Integrating physical activity into cancer care Evidence and guidance Running header Authors: Jo Foster, Sarah Worbey, Kerryn National Gardening Scheme, Sporting Chamberlin, Rhian Horlock, Tamzin Marsh. Equals, Badminton England, Bowls Development Alliance, Medway Public Editor: Dr Nick Cavill, University of Oxford. Health, Walsall Healthcare NHS Trust, Guys Reviewers: Arry Cain, Edoardo Cesarino, and St Thomas NHS Trust, Frimley Health Jane Derbyshire, Jacquetta Fewster, NHS Trust, Yeovil District Hospital, Bury Margaret Greer, Layne Hamerston, Physiotherapy clinic, Sefton Council and John Harkin, Tudor Humphries, Active Lifestyles, Southport & Ormskirk Diarmaid McAuley, Sean Richardson-Jones, Hospital NHS Trust, Help2Change Public Fiona Smith, Justin Webb, Elaine Wilson. Health Shropshire Council, Blackburn with Darwen borough Council, Healthworks With special thanks to: Eastleigh Borough Council, Enable Leisure Sport England, which part-funded this work and Culture, YMCA West & Central Herts, through the National Lottery, as part of the SLL, Finesses Leisure Partnership, Borough Get Healthy, Get Active portfolio. of Broxbourne Council and Active All members of the Specialist Physical Broxbourne, Manchester Community Giants, Activity and Behaviour Change team at Active Luton, Get Berkshire Active, Greater Macmillan Cancer Support, past and Sport Manchester, London Sport, present: Jo Foster, Jacquetta Fewster, Lincolnshire Sport, Worcestershire County Elaine McNish, Emma Batten, Sarah Sports Partnership, Albion in the Community Worbey, Rhian Horlock, Justin Webb, Brighton and Hove, Tottenham Hotspur Jenna Stockwell, Kerryn Chamberlin, Foundation, AFC Bournemouth FC, Sheffield Kirsty Asquith, Arry Cain, Diarmaid McAuley, United, Notts County Fitness in the Margaret Greer, Yanaina Chavez Ugalde, Community, Luton Town FC, Sheffield and interns Harriet Hobbs, Jen Hall, Hallam University, Edinburgh Napier Risqat Fabunmi-Alade, Kirsten Hall, University, University of Surrey, Alex Hamilton, Naomi Wylde, Adam Lever, Bournemouth University, GLL Better, Fusion, Sara White. Creative designer: Lorraine 1 life, Places for People Leisure, Inspiring Cadd, Word to Print. Photographers: Healthy Lifestyles, Lifestyle Fitness, YMCA, Zalihe Collymore-Hussein, Naomi Huq, Bridport Leisure Centre, Motivate East, The SimonaJausovec and Mitsuko Oda. Conservation Volunteers Green Gym, Action Heart, Beth Johnson Foundation, Public Macmillan’s Physical Activity Expert Health Wales, Sport Wales, Sustrans, Pedal Advisory Group: Dr Nick Cavill and Power, YMCA, Maggies, Lets Walk Cymru, Professor Rob Thomas (Joint Chairs), Dr Tim Welsh National Exercise Referral Scheme, Anstiss, John Ainsworth, Dr WilliamBird, Betsi Cadwaladr University Health Board, Rachel Bryce, Kim Buxton, Dr Anna Aneurin Bevan Health Board, Cwm Taf Campbell, Dr Alan Maryon Davis, Dr Charlie Health Board, Hywel Dda Health Board, Foster, Layne Hamerston, Dr Jerry Hill, Abertawe Bro Morgannwg University Health Dr Melvyn Hillsdon, Jane Maher, Mariette Board, Powys Teaching Health Board, Mason, Ollie Minton, Ted Poulter, Karen Velindre NHS Trust, Sport Aberdeen, Robb, Dr Clare Stevinson, Dr Richard Weiler. Edinburgh Leisure, NHS Scotland, CLAN, We would also like thank all the Macmillan Health Scotland, Paths for All, Live Borders, geographic service development teams, NHS Dumfries and Galloway, Fife Sports and Evidence team, Move More practitioners Leisure Trust (FSLT), Glasgow Life, Moray and other service staff, and all the Council, Renfrewshire Leisure, Leisure and stakeholders, healthcare professionals, Culture Dundee, IJBs (Integrated Joint volunteers and service users who gave up Boards) Ards and North Down Borough their time on numerous occasions to share Council; Peninsula Healthy Living Centre; their lessons learnt, and who allowed us to South Eastern Health and Social Care Trust; participate in their service activities. This Antrim and Newtownabbey Borough Council; document would not have been possible Northern Health and Social Care Trust; GLL without their assistance and contributions: (Greenwich Leisure Limited); Belfast Health Development Unit; Active Belfast; Belfast The Academy for Health Coaching, Make Health and Social Care Trust; Armagh City; Sport Fun, Can Rehab, The Wright Banbridge and Craigavon Borough Council; Foundation, CFE Research, Public Health Southern Health and Social Care Trust. England, The Ramblers, Walking for Health, 02 Integrating physical activity into cancer care: evidence and guidance Purpose of this document This document builds on extensive research and evidence from Macmillan’s work with pilot physical activity behaviour change projects. It aims to: • provide decision makers with the evidence for integrating physical activity into cancer care • describe effective intervention models • demonstrate the connection to national policy and targets • outline the economic implications of investing in physical activity for people living with cancer • enable providers to decide on the right model and to implement it effectively as an integrated part of cancer care. This document is designed to be read in conjunction with: • Physical Activity and Cancer: the Underrated wonder drug1 • Physical activity and cancer: a concise evidence review2 Published 2018 This document updates and replaces Macmillan Cancer Support’s document How to run a physical activity project guide. 3 Contents Foreword 5 Executive summary 6 Section one: overview of the evidence 8 1. Background: physical activity and cancer 9 2. An evidence-based approach to integrating the promotion of physical activity into cancer care 20 3. Evidence from the national evaluation 32 4. UK-wide levers for change 43 Section two: how-to guide 46 1. Introduction 47 2. Governance 49 3. Service delivery models 51 4. The Move More workforce 55 5. Workforce skills and competencies 57 6. Awareness raising and referrals 62 7. Referral process 77 8. The Move More guide 78 9. The Move More back office processes 79 10. The physical activity behaviour change care pathway 80 11. Physical activity opportunities 85 12. Ongoing behaviour change support 96 13. Case review and exit 98 14. Ongoing management 99 15. Service sustainability 104 Appendices Useful tools and resources 109 Glossary 120 References 122 Integrating physical activity into cancer care: evidence and guidance Foreword One in two of us will have a cancer diagnosis support behaviour change and can support during our lifetime. Differences in our type of people with a range of long-term conditions. cancer and when we are diagnosed will mean our outcomes will be different. Macmillan’s evaluation and this guidance document show that the promotion of Whilst improvements in cancer diagnosis physical activity can be integrated into and treatments mean many people are living cancer care and people can be supported to longer, they are not necessarily living well. become and stay more active at all stages of Also, many people are living with disabling their cancer journey. consequences of cancer treatment and multiple-health conditions. This guidance document has been produced to provide health and social care Physical activity from the moment of professionals with the evidence and insight diagnosis has been called a ‘wonder drug’ they need to support and influence the as it plays a crucial role in both ‘pre- inclusion of physical activity in habilitation’ (before treatment) and commissioning or reviewing services in rehabilitation. Not only does it help improve cancer care. clinical outcomes, it can also help people take control of their lives, reduce social I hope you will join us in our mission to help isolation, and enable them to live people with cancer enjoy the benefits of independently. moving more. Macmillan has identified and developed ways to support people with cancer to be physically active. Through our pilot work in partnership across the UK with the NHS and James Austin, Director of Specialist Advisory local and national governments, we have Fay Scullion, Director of UK Partnership identified and developed models which Services Lilus and Melani with physiotherapist Stuart, at Guy’s Cancer Centre, London 5 Integrating physical activity into cancer care: evidence and guidance Executive summary Physical activity can help to improve clinical Evidence shows a healthcare professional and quality-of-life outcomes from diagnosis can trigger this teachable moment and help through to end of life. It has been called the motivate people to understand the underrated ‘wonder drug’. importance of moving more and inspire them to make a change, no matter their A cancer diagnosis is a teachable moment, circumstances and barriers to change. when people are more inclined to make positive changes to their behaviour. Macmillan has identified and developed ways However, despite this, people become less to support people with cancer to be active during cancer treatment and physically active, recognising the health remain inactive. benefits of moving more. We have identified and developed models which have the potential to support people with a range of long-term conditions and support behaviour change. A motivational interview with Susan, delivered by her physiotherapist, Isla 6 Integrating physical activity into cancer care: evidence and guidance Macmillan has developed a model of care This guidance document provides a that can be integrated into the cancer care comprehensive overview of the evidence, pathway to support people to become and insight and testing of the