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It is widely acknowledged that increasing physical activity (PA) levels within `hard-to-reach' groups is challenging. Researchers in the School have addressed these challenges resulting in impacts in two recognized `hard-to-reach' groups: ethnic minority communities and patients who are at risk of disease onset and/or are suffering from diminished quality of life/disability due to chronic disease. In the former, our research has demonstrated how to make PA accessible and appropriate; in the latter, in addition, we have increased physical activity levels. In both examples, our research has changed professional training and/or standards.
The Physical Activity in Ageing, Rehabilitation and Health Research Group at Aberystwyth University has designed, implemented and evaluated rural Community Exercise Schemes (CESs), including GP referral of sub-clinical populations, and more specialised schemes, such as cardiac rehabilitation and falls prevention. This research has made a distinct and material contribution to the provision of CESs in the region by providing evidence to inform service planning and delivery, increase access to and engagement with services, improve health and influence professional standards, guidelines and training.
We improve Public Health and facilitate personal growth through promoting active lifestyles. We have provided an evidence-base of effective intervention approaches across settings, in `hard-to-engage' populations and through distinctive planning and delivery approaches. Our support for practitioners and commissioners has developed (i) ways to show the effectiveness of interventions to increase activity and (ii) programmes that achieve wider developmental aims. These effects are achieved by deploying innovative, often bespoke, realistic impact measures that improve programme effectiveness in locations, venues and groups where other groups do not go.
Professor Adrian Taylor and colleagues in Exeter Sport and Health Sciences (SHS) have conducted: (1) laboratory studies to identify the dose of exercise that is sufficient to acutely impact on affect, mood and smoking-related outcomes; (2) rigorous randomised controlled trials to evaluate chronic interventions to increase physical activity among depressed patients, and smokers wishing to reduce or quit; and (3) rigorous systematic reviews and meta-analyses to inform guidance for health care practitioners and policy makers. This work has significantly contributed to the evidence-base underpinning global health care policy guidelines (including those produced by the National Institute for Health and Care Excellence (NICE)), as well as raising global media interest, informing public debate and clinically supporting patients and practitioners on best practice. Commissioned reviews have also identified gaps in the evidence-base for the effects of physical activity on mental health and nicotine addiction which has led to the prioritisation of funding for further research to resolve uncertainty in clinical guidelines.
Lower Urinary Tract Symptoms (LUTS) in men is a chronic disease of ageing that causes significant quality of life impairment in one third of men over the age of 60. Traditional management comprises a step-up regimen of drugs and surgical interventions aimed at relieving symptoms. At UCL we conceived, developed, evaluated and implemented a self-management intervention that results in greater symptom reduction than that achieved by medication, reduction in the use of medication and of referrals to secondary care, and reduced costs. The intervention is now a global standard of care.
The impact of the research described, lies in its ability to identify the prevalence and clustering of unhealthy lifestyle behaviours in young adults, and describe the characteristics of the differing lifestyles. Unhealthy behaviours are primary causes of premature morbidity and mortality. Inactivity, smoking, alcohol use and poor diet are the four major behavioural contributors to chronic illnesses such as cancer, diabetes and cardiovascular disease. The findings have been used to highlight the powerful influence of these behaviours on health, and also to highlight the particular impact on health created by these behaviours interacting together. These timely findings will aid health professionals to develop appropriate health prevention programmes targeting young adults.
This case study describes the research pathway and impact of a behaviour change DVD designed to increase physical activity in sedentary individuals in deprived communities. Developed as part of a randomised controlled trial with the National Institute for Health Research's Health Technology Assessment programme (HTA), together with supporting research expertise, the DVD is now part of NHS/local authority commissioned standard care in Barnsley and has reached over 7,000 individuals and families. Service evaluation data confirm the DVD has significantly improved the cardiovascular risk profiles of users and contributed to a population level rise in physical activity in Barnsley.
Research into service user involvement in mental health care resulted in the development of an educational intervention for registered mental health nurses to deliver effective, ethically appropriate therapeutic interventions for highly distressed and disturbed patients.
The research outputs were taken up and implemented by Halikko hospital in Finland, leading to a significant change in policy and practice, including a substantial reduction in the use of coercive techniques. Following the success of this change, other psychiatric hospitals in Finland have adopted the system.
Research in the area of childhood obesity has focussed on the development, implementation and evaluation of interventions. The APPLES Study (1996-99), the first UK school-based RCT was key in contributing to the evidence-base through wide dissemination including 3 BMJ (2001) publications, cited in NICE (2006) and WHO guidance (2004). Collaborations with academics, practitioners and the RCPCH led to the development of further community-based obesity treatment and prevention interventions including WATCH IT; early programmes e.g. EMPOWER, HELP and HAPPY and more recently innovative school-based initiatives involving school gardening. There is evidence of results being disseminated and influencing research, practice and policy.
The Counterweight Programme (CW) is a structured model for obesity management in primary care settings. CW has made substantial changes to clinical and public health guidelines and to practice nationally and internationally: the Programme has since been adopted in Primary Care Galway, Ireland and for a government funded trial in Ontario, Canada. The creation of a spin out company, Counterweight Ltd, in 2011 resulted in concomitant job creation and significant commercial activity, with CW now being used in private healthcare, pharmacies, fitness clubs, and by freelance healthcare professionals. Moreover, the programme has significantly benefited the health and welfare of obese patients and improved care practice by increasing quality, accessibility and cost effectiveness of weight management services in the UK.