Physiotherapist Anna Lowe reviews Exercise Management for Referred Medical Conditions

Exercise Management for Referred Medical Conditions

Editors: Andrew Scott and David Broom

Publisher: Routledge

Pages: 500

ISBN (paperback): 9781138104006. Price: £39.99

ISBN: (e-book) 9781315102399. Price: £35.99

ISBN (hardback): 9781138103993. Price: £120

This book is roughly divided into two parts; the first half provides a comprehensive review of the background to exercise referral schemes (ERS) providing useful context for readers who are new to this area. It also provides a contemporary view, including how quality and experience can be improved by integrating co-production approaches and ensuring that processes are personalised to the individual. It is good to see that complexity is recognised and that readers will be exposed to evidence-based aspects of behaviour change including case studies that bring this to life. The focus on sustaining behaviour change beyond a finite ERS is also very helpful.

I was particularly pleased to see that inequalities in health are acknowledged; this is dealt with mainly in Chapter 7, where minoritised groups are termed ‘hard-to-engage’ groups. This is followed by a detailed discussion of the challenges of terminology; however, the term ‘hard-to-engage’ is used consistently. The text recognises that this term has connotations of blame (the problem is with the individual/group not the intervention), but despite detailed exploration of these issues, still uses the term. While I agree that this is a challenging area and that terminology should not divert attention from the real issue, a term such as underserved groups might have felt more neutral and also fairer.

Key long-term conditions covered

The second half of the book is a series of chapters, each of which focuses on a key long-term condition, such as obesity, diabetes, asthma and osteoarthritis. The chapters reflect key conditions that health and fitness professionals are likely to encounter regularly and provide a practical overview of background pathology, management, benefits of exercise and considerations for ERS.

It would have been helpful to recognise that these conditions rarely occur in isolation and although people are often referred to an ERS for one condition, they are likely to have a complex mix of conditions with some conditions commonly co-occuring, for example, persistent low back pain and mental health, obesity and osteoarthritis. Furthermore, there is higher prevalence of health conditions within underserved groups, and they are likely to have greater complexity (more conditions, greater progression of disease and symptoms, fewer self-management resources including lower activation, lower health literacy) and are less likely to be referred to and complete an ERS programme. The book could be further strengthened by having more of a focus on health inequalities, including how disadvantage impacts on single conditions and multiple conditions and, critically, how ERS can respond and play their part in addressing inequalities in health.

A 'valuable resource'

This book is a brilliant introduction to ERS for health and fitness professionals. It would be a valuable ‘go-to’ resource for anyone new to this field and would equip them with helpful context and relevant considerations. Further editions could be strengthened by recognising population health trends, including the rise of multiple conditions and the need to design and deliver culturally sensitive services that respond to current trends in population health data.

Anna Lowe, PhD, is programme manager at the National Centre for Sports and Exercise Medicine at Sheffield Hallam University. Anna is employed by the university on behalf of NCSEM Sheffield – a partner collaboration including hospitals, universities, Sheffield City Council and a number of sport and volunteer organisations.