Fit for purpose

Louise Hunt looks at a project clocking up real health improvements for an often marginalised group.

Research shows that adults with learning disabilities are at high risk of obesity and its associated health risks. There are many barriers to this group exercising and eating healthily, says Michael Craven, a clinical specialist physiotherapist with the Manchester Learning Disability Partnership. Many people live sedentary lifestyles because they do not have the support of family or carers to accompany and motivate them to be more active. At the same time most mainstream health promotion initiatives and even those targeted at disabled people frequently fail to address the specific needs of learning disabled people. With these challenges in mind, Fighting Fit – a Manchester-wide strategy to help people with learning disabilities lead healthier lifestyles – has become one of the most established programmes of its kind in the UK. The strategy was launched in 2000 and supports around 1,500 adults with learning disabilities in the city. RAISING AWARENESS Mr Craven, who leads the programme, says that part of his role is to raise awareness of the risks to learning disabled people of unhealthy lifestyles through training with service users, family and carers, and people who work with this group. At the same time the programme aims to create partnerships with a range of services, from day centres and residential accommodation to leisure centres and parks, to provide physical activity opportunities and increase choice for people with learning disabilities. ‘A lot of the strategy is delivered through training to spread the message around Manchester,’ Mr Craven says. ‘Fighting Fit is about partnership working and sharing responsibility between mainstream and learning disability services.’ SUPPORTING SERVICES To support these initiatives, the Fighting Fit team has developed a raft of resources for all service providers. This includes a directory of over 100 exercise opportunities, ranging from cycling and walking groups to tea dances to give people lots of choice. Part of this work involves Fighting Fit monitoring and evaluating activities and identifying gaps in provision. An assessment tool has been created for learning disabilities service providers to assess individual need using a baseline measurement of physical activity, nutrition and weight monitoring. This is currently being updated. The team also provides one-to-one support to a limited number of high priority cases where people are found to be severely obese with co-morbidity risks. ‘We try to see people in their home environment to assess how they can make changes to address particular health concerns. We share reports with everyone who spends time with the person and review their progress on an ongoing basis,’ Mr Craven explains. EVIDENCE BASE An advantage of being one of the longest running learning disabilities fitness projects is that Fighting Fit has been able to build an evidence base of its work through research and evaluation projects. The team believes that the research it published in 2008 is the only study evaluating the impact of health practitioner input on body mass index for people who are learning disabled with long-term follow-up data. The mean BMI of 33 obese people who were referred to the Fighting Fit service went down steadily from 2000 to 2006, whereas the mean BMI of a comparison group of 40 people who were not referred to Fighting Fit remained at the initial level after the six-year period. This was at a time when obesity levels in the general population were rising. Further research is underway, involving monitoring and affecting weight change among 280 people over a 14-year period. Mr Craven attributes the positive results so far in part to having the unusual opportunity as a physio to dedicate his time to addressing inactivity and poor nutrition among learning disabled people. ‘It’s not a traditional physiotherapy role, much of it being a health promotion role,’ he says. He adds: ‘Physiotherapists are well placed to lead on the growing number of fitness projects because adapted exercise is central to initiatives like this one, and physiotherapists are skilled in this for a range of physical disabilities and co-morbidities.’
Louise Hunt

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