A Manchester GP and clinical lead for cardiovascular disease prevention in Greater Manchester is working with a collective of public sector leisure operators to help diffuse a potential time bomb unwittingly ticking away inside hundreds of thousands of people across the city-region.
Dr Aseem Mishra, CVD prevention lead for the Greater Manchester Integrated Care System (ICS), is collaborating with GM Active, a collective of 12 leisure and community organisations representing all 10 local authorities in Greater Manchester, to re-focus the lens on how hypertension – high blood pressure – is perceived, treated and managed.
Data from more than three million GP records compiled for the Greater Manchester ICS show approximately 420,000 known cases of hypertension in the city-region at the end of February 2025. However, Dr Mishra believes the total could be more than double that as hypertension doesn’t display symptoms except in extreme cases, while blood pressure testing in healthcare settings and at home is not prevalent enough.
“Hypertension is now the single biggest global risk factor for preventable deaths and disability adjusted lifespans,” says Dr Mishra. “It accounts for roughly half of all strokes and myocardial infarctions – heart attacks. Yet we still don’t know the prevalence of hypertension in an estimated 40% of the population. This is, unfortunately, not just a primary care or secondary care problem, but a whole system issue.”
Based in Wythenshawe, one of the multitudes of Greater Manchester areas with high levels of social deprivation, Dr Mishra cites health inequalities as a huge factor in the causes of CVD. This has prompted his collaboration with GM Active, whose GM Moving in Action strategy shares the desire to tackle health inequalities in the pursuit of getting more people physically active to improve community health and wellbeing.
Jon Keating, GM Active’s Head of Business Operations: “We have a coalition of 3,600 staff and 99 fitness and community facilities – Dr Mishra’s surgery is based in one of them at Wythenshawe Forum – and we believe we can play a significant role in offering physical activities that could help to combat hypertension.
“Aseem has set the scene that hypertension is a massive issue. We’ve spoken about the fact there isn’t an easy fix, but there are some quick wins in terms of getting people to raise their heart rate by being physically active.
“This piece of work is around how we can connect and work together to try and stop what has been described as a ticking timebomb with a holistic approach that’s not just about exercise and not just about taking tablets.”
Dr Mishra: “Healthcare doesn’t exist in a vacuum and there is often a complex interplay between healthcare, society, politics and economics. For me, the appreciation of the complexity and overlap between classically clinical pathways, wider social and demographic factors and particularly the fields of medicine and public health is the key to not just CVD prevention but for improving the whole of the healthcare system.”
Dr Mishra believes the perception of hypertension is misleading and needs to change to be more holistic: “We often we end up scaring people and causing anxiety when we talk about hypertension.
“It’s not a disease in the same way that you suffer pain, or you have cancer. It’s a risk factor; we know that people with higher blood pressure are more of at risk of heart attacks and strokes.
“But hypertension is getting into a grey area where it might be due to a sedentary lifestyle, it might be due to what you put in your mouth. It might be due to your genes, or in reality, a combination of all those.
“Rather than the standard high blood pressure messaging that you’re going to die of a heart attack type of stuff, we need to frame it in a positive way because there’s so much, we can do about it with treatment and with physical activity.
“People are siloed from the place they’re coming from. For example, charities like the British Heart Foundation are very medical, and lifestyle is just noted. Then there are other people who are all very non-medical and just talk about lifestyle and leave the medication stuff.
“So, I think it would be quite innovative if we were able to balance everything – create the holistic approach Jon has spoken about.”
The hypertension focus has developed from a cardiorespiratory training workshop organised between GM Active and the NHS Greater Manchester Neurorehabilitation and Integrated Stroke Delivery Network (GMNISDN).
It brought exercise professionals, physios, clinicians, and academics together under one roof to create better understanding and a stronger network to support for GM communities.
GMNISDN has since invited Mr Keating and GM Active colleague Michelle Childs, who chairs its health sub-committee, to address its 10th anniversary conference in Manchester in June, when they will be speaking about cardiorespiratory training to support CVD prevention and neurorehabilitation.
Before then, Mr Keating and Kate Harding, Strategic Lead, Health Inequalities, at GM Moving, will be speaking about the role of exercise at the GM Long-term Health Conditions operations and information exchange for clinical and locality leads next month.
Our Head of Business Operations, Jon Keating, is recovering from a hip replacement operation that took place between Christmas and new year.
Having declared himself his very own case study, Jon’s been chronicling his journey from his very first consultation to the time of writing.
Now, three months into his rehab, he has written this third blog contemplating how much more our sector could do to support people on a similar journey. Prehab4Surgery anyone?
As a sector specialising in physical activity – can we do more to help people prepare for surgery? Yes 100%. I’ve mentioned it before, but helping pre-surgery patients lose some weight (only if they need to do, of course), will help with mobility on crutches and not make climbing the stairs or taking a little walk feel like a marathon.
Encouraging and helping people to build upper body strength, certainly for the first week post-surgery, has to be critical too. When you’re on crutches you’re using your upper body for almost every movement, so the stronger we can help patients become, the better. Finally, flexibility, core strength and balance have been key post-surgery. I’m so pleased I did a lot of Pilates, among other things, in the build up to surgery (thanks to Life Leisure Cheadle and Tatton House Studio) – again important areas that we could promote more for pre-op patients.
Part of the Greater Manchester Combined Authority Live Well policy is proactive care. Hip and knee replacements are commonplace these days and the examples I’ve cited above really demonstrate the opportunities we have to help pre-op patients with proactive care. So, we need to forge those connections with hospitals and their waiting lists even more and be that extra support network to help individuals be ready for surgery as much as we can.
Here’s a thought. I waited around three months from initial surgeon consultation to surgery date (I know I’ve been lucky in that respect). Whilst I do have gym membership, if I didn’t, could there be an opportunity – much like Prehab4 Cancer – to give membership to those waiting for surgery? Discuss!
How to fund memberships would be open to debate, I know. But I look at all the kit I have been given – crutches, grabbers, sock applicators, raised toilet seats and more, and realise this is easily worth a few hundred pounds. A six-month membership for people waiting for hip or knee surgery would make such a huge difference.
Here’s how it could work:
Membership for three- or four-months pre-surgery. Freezing membership for a month when the op takes place, then two- or three-months post-surgery for rehab.
This would truly be proactive care, helping our health colleagues and more importantly supporting the individuals to regain an active lifestyle and return to normal life, pain free, sooner rather than later.
A big part of our role is to create behaviour change, and maybe such an offer would create this for those that could and would be willing to benefit from it. (And that’s another challenge, I know!)
Having been given the green light to forge ahead with my rehab, that’s where my efforts and energy have been focused. Sometimes I admit pushing way too much.
Despite staying as active as I’ve been able to, I’ve still managed to gain around 6kg (that’s nearly a stone in old money) in weight. I’ve actually managed to wear through the feet of my crutches and needed replacements. As a Man United fan (not something I should shout about too much at this time) I went for some red ones!
As an avid, former competitive swimmer, getting back in the pool has been amazing. I did one session of hydrotherapy as an NHS patient, (it comes as standard for private patients). My physio recommended that going to one session to be taught the exercises would be of huge benefit. It certainly was, but £67 for the privilege? Definitely, my most expensive swim ever!
I’ve since continued to get into the small pool sessions at Cheadle and Hazel Grove (not quite the warmth of a true hydro pool), but beneficial, nonetheless. But my real point here is that if we are in a space of breaking down inequalities, £67 for a hydro pool session doesn’t sit comfortably with me.
Those that can afford it recover and rehab more quickly. But we need to be working more collaboratively with colleagues in health care to inform people of the sessions at Cheadle, Hazel Grove and many other venues across GM that are more affordable – around £5 rather than £67. I will caveat that, however, and add that it would be without qualified physios supporting you.
I was around four weeks into my recovery when I started feeling OK to start walking crutch-free around the house. I have a Garmin watch and for those that are familiar with them, my Garmin badges have really helped to motivate me. Time to walk (15 hours in a month), Active Month (20 x 20 minutes), Monthly Gains (4 hours of strength training), which kept me up with my physio exercises. However, during one of our sessions my physio told me I needed to get a ‘bit braver’, I was too reliant on the crutches – hence the replacement feet, no doubt!
It is of course, a mental thing; the hip is strong enough to fully weight bear from day one. Trusting the new hip to be able to do that is another matter for the little chimps inside my head stopping me from believing it. That’s why the pool sessions were so positive. The competitive nature in my own head has meant I continue to ask the physio whether I’m ahead or behind in terms of rehab. It’s always nice to hear ‘you’re definitely ahead’. The Garmin insights have been horrible to read. My Vo2 max has plummeted by 10, my resting heart has increased, weight gain, poor sleep, and de-training! But the positive is I’m back exercising now. In the last few days, I’ve managed a 2k swim and 20 minutes on the exercise bike.
But a big one for me has been getting back to rugby coaching, just being out again and supporting the development of a great bunch of lads. That’s been hugely rewarding from a social and mental health perspective. I have made some mistakes along the way, I took a trip to the pub to watch the 6 Nations Rugby Union for the day. Bad mistake and I suffered for it the following day (and I don’t just mean with a headache!)
By pushing too hard I gave myself what can only be described as a feeling of a really bad groin strain. At the time of writing, I’m due to return to the physio, where I hope to be given the green light to do more and hopefully be able to tie up my own shoelaces again!
I guess this is where the real work begins. Losing weight, regaining fitness and being able to do a tumble turn whilst swimming again. Let the journey begin!
But in the meantime, a huge thank you for all those that have helped me through this journey and the support given by my employers. A special mention to my partner, Emily, for her patience throughout! I’m not the easiest patient to deal with. Thank you.
If you’re about to embark on a journey of this kind, or you know someone who is, I can only say it does get better quickly. But there is so much you can do to prepare.
As I said earlier, physically, lose weight, build upper body and core strength, and build up your cardiovascular fitness too.
Practically, get the home ready. Place all those things you need above waist height, do some batch cooking and freeze some. Where possible, create a support network and if you don’t have one be honest about that with health care professionals. Get some Skechers slip-ins!
Post surgery, think about having some books to read, or other interests to keep you busy (like writing a blog 😊). Look at what’s available locally to support your rehab – pools sessions, local walking groups etc. Most importantly stick with the rehab, do the exercises and get walking as soon as possible.
Finally, I have expressed to my physio that I’d like to get running again, something I didn’t think was going to be possible. But looks like it will, so I’ve been encouraged to download the couch to 5k app.
I can’t use it yet, but I can’t wait until the day dawns that I can.
Our Head of Business Operations, Jon Keating, is recovering from a hip replacement operation – not a surprise (we’ll recap on that in a moment), but at the age of 46, it is a little sooner than he anticipated.
Having made himself his very own case study, this is Jon’s second blog in his series looking at his experiences of the NHS and reflecting on how our sector supports him after surgery.
Here, Jon chronicles the events on the day of the operation, which took place between Christmas and new year and the trials – and some tribulations – he’s encountered since.
If a doctor ever tells you an injection will feel like a bee sting, be prepared for the biggest, most painful bee sting you’re ever likely to encounter. That never-to-be-forgotten moment happened when I was given an epidural into my spine to prepare me for my new hip operation at the Alexandra Hospital, known as The Alex, in Cheadle on the outskirts of south Manchester, a plush private hospital supporting the NHS in one of its many hours of need.
It was the culmination of a day that began with a mix of anxiety and anticipation. Having arrived at The Alex early as instructed, I found myself stuck in my private hospital room until 1pm. I wasn’t allowed to go walkabout, which made the wait feel even longer, and it’s fair to say the anxiety triumphed over anticipation when, as I walked to the operating theatre, my vitals were all over the place – blood pressure displaying an amber warning and a sky high temperature.
I was worried the surgery might have to be postponed but it wasn’t, and I soldiered on manfully (well, that’s my version!)
Earlier in the day, as I endured my hospital room imprisonment, I had a visit from Occupational Health to talk me through what was going to happen and to pass on advice about best practice after the operation, such as keeping your hip higher than your knees for three months, avoiding my hips going beyond 90 degrees, getting dressed with a litter picking-style claw, using a sock applicator, and something that looks like a fishing net, but without the net, for getting your leg into bed.
A word to the wise if any clinician is reading this – I couldn’t help but feel some of the information would have been much more beneficial earlier in proceedings, as in not on the day of the op, as it left me feeling totally unprepared for what was to come.
For anyone who hasn’t read the first chapter of my new hip journey, it is the result of something called a slipped epiphysis of the left femur. It happened when I was 16 and I was told at the time that I could be susceptible to some complications when I reached my 40s or 50s. Impeccable timing if nothing else!
The immediate aftermath of the surgery is a blur. My legs felt like they were stuck in the air, and I couldn’t feel them at all. The swelling in my operated leg was significant and was still swollen three weeks later.
Intermittent pneumatic compression, known as IPC, is necessary to prevent deep vein thrombosis after surgery. The IPC device uses cuffs that fill with air to squeeze your leg and increase blood flow through the veins, but its constant inflation and deflation prevented me from sleeping properly.
Regular monitoring and pain relief were a constant, but the sensation of numbness was unsettling. I kept fighting to move my legs, but the nurse kept saying, ‘Jon it won’t happen’.
Anyway, we got to chatting and it turns out my nurse used to be a competitive swimmer just like I once was, so we had a nice long chat about that. It certainly kept my mind off other things before I had to confront the inevitable – the first tentative steps using a Zimmer frame and, later, crutches.
Here I am giving it my best shot but not without a grimace or two!
Using a Zimmer frame, and crutches, was a new experience while getting into bed required a leg lift, which was no easy feat. Here’s what I mean…
While getting used to using a Zimmer frame and crutches is necessary, being given them for the first time after surgery, when you’re at your most tender, isn’t ideal. The pain is relentless and managing it is a full time preoccupation to the point of being exhausting.
Pre-surgery practice with both aids would be very beneficial and I think it would have helped me a lot. I would say the same about post-surgery physio too – doing the exercises in advance of the operation would be good practice and, again, very beneficial.
One final insight – using crutches takes a painful toll on your hands, so be prepared for that.
Going home isn’t an option until you’ve proved you are proficient and reasonably mobile on crutches.
The ride home was uncomfortably challenging, as was the journey to the car in the first place. I was given a low wheelchair that made me bend my hips beyond 90 degrees, going against every piece of advice that this needed to be avoided. I think I would have preferred to walk to the car!
So, what’s it been like being at home after the operation? The aftermath of such an operation is an all-consuming house of cards – one issue leads to another and then to another and so on.
Finding a balance between sleep and pain control (the volume of medication was overwhelming to begin with) is a constant struggle. Fatigue sets in quickly, making everything feel like a monumental task. That particular issue hasn’t been helped by a loss of appetite – struggling to eat doesn’t help recovery. And don’t talk to me about the constipation! This unexpected and uncomfortable side effect might be alleviated with some guidance on food and diet.
Everyday tasks have been transformed into mini challenges. Anyone who has been through this experience will already know that getting dressed is a new creative experience, using a litter picker to help with dressing and a sock device to put on your socks!
Chronicling my journey in this way is partly to reflect on how our industry, let’s call it leisure for now, helps to get me through rehab. That’s another chapter I’ll share with you later on.
For now, much of my rehab has been at home. The process is slow. I like to set myself little targets for the number of steps in a day, but frustratingly, my Garmin doesn’t seem to count steps when you’re using crutches.
Here I am doing some of my exercises…
I must confess, frustration has crept in on occasions. It was difficult to see the small wins amidst all the challenges. I sometimes felt like I’d lost my mojo (although friends and colleagues will be glad to know I’ve got it back again!)
My rehab has coincided with one of the worst cold snaps for several years and that led to another learning curve.
A trip to Aldi (other supermarkets are available) resulted in the crutches going out from underneath me when I encountered a wet floor.
It was pretty scary and really does highlight how those people who are frail, or who have a disability, or balance issues, could face into isolation in inclement weather. Another lesson, but an important one, is the flooring we use in public places can be lethal if they are only slightly wet.
On this occasion, I had my partner Emily with me, thankfully, but I’m not keen to go again and repeat it. On a more positive note, I’ve found snow and crutches can be compatible if you stick to grassy areas, it’s help me get out and about and being in outdoors has done me a power of good.
A massive thank you to Julie Ford, a PE teacher for 48 years and still going strong, who has been involved in health, fitness and wellbeing for the same period of time. Julie is the creator of INSTEPP, an innovative and unique walking resistance invention.
We’ve never met, but Julie saw my story on LinkedIn and got in touch. We chatted about rehab post-surgery, and she has since sent me the instepp.co.uk equipment to help regain my strength and build back my fitness. We’ve since had a really lovely chat on the phone.
The kindness of strangers.
From a personal perspective, I think the following is critical – build up upper body strength and lose weight if you’re packing a few extra pounds, which will make moving about on crutches easier.
However, my best advice for anyone facing this surgery would be to get your house in order for the post surgery period:
Importantly, protect your mental health. There’s been some dark moments, particularly when I was unable to get any fresh air due to the cold snap.
Arguably I’ve done this a little bit soon, but I did manage a little trip to the local for a Guinness 0.0 (it’s dry January after all!) or two. Creating a sense of normality and catching up with mates really gave me the boost I needed.
I’ve also managed a few hours in the Life Leisure offices, and it felt so good again, to be mingling with work friends for a few hours. It’s those little wins and keeping the mind active and stimulated that I believe are as important as the physical recovery.
Jon will be back with more reflections and experiences of his hip replacement journey in the weeks to come. Stay tuned. In the meantime you can also follow his journey on LinkedIn.
At the tender age of 46, our Head of Business Operations, Jon Keating, has been told he needs a hip replacement.
It’s not come as a surprise (more of that in a moment), but it is a little sooner than he thought.
That means Jon has become his very own case study – and in a series of blogs in the coming weeks and months, he is going to share his experiences of the NHS and his learnings about how our sector supports him to prepare for surgery, and more importantly, how it helps him recover and come back as JK mark 2 in 2025.
Read on as Jon explains how he comes to need a new hip and reflects on the first part of his journey that will culminate in surgery between Christmas and new year.
All I want for Christmas is my new front teeth. Nope, let’s change the words of that festive jingle…all I want for Christmas is my new left hip!
Why is that? To give you some context, I suffered something called a slipped epiphysis of the left femur (or in my dad’s simplistic view – your leg tried to fall off 😊) when I was 16. Therefore, I was told when I reached my 40s or 50s I could be susceptible to some complications.
As much as I hoped that wouldn’t come true, sadly it has. I’ve ignored the signs for a while now (as in a couple of years or more), but this year the discomfort has become that acute I finally realised I needed to get looked at.
Cue my first interaction with the NHS.
It was difficult to get a local GP appointment, but after some weeks of waiting I did manage a telephone appointment. In fairness, by looking at my medical history they immediately sent me for X-ray.
I was given a drop-in X-ray appointment with no need to book. I wasn’t aware – or told – that this was only available Monday to Friday. So, having initially turned up on a Saturday morning (before the Saturday sports injuries – from personal experience – started arriving), it meant a trip back the following Monday.
I was in and out of X-ray within about 30 minutes, which was excellent. It then took around two weeks for my results to appear in my NHS app, with a message to book a follow-up with my GP.
However, I couldn’t get a GP appointment for another two weeks, yet I was able to read the radiographer’s report.
To my horror, I had severe OA in both hips, and the report featured many other words that meant nothing to me.
It was going to take two weeks to find out what it all meant. So, as we’re probably all guilty of, I turned to Dr Google. Big mistake! That created more fear than the answers I was seeking.
The real horror for me, was the shock of both hips. I honestly feel little pain or discomfort in the right hip, so it was something of a shock that both were bad.
As our sector is now (bit-by-bit) becoming more connected to academics and healthcare professionals, I was able to call on a few people for some enlightenment, particularly Kris Sorenson, from Keele University, rather than waiting patiently for a fortnight, which is not in my DNA.
It turns out OA is the medical abbreviation for osteoarthritis (every day is a school day).
Anyway, this is how the conversation with Kris went.
“Jon, shall I sugarcoat this for you, or give it to you straight?”
“Straight please, no point in fluffing round the edges.”
“Ok, well your hip joints are pretty x@x@%! In short, you need a hip replacement on both hips, but high priority is the left.”
Holy cr%p! Wowsers! and many other expletives went off in my head.
I finally had my GP appointment – in summary confirming what I already knew. But some pain relief (particularly for sleeping) were prescribed, a physio appointment booked along with a referral to a hip specialist.
I have to credit the system that all these things moved quickly, seeing a physio about a week later and then my NHS referral to The Alexandra Hospital, in Cheadle, a couple of weeks later. Yes, a private hospital easing the NHS burden.
In that vacuum between X-ray report and GP appointment, I spoke to colleagues who encouraged me keep on exercising. I had lots of offers of help and support from exercise professionals (Michelle Childs, Jack Murphy, Kris and others) which has continued since.
Taking on some advice, I stopped running just to avoid some high impact exercise, at least until I had seen a consultant and/or physio – but more on that later. I have to say, my mental health took a hit immediately. Possibility versus reality are very different things to deal with.
Weirdly and maybe it’s a case of my mind doing tricks on me, since having the X-ray the pain has significantly increased. That’s certainly my perception and therefore my reality. The pain and discomfort has gone from bad to worse.
The message from the physio was to keep on doing what you’re doing. And, by the way, we don’t consider running to be high impact. Avoid football and racquet sports etc, where you’re twisting and turning rapidly. A run around the streets or on a treadmill will be fine.
There’s a definite message here for those carrying health conditions or managing pain. Staying active is key.
But what struck me as I waited for the physio was the lack of information about that crucial message. No advertisements, posters or links to exercise classes, local facilities and services that could help. No personal actions that could help manage pain etc. Neither was I asked what I had access to, which I thought was a big omission.
Once at the Alexandra to see a consultant, I was told I had three options:
My response was to ask the expert which option he would choose in my place.
“Well, having looked at your X-ray, you only really have one choice and that’s option three. So, let’s look at dates and get you booked in.”
I could have been booked in for surgery about six weeks later, but I couldn’t commit to this. Instead, a Christmas ‘treat’ awaits me.
What can I do to manage my pain and be as ready for surgery as possible? I enquired.
The reply was to keep doing all the things I am doing but then – mixed messages alert – the consultant advised against running – it’s too high impact!
It’s a strange feeling, I’m not particularly a big running fan but over the last couple of years I have taken to it, and the health benefits from it have been immense. Being told you shouldn’t do something actually makes me miss it and makes me want to go for a run.
Since I’ve stopped I can see from my Garmin watch my VO2 max decreasing, but I guess I’ll get this back in the new year with body parts upgraded.
Where the consultant and physio have been consistent is in promoting Pilates, swimming and cycling. From personal experience, once I’ve done these activities I do get a huge natural pain relief for a while later.
And in a repeat of my physio experience, there no questions, no promotion and no signage about what I could access or what is available locally.
Is this where we as a sector need to be making proactive links? That is, it’s on us to forge these connections and make them happen rather than waiting to be ‘invited’.
I continue to be as active as I can be, sometimes pushing a little bit beyond the pain barrier. Maybe the ex-sports person inside me, still has the ‘no pain, no gain’ attitude circling inside my head. What I do firmly believe is the more I do now, then the speedier recovery will be in the new year.
I can see that there are some areas where patient messaging could be improved, but in truth I cannot complain about the speed with which all of this has happened.
I feel lucky and grateful to be in this position. I’m in such a superb place with such a support network around me to help me through this.
But it does leave me pondering what this would be like for those less fortunate souls, without access to the people, facilities and classes etc that I have at my disposal.
It’s a tough journey with support, so without it, and if I was older, less mobile, more sedentary and many other typical challenges for those people with this common ailment it would be incredibly difficult.
Isn’t this where whole system change can come into its own?
Watch this space as I report a little more about my journey.
People taking part in a postural stability course do so for a variety of reasons and cover a large age spectrum, from people aged in their mid-50s to some clients aged 80 and above.
Fear of falling, hip replacements and many other personal circumstances that culminate in deteriorating health and mobility are cited as reasons for taking part, many through referrals.
Let’s take a look at some of our case studies.
When MB joined the class, she was very afraid of falling and felt that she needed to rely on others for help.
MB has a musculoskeletal condition and did not feel confident getting up from a chair, walking without support or on uneven pavements.
During the 24-week Postural Stability course her confidence improved significantly, she stopped using her walking stick and in her final assessment completed 11 sit to stands in 30 seconds.
Midway through the course MB was encouraged by her instructor to join Broughton Leisure Centre, for which she received a three-month gym pass via the Exercise on Referral programme.
After the induction she started using ladies-only gym at Broughton Leisure Centre, which boosted her self-esteem and ability to go out. She’s also started enjoying swimming with her daughter.
VB was initially quite reliant upon her stick for walking but in her sit to stand at week 1 managed six sit to stands.
She was very disciplined with her exercises throughout the course and was keen for home exercise and any progressions.
She soon made friends with other members of the class and would look forward to coming. The instructor noticed VB’s improvement throughout the course as she began holding herself much better and seemed to have a lot more energy.
She started arriving to the class in leggings and trainers and at week 12 did 13 sit to stands. This improvement continued and she started coming to the class without her stick and by week 24 achieved 15 sit to stands in her assessment.
After years of seeing such incredible improvement in clients’ ability, it has been agreed that on future courses, with client consent, we will request to take video footage in the first few weeks attendance and again at the end to capture their achievements which can then be used to show new clients and commissioners.
BD was one of the younger clients in a class but struggled with her mobility and balance quite considerably.
When she first started attending, she was adamant that she couldn’t get up but to do so would have to sit sideways and use her arms to push up from the chair and the back of the chair.
She came across as quite introverted but quickly seemed to enjoy the classes often smiling during the exercises.
She attended on a regular basis and worked hard in every session. At week 12 she achieved 3 sit to stands and at week 24 she managed 4.
When the 24-week course came to an end at Worsley she was invited to do a 12 week top up at Wardley Community Centre.
She quickly settled in and opened up about herself to the group and would regularly have her fellow classmates laughing. One week she said she wanted to tell the instructor something at the end, but instead decided to share with the group the news that she had lost 2 stone!
She had started walking again regularly between the sessions and she was very motivated with her exercises although still sometimes doubting her ability then demonstrating to herself that she could in fact walk on her toes for example. At the final week of Postural Stability top up (36 weeks) both the instructor and BD were looking forward to her assessments and sure enough in 30 seconds she achieved a phenomenal 14 sit to stands.
BD is now attending the Step-Up maintenance class and after losing so much weight she attended her first gym induction with her Step-Up instructor.
She is over the moon with her progress when we reflected how far she has come.
AP began attending Postural Stability and was later referred onto a top-up class as his health had sadly deteriorated as had his mobility.
In the previous year he had managed 10 sit to stands in 30 seconds but in assessments at week 24 could only manage 1.
When he first started attending the top up class with a new instructor, he seemed to have very little motivation. It could take him around five minutes to walk from the taxi, parked outside, into the room.
As the weeks went on and with constant gentle, light-hearted encouragement, AP started getting more involved and turned out to be quite a comic.
It started taking him much less time to walk in/out of the class and by the end of the course he was actually doing a few extra exercise repetitions without any encouragement.
In his week 24 assessment his leg strength and stamina had returned significantly, and he completed 11 sit to stands with which the whole class were over the moon!
Below is just some of the quotes we have captured from clients.
“I was trying to open the gate in my garden, one of tiles moved and I fell forward hurt my knee and elbow. But I didn’t panic – I just turned myself over, pushed on all fours and stood up like you told us!”
“I’m benefitting therefore I’m determined, and it’s also good meeting people – we’re in it together.”
“Improved confidence, not as reliant on stick, and improved fitness.”
“It gets you out, I’m benefitting from exercising, it gives me motivation, and my fitness has improved.”
“Has given me motivation, maintaining mobility, and improved leg strength.”
“I’m picking my feet up better and standing better.”
Ideas and projects are continuously evolving and progressing at GM Active. View our latest news stories below to find out how we are moving as one and contributing towards building the healthy, happy and prosperous Greater Manchester we all aspire to.
Just as the public sector leisure industry aspires to create a universal offer to put it at the forefront of the preventative health agenda, an existential crisis lurks in the shadows in the form of a reliance on fossil fuels to power our venues.
The potential saviour is Greater Manchester’s ambition to become carbon neutral by 2038.
Here, our Head of Business Operations, Jon Keating, looks at some of the solutions put in place by members of the GM Active collective that could help to turn ambition into reality, and argues the cost of losing facilities is too great to contemplate.
At GM Active we are committed to supporting the ambition of the Greater Manchester Combined Authority (GMCA) to be carbon neutral by 2038. It is vital that we as GM Active play our part in making this happen, and therefore we have included it within our four-part We Move as One strategy, the fourth element of which says:
In light of that strategy, particularly its overarching aim and sub-sections one and two, we’re going to share information about some of the initiatives within the GM Active collective that are aiming to turn ambition into reality.
With the benefit of hindsight, we now know the greatest challenge to our sector was not actually the Covid 19 pandemic – it was actually the energy crisis.
Whilst our losses across Greater Manchester were relatively minimal, nonetheless there were many facilities potentially at risk.
There has to be a better, more secure future for our venues. We know that the technologies exist to move us away from our reliance on fossil fuels. Greener and sustainable solutions can radically reduce our carbon footprint and significantly reduce utility costs too.
A number of provisions have been applied at centres across GM. Here is a selection of some incredibly significant ones (not to hide from the challenge that these are about the carbon footprint and costs associated with our swimming pools):
So, there you have it. Solutions are out there, they just need to be unearthed and put into practice. There’s bound to be more to come. Arguably it’s too early to say whether these solutions are successful in both cost reduction and carbon reduction, but in the coming months the picture will become clearer.
But what it does strongly demonstrate is our commitment not to be held to ransom by fossil fuel costs, and for solutions to be sourced to reduce costs and carbon emissions.
We know that swimming is a hugely subsidised activity, due to the costs of running a pool. But there is another way, the technologies exist for this not to be the case.
This is why we have looked farther afield too, such as the St Sidwell’s Point facility in Exeter, the first leisure facility in the UK to be built to the ultra-energy efficient Passivhaus standard, meaning energy consumption is reduced by 70% when compared with industry best practice standards.
Could Passivhaus be the solution for any potential new facilities within GM?
Whilst solutions exist, the challenge is the capital investment required to make these retrofit changes.
The then-government’s announcement that £63m was being made available to support publicly owned swimming pools and leisure centres as part of a one-year scheme to relieve pressure caused by high fuel bills was welcomed at the time and many boroughs across Greater Manchester benefitted from this, but it did not go far enough.
Likewise, we welcomed the opportunity to host Ofgem to explain and demonstrate why the sector has such significant energy challenges, which you can read about below.
As an ex-swimmer and employee of both the STA and Swim England for many years, I am passionate about doing all we can in protecting community assets.
A recent data collection of school swimming stats for GM has shown the number of children not learning swim to the MINIMUM basic standard of key stage 2 is quite frightening – it’s gone from 1 in 5 to 2 in 5 (according to research by Swim England).
Therefore, we embark on a worrying trend and cycle. Pop up pools in schools are not the solution as this removes ties with the local community assets, the very venues that we want schools, families and children to support.
What we could be facing is a vicious circle and not a positive one. If more pools were to close then less children will have the opportunity to learn to swim (not withstanding that we live on a relatively small island and open water is always close by wherever we are in the UK). Therefore, the total of our potential customers of the future diminishes, thus creating less demand for swimming pools. It’s a worryingly downward cycle.
If, however, we continue to retrofit innovative technologies, and reduce our carbon footprint and costs, then maybe we can see some light at the end of the tunnel.
Yes, it is easy to focus on pools but in reality, this is applicable to almost all sport and recreation facilities.
As we aim to create a universal offer and be at the forefront of the preventative health agenda, we need to commit to Greater Manchester’s 2038 targets and in tandem ensure all our facilities are sustainable community assets able to support health outcomes and much more besides.
The GB success of Paris Olympic and Paralympic Games 2024 show that our facilities are significant in helping athletes of all ages realise dreams and fulfil their potential.
Failure to protect our venues widens our inequality gaps rather than reduces them. I for one believe we have a duty to our children, indeed all future generations, and society as a whole, to protect these vital community assets for all the powerful benefits they can bring.
We lost a significant facility in Ashton Baths back in 2023, for this very reason. Let’s hope we can avoid any more.
Solutions do exist but require capital investment for green and cost reducing solutions. It’s not too much of a stretch to say finding that investment could be a matter of life and death for our sector, and possibly for some of the people we serve.
This case study was developed as part of the SLC’s work on the GM Active Pivot to Active Wellbeing strategy aiming to address health inequalities through the transformation of public leisure services.
The aim of the Public Health Outcomes Framework is to maximise the contribution that Salford Community Leisure (SCL) makes towards the delivery of public health outcomes in Salford against the priorities of the Locality Plan.
The work has been steered by a small group of officers from SCL and Salford City Council’s public health team, who jointly agreed the priorities and workstreams.
A whole organisation approach has been taken to maximise the opportunities for SCL to make an impact at a strategic level.
The specific focus for SCL was in the support for cancer, cardiovascular disease, smoking, vaccines and immunisations, mental wellbeing, suicide prevention, risky behaviours and the wider determinants of health such as poverty and welfare.
This could range from advice as part of Making Every Contact Count (MECC) to offering specific services, support or screening programmes.
All this was in addition to the contribution SCL was already making in raising physical activity levels through its sport, leisure and fitness and community services.
The work has been managed through a work programme which sets out how SCL will contribute towards each of the key themes. Practical and tangible examples includes:
This programme is likely to heavily influence the public health-related outcomes, measures and social value KPIs that will be agreed as part of the SCC/SCL contract post 2025, as well as the emerging 10-year Sport, Leisure and Libraries strategy led by SCC Place Directorate colleagues.
As part of this, the public health portfolio lead for physical activity is meeting with other local authorities to learn how they have collaborated with leisure trusts to ensure an equitable, fit for purpose and holistic offer.
In the immediate future, SCL are gathering stories to evidence the impact related to the thematic workstreams.
This is a long-term strategic programme of work and so far, successful outcomes have been achieved by all parties being honest and transparent and developing good working relationships.
Most importantly, SCL and the council’s public health team have been willing to work together to achieve council priorities and deliver value for service users, communities and their organisations.
But the change process has not been without challenges. Like any transformational piece of work, there are entrenched ‘ways of doing things’ that need to be altered, sometimes quite significantly, so sufficient time needs to be allowed for change to take place.
The council’s advice to other organisations looking to achieve something similar is twofold:
Firstly, ensure there is alignment with other relevant strategies and programmes of work locally and regionally in order to maximise buy-in at all levels and ensure that the implementation happens at pace.
Secondly, learn from similar programmes that are happening now or have already been delivered.
A more detailed report on Salford’s Public Health Outcomes Framework is available from peter.locke@salford.gov.uk
This case study was developed as part of the SLC’s work on the GM Active Pivot to Active Wellbeing strategy aiming to address health inequalities through the transformation of public leisure services.
Your Trust, the leisure operator in Rochdale, recognised that it could play an important role in the recovery of stroke survivors, funding a programme called ‘Moving on After Stroke’.
It aimed to provide stroke survivors with information relating to anything that may have affected them after a stroke. This included nutrition, wellbeing, emotional state/mental health, finance and job-related information.
It also included weekly exercise sessions led by an Exercise After Stroke-qualified instructor to work on improving physical ability. It was available at Rochdale Leisure Centre and online, via live stream. The work of the programme is best explained through the story of a stroke survivor, Alan Phipps.
Alan joined the Moving On After Stroke sessions at Rochdale Leisure Centre to help with his recovery from a stroke in April 2019. Despite all leisure centres closing during the Covid-19 pandemic, this did not stop Alan.
He continued to attend the weekly sessions that had been moved online. He also joined another online group. Throughout lockdown, he started walking outdoors and got back to his 10,000 steps a day on a regular basis.
As leisure centres started to re-open, Alan embraced more of what was available from Your Trust.
He started swimming, attended a nutrition and wellbeing course and started back at face-to-face gentle exercise sessions.
He completed a 10-week functional fitness course and attended a pilot learning course, which enabled him to learn more about health and wellbeing and how to help others who are living with long term conditions.
Alan now volunteers on the falls prevention programme that Your Trust runs and helps others to get their confidence back.
Alan joined the Moving On After Stroke sessions at Rochdale Leisure Centre to help with his recovery from a stroke in April 2019. Despite all leisure centres closing during the Covid-19 pandemic, this did not stop Alan.
He continued to attend the weekly sessions that had been moved online. He also joined another online group. Throughout lockdown, he started walking outdoors and got back to his 10,000 steps a day on a regular basis.
As leisure centres started to re-open, Alan embraced more of what was available from Your Trust. He started swimming, attended a nutrition and wellbeing course and started back at face-to-face gentle exercise sessions.
He completed a 10-week functional fitness course and attended a pilot learning course, which enabled him to learn more about health and wellbeing and how to help others who are living with long term conditions. Alan now volunteers on the falls prevention programme that Your Trust runs and helps others to get their confidence back.
A key learning point has been that neurological specialist instructors are needed, qualified in Exercise After Stroke to run these sessions. An understanding of stroke symptoms and side effects is critical.
The future of Moving On after Stroke was in doubt when the Stroke Association’s funding came to an end in 2020.
However, Your Trust has kept the weekly sessions going online and encourages service users to access mainstream provision at its leisure centres.
Six of the attendees from the 2020 course still attend online sessions each week and several others now attend sessions at their local leisure centre.
Elaine Stott, Your Trust Active Community Development Coordinator, said: “Alan’s story is an inspiration to anyone who thinks they are being held back by a long-term condition.
“He always takes the time to talk to people and reassure them that he knows how they are feeling. He tells them that they can do it because he felt the same once and he has done it.
“He embraces everything with a great level of enthusiasm. The combination of all activities that Alan got involved with provided help in all aspects of his recovery and rehabilitation.
“Moving on After Stroke was a first step and provided a strong base of support and knowledge from which to move forwards and attend other sessions.”
This case study was developed as part of the SLC’s work on the GM Active Pivot to Active Wellbeing strategy aiming to address health inequalities through the transformation of public leisure services.
Denmark Road Leisure Centre (often just referred to as Denmark Road) in Manchester – serving Ardwick, Hulme, Moss Side and Rusholme – presented an opportunity to transition tradition.
There’s lots of talk about transitioning leisure assets from fitness to wellness.
The attempt here was to move towards a more responsive, needs-led, service-led model embedded as part of a whole system.
The concept was ‘spaces that are just spaces’. This means that spaces in the venue could be what they need to be for each resident, whether that’s where someone plays football, where someone meets their link worker or where someone attends a mindfulness workshop.
From the start – the council’s leisure team, MCRactive and its operating partner, GLL, worked with community health providers and services to create a health hub at Denmark Road.
Seventeen organisations came together in a series of workshops and two key themes emerged:
The organisations that signed up and co-designed the hub have acted on their intentions of creating a space for genuine collaboration and partnership working.
Significantly, a local GP practice has located some of its services at Denmark Road including its social prescribing and wellbeing teams.
Partnership meetings are held every six weeks and allows partners to share learning and provide an update on their services.
The initial investment from MCRactive was £20k. This was used to purchase office furniture, cover the desk rental for 11 of the 17 organisations for the first 12 months, and for a series of workshops / events to integrate the organisations.
While it’s difficult to have a clear indicator of success, there have been multiple collaborative projects, events and campaigns that wouldn’t have happened without the Denmark Road health hub.
Funding has been the biggest challenge for this project.
Towards the end of the first year, several organisations pulled out as they couldn’t self-fund for year two, and priorities changed.
It has also been difficult to replicate: similar schemes at Manchester Institute of Health and Performance (MIHP) and Wythenshawe Forum were proposed but couldn’t get traction.
The key success factors have been the diversity and shared ambition of the originations to work collaboratively and learn together.
Setting up the project was relatively straightforward as during the post-Covid period there was a strong appetite for working collaboratively. Being a funded project was also helpful.
This is still very new and evolving project. There is a lot more potential and learning to support the transition from leisure and fitness to active wellbeing.
