#Move4Change: how you can help patients manage symptoms of long-term conditions, enabling them to get active

Article posted on 6th June 2018

Health and social care

For people suffering from long-term health conditions, starting regular exercise can be not only difficult, but daunting too. Many are simply unsure of where to start or what their capabilities may be as a result of their condition.

Often, the first step towards regular exercise is the hardest step of all, particularly for those with long-term health conditions. Patients suffering from long-term mental health or lung conditions can regularly face barriers to exercise as a result of their symptoms. When managed effectively however, patients should find that their symptoms and condition have little effect on their ability to exercise.

“All sorts of medical conditions can make it harder to take the first step towards regular exercise. Yet exercise has proven benefits for your lungs and mental health.”

Dr Sarah Jarvis, clinical director, Patient.info.

Despite any initial concerns patients may have about the effect of exercise on their condition, the benefits of even gentle exercises are clear. In fact, being more active can help to improve breathlessness – a common symptom of long-term lung conditions like asthma. By learning to control their breathing and exercising at the right level, with the right support, patients should see a significant improvement in their symptoms.

By helping your patients to effectively manage their symptoms, you make it easier for them to get started. So how exactly do you make sure they have the tools to achieve this?


How can you tackle mental health barriers to exercise?

Patients suffering with a mental health condition face a number of barriers to exercise which can vary from patient to patient as the nature of mental health conditions varies. There are, however, some barriers which are more common than others. These can include:

Mental health conditions and the medication prescribed to treat them can sometimes cause patients to feel tired and experience disrupted sleep. This can make it difficult for them to feel motivated and energised enough to exercise. Many people also find that they lose the desire to do things they once enjoyed, which can make it difficult for them to get active.

Stephen Buckley, head of information at Mind, recommends that patients are encouraged to “work with their high and lows – if they’re not a morning person, go for evenings, and try to understand their medication, so they can avoid times when side effects could be a problem.”

Anxiety and fears around new people, places and things can also create barriers for those with mental health conditions. With the right encouragement and support this uneasiness should decrease over time. Encourage patients to take someone with them so they don’t have to face the new situation alone.

The first step and the first session are often the most daunting, with Stephen noting that “Over time, you may find that taking up an activity helps to increase your self-confidence as you become fitter and improve your skills.” This can in turn make it easier for patients to interact with the people they exercise with and improve their social life, which is known to benefit those suffering from mental health conditions.

“Patients should never be ashamed of asking for help. Attending with a friend, support worker or even booking with a fitness instructor can really help to get them active. But they don’t just have to go at it alone.”

Stephen Buckley, head of information, Mind.

 It’s also key to remind patients that it’s okay to start small. Even modest amounts of activity can help improve their fitness, so let them know that they don’t have to jump into a full-on routine straight away. Instead, encourage them to build up their activity at their own pace. This will help them to feel comfortable and confident in their abilities as they steadily increase their fitness. With this, embarrassment over their bodies – which can be another barrier to exercise for many - should also decrease as their weight and fitness improves.

There are a number of groups and beginner level activities that GPs can recommend at regular clinics in order to point patients in the right direction. Leeds Let’s Get Active, Alvanley Practice’s Wednesday Wander and The Fairfields Practice’s Couch to 5K programme are all great examples of how patients can start towards a healthier lifestyle.

Understanding barriers to exercise with asthma

For patients with long-term lung conditions, exercise can also be mentally and physically difficult. For those who suffer with breathlessness because of their asthma, the idea of exercising – and becoming more breathless as a result – is not only challenging, but terrifying.

The majority of asthma symptoms can be managed with the right medication, so encouraging patients to take their preventative inhalers correctly can help set them on the right path.

“Some people develop exercise induced asthma which means exercise is a trigger. But as long as they’re taking their medication and it’s kept under control, nothing should stop patients doing light exercises such as walking.”

Rachel Livingston, respiratory physiotherapist, University College London Hospitals, NHS Foundation Trust.

You can also help by making sure both you and your patient get the most out of your consultations with integrated devices. Through the use of fully integrated spirometers you can digitally upload peak flow test results directly to the patient’s file, saving you time which can then be used to share important fitness information.

As with mental health conditions, you can help by advising patients to start small. Suggest lighter exercises such as yoga and walking, which can help improve the strength of their lungs. You can also direct them to Patient.info articles which will provide them with more information on the benefits of gentle exercise and which activities are suitable for people with asthma.

How can you make the most of symptom reviews?

You can keep track of your patient’s progress by holding regular symptom reviews. This helps you make sure their symptoms are improving and being effectively managed so you can intervene if needed.

“Symptom reviews are fundamental to how general practice works. The only way to follow up is to hold symptom reviews to discuss updates. They don’t need to be face-to-face, but they do need to happen to make sure patients are maintaining improvements, or they may need intervention.”

Dr Shaun O’Hanlan, chief medical officer, EMIS Group.

Here, can we say, as Shaun says, symptom reviews don’t need to be face-to-face. There are so many ways you can make sure these are completed. Then they can use an online triage system to fill out a form – with our system, clinicians can customise forms and add any which could include a simple questionnaire asking about their symptoms. Alternatively, a quick phone or video consultation can be an option.

For patients suffering from asthma, symptom reviews are a great chance to measure peak flow, and with integrated spirometers you can also empower your patients to update their results from home. Because the process is fully digitised you can be sure that the results will be accurate, with reduced risk of human error. Using FeNo machines during these sessions can also alert you of a patient’s inflamed airways or poor asthma control so you can discuss potential changes to their medication if required.

How can you help patients manage their symptoms outside the practice?

Ultimately, once your patient leaves the consultation room, it’s up to them to get started on moving towards a more active lifestyle. You can make this easier for them by extending your support outside the practice.

Provide patients with information about groups, exercises and activities by using your practice website. You can also link out to sites like Patient.info where patients can find a range of articles about the type of exercises suitable for them.

To make sure patients are aware of whether an exercise is right for them, Rebecca Livingston, respiratory therapist at University College London Hospitals, NHS Foundation Trust, recommends educating them using the Borg scale. This works on a scale of zero to ten, where four to six is the recommended breathing rate for someone doing exercise. “Patients should still be able to speak in short sentences when exercising, if they can’t, or their breathlessness score is over six, the intensity is too high, and they should decrease it.”

Offering ongoing and flexible support is key to helping patients with long-term conditions manage their symptoms. By providing alternative consultation options such as video consult, you can continue to extend one-to-one advice and support outside the practice walls.

Although it’s down to your patients to make the change to a more active routine, you can offer a range of support systems to help them on their way. By empowering patients with the information and knowledge they need to overcome barriers to exercise, you’ll help them take their first steps to a lasting change of lifestyle.



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