Category Archives: Joint Pain Clinical Hours

11th April 2022

• Hours: 2

Participants

• 10

Education 

• Next steps
  • Reviewing goals and implementing longer term goals
• Self-Talk
  • Positive self talk – saying you are useless doesn’t make you useless, it impedes your emotional wellbeing.
  • Try and catch those moments where you aren’t being kind to yourself – ask yourself, ‘is this true?’ or ‘what could I say about myself instead

Exercise Class – CV circuits & Strength Training

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 60 secs on, 30 secs rest x 3
  • Body Weight Squat Thrusters into calf raise
  • Walking with knee drive
  • Side Step with Knee Lift
  • Toe Taps
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Strength Training

• Warm Up – CV of choice

• Main Session 3 sets of 8 reps
  • Leg Exercise
  • Leg Exercise
  • Chest Exercise
  • Back Exercise
  • Back Exercise
  • Core Exercise
  • Optional: Arm/Shoulder Exercise
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  •  Hamstrings
  •  Back
  •  Chest
  • Shoulders

Analysis & Evaluation 

• Participants were given a rough structure to their workout and I was on the gym floor to provide help if they needed it. I was pleasantly surprised that most of the participants were content with the programme structure and could follow it easily. There were a few things I needed to help with, e.g. adjusting suspension straps, however, they all selected the appropriate exercises for each body part. All reported feeling confident that they could do that on their own again without help or support which highlights that they are ready to independently continue their journey.

Conclusion 

• I have offered a final check-in for those who want additional help or a new programme to follow in the gym to ensure that they have an opportunity to ask any questions they may not have been comfortable addressing to the group.

Revisiting Reflection

References

4th April 2022

• Hours: 2

Participants

• 10

Education 

• Planning for success
  • As the programme is coming to a close we created an action plan for the week, e.g. what days to exercise, what days to rest, what type of exercise, etc.
• Worry less
  • The difference between a practical worry and a hypothetical worry.
  • Hypothetical worries can be addressed during a dedicated time and place so not to intrude on your day.
  • Practical worries can be resolved through problem solving.

Exercise Class – CV circuits & Stability

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 60 secs on, 30 secs rest x 3
  • Body Weight Squat Thrusters into calf raise
  • Walking with knee drive
  • Side Step with Knee Lift
  • Toe Taps
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Functional Stability

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotation

• Main Session 40 secs on, 20 secs rest x 3
  • BOSU Balance
  • Stability Ball Leg Extension
  • Stability Ball Torso Rotations
  • Stability Ball Arm Circles
  • Wall Supported Plank
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  •  Hamstrings
  •  Back
  •  Chest
  • Shoulders

Analysis & Evaluation 

• To increase confidence further from the last two weeks, we completed the stability session in the gym. Participants really enjoyed the change of scenery but also reported that the gym didn’t seem as intimidating as they had once thought. Some had been using the gym in the own time since having the gym induction; however, those who hadn’t now seemed more inclined to come in.
• Participants are reporting increased fitness with many recovery faster in between sets of exercises. This is solidifying that 2 x 30 min sessions a week has been enough to make a meaningful impact and should hopefully encourage individuals to keep their activity levels up.

Conclusion 

• I think next weeks session should involve more gym equipment to give that last little bit of confidence for participants to continue their journey independently. As the classes will cease, they will need to ensure that they have an appropriate replacement ready. Equally, this will allow those who are improving in their CV fitness to challenge themselves as the work will be individual.

Revisiting Reflection

References

28th March 2022

• Hours: 2

Participants

• 10

Education 

• Sleep, rest and recovery
  • Incorporating low impact activity when in pain
  • Knowing when exercise is not the best choice
  • Quality of sleep is linked to perception of pain
• Sleeping better
  • Developing a healthy sleep routine
  • Discussion around sleep hygiene – leaving phones out of the bedroom, no caffeine close to bed time, etc.

Exercise Class – 2 x CV

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 60 secs on, 30 secs rest x 3
  • Body Weight Squat Thrusters into calf raise
  • Walking with knee drive
  • Side Step with Knee Lift
  • Toe Taps
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Cardio Class

Chair based cardio by external instructor

Analysis & Evaluation 

• Participants really enjoyed another class taught by an external instructor and it has the desired effect of cementing their confidence. many participants picked up class timetables when leaving this session which indicates they are very much interested in continue classes once the programme ends.
• Sleep hygiene was a difficult discussion as many stated they know what to do they just don’t do it. Many of the participants stated that there is so much to do to get good sleep that it is almost impossible to get the perfect routine. I encouraged participants to look at it from the perspective that, ‘some change is better than no change.’ Rather than doing everything all at once they should look to change just one thing and see how they get on with that. I also encouraged them to reflect on what they learned about sleep last week which should encourage and motivate them to improve their sleep hygiene.

Conclusion 

• Trying to make positive changes can seem daunting when there are multiple components to try and stick to. However, small changes can be meaningful over time and it is important that people recognise that not being able to do something ‘perfectly’ doesn’t mean we shouldn’t do it at all.
• I will need to ensure I have a discussion with participants about appropriate class they could attend as not all will be suitable.

Revisiting Reflection

References

21st March 2022

• Hours: 2

Participants

• 10

Education 

• Weight management
  • The impact of obesity on load bearing joints such as the knees and hips.
  • Fat creates and releases chemicals that promote inflammation which can exacerbate or speed up the onset of OA.
  • Discussion on ways to manage weight, e.g. exercise and a diet focused on whole foods.
• Accept your mood
  • Take notice of your feelings, especially if you feel your mood is low.
  • Acknowledge the emotion you are feeling and allow it to pass naturally.

Exercise Class – CV circuits & Functional Mobility

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 60 secs on, 30 secs rest x 3
  • Body Weight Squat Thrusters
  • Walking
  • Side Step with Knee Lift
  • Seated Running
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Functional Mobility 

Yoga session taught by an external instructor

Chair based options provided for those with poor mobility

Analysis & Evaluation 

• Many of the participants report that weight management is something they struggle with. They also feel that they haven’t been given the correct support to help them achieve a healthier weight. During the discussion, I made sure to iterate that if anyone felt they did not have control over their eating or that there is an emotional component to their eating, to speak to their GP about further support. After mentioning this, one participant opened up about living with an eating disorder and how knowing she needs to lose weight is triggering for unhealthy habits of restriction which leads to binging.
• I thanked the participant for sharing and at the end of the session I signposted her to BEAT which is a UK charity for people who need help regarding an eating disorder. I am glad that I was aware of BEAT, as if I wasn’t I would have worried about what further help and support I could give to the participant beyond visiting her GP.
• Participants really enjoyed having an external instructor in and it made them feel as though they would be able to do a class once the programme ends. I have planned another session with an external instructor so this can cement their confidence in their abilities even further.

Conclusion 

• This situation has highlighted the importance of networking and signposting. Rehabilitation of any kind needs to centre around the whole person and sometimes you may develop relationships where they share personal information that requires you to either onward refer or provide appropriate signposting. I am going to spend some time creating a document of resources which cover a variety of areas a person may need further help and support on. E.g. BEAT, Alcohol change UK, Gamcare, etc. This will ensure that I can offer immediate signposting.

Revisiting Reflection

References

14th March 2022

• Hours: 2

Participants

• 10

Education 

• Pain Management
  • What have you found helps pain?
  • What do you find exacerbates pain?
• Be happy that you are happy
  • Importance of self care and its link to our happiness
  • Are there any things that make you happy you haven’t done because of your joint pain? Can you see a way of trying to reincorporate it, or something similar, back into your life?

Exercise Class – CV circuits & Functional Strength

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 60 secs on, 30 secs rest x 3
  • Body Weight Squat Thrusters
  • Walking
  • Side Step with Knee Lift
  • Seated Running
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Functional Strength

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotation

• Main Session 60 secs on, 30 secs rest x 3
  • Tempo Squats
  • Wall Push Off combine with Shoulder Taps
  • Leg Extensions
  • Stability Ball Chest Press > Shoulder Press
  • Hamstring/Glute Kick Back
  • Banded Row
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  •  Hamstrings
  •  Back
  •  Chest
  • Shoulders

Analysis & Evaluation 

• Discussion around pain management highlighted how stress, poor diet, etc. can influence pain. This highlighted that the group are in tune with other factors beyond physical can influence how they feel. Some even shared dropping the dosage on their pain medication or removing them entirely which shows that the blended programme has really helped individuals with pain management.
• Participants are becoming fitter and stronger – I can see form improving on exercises such as squats and the group tend to recover from each set slightly better than in the initial weeks. Many take pictures of the class session and then replicate it at home so we celebrated how doing just a little bit extra can make a big difference.

Conclusion 

• To see participants engage with more activity outside of the programme hours instills a confidence that they are taking ownership over their joint pain management. This is hopefully the start of them being able to continue the healthy practices they have incorporated into their life beyond the 12 week programme.

Revisiting Reflection

References

7th March 2022

• Hours: 2

Participants

• 10

Education 

• Exercise and programming
  • FIIT principles
  • Do what you enjoy and don’t over complicate things
• The rule of opposites
  • How can you make your emotional wellbeing suffer?
    • Do the opposite e.g. refuse invites>accepting invites
  • Discussion around the over-simplified rule of opposites.

Exercise Class – CV circuits & Functional Mobility

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 40 secs on, 20 secs rest x 3
  • Body Weight Squat Thrusters
  • Walking
  • Side Step with Knee Lift
  • Seated Running
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Balance and Stability

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotation

• Main Session 40 secs on, 20 secs rest x 3
  • Single leg step ups
  • Stability ball arm circles
  • Seated or standing calf raises
  • Wall supported plank
  • Glute kick backs
  • Stability ball leg extensions
  • Single leg balance
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  •  Hamstrings
  •  Back
  •  Chest
  • Shoulders

Analysis & Evaluation 

• Participants really appreciated the conversation on the principles of exercise design. Many of them reported that they believed exercise had to be intense and vigorous to count and as they couldn’t do this they had resigned themselves to being unable to exercise.
  • As discussed in previous sessions, exercise is beneficial for reducing pain and  increasing function.  So, being able to do some even at lower intensities will have a positive impact.
• The rule of opposites was a really interesting discussion. We talked about how it can be insightful into patterns of behaviour, e.g. avoiding social situations. However, simply doing the opposite is an over-simplified approach. Therefore, we spoke about what barriers might be in the way of somebody being able to do the opposite of their unhealthy habits. This discussion allowed participants to explore their own barriers and identify ways to address them, e.g. financial constraints can be addressed by exercising at home. Participants appreciated the open and honest conversation and felt heard rather than feeling like advice that worked for one person should work for them.
  • ‘Patients with rheumatoid arthritis (RA) who exercise regularly and those who do not, report similar barriers to physical activity and exercise but different coping strategies’ (Veldhuijzen van Zanten, et al, 2015, p.1401.) – This finding highlights why it is important to discuss barriers and allow participants to explore methods to overcome these barriers or view them differently.

Conclusion 

• Working in the field of sport, health and exercise, it can be easier to forget that the general population can have beliefs/perceptions that present as a barrier to improved emotional and physical wellbeing, e.g. carbohydrates are bad for you, exercise will aggravate my joint pain, etc. Therefore, it is important to discuss barriers with patients and address any that need to be identified.

Revisiting Reflection

References

• Veldhuijzen van Zanten, J. J., Rouse, P. C., Hale, E. D., Ntoumanis, N., Metsios, G. S., Duda, J. L., & Kitas, G. D. (2015). Perceived Barriers, Facilitators and Benefits for Regular Physical Activity and Exercise in Patients with Rheumatoid Arthritis: A Review of the Literature. Sports medicine (Auckland, N.Z.), 45(10), 1401–1412. https://doi.org/10.1007/s40279-015-0363-2

28th February 2022

• Hours: 2

Participants

• 10

Education 

• Goal Checking
  • How are you progressing?
  • Has your goal changed or do you want to change your goals based on what we have discussed. E.g. I want to lose weight > I want a healthier relationship with food.
• Living according to your values
  • Do your goals align with your values?
  • What happens if your goals don’t align with your values?

Exercise Class – CV circuits & Functional Mobility

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 30 secs on, 20 secs rest x 3
  • Body Weight Squat Thrusters
  • Walking
  • Side Step with Knee Lift
  • Seated Running
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Joint Mobility

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotation

• Main Session 30 secs on, 30 secs rest x 3
  • Seated or standing side reach
  • Squats or sit to stand
  • Shoulder (horizontal flexion, flexion, extension)
  • Shoulder blade squeezes
  • Leg Circles
  • Side lunge or side steps
  • Hamstring scoops
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  •  Hamstrings
  •  Back
  •  Chest
  • Shoulders

Analysis & Evaluation 

• It is really important to set goals and reassess them on a regular basis for those living with joint pain. Interestingly, a 2015 study found that goal or target setting was something seldom done when individuals visited their health care provider with joint pain (Strand, et al.). And, the group of 10 participants in front of me all agree that their health care provider has not discussed what is important to them and why in regards to management of their joint pain. Many report this has given them feelings of not being heard or ‘they just want to throw painkillers at you and get the next person in.’
• We checked our goals this week and many reworded what they had down or many changed their goals completely. Some admitted to just putting down a generic goal of, ‘to lose weight’ or ‘to exercise more’ but now want to make it more specific and meaningful to them. E.g. lose weight > have a healthy relationship with food or, exercise more > to attend aqua once a week.
• I beleive that having the discussion based sessions allows participants to explore their beliefs, values and joint pain in a way that they maybe haven’t had the opportunity before. This has allowed them to make goals that align more with the ‘SMART’ framework (Doran. 1981).

Conclusion 

• I do ask patients in clinic what their goals are but I fail to revisit them and this experience has highlighted just how important that might be.
• I will make a conscious effort moving forward to check-in with patients and their goals to assess progress, motivation and treatment satisfaction.

Revisiting Reflection

References

• • Doran, G. T. (1981). “There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives”, Management Review, Vol. 70, Issue 11, pp. 35-36.
  • Strand, V., Wright, G. C., Bergman, M. J., Tambiah, J., & Taylor, P. C. (2015). Patient Expectations and Perceptions of Goal-setting Strategies for Disease Management in Rheumatoid Arthritis. The Journal of rheumatology, 42(11), 2046–2054. https://doi.org/10.3899/jrheum.140976

21st February 2022

• Hours: 2

Participants

• 10

Education 

• Healthy Eating
  • Foods for healthy joints
  • Foods that increase inflammation in joints
  • Portion control and a balanced diet
• Acts of kindness
  • Small or big things you choose to do for others
  • How is an act of kindness different from feeling obligated to do something or saying ‘yes’ to everything.

Exercise Class – 2x CV circuits

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 40 secs on, 20 secs rest x 3
  • Marching on the spot
  • Squats
  • Hands to toes > hands to sky
  • Boxing
  • Side Steps
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Cardiovascular

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 30 secs on, 20 secs rest x 3
  • Body Weight Squat Thrusters
  • Walking
  • Side Step with Knee Lift
  • Seated Running
  • Hands to toes > hands to sky with stability ball
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Analysis & Evaluation 

• Reduced time on 2nd circuit due to increased complexity of movements. This was required as participants reported feeling more tired after the 2nd session than the first.
• There has been some success in the group this week. One participant has chosen to stop using her walking stick and another has changed from a walker to a walking stick. When they discussed this with the group they spoke about having much more confidence in their body than they did previously. When asked to explain this in a bit more detail, they explicitly connected the exercise sessions to their increased confidence. This occurrence reflects findings that both aerobic conditioning and strength training can reduce pain and improve function of those living with joint pain (Rahnama & Mazloum. 2012). Strength training was found to be more effective at improving ROM; whereas aerobic conditioning was found to be more effective at improving function and walking ability.
• Therefore, the varied nature of the exercise programme will hopefully help participants in all of these areas, with two already reporting improved walking and functionality.

Conclusion 

• There seems to be benefit to any type of exercise (strength, aerobic and flexibility/mobility). So, it is important to encourage variety so individuals can reap the most benefits. However, some favour other types of exercise over others so I will be sure to inform them of current evidence of how different types of training could impact their joint health.

Revisiting Reflection

References

• Rahnama, N., & Mazloum, V. (2012). Effects of strengthening and aerobic exercises on pain severity and function in patients with knee rheumatoid arthritis. International journal of preventive medicine, 3(7), 493–498.

14th February 2022

• Hours: 2
• Cumulative Hours: 2

Participants

• 10

Education 

• Perceptions of pain
  • What makes pain worse?
  • What makes pain better?
  • How do you feel when you are experiencing pain on a stressful day v a relaxed day?
• Ask yourself questions to thrive
  • What are things in life you want but have not been able to obtain, e.g. a healthier relationship. Ask yourself questions about why you want that and what you would need to do in order to achieve it.

Exercise Class – CV circuit & Joint Stability

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 40 secs on, 20 secs rest x 3
  • Marching on the spot
  • Squats
  • Hands to toes > hands to sky
  • Boxing
  • Side Steps
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Joint Strength

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 30 secs on, 30 secs rest x 3
  • Squats
  • Wall Push Off
  • Leg Extensions
  • Stability Ball Chest Press > Shoulder Press
  • Hamstring/Glute Kick Back
  • Banded Bicep Curl
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Analysis & Evaluation 

• Increased time on CV circuit this week. Some found it quite a struggle, particularly those with limited mobility as they felt the rest time was not enough. This highlights the difficulty on delivering group sessions and has made me realise I need to be able to adjust timings for those who are ready to progress but also respect that timings may need to remain the same for those who are not.
• Participants are really starting to understand the importance of EWB when it comes to their pain. I used an example of stubbing your toe – it is quite a painful thing to do but how you experience that pain depends on how you feel that day. E.g. If you have a busy day and are feeling stressed and overwhelmed, the pain you experience is likely going to be greater than on a day when you are more calm. Immediately, lots of participants shared that their pain is worse when they are stressed and need techniques to help them combat stress effectively.

Conclusion 

• Rather than focusing on timings I should look at how to increase the intensity through exercises and shorter rest periods. E.g. Participants could complete a more demanding exercise and/or start the exercises earlier (reduced rest) but still finish at the same time as the group. This will require some clear and concise communication and coaching; hopefully, it will help maintain a group feel without pushing on before they are ready or pulling people back from progressing.
• I will ensure I share stress management and stress avoidance techniques with the group in future sessions. Especially as stress is known to make chronic pain worse.

Revisiting Reflection

References

7th February 2022

• Hours: 2
• Cumulative Hours: 2

Participants

• 10

Education 

• Emotional Wellbeing
  • What is emotional wellbeing EWB?
  • How do you know when your EWB is low?
  • How do you improve your EWB?
• NHS Emotional Wellbeing Advice
  • Connect, be active, keep learning

Exercise Class – CV circuit & Joint Stability

CV Circuit

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 30 secs on, 30 secs rest x 3
  • Marching on the spot
  • Squats
  • Hands to toes > hands to sky
  • Boxing
  • Side Steps
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Joint Stability

• Warm Up – 3 x 30s each exercise
  • Marching on the spot
  • Half Squats
  • Arm Circles
  • Chest Swings
  • Torso Rotations
• Main Session 30 secs on, 30 secs rest x 3
  • Seated Leg Extensions
  • Hamstring/Glute kickbacks
  • Single Leg Balance
  • Calf Raises
  • Stability ball shoulder circles
  • Banded row
  • Wall supported plank
• Warm Down – Static Stretches, 30 secs per muscle group
  • Glutes
  • Hamstrings
  • Back
  • Chest
  • Shoulders

Analysis & Evaluation 

• Discussed 3 of the 5 steps to EWB as described by the NHS
• Most know what improves EWB; however, everyone reported how difficult it can be to put themselves first when life is busy. We discussed how making an effort it better than not trying at all. For many, they stated that this programme has been a source for improved EWB. This gave me the opportunity to highlight that they have been able to commit 2 hours a week to the programme so that is 2 hours a week they know they can spend of exercise and improving their EWB when the programme ends.

Conclusion 

• It is important to provide participants with the knowledge and skills to continue their joint pain management independently. I am going to continually encourage forward planning so participants know that they can achieve results independently.

Revisiting Reflection

References