It’s a family affair

Involving partners in adopting healthy lifestyles works, says Louise Hunt.

Elederly couple doing excercisesWhen Isabella Ferries’ husband Keith went to his GP for a blood pressure check she did not expect him to come back and tell her they had both been referred to take part in a healthier lifestyle programme. But as it turned out, Ms Ferries, who also has high blood pressure, was able to benefit from the exercise and dietary advice programme called MyAction, which is run in a local leisure centre in Bromley, south London. ‘The programme was good for me too. I did know about my medical condition, but before I wasn’t motivated to do anything about it,’ she says. To her surprise she began ‘really looking forward to’ the weekly group exercise programmes. ‘I got better as the weeks went by, my stamina improved and being part of a group made me a bit more competitive,’ she says. Having almost finished her follow-up sessions, she says she is ‘still addicted’ to exercise and includes much more activity in her daily routine, such as taking her dog for longer walks. ‘I don’t think I would have made the same changes if I hadn’t been involved in the programme,’ says Ms Ferries, adding that she makes sure her husband keeps active too. MyAction is a new model of community-based prevention programme for patients with coronary heart disease or those at risk of developing cardiovascular disease, which employs physiotherapists as core members of the team. Although similar in approach to well-established cardiac rehab programmes in that it is open to people at risk of developing heart problems – such as those with angina, high blood pressure and cholesterol or diabetes – it is able to tackle many of the government’s public health targets in one go.

Keeping it in the family

The 16-week programme is run by nurses, physiotherapists and dieticians, who deliver an integrated exercise and activity, dietary and weight management, smoking cessation and medical treatment package under one roof, with support from visiting general practitioners and cardiologists, and referral to other community-based services as required. What sets it even further apart from more traditional public health intervention programmes is that it not only treats the patient, but their families too, so that the crucial lifestyle changes that are needed to make a sustainable difference to health can be made together. ‘MyAction is very focused on prevention rather than rehabilitation after the event,’ says physiotherapist Jenni Jones, MyAction director of physical activity at Imperial College department of cardiovascular medicine, where the programme was developed. ‘Not only is it fully inclusive of all individuals at risk of cardiovascular disease, it actively recruits family members; so partners, for example, are automatically included and fully participate in the programme.’ ‘There is lots of evidence that shows lifestyle is shared in families. By making it family-based people can make more effective lifestyle changes together,’ adds Ms Jones. ‘By helping a whole household to quit smoking, by involving the person responsible for shopping and cooking for the family and by being active together helps sustainable changes to be made in the whole family for the longer term.’

Strong evidence base

The programme is based on an Imperial College-led study called Euroaction, which carried out a cluster randomised control trial across eight European Union countries, including the UK. The findings of the study were published in the Lancet in June 2008 (see panel: What’s the evidence?). From this demonstration study, the Euroaction team developed MyAction as the UK model. The idea was to bring together coronary disease patients, who are usually managed in hospital, with people at high risk of developing the disease who may be on primary care based intervention programmes, such as those for diabetes. ‘MyAction provides a common service for all in the community, fully integrated with the aim of raising the standards of preventive care,’ says Ms Jones. It is typically being run in leisure centres in partnership with local authorities, with referrals coming from GP practices and hospitals. It aims to recruit participants and involve them in the scheme within one to two weeks of referral. MyAction was piloted last year by Bromley primary care trust and has since been adopted by East Berkshire and Westminster primary care trusts, with 13 UK programmes in total and another two in Galway, Ireland.

Physio-led excercise

Physiotherapists were chosen to lead the physical activity and exercise component of the programme, which was designed by Ms Jones, for their highly developed skills in assessing patients and tailoring programmes. They carry out in-depth assessments on each participant that include testing their physical capacity and identifying any co-morbidities, as well as looking at their lifestyles, so exercise schedules can be tailored to their needs and preferences. Participants’ goals are reviewed weekly during one-to-one sessions within group sessions, which include circuit and aerobic exercises that can be reproduced safely at home, as part of home activity plans. ‘Physios are also very good at adapting activity for complex co-morbidities and recognising when someone is not clinically stable for exercise training. Physios have clinical experience in managing clinically unstable people in relation to physical activity and exercise,’ says Ms Jones. There are five physios so far on MyAction programmes who have been trained by a central team at Imperial College.

A great oppurtunity

Jenny Fernandez, team lead for physical activity on the MyAction programme recently launched by Westminster PCT, says the scheme is a ‘great opportunity’ for physios wanting to get involved in preventive services. ‘Physios don’t always get the opportunity to work in preventive medicine because they are seen as rehab specialists. I’ve always been interested in the preventive work so when I saw the job advertised I thought “this is what I have been waiting for all my professional life”,’ says Ms Fernandez, who is busy working with her core team on developing strategies for the seven programmes being rolled out in the borough. The Westminster programme is focusing on areas of high health inequalities and Ms Fernandez is drawing on her previous experience in a community rehab service in the borough to work hard to reach groups.

An innovative role

Being able to work directly with family members makes the role particularly innovative for physiotherapists, she adds. ‘In my experience this is a rare opportunity. Physios are used to working with families and often rely on them in supporting patients to keep up lifestyle changes, but in this case the partner or family member goes through the same programme. I love it because it promotes health in its widest context.’ Its snug fit with the government public health agendas and the shift to more community-based services gives Ms Jones and everyone involved in MyAction hope that the programme will be widely adopted. A scheme in Lambeth, South London, is imminent and Manchester PCT is going through the commissioning process, while discussions are taking place with at least nine other interested PCTs. With the Euroaction study as a solid evidence base, and further results available from the Bromley pilot, Ms Jones hopes its quantifiable benefits will be attractive to PCT commissioners. ‘One of its strengths is measuring outcomes, using objective validated measures, including at one year, so the PCT can gets lots of information on what the programme is achieving both short term and in the longer term. ‘I don’t think there are many comparable programmes that do that,’ she concludes. The hope now, is that MyAction will go from strength to strength. FL

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Louise Hunt

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