Patient & Carer Partnership
Meeting 2016
Dr. Rosalind Leslie PhD
Jen Davies BSc (Hons) Physical Activity &
Health
Maria Glover RGN BSc (Hons) Health Studies
Aims & Objectives
• What’s new in Physical Activity/Exercise?
• What’s new in Phase 4 Exercise?
• What’s new in Lifestyle/Risk Factor
Modification/Medication?
PHYSICAL ACTIVITY & EXERCISE
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13th May 2016
Annual event
Attended by Chris and Ian
The main topics included exercising with
diabetes, high intensity interval training (HIIT),
maintaining muscle mass and practical ways to
assess fitness
What Does Diabetes Do To The Body?
Issues:
• ‘Sugar’ control
• Cardiovascular disease risk
• Heart Failure (‘preserved
pump’)
• Neuropathy
• Reduced blood flow
Cardiovascular disease is the
number one cause of death in
Type 2 diabetes (T2DM)
Encouraging Everyday Exercise in
Diabetics
• 4.75 million UK people
at high risk of getting
T2DM
• 11.5 million people are
at increased risk of
developing T2DM based
on waist circumference
i.e. 1 in 4 adults
• Most individuals with
diabetes aren’t active
enough
What are the Exercise Guidelines?
1.Moderate-intensity aerobic
physical activity for at least 150
min/week; Lasting more than 30
min on 5+ days
4.Combinations of moderate-and
vigorous-intensity activities are
possible
2.Can be accumulated across
individual bouts of 10+ minutes at a
time
5.Muscle strengthening activities
involving the major muscle groups of
the body on 2 days per week in
addition to 150 min/week moderateintensity activity
3.Vigorous-intensity activity also
provides health benefits; 75
min/week provides comparable
benefits to 150 min/week of
moderate-intensity activity
CHECK WITH YOUR DOCTOR IF YOU
HAVE DIABETIC RETINOPATHY OR
NEUROPATHY – HIIT and heavy
resistance work not recommended
Main Message
• Regular exercise improves blood sugar
control…despite variables such as diet and energy
intake
• Greater exercise intensity may be more effective
than exercise volume (Boulé et al 2003)
• Strength training is important too
So, Does High Intensity Exercise Help?
• HIIT may be more
effective in improving
fitness
• Direct benefits of HIIT
yet to be determined
but if fitness improves
then outcomes likely to
improved
A HIIT Protocol
• Few ‘real world’ studies
• Several recent trials/pilots
in UK based CR
• One example from
Liverpool: 8-weeks
exercise, 1-2 x per week,
5 x 3 min work;
intermittent 2 min rest
• Rating of perceived
exertion used
Results
• “It’s great –something to strive for and
achieve!”
• “It’s not as boring as walking or cycling for
hours on end”
• “The HIIT training is tough, but always feel
better afterwards”
• “Sit to stand’s aren’t for me….!”
• “Really enjoyed it, feel so much better for
taking part!”
Will Too Much Exercise Injure The
Heart?
• Angina
• Arrhythmias (especially Atrial Fibrillation)
LISTEN TO YOUR BODY AND DON’T IGNORE
WARNING SIGNS
…..about high intensity/vigorous
exercise?
Importance of Maintaining Muscle
Mass
• Loss of muscle mass reduces the ‘reservoir’
available in which to dispose of sugars
(glucose)
• This increases risk of T2DM
• Healthy aging is a lifelong process that starts
early in life
• To maintain function, exercise doesn’t have to
be intense – something is better than nothing
• For best results include resistance training
Practical ways to Assess Functional
Capacity
Assessments pre and post exercise programmes
are needed to:
• Assess change
• Provide guidance
• Demonstrate programme efficacy to
commissioners
• We would be awarded ‘a gold medal’ for our
assessment (Professor J Buckley definition)
• John encouraged all CR services to ‘go for
gold’!
A few Things to Reflect On…..
24-hour day
11%
10%
33%
sleeping
work related
eating
spare time?
46%
Is this man fit?
What about him?
Which one is the
fittest?
PHASE 4
What Does Phase 4 Involve?
• We currently offer 20 classes
per week across Wolverhampton
and surrounding areas.
• Offering patients a chance to
continue with their rehabilitation
following their programme with
the Phase III team at New Cross
Heart and Lung Centre.
• Exercise classes are either in 45
minute or 1 hour slots:
• warm up, main component of
exercise using a variety of cv
and resistance equipment/
exercise disciplines and a cool
down.
• During classes patients will
monitor their pulses at the
beginning middle and end of
exercise.
• Patients offer a donation
(minimum £2.50) which is paid
to the instructor upon arrival.
This money goes directly back
into the charity funds.
Venues
• Bilston Community Centre – 2
classes per week. Mixed classes
consisting of cardiac and
pulmonary patients. Simple
circuit using Easyline Technogym
equipment, bikes, rower and free
weights etc. Classes run on
Mondays 3-4pm and
Wednesdays 4.30-5.30pm.
• Aldersley Stadium – 6 classes per
week. Tuesdays 4-7pm and
Thursdays 5.15 – 7pm. Circuit
style set up in main sportshall
composed of various cv
equipment and free weights.
Circuit cards are used labelling
exercise at each station.
Venues
• Bob Jones Hub (previously
Blakenhall Community Centre) – 5
classes per week. 3 classes on
Wednesday 12.45-3pm, located in
the main gym suite using a variety of
Technogym cv and resistance
commercial equipment. 2 classes on
Fridays 11.30-1pm located in the
Genesis suite using Easy Line
equipment, various cv equipment
and free weights.
• Smestow School – 1 class per week
(Term time only) Set within the
schools own gym using a variety of
cv and resistance equipment. Classes
run Mondays 5.30-6.30pm.
New Venue
• Ashmore Park hub – 6 classes per
week.
• 2 are low intensity (patients can
perform seated exercise if
required, but we encourage them
to use equipment where
possible).
• We also offer 2 mixed cardiac &
pulmonary classes at this venue
per week.
• Located in the gym using Easyline
Technogym equipment as well as
other various cv and resistance
equipment .
• Classes run on Mondays &
Thursdays 10.30am-1.15pm.
How Can We Improve?
How can You Help Us?
• Donations you make during classes are of course welcomed.
• Extra donations from yourselves, family and the community
will be greatly appreciated. How? Fundraising! Coffee
mornings, bake sales, signing up for events we organise etc.
• Spread the word !
• Facebook – get friends and family to like and share our page.
• Just giving – we have a just giving link and textcode that
people can use to donate to YOUR charity online or via their
mobile phone. Know someone whos doing an event? Ask
them if they would mind raising money for their local charity.
……….And give us your feedback!
www.justgiving.com/wcasg
LIFESTYLE & RISK FACTOR
MODIFICATION/MEDICATION
Lifestyle / Risk Factors
What’s new… in brief
HIGH
CHOLESTEROL
“Cholesterol is a fatty substance carried around the body by proteins”
Low-density lipoproteins (LDL) is known as the bad type of cholesterol
High-density lipoprotein (HDL) is known as the good type of cholesterol
Continued… in brief
WEIGHT &
WAIST
CIRCUMFERENCE
How does my weight affect my health?
* raise your blood cholesterol levels
* increase your blood pressure
* increase your risk of developing Type 2 diabetes
Continued…. in brief
“Family History of Cardiovascular Disease(CVD) if,
Father or Brother was under the age of 55
or your Mother or Sister was under the age of 65
when they were diagnosed with CVD” (BHF)
“High Blood Pressure isn’t usually something
that you can feel or notice, but if you have it
you’re more likely to develop Coronary Heart
Disease or have a stroke” (BHF)
“If you have Diabetes, you are more likely to
develop Coronary Heart Disease than someone
without diabetes” (BHF)
What’s new… in a little more detail
SMOKING &
E-CIGARETTES
“trends show that smokers and ex-smokers are
increasingly using e-cigarettes as a smoking
cessation aid”
“It is estimated that there are
more than 2 million current
users of e-cigarettes in the UK”
“e-cigarettes are increasingly being used as a cessation aid however, marketed as
‘alternative smoking devices’ rather than smoking cessation devices to aid quitting,
and by not making any health claim they have avoided being regulated as medical
devices like Nicotine Replacement Therapy (NRT) to date” !!
To date, e-cigarettes have been subjected only to minimal scientific study and
there are no studies regarding the effects of their long-term use
Last one….
If you drink alcohol it is important to keep within the guidelines:
Men and women should not drink more than 14 units of alcohol each week
You should have several alcohol-free days each week.
GTN Spray
Sublingual GTN is often prescribed to alleviate
anginal chest pain
Various studies have shown not everybody knows how to
use the spray correctly
NICE emphasise the importance of ensuring that patients with Angina
are prescribed GTN & provided with full advice on how to use it
correctly to prevent and alleviate episodes of chest pain
GTN Spray…. Update
GTN Spray Card
If you experience chest pain (angina), chest ache or chest
discomfort:
• Stop what you are doing, sit down and rest.
• If pain persists, use 1 spray under your tongue and wait 5
min.
• If pain is still present, use another spray and wait 5 min.
• If pain is still present, Ring 999 and Unlock door.
If your pain gets severe at any stage, or if you feel unwell,
(e.g.dizzy, short of breath, sweaty)
call 999 immediately.
Cardiac Rehabilitation Update
• April 2015 – Integration of Services
• Cardiac Rehabilitation Team Update
• Cardiac Rehabilitation Services Update
- Cannock & New Cross Programmes & Clinics
• Introduction of the Patient Education Session at Cannock
• To the future…….
Any Questions?