MOVEment Pills Toolkit: #FindYourMOVE and enjoy better health!

MOVEment Pills

TOOLKIT

#FindYourMOVE and enjoy better health!

An inside look into a successful ISCA & UISP initiative

Disclaimer: Funded by the European Union. Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HADEA). Neither the European Union nor the granting authority can be held responsible for them.

Table of Contents

About the toolkit / 3 Timeline / 4 Bust a Myth by Busting a MOVE / 5 Prevent or improve / 6 Every MOVE Counts! / 7 The story: Pillole di Movimento / 8 The story: MOVEment Pills / 9 The “sales pitch” / 10 MOVEment Pills resources / 11 MOVEment Pills videos / 12 Promote physical activity with MOVEment Pills / 13 What’s next... / 16 Beyond “exercise is medicine” / 17 Credits / 18 Resources and references / 19 2

About the toolkit

The story. The eye-catching boxes. The how-to toolkit.

Have you ever wondered whether doctors and medical practitioners can prescribe exercise to their patients? The answer is yes – and many are doing so today. And many more could be doing the same, but may not have the time, the skills or (unfortunately) the incentive to do so. Did you also know that physical activity promoters like yourself can nudge medical professionals and pharmacies to give out “exercise on prescription” in the form of MOVEment Pills? These are not pills to make you “go”, but to get up and go! (if you know what we mean ) More and more evidence is emerging about the physical and mental health benefits of exercise and leisure. But time is still one of the biggest barriers preventing people from taking up regular physical activity. The clue to taking the first steps towards an active lifestyle is to break it down into “bite-sized” movements – like pausing quickly to take medicine or (in colloquial terms) to pop a pill.

At ISCA, we first developed our eye-catching MOVEment Pills boxes in 2015 (based on a concept created by our Italian member UISP, who has partnered with pharmacies across Italy to distribute its pill boxes). In this toolkit we’ll share the story of the idea and how to use it in your work as MOVE Agents who want engage more people in physical activities.

Our current MOVEment Pills package includes:

QUOTE

“The advice that I would give to one of my patients has now changed significantly because of the recognition that if physical exercise were a drug, it would be hitting the headlines.”

PROFESSOR JANE MAHER

Macmillan Cancer Support Chief Medical Officer

Photo: BG Be Active

1

MOVEment Pills boxes and physical activity inspiration blisters (fake “pills”)

2

A patient information leaflet with “dosage” instructions (in English)

3

YouTube playlists featuring 50+ short exercise videos for the Office, Home and Outdoors

4

A letter template for MOVE Agents to approach potential partners

5

Social media visuals, videos and messages

6

Webpage under the NowWeMOVE campaign umbrella featuring all resources

Browse this how-to toolkit to learn more about this innovative tool, which can open doors to conversations with potential partners, enhance your media coverage, and engage people at your events by showing them the types of exercises that can be done in the same amount of time as it takes to make a coffee or tea.

3

Timeline

Exercise on prescription

1975 1st Guidelines for Exercise Prescription?

Guidelines for Graded Exercise Testing and Exercise Prescription are published in America, and updated in 1980 and 1986: “The overall goal of the Guidelines is to promote a higher standard of practice in preventive and rehabilitative exercise programs, thereby affording effective and safe exercise opportunities for program participants … while at the same time not erecting barriers to participation.”

MOVEment Pills!

2001

2021

Swedish researchers trial Physical Activity on Prescription in primary health care

Intelligent Personalised eHealth Exercise Prescription?

Swedish primary health care units conducted trials in 2001-2003, finding that “if a patient in primary health care needed physical activity preventively or for treatment of a disease and patient-centred motivational counselling found physical activity to be suitable, individualised physical activity could be prescribed.” The model has evolved and still exists today, but “lack of time, resources and knowledge among decision makers and professionals” are still major obstacles to implementation in 2022 .

1990 The idea of ‘exercise on prescription’ is not new, nor is it particularly controversial to suggest that medical practitioners can prescribe exercise as ‘medicine’ to help patients build physical and mental strength, fitness, prevent noncommunicable disease and aid their recovery. That said, it is still very much a work in progress. We traced the concept (and its evolution) back to the US in the 1970s…

Exercise is medicine

Preventive medicine will be health wave of 1990s!

“If the 1980s gave Americans concrete evidence of the benefits of proper diet and exercise, the 1990s will drive home the concept of preventive medicine, said the physician credited with focusing the nation’s attention on the advantages of aerobic exercise. ‘The ’90s will be the decade of prevention,’ said Kenneth H. Cooper.”

2012

“Exercise prescription … has the potential to be an important therapeutic agent for all ages in the prevention of chronic disease ...

However, it is often poorly implemented, as clinicians lack the necessary knowledge and skills while participants have low adherence due to design defects (e.g. prescriptions fail to take individual willingness, the appeal of exercise, and complex physical conditions into account). Intelligent personalised prescription is thus worth exploring.”

UISP launches first Pillole di Movimento (MOVEment Pills) campaign (see page 8)

2007

2015

Exercise is Medicine becomes a trademarked initiative

ISCA launches International version of MOVEment Pills

“The initiative, Exercise is Medicine (EIM), started by the American College of Sports Medicine (ACSM) and the American Medical Association (AMA) in 2007, is ‘calling on all health care providers to assess and review every patient’s physical activity program at every visit’.”

(see page 9)

The European Initiative for Exercise in Medicine (EIEIM) is founded as an independent EIM centre

2022 UK government pledges £12.7 million towards ‘social prescription’ trials “Social prescriptions, including walking, wheeling and cycling, will be offered by GPs as part of a new trial to improve mental and physical health and reduce disparities across the country, the government has announced today (22 August 2022).”

4

Bust a Myth by Busting a MOVE

Why it’s important for many patients to keep MOVING. The myth that exercise is too risky or dangerous for people with pre-existing or new conditions, the elderly, people with disabilities, people with obesity or overweight, or patients recovering from serious illness can be a barrier for millions who could actually feel better if they moved more.

Medical practitioners may be reluctant to prescribe exercise to their patients, and the patients might feel that exercising is beyond their physical capacities. But growing research is showing how important it is to keep moving, with guidance and support, to maintain physical fitness and aid in the prevention of and recovery from adverse physical conditions.

Even the 1975 Guidelines mentioned that “exercise is a normal human activity and is relatively safe”, recommending that healthy people under the age of 45 could be prescribed exercise without physical testing or close monitoring. Those over 45 or with one or more risk factors (pre-existing conditions or disease), should, however, undergo a fitness assessment and be monitored when starting a new exercise programme, it states.

On the next page we’ll show how 5 common patient groups can benefit from exercise.

DID YOU KNOW? That you can study to become an Exercise Physiologist? The University of Canberra in Australia describes the Exercise Physiologist as an “allied health professional” who specialises in “how to help those who are injured or physically impaired get their lives back on track” and “how exercise as a medicine positively affects the mental and emotional recovery of each patient”.

Discover more

Photo: BG Be Active

5

Prevent or improve

Potential benefits of prescribing physical activity to 5 target groups

The elderly

Cancer patients

• Prevention or decreased risk: Non-communicable disease, site-specific cancers, hypertension, falls, dementia, all-cause and cardiovascular disease mortality

• Prevention or management: Side effects of treatment, recurrence, fatigue, lymphedema, inflammation, anxiety, depression, impaired mobility, up to 50% decreased risk of dying from the disease; decreases risk of developing colon, breast and endometrial cancers

• Improvement or increase: Cardiorespiratory fitness, strength, muscle mass, balance, mental and physical wellbeing, cognitive health and rehabilitation after stroke, healthy blood pressure, social contact, sleep quality, quality of life Source: Langhammer, Bergland & Rydwiik, 2018 ; WHO, 2022

People with disabilities • Prevention or decreased risk: Type-2 diabetes, heart disease, weight gain, depression, anxiety, falls • Improvement or increase: Mental and physical wellbeing, strength, flexibility, functional balance, endurance, longevity, independence, social contact, quality of life Source: US National Centers for Disease Control and Prevention, 2022 ; WHO, 2022

People with obesity and overweight • Prevention or decreased risk: Type 2 diabetes, heart disease, premature mortality, depression, further weight gain • Improvement or increase: Cardiorespiratory fitness, metabolic rate, strength, quality of life, emotional health, sleep quality Source: Pojednic, D’Arpino, Halliday & Bantham, 2022

• Improvement or increase: Immune system, metabolic function and digestion, mental and physical wellbeing, quality of life, physical function, balance, strength, healthy body weight, insulin sensitivity, chance of recovery Source: Macmillan Cancer Support, 2012 ; World Cancer Research Fund International, 2018

Covid-19 recovery and long Covid patients • Potential improvement: Muscle strength, lung capacity, fitness, mental wellbeing and relaxation, resistance to reinfection or other viral infection, better chance of recovery Note: Too much exercise may increase symptoms or fatigue in long Covid sufferers. That’s why a paced approach to reintroducing exercise is recommended.

Source: The Guardian, 16 Feb 2022 ; University of Leeds, 2022

6

Every MOVE Counts!

So why don’t we get more people moving?

The WHO’s Global Action Plan on Physical Activity colourfully illustrates how good physical activity is for health and disease prevention in its Sustainable Development Goals (SDG) pie chart (reproduced here ), where we can see a potentially positive impact on SDG 2 (healthy weight), SDG 3 (improved wellbeing and quality of life, mental health and cognitive function; reduction in noncommunicable diseases) and SDG 8 (reduced health costs). The benefits span across 13 SDGs in total.

With the evidence right in front of us, let’s get more people MOVING! On the next pages, we’ll show you the gadget and messages to help you become a health-enhancing physical activity MOVE Agent!

Source: Global Action Plan on Physical Activity 2018-2030

7

The story: Pillole di Movimento

A national NGO “experiment” now used in 2450+ Italian pharmacies.

In 2012, our Italian member UISP (Unione Italiana Sport Per tutti), a national sportfor-all NGO, tried an experiment. Could it get pharmacies in Bologna to hand out “Pillole di Movimento” to encourage people to exercise? A cheeky thought, perhaps, but it worked, and by 2022 UISP’s initiative was rolled out to hundreds of Italian municipalities.

UISP shares the story of how it began.

“The Pillole di Movimento/MOVEment Pills concept is built around the development of a campaign to raise awareness and promote physical activity as a natural remedy capable of preventing and/or lowering the incidence of developing conditions related to a sedentary lifestyle.

Part of UISP’s campaign was the widespread distribution of movement pills boxes – real boxes that resemble those of medicines, but containing a trial subscription for one free month of physical activity in a local gym and swimming pool and a leaflet containing information on the benefits of physical activity and other local sports or gym offers. just like other remedies, these boxes of movement pills are now distributed by pharmacies all around the country. by 2022, 31 local uisp committees are now involved in the implementation of the initiative, 235 italian municipalities, 370 sports clubs and 2457 pharmacies are engaged, 480,000 pills boxes have been distributed and 1200 local sport and physical activities are offered.”

DISCOVER MORE

2012 campaign video

2022 campaign video

Official website

8

The story: MOVEment Pills ISCA launches the concept internationally.

Having learned about the pilot project implemented in Bologna, ISCA took inspiration from the UISP campaign and created a communication and awareness-raising initiative with the same title and similar contents translated into English. ISCA launched the English version of the MOVEment Pills in 2015 as part of the NowWeMOVE campaign.

The NowWeMOVE website now hosts a section dedicated to MOVEment Pills, featuring information on the risks of physical inactivity and the benefits of exercise, the MOVEment Pills “prescription”, plus easy daily physical activity ideas and a set of free workout videos grouped by category (office exercises, home exercises, outdoor stairs and bench and the MOVE Week Gym).

9

The “sales pitch”

A call-to-action aimed at citizens

Ask yourself

Did you know?

20-40 minutes is all it takes

• Do you feel tired?

THE MORE YOU MOVE, THE GREATER IT WILL BENEFIT YOUR OVERALL WELLBEING?

Did you know that all you need to do is 150-300 minutes a week of moderate physical activity? That’s 20-40 minutes a day!

The evidence

There are easy ways to break the barriers and physical activity can be part of your everyday life without costing you money or time.

• Do you have back pain?

• Is your belly growing?

• Are you depressed, stressed or nervous?

Did you know?

There is one pill that could ease your back and joint pain, help you sleep better, extend your life span, and be good for your overall wellbeing.

THIS PILL IS EVERYDAY MOVEMENT! The MOVEment Pill is the only medicine in the world that can be taken every day, at any time and in as large a dose as you need!

And it is our pleasure to introduce it to you!

MOVEment Pill Ingredients Motivation, inspiration, trust, care, ideas, love, positive vibes and everything else you need to be healthy and happy!

Many medical studies and the WHO Guidelines show that regular moderate intensity physical activity can: • Relieve stress • Release happy hormones • Increase the chance of living longer • Reduce the risk of recurrent breast cancer by approximately 50% • Reduce the risk of developing Alzheimer’s disease • Lead to better academic performance among children and adults • Decrease the chance of becoming depressed • Improve quality of sleep • Help increase mobility • Strengthen bones and muscles • Help maintain or get to a healthy weight ... And is a reason to be with friends or meet new people, enjoy yourself, have fun and much more!

In your daily life by: • walking your dog • taking a family walk after dinner • playing with your kids 30 minutes a day At your workplace by: • taking a walk break every time you take a coffee break • taking the stairs whenever you can • walking to a co-worker’s desk instead of emailing or calling them

DISCOVER MORE Find free MOVEment Pills exercise ideas on our YouTube channel.

10

MOVEment Pills resources

The MOVEment Pills box has three printable elements that you can print inexpensively with a good-quality printer or invest a little more in a printer service for a more realistic effect. To the left you can find the link to our printable templates and read how to use the boxes at your in-person events on page 14.

1

MOVEment Pills boxes Print this template on thick semi-gloss paper or card. Think about a regular box of pills - you’ll want to be able to fold into a rectangular box shape.

2

Blisters (fake “pills”) For the best effect, you can get this printed on metallic card with dotted perforations around the squares so you can tear off each pill. Our “blisters” are stamped on the card. Alternatively, you can print the template on thicker paper or card.

3

The “prescription” This template is a PDF that you can print easily on a colour printer. Print two A5 prescriptions on an A4 piece of paper and cut to separate the two. Fold one prescription per pills box. We also provide a Word version that you can translate into your own language.

ITALIAN EXAMPLE In Italy, both for local pilot and the national project, UISP developed its patient information leaflet in collaboration with the the Ministry of Health. The leaflet promotes the benefits of physical activity and includes instructions on how to take advantage of a free month of activities in selected gyms and swimming pools. It lists all of the activities available and contact details of the affiliated sports clubs so the recipient can find out when and where the free activities take place.

Click here to download MOVEment Pills resources

The original Italian version – including local sport and physical activity vouchers

11

MOVEment Pills videos

Office exercises.

Many of us have jobs that require sitting in one place (for example, at a desk) throughout the whole working day. Being inactive for a long time basically shortens our lives – it can increase the risk of developing different diseases, lead to weight gain, spinal deformities, fatigue and many more adverse conditions. So what you can do? You can move! Divide your day into 60-minute blocks and at the end of each block, stand up and move around the office. You can use your desk, your chair, the wall, the floor or the staircase of your office building to help you stretch your muscles and get the oxygen flowing again.

• Office exercises

Home exercises.

The most common reasons for people not to be physically active are lack of time and money or that there is no gym or sports facility nearby. Your home and your backyard can become your gym! What are the benefits of training at home? It will save you time – you won’t have to travel to the gym and back; it’s cost-free; you can fit your training around your daily routine; it doesn’t require any equipment – you can use only your body weight if you prefer; you can choose whatever outfit you feel comfortable in; and you can look silly without worrying someone will make fun of you.

• Living room short workouts • MOVE Week Gym longer workouts • Stairs exercises • Outdoor bench exercises

12

Promote physical activity with MOVEment Pills

The digital promotion approach.

As a physical activity promoter, your most cost-effective approach to using MOVEment Pills to raise awareness about regular exercise for health and wellbeing could be via social media. Share our ready-made social media visuals, videos and tips to spice up your social media campaigns – remember to tag our NowWeMOVE accounts!

Social media hashtags #MOVEmentPills #FindYourMOVE #NowWeMOVE Tag our channels NowWeMove

nowwemove_

Regular tips for active breaks • Active break tip! Having an intense day at the office? Switch off, stand up, step up – take a break by running up and down a couple of flights of stairs #UseTheStairs to exercise or take an active pause during the day #MOVEmentPills • Enjoy an active life by taking #MOVEment Pills every day: No prescription required

VISUALS Share our selection of social media visuals on your channels to promote MOVEment pills.

Click here to download

Active break tip! Walk your dog. Do squats or stretches at the coffee machine at work #UseTheStairs whenever you can.

• Active break tip! Divide your day into 60-minute blocks and at the end of each hour, stand up and move around the office or home office.

Use your desk, your chair, the wall, the floor or the stairs to stretch and get your pulse up #MOVEmentPills #FindYourMOVE Competitions/challenges Use inspiration from our #MOVEChallenge or come up with your own!

Look out for the next challenge here.

Photo: BG Be Active

13

Promote physical activity with MOVEment Pills

The on-site/event approach.

For this approach you need to print physical MOVEment Pills boxes and the patient information leaflet (see page 11). Use our templates to make your own – please keep our logos on the boxes and you may also add your own. Hand out the MOVEment Pills boxes as a conversation-starter, advocacy or marketing tool at in-person meetings and events. Have fun with people’s reactions when they open the boxes!

MOVEMENT PILLS TEMPLATES MOVEment Pills boxes The box (with UISP, ISCA and your logos and links)

Blisters Fake “pills” that you can create with metallic card (punch out or stamp your activities on the card)

The “prescription” Patient information leaflet, “dosage instructions” and other offers as relevant (paper inserts)

Click here to download MOVEment Pills resources

14

Promote physical activity with MOVEment Pills

The partnership and advocacy approach.

For ambitious MOVE Agents who want to use MOVEment Pills to establish partnerships with pharmacies and other stakeholders to help endorse and distribute the boxes, you can try using our letter template to approach potential partners or get inspired by UISP’s example. Through their initiative, UISP’s staff have cooperated with grassroots sport associations, sports clubs, pharmacies, municipalities, local health authorities, social service providers and a famous Italian singer!

MOVEment Pills can also be an eye-opener for politicians who need to shift their views and priorities from cure to prevention. It is a gadget that can carry an important message for our sector and the prevention agenda.

QUOTE “Pharmacies are the direct link between health and physical activity, so are an important part of the MOVEment Pills distribution chain. Notoriously, sedentary people are not motivated to find out about opportunities to be active. They will, however, certainly go to the pharmacy to buy remedies for their ailments (as these individuals are more susceptible to having health problems). There they will find, without having looked for it on purpose, a tool that will encourage them to try out a month of physical activity – right inside the MOVEment Pills box!”

UISP

15

What’s next…

For MOVEment Pills, for this space… and for you?

The main message of this toolkit is that linking physical activity to health is yet another driver to engage the average citizen in physical activity and sustain their motivation. The World Health Organisation’s (WHO) latest campaign, Every Move Counts, provides evidence and a slogan to assure people that small steps can make a big difference to their wellbeing: “Some physical activity is better than doing none. By becoming more active throughout the day in relatively simple ways, people can easily achieve the recommended activity levels.”

Micro-actions are an effective technique to introduce positive lifestyle changes that can grow as the person becomes more confident and feels better. This does not only apply to physical activity, but also to mental health and social wellbeing, as the Act. Belong. Commit. (ABC) initiative for mental health has shown in Australia and Denmark. So your role, as a MOVE Agent, is to share the possibilities and benefits of these micro-actions and you can use MOVEment Pills to attract attention to the cause and help it grow.

This keeping in mind that, while MOVEment Pills are a great attention-grabber, we as stakeholders in physical activity promotion need to work together on a holistic approach to health promotion as an alternative to a single “cure” or “wonder drug”.

So, naturally, the next step for ISCA is to keep exploring the link between physical activity and broader wellbeing. Wellbeing is something that stretches beyond health in a traditional sense, so we will aim to draw more links between physical activity and wellbeing, including mental wellbeing, through this special series of healthenhancing physical activity (HEPA) toolkits, webinars and online learning courses.

DISCOVER MORE

Keep informed isca.org/news Keep learning learn.isca.org/ Keep watching youtube.com/user/iscachannel

16

Beyond “exercise is medicine”

When and how to seek further help.

MOVEment Pills alone cannot replace professional medical advice, and we should always remember to note this when doing this kind of promotion. Physical activity is not a single cure for all physical and mental ailments, so people should always “exercise” caution when starting a more vigorous exercise programme or seek advice if the feel discomfort when trying MOVEment Pills exercises.

People with pre-existing conditions should consult a medical professional before starting an exercise programme, but most MOVEment Pills exercises should be safe enough to try without the risk of over-exertion or injury.

Gradual introduction of exercise is essential for more sedentary patients – and every move does count towards better health and wellbeing.

17

Credits

Text

Layout

History (Italy)

Rachel Payne, ISCA

Kristine Onarheim, ISCA

UISP Bologna

rpa@isca-web.org

ko@isca-web.org

www.uisp.it/bologna

International Concept/ Sales Pitch

NowWeMOVE design

Laska Nenova, ISCA

www.punkt.bg

www.nowwemove.com

Studio PUNKT

18

Websites and Resources ISCA website

MOVEment Pills exercise videos

Pillole di Movimento video (2012)

NowWeMOVE website

MOVE Week Gym longer workouts

Pillole di Movimento video (2022)

ISCA Health

MOVEment Pills box templates

Pillole di Movimento leaflet

MOVEment Pills website

Pillole di Movimento website

References Blair, S. & Gibbons, L. (1986). Guidelines for Exercise Testing and Prescription, Third Edition.

DGI. (2022). ABC for mental sundhed (ABC for mental health).

EU Physical Activity on Prescription. (2022). Physical activity on prescription in Sweden: An elementary mapping of the work in Sweden’s 21 regions.

Exercise is Medicine. (2022). Exercise in Medicine for Health Kallings, L. V., Leijon, M., Hellénius, M. L., & Ståhle, A. (2008). Physical activity on prescription in primary health care: a follow-up of physical activity level and quality of life.

Langhammer, B., Bergland, A., & Rydwiik, E. (2018). The Importance of Physical Activity Exercise among Older People.

Macmillan Cancer Support. (2012). Move More: Physical activity the underrated ‘wonder drug’.

Pojednic, R., D’Arpino, E., Halliday, I., & Bantham, A. (2022). The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review.

Tampa Bay Times. (1990, 14 January). Preventive medicine will be health wave of 1990s.

Resources & references

The Guardian. (2022, 16 February). How to move: exercising after having Covid-19.

Ting Sun, Yang Xu, Hui Xie, Zuchang Ma, & Yu Wang. (2021). Intelligent Personalized Exercise Prescription Based on an eHealth Promotion System to Improve Health Outcomes of Middle-Aged and Older Adult Community Dwellers.

UK Department for Transport, et al. (2022). Walking, wheeling and cycling to be offered on prescription in nationwide trial.

University of Canberra. (2022). Bachelor of Exercise Physiology and Rehabilitation.

University of Leeds. (2022). Exercise warnings over long COVID recovery.

US National Centers for Disease Control and Prevention. (2022). Physical Activity for People with Disability.

WHO. (2018). Global Action Plan on Physical Activity 2018-2030.

WHO. (2020). WHO guidelines on physical activity and sedentary behaviour.

WHO. (2022). Physical activity (fact sheet).

World Cancer Research Fund International. (2018). Physical activity and cancer risk.

19

#FindYourMOVE and enjoy better health!

ISCA launched the NowWeMOVE campaign and its flagship event MOVE Week in 2012 with the vision to help more people find their MOVE and be active through accessible community-led events. The campaign has since grown to feature annual events such as No Elevators Day and advocacy resources such as the MOVEment Pills.

This toolkit was created with support from an EU Operating Grant in the field of Health.

www.nowwemove.com

20