LLT RECS UPDATE 1

Update on programming, physical activity recommendations for

older people and implications for LLT Tutors

LLT RECS UPDATE 2

Purpose of this session

• To consider/understand current issues affecting CBE and LLT

• To update on physical activity recommendations for older people

• To consider implications for LLT programmes and LLT Tutor role

• To provide routes to additional information

LLT RECS UPDATE 3

Practical evidence based interventions for exercise programmes

Development of LLT training continuum• Senior Peer Health Mentoring (Engaging and

motivating the older person to become active)• Chair based exercise for the frailer older person

(Addressing risk factors and independence)• Otago Exercise Programme (Strength and

balance retraining programme)• Postural stability (Falls prevention and

management)

LLT RECS UPDATE 4

“Supervised exercise” - Chair based exercise and assisted

walking• Leadership training for health and care

professionals• Four days training + assessment• 17 specific exercises designed to improve

mobility, strength, flexibility and co-ordination

• Includes assisted walking and games activities (as CPD) and promoting home based exercise “on my own”

LLT RECS UPDATE 5

Developments in LLT CBE• 1999 – 2000 LLT and CBE -

“New Kid on the block”• 2001 – 2005 - Honeymoon period• 2005 onwards ????................• Now many competitors, national and local• Their criteria ? - safety, enjoyment and low cost• Exposure of LLT content, evidence base and

replication

LLT RECS UPDATE 6

LLT Chair based exercise for frailer older people

Targets components of fitness to improve independence, mobility and risk factors for falling

• Strength

• Flexibility

• Muscular endurance

• Cardio-respiratory

• Motor fitness (skills/balance)

LLT RECS UPDATE 7

UK Physical activity recommendations for older people

• A prescription for SEDENTARY Adults

• 30 minutes of moderate intensity physical activity on five or most days of the week.

• No guidelines for older adults

• Integrated physical activity (walking, cycling)

• 10,000 steps• Gentle exercise mafia e.g. “Fit

as a Fiddle”• Only NHS Scotland include

strength and balance

LLT RECS UPDATE 8

Additional recommendations

• “Additionally, specific activities that promote improved strength, co-ordination and balance are particularly beneficial for older people”. (DOH 2005)

• NB This is not a public health message and has never been promoted

Be Strong, be Steady

LLT RECS UPDATE 9

Recent physical activity recommendations for older people

• 30 mins. moderate intensity on 5 or more days a week

• 3 x 20 mins. vigorous – where appropriate

• Strength, flexibility, balance and coordination are vital (2 x per week)

• Individual tailored action plan• Stepwise approach

( AHA & ACSM 2007, Confirmed by DHHSS 2008)

LLT RECS UPDATE 10

BHF NC Guidelines on older people and physical activity

• How much is physical activity is enough and how do we communicate this ?

• Evidence on interventions - what works in practice ?

www.bhfactive.org.ukNB not conditions or

prescriptions

LLT RECS UPDATE 11

2007- 8 BHF NC Dissemination events

• Over 700 + professionals across UK• Strong support for intervention guidance

as professional planning checklist• But• Lack of knowledge of current PA OP

recommendations (beyond mod message)• Unable to “interpret” message• Low understanding of implications for

practice

LLT RECS UPDATE 12

The missing components of fitnessStrength, flexibility, balance,

power and coordinationThis message is not known in public health CBE has become the default mode for all older

people programmes (safe bet)LLT Independence - not being achieved Not all CBE targets strength and power

NB Strength is important in other evidence based exercise interventions e.g. diabetes, weight loss,

mental health improvement

LLT RECS UPDATE 13

Importance of professional understanding

• Levels and tasks• PA and exercise specialist and generic health

promotion• Commissioning services (e.g. LLT programmes)• Design and inclusion within effective

programmes• Promotional and marketing messages/activities• 1 – 1 interventions, educating/advising others

including participants(NB FAME and OEP included with DHHS 2008)

LLT RECS UPDATE 14

Public policy, the recent

shift

LLT RECS UPDATE 15

Independence – the key factor in later life

What does independence in later life really mean in practice ?

Being able to:• Go shopping• Going to the toilet• Visiting the neighbour• Playing with the grandchildren• Posting a letter• Getting into the garden• Going to church (Kings College 2006)

LLT RECS UPDATE 16

“Sit to Stand” and “Up and about” - The key to independence

• Strength, balance and power

• Daily activities – such as the displacement of body weight during walking or getting up from a chair – require power rather than strength alone.

• The ability to perform activities of daily living is therefore related to muscle power.

• Without balance, and endurance walking is not possible

LLT RECS UPDATE 17

Understanding Functional Health

• Does physical activity• (With those who do not have severe functional

limitations) - prevent or delay the onset of substantial functional limitations ?

• (With those who have mild, mod or severe functional limitations) - improve or maintain functional ability

• (Those who are at increased risk) - reduce rates of falls and fall-related injuries ?

PA Guidelines Advisory Committee (Part G, Section 6: Functional Health) DHHS 2008

LLT RECS UPDATE 18

What’s the LLT USP ?CBE and OEP

• Evidence base (but of what ?)

• Properly delivered – progressive, physical function and independence

• But: - Well-being and independence as focal themes are conceptually confused and mixed in policy implementation

LLT RECS UPDATE 19

What’s the LLT USP ?

• Maximising the opportunities for progression and improvement

• Delivery of real independence through all components of fitness

• Implementation of NICE Mental Health Guidelines

We need to make the case differently, smarter to different professional and public

targets

LLT RECS UPDATE 20

Implications for LLT Tutor team

• What’s our role to establish the USP of LLT programmes ?

• How can/should we do it ?

• Re-branding of programmes ?

• How do we develop the message ?

• Who needs to hear it ?