Back issue listing | Subject Index | Journal listing by subject | ImpAct Back issue listing

Exercising the way to better cardiac health

  • Why was the initiative launched?
  • What was done
  • Are people walking?
  • Tips for Success
  • Contacts - to find out more

  • Developing a systematic way of getting patients to exercise.


    Why was the initiative launched?


    After a busy day in the surgery in 1994, Dr William Bird, a GP in Sonning Common, went for a walk in the evening and began to ponder why his patients seemed to be unwilling to exercise. Few patients seemed to accept advice that exercise would be good for them: it could significantly reduce their risk of coronary heart disease. Walking on footpaths in the local woodland he noticed that he was alone. No one else was using the footpaths. He decided that he would look for ways to tackle the problem. How could he get his patients walking?

    What was done


    The practice decided that a structured approach, offering a detailed prescription about what patients should do, might be successful. Subsequent discussions led to the creation of a set of leaflets for a series of walks around Sonning Common. The leaflets provided instructions (such as turn left at Wood Lane) and notes about local history.

    The maps offered walks covering varying distances from one to four miles. They were designed using a pedometer (someone walked the course) and maps giving local contours. Accompanying notes indicate the energy that would be used for each walk and an indication of fitness in five categories ranging from very unfit to very fit. Advice from Loughborough University suggested the use of metabolic equivalents (METS) to assess the walks in terms of their difficulty. Sponsorship from local companies supported the preparation and printing of the leaflets. The first package of Health Walk s was launched in August 1995: the guides were sold for £10 for a set of eight walks.

    Despite the care which had been taken to design and grade the walks, they did not seem to be having an effect. While patients were buying the leaflets, few were seen walking! In October 1995 questionnaires were sent to a sample group of patients from the practice list to find out why patients were not walking: what were the blocks and barriers? The questionnaires prompted an encouraging response with over 70% (400) of the forms returned.

    Sonning Common: reported barriers to walking as exercise



    The replies to the questionnaire were discussed at a public meeting in the village hall in January 1996. About 200 people attended the meeting, a splendid turnout. The idea of health walks was supported and a group of local people agreed to help develop it further. The key points from the subsequent discussions were the need to teach people to walk (they seemed to have forgotten how!), for someone to organise the walks and for the programme to be graded to reflect patients' health and strength. The key to success might be to move from graded to guided walks.

    A local fitness instructor was recruited to organise the walks and recruit volunteers to act as guides. Local sponsorship supported the training for volunteers. This training included resuscitation training and ensured that they were aware of the health benefits of walking and understood the countryside code. A modified programme was launched in April 1996.

    Are people walking?


    Since the re-launch of Health Walks the programme has gone from strength to strength. The initiative is increasingly a community initiative with volunteers forming a management committee to take over the running of the programme. Currently, about 100 people are involved every week in one of a dozen walks . A new timetable is published every three months. Since April 1996, 12,000 walkers have taken part in guided walks: over 800 individuals. A project register is kept to show who is involved and allow progress to be monitored.

    Health Walks: the positive impact


    Health Walks: Reported health benefits



    The objective was to set up the programme as a health promotion scheme, not as a research project. Nevertheless arrangements were put in place to measure the impact of the project. The practice set up a number of surveys and fitness tests between May 1995 and August 1996. Oxford Brookes University was invited by the Countryside Agency to complete an independent evaluation to quantify the benefits of promoting health walks in the community.

    The evaluation found over three-quarters of the participants reported positive impacts of Health Walks and significant health benefits (see above). The surveys showed that taking part in fitness tests over time significantly increased the fitness levels of participants regardless of whether they took part in Health Walks. The evaluation provided useful information about setting up new walking schemes.

    The initiative has attracted much interest and the nearby Wokingham District Council launched a similar scheme covering its population of about 50,000 in October 1997. A full time co-ordinator is now in post there and is gradually creating a significant Health Walks programme. Funding from the Britsh Heart Foundation and the Countryside Agency has enabled this project to be set up as a randomised trial. This will ensure that the programme is rigorously evaluated. The first results of the trial are due to be published late in 1999.

    The initiative attracted the interest of the Countryside Agency from the outset. More recently, as a consequence of the success of Health Walks, the Agency and the British Heart Foundation have created a national initiative Walking the way to Health . The aim is to create 200 walking schemes in the UK over the next five years, and financial support for these schemes will be available. The Agency has published Practical Guidelines for developing Walking for Health schemes to help others develop local schemes.

    Tips for Success


    √ Involve the community from the beginning. Look for volunteers but recognise that it might take time to build their confidence to run the scheme.
    √ Plan how and when ‘ownership' will pass to the community.
    √ Be realistic about what volunteers can do. A project co-ordinator (full or part time and paid) may make the process go smoother.
    √ Listen to what people are saying and adapt your plan to respond to their concerns.
    √ Make use of free local resources like footpaths and local parks when planning exercise projects. You don't need expensive equipment.
    √ Remember that walking as physical exercise is important. Inactivity is as high a risk factor as smoking, high cholesterol, and high blood presure.
    √ Remember that walking is as effective as other forms of exercise when seeking to improve cardiac health.

    Contacts - to find out more


    For information about the initiative at Sonning Common.

    Dr William Bird
    Sonning Health Centre
    Wood Lane
    Sonning Common
    Reading RG4 9SW

    Telephone 01189 722188
    Email cwhbird@aol.com

    ♦ Copies of the Health Walks guides are available.

    For information about developing healthy walk schemes

    Peter Ashcroft
    Walking for Health Co-ordinator
    Countryside Agency
    John Dower House
    Crescent Place
    Cheltenham GL50 3RA

    Telephone 01242 521381
    Email peter.ashcroft@countryside.gov.uk

    Copies of Practical Guidelines for developing Walking for Health schemes are available.

     


    ImpAct bottom line

    Work with volunteers from the community to keep developments going, but be sure that the community supports the endeavour.

     

    previous story in this issue