The Active Hospital pilot: A qualitative study exploring the implementation of a Trust-wide Sport and Exercise Medicine-led physical activity intervention

Background In 2017 Public Health England and Sport England commissioned a Consultant-led Sport and Exercise Medicine (SEM) pilot to test the feasibility and acceptability of embedding physical activity interventions in secondary care clinical pathways. The aim of this paper is to report qualitative findings exploring the experience of healthcare professionals (HCPs) and patients involved in the Active Hospital pilot. Methods Qualitative data was collected by semi-structured interviews with Active Hospital pilot SEM Consultants, and staff and patients involved in three clinical pathways. Interviews with SEM Consultants explored the experience of developing and implementing the pilot. Interviews with staff and patients explored the experience of delivering and receiving Active Hospital interventions. Data were analysed thematically. Results Interviews identified the importance of the Active Hospital pilot being Consultant-led for the following reasons; i) having trusting relationships with decision makers, ii) having sufficient influence to effect change, iii) identifying champions within the system, and iv) being adaptable to change and ensuring the programme fits within the wider strategic frameworks. HCPs emphasised the importance of the Active Hospital interventions fitting easily within existing work practices, the need for staff training and to tailor interventions for individual patient needs. The Active Hospital pilot was well received by patients, however a lack of dedicated resource and capacity to deliver the intervention was highlighted as a challenge by both patients and HCPs. Conclusion The SEM Consultants’ ability to navigate the political climate of a large National Health Service (NHS) Trust with competing agendas and limited resource was valuable. The interventions were well received and a valued addition to usual clinical care. However, implementation and ongoing delivery of the pilot encountered challenges including lack of capacity within the system and delays with recruiting to the delivery teams in each pathway.

Download Full-text

Integrating sport and exercise medicine clinics into the National Health Service: a qualitative study

BMJ Open Sport & Exercise Medicine ◽

10.1136/bmjsem-2020-000888 ◽

2020 ◽

Vol 6 (1) ◽

pp. e000888

Author(s):

Dane Vishnubala ◽

Katherine Rose Marino ◽

Margaret Kathryn Pratten ◽

Andy Pringle ◽

Steffan Arthur Griffin ◽

...

Keyword(s):

National Health Service ◽

Health Service ◽

National Health ◽

Thematic Analysis ◽

Heavy Exercise ◽

Structured Interviews ◽

Ultrasound Education ◽

Exercise Medicine ◽

Sport And Exercise ◽

Inductive Thematic Analysis

ObjectivesTo explore the services National Health Service (NHS)-based sport and exercise medicine (SEM) clinics can offer, and the barriers to creating and integrating SEM services into the NHS.MethodsSemi-structured interviews were undertaken to collect data from identified ‘stakeholders’. Stakeholders were identified as individuals who had experience and knowledge of the speciality of SEM and the NHS. An inductive thematic analysis approach was taken to analyse the data.ResultsN=15 stakeholder interviews. The management of musculoskeletal (MSK) injuries (both acute and chronic) and concussion were highlighted as the two key services that SEM clinics can offer that would most benefit the NHS. MSK ultrasound was also mentioned by all stakeholders as a critical service that SEM clinics should provide. While exercise medicine is an integral part of SEM, SEM clinics should perhaps not have a heavy exercise medicine focus. The key barriers to setting up SEM clinics were stated to be convincing NHS management, conflict with other specialities and a lack of awareness of the speciality.ConclusionThe management of acute MSK injuries and concussion should be the cornerstone of SEM services, ideally with the ability to provide MSK ultrasound. Education of others on the speciality of SEM, confirming consistent ‘unique selling points’ of SEM clinics and promoting how SEM can add value to the NHS is vital. If the successful integration of SEM into the NHS is not widely achieved, we risk the NHS not receiving all the benefits that SEM can provide to the healthcare system.

Download Full-text

A Physical Activity Intervention Feasibility Study for Kidney Inpatients: A Basic Research Protocol

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358120987052 ◽

2021 ◽

Vol 8 ◽

pp. 205435812098705

Author(s):

Kathryn Wytsma-Fisher ◽

Stefan Mustata ◽

Theresa Cowan ◽

Manuel Ester ◽

S. Nicole Culos-Reed

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Physical Function ◽

Kidney Failure ◽

Standard Care ◽

Physical Activity Intervention ◽

Clinical Care ◽

Activity Promotion ◽

Cardiovascular Morbidity And Mortality

Background: Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult kidney failure patients, regardless of treatment modality. Compared with the general population, individuals with chronic kidney disease are physically inactive, have reduced physical abilities and difficulties performing routine daily tasks, lower health-related quality of life, and higher cardiovascular morbidity and mortality. In addition, frail kidney failure patients have higher hospitalization and mortality rates as compared with other kidney failure patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for kidney failure patients. Structured exercise can improve physical function and quality of life in frail older adults and may be used specifically for management of frailty in kidney failure. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard kidney failure care. Objective: The proposed Move More study will assess the feasibility of a physical activity intervention offered to the kidney failure inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist, and supported by the clinical care team including physiotherapists (PT) and nurse clinicians. Methods: The Move More study is a single-arm pilot intervention examining feasibility and optimal improvement in real-world conditions. Kidney failure inpatients at the Foothills Medical Centre will be recruited to participate. Patients will receive an individualized in-hospital physical activity/mobility intervention. Frailty and physical function will be assessed at baseline and postintervention prior to hospital discharge. The goal is to recruit 24 to 36 patients. Conclusions: Evidence needed to support the inclusion of mobility and physical activity as part of standard care will be gathered, with knowledge gained used to help direct future physical activity programming for kidney failure inpatients.

Download Full-text

Special Issue “New Trends in Sport and Exercise Medicine”

Applied Sciences ◽

10.3390/app11188353 ◽

2021 ◽

Vol 11 (18) ◽

pp. 8353

Author(s):

Daniela Galli

Keyword(s):

Physical Activity ◽

Cardiovascular Diseases ◽

Regular Physical Activity ◽

Special Issue ◽

Exercise Medicine ◽

Sport And Exercise

The practice of regular physical activity has been proposed as a determinant in many disciplines, from wellness to physiotherapy; in fact, it reduces the risks of cardiovascular diseases and diabetes [...]

Download Full-text

Remote assessment in sport and exercise medicine (SEM): a narrative review and teleSEM solutions for and beyond the COVID-19 pandemic

British Journal of Sports Medicine ◽

10.1136/bjsports-2020-102650 ◽

2020 ◽

Vol 54 (19) ◽

pp. 1162-1167 ◽

Cited By ~ 1

Author(s):

H Paul Dijkstra ◽

Emin Ergen ◽

Louis Holtzhausen ◽

Ian Beasley ◽

Juan Manuel Alonso ◽

...

Keyword(s):

Patient Care ◽

Clinical Care ◽

Narrative Review ◽

Review Of The Literature ◽

Exercise Medicine ◽

Remote Assessment ◽

Injury Assessment ◽

Guiding Principles ◽

Sport And Exercise ◽

Remote Patient

BackgroundThe COVID-19 pandemic forces sport and exercise medicine (SEM) physicians to think differently about the clinical care of patients. Many rapidly implement eHealth and telemedicine solutions specific to SEM without guidance on how best to provide these services.AimThe aim of this paper is to present some guiding principles on how to plan for and perform an SEM consultation remotely (teleSEM) based on a narrative review of the literature. A secondary aim is to develop a generic teleSEM injury template.ResultseHealth and telemedicine are essential solutions to effective remote patient care, also in SEM. This paper provides guidance for wise planning and delivery of teleSEM. It is crucial for SEM physicians, technology providers and organisations to codesign teleSEM services, ideally involving athletes, coaches and other clinicians involved in the clinical care of athletes, and to gradually implement these services with appropriate support and education.ConclusionteleSEM provides solutions for remote athlete clinical care during and after the COVID-19 pandemic. We define two new terms—eSEM and teleSEM and discuss guiding principles on how to plan for and perform SEM consultations remotely (teleSEM). We provide an example of a generic teleSEM injury assessment guide.

Download Full-text

Reasons for participating and not participating in a e-health workplace physical activity intervention

International Journal of Workplace Health Management ◽

10.1108/ijwhm-11-2013-0040 ◽

2014 ◽

Vol 7 (4) ◽

pp. 229-246 ◽

Cited By ~ 24

Author(s):

Marco Bardus ◽

Holly Blake ◽

Scott Lloyd ◽

L. Suzanne Suggs

Keyword(s):

Physical Activity ◽

Physical Activity Intervention ◽

Feasibility Studies ◽

Target Population ◽

Ease Of Use ◽

Perceived Ease Of Use ◽

Structured Interviews ◽

Behavioural Interventions ◽

Content Type ◽

Purposive Sample

Purpose – The purpose of this paper is to investigate the reasons for participating and not participating in an e-health workplace physical activity (PA) intervention. Design/methodology/approach – Semi-structured interviews and two focus groups were conducted with a purposive sample of employees who enrolled and participated in the intervention and with those who did not complete enrolment, hence did not participate in it. Data were examined using thematic analysis according to the clusters of “reasons for participation” and for “non-participation”. Findings – Reported reasons for participation included a need to be more active, to increase motivation to engage in PA, and to better manage weight. Employees were attracted by the perceived ease of use of the programme and by the promise of receiving reminders. Many felt encouraged to enrol by managers or peers. Reported reasons for non-participation included lack of time, loss of interest towards the programme, or a lack of reminders to complete enrolment. Practical implications – Future e-health workplace behavioural interventions should consider focusing on employees’ needs and motivators to behaviour change, provide regular reminders for participants to complete enrolment and ensure that procedures are completed successfully. Barriers to participation could be identified through formative research with the target population and feasibility studies. Originality/value – This study combines a qualitative analysis of the reasons why some employees decided to enrol in a workplace PA intervention and why some others did not. This study highlights factors to consider when designing, implementing and promoting similar interventions and that could inform strategies to enhance participation in workplace PA interventions.

Download Full-text

A physical activity intervention feasibility study for renal inpatients: a basic research protocol

10.31236/osf.io/xmv4h ◽

2020 ◽

Author(s):

Kathryn Wytsma-Fisher ◽

Stefan Mustata ◽

Theresa Cowan ◽

Manuel Ester ◽

S. Nicole Culos-Reed

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Kidney Disease ◽

Physical Function ◽

Standard Care ◽

Physical Activity Intervention ◽

Clinical Care ◽

Activity Promotion ◽

Cardiovascular Morbidity And Mortality

Background: Low physical activity levels and poor physical functioning are strongly associated with poor clinical outcomes and mortality in adult End Stage Kidney Disease (ESKD) patients, regardless of treatment modality. Compared to the general population, individuals with chronic kidney disease are physically inactive, have reduced physical abilities and difficulties performing routine daily tasks, lower health-related quality of life, higher cardiovascular morbidity and mortality. In addition, frail ESKD patients have higher hospitalization and mortality rates than other ESKD patients. Evidence suggests that assessment and recommendations for physical activity should be part of standard care for ESKD patients. Structured exercise can improve physical function and quality of life in frail older adults and may be used specifically for management of frailty in ESKD. However, research is needed to determine best practices for implementation of physical function measurements and physical activity promotion in standard ESKD care. Objective: The proposed Move More study will assess the feasibility of a physical activity intervention offered to the ESKD inpatients in Calgary, Alberta. Specifically, this study is designed to examine the effects of an early physical activity/mobility intervention led by a kinesiologist (KT), and supported by the clinical care team including physiotherapists (PT) and nurse clinicians.Methods: The Move More study is a single-arm pilot intervention examining feasibility and preliminary efficacy. ESKD inpatients at the Foothills Medical Centre will be recruited to participate. Patients will receive an individualized in-hospital physical activity/mobility intervention. Frailty and physical function will be assessed at baseline and post-intervention prior to hospital discharge. Conclusions: Evidence needed to support the inclusion of mobility and physical activity as part of standard care will be gathered, with knowledge gained used to help direct future physical activity programming for ESKD inpatients.

Download Full-text

Evaluation of the Clinical Champions' Physical Activity Training Programme

10.31219/osf.io/s39ju ◽

2020 ◽

Author(s):

Liz Carlin ◽

Hayley Musson ◽

Emma Adams

Keyword(s):

Physical Activity ◽

Clinical Practice ◽

Healthcare Professional ◽

Healthcare Professionals ◽

Training Programme ◽

Routine Clinical Practice ◽

Training Models ◽

Exercise Medicine ◽

Physical Activity Advice ◽

Sport And Exercise

In 2014 Public Health England (PHE) launched the National Physical Activity Framework ‘Everybody Active, Everyday’. The framework included a key domain for action called ‘Moving Professionals’. The Moving Professionals Programme aims to build expertise and leadership across key professional sectors and to raise awareness and understanding of the health benefits of physical activity among professionals and the wider public. The programme comprises several innovative work packages which are described in full elsewhere (Brannan et al., 2019). One element of the programme was the Clinical Champions’ Physical Activity Training Programme. PHE developed a network of Clinical Champions who were tasked with providing peer-to-peer training on physical activity for healthcare professionals. The long-term aim of the Clinical Champions’ Physical Activity (CCPA) training programme is to increase population levels of physical activity by increasing the proportion of healthcare professionals integrating conversations about physical activity into routine clinical practice in England.An independent evaluation of the Clinical Champion’s physical activity training programme was conducted by researchers based at the National Centre for Sport and Exercise Medicine (NCSEM) in the School of Sport, Exercise and Health Sciences at Loughborough University, UK. The NCSEM were not responsible for the implementation of the Clinical Champions’ physical activity training. The evaluation aimed to: 1) Evaluate the uptake and utilisation of the training programme and the different training models; 2) Assess the perceived impact of the training programme on healthcare professionals’ confidence, knowledge and application of brief physical activity advice in routine clinical practice; 3) Assess whether there is any differential impact of the training programme when sessions are delivered by different types of Clinical Champion (i.e. doctor, nurse or allied healthcare professional) to different healthcare professional audiences and 4) Assess the perceived strategic impact of the Clinical Champion physical activity training programme. A mixed methods approach was used to evaluate the programme. This report details the evaluation findings and provides recommendations for the future implementation of the Clinical Champions’ physical activity training programme.

Download Full-text

Efficacy of an Online Physical Activity Intervention Coordinated With Routine Clinical Care: Protocol for a Pilot Randomized Controlled Trial

JMIR Research Protocols ◽

10.2196/18891 ◽

2020 ◽

Vol 9 (11) ◽

pp. e18891

Author(s):

Bonny Rockette-Wagner ◽

Gary S Fischer ◽

Andrea M Kriska ◽

Molly B Conroy ◽

David Dunstan ◽

...

Keyword(s):

Physical Activity ◽

Physical Activity Intervention ◽

Controlled Trial ◽

Clinical Care ◽

Online Intervention ◽

Activity Levels ◽

Randomized Controlled ◽

Low Activity ◽

Pilot Randomized Controlled Trial ◽

Clinical Referral

Background Most adults are not achieving recommended levels of physical activity (150 minutes/week, moderate-to-vigorous intensity). Inadequate activity levels are associated with numerous poor health outcomes, and clinical recommendations endorse physical activity in the front-line treatment of obesity, diabetes, dyslipidemia, and hypertension. A framework for physical activity prescription and referral has been developed, but has not been widely implemented. This may be due, in part, to the lack of feasible and effective physical activity intervention programs designed to coordinate with clinical care delivery. Objective This manuscript describes the protocol for a pilot randomized controlled trial (RCT) that tests the efficacy of a 13-week online intervention for increasing physical activity in adult primary care patients (aged 21-70 years) reporting inadequate activity levels. The feasibility of implementing specific components of a physical activity clinical referral program, including screening for low activity levels and reporting patient program success to referring physicians, will also be examined. Analyses will include participant perspectives on maintaining physical activity. Methods This pilot study includes a 3-month wait-listed control RCT (1:1 ratio within age strata 21-54 and 55-70 years). After the RCT primary end point at 3 months, wait-listed participants are offered the full intervention and all participants are followed to 6 months after starting the intervention program. Primary RCT outcomes include differences across randomized groups in average step count, moderate-to-vigorous physical activity, and sedentary behavior (minutes/day) derived from accelerometers. Maintenance of physical activity changes will be examined for all participants at 6 months after the intervention start. Results Recruitment took place between October 2018 and May 2019 (79 participants were randomized). Data collection was completed in February 2020. Primary data analyses are ongoing. Conclusions The results of this study will inform the development of a clinical referral program for physical activity improvement that combines an online intervention with clinical screening for low activity levels, support for postintervention behavior maintenance, and feedback to the referring physician. Trial Registration ClinicalTrials.gov NCT03695016; https://clinicaltrials.gov/ct2/show/NCT03695016. International Registered Report Identifier (IRRID) DERR1-10.2196/18891

Download Full-text

Oxford Textbook of Children's Sport and Exercise Medicine

10.1093/med/9780198757672.001.0001 ◽

2017 ◽

Cited By ~ 19

Keyword(s):

Physical Activity ◽

Sport Medicine ◽

Exercise Physiology ◽

Young Athlete ◽

Exercise Science ◽

Contact Sports ◽

Sport Science ◽

Exercise Medicine ◽

Biological Maturation ◽

Sport And Exercise

Comprehensive and up to date, this textbook on children’s sport and exercise medicine features research and practical experience of internationally recognized scientists and clinicians that informs and challenges readers. Four sections—Exercise Science, Exercise Medicine, Sport Science, and Sport Medicine—provide a critical, balanced, and thorough examination of each subject, and each chapter provides cross-references, bulleted summaries, and extensive reference lists. Exercise Science covers growth, biological maturation and development, and examines physiological responses to exercise in relation to chronological age, biological maturation, and sex. It analyses kinetic responses at exercise onset, scrutinizes responses to exercise during thermal stress, and evaluates how the sensations arising from exercise are detected and interpreted during youth. Exercise Medicine explores physical activity and fitness and critically reviews their role in young people’s health. It discusses assessment, promotion, and genetics of physical activity, and physical activity in relation to cardiovascular health, bone health, health behaviours, diabetes, asthma, congenital conditions, and physical/mental disability. Sport Science analyses youth sport, identifies challenges facing the young athlete, and discusses the physiological monitoring of the elite young athlete. It explores molecular exercise physiology and the potential role of genetics. It examines the evidence underpinning aerobic, high-intensity, resistance, speed, and agility training programmes, as well as effects of intensive or over-training during growth and maturation. Sport Medicine reviews the epidemiology, prevention, diagnosis, and management of injuries in physical education, contact sports, and non-contact sports. It also covers disordered eating, eating disorders, dietary supplementation, performance-enhancing drugs, and the protection of young athletes.

Download Full-text

Sports injuries in older people

10.1093/med/9780199533909.003.0034 ◽

2013 ◽

Author(s):

Cathy Speed

Keyword(s):

Physical Activity ◽

Health Status ◽

Sports Injuries ◽

Ageing Population ◽

Activity Levels ◽

Exercise Medicine ◽

Age Related ◽

Physical Activity Levels ◽

Sport And Exercise ◽

Age Related Changes

A generally enhanced health status in an increasingly ageing population allows many to maintain high physical activity levels, and competitive masters and seniors events are becoming progressively more popular. This, together with the recognition of the importance of exercise to mitigate or even reverse many age-related changes, means that the physician in sport and exercise medicine requires a high index of awareness of the specific issues that arise in relation to sporting injury in the ageing individual. These issues include not only recognition and management of sports injuries ...

Download Full-text