Love activity but hate exercise? by Erin Archibald

“Drop down and give me 20”…

What do you think about when you hear exercise and strengthening: sweatiness, gyms, Lycra, pain. As a busy mum to 3 children, exercise is something I don’t have much time to do but am I active? Absolutely!!

I am a specialist Physiotherapist within the reablement service STARS ( short term assessment reablement team)- and my main role is to promote exercise and well being in the community- my target audience- not lycra gym bunnies, but over 65 year olds who normally have a long term condition who are recovering from a spell in hospital, and likely do not own trainers or know what a squat entails.  Who am I to advise to join a swimming group, attend low impact exercise classes or complete a rehab programme when I do not complete myself? Instead I walk to the park, climb up woods, I cycle with my children, I chase after them endlessly… so we need to think different about activity.

The benefits of rehabilitation, recovery and reablement support are well evidenced in Health and Social Care interventions.  The support improves a person’s ability to function independently, encourages exercise choices and to take control of their daily activities.

I work closely with 3rd sector and community teams, to encourage and promote active participation socially- tailoring every service users needs with their capabilities and skill sets and I see the patient as an individual not a condition.

• what are their hobbies ?
•  what do they enjoy the most in life?
•  what is meaningful to them?
•  what matters to them which they are currently not able to do or accommodate?

We support service users to identify their goals through good conversations. We also support them to develop, retain and regain their skills by understanding what matters to them- this may not often happen initially but over the course of the reablement process from our support workers, we build relationships and find getting to know them and their families/carers imperative for helping them identify their goals.

We look at well being plans which can be something as simple as getting to the shop to purchase a daily paper, getting back to social activities, or being able to transfer into a bed or car again so they can visit someone important to them. We promote the benefits to exercise in line with recent evidence via Scottish government 2017.  Many include:

• Reducing falls
• Improving strength and balance-
• Improve wellbeing
• Reduce anxiety, improve sleep
• Social Interactions/ reduces isolation
• Day to Day activities become easier

As a registered practitioner, we document their wellbeing plans and agree this with the service user, enabling our health care support workers to deliver the daily practice of the chosen activity, whether this is a walk to the shop, a spot of gardening, making soup or practising stairs/ steps. This allows us to see progression and plan goals,

As a physiotherapist, I have blended alongside the occupational therapists in our team in the last five years to learn the importance of occupation (activity) led tasks and changing mindsets to linking social interests to exercise. In the time it takes someone to boil the kettle, they can do basic exercises such as the Balance challenge or super 6 exercise programme.  Reactivating “activity” to improve health and well being, Independence and quality of life is based on continuing research carried out at Newcastle University Institute for ageing with Professor Gore (2017). For example being able to reach your feet to cut your toenails, walk 400 yards or maintain heavy housework. (http://www.knowedlge.scot.nhs.uk/ahpcommunity/lifecurve-survey-2017.aspx)

So, lets get more active and promote activity, lets think differently about exercise , and think about What matters to you for healthy ageing?

Erin Archibald is a Specialist Physiotherapist, STARS- Short term Assessment and Reablement service 28^th January 2019.

Get up, Get dressed, Get moving by Amy Conley

Think about an older person, someone in their eighties – let’s say it’s your Granma…

Your Granma lives in her own house; she’s not quite so good on her feet anymore, but she gets about OK.  Stairs are difficult but she manages – and she manages to get up and dressed, make her breakfast and her tea, feed her cat, read the paper, get to Tesco in the car with you.

Then your Granma gets ill – she has say, a chest infection.  She is admitted to hospital.  You pack her bag – nightie, toothbrush, comb.  She is admitted to the ward – she is poorly, needs antibiotics and a drip for a few days. So, on goes the nightie and your Granma is in bed; that’s what you do in hospital – you are poorly and tired and you need to rest in bed.

Your Granma is in bed in her single room.  She needs the toilet but doesn’t think she should get up by herself – she is a patient in a nightie so needs help.  But she can’t see very well or hear very well and can’t find her glasses or hearing aids.  She can’t find the buzzer to buzz the nurses and she can’t hear when they are near.   She thinks maybe she could get herself to the toilet, but she can’t see her walking sticks and is scared she will fall. 

Time passes.  Your Granma is incontinent in the bed.  She is embarrassed and frightened – what will the nurses think?

Now she is scared to drink and eat because she doesn’t want to need the toilet and be incontinent again.  And she doesn’t want to bother anyone.  The physio comes to see her, tries to get her up.  But she is still embarrassed and frightened.  She has no clothes to wear.  And she has only those foam slippers she got from the nurse.  So it’s best just to stay in bed.

Your Granma stays in bed for longer and longer.  There is nothing to do.  There is a TV but she can’t see it or hear it without her glasses and hearing aids.   She is getting mixed up now; she can’t remember when she came here or why or what day it is.  She thinks she can see cats in the corner of her room.  She still won’t eat, so she has no strength and feels weak. She doesn’t want to get up.  Her bottom and back hurt.  Her leg has swollen up – they said it is a blood clot.

The physios keep coming back.  They try to get her up; two of them struggle to get her to stand.  She is stuck in bed. 

Your Granma’s chest infection has been treated and she has no acute medical illness, but now she is immobile, confused, dehydrated, incontinent, her muscles are weak and she cannot walk anymore, or get herself washed or dressed. 

Your Granma is not going to manage at home anymore; she has to go to a care home.

 

“GET UP, GET DRESSED, GET MOVING”

At DGRI, we are launching our campaign on Monday 23rd July– the aim is help our patients maintain their function, mobility and independence while in hospital, and for them to return home as soon as possible, as able as possible.

 

WHY HAVE THIS CAMPAIGN?

• Most patients in hospital are over 65
• In hospital, older people spend up to 83% of their time in bed
• 65% of people’s functional ability declines during admission
• 60% immobile older patients in hospital have no medical reason to stay in bed
• If you are over 80, 10 days in hospital ages muscles by 10 years
• 1 week of bed rest equates to 10% muscle loss
• These changes are “deconditioning” –  “reconditioning” takes twice as long

WEARING YOUR PYJAMAS IN HOSPITAL

• Affects your confidence and self-esteem
• Changes how you interact with healthcare staff and other people
• Is usually unnecessary no matter why you are in hospital
• Doesn’t feel very dignified when you are trying to eat your dinner

 

STAYING IN BED IN YOUR PYJAMAS

• Reduces muscle strength
• Reduces confidence
• Reduces function
• Increases blood clots, delirium, pressure sores and infections
• Leads to reduced appetite, low mood and anxiety
• Reduces social interactions
• Lowers pain thresholds
• Can make blood pressure drop
• Causes constipation and incontinence

WHAT CAN HEALTHCARE STAFF DO?

• All of us can and should help patients get moving – nurses, doctors, AHPs, porters, domestic staff, pharmacists…
• Ask the patients how they normally get about and what they normally do
• Make sure patients can access buzzers, water, remote controls
• Encourage patients to get dressed and sit up in the chair

 

WHAT CAN PATIENTS DO?

• Tell us how you normally get about and get things done and what you need to help you
• Try to do things that you do at home – wash and dress, eat and drink on your own if able
• Sit up in your chair and for meals
• Drink lots
• If you can’t get out of bed, do little things – wiggle your toes, do a crossword – every little movement  helps

 

WHAT CAN VISITORS DO?

• Tell us what you do at home
• Bring in glasses, hearing aids and walking aids
• Bring in comfortable day clothes and well fitting shoes
• Encourage you to sit up in the chair and for meals
• Take you for a walk
• Bring in photos, books, puzzles, crosswords

THE BENEFITS

• Speeds recovery
• Reduces time in hospital
• Encourages patient and carer involvement in healthcare and recovery
• Helps to retain patients’ individuality and self-esteem
• Helps patients to quickly return home, mobile and functional

 

If you or your family are worried that it is not safe for you to get up or you might do the wrong thing – ASK US!  We will tell you what is safe and OK for you!

#endpjparalysis

#goinghome

Amy Conley is a Consultant in Geriatric Medicine at Dumfries and Galloway Royal Infirmary

Let’s Get Physical by Amanda Taka

With the festive season looming towards us, the last thing you want to be told is to get physical right? However with 8 weeks to Christmas, we still have plenty of time before we carve the turkey. The Physical Activity Guidelines for adults recommend that we build up to 30 minutes of moderate intensity activity 5 days out of 7. But how do we fit this in to our busy working lives? And is it worth the effort?

We’ve all heard of the benefits of exercising, but here’s a recap:

Regular exercise:

• reduces the risk of many diseases such as type 2 diabetes, coronary heart disease and stroke
• helps us to maintain a healthy weight
• improves our self esteem
• promotes a sense of wellbeing
• reduces symptoms of depression and anxiety

Working in the NHS we can’t fail to be reminded of what we should be doing and why. However, being ready, willing and able to make those lifestyle changes can be another matter.

And before you write me off as one of those typical fitness fanatics, let me tell you a bit of my story. At school I was always the last to be picked for team games, I didn’t learn to swim until I was 16 because I was frightened to put my head under water, I hated PE and used to hide in the Geography block toilets to avoid detection. My Mum and Dad told me to stay as I was because playing squash and golf gave you a heart attack. My Dad’s motto was ‘built for comfort not for speed’. They were both overweight and although I wasn’t, I always knew I would be too because that’s what happened to us in our family. And so it would have gone on if I hadn’t returned to Uni and trained to be a nurse.

Anyone who has trained to be a nurse knows that it changes you. It changes the way you look at people, the way to speak to people and the way you react to people. Furthermore, it challenges hard held beliefs and preconceptions. Studying at UWS under the influence of Julie Orr and her colleagues, I began to see that getting older doesn’t need to mean that we inevitably get bigger and slower. I realised that the ability to change was within me and additionally I had the power to influence my young daughters’ long term health.

This Eureka moment happened to me in the middle of one lecture towards the end of my training. Julie was telling us about when she was doing her Masters and how she fitted it into family life “and I still went to the gym three times a week” was the phrase that hit home for me. Like a bolt of lightning I realised that I needed to make physical activity a priority for me. I started to take up yoga again – something that I hadn’t done regularly since I’d had my children. Slowly I began to build physical activity into my day, feeling very smug about it too thank-you very much.

After qualifying, I got a job on a fast paced 22 bedded respiratory ward. Working full time was enough to achieve my 30 minutes a day. Life doesn’t stay static though, and I moved to a 6 bedded Coronary Care Unit. My daily steps dropped, my waistband started to feel a bit tighter and I put half a stone on. I realised that I had to change tactics. I began to walk into town on my days off, I got myself a Fitbit and tried to do 10,000 steps a day, challenging nurses on other wards inspired my competitive streak. Obviously when you put physical activity first, other things slide. I won’t be winning any Good Housekeeping awards imminently and I don’t have time to watch TV. But as I see it, the benefits outweigh the costs.

Then earlier this year I left Coronary Care and moved to the Keep Well project here in Dumfries and Galloway. Keep Well is an anticipatory person-centred service that aims to reduce health inequalities. Part of this role involves delivering brief interventions for physical activity. I started to see that the guidelines weren’t going to be achievable for everyone – like the 64 year old lady who had to use a wheelchair because of her COPD. In that case, the message is do what you can, keep doing it and try and build on what you can do. Most of my clients with long term conditions are very aware of their limitations and they know better than I do, what is achievable for them.

Changing from a shift based work life to a ‘normal’ 8.30 to 4.30 job required further readjustment to my physical activity routine. Covering the whole of D&G has found me spending large amounts of time in the car. But the advantage is that I now have my weekends free and I make sure I do something active with my children. But I was struggling to do something on week days. So I started a 90 day Yoga challenge – 30 minutes of aerobic yoga for 90 days. The only time of the day I could fit this in was before everyone else got up. I found that I was so used to getting up at 5am to go to Carlisle that doing yoga at 6.30am was achievable for me. In all honesty, I haven’t made it onto my yoga mat every single day because sometimes life gets in the way, but I didn’t beat myself up because I knew that tomorrow was another day.

Now I realise that getting up at 6am to exercise isn’t going to work for everyone. So, I suppose the main message I’m trying to share is

• Find an activity that you enjoy
• Small changes really make the difference if you do them often enough
• Give yourself permission to exercise – no one else can do it for you
• Don’t give up if you miss a few days/weeks/months. Life gets busy and big events sometimes engulf us.
• Set a SMART goal, running the London marathon next April is not appropriate for everyone. Parking the car as far away from the office 3 days a week could be more achievable.

As the largest occupational group in Scotland, we nurses are in an incredible position to reach a huge number of people. If we start with ourselves, this will ripple out to our families, our communities and ultimately to the Scottish population.

Lesley Fightmaster Yoga Fix 90 – 90 day to build a healthy habit https://www.youtube.com/watch?v=ArZDT5zXSR0

Amanda Taka is a Keep Well Nurse based in Public Health, Crichton Royal Hospital and a Coronary Care Nurse with North Cumbria University Hospitals NHS Trust.

Be Willing to Make the Change by Sylvia Crosby

Having always been a “Border Collie” person and admiring their qualities – attractive, loving, caring and hardworking, I was never very keen on Black Labradors and felt them to be a bit slow and boring ( we admire the traits in our pets that we aspire to in ourselves).

However, after spending a few months on Isle of Islay, escaping the rat race of the mainland, we felt the need of a new 4 legged addition to the family and, through a series of circumstances, and not many puppies available and a potential owner who may have had too much whisky to look after a new puppy, we became the proud owners of a Beautiful Intelligent Labrador puppy who turned into one of the most lovely, caring and attractive dogs we have ever had! !

So lesson learned and we CAN learn to ignore our lifelong prejudice and accept new thoughts and ideas.

In the World of Physiotherapy, much has changed since I started twenty something years ago, when there was no waiting lists and no computers and lots of electrotherapy (which is still relevant, evidence based but out of vogue). We heated, microwaved and pulsed electric currents of various voltage , type and intensity, lots of exercise therapy and lots of time for group exercise ( which is still relevant but again less fashionable than in the past) and patients got better.

Now we embrace a world of statistics, computers, waiting lists, and are welcoming Manipulation, T’ai chi, Acupuncture and Craniosacral therapy into our treatment plans to name just a few. The new Electrotherapy treatments include Laser, Shock wave therapy and Electroacupuncture, which all have a VERY definite evidence base . And Exercise Therapy remains our constant for everything from Major Heart surgery, MS, and Orthopaedics to an effective treatment for many mental illnesses.

Hopefully we will continue to embrace change while still holding onto our Core Values, (following a recurring theme in these blogs) and at all times put the patient first in all our patient contacts and treatments to provide a service which embraces the Best of the Old with the Challenges of the New. 

 

PS I now have a Collie/Labrador cross!

Sylvia Crosby is a Senior Physiotherapist at Moffat Hospital