L.I.F.E.(Leisure Inclusion For Everyone)

By Alison Harkess

Staff Nurse – Learning Disabilities

Introduction

• Physical Health

• Mental Health

• Health Promotion

• Social Skills/Social Inclusion

PHYSICAL HEALTH

• To improve baseline fitness levels

• Healthy BMI

• Improve core fitness

• Maintain/improve mobility

• Off set co-morbidity

MENTAL HEALTH

• Reduce Depression

• Reduce Anxiety

• Increase motivation

• Improve wellbeing/coping ability

HEALTH PROMOTION

• Promote healthy lifestyle

• Explore how exercise affects the body and mind

• Increase personal expectations

• Safe/realistic goal setting

SOCIAL INCLUSION/SKILLS

• Community resource

• Increase social opportunities

• Promote independence/skills

• Transferrable skills

IMPLEMENTATION

• Made proposal and secured hours• Secured group access cards• Identified clients, obtained permission/physical

examination by RMO• Identified gym and risk assessed suitability• Completed physical readiness questionnaire• Identified appropriate mental health assessment tools x4

and obtained baseline recordings• Induction at gym including fitness test, introduction to

equipment and fitness programme setting• Commenced twice weekly, 2 hour sessions

RESULTS

• Resting pulse rate reduced• Blood pressure reduced• Some weight reduction• Co-morbidity effects challenged• Motivation increased• Well being increased• Anxiety reduced• Depression reduced• Independent/social functioning increased

CLIENT FEEDBACK

• Client questionnaire completed

• Enthusiastic response

• Commitment of clients

• Would like other opportunities to engage in physical exercise

• Feel they are achievers

• Same as everyone else

CONCLUSION

• Physical exercise is cost-effective• Inexpensive to deliver (cost to NHS Lothian NIL!)• Inexpensive to participate in• Minimal adverse side-effects compared to

pharmacological interventions• Can be indefinitely sustained• Exercise is a valuable transferrable skill• Holistic and individual• Trinity of treatments (mind, body and soul)

L.I.F.E

‘Case study’

‘Kevin’

Kevin’s pathway of care to NHS Lothian LD services

Up to 16yrs:Special School and lived at home

Parents found it difficult to cope and challenging behaviour and physical aggression

Residential home2 yrs

Placement broke down due to challenging behaviour

Supported by Social Work 2 yrs

Placement broke down due to behaviour that challenged

Residential accommodation 8yrs

Admitted to the REHshort term

Aggressiveoutburst

Back to same residential placement(one night)

Police custody then respite care (three

weeks)

Inpatient LD resource

NHS Lothian(March 2008)

Similar aggressive outburst

Needs 1:1 supervision

in communitysettings

Increased riskof Type II diabetes

Language comprehension

8yrs old

Need of clearboundries/

rules& structure

History of aggressive/

violentbehaviour

High bloodpressure

Morbidly Obese (115 kg)

Mild LD

Prader-Willi

syndrome

‘Kevin’ 29yrs

‘Kevin’ - profile

Mood swings/difficulty with

change

Behaviouralproblems

(anger/inflexibility)

Low muscletone

Learningdisability

Dental problems

Hormonalimbalance

Type IIdiabetes

High blood

pressure

Obesity/morbidobesity

Insatiablehunger

Prader – Willi

Syndrome

Treatment/management

Food restriction/supervision Daily structure/routineRegular exercise Firm rules Hormone treatment

Kevin and the L.I.F.E programmeKevin joined the project

- morbidly obese (115 kgs)- High blood pressure (medicated)- challenging behaviour

Goals:

assist with weight reduction increase confidenceimprove CV functioning reduce anxiety decrease blood pressure promote coping abilitiesimprove muscle tone

Programme:

2 x per week – Edinburgh Leisure30 minutes cardio and range of equipment useWalk to/from gym (2 miles)

Reduce co morbidities

Extend life expectancy

Results…

More confident

Improvedmusclestrength

More sociable/

happiermore in control

Increase CV functioning

(reduced resting HR)

Decreased Blood

pressure

66 kg (49 kg weight

loss)

KEVINNOW