Embed Size (px)
Citation preview
Wales National Exercise Referral
Scheme Gwynedd Progress Report
2013-‐2014
Emma Quaeck, Exercise Referral Coordinator Glaslyn Leisure Centre
Church Street, Porthmadog, Gwynedd LL49 9HW
[email protected] 01766 512711 / 07768988095
1
Foreword The benefits of being physically active have been widely researched, documented and announced extensively to the general public, and yet only 35% of Gwynedd residents report that they meet recommended guidelines of 150 minutes (2.5hours) of moderate physical activity each week. As stated in the document ‘Creating an Active Wales’, those who are physically active are up to 50% less likely to develop major chronic disease such as coronary heart disease, stroke, diabetes and some cancers and between 20-‐30% reduce risk of premature death. Guidelines also recommend muscle strengthening activities on 2 or more days a week. ‘Those who do not find time for exercise now will have to find time for illness’. -‐ Earl of Derby 1873 Physical inactivity is estimated to cost Wales £650 million each year and is therefore a major issue. This report aims to illustrate the progress and developments of the National Exercise Referral Scheme (NERS) in Gwynedd as an intervention to help improve the current inactivity culture that has developed over the past decades. The report will describe how the scheme has operated over a 12 month period from April 2013 to March 2014, as well as the developments and opportunities that have arisen over the stated period.
2
Main Aims and objectives Wales’ National Exercise Referral Scheme :-‐
• To offer a systematic and safely controlled system of referral to exercise. • To help improve physical and mental health of clients. • To encourage long term participation in physical activity. • To determine the effectiveness of the intervention in increasing activity
levels and improving health. Creating an Active Gwynedd and Anglesey Vision for the Action Plan 2011-‐2014
• ‘Active Adults – encouraging more adults to be more active, more often, throughout their lives’
Byw’n Iach ( Healthy Living) Vision – Gwynedd Council
• People in Gwynedd are supported and encouraged to make healthy lifestyle choices
• People in Gwynedd have the same opportunities to enjoy the best possible health
• People living in Gwynedd are living in a county that prioritises health and maximize the potential benefits
• Gwynedd Council prioritises the health of their staff in the workplace and seeks to influence other employers.
3
Content:-‐ Forward Aims Section1 – Progress & Development 2012-‐2013 1.1.1 Introduction 1.1.2 Funding 1.1.3 Staff 1.1.4 Staff Developmentt 1.1.5 Stakeholder sand Partnerships New Projects 1.2.1 Blaenau Ffestiniog Falls Prevention Programme 1.2.2 Chronic Respiratory exercise & Education Programme-‐ Barmouth 1.2.3 Cancer & Exercise Class-‐ Caernarfon 1.2.4 Foodwise-‐ Blaenau Ffestiniog 1.2.5 Dwyfor Gardening Project Section 2 -‐ Review of Referrals Table 1 Referring Locations-‐ Primary Care Table 2 Referring Locations-‐ Secondary Care Table 3 Referring Locations-‐ Other Table 4 Total Number of Referrals Table 5 Generic Initial Consultations Referrals by Sex & Age Table 6 Generic Initial Consultations Reasons for Referrals % Table 7 Reasons for not take up programme/Withdraw % Table 8 Number of Referrals per Leisure Centre Table 9 Class Attendances & Income Table 10 Class attendances & Income 2011-‐2014 Table 11 Performance Indicators Table 12 PI’s achieved in Gwynedd Section 3 -‐ Case Studies – Lifestyle Management Programme Section4 -‐ Future Developments for 2012-‐2013 Appendices Appendix 1 – Integration of Health & NERS in prevention of chronic conditions Appendix 2 – Gwynedd NERS flow chart Appendix 3 – Class Time Table Appendix 4 – Map of location of Gwynedd Council Leisure Centres Appendix 5 -‐ NERS Staff Qualifications Appendix 6 – SWOT analysis Appendix 7 – RBA Card Appendix 9 – Gwynedd Client Success Stories
4
SECTION 1 1.1 Introduction The National Exercise Referral Scheme (NERS) has been established in Gwynedd since 2008. The scheme is run in 11 Gwynedd Council’s leisure centres with a variety of gym based, circuits, pilates, tai chi and aqua exercise classes at:-‐
1. Plas Ffrancon Leisure Centre – Bethesda 2. Swimming Pool -‐ Bangor 3. Tennis Centre – Caernarfon 4. Plas Silyn Leisure Centre -‐ Penygroes 5. Dwyfor Leisure Centre – Pwllheli 6. Glaslyn Leisure Centre – Porthmadog 7. Moelwyn Leisure Centre – Blaenau Ffestiniog 8. Penllyn Leisure Centre – Bala 9. Glan Wnion Leisure Centre– Dolgellau 10. Pavilion leisure Centre – Barmouth 11. Bro Dysynni Leisure Centre – Tywyn
Generic NERS involves clients undertaking a 16 week programme of supervised group based exercise aimed at increasing activity levels. Clients are referred to the programme by clinically trained professionals if they are inactive, deconditioned and have a low risk medical condition which could be improved by undertaking more physical activity. Exercise Professionals instructing the classes are Level 3 Advanced instructors and Exercise Referral qualified. Appendix 1 -‐Referral Pathway from Primary Care and Secondary Care Appendix 2 -‐Gwynedd NERS Flow Chart Appendix 3 -‐Programme of Activities 1.1.2 Funding. Funding for NERS made available from the Welsh Government was realigned from WLGA to Public Health Wales in April 2012. The total allocated was £173,000 for 12 months for staff, travel costs, administration and training. Gwynedd Council fund 50% of the Coordinators post. 1.1.3 Staff. The Exercise Professionals have also achieved various Level 4 qualifications which allow them to specialise in working with clients with chronic conditions. Specific sessions have been established in the following:-‐
• 2005 Cardiac Rehabilitation • 2011 Postural Stability and Falls Prevention • 2012 Orthopaedic Lifestyle Management
5
• 2013 Cancer Rehabilitation • 2013 Chronic Respiratory Exercise & Education
Clients with other Level 4 chronic conditions including Mental Health, Back Care, & Obesity and Diabetes can access the generic classes under the supervision of qualified Exercise Professionals. Number of staff working on the scheme:-‐
• 1 x Full time Coordinator (37 hrs) • 7 x (Equivalent of 5) Full time Exercise Professionals • 1 x Part time Administrative Officer (7.5 hrs)
All Exercise Professionals are on the Register of Exercise Professionals (REP’s) as Advanced Level 4 Instructors. Appendix 4 – Map of Gwynedd Classes 1.1.4 Staff Development. The Exercise Professionals undertake continuous training throughout the year. Qualifications achieved this year :-‐
• 1 x Level 4 Exercise Training for Chronic Respiratory Disease • 2 x Cancer Rehabilitation and Exercise • 2 x Tai Chi Movement for Wellbeing Instructors • 1 x Level 3 Aqua Fitness Training • 1 x Level 3 Pilates • 1 x Level 3 Adapting Exercise for Pre & Post natal Women • 2 x Community Food & Nutrition Skills • 8 x Gwynedd Council Corporate Training -‐ Effective Communication
-‐ Assertiveness -‐ Manual Handling
• 8 x First Aid & Defibrillator Update • 3 x Osteoporosis CPD Training
Appendix -‐ 5 Staff Qualifications 1.1.5 Stakeholders & Partnerships
• Gwynedd Council:-‐ • Leisure centres - Occupational Health - Older People Programme - Social Services – Mental Health Team - Learning Disability Teams - Sports Development - North Wales Outdoor Partnership - Disability Sports Wales - Let’s Walk Cymru
• Betsi Cadwalader University Health Board ( BCULHB):-‐
6
- GP’s - Practise Nurses - District Nurses - Community Advanced Nurse Practitioners - Physiotherapist - Dieticians - Occupational Health - Cardiac Rehabilitation - Cancer specialists - Pulmonary Specialists - Mental Health specialists - Health Visitors - Substance Misuse Team - Brain Injury Team - Incontinence specialist nurse
• Public Health Wales • Bangor University BReC ( Bangor Rehabilitation centre) • Mantell Gwynedd-‐ a registered charity that aims to strengthen and promote voluntary
and community groups and develop voluntary action in Gwynedd. • Macmillan • Carers Outreach • Dwyfor and Meirionydd Hearing Group • Corun i’r Sawdl -‐ a holistic wellbeing course for young mothers. • Mental Health Advocacy Scheme – user led service offering unbiased information on
all mental health issues. • Hafal – organisation for the recovery from serious mental illness for induividuals and
their families. • Age Cymru • Osteoporosis Society • MS Society North Wales • Expert Patient Programme EPP • Arthritis care. • British Heart Foundation • Federation of City Farms and Community Gardens • Groundworks • Eco Bro
1. 2. New Projects 2013-‐2014 New developments established over the past 12 months through close partnership working with BCULHB clinical specialists:-‐ 1.2.1 Blaenau Ffestiniog Postural Stability & Falls Prevention Program - Criteria, 65+ have had a fall or are afraid of falling - Score of > 3 on FRAT - Based at the old Memorial Hospital, Blaenau Ffestiniog.
7
- Started 15th January 2013 for 32 weeks , followed by a 16 weeks NERS maintenance class.
- Wednesdays 2.00-‐3.30pm - 12 Referred from physiotherapist and cardiac specialist nurse - Class run by a PSI Falls Prevention qualified Exercise Professional and a
Physiotherapist. Appendix 6 BCULHB Website page advert 1.2.2 Chronic Respiratory Exercise & Education Programme - Criteria -‐ Diagnosed COPD or other respiratory disease - Clinically stable, FEVof >60%, MRC dysponea Score of 3 or less - Based at The Pavilion Leisure Centre, Barmouth - Started 11th October 2013 - 32 weeks gym based exercise programme run by the level 4 Respiratory Disease
Exercise Professional - First 8 Weeks to include Education sessions run by Community Advanced Nurse
Practitioner (CANP) - Fridays 2.00-‐4.00pm - 9 Referred from GP and (CANP)
1.2.3. Cancer and Exercise Class - Criteria-‐ On treatment or recovering from Cancer - Based at the Tennis Centre, Caernarfon - Started 18th February 2014 - Tuesdays 2.00-‐3.30pm - 32 Week programme run by the Exercise Professional who is a Level 4 Cancer
Rehabilitation Exercise Instructor. - 1 hour gym based and circuit training class. - ½ hour cuppa and a chat to develop a Cancer Support group with funding through
Macmillan. Clients can attend the support group without doing the exercise programme.
1.2.4 Foodwise - 8 Week education programme for those who wish to learn about losing weight and
maintaining weight loss. - Topics include Preparation to Change for Life; The Eatwell plate; Portion Sizes; Food
Labels; Planning/hunger & cravings; Food and Drink Swaps; Managing Lapses. - Criteria-‐ BMI 30+ or BMI 28+ and other chronic conditions. - Based at the old Memorial Hospital in Blaenau Ffestiniog - Started 14the November2013 - Aimed the class at young mums and received 12 referrals from the Health visitor. - 6 started the programme, the remaining 6 were unable to attend due to childminding
issues. 4 Completed and have been referred to the exercise programme based at the Moelwyn Leisure Centre, Blaenau Ffestiniog.
- The 4 who completed had a positive experience and felt that they had gained valuable strategies for ealthy Eating for themselves and their families.
8
1.2.5 Dwyfor Gardening Project - Following the success of the Glaslyn Gardening Project, it was decided to develop the
same using the disused Bowling Green at the Dwyfor Leisure Centre, Pwllheli. - Funding was secured through the Council’s Health & Well Being fund, various grants
and local donations and sponsorship. - Equipment bought with the funds includes a garden shed, green house, 3 raised beds
and various garden equipment. - The project was launched officially during with an Open Day on 20th July 2013 - 10 local Ynys Enlli apple trees were planted to create an orchard which meant that the
project could register for NHS Forestry status. - Criteria-‐ Open to all, NERS clients and the general public. - The sessions run every Thursday 11.00am-‐1.00pm
Appendix 7 – SWOT analysis of Gwynedd Council’s Exercise Referral Scheme Appendix 8 – RBA Card
9
SECTION 2 Table 1. Referring Locations-‐ Primary Care The first 4 tables look at the number of referrals received from the different Primary care locations within the three localities-‐ Arfon, Dwyfor and Meirionydd Number of ReferralsPrimary Care G eneric Card iac Cancer Pu lmonaryWeig h t Men ta l H F alls L ifestyles To talsLO CAL ITY -‐ ARFO NBangor Med Centre. 2 2
Bodnant, Bang or 27 27
Bron Derw, Bang or 36 1 1 2 40
Deiniol, Bang or 13 13
G lanfa, Bang or 6 1 7
Ty Ceg in, Bang or 1 1
Llanberis 24 2 26
Bethesda H/C 32 32
Felinheli Surg ery 11 1 12
Market Street, C'fon 1 1
Bron Seiont, C'fon 20 20
Hafan Iechyd, C'fon 67 1 68
Plas Pawb, C'fon 21 21
Waunfawr Surg ery 34 2 36
Corwen House, Penyg roes 20 20
Dolwenith, Penyg roes 5 5
Bodnant, Penyg roesLlys Meddyg , Penyg roes 4 4
V ictoria, Penyg roesLO CAL ITY -‐ DWYFO RTy Doctor, Nefyn 50 1 1 52
Treflan, Pwllheli 21 2 1 24
Rhydbach, Botwnnog 8 1 1 10
Criccieth H/C 41 1 1 1 44
Madog , Porthmadog 3 2 5
Y Feddyg fa Wen, Porthmadog31 31
LO CAL ITY -‐ ME IRIO NYDDBlaenau Ffestin iog H/C 11 11
Bala H/C 36 1 3 40
Caerffynnon, Dol 47 2 1 50
Harlech Health Centre 3 3
Plas Brith, Dolg ellau 2 1 3
Minfor Surg ery, Barmouth 40 1 41
Bron Meirion, Penrhyn 40 2 3 45
Tywyn H/C 110 6 1 1 118
10
Table2. Referring Locations-‐ Secondary Care The main Secondary Care referrals come from Gwynedd’s major hospital Ysbyty Gwynedd, Bangor. Most of these referrals are received from the Physiotherapy Department for Musculoskeletal and joint pain. SECO NDARY CARE G eneric C a rd ia c C an cer Pu lmonary Weig h t Men ta l H F a lls L ifestyles Tota lsYsbyty Gwynedd 190 190Ysbyty Gwynedd-‐ Calon Lan 145 145Ysbyty Gwynedd-‐ Pulmonary 19 19Ysbyty Gwynedd-‐ Herg est 3 3Ysbyty Gwynedd Oncolog y 15 15Ysbyty Gwynedd CMATS 12 12Ysbyty A lltwen 83 1 3 87Ysbyty A lltwen-‐ Physio 13 13Ysbyty Blaenau Ffestin iog 13 13Ysbyty Colwyn Bay 2 2Ysbyty Dolg ellau 25 25Ysbyty Eryri 54 54Ysbyty G lan Clwyd 1 1Ysbyty Llandudno 17 17Ysbyty Tywyn 17 17 Table 3. Referring Locations-‐ Other
Generic Card iac Cancer Pu lmonary Weig ht Men ta l H Falls L ifestyles TotalsCMATS/GP/PN/Physio 81 81Community Advanced Nurse Practitioner 7 7Occupational Health-‐ Gwynedd Council35 1 36Flex Physio & Support 13 13Cartref, Llanfairfechan 2 2Corun I'r Sawdl-‐ Blaenau Ffestiniog 12 12O ther 106 4 110 Table 4. Total Numbers of Referrals TOTAL REFERRALS Generic Cardiac Cancer Pulmonary Weigh t Mental H Falls Lifestyles Totals
1324 145 34 31 47 11 13 81 1686
11
These next set of tables 5-‐7 shows information taken from those who have attended the Initial Consultations in the Generic Programme Table 5. Sex and Age Profile G ENERIC Prog ramme
Centre Male Female TotalUnder 1 7
1 7 -‐2 5 2 6 -‐3 5 3 6 -‐4 5 4 6 -‐5 5 5 6 -‐6 5 6 6 -‐7 5 7 6 -‐8 5 8 6 +
Canolfan Hamdden Bangor 38 73 111 0 6 9 16 18 18 20 8 0Canolfan Hamdden Glaslyn 43 66 109 0 2 8 10 21 23 22 11 0Tenis Arfon 54 114 168 1 5 10 18 16 24 17 5 1 Plas Ffrancon Bethesda 17 28 45 2 6 8 17 6 31 17 8 0Canolfan Hamdden Plas Silyn 7 16 23 0 13 17 21 17 21 4 4 0Canolfan Hamdden Dwyfor 25 38 63 0 0 7 7 30 33 15 4 0 Y Moelwyn 3 14 17 0 11 29 17 11 17 11 0 0Penllyn Bala 4 17 21 0 19 9 4 19 38 9 0 0Glan Wnion Dolgellau 15 26 41 2 14 9 19 9 19 17 7 0Y Pafiliwn Bermo 14 19 33 3 0 3 18 12 12 36 15 0Bro Dysyni Tywyn 30 43 73 0 15 13 10 12 23 15 9 0
TO TAL 2 5 0 4 5 4 7 0 4 0 9 1 1 2 2 1 5 7 1 7 1 2 5 9 1 8 3 7 1 1
In itia l Consu ltations % Ag e Pro file
Table 6. Reasons for Referral in Initial Consultation
Reason s for Re ferra l %
Musculoskeletal and joint pain 43
Referral from NERS L4 8
Respiratory Problems 5
CHD Risk factors 19
Mild Anxiety / Depression 13
D iabetes 8
O steoporosis 1
Tota l of 924 reason s log g ed for 704 partic ipan ts.
12
Table 7. Reasons for not taking up the programme and Reasons for withdrawal from the programme following Initial Consultation
% % % %
Lost the motivation to continue 1 The session time did not suit me
4 Lost the motivation to continue 6 The session time did not suit me
1
Problems w ith transport to the venue 0 Other commitments 6
Problems w ith transport to the venue 0 Other commitments 14
Illness -‐ deterioration of current condition
3 Illness -‐ other 3 Illness -‐ deterioration of current condition
11 Illness -‐ other 7
Change of job or working hours 1 Participant deceased 0 Change of job or working hours 3 Participant deceased 0
I did not enjoy the activity sessions 0 I don't like exercise 1 I did not enjoy the activity sessions 0 I don't like exercise 0
There was nobody to g o w ith 0 I felt self conscious 0 There was nobody to g o w ith 0 I felt self conscious 0
The session fee was too expensive 0 Negative impression of the scheme / venue
0 The session fee was too expensive 1 Negative impression of the scheme / venue
0
I am undertaking regular exercise elsewhere
5 Returned to work 3 I am undertaking regular exercise elsewhere
3 Returned to work 3
Referred back to GP, then w ithdrawn by GP
3 Bereavement 0 Referred back to GP, then w ithdrawn by GP
0 Bereavement 0
Reason D eclined 4 No Answer 58 Reason D eclined 1 No Answer 42
Transferred to another area 0 Transferred to another area 0
Reason s fo r n o t takin g u p p ro g ramme
To ta l o f 628 reason s lo g g ed fo r 582 partic ip an ts.
Reason s fo r W ith d raw al
To ta l o f 218 reason s lo g g ed fo r 207 partic ip an ts.
The NERS programme is run from Gwynedd Council’s 11 leisure centres. Table 8-‐10 figures look at the number of referrals per centre and the how many of those referrals have attended NERS classes over the past 12 months and the income achieved. Table 8. Number of Referrals to each Leisure Centre # Referrals per leisure centreBangor Sw imming Pool 258Plas Ffrancon, Bethesda 80Arfon Tennis Centre 399Plas Silyn, Penygroes 71Dwyfor, Pw llheli 184Glaslyn, Porthmadog 256Moelwyn, Blaenau Ffestiniog 69Glanwnion, Dolgellau 76Penllyn , Bala 58Pavilion, Barmouth 74Bro Dysynni, Tywyn 161
1686
13
Table 9. Number of Class Attendances & Income Niferoedd & Incwm Dobsarthiadau NERS 2013-2014Usage & Income from NERS classes 2013-2014Mis/ Month Defnydd/ Usage Incwm/ IncomeEbrill / April 1151 1726.5Mai / May 1125 1687.5Mehefin / June 1098 1647Gorffennaf/ July 1093 1640Awst / August 954 1431Medi / September 1032 1548Hydref / October 1487 2305Tachwedd/ November 1270 1905Rhagfyr/ December 690 1035Ionawr / January 1701 2551.5Chwefror / February 1432 2148Mawrth / March 1693 2539.5Cyfanswm / Total 14726 22164 Table 10. Number of Class Attendances & income 2011-‐2014 Financial Year Usage Income2011-2012 13038 £19,456.002012-2013 13585 £20,060.182013-2014 14726 £22,164
14
Table 11 below demonstrates the minimum area Performance Indicators (PI’s) targets set by Public Health Wales. The figures are based on the number of full time Exercise Professionals; Gwynedd has the equivalent of 5 and Table 12 shows the targets achieved. The figures in red indicated where the targets were not met. Table 11. NERS Minimum area PI targets 2013-‐2014
Target Referrals 20 Referrals per Full Time InstructorTarget Consultations 20 Consultations per Full Time InstructorTarget Uptake -‐ 1st Session 75% of Target Consultation16 Week Retention 45% of Target Uptake12 Month Retention 50% of 16 Week Retention Table 12. PI Target Achieved in Gwynedd 2013-‐2014 GWYNEDD % PI TARG ET REF S% TARG ET CO NS % TAKE UP % 16 WK COMPLETE % 1 YEARQ 1 105% 117% 81% 126% 118%Q 2 115% 101% 80% 85% 112%Q 3 127% 118% 91% 113% 158%Q 4 166% 155% 141% 123% 103%
15
SECTION 3 Case Studies
Lifestyle Management Programme The Lifestyle management programme has been designed to support and deliver a weight management and exercise programme for clients with hip or knee osteoarthritis requiring arthroplasties. After completing the programme individuals going on to have surgery will be fitter, healthier, and less likely to suffer from post-‐operative complications. At best it will avoid the need for surgery and enable self-‐management. The scheme is run by BCULHB in conjunction with NERS. It is aimed at those over 18years of age and with a BMI of 35+ and clients will have access to qualified dietician, physiotherapist and NERS Exercise Professional. The programme runs for 32 weeks plus a further 16 weeks on generic NERS and clients are encouraged to attend a minimum of 2 sessions per week. See the table below for progress report from the start of the programme in December 2012-‐ March 2014 Table 13. LMP Progress Report December 2012-‐March 2014 Referrals for
Lifestyle Manag ement Prog ramme Glaslyn LC Dwyfor LC Arfon LC Glanwnion LC TOTALSCMATS 17 7 23 3 50GP 9 5 5 19Physio 9 13 13 35D ietician 1 1Rheumatolog ist 1 1NERS 3 8 15 26Total 38 34 57 3 132TO TAL REF ERRALS 132# Completed 29# Not Completed 54Active / On Hold 49
General D ischarg e & DNA's CMATS 10 12%Referred to :-‐ GP 73 87%
General D ischarg eof 29 Completed CMATS 10 35.70%
GP 19 64.20%
16
Case Study 1 Name: Carys Wyn Jones
Age : 64yrs Leisure Centre: Dwyfor Leisure Centre, Pwllheli
Reason for Referral: Left knee Osteoarthritis & Weight loss Referred by: Practise Nurse, Ty Doctor, Nefyn
Measurements Week 1 Week 32 Results Weight kg 93.8 80 ↓ 13.5kg (14%) Height cm 150.5 150.5 -‐
BMI 41.41 35.73 ↓ Blood Pressure 181/102 159/86 ↓
Resting Heart Rate 69 61 ↓ EQ-‐5D-‐5L Questionnaire 17/48 26/48 á Oxford Knee Score ( OKS) 50% 80% á Physical activity per week Dim / None 3 to 4 á
What Carys said:-‐ ‘I am extremely happy that I had the opportunity to take part in this class. The dietician was very thorough and helped show me how to change the way I thought about food. When she weighed me she often helped me understand where I’d gone off track so to speak, and was eager for us to get back on. I am much more aware of the Eatwell Plate when I am preparing food at home. Even though I’ve seen the plate so many times, I’m still look at the poster up on the way outside the fitness room to remind me.
I also enjoyed going to the studio where we did circuit training. We had lots of fun with Terry our Instructor, although unfortunately we haven’t been chosen for ‘strictly’ quite yet! I loved going to the gym, there was usually someone I knew there so we could have a good old natter. The programme has been a blessing for me, where else would I have had such support and attention and all free of charge. I feel better and I look better, and as the old saying goes ‘ If at first you don’t succeed, try, try again’. The Dietician said:-‐ “This lady showed commitment to the programme throughout. Her excellent attendance, participation during sessions and readiness to make positive adaptations to her lifestyle has demonstrated how much can be achieved by individuals during this programme. It has been great to observe her success over the months and I’m confident that she will maintain these positive lifestyle changes in the longer term.”
NERS Exercise Professional said:-‐ ‘Carys has done really well over the 32 weeks. Her attendance record was excellent and this showed in the results she achieved. She lost 14% of her start weight and has gone back to playing golf twice a week. Her blood pressure also improved. She has been referred to the 16 weeks Exercise Referral programme and attends the gym twice a week.’
17
Case Study 2
Name: Yvonne Burgess Age : 52yrs
Leisure Centre: Dwyfor Leisure Centre, Pwllheli Reason for Referral: Weight loss, O/A knees & high blood pressure
Week 1 Week 32 Results Weight 87.2KG 75KG ↓13kg BMI 37.10 31.91 ↓ Blood Pressure 194/117 138/85 ↓ EQ5 127.9, VAS-70 136.7, VAS 75 á Oxford Knee Score
19/48 33/34 á
What Yvonne Said:-‐ My BP was 190/ I had to get a letter from my GP before I could start the programme. My BP is now down to 149/84. I was borderline Diabetic but now all my sugar level is normal. My knees have improved quite a lot, but still ache in bed and when I go up and down stairs and on long walks. At 32 weeks I have lost 13kg and I have dropped 4 dress sizes. I’m doing 23km per day at home on my cross trainer/bike as well as going to the gym twice a week. I have done this with the help from Terry (Instructor), Iona (Dietician) and Fflur (Physio). Terry – Terry keeps you motivated, gives you encouragement when you need it. He is there to give help when needed; he explains what the exercise will do for your body and what muscles it will strengthen. Iona(Dietician) – Iona helped me recognize where I was going wrong with my eating habits and stress levels. Helped me get back on track and look at calories on food before buying them, also she made me focus on myself instead of everyone else. Fflur (Physio) – is a great support if you have any problems with strains, pulled muscles, aches or pains. She gives you exercises to get you back on your feet. From a slightly negative angle the session at 6pm in the gym had groups of young lads, swearing and showing off in way which was intimidating especially to the elderly members of our group. I would like to say thank you to these three for helping me along this path.
18
SECTION 4 PRIORITIES for 2014-‐2015 4.1.1 Postural Stability and Falls Prevention Exercise Programme Following the success of the Falls programme in Tywyn and Blaenau Ffestiniog, a 32 week programme will start at the Glanwnion Leisure Centre in Dolgellau in May 2014. 4.1.2 Chronic Respiratory Exercise and Education Class A second venue has been identified to deliver a Chronic Respiratory class in the community. Because of the distance clients have to travel to Ysbyty Gwynedd in Bangor for Pulmonary Rehabilitation sessions, the focus is to develop a further class in the Meirionydd area. By working in liaison with the Community Advanced Nurse Practitioner, the new class will be held at Glanwnion Leisure Centre, Dolgellau in May 2014. 4.1.3 Cancer and Exercise Class The third Cancer & Exercise class in Gwynedd will be starting at the Dwyfor Leisure Centre in May 2014. The class will follow the same format as those in Caernarfon & Tywyn with the exercise class followed by a sit down with a cuppa for the opportunity to discuss any issues around cancer. It is hoped that we will be able to access funding through Macmillan to help fund and develop the support group. 4.1.4 Foodwise Programme Following the pilot for the Foodwise programme in Blaenau Ffestiniog, the next programme will be run in Bro Dysynni Leisure Centre, Tywyn. Clients will be referred into the programme through the health visitor who will target young parents in the area. The programme will start in May/June 2014. The aim is to also run 1 x other programme in the county before December 2014, the location will be decided depending on demand. 4.1.5 Work closer with Leisure Centre Level 3 Instructors Because of the demands on the NERS Exercise Professionals to deliver more chronic condition specific classes, the aim is to involve level 3 advance instructors working in the leisure centres to teach clients that are referred for general weight loss and fitness classes. From April 2014, the Instructor from the Arfon Tennis Centre will hold 2 x classes for these clients thus releasing the Exercise Professional to focus on those in need of more specialist attention as well as developing a new Cancer & Exercise Class. 4.1.6 Health & Wellbeing Clinics for Cancer patients BCULHB’s vision for patients who have had a cancer diagnosis and are living with cancer to have access to comprehensive and holistic support to enable them to lead as normal a life as possible. In order to help achieve this NERS will be working with a physiotherapist who is employed by BCUHB and funded by Macmillan Cancer Support to lead on improving support and information for cancer patients. The objective is to offer Health & Wellbeing Clinics to patients in Gwynedd with a view to establishing this as an integral part of the cancer pathway. These will be one off multi-‐disciplinary clinics to support people around the end of treatment; offering expert advice on healthcare and lifestyle to minimise risk of recurrence,
19
access to information, support and care and empowering patients to self-‐manage as far as possible. The first clinic will be held at the Arfon Leisure Centre in June 2014, which will be repeated every 2-‐3 months. There will be information stalls and workshops offering advice and support. The clinics will then be developed at Tywyn and Pwllheli leisure centres.
20
APPENDICES
1. Integration of Health & NERS in Prevention and Management of Chronic Conditions. 2. Gwynedd NERS Flow Chart. 3. Gwynedd NERS Exercise Classes 4. Map showing Location of Gwynedd Leisure Centres 5. List of Staff Qualifications 2008-‐2012 6. Falls BCULHB Website advert 7. SWOT analysis 8. RBA card 9. Gwynedd Client Success Stories
21
Appendix 2. Gwynedd NERS Flow Chart
Form sent to Coordinator
Letter sent to client informing them that their referral form has been received
Letter sent to client inviting them to an
Open Day or Consultation. Or
telephone appointment
Agreed classes, various times and locations:-‐ Gym Circuits Aqua Fit Metabolic Effect Tai Chi Gardening
Waiting approx 2 weeks Waiting approx 3-‐8 weeks
Exit Routes:-‐ Leisure Centre Classes Swimming Lets Walk Cymru Green Gym Community Classes
22
APPENDIX 3 GWYNEDD AMSERLEN DOSBARTHIADAU / CLASS IMETABLE 01/01/14
Venue-‐ Leisure Centre Exercise Professional
Day of session Time of session Type of Session
Tennis Centre, Caernarfon Debbie Jones Monday 9.00am -‐10.30 Cardiac -‐ Gym 01286 676945 Craig/Debbie Tuesday 10.00am-‐12.pm NERS -‐ Gym Craig Cornes Tuesday 12.15-‐1.00pm Tai Chi Debbie Jones Tuesday 2.00-‐3.30pm Cancer Rehab Exercise class Craig / Debbie Tuesday 5.00-‐7.00pm NERS-‐ Gym Debbie Jones Wednesday 11.00-‐12.15 NERS-‐Aqua Craig Cornes Wednesday 5.30-‐6.30pm Lifestyle Pathway Prog-‐ Circuits Craig Cornes Thursday 10.00am-‐12.00 NERS -‐ Gym Craig Cornes Thursday 5.00-‐7.00pm NERS -‐ Gym Debbie Jones Friday 9.00am-‐10.30am Cardiac -‐ Gym Debbie Jones Friday 12.00-‐1.00pm NERS -‐ Circuits Craig Cornes Friday 1.00-‐2.00pm Lifestyle Pathway Prog-‐ Gym Plas Francon, Bethesda Elen Evans Monday 11.00-‐12.00 Cardiac -‐ Gym 01248 601515 Elen Evans Monday 7.30-‐11.00am NERS-‐ Gym Elen Evans Friday 9.00-‐11.00am NERS -‐ Gym Elen Evans Friday 11.00am-‐12.00 Cardiac -‐ Gym Bangor Swimming Pool Elen Evans Monday 1.00-‐2.00pm Cardiac -‐ Gym 01248 370600 Elen Evans Monday 2.00-‐4.00pm NERS -‐ Gym Elen Evans Tuesday 9.45-‐10.15am NERS-‐Metabolic Effect (ME) Elen Evans Tuesday 12.00-‐1.00pm NERS-‐ Aqua Fitness Elen Evans Thursday 9.45-‐10.15am NERS-‐Metabolic Effect (ME) Elen Evans Thursday 10.15-‐12.00 NERS-‐ Gym Plas Silyn, Penygroes Terry Williams Monday 11.00am -‐12.00 NERS -‐ Gym 01758 882047 Terry Williams Friday 1.00-‐ 2.00pm NERS -‐ Gym Dwyfor, Pwllheli Terry Williams Monday 1.00-‐2.00pm NERS -‐ Gym 01758 613437 Terry Williams Tuesday 9.30am-‐10.30am Cardiac -‐ Gym Terry Williams Tuesday 10.30-‐11.30am NERS-‐Gym Terry Williams Tuesday 2.45-‐3.45pm Lifestyle management prog-‐ Circuits Terry Williams Tuesday 5.00-‐6.00pm NERS/ Cardiac/LMP -‐ Gym Terry Williams Thursday 9.30am-‐10.30am Cardiac -‐ Gym Terry Williams Thursday 10.30-‐11.30am Lifestyle management prog-‐ Gym Terry Williams Thursday 11.30-‐1.00pm Gardening Project Terry Williams Thursday 1.00-‐3.00pm NERS-‐Gym Craig Corne Friday 10.00-‐12.00 Falls Prevention strength & balance Glaslyn, Porthmadog Graham Pierce Tuesday 8.00am-‐9.00am NERS -‐ Gym 01766 512711 Graham pierce Tuesday 9.30am-‐11.30am Cardiac -‐ Gym Terry Williams Tuesday 12.00-‐1.00pm Lifestyle management Prog-‐ Gym Graham Pierce Tuesday 1.00-‐2.00pm NERS-‐ Gym Graham Pierce Thursday 9.30-‐11.30am Cardiac -‐ Gym Graham Pierce Thursday 12.00-‐1.00pm NERS-‐Gym Terry Williams Thursday 5.45pm -‐6.45pm Lifestyle management-‐ Circuits Graham Pierce Friday 10.00-‐11.00am NERS-‐Gym Graham Pierce Friday 10.00-‐12.00 NERS -‐ Gardening Project Penllyn, Bala Graham Pierce Monday 12.00-‐1.00pm NERS & Cardiac -‐ Gym 01678 521222 Graham Pierce Wednesday 12.00-‐1.00pm NERS & Cardiac -‐ Gym Moelwyn, Blaenau Ffestiniog James Richards Wednesday 6.00pm-‐7.00pm NERS & Cardiac -‐ Gym Memorial Hospital, Blaenau Ff James Richards Wednesday 2.30 – 4.00pm Falls Prevention strength & balance
23
Glan Wnion, Dolgellau James Richards Monday 12.00pm-‐1.00pm NERS & Cardiac-‐ Gym 01341 423579 James Richards Monday 5.00-‐6.00pm NERS & Cardiac -‐ Gym James Richards Wednesday 12.00-‐1.00pm NERS & Cardiac -‐ Gym James Richards Friday 12.00pm-‐1.00pm NERS & Cardiac-‐ Gym Y Pafiliwn, Barmouth James Richards Tuesday 12.00-‐1.00pm NERS & Cardiac& Respiratory -‐ Gym 01341 280111 James Richards Tuesday 5.00-‐6.00pm NERS & Cardiac -‐ Gym James Richards Thursday 12.00-‐1.00pm NERS & Cardiac & Respiratory-‐ Gym James Richards Thursday 5.00-‐6.00pm NERS & Cardiac -‐ Gym Bro Dysynni, Tywyn Rachael Roberts Monday 6.00pm-‐7.00pm NERS -‐ Gym 01654 711763 Rachael Roberts Tuesday 9.45am-‐10.45am Cardiac -‐ Gym Rachael Roberts Tuesday 11.00am -‐12.00 Gentle Exercise FALLS Rachael Roberts Wednesday 10.00-‐12.00am Cancer & Exercise Class Rachael Roberts Wednesday 1.00-‐2.00pm NERS -‐ Gym Rachael Roberts Wednesday 6.00-‐7.00pm NERS -‐ Gym Rachael Roberts Thursday 10.15-‐11.15am NERS -‐ Gym Rachael Roberts Thursday 11.30-‐12.30pm NERS -‐ Aqua Fit Rachael Roberts Thursday 3.00-‐4.00pm NERS-‐Pilates Rachael Roberts Thursday 6.00-‐7.30pm Pilates
24
APPENDIX 6. Betsi Cadwalader University Health Board-‐ Website. Advertisment for new Falls class
Falls Champions join forces (Friday, 11 April 2014)
The Physiotherapy Department at Betsi Cadwaladr University Health Board are committed to tackling Falls in the over 65s by running a 32 week Falls Prevention and Balance Exercise class. This is being done jointly with Gwynedd’s National Exercise Referral Scheme (NERS). The classes are to be held at the Glanwnion Leisure Centre, Dolgellau every Thursday morning, and will commence on the 8th May 2014. In Wales, it is estimated that about a third of people over the age of 65 fall each year, and half of those in the over 80’s age group. The Health Board and NERS will be working in partnership to address some of these issues. Falls represent over half of hospital admissions for accidental injury, particularly fractures, which cost the NHS an estimated £1.7 billion per year. Councillor Paul Thomas, Gwynedd Council’s Healthy Gwynedd Cabinet Member said: “I am extremely pleased that we are working together with our partners to offer this important service. The programme aims to help local residents over the age of 65 years build strength, and improve balance and co-‐ordination so that they are less likely to fall. This not only helps to maintain confidence to live independently at home, but also avoids potentially life threatening injuries.” The Falls Prevention programme was designed by Later Life Training and follows evidence based research. The seven components include strength, balance, flexibility, endurance, floor activities, getting up and off the floor and tai chi. Also, an important element is the cup of tea and socialising at the end of the class.
Senior physiotherapist Clare Horton and NERS Exercise Professional James Richards will be working together on this venture. They are both Postural Stability and Falls Prevention Instructors and are specialists in this area. Clare said:-‐ “In our roles as a Physiotherapist and Exercise Professional the benefits of exercise for balance and mobility, strength and function and of course, enjoyment is there to be seen.
“Using the specific training we have the opportunity to work together to help people realise the benefits of this programme and what it can bring in terms of increasing confidence, maintaining independence and preventing injury.’’ If anyone is interested in taking part in the programme they can visit their local GP for a referral or complete the relevant application forms to be found in health and leisure centres, chemists, shops and with local agencies.
25
Appendix 7 SWOT Analysis for Gwynedd Council’s National Exercise Referral Scheme (NERS) – January 2014
Positive Negative STRENGTHS ( S) WEAKNESSES (W) Internal • Part of the Welsh National Exercise Referral
Scheme. • Evidence based and quality assured, with clear
aims and objectives. • Defined protocols and procedures developed
and agreed with a range of professional bodies and specialist input.
• Clear direction and support for the scheme within the Council’s ‘Byw’n Iach’ vision.
• Strong links with other departments within the Council.
• Strong links and working relationships with a broad range of health professionals BCUHB
• Strong links with PHW enables the scheme to remain strategically relevant and respond to the developing needs of BCUHB .
• Large and diverse directory of stakeholders locally, regionally and nationally.
• Good reputation and well thought of by stakeholders, including NHS professionals.
• Good links with Community Groups & organisations.
• Dedicated staff to work on the scheme, Coordinator , 7 Exercise Professionals & Admin post
• Level 4 Chronic Conditions training for NERS staff & continuous training.
• A High Standard of Leisure Centre facility to work from.
• Variety of NERS classes throughout the county.
• Targeting Chronic conditions as well as generic -‐ Cardiac, Pulmonary, Falls Prevention, Cancer, Orthopaedic Lifestyle Management, Mental Health, Back care.
• Is trusted and valued by NHS professionals in North Wales as an integral part of several ‘patient pathways’ for primary and secondary prevention of chronic conditions and rehabilitation..
• Low class fee for clients. • Leisure Centre membership rates post NERS. • Exit routes within Leisure Centres or outdoor
activities.
• Scheme not known or fully understood by some stakeholders.
• Scheme not known or understood by potential clients.
• Need to have stronger links with Leisure Centre staff for better signposting post NERS.
• Some Leisure Centre managers and staff do not fully understand the scheme’s value.
• Poor understanding of the scheme within Gwynedd Council.
• Not enough Exercise Professionals working on/or with the scheme to maximise its potential.
• Coordinator‘s duties including instructing classes.
• The geography of the county makes it difficult to see and support the individual staff on a regular basis.
• The geography and the class timetables make it difficult to get the team together for regular meetings.
• Travel time for Coordinator attending meetings is disproportionately high due to the geography of Gwynedd.
• Having to instruct NERS classes in the gyms during public times, no sole use.
• Require a wider variety of class types. • Too many clients attending generic
classes therefore may not get the best and most effective supervision.
• Generic classes often have a broad mix of conditions, making it difficult tailor the activity to the specific needs of each condition and ensure effective instruction for specific problems.
• Numbers of clients referred to outdoor activities.
• Numbers completing 16 weeks. • Monitoring clients post NERS.
26
• Good publicity in local papers, websites
Positive Negative OPPORTUNITIES (O) THREATS (T) External • Byw’n Iach, Gwynedd Council’s vision for
health improvement. • Working closely with stakeholders including
PHW and BCUHB to develop additional customer groups.
• Research opportunities. BReC • Funding for additional innovative projects. • Outdoor activities • Acquisition of new technology to reduce time
consuming admin procedures and improve efficiency/access to data and communications.
• Marketing officer within the Council. • Staff development outside the frame work of
NERS through Gwynedd Council’s corporate training via team training.
• Staff involvement in taking responsibility for leading projects within the scheme previously undertaken by the Coordinator.
• Gwynedd Council review of NERS to discover ways of maximising its potential.
• Short term contracts-‐ annual/ bi annual, make long term planning difficult.
• Short term contracts for NERS staff. • Potential for % cut in budget • Ongoing capacity issues limit the scope for
significant development into the future
![Protocol for a feasibility randomised controlled trial of the use of … · 2017. 12. 12. · Exercise referral schemes (ERS) are one common model [5], usually involving referral](https://img.pdfslide.net/doc/110x75/6100414dfe542029f4452ca7/protocol-for-a-feasibility-randomised-controlled-trial-of-the-use-of-2017-12-12.jpg)
