36 per cent fewer GP consultations and an 11 per cent reduction in practice nurse consultations. The scheme as a whole achieved


a 70 per cent retention rate – those embarking and remaining on the course – with a GP survey suggesting that “signifi cant benefi ts” had been noted in patients who had been referred to 1-Greatlife, and that “lifestyle modifi cation should be a top priority” going forward. Three packages are currently


available within the 1-Greatlife programme: the preferred introductory 12-week course (24 physical activity sessions, six weekly educational seminars and three surgery assessments, at a cost of £480 per patient); an eight-week introductory course for those under budgetary restraints (a possible 16 physical activity sessions, eight educational seminars and two surgery assessments, at a cost of £325 per patient); and an eight-week follow-on maintenance course (a possible eight physical activity sessions, two educational seminars and one surgery assessment, at a cost of £275 per patient).


april 2011 © cybertrek 2011


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