exercise prescription basics and exercise referral Flashcards
definition pa
caspersen 1985
bodily movement produced by skeletal muscles
energy expend
postive correlated to phy f
def exercise
caspersen 1996
pa def plus
- planned,structured and repetitive
-aim to improve fitness maintain
def fitness
usdhhs 1996
fitness is the ability to carry out daily tasks with vigour and alertness and without undue fatigue and to have ample enough energy to enjoy leisure time pursuits and to meet unforeseen emergencies
components hrf
crf body comp ms me flexibility
assoc. pa and fitness
pate et al 1995
inactivity and mortallity
lee et al 2012
9% of premature death caused by inactivity
5.3 million deaths in 2008 due to inactivity
pa guidelines adults
150 minutes a week can be done as 5x30 minutes, should be active daily
or 75 mins vigorous pa a week
2x strength
minimise sedentary
pa guidelines older adults
for adults plus
balance and co-ord 3x a week
recommend some activity is better than none and more will produce more benefits
pa guidelines children 5-18
active daily
60mins mpva a day
3x vig a week to strengthen muscle and bone
minimise sedentary
knowledge of guidelines
shs 2013
4% adults knew
26% parents knew children’s
24% children knew own
meeting guidelines
shs,2015
59% adults meeting guideline
def rehab
stucki et al 2007
aims to enable people with health conditions experiencing or likely to experience a disability to achieve optimal functioning in interaction with the environment
prescrip def
specific guide provided to an individual for performance of programme
exercise prescrip for rehab guideline
process of restoring someone to health via a specific and guided exercise training programme designed to improve or maintain physical fitness
medics knowing guideline
scott et al 2016 85.1%
components of an exercise prescription =7
type frequency intensity progression duration weeks and minutes aspect of fitness pattern
5 phases of exercise prescription consultation
- establish physical activity history-stage of change
2.self-efficacy
3.decisional balance
4.SMART goals
5.action planning
kirk et al 2007
condition and patient influence requiring consideration
- precaution if med condition exists
- based on fitness level
- based on interest
- based on facilities
screening for contraindications methods
- PAR-Q
- medical history
- prescence of a medical condition based on measuring eg BMI
- exercise testing eg ECG cardiac stress, ECG arthymia, TUG, tineeti max incremental shuttle test, 6mwt
physical inactivity cost to nhs statistic
physical inactivity cost the NHS scotland 94.1 million a year foster et al 2012
patients visit their GP
6x a year BMA,2013
NHS pathway for exercise referral
- scot PASQ ask in past week number of days active >30
if 4 and less ask are you interested in doing more pa?
if say no then give leaflet and guidelines
if say yes then start with brief advice and brief intervention and give exercise refferal
what is brief advice
pro actively raising awareness of and assesses a person’s willingness to engage in pa.
-less than 3 minutes
-listen to their needs/ concerns and observe for health related conditions
-ask raise issues
assess person’s response
- advice
what is brief intervention
opportunity if people respond positvely to BA to give a more detailed advice on changing lifestyle and behaviour
- 3-30 minutes
- use behavioural change techniques, counselling or motivational interviewing to support
what is signposting or green prescription
health professional may recommend a suitable activity or green prescription
-from NZ 1990s
definition of a green prescrip
swinburn 1998
similar to a normal prescrip but emphasises the importance of pa in improving their condition rather than relying on drugs alone
what settings are there for NHS pathways for PA
- secondary care ie urgent and planned care in a hospital with referral from primary care
- in acute settings such as long stay in hospital
- in health and social care eg the pharamacy
exercise referral definition NICE 2014
- an assessment of PA by a health professional
- a referral by a health professional to a PA specialist/ service
- a personal assessment to determine what programme of PA to recommend for their specific needs
- an opportunity to participate in a PA programme
- does not cover structured exercise programmes designed for managing a specif health condition or for rehab ie its not rehab
exercise referral def by the register for exercise professionals 2018
- specific and formalised programme
- medical professional refers patient to fitness programme
- not same as reccommendation to exercise
- formal agreement between referer and exercise project
- usually run by LOCAL AUTHORITY but not exclusive
national quality assurance framework for exercise referral 8 nhs 2001
- establish a formally agreed process for the selection, screening and referral of specific patients.
- conduct appropriate assessments of patients prior to the exercise programme
- provide a specifc range of appropriate and agreed pa for a defined period of time to maximise likelihood of long term participation
- ensure any assessments and the exercise programmes are delivered by professionals and with appropriate competencies and training to match the needs of the patient referred
- incorporate a mechanism for evaluation
- facilitate long term support for patients
- ensure the patient is consulted and involved throughout the referral process and encouraged to take responsibility
- ensure confidentiality of patient info
references for effectiveness of exercise referral
pavey et al 2011
Elley et al 2003
swinburn 1998
live active referral scheme
NICE guidance on ERS
- ERS should not be funded for those who are sedentary but otherwise are healthy
- ERS should be funded for those who are inactive AND have existing health conditions or other factors that have put them at increased health risks
- ERS should incorporate behaviour change techniques
- collect data to facilitate analysis and monitoring
pavey et al 2011
-8 RCT 6 compared ERS to usual care -2 to alternative PA intervention -self report measure white middle aged mostly -found it increased pa by 90-150 minutes a week for ERS and decreased depression
limitation of pavey et al 2011 study
- marginal added effect relative to other ways of increasing pa
- weak evidence short term increase
- heterogenity across studies
- little evidence studies used behavioural change techniques or theories that underpinned bct
- no evidence on specific med diagnosis
- only short term
Elley et al 2003 STUDY DESIGN
long term effectiveness of green prescription
12 months
-GP summary: screen, discuss goals, copy sent to foundation & exercise specialist makes 3 telephone calls to patient
-intervention study with patients prompting gp to give oral/ written advice and exercise specialist continuted support by telephone
versus Cg USUAL CARE
RESULTS ELLEY ET AL 2003
-energy expend increased 9.4kcal/kg week more IG vs CG
-leisure exercise increased 2.7 kcal/kg/ week more or
34 minutes LEISURE EXERICSE A week more IG
-proportion of IG meeting guidelines increased 9.72% more then CG
-SF-36 measures self related health increased more in IG
-trend toward decreased bp but no change 4yr risk CHD
swinburn 1998 green prescription
- RCT green prescrip written versus usual verbal advice over 6 weeks
-456
-79% advice to increase walking
-in both groups combined the percentage engaging in any recreational pa increased 54% to 81% - recreational pa baseline to follow up increased more in the green prescription group
-self report pa in order to maintain health increased more in green prescription from 36% to 68% sig more than
-both increased in duration of pa
concluded green prescrip more effective for 6 weeks
live active referral aim
to improve the health and pa levels of greater glasgow by providing cllients with the knowledge, tools and confidence to meet pa goals
how does the live active referral scheme work
1:1 behavioural support consultation personalised goal set/pa plan supervised activity sessions relapse prevention live active monitors
live active consultation
parq history measurement discussion pa readiness db relapse prevent lifestyle goals agreed
live active referral process
either from gp green prescription or cardio rehab physio identifies patient
live active referral heart disease special consideration
need an exercise tolerance test
and special referral from B
inclusion criteria for live active
> 16
bp 160/90 less then
more contra i
referral for live active statistics from 2015
85% patients without etablised hd 6% with hd 8% cardiac referral 72% attended baseline 44% 6 month 22% attend 12 month
out of 22% 63% are meeting pa guideline
what are the live active referral vitality classes
exercises classes designed for specific med conditions
dont need one to one support- decrease instructor ratio as move through
- strength and balance class= chair based ie limited dynamic balance walks slow with mobility aid
- strength and balance circuit= independent mobility but low func capacity
- step in circuit mod func capacity
- step up circuit= good func capacity
ie copd would be towards early stages with poor fuc capacity
5 phases of exercise prescription for a consultation
- stage change and pa history
- self-efficacy
- decisional balance
- goal setting
- action planning kirk et al 2007
6 stages of exercise prescription
- screen
- pa history and stage of change
- self efficacy
- decisional balance
- goal set
- action plan w,w,w,w,h
- relapse prevention
FIT principles ie general exercise prescription guidelines action planning
aerobic frequency= 3-5 times a week intensity= mod to vig duration= 20-35 minutes session flexibility 2-3 times a week 4 or more reps on muscle group hold 30-60s static average person Ep guidelines strength 2-3 days a week 2-4 sets, 8-12 reps, 2-3 min rest 60-80% 1rpm or for ME 1-2 sets 15-25 reps, 50% 1rpm
o’halloran and bhogal 2014
garber et al 2011 resistance training
2-4 sets
2-3 min rests
60-80% 1pm but 40-50% for elderly
bmi CLASSIFICATION
.18.5 > NORMAL >25 OVERWEIGHT >30 OBESE >35 OBESE ii >40 OBESE iii
ASIAN
18.5 TO 22.9 IS NORMAL
>23 OVERWEIGHT
>27.5 OBESE
FFIT PRINCIPLES
FREQUENCY, INTENSITY, TIME AND TYPE
O’halloran & bhogal 2014
overweight person that wants to exercise- exercise program should include:
type=walking or cycling
duration= 30 minutes 3 times a week that could be broken down to at least 10 minute bouts
intensity= moderate to vig walking pace to notice an increase in hr and breathing
progression= increased by 10 minutes every 1-2 weeks so end of month 60 minutes of mod vig 3xweek
-first alter duration then alter intensity by changing mode of exercise to cross training and rowing such as to provide more variability or swimming ie (avoid load bearing)
-ensure follow up
Resistance training should be added on additional to aerobic. 3x per week 8-10 exercises with 10-15 reps set at a weight that will not strain.
O’halloran and bohgal 2014
risk factor testing
- bmi for children percentile 85th-94th risk of overweight, >95 overweight >98 obese
- blood pressure 140/90 hypertension
- blood glucose ogtt > 11.1 fasting >7 random >11.1
- alcohol
- diet
- smoking
- exercise tolerance test
- ecg
- waist circumference >35 88cm inches for women and >40 inches for men 102cm
cmo,2011
the 8 benefits of physical activity and percentages
