Making Physical Activity Business as Usual: A Comparison of Design Features in Cancer Care Models Across the Atlantic

Beth Brown Churchill Fellowship Part Two

Beth Brown, MPH | Feb.2024

Evidence shows that physical activity is highly beneficial for people living with and beyond cancer and is one of the most effective ways to manage the side effects of treatment and improve quality of life1. Despite this, physical activity support is not routinely available within cancer care and most people diagnosed with cancer are not meeting the recommended levels of physical activity. This challenge has been recognized globally, leading to the establishment of the American College of Sports Medicine’s (ACSM) Moving Through Cancer initiative, with a mission to integrate exercise as standard practice in oncology by 20292. During the tenure of my Churchill Fellowship, I investigated exemplar exercise oncology programs in North America to gain insights into the cultural and contextual factors that have contributed to successful implementation. Exploring international perspectives can help us to overcome common barriers and make progress towards making physical activity ‘business as usual’ worldwide.

I hypothesized that the U.S. and UK’s differing healthcare models would influence the availability of funding and thus the culture of embedding physical activity into clinical care. However, I learned that how programs are funded had very little impact on their success, and the extent to which physical activity was normalised by the design of clinical environments and processes was far more influential. Design features can significantly affect people’s perceptions and behaviours. Health professionals are more likely to talk about physical activity and refer patients to support programs if it feels like a normal part of their work. Equally, patients will be more receptive to the conversation and adhere to the physical activity support if it feels like a normal part of their cancer treatment.

In some exemplar programs in the U.S., exercise facilities have been strategically placed next to a hospital reception and in close proximity to chemotherapy wards. This intentional design allows for a powerful message to be conveyed to all those who enter the hospital - that in the midst of cancer treatment, it is possible and encouraged to stay physically active. By being visible and easily accessible during treatment, the facilities also serve as regular prompts for both patients and clinicians to incorporate physical activity into their routine. This reduces stigma and creates the perception that exercise is an essential part of cancer care. In contrast, many exercise programs in the UK are delivered in community gyms without any visible connection to healthcare. This separation leads to the misconception that exercise is optional or only for those who are interested. Although there are advantages to offering physical activity support outside of hospital settings and closer to people’s homes, when a visual prompt for physical activity is provided within a clinical environment, it increases the likelihood that individuals will utilize these opportunities, even if they are not located within that facility. Successful programs recognize that the needs of people living with cancer can vary greatly and offer a range of options, including clinical exercise interventions, self-management advice, and community signposting. They also acknowledge that the success of any program relies on uptake and adherence by patients. Thus, it is crucial that the importance of physical activity is emphasized throughout the design of the clinical pathway to enable more people to access various forms of support.

In the physical activity sector, we often use the ambition of programs becoming funded by healthcare systems as a marker of success, and the importance of normalising physical activity through design features is often overlooked. Of course, funding is essential to deliver programs, but the most successful interventions had sustained the program for several decades without funding from healthcare systems. In some cases, funding from the system was viewed as a disadvantage due to its volatility and using charitable and commercial funds instead allowed awareness and trust to be grown over a longer period of time. In these examples, the healthcare systems had still committed to the program by providing space within a hospital.  As healthcare space is a premium commodity, this provision creates the perception that physical activity is prioritized by the organization, further re-enforcing its importance. In contrast, if a health organization supports a programme purely through funding, the support is unlikely to create a normalizing effect, as clinicians and patients aren’t usually aware of how the programs are funded.

As we continue to advocate for physical activity to become part of standard care worldwide, the importance of making physical activity look and feel part of normal cancer treatment cannot be forgotten. Building new hospitals to accommodate exercise facilities is not feasible everywhere; nevertheless, there are simple and cost-effective design modifications that everyone working in cancer care could implement. For millions of people living with and beyond cancer, the benefits of physical activity could be truly life changing, and in some cases, lifesaving.

Whether you are a clinician, exercise professional, or researcher working with cancer patients, ask yourself, how can we work together to create a culture where physical activity is ‘business as usual’?

Beth Brown, MPH. As the Operations Manager of the National Centre for Sport & Exercise Medicine in Sheffield, England, Beth brings over 10 years of experience developing physical activity interventions for chronic health conditions. In her current role, she is responsible for overseeing a co-location model that aims to transform the way physical activity is integrated into the National Health Service. In recognition of her expertise and dedication to this field, Beth was awarded with a Churchill Fellowship in 2020. This fellowship funded her travels across North America, where she was able to explore and learn about the latest innovations and best practices for incorporating physical activity into cancer care.

References

1. Patel, A. V., Friedenreich, C. M., Moore, S. C., Hayes, S. C., Silver, J. K., Campbell, K. L., ... & Matthews, C. E. (2019). American College of Sports Medicine roundtable report on physical activity, sedentary behaviour, and cancer prevention and control. Medicine and science in sports and exercise, 51(11), 2391.

2. Schmitz, K. H., Stout, N. L., Maitin‐Shepard, M., Campbell, A., Schwartz, A. L., Grimmett, C., ... & Sokolof, J. M. (2021). Moving through cancer: Setting the agenda to make exercise standard in oncology practice. Cancer, 127(3), 476-484. 

Move More Celebrates Inclusive Sport

‘The best day of my life’ is how 8-year-old Isa described the ‘Move More’ event at the English Institute of Sport (EIS) in Sheffield, an annual two-day event held on 14th and 15th September this year.

The Inclusive Sports event is run by Sheffield City Trust in conjunction with Links School Sports Partnership, Sheffield City Council and Yorkshire Sport Foundation. Tom Hughes Development Manager for Sheffield at Yorkshire Sport Foundation described it as their ‘showcase event’ where attendees get to try a host of different activities, some 23 in total, to show them what is available to them, and encourage them to be more physically active and just ‘Move More’.

As Tom stated, whether it’s the participants themselves, the carers, or the staff from the various centres and daycare centres that they come from, it’s just about giving them that breadth of opportunity and showing them what’s actually possible, not limiting the individual by what their disability might be.

It’s breaking down those systemic barriers and showing them that they can do pretty much any sport or activity if it is adapted slightly. The participants certainly seemed to enjoy the array of adaptive activities available, with Isa commenting: ‘It’s a great opportunity for us. I really liked how we got to try lots of new things. I liked the sensory circuit the best, and the table tennis and netball were fun. But what I loved the most is that there was something for everyone, that everyone was included, and no one was left behind.’

Emma Smith, teacher at Archdale Primary School in Sheffield, thought that the event was amazing and very rewarding for her pupils who can find sport inaccessible at times due to lack of equipment, or just equipment that is unsuitable for them. Although they do have some adaptive equipment available in school, according to Emma it’s obviously not on the scale of what was available at the EIS event, highlighting in particular the phenomenal array of specialised bikes provided by TomCat, Cycle Happy and Sheffield Cycling for All. Some of her children had never been on a bike before and so this was a fantastic opportunity for them.

There is certainly a ripple effect from these events too. In addition to the impact on the children, Emma was taking a lot away from the day on a personal level. She was extremely impressed with the Sensory Circuit provided by the Special Olympics Motor Activity Training Programme and intends to follow up on some training with them, in addition to implementing some different activities in the classroom to enhance movement, and basically make life better for the children.

For her it was also wonderful to see the children mix with the leaders from mainstream schools, quite a few of whom had been interested in asking about her children and getting to know what they had enjoyed about the event. Emma believes that the event will have had a positive impact on all of the children and summed it up by saying that ‘it’s not just about doing lots of PE, it’s about having lots of fun’, and that’s what she believes her children will take away from the event.

Also at the event was Tracy from Sheffield City College who was there to support a hearing-impaired student Adam, and she was amazed by the opportunities available and the supportive environment at the event.  Adam had been reticent initially about taking part saying that he would just watch others on the bikes but was soon ‘zooming up and down’ at some speed having been matched with a suitable TomCat cycle.

As Tom Hughes observed, it’s wonderful to see everyone getting involved. Some children have sat on the side-lines at these events for years, so to witness the transition they have gone through in their relationship with physical activity is inspiring.

Tom says the activity generates conversation and enthusiasm, and soon sees the individual interacting with the staff and other participants. ‘They may be quiet in their own settings and so to see them come out of their shell is amazing,’ he said. ‘It’s those ‘light bulb moments’ where you see that increase in confidence, and that they’re so passionate about what they’re doing. That’s what these events are all about.’

Luiz Faye from Kronik Warrior Adaptive Boxing Academy believes there is an element of ‘fear of the unknown’ which can sometimes hinder people, particularly those with disabilities, when it comes to trying new activities. For her it’s about spreading awareness that everyone can enjoy boxing in some format, regardless of body conditions and impairments.

This is the importance of these events, to show people with disabilities that there are so many sports which are accessible to them. As Luiz says: ‘You literally see people’s eyes open up when they realise the possibilities.’

Gareth Davis, Head of Region for Yorkshire Cricket Board, agrees that the ‘Move More’ is about showcasing what is available in sport for people with disabilities. He has attended previous events at the EIS and provided inclusive activities such as table and softball cricket.

His goal is to just get more people playing; girls, boys, people with disabilities and of all age groups, making it inclusive for all. There are opportunities to go right through as England have a Physical Disability side for amputees and wheelchair users, as well as Visually and Hearing-Impaired Teams, but at base level it’s more about just connecting people, having fun and promoting physical activity.

 Their sessions for children are fully adaptive and sometimes just involve a bat and a balloon, but as Gareth points out, ‘That’s their form of cricket, and that’s fine.’

Also present at the two-day event were Niamh Mourton and Angela Lyndon from the Special Olympics Motor Activity Training Programme (MATP) which is a movement-based sports programmes which provides meaningful sport and physical activity for young people with profound disabilities and complex needs.

They had set up a Sensory Circuit based on the core MATP skills: mobility, dexterity, kicking and striking, and were supported by some fantastic PE students from UTC college who helped on the different stations, and with just adapting the activities, breaking them down in a fun way so that participants could engage in the movement and just have fun. As Niamh says: ‘It’s about educating people on what they can achieve and catering for every single disability so that everyone can get involved. Young people who take part in the programme also get chance to come to a Challenge event at the EIS, which is in front of a crowd, and where they showcase what they have learned, at whatever level that may be.

As Angela said: ‘It’s about celebrating their achievements, but also about coming together to support each other.’ She related a story of one athlete who was struggling at the event and his mum got the assembled crowd to sing his favourite song, ‘If you’re happy and you know it’ to motivate him, and so that camaraderie and support is so important.

Julie Grafton has been running the Cycle Happy Club in Sheffield for five years alongside her husband. Both enthusiastic cyclists, they decided to set up the club, which promotes cycling for people with learning difficulties, after their daughter was a competitor at the Special Olympics.

She was grateful for the support of Dawn Wood at Links SSP/SCT who assisted her with applying for funding which allowed them to purchase a fleet of bikes, trikes, and balance bikes which they could adapt for people with disabilities.

As Julie attests though it’s not just about learning to ride a bike, it’s about health and fitness and being more physically active. One of their children was borderline needing hip replacement surgery, but since taking part in the strengthening and aerobic activities provided by the club their condition has apparently improved dramatically.

Cycle Happy has also had a significant impact on Niall Guite, a young man with learning difficulties, who had an obvious aptitude for cycling. Having recognised this, the club referred him to the Youth Team to instigate further appropriate training in competitive cycling and he eventually went on to compete in cycling at the Special Olympics. Julie and the club are obviously immensely proud of the achievements of their ‘celebrity’ and were delighted when he returned to show his medals in the hope of inspiring other young people at the club.

Phillimore Community Primary School brought by far the biggest contingent to the event with some 60 pupils in attendance alongside their PE leader Jo Searle. The impact of these events on the children is huge, according to Jo, in terms of broadening their horizons.

Eight-year-old Aya described the day as ‘amazing’ and couldn’t wait to tell his parents all about it, and particularly how much he had enjoyed the table tennis. He said: ‘I didn’t really know how to play until after practice but then I got really good.’

Mohammed was also full of praise for the event and commented that, ‘today I had a really good day, the best day of my life’. Jo advised that some of the children had also been given information slips relating to clubs they could join at EIS as pathway to community activities, proving again just how far reaching the effects of these events are.

For Tom Hughes the event is the most inspiring and rewarding that they host in Sheffield, and he is justifiably proud of the achievements of a brilliant network of disability partners who bring these events to life. Whilst it’s hard - Tom says ‘at times a little like organised chaos’ - everybody embraces it.

There can be no doubt that the event was hugely rewarding and beneficial for all involved, and final word has to go to 8-year-old Isa, who said: ‘I just want to say thank you to you, and all the teachers and parents and organisers for this day because you’ve made us all so happy. I wish we could come every day’.

Churchill Fellowship – Making Physical Activity business as usual in Cancer Care

The National Centre for Sport & Exercise Medicine Operations Manager, Beth Brown, tells us about her Churchill fellowship, learning about physical activity services for people diagnosed with cancer in Canada and the USA.

In February 2020, I was awarded a Churchill fellowship to explore how we can make physical activity ‘business as usual’ within cancer care. The Churchill Fellowship is a charity which supports individual UK citizens to follow their passion for change, through learning from the world and bringing that knowledge back to the UK.

I first started planning my trip over 3 years ago but was unable to travel due to the pandemic. This year, I have been able to start my long-awaited fellowship which involves travelling to Canada and the USA.

There is strong evidence that physical activity is highly beneficial for people living with and beyond cancer. Research has shown it can reduce side effects and improve quality of life at all stages of cancer treatment. There is also evidence physical activity can reduce reoccurrence and improve survival rates in some cancers. Despite the evidence, physical activity is not recommended as part of standard cancer care, and the availability of support services is inconsistent across the UK.

My fellowship involves looking at how the culture within healthcare systems impacts the way physical activity is offered to patients, and how different contexts such as competitive healthcare markets and government policies influence service developments.

I have just returned from the first half of my travels, where I visited programmes in Alberta (Canada), Colorado (USA), and attended the American College of Sports Medicine World congress. The trip was a fantastic experience and I met with a range of leading researchers in exercise oncology, and visited innovative services.

Through my conversations, it was clear the challenges the UK faces in its attempt to integrate physical activity are echoed around the world. However, in Canada and USA there are some highly successful services that have supported many people with cancer to become active. I observed several common factors that allowed these services to be successful, these factors include persistency, bold leadership, dedication and passion. The services I visited had all been operating many years (some over 20 years), and all were initiated by prominent local leaders who were personally passionate about the benefits of physical activity. As in the UK, physical activity isn’t funded routinely by healthcare systems in Canada or USA. However, a passionate belief that people diagnosed with cancer need to be physically active, led to tenacious and creative approaches that allowed services to be delivered beyond research funding. I also learnt about work happening at strategic levels to influence policy makers, and the strategy both countries are using to ensure systematic change is achieved.

In October, I will be returning to USA to continue my learning. Following this, I will be writing a full report of my findings and developing recommendations. If you’d like to hear more about my fellowship and the learnings, please get in touch at beth.brown12@nhs.net

You can learn more about Churchill fellowship here Beth Brown (churchillfellowship.org)

Sheffield’s two halves with one goal.

Although Sheffield’s football allegiance is split into two halves, off the pitch, both clubs have teams working towards the same goal – improving health through physical activity.

Sheffield United Foundation and Sheffield Wednesday community programme offer a range of programmes to support their local communities. Both clubs have a focus on reducing inequalities, through working with people at risk of long-term health conditions and socially disadvantaged groups. Here’s some examples of the amazing programmes that clubs are running.

Hillsborough Tackles Diabetes 

Sheffield Wednesday Community Programme works in partnership with Tramways and Middlewood Medical Centres, and other GP practices around Hillsborough to help support people with type 2 diabetes or people at risk of becoming diabetic.

Once a month practice nurses from the medical centres come to Hillsborough Stadium to do diabetic health checks from the executive boxes.

After seeing the nurse, the health team from Sheffield Wednesday talk to people about the type of activity they would be interested in and their current lifestyle. People are then offered 1-1 physical activity support with a qualified fitness instructor and the chance to see a nutritionist.

Sheffield Wednesday Community Programme will also be setting up a 6-week group course which involves a session about healthy eating followed by a group exercise class. Nurses and GPs from the Hillsborough medical centres can also refer patients directly into the programme for 1-1 or group support. 

Walking Bus United

Sheffield United Foundation have been working with refugees and Mears Housing to offer sessions and opportunities to all refugees that are new to Sheffield. They offer physical activity and social opportunities to help improve people's physical and mental health and help build social connections.

Navigating around a new city with little knowledge of the area is a big challenge for the refugee community and can be very daunting. As a result, refugees are much more likely to be physically inactive and isolated. To help overcome this barrier, Sheffield United Foundation have set up a walking bus initiative.

Before a session, a member of staff from Sheffield United will go to the accommodation, meet everyone that’s signed up and walk everyone across to the venue. The programme has had great success and is helping refugees to build confidence in their local area and make connections. 

Sheffield United Foundation plan to embed more programmes locally in the 29 ward areas they work in, aiming to provide accessible opportunities within everyone's 10 minute travel bubble, allowing communities to connect more.

These programmes are great examples of doing things differently - Partnership working with the NHS and the value of providing support outside traditional medical settings, as well as removing barriers to people being active, in creative ways.

If you’d like more information about the work either of our football clubs are doing to support local people to be more active, please contact:

James Ball from Sheffield Wednesday Community Programme James.ball@swfc.co.uk

Beth Wragg from Sheffield United Foundation beth.wragg@sufc-community.co.uk

Move More Professional Networking event

On Thursday, 23 March, people working across the healthcare sector, including primary secondary care and voluntary sector gathered at Blend Kitchen on Sheffield’s Ecclesall Road.

Physical inactivity directly accounts for 6% of deaths per year globally, [1,2] and is ranked as the 4th most prevalent risk factor for global morbidity and premature mortality by the World Health Organisation. People who have a physically active lifestyle have a 20-35% lower risk of cardiovascular disease, coronary heart disease and stroke compared to those who have a sedentary lifestyle. Regular physical activity is also associated with a reduced risk of diabetes, obesity, osteoporosis and colon/breast cancer and with improved mental health. In older adults physical activity is associated with increased functional capacities. How this message is presented in consultations and within healthcare teams can be is challenging. And yet, as many at the event testified, it’s a conversation that needs to be had.

After a good bit of chat & networking- but crucially before dinner! Dr Claire Cruikshanks Consultant anaesthetist spoke encouraging everyone to use the Moving Medicine resources and specifically their Active Conversations course. Dr Jo Maher focused on community events in the city and how to move away from discussing physical activity solely as about exercise. Parkrun, local green spaces and the support from social prescribing hubs such as SOAR Community all featured.

Physical Activity post covid?

ONS data suggest activity levels remain down compared to pre-pandemic, but haven’t fallen further, with significant differences reported between different ethnic groups. People who identify as White British are more likely to be physically active (47.7%) than people identifying as Black or Asian, at (35.7%) or (38.7%) (3)

‘Everything closed down. People were told to stay in their houses, so of course people weren’t moving as much,” said local GP Dr Fran Norman. ‘’Habit forming is really important and coming out of the habit of being physically active [means] it’s then really hard to get going again.”

In Yorkshire, the percentage of adults who were physically inactive jumped from 25.6% to 29.2% during the first year of the pandemic. The dip in fitness also affected children, with just 45% getting the recommended amount of exercise of at least one hour a day across England in 2020. (Levels have now returned to what they were pre-pandemic but are still less than half of all children at just 47%.)

While those who could took their daily walk or got on a bike during the Covid lockdowns, the number of journeys people took on foot dropped by 16% this was more than offset by the decrease in utility journeys for including commuting.

An unequal landscape

But whether someone is active or sedentary is determined by much more than just their habits. There are wider structural & social issues at play, as Dr Jo Maher explained. These include access to public transport, safe spaces to walk and the car culture we live in. Unfortunately for many modern lives have exercise and physical activity engineered out of them and with that is a loss of community contact & increased isolation, which itself has negative health effects.

These factors hit people living in poverty hardest. “Unfortunately, we know there’s a very strong link between people who live in more deprived areas of the city and those who don't have the same opportunities to access physical activity as people in the wealthier areas,” Doctor Maher said. “I’m afraid this plays out in the number of years people can expect to live a healthy life, with someone from the North or East of the city developing conditions such as diabetes and heart disease 10-20 years ahead than in the wealthy westside. We also know people from deprived communities are less likely to seek medical help, living with undiagnosed hypertension & diabetes as an example. It’s a bleak picture.

Move Move’s outreach works with projects across the city, including the two football clubs which puts on a range of activities across the city. The Voluntary sector organisations including SOAR community & many more organise Roma dance classes, a fitness club for young men or a Somali disabled women’s group. A wealth of other opportunities are available and Move More is also linked to projects like This Girl Can, Active Through Football and the Dame Kelly Holmes Trust.

Recognising that despite the factors beyond our individual control, there is a community of enthusiasts who want to advocate for the importance of physical activity, as well as sharing what had worked or not worked in their sphere of work left all the attendees asking for further networking events, especially if there is more of the excellent Blend Kitchen curry available!

For More information on Moving Medicine active conversations

 https://movingmedicine.ac.uk/activeconversations/

If you would like to get involved with Move More primary care active practice sign up here

https://www.movemoresheffield.com/move-more-active-practice

1 WHO. WHO | Global recommendations on physical activity for health. Geneva: :

World Health Organization 2010.

http://www.who.int/dietphysicalactivity/publications/9789241599979/en/

2 WHO. WHO | Global status report on noncommunicable diseases 2010. Published

Online First: 2010.http://www.who.int/nmh/publications/ncd_report2010/en/

3 https://www.gov.uk/government/statistics/physical-activity-data-tool-january-2022-update/physical-activity-data-tool-statistical-commentary-january-2022#main-findings

(4) https://www.ethnicity-facts-figures.service.gov.uk/health/diet-and-exercise/physical-activity/latest#download-the-data

Move More Empowering Communities

Move More Empowering Communities – A summary of key findings from the project evaluation.

Over the last few years, we’ve been working on the Move More Empowering communities project. This is a Sport England funded project, coordinated by Voluntary Action Sheffield, involving partners from across the physical activity sector. We’ve been fortunate to work with some great people and have achieved some good impact.

 The project ultimately aimed to support people to be more active in ways that suit them. But, we also wanted to explore what does and doesn’t work, and under what circumstances, when it comes to community physical activity.

We have had ups and downs over the course of the project. But, we have learned a lot about what is most likely to work for people in different circumstances. We have also been able to work with other members of the Move More network to use this learning to inform other ways of working too.

This work is a small step towards bigger change, which takes time, and we hope that the lessons we have learned will help guide others who are trying to achieve similar things in their work. Read on for a summary of key findings…

The background

Move More Empowering Communities (MMEC) project aimed to support voluntary, community, faith, and social enterprise (VCSE) organisations across Sheffield, working with communities with the lowest levels of physical activity.  The aim was to work with these communities to understand what works to enable physical activity at a local level, what factors affect this, and ultimately enable more people to be active in ways and places that suit them. We have been working on this project from Apr ’19 to Aug ‘22.

Themes

Findings are organised into five interacting theory themes, which explain how and in what circumstances organisations worked to enable physical activity. These are;

·         Building capacity in the VCSE to understand the needs of the target communities (insight)

·         Building on assets (use of facilities, green and blue spaces, networks)

·         Working with partners

·         Developing a supported and person-centred approach

·         Building capacity to deliver activities

Figure 1 - Boxercise class delivered by experienced community development worker (Kellyanne from Manor and Castle Development Trust)

Building capacity in the VCSE to understand the needs of the communities we’re working with

All organisations were able to develop an understanding of the needs of target communities. Ring-fencing time for local officers to develop this insight made it central to local plans and provided a legacy of knowledge likely to be drawn on following the end of the funding period. 

Time taken to establish trustful relationships was essential for honest communication about physical activity (both in conversation between organisations and clients, and between organisations and funders)

Who the officer is, their personality traits and their outlook is important.  They need to be experienced in both community development and have a passion for physical activity, and their host organisation needs to be bought into the role and importance of physical activity. It was helpful, but not essential, that the local MMEC officer was from the community and already had established links to groups and networks in the area. 

Building on assets

We used a strength-based approach. Key to this is recognising and building on what communities themselves identify as assets that help them to be more active.  Places, spaces, facilities, individuals, networks, and groups.  Our findings highlighted that at the start of the projects relevant assets were the individuals and organisations that were working with the community as well as local parks and open spaces.  Most individuals were not making use of more traditional leisure facilities and / or travelling far to access blue and green spaces. 

People appreciated being introduced to something new, by those that they trusted.  Such as trips to the Peak District, the Botanical Gardens, the gym, and fun football / footysize sessions.  The sessions included building confidence and practical knowhow about how to access these opportunities without the need for support in the longer term. 

Whilst it is arguably less sustainable to simply deliver sessions, in the right circumstances, these give people who are furthest from physical activity more than just the benefit of the session but make them feel valued and boost their self-esteem.  This is an important pre-cursor for people seeking out further opportunities.

Figure 2- Kids having fun at weekly football session lead by DESA. Invited in through the 100’s of families DESA have contact with through their formal and informal networks

Working with partners

MMEC enabled organisations to nurture a community base of interest in physical activity amongst those who are traditionally underserved.  This increased demand for activities and opportunities.  Prior to MMEC, organisations had tended to go to ‘the usual suspects’, that is those organisations who were well established and had a track record of effective delivery.  MMEC broadened that base and opened a wider range of connections from which we have already seen a sustainable legacy. 

Through the networking and conduit role played by VAS, enabled greater connectivity between VCSE organisations, for example by pairing smaller niche organisations with more established groups, which enabled greater reach and a wider range of support to be offered. 

Important aspects of working in partnership therefore are to encourage facilitated opportunities for sharing learning and good practice between organisations and exploring ways to work together.  Support to identify the ‘right’ partners to work with - what is going to work for different people with different needs (for example, choosing local providers who know the local community) and Move More continuing to explore ways to work with partners to potentially offer something different which might engage more participants, or those that are reluctant to be physically active.

Developing a supported and person-centred approach

The evaluation findings build on wider knowledge that supporting people who are less likely to be active to build physical activity into their lives takes a person-centred approach.

This is not just about putting on sessions that people have asked for but also about tackling wider needs simultaneously (for example, with childcare), and in some cases, as a precursor (for example with confidence building) to physical activity. 

This takes considerable time and skill, but investment in working in this way shows high returns in engagement and sustained participation. 

The evaluation approach, which did not stipulate high numbers of participants as a marker of success, freed organisations to work in a way which built quality interactions.

Figure 3 - Firvale Community Hub's Roma Slovak exercise and healthy eating class. Where, no doubt, people then went on to take part in other services (i.e. debt advice, advocacy) once in the building.

Building capacity to deliver activities

MMEC considered prior lessons that simply delivering activities did not tackle inequalities in physical activity participation. However, those who experience inequalities in physical activity are also highly likely to be living in deprivation and lack access to affordable, safe, and appealing options for physical activity.  It is argued, therefore that some element of provision of opportunities at low to no cost is an important aspect of enabling physical activity. 

Simply asking people what they want did not necessarily translate into high attendance, and a degree of trial and error was necessary to find an appropriate delivery approach.  MMEC was designed to incorporate this by being flexible and for local organisations to change their approach as they learnt what did or did not work. 

Consistently, the delivery of physical activities was enhanced when sufficient time and opportunity was built in for socialising before, during, or after the session.

Case Story - ISRAAC: Impact report

Please share a story of a time where you successfully supported someone to be more active and you felt proud because of it?

I supported a 58 year old woman who was from Sri-Lanka. Her daughter had seen it on our website and our walking group and phoned me to enquire. She told me, “My mum came to this country last year; she left her country due to domestic abuse by my dad. She is really stressed and can’t speak English. I work full time, and since she arrived, she is getting more depressed as she is unable to go out. But I know my mum loved to walk when she was back home”. 

I suggested to her that she brought her mum with her for the first session. I also told her that we have some other women in the group who can’t speak English, but they are very friendly and they are from various backgrounds and ethnicities. She agreed and brought her mum.

Her mum was very nervous for the first session and hardly spoke to others, but after the walk she felt really good and said that she will come again next week. She came again and again and again; now she has opened up and has started to speak some English. She made some very good friends within the group. She started to get better and better every week with her English. I see her smiling and as a very happy person within weeks.

She asked me that she wants to learn English and would like to do some work. I gave her details for some courses. She has enrolled in some courses and has started taking sessions. Within 6 months she has significantly improved her English speaking and understanding, which has amazed us all.

She walks every single day and comes regularly to our walking group. Recently she completed a food hygiene course and started volunteering as a cook in a community project. Everyone loved her Siri Lankan dishes that they have offered her a paid job. It was unbelievable.

She said it all started with my walking group, which reduced my stress, helped me to socialise with others and build my confidence. She is still a regular member of our walking group.

Other lessons from other stakeholders outside the VCSE

Stakeholders reported that MMEC complemented and extended knowledge from the This Girl Can and Active Burngreave projects and provided an example of best practice for working with communities. 

Several lessons have been learnt about how to commission and manage this work.  This includes the need to invest in capacity, and to allow for flexibility, learning and adaptation as part of the contract and governance arrangements. 

Figure 4 – Building on the SACMHA lunch club so physical activity can be delivered where people already are. Nothing draws people in like socialising and good food

There are still challenges and opportunities that this work did not address

The adequacy, consistency, and breadth of funding available to the VCSE.  If this could be resolved it would provide a more enduring platform to retain and build on the trustful relationships, holistic and flexible support and diversity of offer which seems critical to working with communities.

The pooling of resources across the city in an equitable and timely fashion.  Some opportunities were, and are still being missed by some elements of the MMEC work not being fully joined up with other elements of Move More and the wider health ‘system’ in Sheffield.  Clear lines of responsibility to raise opportunities and resolve issues collectively should be part of the planning associated with future investments.

Sharing lessons across VCSE organisations and wider strategic partners in a timely manner and appropriate formats.  Investment in community of practice, with support for VCSE officers and volunteers to attend, and a communications strategy, may go some way to alleviating this, as will key stakeholders taking responsibility to advocate and share the learning within their spheres of influence.

The key principles

“when you are thinking about what your role is in reducing inequalities, here is a set of principles for you to consider”

·    Ring-fencing time for local officers allows local insight to be developed which can inform local plans and provide a legacy of knowledge and understanding of how to create impact

·    Time taken to establish trustful relationships was essential for honest communication between organisations and clients, and between organisations and funders. Speed of progress is dependent on the level of trust

·    Who the officer is, their personality traits and their outlook is important

·    Recognising and building on what communities themselves identify as assets is key to successful strength-based approaches

·    Working in partnership is more effective with facilitated opportunities for sharing learning and good practice between organisations and exploring ways to work together. 

·    It is key to identify the ‘right’ partners to work with by considering what is going to work for different people with different needs (for example, choosing local providers who know the local community)

·    Person-centred approaches are critical. This is not just about putting on sessions that people have asked for but also about tackling wider needs simultaneously (e.g. childcare), and in some cases, as a precursor (for example with confidence building) to physical activity. 

·    Proper person-centred work takes considerable time and skill, but investment in working in this way shows high returns in engagement and sustained participation

·    Contract arrangements which do not stipulate high numbers of participants as a marker of success, invests in capacity, and allows for flexibility, learning and adaptation will free organisations to work in a way which builds quality interactions and increase impact.

·    Many VCSE partner involved in this work are subject to short term and unpredictable funding streams. There needs to be an enduring platform to retain and build on the trustful relationships, holistic and flexible support and diversity of offer which seems critical to working with communities.

·    Pooling of resources across the city and its institutions in an equitable and timely fashion is an important part of approaches to work like this. Clear lines of responsibility and stipulation to raise opportunities and resolve issues collectively should be part of the planning associated with future investments

Thanks to Katie Shearn and Kerry Griffiths at SHU for their hard work and skill on this evaluation. The full evaluation report can be found here.

Found this interesting and want to chat more about these findings and their implications for your work? I’d be happy to discuss. Just send me an email on a.batty@vas.org.uk

International Mixed Ability Sports (IMAS)

Written by Kelly Heathcoate, IMAS Business Manager

Our vision is to radically change the way we think of, join in, and enjoy sport, leading to a fairer and more equal society.

International Mixed Ability Sports (IMAS) is a Community Interest Company promoting social inclusion, personal development, and wellbeing for the most disadvantaged groups in our communities. Through using peer education and practical participation in sports as change agents.

Our vision is to radically change the way we think of, join in, and enjoy sport, leading to a fairer and more equal society. IMAS was founded in 2014 from the lack of opportunities for disabled people to play competitive sports in mainstream community clubs without being separated, segregated or classified, and has now become a movement that supports the creation of safe, welcoming and non-judgmental environments for all those who experience barriers to participation in sport and society. Our values are upheld by the Mixed Ability Manifesto.

We work with a group of ‘experts by experience’ who have gone through a journey to become a part of their local clubs and have become community champions as well as IMAS trainers. Together, we co-produce and co-deliver educational resources to community clubs, coaches, and partners such as healthcare professionals, educational institutions, as well as third sector and private organisations.

Our activities challenge the medical and charitable models and offer a sustainable route to tackle stigma and prejudice around disability and diversity more in general through education and intergroup contact, promoting equal status, cooperation, common goals, and positive change in attitudes and behaviours.

We are always looking for new connections; whether you are a club wanting to become more representative of your local community by introducing Mixed Ability, a champion who has overcome barriers to participation and wants to share your story with us (or an ally of someone who has taken this journey), or an organisation who aligns with our values and wants to discuss ways we could work together.

Please don’t hesitate to contact us on contact@mixedabilitysports.org or take a look at our website at www.mixedabilitysports.org

Watch these videos to find out more:

What is Mixed Ability: https://youtu.be/MKFwP-lgXk0

Who are IMAS: https://youtu.be/SIAWVdcuLco

Ryegate Summer Events

Written by Reece Goodwin, Exercise and Physical Activity Therapist, Sheffield Children’s NHS Foundation Trust

Supporting children with additional needs to participate in physical activity over the summer holidays.

During the Summer Holidays, Ryegate Children's Centre Therapy Team (part of Sheffield Children's Hospital) held a Summer Spectacular, which included a number of taster and fitness bootcamp sessions, for children with Physical and Learning Disabilities and Autism. The purpose of this was to get as many children as possible active over the holidays. Many families with children with additional needs, struggle to find fully inclusive sessions to join in with to enable participation in physical activity. 

Overall, 41 referrals were received from Physiotherapists and Occupational Therapists from the Mainstream and DCD community therapy teams. Referrals from other teams across the trust accounted for 2 out of the total. A total of 23 children attended at least one activity session, this therefore means that 53.48% of the overall referrals attended at least one session. 

Groups included Football, Boccia, Fitness Bootcamp, Dance and Walking; all with the aim of increasing physical activity.  During sessions, additional information of suitable groups was given out to enable families and children to pursue any activities they enjoyed.

One parent said "Great dance sessions. It is difficult to find structured activities for children with additional needs over the summer holiday, so these sessions were very welcomed".

Whilst another parent said ""Fun atmosphere, we had good opportunities to chat to people he didn't know which is great for his communication. Walk was just the right length. The therapy dogs added extra entertainment; therefore, our child had a good workout without feeling it was a big effort. Thank you so much for organising these events".

There were a number of organisations involved in the delivery of the sessions, such as Spotlight School of Dance, Sheffield Smasher, Sport Sheffield and Dogs for Therapy. It was a great way to connect the healthcare sector with sport and physical activity, to help reduce the barriers to participation children with additional needs face on a regular basis. 

 There are future plans to develop additional programmes to encourage physical activity participation for children and families within Sheffield Children's Hospital. 

 If there are any organisations who would like to help in providing fully inclusive and accessible activities, please email Reece Goodwin on reece.goodwin@nhs.net (Exercise and Physical Activity Therapist).

How Bikeability is generating pedal power in Sheffield

Written by Emily Cherry, CEO Bikeability Trust

Sheffield – The Outdoor City – a city where cyclists commute, hit the mountain bike trails, and tackle hills that have been part of some of the biggest cycling races in history.

Whilst it’s been almost a decade since the Tour de France whizzed through the city’s suburbs, Sheffield continues to be a place of pedal power – and you need a lot of power for all those hills!

It was in Sheffield that I had one of my most proud moments as CEO of Bikeability. I was visiting a school on the outskirts of the city with champion cyclist Dame Sarah Storey, who was Active Travel Commissioner for South Yorkshire at the time, to see some Bikeability cycle training in action.

One girl raised her hand and said: “I didn’t know how to ride a bike before Bikeability came to school. At first, I kept struggling but then I managed to do it and I feel really proud of myself.”

It’s stories like that that make me proud to be at the helm – or should that be handlebars – of the Bikeability Trust, the organisation responsible for delivering the government’s national cycle training programme. That young girl in Sheffield is one of more than four million children who have learnt to cycle confidently on our roads with Bikeability since 2007. By 2025 it’s our ambition to give every child in England the opportunity to learn to cycle with Bikeability.

Emily Cherry with then Active Travel Commissioner Dame Sarah Storey at a Bikeability session

In 2021/22 we taught 3,256 children to cycle in Sheffield, and Bikeability does more than just teach an essential life skill. We’re helping children and their families to live more active and healthier lives, whilst protecting the health of the planet and tackling climate change.  Research shows that cycling at a young age has a long-term beneficial impact on the health of children right through to adulthood. With studies showing that cycling provides positive experiences, enjoyment, self-esteem, reduced stress, and improved mood. 

Cycling infrastructure is improving in Sheffield. With new cycling routes such in the city centre and Sheaf Valley, as well as low traffic neighbourhoods in Crookes and Nether Edge. It’s becoming easier for families to choose to cycle. But as a mum, I know that’s easier said than done. Even if your children are expert cyclists away from traffic, the thought of letting them loose on the roads for the first time can be daunting. But with Bikeability Family, we bring the whole household together to tackle the tricky bits of starting out on the roads.

We know children are much more likely to become cyclists if they see the grownups in their lives travelling by pedal power. Bikeability Family gives the whole family the opportunity to take part in a bespoke session with one of our expert instructors to gain cycling confidence together. They’ll help you practice common journeys so you can leave the car at home and cycle to school, the shops, or just for fun!

This October, we’re asking children and their families to put their cycling skills to the test as Cycle to School Week returns from 3 – 7 October. With Bikeability leading the way with continued support from Sustrans, we’re celebrating and promoting cycling to get more pupils travelling by pedal power to school.

My children are old enough to cycle themselves to school now – it would be far too embarrassing for them to be seen with me! But when they were younger, I really valued the time we spent cycling to school. It was the perfect opportunity to get some exercise in before lessons and have a chat about the day ahead – so they felt physically and mentally prepared for school.

Individuals can get involved in Cycle to School Week by pledging to cycle more on the Bikeability website, with exciting prizes up for grabs for those who take part. I’ll be pledging to discover somewhere new on a cycle ride! There are lots of ways for schools to get involved too, with presentations, activities and lesson plans available to promote cycling all year round.

Cycle to School Week is just one thing Bikeability is doing to get kids cycling. We’re working with councils, community groups and corporate partners to give more children and their families the opportunity to gain cycling confidence. Follow @BikeabilityUK on social media to keep up with our latest news.

Find out more about Cycle to School Week or search for a Bikeability course near you.

Sheffield Make the Move day

They say Sheffield is built on 7 hills, or is it built on 7 parkruns?

On 9th July Move More Sheffield collaborated with parkrun for the first time creating a city wide event, celebrating the fantastic work done across the city by health and social care teams.

With health care professionals from across the city taking part in various different ways, from running to volunteering or bringing their families down to enjoy the brilliant weekly community event that is parkrun.

We wanted to celebrate the contribution made- not just within the NHS, but also from our social prescribing partners. Collaboration and community have been at the heart of the pandemic response and physical activity continues to be of vital importance for people to recover and reconnect.

Recent research highlights that parks and open spaces as well as having a sense of belonging within their community, improve people’s wellbeing looking at these joyful pictures, it’s easy to see why!

Check out the parkrun page for information on where they take place in Sheffield and how to join!