1. LLT RECS UPDATE1 Update on programming, physical activity recommendations for older people and implications for LLT Tutors

2. LLT RECS UPDATE2 Purpose of this session To consider/understand current issues affecting CBE and LLT To update on physical activity recommendations for older people To consider implications for LLT programmes and LLT Tutor role To provide routes to additional information

3. LLT RECS UPDATE3 Practical evidence based interventions for exercise programmes Development of LLT training continuum Senior Peer Health Mentoring (Engaging and motivating the older person to become active) Chair based exercise for the frailer older person (Addressing risk factors and independence) Otago Exercise Programme (Strength and balance retraining programme) Postural stability (Falls prevention and management)

4. LLT RECS UPDATE4 “Supervised exercise” - Chair based exercise and assisted walking Leadership training for health and care professionals Four days training + assessment 17 specific exercises designed to improve mobility, strength, flexibility and co- ordination Includes assisted walking and games activities (as CPD) and promoting home based exercise “on my own”

5. LLT RECS UPDATE5 Developments in LLT CBE 1999 – 2000 LLT and CBE - “New Kid on the block” 2001 – 2005 - Honeymoon period 2005 onwards ????................ Now many competitors, national and local Their criteria ? - safety, enjoyment and low cost Exposure of LLT content, evidence base and replication

6. LLT RECS UPDATE6 LLT Chair based exercise for frailer older people Targets components of fitness to improve independence, mobility and risk factors for falling Strength Flexibility Muscular endurance Cardio-respiratory Motor fitness (skills/balance)

7. LLT RECS UPDATE7 UK Physical activity recommendations for older people A prescription for SEDENTARY Adults 30 minutes of moderate intensity physical activity on five or most days of the week. No guidelines for older adults Integrated physical activity (walking, cycling) 10,000 steps Gentle exercise mafia e.g. “Fit as a Fiddle” Only NHS Scotland include strength and balance

8. LLT RECS UPDATE8 Additional recommendations “Additionally, specific activities that promote improved strength, co- ordination and balance are particularly beneficial for older people”. (DOH 2005) NB This is not a public health message and has never been promoted Be Strong, be Steady

9. LLT RECS UPDATE9 Recent physical activity recommendations for older people 30 mins. moderate intensity on 5 or more days a week 3 x 20 mins. vigorous – where appropriate Strength, flexibility, balance and coordination are vital (2 x per week) Individual tailored action plan Stepwise approach ( AHA & ACSM 2007, Confirmed by DHHSS 2008)

10. LLT RECS UPDATE10 BHF NC Guidelines on older people and physical activity How much is physical activity is enough and how do we communicate this ? Evidence on interventions - what works in practice ? www.bhfactive.org.uk NB not conditions or prescriptions

11. LLT RECS UPDATE11 2007- 8 BHF NC Dissemination events Over 700 + professionals across UK Strong support for intervention guidance as professional planning checklist But Lack of knowledge of current PA OP recommendations (beyond mod message) Unable to “interpret” message Low understanding of implications for practice

12. LLT RECS UPDATE12 The missing components of fitness Strength, flexibility, balance, power and coordination This message is not known in public health CBE has become the default mode for all older people programmes (safe bet) LLT Independence - not being achieved Not all CBE targets strength and power NB Strength is important in other evidence based exercise interventions e.g. diabetes, weight loss, mental health improvement

13. LLT RECS UPDATE13 Importance of professional understanding Levels and tasks PA and exercise specialist and generic health promotion Commissioning services (e.g. LLT programmes) Design and inclusion within effective programmes Promotional and marketing messages/activities 1 – 1 interventions, educating/advising others including participants (NB FAME and OEP included with DHHS 2008)

14. LLT RECS UPDATE14 Public policy, the recent shift

15. LLT RECS UPDATE15 Independence – the key factor in later life What does independence in later life really mean in practice ? Being able to: Go shopping Going to the toilet Visiting the neighbour Playing with the grandchildren Posting a letter Getting into the garden Going to church (Kings College 2006)

16. LLT RECS UPDATE16 “Sit to Stand” and “Up and about” - The key to independence Strength, balance and power Daily activities – such as the displacement of body weight during walking or getting up from a chair – require power rather than strength alone. The ability to perform activities of daily living is therefore related to muscle power. Without balance, and endurance walking is not possible

17. LLT RECS UPDATE17 Understanding Functional Health Does physical activity (With those who do not have severe functional limitations) - prevent or delay the onset of substantial functional limitations ? (With those who have mild, mod or severe functional limitations) - improve or maintain functional ability (Those who are at increased risk) - reduce rates of falls and fall-related injuries ? PA Guidelines Advisory Committee (Part G, Section 6: Functional Health) DHHS 2008

18. LLT RECS UPDATE18 What’s the LLT USP ? CBE and OEP Evidence base (but of what ?) Properly delivered – progressive, physical function and independence But: - Well-being and independence as focal themes are conceptually confused and mixed in policy implementation

19. LLT RECS UPDATE19 What’s the LLT USP ? Maximising the opportunities for progression and improvement Delivery of real independence through all components of fitness Implementation of NICE Mental Health Guidelines We need to make the case differently, smarter to different professional and public targets

20. LLT RECS UPDATE20 Implications for LLT Tutor team What’s our role to establish the USP of LLT programmes ? How can/should we do it ? Re-branding of programmes ? How do we develop the message ? Who needs to hear it ?