WHAT IS ACTIVITY THERAPY?
Activity Therapy is defined as the promotion and enablement of activity, physical, cognitive and emotional for people with, or at risk of, long term conditions. It complements and supplements the NHS services for preventing long term conditions and supporting people with long term conditions.
Rest is certainly important in acute illness, immediately after a myocardial infarction or a bout of the flu for example, although there is increasing awareness of the fact that an acute illness particularly if it results in hospitalisation may lead to a rapid loss of ability in people, particularly in people with frailty, a process called the Deconditioning Syndrome. However with all long-term health problems there is a need to pay additional attention to loss of fitness because the evidence is that a loss of fitness is responsible for much of the disability that we have assumed to be due to disease and ageing and the evidence is also that activity can play a very important part in coping with disease, preventing disability and maintaining a good quality of life. The Academy of Medical Royal Colleges sums it up in the title of their 2015 report, Exercise the Miracle Cure
Much publicity has rightly been given to the fact that some people who have been treated with drugs can be managed without drugs or with drugs and other interventions such as activity and the prescribing of activity in what is called social prescribing is beginning. Millions of people who have a long-term health problem and who benefit from high tech medicine and pharmaceutical developments would get additional benefit from prescribing of activity whereas at present only a proportion of people receive this usually if they are referred to a specialist service such as cardiology or respiratory medicine .
The more conditions that a person has the more encouragement and support they need so with every diagnosis that is made more attention should be given to prescribing and dispensing activity. The Chief Medical Officer Sir Andrew Whitty emphasises the importance of focusing more on multi morbidity in his 2023 Annual Report titled 'Ageing in a Healthy Society'
HOW DOES ACTIVITY THERAPY EXERT ITS BENEFICIAL SUCCESS
The beneficial effects of activity for people with long term health problems are realised in four ways:
It is very important to appreciate that the term Activity Therapy was chosen with care and should not be regarded as shorthand for physical activity. It is helpful therefore to speak about activity, physical, cognitive and emotional
A National Activity Therapy Service is needed to enable these people to become more active, physically, cognitively and emotionally
What is needed is an integrated system
Developing the NATS as a system
The development and delivery of an Activity Therapy Service does not need a new bureaucratic structure nor does it need the integration of, for example, health and social care or health and fitness services. The service model is that of an integrated system, described clearly in the NHS White Paper Integration and Innovation which uses the term ‘system’ 251 times.
What is needed is an integrated system with a common aim and set of objectives . The proposed aim for the National Activity Therapy Service is to ensure that people who would benefit are offered activity therapy and enabled to take up that offer.and the draft set of objectives are listed below:
A system is a set of activities with a common aim and a common set of objectives and there are many examples of systems that can be used as a model, for example the National Screening Programmes, although screening is a less complex challenge than deconditioning.
Activity Therapy and NHS Rehabilitation and Ageing Well services
It might be thought that the need could be met by those NHS services with a particular focus on rehabilitation but the scale of the need is so great that a new approach is needed.
Rehabilitation, of course, plays a very important part in the work of the NHS and there are particular specialties in which it is a major theme, notably geriatric medicine, rehabilitation, and sport and exercise medicine. Furthermore, some specialties have introduced rehabilitation as a core part of their offering, notably cardiac rehabilitation and pulmonary rehabilitation. There are also a range of clinical professions focused on helping people with significant health problems who reach them reduce the effects of deconditioning and recapture lost ability, notably physiotherapy, occupational therapy, exercise physiology and podiatry. Further the concept of rehabilitation runs through mental health services and clinical psychologists have a very important part to play.
However, these services can only reach a small proportion of those who would benefit, focusing on those who have been most severely affected, perhaps five million, leaving another fifteen million people with long-term health problems who need to think and behave in a different way, a
Obviously it could be said that primary care should take over this responsibility but it is clear that primary care teams are under significant pressure, aggravated by the Covid pandemic, and have no capacity and, it has been pointed out, no space even if more physiotherapists and nurses could be employed, so a radical new approach is needed.
What is proposed is that the National Activity Therapy Service would be based on people who are not currently recognised as being in the healthcare sector but who could very well claim to be in the wellbeing sector, usually called personal trainers or health and wellbeing coaches. This service by engaging physical activity professionals and exercise physiologists could reduce demand on primary care teams and Primary Care Networks
Furthermore, there are many voluntary organisations like Age UK and Move It or Lose It where people are specifically trained and committed to encouraging increased activity
Activity Therapy is defined as the promotion and enablement of activity, physical, cognitive and emotional for people with, or at risk of, long term conditions. It complements and supplements the NHS services for preventing long term conditions and supporting people with long term conditions.
Rest is certainly important in acute illness, immediately after a myocardial infarction or a bout of the flu for example, although there is increasing awareness of the fact that an acute illness particularly if it results in hospitalisation may lead to a rapid loss of ability in people, particularly in people with frailty, a process called the Deconditioning Syndrome. However with all long-term health problems there is a need to pay additional attention to loss of fitness because the evidence is that a loss of fitness is responsible for much of the disability that we have assumed to be due to disease and ageing and the evidence is also that activity can play a very important part in coping with disease, preventing disability and maintaining a good quality of life. The Academy of Medical Royal Colleges sums it up in the title of their 2015 report, Exercise the Miracle Cure
Much publicity has rightly been given to the fact that some people who have been treated with drugs can be managed without drugs or with drugs and other interventions such as activity and the prescribing of activity in what is called social prescribing is beginning. Millions of people who have a long-term health problem and who benefit from high tech medicine and pharmaceutical developments would get additional benefit from prescribing of activity whereas at present only a proportion of people receive this usually if they are referred to a specialist service such as cardiology or respiratory medicine .
The more conditions that a person has the more encouragement and support they need so with every diagnosis that is made more attention should be given to prescribing and dispensing activity. The Chief Medical Officer Sir Andrew Whitty emphasises the importance of focusing more on multi morbidity in his 2023 Annual Report titled 'Ageing in a Healthy Society'
HOW DOES ACTIVITY THERAPY EXERT ITS BENEFICIAL SUCCESS
The beneficial effects of activity for people with long term health problems are realised in four ways:
- In some diseases, Type 2 Diabetes for example, physical activity has a direct effect on the disease process
- In all diseases and conditions activity reduces the loss of fitness that so often follows the decrease in activity following diagnosis, often complicated by the ministrations of well-meaning relatives
- Increased activity and fitness have positive psychological effects and increase wellbeing so it is appropriate to think of activity as being not only physical but also cognitive and emotional. Physical activity does improve mood, and reduce the risk of dementia but it is even more effective if it is enjoyed
- In a group especially in a group
- With a social purpose such as raising money for the local Wildlife Trust and the motivation is further increased
- If there is competition with other similar groups
- Activity reduces the risk that a person with one condition will develop other preventable conditions, such as Type2 diabetes or dementia; people with long term conditions should not be excluded from the opportunities for primary prevention and health improvement, and the possibility of living as well as possible aslong as possible, and aiming for a good death as well as a good life
It is very important to appreciate that the term Activity Therapy was chosen with care and should not be regarded as shorthand for physical activity. It is helpful therefore to speak about activity, physical, cognitive and emotional
A National Activity Therapy Service is needed to enable these people to become more active, physically, cognitively and emotionally
What is needed is an integrated system
Developing the NATS as a system
The development and delivery of an Activity Therapy Service does not need a new bureaucratic structure nor does it need the integration of, for example, health and social care or health and fitness services. The service model is that of an integrated system, described clearly in the NHS White Paper Integration and Innovation which uses the term ‘system’ 251 times.
What is needed is an integrated system with a common aim and set of objectives . The proposed aim for the National Activity Therapy Service is to ensure that people who would benefit are offered activity therapy and enabled to take up that offer.and the draft set of objectives are listed below:
- To link activity prescriptions to drug prescriptions and the prescription of psychological therapies.
- To offer activity therapy to people with both newly diagnosed and long-established long-term conditions
- To provide a digital activity therapy service and reduce digital exclusion
- To educate and inform the public and all professionals about the benefits of activity therapy
- To link activity therapy with other therapeutic options.
- To promote research.
- To mitigate the effects of deprivation.
- To provide digital opportunities , for example those offered by the Richmond Group of charities and enable increased use, and development, of local activities
- To make the optimal use of resources.
- To prepare an annual report for the population served.
A system is a set of activities with a common aim and a common set of objectives and there are many examples of systems that can be used as a model, for example the National Screening Programmes, although screening is a less complex challenge than deconditioning.
Activity Therapy and NHS Rehabilitation and Ageing Well services
It might be thought that the need could be met by those NHS services with a particular focus on rehabilitation but the scale of the need is so great that a new approach is needed.
Rehabilitation, of course, plays a very important part in the work of the NHS and there are particular specialties in which it is a major theme, notably geriatric medicine, rehabilitation, and sport and exercise medicine. Furthermore, some specialties have introduced rehabilitation as a core part of their offering, notably cardiac rehabilitation and pulmonary rehabilitation. There are also a range of clinical professions focused on helping people with significant health problems who reach them reduce the effects of deconditioning and recapture lost ability, notably physiotherapy, occupational therapy, exercise physiology and podiatry. Further the concept of rehabilitation runs through mental health services and clinical psychologists have a very important part to play.
However, these services can only reach a small proportion of those who would benefit, focusing on those who have been most severely affected, perhaps five million, leaving another fifteen million people with long-term health problems who need to think and behave in a different way, a
Obviously it could be said that primary care should take over this responsibility but it is clear that primary care teams are under significant pressure, aggravated by the Covid pandemic, and have no capacity and, it has been pointed out, no space even if more physiotherapists and nurses could be employed, so a radical new approach is needed.
What is proposed is that the National Activity Therapy Service would be based on people who are not currently recognised as being in the healthcare sector but who could very well claim to be in the wellbeing sector, usually called personal trainers or health and wellbeing coaches. This service by engaging physical activity professionals and exercise physiologists could reduce demand on primary care teams and Primary Care Networks
Furthermore, there are many voluntary organisations like Age UK and Move It or Lose It where people are specifically trained and committed to encouraging increased activity
