Research Proposal

Promoting Health through “Inspired Living”

The development, implementation and evaluation of a health promotion project “Cycling for Cancer and Cardiac Health”

This project outline has been compiled by:
Dr Thomas Frank, GP, Hampshire PCT
Dr Chris Gordon, Consultant Physician, Winchester and Eastleigh Healthcare NHS Trust
Ms Barbara Parry, Research Dietitian/Public Health Nutritionist, Winchester and Eastleigh Healthcare NHS Trust
Lt Cdr Chic Stewart, Physical Training Instructor, Royal Navy, Portsmouth
Dr Mark Rickenbach, GP, Associate Dean and Lecturer, University of Winchester
Mr Mike Spencer, Project Manager, IBM, Hursley, Hampshire.

Identified needs and priorities:

Cardiovascular disease and cancer diagnoses contribute to significant morbidity and mortality in the UK. Additionally, the health care burden of such chronic diseases puts considerable strain on NHS resources (ref: DH literature here).

There is good epidemiological evidence suggesting that being physically active reduces chronic disease risk, benefiting vascular health and reducing the risk of development of certain cancers, particularly breast and colo-rectal cancer…

  • Lifetime exercise activity and breast cancer risk among post-menopausal women CARPENTER C. L. (1) ; ROSS R. K. (1) ; PAGANINI-HILL A. (1) ; BERNSTEIN L. (1) ; Department of Preventive Medicine, University of Southern California School of Medicine, USC/Norris Comprehensive Cancer Center, 1441 Eastlake Ave., MS-44, Los Angeles, CA, ETATS-UNIS
  • THUNE, I., and A. S. FURBERG. Physical activity and cancer risk: dose- response and cancer, all sites and site-specific. Med. Sci. Sports Exerc., Vol. 33, No. 6, Suppl., 2001, pp. S530-S550.
  • C. Friedenreich, T. Norat, K. Steindorf, M.-C. Boutron-Ruault, T. Pischon, M. Mazuir, F. Clavel- Chapelon, J. Linseisen, H. Boeing, M. Bergman, et al. Physical Activity and Risk of Colon and Rectal Cancers: The European Prospective Investigation into Cancer and Nutrition

Changing risky lifestyle behaviours to reduce chronic disease risk in the population can be difficult to implement. Interventions to achieve behaviour change vary in effectiveness and with an individual’s readiness to change (ref: Prochaska and DiClemente, 1982). However, seeking unique ways to motivate people towards the development of a healthier lifestyle could result in enduring health benefits.

Challenging physical activities have been undertaken by many people whose participation seems fuelled by the desire to fundraise for an identified charitable cause. For example, running the London marathon in aid of the British Heart Foundation; walking Hadrian’s Wall in aid of The Stroke Association; participating in tandem sky diving in aid of MacMillan Cancer Support. Cycling is, for some people, a weekend leisure interest; for others, a means of routine “green” transportation; for still others, a fitness passion. Recognising that cycling is an affordable activity for a broad spectrum of the population, a community-based cycling project (with a shared goal of charitable fundraising) has been planned.

A new local organisation, Inspired Living, has been established in response to the death of Marey Frank and aims to raise £1million for cancer research. The central theme of the project is a 1250mile sponsored cycle ride from Winchester to Gibraltar.

GPs in the Mid Hampshire area have identified the promotion of regular physical activity and improved nutrition as health promotion initiatives to reduce cardiovascular and cancer risk factors. The Inspired Living charity trustees and supporting committee have suggested that participation in this challenge may also result in continuation of improved diet and regular physical activity after the event.

The greater the physical challenge, the greater the need to prepare for the event and achieve an appropriate level of fitness conducive to participation in the fundraising venture. The opportunity to develop a health promotion project has, therefore, emerged with recognition that charitable fundraising may provide the necessary motivation for longer term behaviour change towards a healthier lifestyle.

Project Aims and Objectives:

Organisational aim(s):

  • To fundraise for cancer research through the Inspired Living charity.

    • Objectives:

    • To convene a steering group to project manage the fundraising.
    • To plan and conduct publicity events to launch the community cycling project and Inspired Living as a registered charity.
    • To conduct a literature review of any existing and past projects to inform detailed operational objectives for the project.

Operational aim(s):

  • To engage local people in the community cycling project
  • To evaluate the fundraising process.

    • Objectives:

    • To enroll between 50 and 100 people at various fitness levels who are already volunteering to take part in the fundraising project
    • To measure baseline health parameters on the date of enrollment
    • To provide healthy eating, a specialist training programme & sports nutrition advice to participants, according to their health needs and the aspired level of participation in the sponsored cycle ride.
    • To document reasons for participation and identify the main motivators.
    • To collate “well person” parameters at 5 points over a 19-20 month period including at enrollment (pre-training), pre-cycle ride (post-training) & one year post event. This will include physical activity levels, psychological parameters & occupational markers
    • There will be a greater degree of scrutiny of those participants aiming to cycle for 3 days or 200 miles or more as this group is likely to have a different activity & health profile.
    • To report defined indicators of health impact – pre-training, post-training, post-cycling for anonymised individuals in terms of cardiovascular risks.
    • To report physical activity levels of participants one year after the cycle ride (1 yr post-cycle)
    • To describe quality of life indicators at 4 time points (pre-training, post-training, post-cycle and 1 yr post-cycle.
    • To describe, both qualitatively and quantitatively, the process undertaken.

Outcome aim(s):

  • To raise £1million for cancer research
  • To publicise the project outcomes via media and health promotion publications.
  • To report results of the initiative to the local population and healthcare providers using the media and health promotion publications.

    • Objectives:

    • To present and report anonymised “well person” parameters* at 4 time points throughout the project.
    • To assess general participant feedback using a standardised evaluation form completed at the end of involvement in the project.
    • To conduct an economic evaluation of the project, within the context of mass health-directed behaviour change.
    • To document evidence of sustained behaviour change through participant reporting at 4 time points.

Towards an evidence-based approach to being and staying active:

This project offers a novel opportunity to identify factors which contribute to the adoption and maintenance of healthy lifestyle behaviour amongst a sub-section of the population who seek to fundraise for charity.

Recruitment to formal research studies, such as the Women’s Cohort Study (funded by the World Cancer Research Fund), has in the past utilized a recruitment strategy which initially sought to identify women who were seeking to fundraise for the charity before confirming formal eligibility for enrolment in the study.

Those who engage in this health promotion project, for the purposes of fundraising, could be offered a linked opportunity to participate more formally in a cancer research cohort, possibly funded by Cancer Research UK and this possibility is being explored. It would add a further dimension to the project and seek to meet the needs of participants who have a particular interest in supporting formal cancer research.

Identified resources:

People who can help:

This project is currently supported by an expanding team of people who have not only their professional expertise, knowledge and skills to contribute but also their time, enthusiasm and energy.

Advice and support has also been identified and provided by University of Southampton Professors Tony Kendrick, Professor of General Practice, Peter Johnson (Cancer Research UK Centre), Southampton General Hospital, the University of Southampton’s Institute of Human Nutrition, the department of Public Health Nutrition and academic colleagues allied to cancer research.

The target group for participation:

Volunteers from the general population in the Winchester/Southampton area will be identified through the interest they show in participating in fundraising for the new local charity. While participation in the long distance cycling will require “health clearance”, it is envisaged that adults of all fitness levels may seek to participate. It is an explicit goal of the fundraising project, however, to ensure participants come to know harm and have their health only enhanced through their involvement.

People who influence the target group:

The support of family and friends will be an important factor in encouraging registration of interest. Further media support and the involvement of a local television celebrity, together with the possibility of a high-profile celebrity chef, could enhance interest in participation.

At this stage, Sally Taylor, BBC South Today news presenter, has confirmed her support for the charity and the project. Further, the engagement of a celebrity chef to support the actual 1250 mile cycle ride with catering that meets the appropriate nutritional standards for such a physical challenge, gives the project steering group some hope that the initiative might lend itself to being recorded for a television programme, following the cyclists on their journey, day-by-day.

Working with existing facilities and resources:

The services of a fitness instructor have been secured in support of the project’s planning and implementation. Tailor-made fitness programmes for participants will be formulated to prepare each one for the mileage that they are planning to cover by cycling.

A registered dietitian/public health nutritionist and a group of specialist sports dietitians have also confirmed their support and will help to develop bespoke nutrition education resources to meet individual participant’s nutritional needs. The nutritionist will also work collaboratively to ensure the catering provision during the long-distance legs of the cycle ride is appropriate.

Local Primary care services are uniquely placed to assess baseline health status of potential participants and also to measure the “well-person” parameters, once comprehensively defined.

Material resources:

Corporate support has been obtained from IBM, whose staff forms the crucial project management team within the steering group. Further the possibility of corporate sponsorship for the project from British Telecom is being explored. In particular, BT would like to see some workplace health benefits for their staff who engage with the project.

Physical activity/training resources will be developed and supplied to each participant to facilitate their personal level of involvement in the cycling itself. Similarly, dietary advice literature will be developed to promote a nutritionally adequate food and fluid intake during a participant’s involvement in the project.

Defining evaluation methodology:

Evaluation is a process of assessing what has been achieved and how it has been achieved (Ewles L and Simnett I, 2003). Evaluation allows healthcare practice to improve (learning from success and/or failure), it can justify the use of resources, it can define the usefulness or effectiveness of a piece of work and it can help to identify unplanned or unexpected outcomes from a project.

In view of the potential for this project to identify motivators for medium term, health-directed, lifestyle behaviour change, evaluation data is likely to be of particular benefit to primary care health professionals and possibly also secondary care colleagues.

Evaluation outcomes will be informed by the earlier organisational and operational aims and objectives and could assess:

  • Changes in health awareness
  • Changes in knowledge or attitude
  • Behaviour change
  • Changes in health status.
  • Changes in susceptibility to minor illnesses and absenteeism from work.

Evaluation methodology will be made more explicit as this project outline becomes a project profile for implementation. However, it will include both process and outcome evaluation.

The action plan:

Project management expertise has been secured through colleagues at IBM and a Gant chart, flow diagram and time line developed including key milestone events and dates.

The project put into action:

The completion of the full project profile will occur in collaboration with key steering group members and the scheduled implementation date is 1st February 2010.

The training programme for participants will commence on 1st February 2010 in preparation for the sponsored cycle ride to be held in September 2010.