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Exercise on prescription

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Carol Corbett, ILAM, YMCA Fitness Trainer Award, Dip Sports Ther, Dip Sports Massage; Becky Woodiwiss, BSc Hons, PG Dip Health Ed

Carol-Health Liaison Officer, Co-ordinator and Lead Instructor, Exercise Recommendation Scheme, Crawley Borough Council; Becky-Formerly Health Promotion Specialist, Crawley Primary Care Trust, West Sussex

Crawley Borough Council in West Sussex has funded an exercise recommendation scheme (ERS) for the past six years, in collaboration with West Sussex health promotion department and Crawley Primary Care Trust. It enables people in the local community to be guided through a safe, effective, enjoyable exercise programme tailored to their needs under careful supervision. Many people become unfit through inactivity and the ERS is a way to get back into exercise.
Crawley Borough Council in West Sussex has funded an exercise recommendation scheme (ERS) for the past six years, in collaboration with West Sussex health promotion department and Crawley Primary Care Trust. It enables people in the local community to be guided through a safe, effective, enjoyable exercise programme tailored to their needs under careful supervision. Many people become unfit through inactivity and the ERS is a way to get back into exercise.


Modern lifestyle is taking its toll on many people. We seem to get busier and, with less time for relaxation and recreation, stress levels are on the increase, with many people suffering from high blood pressure, depression and fatigue. People are becoming overweight and diabetes is fast becoming a major issue. These conditions are often caused by poor diet and lack of exercise.


A general lack of movement can make people feel tired and out of condition. Exercise is one lifestyle change that can improve general well-being, in mind and body.


There is an established body of evidence that exercise helps in a number of conditions. Box 1 provides the policy and research background to such schemes.


The instructors
The scheme is run by qualified fitness instructors who have attained the Institute of Leisure and Amenity Management Certificate of Competence. This is a GP referral scheme qualification and is taught by doctors and sports specialists.


The instructors are taught about low-risk category health problems and the associated effects of medications on the body during exercise. They hold the YMCA Fitness Trainer Award and first aid training certificates; they also carry a defibrillator and are trained to use it, although this has not been needed to date.


Referral system
Health professionals such as doctors, practice nurses, physiotherapists, dietitians, cardiac rehabilitation teams and so on are invited to identify patients with low-risk health problems who they feel would benefit from regular supervised exercise. Such problems include general lack of condition owing to lifestyle, high blood pressure, asthma, muscular/joint problems, stress/anxiety and depression, being overweight, obesity, diabetes and so on.


The health professional fills in a form, detailing the patient's health conditions and relevant medication, along with past medical history. These are passed to the health liaison officer at the borough council.


The scheme
Patients are invited to a welcome meeting two weeks before the start of the scheme. This offers them a chance to meet other participants, discuss the scheme with instructors and ask questions about beginning an exercise programme. They are allocated to their classes, given timetables and asked to book a 20-minute pre-assessment appointment. At this stage, they also sign a consent form, to confirm that they understand what the scheme entails and that they will inform the instructors of any health or medication changes that may occur while they are on the programme.


The pre-assessment session includes a friendly individual chat about any fears or concerns patients may have before starting on the scheme. It also gives the instructor a clear overall view of how motivated the person is and whether any extra advice is needed before the course begins. The assessment also involves recording height, weight, body mass index, peak flow and blood pressure/resting pulse readings. The person may then begin the programme the following week.


The ERS runs for 10 weeks, and participants are asked to attend twice a week. The classes are run in local community centres, and the gym-based classes are run at a leisure centre. The gym is closed to the public at these times to ensure maximum safety and privacy. There is a small charge - £2.50 in the gym and £2.50-£3.50 in the community centres.


The council runs the programme as a rolling process, which helps keep waiting lists short. It is considered that a 10-week course of twice-weekly sessions is a reasonable amount of instruction to identify some clear health changes in the body, such as improved cardiovascular capacity, improved motor skills and muscular movement.


Improved cardiovascular fitness is a most important element of the exercise programme. By obtaining a better oxygen flow through the blood in the body, the exerciser will feel better overall, and lose that heavy, sluggish feeling. Many people are concerned about losing weight. The instructors explain that, while the ERS focuses on overall general health, as a result of getting back into regular exercise the metabolism will adjust and weight may be lost. A specific weight-loss programme can be introduced at a later date.


Stretching is a very important part of the sessions. Performing regular slow stretching improves flexibility, enabling a better range of motion in the joints. Lack of flexibility can result in poor posture, creating mechanical im-balances in the back, hip and neck. Such imbalances pull segments of the body out of line, causing stress, strain and poor posture.


Some of the exercises also help improve motor skills, which is very important as we get older. Resistance training is introduced to strengthen the muscles to resist atrophy or a weakening of the muscles over time.


Mid-point and post-course assessments are made and individual reports sent to the recommending health-care professional.


Participant feedback
Many people have enjoyed being part of the scheme and have given positive feedback. People who have had replacement hips or knees have noted that they have an improved range of movement after regular exercise, and have found that by continuing stretching at home every day they continue to improve. They have often been surprised that they can do many of the exercises if they persevere and keep moving their muscles.


Several people with asthma feel they have improved their lung capacity and strengthened their chest muscles, and have had to use their inhalers less often. They note that they are doing more general activities, such as walking, gardening and so on, without getting breathless.


All classes are held in groups - the social aspect is important. Many people make friends, some car share and continue to meet after the course has finished.


Patients who complete 80% or more of the full programme are given a council Leisure Plus card, normally sold for around £7, which entitles them to reduced rates. They also get a gym card giving them access to gyms without paying for a new induction session. This means they can continue to improve their health and fitness levels in their own time. Extra classes are also held in local community centres for people who have completed the course but wish to stay with the same instructors.


Future developments
The council hopes to continue the ERS and get as many people in our community as possible involved with movement and physical activity. We accept people aged 18-75 years. In practice, most participants have been aged 45-70 years.


There are plans to develop sessions for older people in warden-based accommodation or homes. The council also hopes to tackle the growing problem of overweight and obese children over the coming year.


- The authors wish to thank Lyn O'Doherty, RGN, Sarah Ray and Nicki Lloyd, ERS instructors, and the other health professionals involved

British Heart Foundation National Centre for Physical Activity and Health. (2001) Physical Activity Toolkit: A training pack for primary health care teams. Loughborough: BHF NCPAH.

Department of Health. (1999a) Saving Lives: Our healthier nation. London: The Stationery Office.

Department of Health. (1999b) The National Service Framework for Mental Health. London: The Stationery Office.

Department of Health. (2000a) The National Service Framework for Coronary Heart Disease. London: The Stationery Office.

Department of Health. (2000b) The Cancer Plan. London: The Stationery Office.

Department of Health. (2001) The National Service Framework for Older People. London: The Stationery Office.

Department of Health. (2002) The National Service Framework for Diabetes. London: The Stationery Office.

Garrow, J.S., Jones, W.P.T., Ralph, A. (2000) Human Nutrition and Dietetics. Edinburgh: Churchill Livingstone.

Health Education Authority. (1997a) Effectiveness of Mental Health Promotion Interventions: A review. London: HEA.

Health Education Authority. (1997b) Arthritis Research Campaign Guidelines on Promoting Physical Activity for Older People. London: HEA.
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