Physical activity is well documented for its health benefits. Yet 26% of adults in England are considered "inactive" aka taking part in less than 30 minutes of physical activity a week (NHS Digital, 2016)
15 million people in England are living with a long-term health condition (Department of Health, 2012) Chicken or egg, but physical inactivity surely contributes to these rising numbers which are causing a huge amount of strain to the National Health Service.
I am a physiotherapist. I've spent most of my career working in chronic respiratory medicine and more recently musculoskeletal outpatients. On a daily basis, I come across patients living with a long-term health condition (I have included some examples throughout my blog). The symptoms of their condition (e.g. pain, breathlessness) makes them fearful of physical activity. They avoid moving. They become deconditioned and spiral downwards into a vicious cycle of worsening symptoms, physical inactivity, and disability.
Do you ask the question, how physically active are you?
As healthcare professionals (HPC), we should assess for physical inactivity. It should be as important as "do you smoke". Like referring a patient to smoking cessation services, a plan needs to be put in place if your patient is deemed physically inactive.
This isn't always a straightforward process. It takes time to break down barriers and misconceptions about physical activity.
"I can't afford to go to the gym"
"I don't have time"
"It will make my back pain worse"
"I'm too embarrassed"
"I don't like exercise"
Education and encouragement is key
You would be silly to simply give a patient an exercise prescription and send them on their way. It requires motivational interviewing, gentle persuasion and ideally setting some goals with your patient. Having a bit of passion about it doesn't go amiss either. In some ways, an HPC needs to be excellent a salesman/woman. You need to make your patient believe it's going to work, particularly if they have misconceptions.
Susan has a longstanding history of lower back pain which was flared up by starting a fitness class a few months ago. She is significantly overweight and is pre-diabetic. She works at a desk job and leads a sedentary lifestyle. She is really motivated to lose weight but is fearful that exercise will make her back worse.
What should I do with Susan?
She's motivated but not particularly keen on the gym. She has a dog and likes being outdoors.
"Have you heard of parkrun?"
Susan recoils at the word "run".
What is parkrun?
parkrun is a free timed 5k event held in local parks around the world. Founded in 2004 it becomes a phenomenon over the last 10 years.
For many parkrun is a "run". Some run fast. Others have a gossip gallop with a friend. There's dogs, pushchairs, families, and people of all shapes, sizes and fitness levels.
Being able to run is not a requirement and walking is welcomed. In fact, there is even a tail walker. No one is ever left behind. No one is ever "last"(parkrun is not a race).
parkrun is an all accessible and inclusive way to get the UK moving. It's arguably been the best public health innovative of our time.
I explained this to Susan. I break down her misconceptions that exercise will make her back pain worse and that it is safe. In fact, moving will make her better.
Movement is medicine
Jim has COPD. He has just completed Pulmonary Rehabilitation. He is feeling more confident and is managing his breathlessness better. He is keen to keep up being physically active but is worried that he'll lack motivation on his own.
Getting patients with long-term health conditions moving makes a huge impact on their health, well being and quality of life.
Exercise has always been the most effective treatment method in my physio toolbox. Pulmonary Rehabilitation is a fantastic example. An exercise and education programme targeted at patients with chronic respiratory conditions, it has the highest level of evidence for improving exercise capacity, breathlessness, health status and psychological well-being (The British Thoracic Society, 2013).
The benefits of exercise in improving physical health is well documented.
If you're recommending exercise for a patient do you think they would they get the same benefits from walking 5k on a treadmill vs. walking 5k at parkrun?
Our wellbeing is influenced by biological, psychological and social factors. Being outdoors in daylight amongst human contact is essential to health. Parkrun not only gets people outdoors being active but it makes people feel part of a community, both through taking part or volunteering.
"Feeling part of something" combined with the endorphins of exercise makes us feel good and can improve psychological well-being as well as physical.
Parkrun provides a supportive community that encourages and includes everyone. It addresses all elements of the bio-psycho-social model giving that all desired "holistic" approach to patients care.
A recent survey revealed that 63% of HPC's surveyed prescribe (parkrun, 2017). If more HPC's were aware of this form of social prescribing, I'm sure more of us will be recommending it to our patients.
Let's take some responsibility in increasing our patient's health. Empower them to take ownership and let's move away and reduce passive treatments such a medication and short-lived hands-on methods.
Send them out your clinic room not clutching a green bit of paper but a parkrun barcode. Give patients a parkrun prescription, not a repeat one
Head to the Royal College of General Practitioners to register your practice to parkrun and download your parkrun toolkit.
Top tips for prescribing parkrun
If you haven't done parkrun, go and do one. You need to know what you're prescribing and it will help you "sell it".
Consider if your local parkrun is a lapped course if it has hills, benches and if there is parking/toilets nearby
Walking is welcome. There is always a tail walker
It's not essential to complete the whole 5k. A patients goal might be to build up to completing 5k
If a patient is nervous suggest they volunteer first to get a feel for it.
The Couch to 5K programme is excellent for those wanting to start running
Families and dogs are welcome
Lycra is not essential but your barcode is. Sign them up and print them off a barcode
GP's can register their practice and get further information from the parkrun toolkit here
GP practices will be encouraged to develop closer links with their local parkrun to become certified “parkrun practices”, with healthcare practitioners signposting patients and carers to the events, particularly those who are the least active and have long-term health conditions.