Royal College of Physicians of Edinburgh

Scottish Stroke Collaboration Meeting

22nd September 2010

Queen Mother Conference Centre

Exercise after Stroke

Towards the provision of Community Exercise after Stroke

Services

Project team

Dr Gillian Mead (PI) University of Edinburgh

Dr Catherine Best University of Edinburgh

Mr John Dennis NHS Greater Glasgow and Clyde

Dr Susie Dinan-Young University College London Medical School

Ms Hazel Fraser NHS Fife

Professor Marie Donaghy Queen Margaret University

Mr Mark Smith NHS Lothian

Dr Frederike van Wijck Glasgow Caledonian University

Disclosure

• Dr Susie Dinan-Young is a co-Director of Later Life Training

• Queen Margaret University and the University of Edinburgh receive royalty payments from Later Life Training for the ongoing development and quality assurance of the Exercise and Fitness after Stroke training course

Outline

• Evidence for Exercise after Stroke

• Policy

• Current provision of Exercise after Stroke Services

• Guidelines for development of Exercise after Stroke Services

• Training the exercise professionals

Life after Stroke

‘It was such a shock.

The medical treatment

was very good, but we

were left in the dark

about what was going to

happen next.’ says Jean,

carer for her husband Tom.

Source: Stroke Association www.stroke.org.ukSource: Stroke Association www.stroke.org.uk

ActivPalTM physical activity monitoring

Physical Fitness, Muscle Strength and Power after stroke

• Peak VO2 of stroke survivors ~ 50% of that of sedentary adults of same age

• Muscle strength and power output significantly lower than age and sex matched values from the population

Greig et al 2001, Ivey et al. 2005

Cochrane Systematic Review of Physical Fitness Training after Stroke

• 23 trials, 1147 participants

• Training improves physical fitness and walking compared with control intervention

• Insufficient data to determine effects on disability, death & dependence

• Benefits are not retained longer-term

Saunders et al 2008, Cochrane library

Policy in this area

• Scottish Government’s Better Heart Disease and Stroke Care Action Plan (2009: 5.40) recommends:

‘NHS Boards….. should continue to work with leisure industry representatives …… to improve access to exercise and fitness training for people with stroke in their area.’

• The Department of Health’s National Stroke Strategy (2007) also states that

‘Rehabilitation – support to regain well-being – requires rehabilitation specialists and continuing support from a wide range of community-based services, such as exercise classes…. ‘

NACS project: Scoping provision of Exercise after Stroke Services

• Identify Exercise after Stroke Services in Scotland

• Write best practice guidelines for development of Exercise after Stroke Services

• Create a website with a directory of services

14 Exercise after Stroke Services

Best practice guidelines Draft at www.exerciseafterstroke.org.uk

Foreword

The guideline…is applicable to the development of services throughout the UK….

I have no doubt that the development of such services will have a major impact on the quality of life of stroke survivors…

I would urge you to use this guideline to start to drive forward the development of Exercise after Stroke services….

Professor Martin Dennis, Chair, National Advisory Committee Stroke

Areas covered by the guidelinesGovernance

Multidisciplinary working group to oversee service developmentReferral

Align with Department of Health’s (2001) National Quality Assurance Framework for Exercise Referral Systems

Pre-exercise health screening Health professional identifies absolute contraindications to exercise

Instructor trainingExercise professionals must have appropriate training

Content of exercise programme A significant proportion of cardiorespiratory walking training

Record keeping Minimum data set of participants’ CHI number, referral information, attendance records. Adverse events recorded

Screening for absolute contraindications

Suitability of exercise session (inclusion criteria)

Multidimensional assessment

Referral to EAS serviceReferral form

Identification of key risk elements

Pre-exercise assessment

Alternative exercise options

Exercise after stroke session

Health care professional

Exercise professional

Recommended referral and assessment process

Training the trainers

• Exercise and Fitness Training After Stroke

• Provided by Later Life Training www.laterlifetraining.co.uk

• 5 day course plus assessment

• Large practical component: how to provide exercise after stroke to groups of stroke survivors

UK-wide launch of Exercise and Fitness Training after Stroke

• Courses in – Cardiff (Sept 10)– Cambridge (Nov 10)– Hull (Dec 10)– Wiltshire (Jan 11)– London (Jan 11)– Glasgow (Feb 11)– More plannned!

Summary

• Exercise after stroke improves physical function and fitness

• Policy drivers to development of Exercise after Stroke Services

• Draft guidelines available at www.exerciseafterstroke.org.uk

• Exercise and Fitness Training after Stroke: available at www.laterlifetraining.co.uk

Funders

Supporters

Reference groupMrs Sara Paul Ms Carolyn Agnew Ms Gill Baer Ms Lorraine Ayers Mrs Sheena BorthwickMs Wendy Beveridge Mr John Brown Ms Audrey Bruce Mr Cliff Collins Prof Martin Dennis Mr Ben Gittus Dr Carolyn Greig Ms Fiona Hamilton Ms Maddy Halliday Ms Pauline Halliday Dr Julie Hooper Ms Heather Jarvie Mrs Anita Jefferies

Ms Aisha Sohail  Ms Helen Macfarlane  Dr Christine McAlpine Ms Clare McDonald Ms Karen McGuigan Ms Hannah Macrae Dr Sarah Mitchell Dr Jacqui Morris Ms Clair Ritchie Mr Alan Robertson Mr Pat Squire Ms Margaret Somerville Dr Morag Thow Prof Caroline Watkins Ms Fiona Wernham Mrs Lorraine Young Prof Archie Young

Further information

• www.exerciseafterstroke.org.uk

• www.laterlifetraining.co.uk

• www.ccbs.ed.ac.uk

• www.geriatric.med.ac.uk

Royal College of Physicians of Edinburgh

Scottish Stroke Collaboration Meeting

22nd September 2010

Queen Mother Conference Centre