1. L.I.F.E. (Leisure Inclusion For Everyone) By Alison Harkess Staff Nurse – Learning Disabilities

2. Introduction Physical Health Mental Health Health Promotion Social Skills/Social Inclusion

3. PHYSICAL HEALTH To improve baseline fitness levels Healthy BMI Improve core fitness Maintain/improve mobility Off set co-morbidity

4. MENTAL HEALTH Reduce Depression Reduce Anxiety Increase motivation Improve wellbeing/coping ability

5. HEALTH PROMOTION Promote healthy lifestyle Explore how exercise affects the body and mind Increase personal expectations Safe/realistic goal setting

6. SOCIAL INCLUSION/SKILLS Community resource Increase social opportunities Promote independence/skills Transferrable skills

7. 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

8. 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

9. 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

10. 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)

11. L.I.F.E ‘Case study’ ‘Kevin’

12. 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 home 2 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 REH short term Aggressive outburst Back to same residential placement (one night) Police custody then respite care (three weeks) Inpatient LD resource NHS Lothian (March 2008) Similar aggressive outburst

13. ‘Kevin’ 29yrs Prader- Willi syndrome Mild LD Morbidly Obese (115 kg) High blood pressure History of aggressive/ violent behaviour Need of clear boundries/ rules & structure Language comprehension 8yrs old Increased risk of Type II diabetes Needs 1:1 supervision in community settings ‘Kevin’ - profile

14. Prader – Willi Syndrome Insatiable hunger Obesity/ morbid obesity High blood pressure Type II diabetes Hormonal imbalance Dental problems Learning disability Low muscle tone Behavioural problems (anger/ inflexibility) Mood swings/ difficulty with change Treatment/management Food restriction/supervisionDaily structure/routine Regular exercise Firm rules Hormone treatment

15. Kevin and the L.I.F.E programme Kevin joined the project - morbidly obese (115 kgs) - High blood pressure (medicated) - challenging behaviour Goals: assist with weight reduction increase confidence improve CV functioning reduce anxiety decrease blood pressure promote coping abilities improve muscle tone Programme: 2 x per week – Edinburgh Leisure 30 minutes cardio and range of equipment use Walk to/from gym (2 miles) Reduce co morbidities Extend life expectancy

16. Results… KEVIN NOW 66 kg (49 kg weight loss) Decreased Blood pressure Increase CV functioning (reduced resting HR) More sociable/ happier more in control Improved muscle strength More confident