Exercise after Stroke

1. Royal College of Physicians of EdinburghScottish Stroke Collaboration Meeting22nd September 2010Queen Mother Conference Centre

2. Exercise after Stroke Towards the provision of Community Exercise after Stroke Services

3. 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

4. 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

5. 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

6. Life after Stroke Source: Stroke Association www.stroke.org.uk ‘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.

7. ActivPalTM physical activity monitoring

8. 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

10. 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

11. 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…. ‘

12. 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

13. 14 Exercise after Stroke Services

14. 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…. Best practice guidelines Draft at www.exerciseafterstroke.org.uk Professor Martin Dennis, Chair, National Advisory Committee Stroke

15. Areas covered by the guidelines Governance Multidisciplinary working group to oversee service development Referral 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 training Exercise 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

16. Recommended referral and assessment process Screening for absolute contraindications Alternative exercise options Suitability of exercise session (inclusion criteria) Multidimensional assessment Identification of key risk elements Referral to EAS service Referral form Health care professional Pre-exercise assessment Exercise professional Exercise after stroke session

20. 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

22. 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!

23. 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

24. Funders

25. Supporters

26. Mrs Sara Paul Ms Carolyn Agnew Ms Gill Baer Ms Lorraine Ayers Mrs Sheena Borthwick Ms 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 Reference group

27. Further information • www.exerciseafterstroke.org.uk • www.laterlifetraining.co.uk • www.ccbs.ed.ac.uk • www.geriatric.med.ac.uk

28. Royal College of Physicians of EdinburghScottish Stroke Collaboration Meeting22nd September 2010Queen Mother Conference Centre