INTRODUCTION:-

1. CLIENTS IN THE CLASSROOM– An evaluation of Student-led Diet and Exercise Prescriptions within the Workplace INTRODUCTION:- Nearly two-thirds of men, more than half of women, and one in 10 children under the age of 11 are overweight in the UK. 1 in 5 of the UK population are now classified as obese, a statistic which has trebled in the past 20 years (NAO,2001). This statistic is replicated in Scotland = Scottish NHS spending £170million/year treating the consequences of obesity (Foster,2006). Obesity is now considered by some to be the leading public health problem in the UK (Fox,1999)

2. CLIENTS IN THE CLASSROOM Underpinning factors = low levels of physical activity married with a hypercalorific diet. Changing lifestyle behaviour can be challenging(Heath & Stuart,2002; Hawkins et al, 2002; Bergman & Bertero,2001) Compliance being the challenge(Scheen,2002; Miller, 2001). drop out rates for dietary classes have been noted to be as high as 80% with considerable variation in adherence rates (NIH,1992) . Typically one third of the weight lost is regained in the first year and most is regained in 5 years (NIH,1992) this is matched by the statistic that about 92-96% of all weight reducing diets fail (Safer,1991 cited in Zabrodski,1996).

3. CLIENTS IN THE CLASSROOM If behaviour change is staged, individualised and supported there is more likelihood of success (Daly et al,2002; Duncan & Pozehl, 2002; Gordon et al,2002; Cooper et al,1999). A combination of a dietary and exercise prescription is thought to be one of the more effective means of achieving long-term weight loss and improved health indicators with overweight clients (Smith & Wing,2000) Success may be more likely if there are clear programme goals based around client history, that the exercise mode is enjoyable, and that a behavioural plan is prescribed for the duration of the programme, and also for maintenance beyond this period (Miller, 2001) .

4. CLIENTS IN THE CLASSROOM The workplace has several advantages in terms of health promotion:- easy and regular access to a client group being able to utilise peer support to aid behaviour change(Scanes,2003; Naidoo & Wills,2000; Harden et al,1999) but sustaining motivation and participation can be issues(Scanes,2003; Harden et al,1999;Biddle & Fox,1998; Mains et al,1992).

5. CLIENTS IN THE CLASSROOM Employability as a consequence of possession of vocational skills is high on the political agenda (Barr,2002), was a key feature of the Dearing Report (1997) and is the thrust behind the inception of the Sector Skills Councils. HEIs are now being challenged as to how they will address these issues in the curriculum a model of learning which would allow students to apply theory directly to practice whilst working (under supervision) with members of the general population could potentially engender a sense of vocationalism and develop key skills.

6. CLIENTS IN THE CLASSROOM use of active learning methods = students having a heightened appreciation of the real world context (Smith et al,2005) when students have engaged with clients during their studies = contributed to personal development (Kim et al,2003). N.B. Module tutors from health professional background. PROJECT AIMS:- To evaluate the experiences and efficacy of a workplace intervention, based on student-led diet and exercise prescriptions for weight loss, and to give students direct experience within a module of learning of engaging with clients.

7. CLIENTS IN THE CLASSROOM RESEARCH QUESTIONS:- Could a student-led 10 week diet and exercise intervention result in positive physiological changes and changed diet and exercise behaviour? What is the subject experience of engaging in a student-led diet and exercise programme occurring within their workplace? What is the student experience of working directly with clients in their workplace engaging in health behaviour change?

8. CLIENTS IN THE CLASSROOM METHODOLOGY:- Approval for the project was granted by the University Ethics committee electronic and paper posters within the university used to recruit employees as volunteer subjects for the project. 45 individuals volunteered, and 10 were randomly selected (9 female, 1 male, age range =26-55, mean = 40.7; sd =8.96 years) to be subjects. Each subject was screened for health and assigned a student advisor

9. CLIENTS IN THE CLASSROOM METHODOLOGY:- The students (10 females, 4 4th year BSc Food, Nutrition and Health students; 6 3rd year BSc Health Sciences students) Module = 4x2hr lectures in first 4 weeks of module:- Theory:- Health and Fitness Measures/Assessment Healthy Diet Exercise Prescriptions Behavioural Change Theory rest of module delivered by 11 x 1 ½ hr practical classes timetabled for lunchtime = 1hr client contact time = 40mins exercise session, 20 mins client discussion/advice

10. CLIENTS IN THE CLASSROOM METHODOLOGY:- Students were encouraged where practicable to be the subject’s exercise partner = further opportunity for information exchange. 12x1hr tutorials with module tutors to consider suitable client interventions using SMART goals ( = advise underwritten by the project leaders =a Registered Dietician and an Exercise Scientist).

11. CLIENTS IN THE CLASSROOM • Interventions:- Practicals: week 1 = student measures of health/fitness to learn skills • Week 2 = client enrolment and baseline measures = blood pressure, RHR, waist, weight, %body fat, BMI, VO2max, food diary, activity log, pedometer • Week 3 – start of exercise class = 40 minute circuit class designed for home translation; collection of food/activity diaries; questionnaire re.diet and exercise history. • Week 5 – use of HRM to help clients match kcal expenditure to effort • Week 6 – repeat of some baseline measures to help SMART goals • Week 11 = all measures repeated ; week 12= submission of written case study by student plus reflective account.

12. CLIENTS IN THE CLASSROOM METHODOLOGY:- Subjects and students were also asked, via a questionnaire, to evaluate their experience of participating in the project using a 5 point rating scale (1= not happy, 5= very happy) as well as some open ended questions relating to change.

13. CLIENTS IN THE CLASSROOM RESULTS:- A dependent t-test applied to before and after results produced healthy statistically significant changes (p<0.05, 2-tailed) in:- waist circumference (t=3.162,p=0.013), VO2max (t=-2.555, p=0.034)) and systolic blood pressure (t=3.052, p=0.016). Subjects on average lost 0.2kg in weight, 0.8% body fat, 1 inch from their waist, reduced systolic blood pressure by 9mmHg, and had a 4ml/kg/min increase in VO2max.

14. CLIENTS IN THE CLASSROOM RESULTS:- 7 of 10 the subjects lost weight (range= 2.5kg lost – 3.9kg gained) a clear correlation (r=0.679, p=0.031) existed between weight loss and attendance at sessions. 1 subject left the uni during week 6 and 1 client couldn’t attend classes but remained in contact with the student. all subjects experienced at least one positive change in body composition or aerobic fitness.

15. CLIENTS IN THE CLASSROOM RESULTS:- The mean percentage change for body composition and aerobic fitness when examined for the whole group produced overall positive changes:-

16. CLIENTS IN THE CLASSROOM RESULTS:- Subjects rated their experience of being involved in the project positively with all items scoring an average 4.4 or above. All had made dietary changes which they intended on sticking with as a result of the project. Half had made changes to their levels of physical activity during the project, but all intended on implementing the exercise advice they had been given for the future.

17. CLIENTS IN THE CLASSROOM RESULTS:- Students also rated the project favourably with all items scoring an average of 3.3 or above. The item which had the lowest scoring (=3.3) related to attendance of the subject at the session 50% of subjects had 50% attendance or less at the weekly sessions. (N.B. student attendance excellent) An issue raised by the students was a need to address the balance between exercise and dietary advice that they had been given in the tutorial sessions

18. CLIENTS IN THE CLASSROOM RESULTS:- Student comments:- = the reality of practice re. Difficulties of behaviour change The challenge of advice giving in limited time Good to work with real people = worthy ‘real world’ experience Nice to tailor advice to an individual (3 students also enrolled themselves as clients on the programme) (7 students regularly engaged in the exercise class = client’s exercise partner, increasing student-client rapport.)

19. CLIENTS IN THE CLASSROOM DISCUSSION:- A combined diet and exercise prescription has been suggested as a means of aiding clients toward longer term weight loss (Scheen,2002; Miller, 2001; Smith & Wing,2000) - the physical results from this small 10 week project has produced positive, if in some cases, small changes. However more positive are the experiences of the subjects involved, and their future intentions Lifestyle behaviour change has been noted to be challenging (Heath & Stuart,2002; Hawkins et al, 2002; Bergman & Bertero,2001) = longer term results which could be of greater significance

20. CLIENTS IN THE CLASSROOM As with many other diet and exercise classes, attendance can be a problem (NIH,1992), particularly within the workplace (Scanes,2003; Harden et al,1999; Mains et al,1992),and this was correlated with the degree of change. For some students this was a frustrating aspect of the project, but appreciated that this can be the ‘real world context’ (Smith et al,2005); they were still grateful for the opportunity for ‘hands-on experience’. Lessons learned for next time:- Have a separate session for advice giving = tutorial = ½ student-tutor interaction, ½ student-client interaction ?timetable in semester 2 to harness New Year’s resolutions Challenge = how to improve client commitment (?additional challenge of occurrence in the workplace)