The Angus Activity Programme for People with a Long-term Condition aims to provide suitable physical activity opportunities for anyone with a long-term condition living in Angus. Research suggests that ‘exercise enables a person to achieve a greater degree of self-management of their condition and can be worthwhile, safe and reduce disability with few adverse effects’ (Forster et al, 2009).
Our overall aim wasto increase people’s ability to manage and live better with their long term condition/s.
We identified 5 main outcomes for this, the second phase, of the Project’s work. These were to:
- Increase people’s abilities to manage their long-term condition better through attending exercise sessions
- Increase the knowledge and skills of exercise leaders in self-management and health behaviour change techniques
- Recruit, train and support more volunteers to ensure the ongoing development of the Project
- Improve the health of carers, and help to ensure the person they look after can live better with their long-term condition
- Improve partnership working to ensure sustainability
Training formed a significant part of our work. By increasing the skills and knowledge of exercise instructors it was anticipated that people with a long-term condition attending exercise classes could be better supported (to manage their health condition/s even better). Increasing the number of trained exercise instructors was undertaken to improve capacity. More training in seated exercise for volunteers involved in the Project, as well as people working in Angus (e.g. care home staff) was provided, to increase our ability to offer 1-1 seated exercise for housebound people, and increase the number of locations where seated exercise could be offered.
Volunteers have contributed significantly to the success of the Project and we recognised there was a requirement to increase the number of volunteers to support ongoing development. A volunteer coordinator role was established and we have had someone in this role since February 2012.
Carers were recognised as a special group who we actively engaged with. Carers are eligible to attend classes in their own right, not just when accompanying those they care for.
We have been developing the use of the Nintendo Wii as an innovative way of promoting physical activity for housebound and in-hospital patients.
Promotion formed a big part of our work as well- both to engage with potential beneficiaries and to encourage organisations out with Angus to learn from what we have done.
Provision of appropriate exercise equipment to support exercise instructors and volunteers to deliver exercise sessions was also undertaken.
What we actually did
- Health Behaviour Change training undertaken over two and a half days by 8 exercise instructors. This training was provided by NHS Tayside who recognise the benefit of partnership working with Angus Council Leisure Services and the local peer support groups, led by Angus Cardiac Group
- Vitalyz Silver seated exercise training was delivered in Angus on 5separate occasions (2 days in November, 2 days in June and 1 day in September). We delivered the November sessions in partnership with Volunteer Gold, with 12 people in our Project benefitting. In total, 65 people have been trained by us in Vitalyz Silver seated exercise. These include volunteers within our Project, employees from the Adult Resource Centre in Montrose, and people working in care homes across Angus. The Project has also paid for 18 of our volunteers to complete GOLD distance learning seated exercise (the accredited training which follows on from Silver training)
- Half day training on Self-management with 24 participants (exercise instructors, and volunteers). Each leisure facility was given a ‘Professional Toolkit’ on self-management which gives information to facilitate sign-posting for participants to various support networks, e.g. smoking cessation and peer support groups
- Dr Sanderson, a leading specialist in Nutrition from Leeds Metropolitan University, delivereda 2 day Nutrition course for exercise instructors and volunteers in May 2012, with 15 people in attendance
- A workshop on Mental Health & Dementia was provided in June 2012. 20 volunteers and exercise instructors attended. This was provided by NHS colleagues, with help from one of our volunteers who talked about her experiences of providing exercise sessions for people with dementia
- 2 exercise instructors trained in BACR phase IV exercise instructor training
- 3 exercise instructors undertook level 3 Exercise Referral distance learning training (an accredited training which will allow access to further specialised exercise courses)
- Support of Angus Falls Prevention in bringing Postural Stability Instructor training to Angus. 2 exercise instructors trained. This is part of a wider initiative to pilot exercise sessions for people in Angus that are at risk of falling
- Aqua Zumba training for 3 exercise instructors. These exercise instructors are already qualified to teach special populations and this training was an opportunity to be able to provide this popular class to our target group
- Support for 1 exercise instructor who is undertaking a Pilates qualification. Pilates is recognised as a low intensity, low impact form of exercise beneficial for core strength and posture. This instructor already works within the Project and we believed that Pilates is a possible new type of exercise that we could offer to people with long-term conditions
- First Aid training provided to 31 volunteers on 3 separate training sessions
- In order to identify future training requirements a study day in September for exercise instructors was organised. This also allowed exercise instructors to share experiences and good practice
- Adult Protection & Prevention of Scams training attended by 11 volunteers
- Bags of exercise equipment to support volunteers in delivering exercise, plus sundry equipment for existing classes were purchased
- We purchased a number of ‘Exercise for Cardiac Rehabilitation’ DVDs from Gloucestershire NHS and have made these available to participants who have expressed an interest in doing exercises at home. We have also been working with Gloucestershire NHS to advise and support them in making this DVD more generic so as to encourage people with any long-term condition to use it
- All circuit classes are now open to people with any long-term condition and partners/carers except two as these were started for cardiac patients (phase IV) and are currently at capacity
- From October 2011 to September 2012, there were 415 new participantsin exercise provided by the Project
- We currently have 37 volunteers who are registered with the Project, which is an increase of 20 since October 2011
- There are 25 volunteers who are trained to deliver seated exercise. The Project appointed a Volunteer Coordinator for 10 hours per week who recruited and supported these and other volunteers
- Additionalseated exercise class started in January 2012 at Lochside Leisure Centreand in October 2012 at Brechin Leisure Centredue to the popularity of original classes
- Opening up Refer 2 Exercise to include anyone with a long-term condition has resulted in gym-based exercise classes being made available in all Angus Leisure Centres (previously only 2 classes available)
- The Project was awarded ‘Partnership of the Year’ at the LTCAS Self-Management Awards
- Worked with Angus Council Leisure Services in the development of a ‘Buddy Card’ which will allow a buddy/helper to support participants who cannot access the leisure activities on their own (see appendix 1). This will allow the buddy/helper to access the class free of charge
- The steering group membership has been increased so more organisations/departments are represented. Falls Prevention, Angus Carers, and Healthy Ageing (Volunteer Gold) are now all partners
- The Project worked in partnership with Angus Care and Repair to produce a booklet promoting physical activity opportunities in Angus for people with a long-term condition and/or older adults. 5000 booklets printed for distribution across Angus
- A set of short films featuring the types of exercise offered by the Project was produced. As well as featuring at a launch event attended by around 90 people in Forfar in October, DVDs of the film have been made available and the films can be accessed on You Tube via the Angus Cardiac Group website
What difference we actually made
We are delighted to be able to report that 415 new participants have benefitted from the exercise opportunities we offered during this phase of the Project. This confirms that there is continued interest and demand for what we are providing.
Outcome 1: Increase people’s abilities to manage their long-term condition better through attending exercise sessions
This can be evidenced by results of questionnaires, interviews, and participant experiences.
A lady attending seated exercise told us:
-‘I have more movement in my legs and arms than before. I suffer from arthritis. I now have really good movement in my legs. The exercise has helped my ankle and really benefitted my shoulders and arms.’
A gentleman attending one of the circuit classes stated that the class helped him relieve the stress of his job and enable him to keep working.
Results of Participant questionnaires showed that 83% claimed the exercise sessions made them feel fitter, 59% reported that they felt better able to manage any health condition they have, and 42% felt that their health condition bothered them less than it did. Positive comments included:
‘As a Parkinson patient the exercise helps me with mobility.’
‘My balance has improved greatly. As has my general ability. I attend twice weekly (seated) and love it. It has done wonders for me, thank you.’
This feedback came from questionnaires distributed to participants. 89% of those given questionnaires returned them, positively reflecting the value that participants place on the classes.
Outcome 2: Increase the knowledge and skills of exercise leaders in self-management and health behaviour change techniques
Of the exercise instructors who attended health behaviour change training and who responded to our questionnaire, all felt that their knowledge had been greatly improved. All reported that the training workshops had increased their knowledge and confidence in working with people with long-term conditions. All felt that they had an improved understanding/empathy in working with participants. There is also evidence from the exercise instructor questionnaires of them promoting self-management, with instructors having sign-posted to smoking cessation, weight management, and local support groups. The skills of the exercise instructors are appreciated by participants with feedback such as:
‘Love the class its sociable as well as healthy thanks to a great instructor’
‘Fantastic class and teacher’
Feedback following attendance on behaviour change training shows it has had an impact on exercise instructors’ way of working and on the service we are able to provide. Feedback has shown that exercise referral consultants are now ‘using evidence-based behaviour change strategies to help support participants in increasing their physical activity’. One instructor commented:
‘I used to be quite guilty of telling participants the benefits of exercising and then just assuming that with that knowledge then of course they would want to start! With the techniques learnt on the behaviour change course, I now let the client come up with reasons for changing, and I can then mirror back and reinforce the positive things they say.’
This shows that the exercise instructors have an increased understanding, allowing them to support participants better and so allowing participants to better manage their health condition.
Outcome 3: Recruit, train and support more volunteers to ensure the ongoing development of the Project
Since October 2011, 20 new volunteers have joined the project.
Of the volunteers who returned questionnaires (return rate of 57%), 39% of volunteers became involved in the Project through support groups and 25% through our volunteer coordinator. 22% of respondents were from Volunteer Gold (a partner organisation). Volunteer Gold focus on 1-1 seated exercise with housebound people and have 7 volunteers. We have worked in partnership with this organisation to support their volunteers by offering them places on all our training. The sharing of procedures and protocols has been beneficial for us in developing 1-1 seated exercise for the housebound within our Project.
80% of volunteers said they felt very well supported or well supported in their roles. Roles include leading exercise sessions (59%), organisation of Project (17%), and buddies/befrienders (14%).
Many of our volunteers themselves have a long-term condition (60% of those who responded). Of these people, 86% either strongly agreed, or agreed that their volunteering work improved their own health condition- further evidence that the Project is achieving its overall aim!
The majority of volunteers (84%) agreed or strongly agreed that their work improves the lives of participants/others. The others neither agreed nor disagreed. Comments from volunteers include:
‘Found the training session on seated exercise very educational, entertaining and also highly enjoyable’
‘Volunteering for this programme has led to volunteering for other things which has improved mental and physical well-being’
Overall it is encouraging to see that volunteers feel supported, feel that what they do makes a positive difference to others, and feel health benefits themselves. This is likely to mean that they continue to be involved in the Project- which is crucial for our ongoing development and sustainability.
Outcome 4: Improve the health of carers, and help to ensure the person they look after can live better with their long-term condition
Carers can attend exercise sessions on their own or with those they care for. We have Angus Carers Centre represented on our steering group so exercise opportunities are promoted to carers. Of the sample of participants who received questionnaires, 19% were carers. We asked them why they attend the class- 53% enjoy coming to the class alone, 23% attend because the person they care for prefers them to come, and 16% said they come with someone who could not attend without them. This emphasises the importance of the work we have undertaken with Angus Council to produce a buddy card so that this type of carer does not have to pay to attend the class (see appendix 1).
Our aim of improving health of carers is shown by the fact that 92% of responding carers felt that their physical health had improved, and 65% felt that their mental health had improved.
- Case Study
‘I like the fact that she always comes out smiling. Not only is she able to exercise she is finding it very sociable which is great for myself and my Dad as she understandingly clings to both of us.
This class has given my Dad a breather from the everyday routine. I spend the time with him having a coffee and relaxed chat knowing that she is really enjoying the group…’
Outcome 5: Improve partnership working to ensure sustainability
Our large number of new exercise participants (415) can be attributed to improved partnership working. This is illustrated by the fact that 80% of new people were referred (from GP practice, rehabilitation programmes, and physiotherapy), compared to 20% who self-referred. This shows that as an organisation we are developing, and with classes growing in size we can be positive that our activities are likely to continue in the future.
The funding we received from LTCAS has built our capacity to work with new partners and as a result has expanded our work. The inclusion of Angus Carers Centre as described already, has allowed us to promote our activities to carers more effectively. Having the Angus Falls Service join our steering group this year has also developed us as a Project. Two of our exercise instructors are now trained in falls prevention and we receivereferrals from the Falls Service- an additional source of participants. It has also broadened our skills and expertise as a group to have the Falls Service as a partner (because they are able to act as a clinical advisor). Working with Volunteer Gold to develop our capacity to offer 1-1 seated exercise for the housebound (delivered by volunteers) although not without its challenges (see below) has been mutually beneficial to both groups.
Strengthened partnerships have led to a more robust referral system, and to participants making behaviour changes. This is well illustrated by the experience of one participant who was signposted to the Winning Weigh (weight loss service run by NHS) by one of the exercise instructors. The gentleman said:
‘Enjoy the exercise; have lost 20lb in weight and feel healthier, stronger, and more mobile’.
Challenges and changes
Volunteer Coordination
Building our capacity to offer 1-1 seated exercise to housebound people was a significant area for development for us. This was to be achieved by using volunteers to deliver the exercise. This relied on recruiting and supporting more volunteers than we currently had. There was a delay in recruiting a Volunteer Coordinator -we did not get anyone for the role until February 2012. However we increased the coordinator’s hours from 5 to 10 hours per week to try and make up for the delay. The coordinator has done an excellent job in recruiting volunteers and the value of the role is recognised by Angus CHP. Discussions are underway to ensure that we can work towards long term sustainability.