Importance of being active

The benefits of regular physical activity are clearly articulated:

• for adults, achieving 150 minutes (2 ½ hours) of at least moderate intensity physical activity over a week

• Comparable benefits can be achieved through 75 minutes of vigorous exercise throughout the week

• helps prevent and manage over 20 chronic conditions including coronary heart disease, stroke, type 2 diabetes, cancer, obesity, mental health problems and musculoskeletal conditions

What does this look like?

• Only 39% of men and 29% of women are currently meeting the CMO recommendations for physical activity

• That’s 27 million people in England alone who are not active enough to benefit their health

• The NHS spends £3,000 every minute on combating illness, which could be prevented by increased physical activity

• A modest increase in physical activity amongst older people could cut hip fractures by one per cent, saving the NHS more than £200 million a year.

• A 20 per cent increase in cycling would save the NHS more than £50 million in treatments.

Why commission Let’s Get Moving?

Making the case • NICE fully endorses the importance of physical activity as a

means to promote good health and prevent disease (NICE 2006 PH2)

• NICE endorses brief interventions in physical activity as being both clinically and cost-effective for delivery by the NHS in primary care. (NICE 2006 PH2)

• Around one in four people in England say they would be more active if they were advised to do so by a GP or nurse. (HSE 2007)

• 54 per cent of patients said that their GP had not provided advice on diet and exercise. (Lord Darzi's NHS Next Stage Review Final Report)

The Evidence

According to NICE PH guidance 2, primary care practitioners should:

• using a validated tool (GPPAQ), identify inactive adults

• advise them to aim for the amount of activity outlined in the guidelines

• take into account the individual’s needs, preferences and circumstances

• agree goals with them

• provide written information about the benefits of activity and the local opportunities to be active

Brief interventions

Following a review of the extensive evidence on lifestyle change, NICE recommended the delivery of brief interventions that help people to:

• understand the likely impact of their behavior on their health • feel positive / optimistic about changing their behaviour• make a personal commitment to change• set goals to undertake specific actions over a specified time• plan changes in terms of easy steps • plan for events or situations that might get in they way of change• share their behaviour change goals with others

Lets Get Moving

Introducing ‘Lets Get Moving’

• a behaviour change programme that incorporates a Physical Activity Care Pathway based on recommendations of the NICE Public Health Guidance 2 & 6

• LGM is designed to assist practitioners in guiding inactive adults aged 16-74 towards gradually become more active, for the prevention and management of chronic disease

• has proven feasible for delivery by practitioners working in primary care settings.

Local priorities

LGM presents important commissioning opportunities for

a new Public Health Service

LGM will help to drive public health outcome indicators and

reduce health inequalities caused by physical inactivity

LGM supports delivery of public health initiatives, such as:• NHS Health Check• Long term conditions

Step 1. Recruit

1. Recruitment methodology decided at a local level

2. Flexible entry route:

• New Patient Registration • Health Check• Diabetes Clinic• Disease Registers

Step 2. Screen

Assess physical activity levels using the GPPAQ

This classifies people into one of four categories:• Inactive• Moderately inactive• Moderately active• Active

Step 3. Intervene

The spirit of the approach

• Telling people what to do can sometimes be helpful• However, in health behaviour change, a telling

approach can sometimes get in the way• Evidence suggests that adopting a “guiding style” can

be more effective and helpful in motivating people to think about, start and persist with lifestyle change

• Lets Get Moving takes a motivational interviewing approach

Step 3. Intervene cont’d

3. The practitioner, skilled in the use of motivational interviewing principles follow initial steps to guide the patient towards one of the following options:

a. Patient decides to do nothing further and so leaving the pathway

b. Patient chooses to become more active and sets a personal physical activity goal

c. Patient chooses to have a more in-depth motivational interview about physical activity with a trained MI practitioner.

LGM patient support pack

Intervene options b or c.

Patient is provided with a Let’s Get Movingpatient support pack, which includes:

Motivational interviewing exercises Goal setting sheet Customised insert featuring local physical activity

opportunities

Step 4. Active participation

Following a brief intervention there is about a 12 week period where the patient gradually becomes active on their own

Patients may need to be followed up more regularly than this

Some patients may benefit from extra support during this time, for example by a health trainer

Step 5. Review

It is recommended that the patient is followed up at regular intervals, for example 3,6 and 12 months The NICE guidance says patients should be followed up at

regular intervals over 3 and 6 months The GPPAQ requires annual completion

Feasibility pilot

Summary of findings

• 526 adults were screened, of which 86% were found to be less than active and 83% were interested in becoming more active

• 315 attended the LGM brief intervention, of those, 54% were from black and ethnic minority groups

• The LGM brief intervention took between 3 to 21 minutes to complete

• Patients who attended the follow up intervention, 62% self reported an increase in their physical activity levels

• Also at the follow up intervention, 59% of adults reported undertaking self-directed outdoor activities e.g. walking.

Commissioning Let’s Get Moving

Commissioning Let’s Get Moving

• It is up to each commissioner to decide whether they want to commission LGM to meet their:– communities’ health needs (JSNA) and – Local priorities including those identified through the public

health outcomes framework

• In commissioning LGM, commissioners will stipulate the model used, who will provide the service, and who the service is open to and then how they plan to monitor the service

Commissioning Let’s Get Moving cont…

To commission LGM, the commissioner should ensure the following:

• Appropriate service provider commissioned to target specific population

• Service providers are appropriately trained to deliver Lets Get Moving

• The patient pack is available with local activity inserts completed for the service provider to give to patients

• The service provider is the appropriately supported and monitored

Partner opportunities for LGM

• LGM offers a real opportunity for partnership working to ensure that appropriate physical activity opportunities are available.

• The patient pack should include a wide variety of physical activity and sport opportunities for people new to physical activity– Such as walking groups, led cycle rides, dance, swimming,

leisure centre based classes

Further information on delivery

For further information about Let’s Get Moving, visit: www.dh.gov.uk and search for Let’s Get Moving

You will find details of:

• LGM commissioning guidance

• LGM patient support pack

• GPPAQ

• LGM feasibility study

• LGM training information

• NHS choices physical activity search tool for local opportunities

• Email queries to: letsgetmoving@dh.gsi.gov.uk

Insert contact information of

the person delivering

presentation

Questions