The Importance of Regular Physical Activity for Health

Background

Exiting research has established a clear relationship between regular physical activity and good health. According to Naci & Loannidis (2013), regular physical activities have similar impacts on health as medical interventions, and have been considered an alternative to conventional drug interventions. Similar evidence has been highlighted by Department of Health (2011), who found that walking at a speed of at least 5 kilometres per hour allows an individual to expend energy and is an easier way of achieving the required physical activity levels. Apart from two studies, several systematic reviews have highlighted the health benefits of physical activity, including its benefits on fatness, fitness, required blood pressure levels, depression, cardiovascular disease risk reduction and weight loss (Murphy et al 2007, Richardson et al 2008, Robertson et al 2012, & Hamer & Chida 2008). In the UK, the government, through the Change4life (NHS choices, 2013), has made several efforts in campaigning for increased physical activity and change of lifestyle, but with insignificant success. In an earlier study by SportEngland (2013), results revealed that 29% of adults perform less than 30 minute-moderate physical activity in a week while at least 8% of do not engage in a continuous walk for at least 5 minutes in four weeks (Farrell et al, 2013). These results indicate that the activities meant to increase uptake of physical activity among adult patients may not yield the desired results, and that delivering just simple advice on the importance of engaging in physical activity may only lead to moderate and short-term effects. Thus, improving the uptake of physical activity as a remedy to good health requires an elaborate and well-implemented service improvement plan that can be evaluated afterwards.

One of the most effective ways of promoting physical activity through walking behaviours is developing walking groups (Lamb et al, 2012). According to Kwak et al (2006), walking groups are physical activities involving short walks of less than one hour participated by trained laypeople. A typical example is the ‘Walking for Health’ initiative developed and implemented in 2000 by an Oxford-based practitioner. According to Macmillan Ramblers (2013), the Walking for Health initiative is one of the largest walking group initiatives in England with at least 70,000 walkers, 3000 short walks, and 10000 volunteer walk leaders. The initiative has largely proven that group walk is an effective physical activity intervention with a potential of attracting and engaging people who have an interest in outdoor physical activities both for leisure and as a health intervention (Gusi et al, 2008). Furthermore, according to Gusi et al (2008), walking groups have proven to be more cost-effective compared to other physical activities that may require gym subscription or acquisition of personal physical trainers.

Project Rationale

A significant impact of walking groups is that they involve social dynamics and enhance social cohesion, making it easier for participants to encourage each other and develop a positive attitude towards physical activity (Kwak et al, 2006). In the process, the participants develop a sense of companionship and a common experience of wellness. Nonetheless, Ogilvie et al (2007) conducted a systematic review study and concluded that to encourage more people into joining walking groups; the intervention must be tailored to their needs, with much focus given to those motivated to change. This implies that developing effective and well-received walking groups require more social support in terms of knowledge of physical health and resources needed for participants to effectively participate. The target population must be aware of the health benefits of walking groups intervention before the can be convinced to join it. Besides, the target population will require an attitude change to accept being part of the intervention. Therefore, the main aim of this project is to introduce an educational intervention aimed at improving awareness and uptake of walking groups as an effective health and wellness intervention that can be used as a substitute for medical interventions.

Project Aim

A project to improve awareness and uptake of outdoor community walking group intervention

Project Objective

To educate people with mental health issues on the importance of walking groups to their mental health

Methodology

The purpose of this quality improvement project is to develop an educational initiative aimed at creating awareness among mental health carers and patients on the importance of adopting walking groups as an alternative health intervention. This section will give a detailed account of the design and approach chosen for the project, as well as the tools and techniques to be applied. In this section, we will also highlight how each design and technique of the project can help improve the uptake of walking groups among patients and their caregivers in the selected a selected (X).

The Plan-Do-Study-Act Framework

To develop this educational initiative, the researcher will use the Plan-Do-Study-Act framework (IHI, 2010). The project team will operate based on systems and organizational leadership frameworks as they engage in all the activities and processes involved in the project. As illustrated below, the project will be based on the PDSA cycle.

Plan

The author assumed the project leadership position, including all the responsibilities of the project. The project leader used various leadership strategies and techniques of interpersonal relationships to guide the organization into the change. Therefore, the project began by assembling the team, consisting of the project author, the chief Executive officer of X, and three mental health care nurses.

The planning step also involved the development of the project milestones, the respective timelines for achieving each milestone, and the methods used in evaluating the project’s success. This section also involved an analysis of existing literature or evidence-based research on walking groups as presented herein. Upon reviewing the evidence on walking groups, an educational curriculum, as well as a training protocol, was developed. Furthermore, the researcher approached the facility’s manager to include group walking as part of the organization’s training policy before validating both the training content and the training protocol. As will be discussed later in this write-up, the walking group educational project was implemented using the Lewin’s change model. On the other hand, the researcher developed a plan for evaluating the project using the logic model, which will also be discussed later in this write-up.

Do

This was the second step of the project initiation process. It involved designing the project by the project team with the guidance of the project leader. Apart from leading the project team, the project leader also performed the directing role especially during the project evaluation process which was on going during the project development. The project development process was captured in the meeting minutes during the project meeting sessions which also entailed a presentation of and analysis of working group literature. More importantly, the literature analysis was a key pillar in the development and design of the educational initiative.

Study

This step mainly involved an assessment of possible risks that might affect the development and implementation of the project using the Force Field Analysis. Besides, the step involved an outcome evaluation, whereby the team members identified the possible or expected outcomes of the project.

Act

This was the last step in the PDSA cycle, and involved reviewing the staffs’ performance, as well as the general outcome of the project implementation (Kettner et al 2013).

Project Teamwork

During the implementation of the entire PDSA framework cycle, the researcher observed and maintained interdisciplinary teamwork, which entailed a group of people working together to achieve the same gal-improving the uptake of walking group intervention among mental health patients. With this regard, Kelly (2013) asserts that an effective team can be achieved by carefully and meticulously selecting the team members. Therefore, the project team members were carefully chosen based on their skills and experiences in mental healthcare, including their ability to identify the need for change within a mental healthcare setting as well as their ability to provide safe patient-centred care.

As the project leader, I applied various leadership skills and techniques to coordinate the project team. For instance, as recommended by Porter et al (2003), I used my backup skills by anticipating possible needs of the team and taking care of those needs, as well as balancing their workload to avoid burnout. I also maintained an adaptable relationship with the team members by adjusting the resources and my behaviours based on the feedback received from team members.

An important aspect of team leadership is the ability to conduct focused and effective team meetings. According to O’Dea et al (2006), meetings are a platform to develop outcome-driven collaboration between the team members. Through face to face interactions, team members can think and present different points and perspectives of how the project can be implemented better. But, meetings can only be successful if there is proper planning, coordinating and conduction of the meetings. Therefore, as the project leader, I ensured prior agenda development for each meeting and reached out to every member before the meetings to involve them in developing the agenda meetings.

The Implementation Plan

The project implementation followed an elaborate theoretical background that could enable the achievement of the educational intervention goals and objectives. Besides, as recommended by Hodges & Videto (2011) the theoretical background of the study enabled an understanding of the complex interventions that had to be implemented to achieve the project goal. Fundamentally, the educational program was implemented based on the Kurt Lewin’s model of change, which, when successfully implemented would enhance the participants’ understanding and uptake of the walking group intervention (Hodges & Videto 2011). Furthermore, we assumed that pegging the project on Kurt Lewin theory of change would help in providing a proper guide to the participants on the introduction, implementation and maintenance of walking group intervention.

However, implementing a staff training protocol in X required the input of all service departments. With this regard, according to White & Dudley-Brown (2012), the Lewin’s force field analysis assumes that change can be achieved by maintaining equilibrium between the dividing forces and restraining forces. White & Dudley-Brown (2012) used Lewin’s theory to study how people change their attitudes and mindset to lose weight. Therefore, to achieve the objectives of the current project, Lewin’s theory was useful in understanding the effect of education and training on a change practice within X.

While writing an article on self-determination theory, Deci & Ryan (2012) asserted that autonomy can effectively be used to boost patients’ ability to adopt a new practices such as smoking cessation. The understanding and use of walking groups will enhance the patient’s mental health status by teaching self-determination and commitment to the groups, thereby allowing the patients to adopt self-care. Furthermore, we assumed that exposing patients to the change early enough in their mental illness status will contribute to a smooth changing process.

According to White & Dudley-Brown (2012), people are more likely to resist change when they are not allowed to take part in bringing the change despite being affected by the change. Therefore, as will be described below, Lewin’s theory consisted of three major stages, namely unfreezing, changing and Freezing.

Unfreezing

In this stage, all the stakeholders were engaged and participated in a team that represented the target audience. The researcher then used force field analysis to identify the restraining forces that could affect the project implementation process. Observably, the restraining forces consisted of nurses’ workload, organization X’s culture, and lack of extra time for leaders to participate in the training. Therefore, we observed a need for updated policies that support nurses and leadership to sustain walking groups as a treatment intervention for mental health patients. Doing this would enhance the uptake of the project.

The Change

This stage involved maintaining a balance between factors that keep X from moving forward to implement walking group intervention and the resources needed to implement the intervention. This balance could be achieved by redistribution of nurses’ workload to allow their participation in the project, giving the project a financial recognition, and conducting a periodic follow up on staffs.

Refreezing

After delivering the training on walking group intervention, nurses and caregivers will understand the importance of the change and communicate the same to other stakeholders. As recommended by White & Dudley-Brown (2012) the management should develop a measurement system as well as an on-going monitoring mechanism that keeps the intervention effective.

The walking group education project, after a successful implementation, will enhance the health and well-being of participants by improving their understanding and uptake of the intervention. To identify and analyse the results of the project, the researcher relied on the logic model of evaluation, which could show how the curriculum was effective (Hodges & Videto 2011). The logic model identifies the activities within the implementation process and outlines the relationship between them. Besides, as described by Hayes et al (2011), the logic model is a framework that evaluates the relationship between activities, resources, and the results with regards to a particular project objective. The logic model was particularly chosen for this project because it would assist in developing assumptions regarding the training curriculum. The following table illustrates the application of the logic model to the project results analysis:

Discussion

After the implementation of the training, all members of X should have a better understanding and uptake of walking group intervention as an alternative treatment for mental health issues. An improved understanding of the intervention will lead to increased physical activity among mental health patients, and this will ultimately enhance their well-being.

The effectiveness of walking group intervention to mental health has been proven by various pieces of research evidence. For instance, a systematic literature review by Hanson & Jones (2015) found that walking group interventions have specific health benefits attributable to individuals engaging in outdoor walking among adults, including those with mental health issues such as stress, anxiety and depression. Thus, the project is likely to realise positive effects on the health and well-being of mental health patients by creating awareness about the walking group intervention.

While there are several implications of this project to the practice of mental healthcare, a significant one is that developing an education initiative on walking group intervention within a mental healthcare organization can stimulate the understanding and uptake of the intervention, thus improving the health and well-being of patients. These implications affect policy because they inform the development and inclusion of such innovating treatment interventions to be part of hospital programs. However, implementing such a project would have serious financial and time implications, thus limiting its applicability.

In conclusion, developing innovative interventions without creating an understanding among the target population about the intervention makes it difficult to achieve the impact for which the intervention is created. However, with effective training and education, it is highly likely that the target population will participate in the intervention, especially after understanding its rationale. Nonetheless, further research is required on the walking group intervention, particularly with regards to its costs and benefits.

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