In previous posts WorkoutWith has spelt out a role for Fitness Professionals in Public Health.

The referral of people under ‘GP Exercise Referral’ is well known although there are no reliable sources of information about how many GPs are referring patients nor the number of patients that have been referred and follow the referral program. A report by The Mental Health Foundation  offer some clues and based on their survey it is a single figure percentage of GPs that know about and believe that referring patients under “GP Exercise Referral’ is worthwhile.

This graph may explain a GP’s reluctance to refer?

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You can access the report from which this graph was pulled using a link at the bottom of the page.

So where next?

Social Prescribing – what is that?

Social prescribing is designed to support people with a wide range of social, emotional or practical needs, and many schemes are focussed on improving mental health and physical well-being. Those who could benefit from social prescribing schemes include people with mild or long-term mental health problems, vulnerable groups, people who are socially isolated, and those who frequently attend either primary or secondary health care.

Social prescribing connects all those exercise professionals that are qualified to support people in these groups – will it happen? Not of its own accord and it will require a coordination of resources and commitment involving many stakeholders to include: Politicians, NHS, CCGs, GPs, CIMSPA, REPS being far from a complete list.

A YES to Social Prescribing

There is a rising epidemic of people visiting their GP for sick notes. Report at The Daily Telegraph 1 September 2017.

The two top reasons for GPs issuing a sick note are:

1. Anxiety and stress – the blues and feeling depressed

2. Bad backs – so many people work in sedentary jobs with sit down commuting

Both these conditions can be addressed with exercise when that person is referred to a qualified exercise professional.

 Quoting from The Mental Health Foundation Report

It highlights the considerable costs associated with the writing of prescriptions for anti-depressants in England (£397.2 million in 2003) and identifies the following advantages:

• Exercise is cost-effective – compared to pharmacological and psychological interventions, even structured exercise programmes cost less over an equivalent time period.

• Exercise is available – all except those in very poor physical health can take some form of exercise which makes it a far more available option that many psychological treatments (highlighted by a variety of recent reports as being in short supply and subject to long waiting times on the NHS). • There are co-incidental benefits – unlike the unpleasant side effects that can accompany some antidepressant medications, physical activity is relatively low risk. In addition, exercise can be used to treat patients with a mix of physical and mental health problems – for example, it can lead to healthier muscles, bones and joints alongside promoting a sense of achievement and increased self-esteem arising through an improvement in physical appearance. (A lack of physical fitness may in itself be a contributing factor to a person’s mental health problems).

• Exercise is a sustainable recovery choice – exercise requires the active participation of the individual which can encourage and support people’s ability to make choices and which can be continued without ongoing professional supervision. This is in sharp contrast to some treatments which can reinforce the sense of being a ‘passive recipient’of care, which can reinforce one of the common characteristics of depression, that is, of feeling that one is unable, or has lost the ability to make choices.

• Exercise promotes social inclusion and is a ‘normalising’ experience – exercise is widely seen as something that is done by ‘healthy’people and as such, carries no stigma. Medication and/or psychotherapy on the other hand, are often disliked because of the stigma attached to such treatments. The fact that exercise can easily be undertaken alongside other people, and can provide an avenue for shared common interests, provides an important social dimension to the activity, which can help to counter the feelings of isolation so often experienced by people with depression and other mental health problems.

• Exercise is popular – although only few qualitative studies have been undertaken, people with depression are reported to cite exercise as being an important and positive part of their recovery programme. For example, in a survey of people who had experienced mental health difficulties by Mind in 2001, 50% reporting finding that exercise had helped them to recover.

A NO to Social Prescribing

Quoting from The Mental Health Foundation Report

The system prefers to dispense medication over exercise. There a myriad of reasons but is this in the best interest of the person and is it educating that person to think about the root cause of their afflictions and what ‘they’ can do to improve their situation?

Set against these generally positive findings however, the report also highlights some of the key findings from survey of two hundred GPs which goes some way to explaining why exercise is still not often thought of a ‘treatment of first choice’. These include:

• Pressure to act – to alleviate the distress a patient may be feeling, GPs can feel pressured into offering immediate relief in the form of medication (especially if this is requested by the patient).

• Time poverty – the survey results indicate that drug prescription rates increase with the numbers of patients on the GP’s list which may suggest that those GPs who are more time-pressured are also more likely to prescribe anti-depressants.

• Limited alternatives – difficulties accessing psychotherapy or counselling provision (which can also be expensive) can result in GPs opting for the immediately available option of prescribing anti-depressants. • Limited visibility of non-pharmacological and non-psychotherapeutic alternatives – in comparison to the well-publicised trials of antidepressants, which are largely funded by the pharmaceutical industry, much lower levels of funding have been available for research into the outcomes of alternatives such as exercise; the findings of the research that has been carried out also may not reach GPs and other healthcare decision-makers.

• Expediency – findings from the ‘Up and Running?’study suggested that doctors are aware of the strong placebo response an antidepressant may produce and that, given the limited availability of preferred alternatives, may prescribe antidepressants as an expedient in the hope of inducing such a response.

• The dominance of pharmacology – medication has been the favoured response in primary care for some considerable period of time, a response that has been reinforced by extensive powerful marketing by the pharmaceutical industry.

The Social Prescribing Pathway


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