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Select Committee on Health Minutes of Evidence



MEMORANDUM BY BOB LAVENTURE, ASSOCIATE CONSULTANT TO THE BRITISH HEART FOUNDATION NATIONAL CENTRE FOR PHYSICAL ACTIVITY AND HEALTH (PH 96)

THE POTENTIAL OF PHYSICAL ACTIVITY TO IMPROVE THE HEALTH OF OLDER PEOPLE

CONTENTS

  Executive summary

  1.  Older People and Physical Activity—the Potential;

  2.  Recent developments;

  3.  The role of the British Heart Foundation National Centre;

  4.  Increasing levels of physical activity among older people—Policies and action required

  Appendices.

    "The greatest risk for older adults is sedentary living." (World Health Organisation 1997)

EXECUTIVE SUMMARY

  Physical activity provides a substantial number of benefits for the older person. Its importance as a public health issue is highlighted by increasing evidence of effectiveness in meeting those health needs and by the increasing numbers of older people in the population.

  Whilst the evidence relating to disease prevention is well recognised there is increasing evidence relating to the important role of physical activity in:

    —  The improvement of functional capacity and the maintenance of independent living;

    —  Improvements in psycho-social health benefits leading to an improved quality of life and the inclusion of older people in society.

  A range of policies are consistent in their references to the need for older people to retain a level of functional capacity and independence to enable them to remain in their own homes, retaining the capacity to undertake activities of daily living and maintain their social networks. This is an important aspiration and need expressed by older people themselves.

  There is very limited evidence of national or local programmes designed to:

    —  meet the physical activity and health related needs of healthy but sedentary older people;

    —  offer recreational and active leisure choices in the community;

    —  provide appropriate programmes in care settings for frailer, older people.

  Low levels of physical activity among older people may be attributed to the lack of provision and opportunity as a result of:

    —  A lack of professional education and training;

    —  An absence of sport, recreation and exercise policy;

    —  An imbalance of resources and investment—which to-date has excluded older people from national and local opportunities to choose to be involved in a wide range of physical activities.

  Recommendations are included to highlight actions required to ensure that in the future, older people enjoy equality of opportunity and are able to make informed choices to participate in safe, effective and enjoyable opportunities for physical activity. They highlight the need for:

    —  National leadership;

    —  Advocacy;

    —  Support for professionals;

    —  Support for local activity;

    —  Developing the skills of front line workers.

1.  OLDER PEOPLE AND PHYSICAL ACTIVITYTHE POTENTIAL

1.1  The Benefits of Physical Activity for Older People.

  There is mounting evidence of the importance of physical activity for the older person. The World Health Organisation (1), the American College of Sports Medicine (2) and the Report of the US Surgeon General (3) have identified the range of benefits of participation in regular physical activity for older people. These are summarised as:

    —  The physiological benefits;

    —  The psychological benefits;

    —  The social benefits;

  Other classifications Young and Dinan (4) summarise these benefits as

    —  The prevention of disease;

    —  The prevention of disability;

    —  The prevention of immobility;

    —  The prevention of isolation.

  "A regular programme of moderate exercise is a very appropriate recommendation for almost all older adults. Moreover, there is no known pharmacological remedy that can so safely and effectively reduce a person's biological age and enhance his or her quality-adjusted life expectancy."

  Shephard, R 1997 (5).

1.2  Levels of Participation

  There is substantial evidence relating to the decline in levels of physical activity, exercise, fitness and functional capacity among older people.

Levels of Physical Activity

  In the 45-54 age group, only 39 per cent of men and 35 per cent of women participate in enough physical activity to benefit their health.—By the age of 74, this figure has declined to 14 per cent for both men and women. (6)

  Participation in at least 30 minutes of moderate intensity physical activity on at least five days of the week.

  Sedentary behaviour—increases with age. Although 40 per cent of men and women aged 50 and over are sedentary, the overall figures conceal an important difference. There is a marked age effect among women. The proportion of women judged to be sedentary increases steadily with increasing age, doubling between those aged 50-54 (28 per cent) and those aged 80+ (65 per cent). (6)

  Participation in less than 30 minutes of moderate intensity physical activity less than once a week.

  (These figures include involvement in "heavy" housework, gardening and DIY, walking and stair use as well as sports and exercise activities.)

Sports and Exercise Activities

  Participation in sports and exercise activities do not play a large part in the overall activity levels of people aged 50+ despite the fact that many of these people have considerably more leisure time than the general population.(6)

Fitness and Functional Capacity

  Functional capacity declines with age. This loss of function is exponential and will eventually cross a threshold level beyond which a person cannot maintain an independent life. (6) for some older people, rising from a chair is difficult and getting up off the floor is impossible.(6)

Inequalities in Participation.

  Inequalitites relating to participation on physical activity have been identified by Cooper et al (7).

1.3  Evidence of effectiveness

Physical activity and exercise interventions

  A recent critical review of physical activity interventions targeting older adults by King et al (8), reported the possibility of higher physical activity participation rates in older adult samples relative to younger samples. This included frequency of participation as well as the duration of the intervention. Several studies reported satisfactory longer-term class or group participation rates extending up to three years in at least one case. Both group/class based activities as well as home based activity were found to be effective.

Functional decline

  Skelton and McLaughlin (9) have reviewed a number of research studies which indicate the ways in which appropriate, specific, tailored and progressive exercise interventions can demonstrate significant improvements in functional capacity in a relatively short space of time. These studies also include improvements in many of the risk factors for accidental falls eg 8-26 weeks in the case of strength, static and dynamic balance, power, endurance, transfer and postural hypotension.

  Older people are just as likely to change their physical activity related behaviour as young people and it is possible to reverse age-and activity-related decline relatively quickly. For example, among people over 75 years, 15 years of rejuvenation of muscle strength (27 per cent) can be regained in six months through strength training with one supervised class a week and some home exercises. (9)

Falls and accidents among older people

  A number of studies indicate the effectiveness of exercise as an effective intervention in both stand-alone including Skelton (in press 10), Campbell et al (11), FICSIT (12) and as part of a combined intervention by Tinneti et al (12), Queen Mary and Westfield College (13) and Wagner et al (14) to prevent accidental falls and accidents among older people.

The cost of hip fractures

  Using Department of Health benchmark figures Dolan and Togerson (15) estimated the costs of hip, wrist and vertebral fractures sustained as a result of a fall, to be in excess of £940 million per annum. This figure includes acute care, social care and long-stay hospital costs as well as primary health care and follow-up costs.

1.4  Ageing and demographic trends

  The UK population is gradually becoming older, with the number of children aged under 14 projected to fall by around three-quarters of a million (9 per cent), between 1996 and 2021 and the number of people aged 65 and over projected to increase by over 2 million (30 per cent) between 1996 and 2021. (16)

  A more comprehensive review of the evidence relating physical activity and the health of older people is included as appendix 2.

RESEARCH EVIDENCE—SUMMARY

  Physical activity provides a substantial number of benefits for the older person. Its importance as a public health issue is highlighted by increasing evidence of effectiveness in meeting those health needs and by the increasing numbers of older people in the population.

  Whilst the evidence relating to disease prevention is well recognised there is increasing evidence relating to the important role of physical activity in:

    —  The improvement of functional capacity and the maintenance of independent living.

    —  Improvements in psycho-social health benefits leading to an improved quality of life and the inclusion of older people in society.

  This has important implications for current and future policy in the social and caring services.

2.  RECENT DEVELOPMENTS

2.1  Policy Direction

  In addition to the focus upon CHD, mental health, cancers and accidents in Government Health Strategy through "Saving Lives—Our Healthier Nation (1999), other policy frameworks indicate the importance of complimenting disease prevention policies with those which stress the need to maintain independent living and mobility in later life eg

    —  Modernising Health and Social Services: National Priorities Guidance 1999-2000—2001-02 (17)

    —  Better Services for Vulnerable People (18)

    —  Better Government for Older People (19)

    —  Reducing Health Inequalities, Acheson (20)

  This important policy direction and implications for health and social care was also addressed in 1999, the International Year of the Older Person, through the "Debate of the Age" led by Age Concern England (21) which led amongst others, to the following recommendations:

    —  The compression of morbidity as an explicit health objective

    —  Reducing chronic illness and disability should be a central and explicit objective of health policy

    —  The targets for saving lives should be matched by strategies for reducing ill health and morbidity—

  Similarly through the publication of "With Respect to Old Age—a Report by the Royal Commission on Long Term Care (22*) and "Fit for the Future, the Prevention of Dependency in Later Life." (23)

  These and other policies are consistent in their references to the need for older people to be able to retain sufficient functional capacity and independence to remain in their own homes thus retaining the capacity to undertake activities of daily living and maintain social networks. The balance between disease prevention and quality of life is an important need expressed by older people themselves.

2.2  Health Promotion in Practice

National Campaign

  In 1997, the former Health Education Authority included work with older people 50+ within the ACTIVE for LIFE National Campaign to promote physical activity. In addition to the public communications and media components, work included a programme of underpinning research, professional advocacy and support for a range of health and other professionals, including a conference and seminar programme, guidance materials, publications and a professional support network. This remains the only example of a national programme relating to the promotion of physical activity and the health of older people.

Local Programmes and Partnerships

  There is no national intelligence or understanding of the extent to which local programmes are addressing the physical activity and health related needs of older people through health promotion or local authority leisure and recreation provision.

  Of the current programme of 26 Health Action Zones (24) only four have evidenced specific work in this area. A similar low figure was reported within the Cabinet Office Initiative "Better Government for Older People". Although the Hackney Senior's Health and Active Retirement Project is one example, there is also limited evidence of these needs being addressed through the Healthy Living Centre programme.

  Through the Ageing Well programme of Age Concern England a small number of health-related, physical activity, exercise and recreation programmes have been developed. These vary in nature and are based upon local needs. There has been no published evaluation of the impact of these programmes.

  A recent report from the Health Development Agency (25) examining the first year of Health Improvement Programmes gives no indication as to the inclusion of physical activity and older people in local health strategies.

Falls and Accidents

  Recent Department of Health commissioned work has included the development of evidence-based guidance on policy and education and training programmes relating to the role of physical activity in the prevention of falls among older people. A national programme of dissemination has recently been disseminated and a three level education and training programmes for exercise and health professionals is being implemented. (26)

2.3  Primary Health Care

  Much attention has been focussed upon the role of primary health care and in particular the development of a significant number of exercise referral schemes. Based upon the work of Riddoch et al (27), the Department of Health has commissioned the development of a Quality Assurance Framework for Exercise Referral Schemes (28). Evidence suggests that although these schemes remain a popular form of physical activity intervention.

    —  few involve older people as a specific population target group;

    —  few target healthy but sedentary people;

    —  many adopt a "treatment" perspective rather than a "prevention" perspective (as evidenced by the many schemes that target people with CHD risk factor);

    —  primary care does not have the resources and is not an appropriate setting for such a "population" strategy.

  There is some evidence that Primary Health Care professionals including General Practitioners are unwilling to recommend physical activity programmes to older people which may relate to concerns over appropriate provision and safety considerations.

2.4  Leisure, Recreation and Sports Development

  Sport England, the Government Sports Development Agency and the distributor of National Lottery Funding has no current policy, strategy or development programme relating to the needs of people over the age of 50 years.

  In the last 10 years, there has been a welcome and significant investment in Sports Development Officers, a valuable resource within the individual Governing bodies of Sport and local authority leisure, recreation and sports development departments. However, whilst some of these resources have addressed inequalities in sports participation among ethnic minority communities, disabled people and women, there has been no such investment in relation to older people.

  Through an ongoing programme of development and assistance through National Lottery Funding, Sport England, in collaboration with the Youth Sport Trust, has a national infrastructure of developmental programmes that target young people. Whilst a similar mechanism would not be appropriate for older people, national and local support in the form of accessible, evidence based and high quality programmes and resources is lacking. Some National Governing Bodies of Sport do make provision for continued participation but largely as a result of "Veteran" competition programmes eg the ASA Masters Swimming programme.

  There is a similar imbalance in dance related arts provision.

  With the exception of newly commissioned work relating to falls and accident prevention referenced above, few local authorities and health authorities have invested specific human resources in this area. There is a small number of partnership developments posts supported by Age Concern England.

  Whilst the potential impact of demographic change upon services is recognised, not all changes have a negative "cost of care" implication. The new generation of "baby boomers" have experienced some of the opportunities that have materialised from the "Sport for All" policies of the 1980's and the expansion in the commercial exercise and fitness industry and may have different expectations of their middle and later years.

  The private sector exercise and fitness industry has recognised the potential for growth among the "mature" market with a number of international providers eg the Keizer Foundation, Powerjob, Nordik Track. Consequently are actively promoting new forms of services and programmes for the older person through niche marketing and special provision.

2.5  Training and Education

Sports and Exercise Sciences

  The British Association of Sport and Exercise Sciences (BASES) membership includes all UK University and Institutes of Higher Education departments for leisure and recreation, sport and exercises and health sciences. BASES has recently undertaken a review of physical activity, exercise and sports relating to older people. The review included curriculum development in first and second level degree courses, research activity and support for local community interventions and included biological and social science applications.

  The findings of the report (29) indicate

    —  Only 31 per cent of institutions contacted (n = 26) were at least partly concerned with older adults, thus only 30 per cent of undergraduate students were studying for an award that has a partial focus on older people. At post-graduate level about 66 per cent of students were studying for an award that had at least a partial focus upon older people.

    —  Only 8 per cent of final year under-graduate research projects involved older people with this figure rising to 18 per cent among post-graduate research. Only 14 of the 83 institutions referred to specific research projects undertaken by staff. This figure is reflected in the low level (4 per cent) of papers presented to the BASES annual conference.

    —  Only 12 per cent of institutions reported any extra-curricular activity relating to developing links and support for local community interventions involving older people.

  These low figures indicate a marked lack of related education and training among future sports, exercise and health science professionals.

Physical Education and Teacher Training

  Professional education and training for the physical education profession is predominantly concerned with the implementations of the National Curriculum for Physical Education, GCSE and A level physical education and more recently, support for sport in schools through external funding from Sport England and the Youth Sport Trust. There is no physical education or teacher training provision or support for anyone working with people over the age of 18.

Training for Exercise, Fitness and Health Professionals

  A UK survey of professional education and training programmes for the exercise and fitness industry undertaken by the Health Education Authority and Exercise England (30) reported significant differences in curriculum development, standards and assessment methods that relate to older people and special populations. This is to some extent the result of piecemeal development brought about by competition within the private sector and an absence of guidelines or framework to assist nationally and locally developed training programmes. This situation is mirrored in the health and care sectors where a small number of local schemes have been developed without any reference to evidence, national guidelines or quality standards. Many of these schemes do not relate to the NVQ Frameworks in Health and Social Care.

  Although not specifically relating to the needs of older people, recent Department of Health initiatives (eg the Quality Assurance Framework, for Exercise Referral Schemes and the National Fitness Register) are eagerly awaited as a means of providing national standards in exercise and fitness training.

Training and Education for the Older Person

  In collaboration with Age Concern England, the British Heart Foundational Health Centre for Physical Activity and Health is currently developing a Senior Peer Mentor Activity Motivator programme to involve older people in physical activity training opportunities. The Northumberland Health Action Zone and Wealden District Council in East Sussex have developed innovative approaches to the training of older people to become leaders, organisers and teachers of recreation and fitness programmes.

CURRENT PRACTICE—SUMMARY

  Current health and care policies are consistent in identifying the need for older people to be able to retain sufficient functional capacity and independence to remain in their own homes, retain the capacity to undertake activities of daily living and maintain their social networks. For those in different care settings, independence and mobility remain important components of an enhanced quality of life. The balance between disease prevention and quality of life is an important need expressed by older people themselves.

  There is very limited evidence of national or local programmes designed to:

    —  meet the physical activity and health related needs of healthy but sedentary older people

    —  offer recreational and active leisure choices in the community

    —  provide appropriate programmes in care settings for frailer, older people;

  There is more evidence of physical activity opportunities in residential and care settings;

  Low levels of physical activity among older people may be attributed to the lack of provision and opportunity as a result of

    —  A lack of professional education and training;

    —  An absence of sport, recreation and exercise policy;

    —  An imbalance of resources and investment.

  which to-date have excluded older people from national and local opportunities to choose to be involved in a wide range of physical activities.

3.  THE ROLE OF THE BRITISH HEART FOUNDATION NATIONAL CENTRE FOR PHYSICAL ACTIVITY AND HEALTH AT LOUGHBOROUGH UNIVERSITY

  The British Heart Foundation National Centre for Physical Activity and Health is committed to long-term developmental activity in the area of physical activity and older people through:

    —  partnership development with a range of national and local agencies;

    —  accessible programmes and activities for older people;

    —  the provision of guidance, support and information to professionals.

3.1  Partnerships

  The National Centre is currently developing partnership working with:

    —  Age Concern England, and Ageing Well

    —  Anchor Trust

    —  British Association of Sport and Exercise Sciences

    —  Health Development Agency

    —  Pentland Healthcare

    —  The Beth Johnstone Foundation

    —  The Institute of Leisure Amenity Management

    —  International Society for Ageing and Physical Activity

3.2  Outline of Programmes

THE ACTIVE FOR LATER LIFE RESOURCE

  The BHF National Centre is currently undertaking work based upon the development of the Active for Later Life Resource, a professional toolkit designed to provide advocacy guidance and outline programmes for service managers and providers. The resource will include a framework designed to stimulate:

    —  Activity choices in the local community

    —  Home base activity programmes

    —  Programmes relevant to a range of older people settings, including the home, day centres and residential and care.

  And will include a Senior Games and Activities Pack.

  The Active for Later Life resource will be available from Autumn 2000 onwards and will be supported through a national training and professional education.

THE DEVELOPMENT OF THE SENIOR PEER ACTIVITY MOTIVATOR PROGRAMME

  Working in partnership with Age Concern England and the Ageing Well programme, the programme comprises training in health behaviour change, communication, using a posture check and chair games and activities to be delivered by older people Senior Peer Mentors with older people.

  The course aims to provide senior peer mentors with the skills necessary to:-

    —  Promote the benefits of regular physical activity

    —  Where appropriate, promote participation in physical activity eg attendance at a seniors (or an exercise for the older person) exercise session or a local walking group

    —  Increase daily activity levels and opportunities to socialise with inactive older people.

  Additional planning includes a number of opportunities to build on Senior Peer mentoring skills whereby Senior Peer Activity Motivators may make a decision to undertake additional training and education to become activity leaders. Leadership and teaching skills will be developed in a number of areas providing access to a range of skills, experiences and qualifications eg through the Central Council for Physical recreation and British Sports Trust Community Sports Leadership Award Scheme, Walk leadership and exercise class leadership.

CURRICULUM DEVELOPMENT IN HIGHER EDUCATION

  Continued work with the British Association of Sport and Exercise Sciences to: further develop

    —  opportunities for curriculum development relating to physical activity and ageing.

    —  BASES own development activity via the BASES continuing professional education scheme—A series of events and seminars.

    —  The continuing professional training of:

      —  Sports development officers and sports coaches, including work with the governing bodies of sport.

      —  The leisure and recreation industry

      —  Exercise and health science professionals.

THE 2003 INTERNATIONAL SOCIETY FOR AGEING AND PHYSICAL ACTIVITY (ISAPA) WORLD CONGRESS ON PHYSICAL ACTIVITY AND AGEING

  In August 2003 the BHF National Centre will host the ISAPA World Congress on Physical Activity and Successful Ageing including a World Summit on interventions. The major international health conference relating to physical activity and the needs of older people, the Congress will target a national and international audience comprising:

The exercise and fitness industry, Academic institutes and higher education, health professionals, including health promotion, General Practitioners, Primary Health Care, physiotherapists and occupational therapists, those that work in residential and care settings. The leisure and recreation industry and national and international age related organisations.

4.  INCREASING LEVELS OF PHYSICAL ACTIVITY AMONG OLDER PEOPLE

  As a result of the first three sections of this evidence, the following areas are highlighted for action together with constructive recommendations. These recommendations are designed to ensure that in the future, older people enjoy equality of opportunity and are able to make informed choices to participate in safe, effective and enjoyable opportunities for physical activity.

  These opportunities will contribute greatly towards improving the quality of life of older people, maintaining their independence and assist in the inclusion of older people in the life of the community.

  As a result, there will be a decrease in the demands made upon public health, social and caring services. The recommendations also recognise the need for the provision of quality standards of service delivery exemplified by the impending National Service Framework for Older People and other similar other quality standards of care and service delivery.

  The proposals are based on the following areas of complimentary activity.

    —  National leadership

    —  Advocacy

    —  Support for professionals

    —  Support for local activity

    —  Developing the skills of front line workers

4.1  National Leadership and Development

DEVELOP A NATIONAL BLUEPRINT

  Given the range of sectors, interested bodies, agencies and different providers with the potential to be involved in promoting physical activity with older people, there is a need for a blueprint which outlines a national framework or plan of action for the promotion of physical activity with older people.

  Such a framework would provide a collective direction for current and future development as serve as a planning tool for policy makers and programme designers. The framework would outline guiding principles and priority areas for action and provide support for organisations, agencies and individuals in planning for and addressing the physical activity needs of older people.

PROVIDE LEADERSHIP

  A number of agencies and organisations have an important role to play, but there is currently no identifiable lead agency or organisation in a position to take this work forward. Without clear leadership and direction, future development will continue to be piecemeal and uncoordinated.

FACILITATE COLLABORATION AND PARTNERSHIP

  Clearly no single agency has the sole responsibility for this work. There is a need to ensure that local collaboration, partnerships and alliances (exemplified by the Local Health Improvement Programme) are reflected by complimentary national alliances between government departments and non-governmental organisations, age-related agencies, health organisations and the physical activity community.

  The Cabinet Office Initiative "Better Government for Older people" has demonstrated the potential for "joined up" thinking when applied to national and local government.

DEVELOP A STRATEGIC APPROACH

  There are a number of initiatives being carried out, but there is a lack of co-ordination, with a resultant loss of health focus. There is a need to bring together many of these initiatives and ensure that they are aimed at maximising the benefits to public health. This implies a "joined up" strategy involving all the appropriate government departments and key players.

4.2  Advocacy

INCREASE AWARENESS AND PROFILE

  Although there is ample evidence relating to the health benefits of physical activity for the older person, this area has received little attention and should be given a higher priority and status.

  There is a need to raise the profile of physical activity for older people across all sectors including government departments, non-governmental organisations, and the broad range of national and local providers and agencies. This is required to ensure the inclusion of the promotion of physical activity with older people within the Local Health Improvement Programmes in addition to other local programmes and initiatives.

PROMOTING INDEPENDENCE

  Whilst the role of physical activity in the prevention of and management of disease is well established, its value in maintaining independent living and an improved quality of life among older people has not received sufficient recognition in public health policy.

EDUCATING OLDER PEOPLE

  There is a need for education and promotion of the health benefits of physical activity to enable older people to experience, value and make informed choices and increase their participation.

  Older people should be encouraged to advocate for the right to a quality of life that includes access to physical activity opportunities and choices.

4.3  Support for Professionals

  A significant number of professionals at a local level have the potential to play a part in the promotion of physical activity among older people. Work to support professionals should include:

Guidance

  The provision of clear and practical evidence-based guidance on how to develop local strategies for physical activity as set out in the National Service Framework for CHD.

Networks

  Develop a network of physical activity/leisure co-ordinators with the responsibility for ensuring that older people are included in all local physical activity development. These co-ordinators would facilitate links between all agencies at a local level.

Co-ordination

  The identification of one organisation (or an alliance of organisations) to maintain and support physical activity networks for older people. This is essential for sustainable action at a local level. This would ensure some degree of co-ordination of local activity and ensure compatibility with government policy.

  The functions for such an organisation would include:-

    —  Advice on local policy and strategy

    —  Information, evidence and data, sharing good practice

    —  The building of local exercise alliances and partnerships

    —  Co-ordination of local activity

    —  Develop an alliance for physical activity

  NB These suggestions would be replicated by any other approach to promoting physical activity eg with young people.

4.4  Support for Local Activity

  Community level programmes have the potential to increase participation in physical activity among older people across a range of settings. Stimulating community level action can help to improve environmental and social conditions for older people as well as increase physical activity participation. Such action needs to meet the needs of an increasingly diverse older population.

  Work needs to be undertaken in a number of areas eg:

Inclusion

  Ensuring the inclusion of physical activity programmes for older people within other local strategic development eg The Healthy Communities Collaborative, Sport England's Active Communities programme, the "Homezone" initiative, Safe and Sound.

Collaborative action

  Collaboration between Government departments eg DOH, DCMS, DETR on a funding programme for locally led projects that would aim to tackle the social exclusion of older people. These projects would strengthen links between health, education, leisure and the caring and social services and based on learning from current practice including Health Action Zones and fulfil a number of broader social objectives as well as promoting physical activity.

  Establish a programme of development that secures the promotion of physical activity for older people within:

    (a)  Primary Health Care Groups and Trusts

    (b)  Social, caring and residential services and the merging of health and social care responsibilities into care trusts.

Resourcing

  Develop a strategy to ensure an equitable approach to National Lottery funding including the New Opportunities Fund as well as existing physical activity and recreation funding for programmes and facilities eg through Sport England.

4.5  Developing the skills of front-line workers

  A range of front-line workers and practitioners eg exercise teachers, health care workers, sports coaches and recreation leaders, community workers, health visitors and volunteers are in a position to plan and organise a variety of programmes for older people.

Enjoyable and effective programming

  Sustained participation by older people will only be achieved if programming ensures safety, enjoyment and meets the varied needs of older people. Effectiveness of health, outcome eg an increase in functional capacity can only be achieved with training and education which develops programmes that are specific, progressive and tailored to individual need.

Reflecting needs and interests

  Training programmes need to reflect the wide range of physical activity needs and interests of older people including dance and games related activities, Tai Chi and walking as well as more structured exercise and fitness classes. There is a need to encourage and provide leadership training to new and existing leaders about the participation, motivational and programming needs of older people.

Setting standards

  Training programmes must reflect national occupational standards and competencies.

Investing in the skills of older people

  Older people should be included within training and education programmes to encourage the development of their skills in becoming physical activity leaders, teachers and organisers.

January 2001


 
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