November 2018 network news

Parkrun practices – a fantastic new collaboration to support your patients

It’s Saturday morning 8.55am. I’m gathering with around 200 people in Graves Park, Sheffield getting ready for the start of Graves parkrun. I recognise lots of patients from our practice – people living with MS, depression, arthritis, diabetes, obesity, as well as plenty of our patients I never see (I suspect doing parkrun is a great way of keeping you out of the doctor’s surgery!). I spot a few of our doctors with their kids and some nurses from the neighbouring practice. I can’t make it every week, but each time I do I’m flushed with pride that this was the parkrun event that our GP practice helped to set up six years ago and have promoted ever since. A huge number of our staff and patients get so much from volunteering, running, walking or even spectating at this weekly event; whether it be from the opportunity to socialise and make friends, improved fitness, skill development through volunteering, improved self-esteem and having a supportive community that you can always rely on.

I am convinced that parkrun is the single most effective, enduring community intervention that our GP practice has been involved with.

We are certainly not the only practice in the UK that has formed such a rewarding partnership with their local parkrun. So far over 420 practices have signed up for the ‘parkrun practice’ scheme, launched in June this year by parkrun in collaboration with Royal College of GPs. They have created a really easy registration process (which takes less than five minutes) and developed some excellent supporting resources to help practices get the most out of a partnership with their local parkrun event. I know first-hand what such a partnership can do for you, your team or your patients.

In the last few years parkrun has been very proactive in developing its reach and appeal to people living with health conditions. It has a whole team of ambassadors dedicated to specific support for a wide range of conditions. Parkrun data shows that musculoskeletal conditions are the most common long-term conditions that people identify on registration. Parkrun provides peer support via a closed Facebook group for people with arthritis and musculoskeletal conditions to share stories, advice and tips on parkrun, exercise and their condition in a supportive manner. This can be found by searching for ‘parkrun arthritis’ on Facebook.

To find out more, contact Dr Ollie Hart (@olliehart7 - Twitter).

Moving medicine

Moving Medicine, developed by the Faculty of Sport and Exercise Medicine in partnership with Public Health England, aims to provide healthcare professionals with the information and tools to assist individuals in becoming more physically active through a series of online disease-specific resources. The evidence-based benefits of physical activity are presented alongside a motivational interviewing framework to help guide clinicians through a physical activity consultation. Ten modules, including Musculoskeletal Pain and Inflammatory Rheumatic Disease which have been developed in collaboration with Versus Arthritis, were launched by the Secretary of State for Health and Social Care, Matt Hancock, on 16 October 2018 at the 7th International Society for Physical Activity and Health (ISPAH) Congress in London.

Activity levels in the UK are low, and 26% of its population does less than 30 minutes of moderate intensity physical activity per week. Addressing this now is important because physical inactivity is responsible for more deaths than smoking, and contributes to the increasing burden of preventable illness, such as heart disease, diabetes and musculoskeletal pain. For instance, 44% of older adults with knee pain do not meet current physical activity guidelines. Additionally, physical activity has been demonstrated to reduce pain and stiffness and improve physical function in those with osteoarthritis of the knee or hip. These individuals also have an increased risk of cardiovascular disease and all-cause mortality, and physical activity can positively influence this risk.

It is important that these benefits are conveyed to patients and that common barriers are broken down in order to assist and support patients to live a more active lifestyle. Healthcare professionals have an important role to play in promoting physical activity, but historically the confidence and skills required to have good quality conversations to support behavioural change have been low. Moving Medicine is a new resource that has been designed to equip all healthcare professionals with the knowledge and skills required to do this.

To find out more, visit www.movingmedicine.ac.uk.

Top tips – managing physical activity and OA

Many clinicians worry about prescribing physical activity for those with OA and making things worse; like-wise patients are also unaware of the best course of action to take.

Physical activity is highly beneficial for osteoarthritis. It has been proven to:

  • Reduce pain
  • Reduce stiffness
  • Improve physical function
  • Improve quality of life
  • Improve general health
  • Improve mental health.

Here are some key points, which I feel we should enforce to our patients.

1. Physical Activity should be a cornerstone of treatment for Osteoarthritis.

Numerous studies support the improvement in function and pain that occurs through physical activity. Therefore, we must ensure that those with osteoarthritis are given physical activity advice. Fantastic resources such as the evidence based Moving Medicine project will hopefully help to support clinicians provide advice to patients.

2. Reassure patients, they won’t make their arthritis worse and that physical activity is safe.

Due to the term wear and tear still commonly banded around, many patients believe their joints will “wear” quicker if used more. We need to dispel this myth as clinicians to ensure they become more physically active.

3. Advise patients around making the right choices about mode of activity.

Exercise prescription is always a challenge and needs to be specific to the individual, their function and their pain. Having worked as an exercise professional prior to medicine, there are very few activities that are “off limits”.

Depending on the joints affected, caution may be taken with more high impact activities as well as extremely repetitive higher repetition resistance training under heavy loads. Strength training however is important. With more severe osteoarthritis, particularly of the lower limb, lower impact choices such as walking, cycling, rowing, swimming and using a cross trainer may be more appropriate.

Exercise or physical activity choices also need to challenge the individual and be appropriate to their goals. There are a range of exercise professionals e.g. those with an Active IQ Exercise Referral Level 3 qualification who have the skills to prescribe exercise to those with osteoarthritis if more specific programmes were required.

4. Set Realistic Goals.

This is important. While the CMO guidelines may recommend 150 minutes of moderate exercise and two strength training sessions, this may be difficult if the patient’s starting point is considerably low or they are inactive (less than 30min a week). Therefore, a realistic starting point needs to be set.

Physical activity benefits for adults and older adults infographic.

5. Progress and increase patient physical activity safely.

Once the patient is regularly physically active by whatever means they have chosen, then they can start to progress their exercise. Getting the habit formed first is critical. In the world of strength and conditioning a researcher named Tim Gabett is the current gospel for managing how much activity to do and how to increase it. However, with regards to health, there is no clear consensus and anecdotally I use the 10% rule and advise patients not to increase their time/distance/speed depending on the variable being measured by more than 10% from the week before. Physical activity is a critical part of osteoarthritis management. Please see the other resources and training opportunities below that maybe relevant to a health care professional working with those with osteoarthritis.

Contact dane.vishnubala@nhs.net for more information.

Moving Medicine

www.movingmedicine.ac.uk (see featured article).

Public Health England: Clinical Champions Programme

For clinicians, interested in learning more about physical activity and prescribing it to their patients. Contact PhysicalActivity@phe.gov.uk to organise free training and access your local Physical Activity Champion.

PHE provides funded training supported by Sport England and the Burdett Trust and is delivered by a range of health professionals. Training can be delivered to a range of primary and secondary care settings.

Active IQ Exercise Referral Qualification

Active IQ is a UK based Awarding organisation regulated by OfQual.

To learn more about the Exercise Referral Qualification please visit the Active IQ website www.activeiq.co.uk.

Royal College of GPs: Physical Activity and Lifestyle Priority

Physical activity and lifestyle is a key priority for the RCGP. Toolkits and resources are being developed to support clinicians to provide better advice and care in this area. There is definitely a noticeable shift in culture around physical activity occurring. See the parkrun feature and visit http://www.rcgp.org.uk/parkrun for more information.

British Association of Sport and Exercise Medicine (BASEM)

BASEM is a member organisation for clinicians working in sports medicine, musculoskeletal medicine or exercise medicine. BASEM runs and supports a range of courses and conferences all year around as well as hosting online learning for its members as well as grants and prizes. Visit www.basem.co.uk.

'Providing physical activity interventions for people with musculoskeletal conditions' report

It isn’t news that physical activity is good for you, but with an estimated 17.8 million people living with a musculoskeletal condition, physical activity for people with musculoskeletal conditions can really help to improve pain and improve their quality of life. An estimated 8.75 million people aged 45 years and over (33%) in the UK have sought treatment for osteoarthritis.

It can be challenging for those with joint and back pain to be physical active. There is a fear that they may make their condition worse and they may hear conflicting advice.

Supporting people to take part in physical activity will need a personalised approach; it may be helping people to access facilities that are sensitive to the needs of people with a musculoskeletal condition or there may be more 1:1 care needed for example through physiotherapy.

Consider ESCAPE-pain which is an evidenced based 6-week rehabilitation programme which provide peer support, education enabling self-management and exercise programme, the research shows that participants have a reduction in pain and an increase in mobility. These positive outcomes are replicated in the ESCAPE-pain classes across the country. Visit www.escape-pain.org to find out where your nearest class is & how you can refer your patients or ask about ESCAPE-pain coming to your area.

Physical activity isn’t just going to the gym, or going for a run, but includes all forms of activity including everyday walking and gardening. Regular physical activity that meets national guidelines has wider benefits to health including improving sleep, maintain healthy weight and managing stress.

Advice and support from health care professionals should take a personalised approach and support positive behaviour change including incorporating social support, motivational interviewing, encourage self-efficacy, allow choice of activity and positive reinforcement. For more details see the Versus Arthritis Policy and Public Affairs physical activity report.

'If we only offer medical treatments to our patients with arthritis, we are doing them a disservice. Physical activity helps joint pain, stiffness and fatigue and is safe for people with arthritis,' says Dr Benjamin Ellis, senior clinical policy advisor at Versus Arthritis. 'But many people with arthritis need support to become more physically active. As clinicians we must advocate for our patients, so that everyone who can benefit has access to the ESCAPE-pain programme locally.'

Research investigating physical activity and chronic pain

Dr Daniel Whibley at the University of Aberdeen has been investigating the relationship between pain, sleep and exercise, in people living with chronic pain. As we all know, physical inactivity and poor sleep quality have been related to worse outcomes for people with chronic pain. The researchers will use existing literature to extract insights into the links between pain, exercise and sleep in the lives of those with chronic pain. This information will be used to develop a new treatment package that will aim to improve sleep and exercise over 6 weeks to ultimately reduce pain. This new approach will be tested by people living with chronic pain and could inform a future clinical trial to investigate the effectiveness of this type of programme.

Find out more here: Investigating the role of exercise and sleep in the management of chronic pain.

Increasing the activity of older people with long term pain (iPopp)

As well as looking at complex relationships between sleep, exercise and pain, we are also funding research looking at a potentially simple solution for getting people living with chronic pain to be more active…walking. Dr Clare Jinks, based at the University of Manchester, is hoping to find out whether a walking programme (iPOPP) can encourage people over the age of 65, with joint pain, to be more active. A smaller study that we funded has already been carried out to look at delivery and impact of the programme. Now, a much larger study that we have also funded, is looking to assess the effects of the programme, and the cost implications of any health benefits. Increasing physical activity levels in older people with joint pain could have several benefits including less pain, greater physical function, improved mental health and overall quality of life. Hopefully, this is an outcome that the iPOPP walking programme can deliver.

For further information visit Increasing the activity of older people with long-term pain.

Both of these approaches are simple programmes, which if successfully developed, could allow GPs to better support people living with chronic pain.

Meet a member of the network

Dr Rob Hampton, GP and Occupational Physician, introduces the New GP Interest Group in Health and work.

The time is right for a GP Interest Group in Health and Work!

As a GP with an occupational medicine practice and long-term interest in the health of the working age population, I've always wanted to see UK occupational health move closer to mainstream healthcare. It feels that we are now moving closer to a world where GPs and other healthcare professionals will think about referring patients towards vocational rehabilitation as naturally as they would request a blood test, X-ray or other forms of therapy.

The themes outlined in the joint DoH/DWP Improving Lives paper set out a path for changes that will help GPs recognise the importance of work as a health outcome and facilitate referral to improved employment support services.

So why is a GP Interest Group (GPSIG) so important?

GPs need to be at the heart of these changes! There is currently no recognised ‘peer-grouping’ of GPs with an interest in health and work. This is unusual, given the number of GPSIGs in virtually every other recognised specialty in the UK. There are an estimated 2,000 GPs with postgraduate qualifications in Occupational Medicine but most practice in absolute/relative isolation. The Society of Occupational Medicine (SOM) Council has recognised this and approved the development of a GP Interest Group (GPSIG) in Health & Work within the society. This will be a forum for GPs to discuss all areas of mutual interest and will inform and guide the SOM Council and Board in matters relevant to primary care, health and work.

The RCGP has welcomed the formation of this group and, ‘will consider the criteria for a potential role as GP with an Extended Role (GPER) in Health and Work in conjunction with the Society and Faculty of Occupational Medicine’.

A launch is planned soon. In the meantime, SOM have set up a GPConnect area where health and work news will be sent to interested GPs. Sign-up to GPConnect if you want to know more: SOM GP Connect bulletin.

Versus Arthritis Survey

The launch of the GP interest group for health and work is great news for people with arthritis. Here at Versus Arthritis, we recently carried out a survey which highlighted that people with arthritis across the UK are missing out on the support they need to stay in work.

We had more than 1,500 survey respondents who shared that they had experienced pain (95%), fatigue (86%) and stress (53%) at work because of their condition.

The survey also told us 35% of respondents had reduced their working hours, 26% had changed the type of work they do and a further 19% had given up work completely or taken early retirement.

We believe the help on offer to support people with arthritis to be in work must be improved.

What can you do?

  • Support our campaign calling for improvements to the Access to Work scheme. You can find out more and get involved here and send our powerful new report Working It Out to your local MP to help us draw attention to this issue.
  • Join our campaign network to be kept up to date with projects like this.
  • Make your patients aware that support is available from the Government through the 'access to work' scheme by just going online to www.gov.uk/access-to-work or calling 0800 121 7479. Access to Work grants can be used to fund specialist equipment, support workers, taxi costs, mental health support services or disability awareness training for colleagues. 69% of our survey respondents who hadn’t accessed the scheme said they believed these forms of support could have helped them in the workplace.

Dr Hampton concludes, 'The Access to Work scheme is a really important service for people with long term health conditions such as arthritis and back pain to stay at or return to work. The fact that 60% of respondents to the survey had not heard of the scheme is not a surprise. I would anticipate that a similar or even higher percentage of healthcare practitioners would respond in the same way. The importance of work as an outcome of health delivery cannot be underestimated and the Access to Work scheme can make such a difference. I always advise GPs who attend my workshops on sickness absence to suggest the scheme as a ‘reasonable adjustment’ on fit notes. This can stimulate helpful dialogue at work, or with the Job Centre.'