Active Hospitals

Active Hospitals aims to change the physical activity culture within hospitals to encourage patients to move more. We've prepared this toolkit to help you to create your own Active Hospital.

Moving Healthcare Professionals’ forms part of Public Health England’s ‘Everybody Active Every Day’ strategy (1), and aims to help healthcare professionals to understand and promote the benefits of physical activity with their patients.

As part of this initiative Public Health England and Sport England invited expressions of interest from applicable NHS Trusts (those employing a Sport and Exercise Medicine Consultant) to deliver a pilot in secondary care.

The Moving Medicine team in Oxford were commissioned to deliver a pilot that focused on the integration of physical activity into care pathways within secondary care within the Trust.

External independent evaluation was undertaken by Sheffield Hallum University at the National Centre for Sport and Exercise Medicine. The evaluation report found that this approach is highly valued and acceptable to patients and staff within the NHS.

References:

  1. Public Health England 2014. Everybody Active Everyday: National Physical Activity Framework. In: ENGLAND, P. H. (ed.). London: Public Health England.

Why moving more is important

As hospital staff drive and deliver patient care, they play an important role in helping hospitals to become environments which help patients to become more active. Some of the reasons why it matters that patients move more within a healthcare setting are shown below:
1

Prevents deconditioning

2

Positively impacts on patient outcomes

3

Benefits those most in need

4

Aligns with preventative healthcare objectives

Hospitals are dominated by a culture of ‘rest’. There is evidence that hospital associated deconditioning (post-hospital syndrome) leads to increased risk and adverse outcomes (1, 2). These include poor functional ability below that of pre-hospital admission, an increased risk of activity of daily living disability, as well as a decline in muscle strength, muscle mass and cognitive function. Older people with deconditioning have higher rates of re-admission and lower rates of community discharge (3).

These adverse outcomes are in part (if not completely) avoidable during acute hospitalisation. They are caused by older adults having prolonged bed rest (up to 95% of time spent by patients in hospital is in bed), relative inactivity compared to pre-hospital admission, as well as disturbed sleep and nutritional deficits (3).

Systematic reviews have shown that improvement in mobility and balance over the first 48 hrs of admission are associated with prevention of hospital associated deconditioning by maintaining or improving physical functioning, as well as shorter recovery times and reduced length of stay (4).

Changing the culture within hospitals to encourage patients to move more whilst in hospital and upon discharge will have positive benefits.

References:

  1. Brown CJ, Redden DT, Flood KL, Allman RM. The underrecognized epidemic of low mobility during hospitalization of older adults. J Am Geriatr Soc . 2009;57:1660–1665.
  2. HM Krumholz. Post-hospital syndrome—an acquired, transient condition of generalized risk. New England Journal of Medicine, 2013 – Mass Medical Soc
  3. Falvey JR, Mangione KK, Stevens-Lapsley JE. Rethinking Hospital-Associated Deconditioning: Proposed Paradigm Shift. Phys Ther. 2015; 95(9): 1307-1315.
  4. Cortes OL, Delgado S, Esparza M. Systematic review and meta-analysis of experimental studies: in-hospital mobilization for patients admitted for medical treatment. J Adv Nurs. 2019; January 22.

Evidence demonstrates positive health benefits for patients who are able to increase their physical activity levels (3, 4). The Moving Medicine Prescribing Movement resource provides detailed information on the research of the benefits of physical activity tailored to a wide range of specific conditions.

References:

3. Wen CP, Wai JPM, Tsai MK, Yang YC, Cheng TYD, Lee M, et al. (2011) Minimum effort of physical activity for reduced mortality and extended life expectancy. The Lancet; 378:(9798): 1244-1253.

4. Blair SN. (2009) Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine; 43:1-2

Patients with the lowest levels of physical activity stand to gain the most from high quality intervention on physical activity (5).

Hospital admission provides a unique opportunity to empower patients and potentially influence positive patient-led behavioural change.

References:

5. Moore SC, Patel AV, Matthews CE, Berrington de Gonzalez A, Park Y, Katki HA, Linet MS, Weiderpass E, Visvanathan K, Helzlsouer KJ, Thun M, Gapstur SM, Hartge P, Lee IM. Leisure Time Physical Activity of Moderate to Vigorous Intensity and Mortality: A Large Pooled Cohort Analysis. 2012. PLoS Med 9(11): e1001335.

Integrating physical activity into patient care pathways using the Active Hospitals Toolkit aligns with key preventative objectives of the NHS 10 year plan (6).

References:

6. NHS England NHS Long Term Plan. https://www.longtermplan.nhs.uk/ (accessed on 27.03.2019)

Making a start

You could look at the guide to using the Active Hospital toolkit and take the quiz to help you think about what you can do

Design

We conducted insight conversations with staff to explore the barriers and enablers to changing behaviour across different clinical settings. This provides a guide on how to conduct your own insight work to support the design of your Active Hospital

Deliver

A range of case studies across different healthcare settings have been shared to provide information about our experience, system wide interventions and the key components of the governance framework that you might want to consider

Maintain

Working together - by collecting and sharing data, information and expertise - will help us to help our patients to become more active

Governance

Our governance framework has been set up to support an Active Hospital

Future

Our vision for the future of Active Hospitals and funding opportunities

Business case

Developing a business case for an Active Hospital needs to be nationally informed, locally driven and fit with local strategic objectives. To support your business case preparation, we have provided an example business case template that fits with the key components of the NHS Long term plan

Resources

All our resources are available for you to use