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Machaczek KK, Firth J, Tew GA, Stubbs B, Jones G, Peckham EJ. Towards the standardization of physical activity programs for severe mental ill health: A survey of current practice across 54 mental health trusts in England. Psychiatry Res 2023; 330:115602. [PMID: 37972497 DOI: 10.1016/j.psychres.2023.115602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
AIMS While physical activity (PA) is recommended in the treatment of severe mental illness (SMI), there are no standardized processes for implementing PA in mental healthcare, and the extent to which PA programs have been implemented is unknown. Therefore, we sought to describe usual care in terms of the provision of PA in the National Health Service (NHS) mental health trusts in England for people with SMI. METHODS We invited all NHS Mental Health Trusts across England to participate in a bespoke survey. RESULTS Fifty-two mental health trusts (96.2%) responded, of which 47 (87%) offered some form of physical activity provision. The provision across these 47 trusts comprised 93 different types of PA programs. The programs that were identified showed vast differences in the types of physical activity offered, the settings in which they were provided, and the providers. CONCLUSIONS Although existing mental healthcare services are demonstrating good practice in some areas, the findings of this survey underline the pressing need for more standardization of PA programs that are delivered to people with SMI, better allocation of resources, staff training, improved monitoring of the delivery of these programs, and better PA support for patients as they transition to community care.
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Affiliation(s)
| | - Joseph Firth
- Division of Psychology & Mental Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester M13 9PL, UK
| | - Garry Alan Tew
- Institute for Health and Care Improvement, York St John University, York YO31 7EX, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Gareth Jones
- Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield S1 1WB, UK
| | - Emily Jane Peckham
- Centre for Mental Health and Society, School of Medical and Health Sciences, Bangor University, Wrexham LL13 7YP, UK
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Tew GA, Bedford R, Carr E, Durrand JW, Gray J, Hackett R, Lloyd S, Peacock S, Taylor S, Yates D, Danjoux G. Community-based prehabilitation before elective major surgery: the PREP-WELL quality improvement project. BMJ Open Qual 2020; 9:bmjoq-2019-000898. [PMID: 32213551 PMCID: PMC7206908 DOI: 10.1136/bmjoq-2019-000898] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/12/2020] [Accepted: 03/03/2020] [Indexed: 01/28/2023] Open
Abstract
Optimising health and well-being before elective major surgery via prehabilitation initiatives is important for good postoperative outcomes. In a busy tertiary centre in North East England, the lack of a formal prehabilitation service meant that opportunities were being missed to optimise patients for surgery. This quality improvement project aimed to implement and evaluate a community-based prehabilitation service for people awaiting elective major surgery: PREP-WELL. A multidisciplinary, cross-sector team introduced PREP-WELL in January 2018. PREP-WELL provided comprehensive assessment and management of perioperative risk factors in the weeks before surgery. During a 12-month pilot, patients were referred from five surgical specialties at James Cook University Hospital. Data were collected on participant characteristics, behavioural and health outcomes, intervention acceptability and costs, and process-related factors. By December 2018, 159 referrals had been received, with 75 patients (47%) agreeing to participate. Most participants opted for a supervised programme (72%) and were awaiting vascular (43%) or orthopaedic (35%) surgery. Median programme duration was 8 weeks. The service was delivered as intended with participants providing positive feedback. Health-related quality of life (HRQoL; EuroQol 5D (EQ-5D) utility) and functional capacity (6 min walk distance) increased on average from service entry to exit, with mean (95% CI) changes of 0.108 (−0.023 to 0.240) and 35 m (−5 to 76 m), respectively. Further increases in EQ5D utility were observed at 3 months post surgery. Substantially more participants were achieving recommended physical activity levels at exit and 3 months post surgery compared with at entry. The mean cost of the intervention was £405 per patient; £52 per week. The service was successfully implemented within existing preoperative pathways. Most participants were very satisfied and improved their risk profile preoperatively. Funding has been obtained to support service development and expansion for at least 2 more years. During this period, alternative pathways will be developed to facilitate wider access and greater uptake.
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Affiliation(s)
- Garry Alan Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK .,Department of Health Sciences, University of York, York, UK
| | - Robin Bedford
- Public Health South Tees, Middlesbrough Council, Middlesbrough, UK
| | - Esther Carr
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - James William Durrand
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK.,Northern Schools of Anaesthesia, Newcastle upon Tyne, UK
| | - Joanne Gray
- Department of Nursing, Midwifery and Healthcare, Northumbria University, Newcastle upon Tyne, UK
| | - Rhiannon Hackett
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Scott Lloyd
- Public Health South Tees, Middlesbrough Council, Middlesbrough, UK.,Fuse-The Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
| | - Sarah Peacock
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - Sarah Taylor
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - David Yates
- Department of Anaesthesia, York Hospitals NHS Foundation Trust, York, UK
| | - Gerard Danjoux
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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Klonizakis M, Tew GA, Gumber A, Crank H, King B, Middleton G, Michaels JA. Supervised exercise training as an adjunct therapy for venous leg ulcers: a randomized controlled feasibility trial. Br J Dermatol 2018; 178:1072-1082. [PMID: 29077990 PMCID: PMC6001633 DOI: 10.1111/bjd.16089] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/22/2023]
Abstract
Background Venous leg ulcers (VLUs) are typically painful and heal slowly. Compression therapy offers high healing rates; however, improvements are not usually sustained. Exercise is a low‐cost, low‐risk and effective strategy for improving physical and mental health. Little is known about the feasibility and efficacy of supervised exercise training used in combination with compression therapy patients with VLUs. Objectives To assess the feasibility of a 12‐week supervised exercise programme as an adjunct therapy to compression in patients with VLUs. Methods This was a two‐centre, two‐arm, parallel‐group, randomized feasibility trial. Thirty‐nine patients with venous ulcers were recruited and randomized 1 : 1 either to exercise (three sessions weekly) plus compression therapy or compression only. Progress/success criteria included exercise attendance rate, loss to follow‐up and patient preference. Baseline assessments were repeated at 12 weeks, 6 months and 1 year, with healing rate and time, ulcer recurrence and infection incidents documented. Intervention and healthcare utilization costs were calculated. Qualitative data were collected to assess participants’ experiences. Results Seventy‐two per cent of the exercise group participants attended all scheduled exercise sessions. No serious adverse events and only two exercise‐related adverse events (both increased ulcer discharge) were reported. Loss to follow‐up was 5%. At 12 months, median ulcer healing time was lower in the exercise group (13 vs. 34·7 weeks). Mean National Health Service costs were £813·27 for the exercise and £2298·57 for the control group. Conclusions The feasibility and acceptability of both the supervised exercise programme in conjunction with compression therapy and the study procedures is supported. What's already known about this topic? Almost 70% of all leg ulcers have a venous component. Up to 30% of venous leg ulcers (VLUs) do not respond to compression alone, remain open after 1 year of treatment and need an average of 51 treatment visits to heal. Adjunct therapies to compression are needed. Exercise can form part of the therapeutic pathway, but evidence to determine whether exercise training has an effect on ulcer healing and quality of life is limited.
What does this study add? The findings support the feasibility and acceptability of supervised exercise training as an adjunct therapy for adults with VLUs. The preliminary data also support the potential effectiveness of exercise training in improving ulcer healing. An appropriately powered, multicentre trial is required to confirm the clinical and cost‐effectiveness of the intervention.
Linked Comment: https://doi.org/10.1111/bjd.16523. https://doi.org/10.1111/bjd.16618 available online https://goo.gl/Uqv3dl
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Affiliation(s)
| | - G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, NE1 8ST, U.K
| | - A Gumber
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10 2BP, U.K
| | - H Crank
- Centre for Sport and Exercise Science
| | - B King
- Manor Clinic, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S12 2ST, U.K
| | - G Middleton
- School of Sport and Exercise Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, U.K
| | - J A Michaels
- School of Health and Related Research, University of Sheffield, Sheffield, S1 4DA, U.K
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Tew GA, Ayyash R, Durrand J, Danjoux GR. Clinical guideline and recommendations on pre-operative exercise training in patients awaiting major non-cardiac surgery. Anaesthesia 2018; 73:750-768. [PMID: 29330843 DOI: 10.1111/anae.14177] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2017] [Indexed: 01/17/2023]
Abstract
Despite calls for the routine implementation of pre-operative exercise programmes to optimise patient fitness before elective major surgery, there is no practical guidance for providing safe and effective exercise in this specific context. The following clinical guideline was developed following a review of the evidence on the effects of pre-operative exercise interventions. We developed a series of best-practice and, where possible, evidence-based statements to advise on patient care with respect to exercise training in the peri-operative period. These statements cover: patient selection for exercise training in surgical patients; integration of exercise training into multi-modal prehabilitation programmes; and advice on exercise prescription factors and follow-up. Although we acknowledge that further research is needed to identify the optimal exercise prescription in different clinical scenarios, we urge peri-operative teams to make use of these recommendations.
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Affiliation(s)
- G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle-upon-Tyne, UK
| | - R Ayyash
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - J Durrand
- Northern School of Anaesthesia and Intensive Care Medicine, Newcastle University, Newcastle, UK
| | - G R Danjoux
- Department of Anaesthesia, James Cook University Hospital, Middlesbrough, UK.,School of Health and Social Care, Teesside University, Middlesbrough, UK
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Tew GA, Batterham AM, Colling K, Gray J, Kerr K, Kothmann E, Nawaz S, Weston M, Yates D, Danjoux G. Randomized feasibility trial of high-intensity interval training before elective abdominal aortic aneurysm repair. Br J Surg 2017; 104:1791-1801. [DOI: 10.1002/bjs.10669] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 04/25/2017] [Accepted: 07/11/2017] [Indexed: 12/23/2022]
Abstract
Abstract
Background
This study assessed the feasibility of a preoperative high-intensity interval training (HIT) programme in patients awaiting elective abdominal aortic aneurysm repair.
Methods
In this feasibility trial, participants were allocated by minimization to preoperative HIT or usual care. Patients in the HIT group were offered three exercise sessions per week for 4 weeks, and weekly maintenance sessions if surgery was delayed. Feasibility and acceptability outcomes were: rates of screening, eligibility, recruitment, retention, outcome completion, adverse events and adherence to exercise. Data on exercise enjoyment (Physical Activity Enjoyment Scale, PACES), cardiorespiratory fitness (anaerobic threshold and peak oxygen uptake), quality of life, postoperative morbidity and mortality, duration of hospital stay and healthcare utilization were also collected.
Results
Twenty-seven patients were allocated to HIT and 26 to usual care (controls). Screening, eligibility, recruitment, retention and outcome completion rates were 100 per cent (556 of 556), 43·2 per cent (240 of 556), 22·1 per cent (53 of 240), 91 per cent (48 of 53) and 79–92 per cent respectively. The overall exercise session attendance rate was 75·8 per cent (276 of 364), and the mean(s.d.) PACES score after the programme was 98(19) (‘enjoyable’); however, the intensity of exercise was generally lower than intended. The mean anaerobic threshold after exercise training (adjusted for baseline score and minimization variables) was 11·7 ml per kg per min in the exercise group and 11·4 ml per kg per min in controls (difference 0·3 (95 per cent c.i. –0·4 to 1·1) ml per kg per min). There were trivial-to-small differences in postoperative clinical and patient-reported outcomes between the exercise and control groups.
Conclusion
Despite the intensity of exercise being generally lower than intended, the findings support the feasibility and acceptability of both preoperative HIT and the trial procedures. A definitive trial is warranted. Registration number: ISRCTN09433624 (https://www.isrctn.com/).
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Affiliation(s)
- G A Tew
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | - A M Batterham
- School of Health and Social Care, Teesside University, Middlesbrough, UK
| | - K Colling
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - J Gray
- Department of Nursing, Midwifery and Healthcare, Northumbria University, Newcastle upon Tyne, UK
| | - K Kerr
- Department of Anaesthesia, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - E Kothmann
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
| | - S Nawaz
- Sheffield Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - M Weston
- Department of Psychology, Sport and Exercise, School of Social Sciences, Business and Law, Teesside University, Middlesbrough, UK
| | - D Yates
- Department of Anaesthesia, York Hospital, York Teaching Hospital NHS Foundation Trust, York, UK
| | - G Danjoux
- Department of Academic Anaesthesia, James Cook University Hospital, Middlesbrough, UK
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Abstract
The ability to control skin blood flow decreases with primary aging, making older adults less able to adequately thermoregulate and repair cutaneous wounds. Lifestyle factors such as physical activity, diet, and smoking might interact with the aging process to modulate "normal" age-associated changes in the cutaneous microcirculation. The main focus of this brief review is the effects of exercise training on the control of skin blood flow in older adults.
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Affiliation(s)
- G A Tew
- Centre for Sport and Exercise Science, Sheffield Hallam University, UK.
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Tew GA, Nawaz S, Zwierska I, Blagojevic M, Saxton JM. Physiological Predictors of Maximum Treadmill Walking Performance in Patients with Intermittent Claudication. Ann R Coll Surg Engl 2009. [DOI: 10.1308/003588409x432220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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