Walking football for people with chronic breathlessness – has it got legs?

Posted by Callum Bradford, Research Associate, Teesside University

Following on from the recent success of the England Women’s football team, and with the Men’s World Cup final just around the corner, now seems like a good opportunity to talk about our walking football project, designed exclusively for people with chronic breathlessness. What is walking football you ask? Well it's football, without running (you don’t say?!), and the physical contact is a bit more restricted. Thankfully, FIFA hasn't got its hands on walking football just yet, with the World Cup being an example of why we perhaps should avoid such a thing.

 

Chronic Breathlessness is predominantly caused by pulmonary conditions, such as chronic obstructive pulmonary disease (COPD), impacting 75 million people globally. With Covid-19 and an ageing population this number is expected to rise, increasing the burden on families, carers, and health and social care services. For individuals, breathlessness is associated with a lower quality of life, decreased capacity to do exercise, and higher levels of anxiety and depression

Pulmonary rehabilitation is recommended for everyone with breathlessness. Consisting of both exercise and education, its benefits on health are unequivocal, however, any benefits gained by patients are often reduced three months after completion. This is primarily because patients go back to doing less physical activity once the programme has finished and support from healthcare professionals is removed. With this in mind, we wanted to develop an intervention that could step-in when patients finish their rehabilitation, offering a form of exercise maintenance and continued social support. Given the nation's love of football (most of the time), we believed walking football might have potential.

To develop the intervention, we initially consulted pulmonary physiotherapists, and a local walking football team. The physios were initially very sceptical, raising concerns that the pace would be too fast, and highlighting the number of people with breathlessness who required oxygen or walking-aids. Walking-aids?! Oxygen?! I hadn't even considered that. I was starting to worry that this idea might be a complete non-starter.

So next stop was to see some walking football for myself at Middlesbrough’s Herlingshaw Centre. I left the session with mixed feelings. They played three-touch, meaning everyone got the opportunity to play, forcing that one player who thinks they're Allan Saint-Maximin to pass the ball. It was also proactively refereed to the benefit of everyone, with players encouraged to talk to the ref if they felt the pace of the game was too fast. However, after giving it a go myself, the pace was still surprisingly quick, despite what Father Ted might have you believe, bringing back concerns as to whether it would be too high an intensity. What I really needed to know was what patients themselves thought of walking football.

So we linked up with Breathe Easy Darlington, a local support group for people with lung conditions. Describing the input from Breathe Easy members as invaluable to our research over the last few years would be a massive understatement. So much so that, as a small thank you, we held a fundraiser for them last month on World COPD Day, raising £1120.76.

Their opinions would be vital to walking football’s success... however, they were also dubious of the idea. Again, concerns were raised about the speed, the walking-aids, and the balance required to play. So I asked, under what circumstances – if any – would they consider giving walking football a go? They stated that if the football was exclusive to people with breathlessness like themselves, they would give it a try, as they would be able to dictate the pace of the game and not feel too self-conscious of their footballing abilities. Our original plan involved asking patients to join onto sessions at the Herlingshaw. Luckily, by consulting with Breathe Easy members, I now understand how that plan – to mix people with and without breathlessness - would have likely ended in disaster, demonstrating the importance of including end-users when designing research studies.

Twelve Breathe Easy members agreed to play and the stage was set for our walking football taster sessions, and as you can see from our video, I don't think it could have gone much better.

The players embraced the competitive aspect of football, stating that “On the pitch you forget about breathlessness”; and the concern for walking-aids was turned on its head after we agreed that hitting the ball with a walking-stick is a perfectly fine way to score a goal. Our coach, Monty Towers, was key to its success, mixing up the session with fun games, while allowing everyone to play football at their own pace. In our follow-up conversations, members also suggested implementing a buddy system, where more experienced participants take responsibility for introducing new patients to the group so they feel more welcome – a brilliant idea that we intend to implement in the future.

Throughout 2023 we will be assessing the feasibility of walking football following pulmonary rehabilitation in collaboration with both North Tees & Hartlepool and South Tees NHS Foundation Trusts, plus the North Riding FA; and I’m confident if it’s anything like our sessions with Breathe Easy members, it will be a great success.

And if you’re still upset about the World Cup, don’t worry, I’m sure our walking football team will bring it home next year.

The views and opinions expressed by the author are those of the author and do not necessarily reflect those of Teesside University or Fuse, the Centre for Translational Research in Public Health.

Putting the 'occupation' in Occupational Therapy and debating its role in Public Health

Guest post by Andrew Graham, Registered Occupational Therapist and PhD Candidate, Teesside University

Having recently made the move from NHS clinician into academia (I started my PhD at Teesside University in December 2017), I arrived in Belfast for the Royal College of Occupational Therapy Annual Conference with an appetite to hear new and interesting research in the profession.

In my welcome pack, I received a copy of the RCOT’s Strategic Intentions which represent the leadership response to the challenges of the changing landscape of health and social care. The principle that stood out for me was to ‘position the Profession, and our members, for the 21st century’.

With my background in amputee rehabilitation I have seen first-hand the impact of socio-economic inequalities and lifestyle trends on amputation rate in North East England. For example, the amount of amputations due to diabetes, and more shockingly intra-venous drug use, has spiked in the past 10 years or so. As an Occupational Therapist (OT), I view the person holistically and always try to take into account the social and psychological not just physical barriers they will need to overcome post amputation. My focus will always be on what the person needs and wants to do. The person’s meaningful activities (occupations).


The pledge tree

During the conference, we were asked to make a pledge about how we would do our part to ensure the new strategic intentions are met. The pledge tree seemed to have a recurring theme of ‘ensuring occupation is central to my work’.

My own pledge was to better explain ‘occupation’ and its meaning within occupational therapy to a range of audiences.

So, my attempt at articulating ‘occupation’? I’ll go with ‘doing things that we need to do and want to do (meaningful activities), which enable a sense of self-meaning and improved health and well-being.

I feel as a profession we are experts in using occupation as a goal (top down approach) and/or a means (bottom up approach) to ensure provision of high-quality, client centred services. Utilising the OT process from information gathering to evaluation we strive to enable growth, confidence and self-meaning.

Despite OTs generally being able to better define what they do and what the outcomes can be, it was a bit of a shock to see that the debate at the conference highlighted that the profession is still unsure about its stakeholders. The topic up for discussion was ‘This house believes that Occupational Therapy needs to be predominately based in public health, not in secondary or tertiary services’.

From my experience, this issue had been debated and answered years ago. My pre-registration training saw me working in the NHS, community mental health teams, a special needs school and a charity. The OTs all had a prominent and effective role in these sectors, so as intrigued as I was to hear the debate, I knew which way I would be voting!

For the purpose of this blog I’d like to highlight the case for OTs working in Public Health. A starting point would be the statement by the professional body, which points out that the Public Health Agenda has been of increasing importance and relevance for occupational therapists, who facilitate health promotion through working with people of all ages to enable their participation in meaningful occupations (RCOT 2004).

The evidence base is also pretty strong. A systematic review of Allied Health Professions and Health Promotion (Needle et al 2011) reviewed 28 studies related to occupational therapy and Public Health, and found related interventions in the areas of mental health, arthritis, pain and fatigue, pulmonary rehabilitation, stroke, drug and alcohol problems, and falls prevention.

Not only are OTs already working with people on aspects of Public Health and health promotion activity, but there is an expectation that this focus will form part of the delivery of all occupational therapy interventions in the future. For example, I remember reading about the ‘make every contact count’ campaign when working on an acute stroke ward and making sure I asked about smoking and drinking habits as part of my OT assessment.

So, it was with no surprise that the result swung against the motion at the conference. A particularly convincing rebuttal speech was given by Professor Diane Cox and Dr Jenny Preston, clearly showing the professions ability to address Public Health matters but also reach a wider audience through demonstrating outcomes in secondary and tertiary services.

Overall, I left the conference with a sense that the profession has strategically positioned itself to demonstrate that it is making a difference and will continue to make a difference to the health and well-being of people in the 21st century. It is time for OTs working in Public Health and other services to be proud. In my favourite quote of the conference….‘we are not the jack of all trades, rather we are the masters of human occupation’.


Andrew Graham is investigating ‘Sensory Discriminating Training for Phantom Limb Pain’, as a PhD candidate in the School of Health and Social Care at Teesside University.