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Why exercise is needed now more than ever, by nurses as well as patients

Clinical physical activity champions are inspiring healthcare workers to stay healthy
Healthcare professionals should be up to speed with the value of physical activity. Picture: Neil O'Connor

Clinical physical activity champions are inspiring healthcare workers to stay healthy

  • Physical activity clinical champions offer peer-to-peer, face-to-face training in how to encourage patients to move more
  • Ensuring that healthcare professionals understand the benefits of physical activity and their role in promoting it is an important first step
  • Nurses are a trusted source of advice, so what they say about physical activity can have a big impact on patient outcomes, say experts

As a physical activity clinical champion, Jan Sinclair trains and supports nurses to promote the benefits of moving more to their patients and members of the public.

Very often, however, she finds that the one-hour training session also has a surprisingly personal impact on the nurses themselves.

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Clinical physical activity champions are inspiring healthcare workers to stay healthy

  • Physical activity clinical champions offer peer-to-peer, face-to-face training in how to encourage patients to move more
  • Ensuring that healthcare professionals understand the benefits of physical activity and their role in promoting it is an important first step
  • Nurses are a trusted source of advice, so what they say about physical activity can have a big impact on patient outcomes, say experts
 Neil O'Connor
Out in front: physical activity champion Jan Sinclair, left, keeps active with a colleague ​​​​​​ Picture: Neil O'Connor

As a physical activity clinical champion, Jan Sinclair trains and supports nurses to promote the benefits of moving more to their patients and members of the public.

Very often, however, she finds that the one-hour training session also has a surprisingly personal impact on the nurses themselves.

At a time when the UK population has been instructed to stay at home to curb the spread of coronavirus, the public health message of remaining active becomes even more pressing. And for nurses shouldering much of the physical and emotional strain resulting from the pandemic, the outlet of exercise will be critical, making the work of Ms Sinclair and her fellow physical activity clinical champion all the more important.

Spreading the benefits of physical activity to nurses as well as patients

‘When you start the session, some of the people don’t know what they’re coming into – some of them are worried that I‘m actually going to make them do physical exercise,’ says Ms Sinclair. ‘But one thing that’s guaranteed is that people are interested and quite blown away by the data and statistics.

‘Often after a session I’ll get comments from people saying they’re going to do a little bit more physical activity themselves.’

The physical activity clinical champions initiative is part of the Moving Healthcare Professionals programme. This project, led by Public Health England and Sport England, aims to use the roles and expertise of healthcare professionals to help embed physical activity in people’s lives. 

Other strands include online learning resources for healthcare professionals, embedding physical activity in undergraduate programmes, and testing innovations such as the Active Hospitals initiative.

What physical activity clinical champions do

Ensuring healthcare professionals themselves are up to speed with the benefits of physical activity and their role in promoting it is important. The clinical champions project is a major part of that.

There are almost 50 champions in England. Ms Sinclair, Public Health England’s lead nurse for physical activity, is one of three national clinical leads; the others cover allied health professionals and doctors.

‘Evidence suggests that one in four people trust healthcare professionals’ advice when it comes to being active’

Ben Jackson, diet, obesity and physical activity project manager, Public Health England

The role sits well alongside Ms Sinclair’s ‘day job’ as senior public health nurse in Stockport NHS Foundation Trust, because the two roles are concerned with spreading the benefits of physical activity to nurses as well as to patients.

The message that the peer-to-peer, face-to-face training offered by the clinical champions is designed to get across is that we can all do more, and that moving even a little bit more can bring tremendous benefits.

Benefits of physical activity – and the risks of inactivity

Physical activity has proven health benefits. It is known to help prevent and manage some 20 chronic conditions and diseases, including some cancers, heart disease, depression, and type 2 diabetes.

According to Public Health England, physical inactivity is responsible for one in six deaths in the UK – the same number attributed to smoking – with an estimated annual cost of £7.4 billion; this includes £900 million to the NHS.

A poster from Moving Medicine, a resource to help healthcare professionals to promote physical activity to patient
A poster from Moving Medicine, which
offers resources for healthcare professionals

Yet the population is around 20% less active than it was in the 1960s, and if current trends continue, will be 35% less active by 2030.

The UK chief medical officers’ guidelines recommend that each week adults do at least 150 minutes of moderate-intensity activity, 75 minutes of intense activity, or a mixture. They also advocate undertaking strengthening activity on two days, as well as reducing extended periods of sitting.

Communicating the health outcomes of increased physical activity

Getting these messages across to the public is a challenge, but health professionals, including nurses, are seen as vital to achieving this.

‘The evidence suggests that one in four people trust healthcare professionals’ advice when it comes to being active,’ says Public Health England diet, obesity and physical activity project manager Ben Jackson.

‘There are more than 600,000 healthcare professionals in the country who have multiple contacts with people. They are considered a trusted source of advice, so what they say about physical activity and how they raise it as a topic could have a big impact on activity levels.’

Of course, there are challenges – among them, the need for healthcare professionals to have the knowledge, confidence and time to promote physical activity to patients.

‘We want to equip healthcare professionals with the skills, knowledge and confidence to deliver advice’

Dr Anne Lowe, programme manager, National Centre for Sport and Exercise Medicine, Sheffield

Phase one of the Moving Healthcare Professionals project was designed around the evidence that 80% of GPs in England are unfamiliar with the national physical activity guidelines and fewer than half (44%) feel confident about broaching the subject of physical activity with patients.

The programme provides peer-led training and is developing practical resources to help healthcare professionals implement the NICE guidance on physical activity, as well as guidance for treatment of a range of conditions for which physical activity is recommended.

The training resources available to healthcare professionals

So far, more than 25,000 healthcare professionals have attended peer-to-peer, face-to-face training, and others have completed the modules available on the e-learning for healthcare platform (see box).

‘These are free-to-access modules on physical activity, targeted at healthcare professionals,’ says Mr Jackson. ‘There are also e-learning modules on the BMJ website that have been really well used, with approximately 180,000 modules completed.

‘We also support the Faculty of Sport and Exercise Medicine, which has developed Moving Medicine, a resource for healthcare professionals that provides evidence-based information on the specific benefits physical activity has for people with certain long-term health conditions. There are 12 modules on the Prescribing Movement section, including cancer and chronic obstructive pulmonary disease (COPD).

‘Evaluation of phase one of the physical activity clinical champions project suggested that the most frequently reported barrier to having physical activity conversations with patients was healthcare professionals’ lack of time, so the Moving Medicine resource breaks down the information for those having one-minute, five-minute, or longer conversations. More modules will be added to the resource over the coming 12 months.’

Trusted advice can influence people’s behaviour

In February, it was announced that the National Centre for Sport and Exercise Medicine (NCSEM) and market research company Ipsos MORI had secured a £500,000 contract to evaluate the Moving Healthcare Professionals programme, through the Advanced Wellbeing Research Centre at Sheffield Hallam University.

‘Nurses do spend a lot of time on their feet, being mobile, but they’re probably not ticking the box for the chief medical officer’s physical activity guidance’

Jan Sinclair, Public Health England’s lead nurse for physical activity

Anna Lowe, programme manager at the NCSEM Sheffield, will be involved in the evaluation. A physiotherapist and former physical activity clinical champion herself, she believes that nurses and other healthcare professionals have more influence over people’s behaviour than many of them realise.

‘We know from the Health Survey for England that one in four patients would be more active if they were advised by a GP or nurse, and we want to equip healthcare professionals with the skills, knowledge and confidence to deliver this advice,’ says Dr Lowe.

How to have a high-impact conversation about physical activity

 iStock
Even a one-minute conversation with a patient can have an impact Picture: iStock

  • Be aware that every conversation you have with people about physical activity is important in supporting behavioural change over the course of someone’s life, says Moving Medicine, a resource for healthcare professionals
  • Even a short conversation can have an impact. Moving Medicine’s one-minute conversation targeted at people with cancer, for example, suggests this three-part approach:
    1. Ask if patients know that many people with cancer find that moving more helps them
    2. Explain that physical activity is an important part of maintaining and optimising their health through all stages of the cancer pathway
    3. Invite them to return and discuss their thoughts about being more active with you or a colleague and offer them patient information
  • Do not over-complicate the message with too much research-based information
  • Suggest patients start small and build up gradually – the chief medical officer’s guidance says ‘some is good; more is better’

Sources: Moving Medicine and UK chief medical officer physical activity guidelines

 

Nurses are on their feet all day, but may not meet physical activity guidelines

There is, however, the issue that nurses themselves often do not follow physical activity guidelines, which can be an inhibitor to passing the advice on to others. This should not be the case, says Dr Lowe. She believes nurses who struggle with being active can be viewed by patients as having empathy with them.

According to activity champion Ms Sinclair, nurses who are active are more likely to raise the issue of physical activity with patients than those who are not – but she accepts there are challenges.

 Neil O'Connor
Jan Sinclair: ‘Nurses may not be as active
​​​​​as they think’ Picture: Neil O'Connor

‘We have to recognise that a lot of nurses don’t keep themselves as physically active even as they might think they do – they do spend a lot of time on their feet, being mobile, but they’re probably not ticking the box for the chief medical officer’s guidance,’ she says. ‘It’s what I often say to nurses – you might think you do a lot because you’re on your feet all day, but it’s about the length of time and the intensity with which you’re doing the activity; that’s what really counts towards the numbers.’

While there are challenges for nurses who want to make healthier choices – shift patterns and a lack of healthy food at work being just two of them – she stresses there are many benefits of doing so. ‘It’s important that nurses – and everyone else – takes time out to think about how they can increase their physical activity and look at the wider benefits of being more physically active.

‘There are mental health benefits of physical activity too – it can lessen your stress and anxiety levels. Nurses are under an awful lot of pressure in a very target-driven NHS, and we need to be looking after ourselves a lot more. We don’t want to make it too hard – at the trust I work for, we put on a lot of classes for people, and we’ve organised that with our community providers too.’

A culture change coming within the NHS

She believes the culture of the NHS is beginning to change, with more nurses being aware of the importance of physical activity, helped by campaigns like this. 

‘It’s about nurses looking at patients with long-term conditions and seeing how they can support them. They should have conversations about physical activity with those patients because there is help and support out there,’ says Ms Sinclair. ‘What we need to do more of is make sure our signposting is spot on, because if nurses don’t know who they are referring patients to, or what the processes are, they are even less likely to have that conversation.’

‘Start small, then build. If someone doesn’t do exercise, you’re going to put them off if you start quoting big figures like 150 minutes a week’

Jan Sinclair

Part of the challenge is the terminology, which can put people off. ‘People don’t like the word exercise,’ says Ms Sinclair. ‘Being physically active is what you do every day, but you might not see it as a form of exercise. So, it’s about how you sell physical activity to people, whether it’s going for a walk up the road or walking the dog.

‘As nurses, we are so well positioned in terms of the opportunity we have to increase health benefits for people by having those very simple conversations. That’s how we have to sell it to our general public, in terms of it being something that they do every day – start small, then build. If someone doesn’t do exercise, you’re going to put them off if you start quoting big figures like 150 minutes a week.

‘What we know from research is that you just need to be doing something more than you’re doing now to start you off. Nurses are vital to making that happen.’

At a glance: resources for nurses

  • Moving Medicine is an initiative from the Faculty of Sport and Exercise Medicine UK in partnership with Public Health England and Sport England. It works with clinicians, hospitals and patients to provide information on the health benefits of movement. It includes a step-by-step guide to conversations with patients about physical activity, online courses on specific long-term conditions, and a toolkit to help people create active hospitals
  • The Importance of Physical Activity is a BMJ Learning module funded by and developed with Public Health England
  • E-learning for Healthcare, is a course to prepare nurses and other healthcare professionals to champion the benefits of physical activity to their patients
  • Moving Healthcare Professionals has information on this programme, with useful links to relevant publications
  • We Are Undefeatable is a resource to help people managing long-term conditions to become more physically active

 

Jennifer Trueland is a health journalist

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