The PIE=M project:development of a tool to support exercise as medicine in hospital care

Physical inactivity has led to an increase in the prevalence of lifestyle-related chronic diseases on a global scale. There is a need for more awareness surrounding the preventive and curative role of a physically active lifestyle in healthcare. The prescription of physical activity in clinical care has been advocated worldwide through the ‘exercise is medicine’ (E=M) paradigm. However, E=M currently has no position in general routine hospital care, which is hypothesized to be due to attitudinal and practical barriers to implementation. This study aims to create an E=M tool to reduce practical barriers to enforcing E=M in hospital care. Firstly, this project will perform qualitative research to study the current implementation status of E=M in clinical care as well as its facilitators and barriers to implementation among clinicians and hospital managers. Secondly, an E=M tool towards application of active lifestyle interventions will be developed, based on a prediction model of individual determinants of physical activity behavior and local big data, which will result in a tailored advice for patients on motivation and physical activity. Thirdly, the feasibility of implementing the E=M-tool, as designed within this project, will be investigated with a process evaluation, conducting a pilot-study which will integrate the tool in routine care in at least four clinical departments in two Dutch hospitals. This project will give insight in the current implementation status of E=M and in factors that influence the actual E=M implementation. Secondly, an E=M tool will be designed providing a tailored E=M prescription for patients as part of clinical care. Thirdly, an implementation strategy will be developed for implementation of the E=M tool in clinical practice. This project envisages an extensive continuation of research on the implementation of E=M, supports the mutual decision making process of lifestyle referral of clinicians and will provide insights which can be used to assist in implementing physically active lifestyle prescription in the medical curriculum

A cross-sectional analysis of motivation and decision-making in referrals to lifestyle interventions by primary care general practitioners: a call for guidance

Aim: To explore 1) GPs´ motivation to refer to lifestyle interventions and to investigate the association between GPs’ own lifestyle-behaviors and their referral behavior, and 2) patient indicators in the decision-making process of the GPs’ referral to lifestyle interventions. Method: A cross-sectional study was conducted among 99 Dutch primary care GPs. Their motivation to refer was assessed by beliefs regarding lifestyle interventions. GPs’ referral behaviors were assessed - considering referral and self-reported actual referral - and their own lifestyle behaviors - physical activity, dieting, being overweight). Decision-making regarding referring patients to lifestyle interventions was assessed by imposed patient indicators, spontaneously suggested decisive patient indicators, and by case-based referring (vignettes). Results: A substantial group of GPs was not motivated for referral to lifestyle interventions. GPs’ refer behavior was significantly associated with their perceived subjective norm, behavioral control, and their own physical activity and diet. Most important patient indicators in referral to lifestyle interventions were somatic indicators, and patients’ motivation for lifestyle interventions. Conclusions: GPs motivation and referral behavior might be improved by providing them with tailored resources about evidence based lifestyle interventions, with support from allied health professionals, and with official guidelines for a more objective and systematic screening of patients

The barrier-belief approach in the counseling of physical activity

Objective: To understand inactivity and relapse from PA, and to develop theory-based behaviour change strategies to stimulate and support maintenance of PA. Methods: We conducted a literature search to explore barriers to PA. Social cognitive theories and empirical evidence were evaluated and guided the process developing a theoretical framework and counselling strategies. Results: A theoretical framework is presented to understand why people do not engage in PA and often relapse once they started PA. A distinction is made between three related types of BBs. In PA counselling these three beliefs are addressed using four different BB behaviour change strategies. Conclusion: BB counselling aims to develop an individual pattern of PA for the long term that is adapted to the (often limited) motivation of the client, thereby preventing the occurrence of BBs. The client will learn to cope with factors that may inhibit PA in the future. Practice implications: The BBs approach composes a way of counselling around the central construct of barrier-beliefs to stimulate engagement in PA independently, in the long term

Bovenschoolse Kenniswerkplaats Gezonde Leefstijl

Onderwijs, onderzoek en werkveld: samenwerking vanuit de bovenschoolse Kenniswerkplaats Gezonde Leefstijl   Achtergrond en doelstelling Het gezondheidsdomein verandert sterk en vraagt van nieuwe gezondheidsprofessionals dat zij in staat zijn om over de grenzen van hun eigen expertise heen te kijken. Binnen de Hanzehogeschool Groningen (HG) leent het speerpunt Healthy Ageing zich voor een multidisciplinaire aanpak van gezondheid: gezond opgroeien en gezond ouder worden vereisen preventieve benaderingen, interventies en begeleiding die gericht zijn op zowel lichaam als geest en waarbij diverse professionals betrokken zijn. Multidisciplinaire kenniswerkplaatsen (KWP’s) zijn een manier om deze samenwerking binnen de HG tot stand te brengen. In deze poster beschrijven we de opzet van de KWP Gezonde leefstijl.   Aanpak en methode van het project  In de KWP Gezonde Leefstijl  hebben docenten van de opleidingen Sport Gezondheid Management, Toegepaste Psychologie, Pabo, Verpleegkunde, Voeding en Diëtetiek en de Academie voor Lichamelijke Opvoeding zitting. Samen met studenten en werkveldpartners werken zij aan multidisciplinaire vraagstukken op het gebied van Gezonde Leefstijl. Dat wil zeggen: vraagstukken die vanuit verschillende vakgebieden bekeken en opgelost kunnen en moeten worden. Kernonderwerpen zijn: gecombineerde leefstijlinterventies, gedragsdeterminanten voor een gezonde leefstijl, en de implementatieprofessional.   Resultaten en opbrengsten Inmiddels is de KWP ruim twee jaar in de lucht. Met een aantal praktijkpartners vindt samenwerking plaats: de gemeente en provincie Groningen, GGD Groningen, Huis voor de Sport Groningen en de Hanzehogeschool zelf. Studenten van verschillende opleiding werken onder andere aan:  (1) de uitvoering van een duurzame inzetbaarheidsinterventie voor Hanze personeel, (2) het ondersteunen van scholen om een vignet Gezonde School aan te vragen en (3) Onderzoek naar Jongeren op Gezond Gewicht in een specifieke gemeente. De studenten komen bij elkaar Communities of Learners, waarin zij kennis en ervaring met elkaar en praktijkpartners uitdelen. Ook zijn diverse minoren gekoppeld aan de KWP.   Conclusies en aanbevelingen De bovenschoolse KWP Gezonde Leefstijl is een meerwaade in het opleiden van de toekomstige T-shaped professional. Ook de projecten hebben baat bij de multidisciplinaire invalshoek en de eerste ervaringen rondom de multidisciplinaire samenwerking in de CoL zijn positief. Toch vormt deze vorm van multidisciplinair samenwerken uitdagingen op organisatorisch vlak: de diversiteit aan opleidingskaders vormt het voornaamste struikelblok. De aaanjaagfunctie van de bovenschoolse KWP is een belangrijke voorwaarde voor samenwerking tussen opleidingen gebleken.    Visuele presentatie: Weergave van relaties tussen opleidingen, werkveldpartners en projecten en hoe deze binnen het onderwijs worden ingevuld

Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals

Background There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as 'Exercise is Medicine' (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care. Methods A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide. Results An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients' electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care. Conclusions This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation.</p

Implementing Exercise = Medicine in routine clinical care; needs for an online tool and key decisions for implementation of Exercise = Medicine within two Dutch academic hospitals

BACKGROUND: There is much evidence to implement physical activity interventions for medical reasons in healthcare settings. However, the prescription of physical activity as a treatment, referring to as 'Exercise is Medicine' (E = M) is currently mostly absent in routine hospital care in The Netherlands. To support E = M prescription by clinicians in hospitals, this study aimed: (1) to develop an E = M-tool for physical activity advice and referrals to facilitate the E = M prescription in hospital settings; and (2) to provide an E = M decision guide on key decisions for implementation to prepare for E = M prescription in hospital care. METHODS: A mixed method design was used employing a questionnaire and face-to-face interviews with clinicians, lifestyle coaches and hospital managers, a patient panel and stakeholders to assess the needs regarding an E = M-tool and key decisions for implementation of E = M. Based on the needs assessment, a digital E = M-tool was developed. The key decisions informed the development of an E = M decision guide. RESULTS: An online supportive tool for E = M was developed for two academic hospitals. Based on the needs assessment, linked to the different patients' electronic medical records and tailored to the two local settings (University Medical Center Groningen, Amsterdam University Medical Centers). The E = M-tool existed of a tool algorithm, including patient characteristics assessed with a digital questionnaire (age, gender, PA, BMI, medical diagnosis, motivation to change physical activity and preference to discuss physical activity with their doctor) set against norm values. The digital E = M-tool provided an individual E = M-prescription for patients and referral options to local PA interventions in- and outside the hospital. An E = M decision guide was developed to support the implementation of E = M prescription in hospital care. CONCLUSIONS: This study provided insight into E = M-tool development and the E = M decision-making to support E = M prescription and facilitate tailoring towards local E = M treatment options, using strong stakeholder participation. Outcomes may serve as an example for other decision support guides and interventions aimed at E = M implementation