No abstract

Background: In an ageing population with high levels of multi-morbidity, the preventative effects of exercise rehabilitation(ER) are significant. The NHS currently delivers ER mainly in disease-specific areas. There is a lack of published data to support the long term effectiveness of this model. In the light of emerging evidence supporting the effectiveness of physical activity for multi-morbidity, it is timely to consider different models of ER service delivery. Engagement with and adherence to ER is an important factor in its long term effectiveness. Active involvement and engagement with users is therefore essential at the service design level. The objective of this project, therefore, is to involve users in the preliminary stages of service re-design by seeking to identify and prioritise service needs from a users perspective. These priorities will be used to form the aims of a co-design project with ongoing involvement of service users, aims which can be investigated as individual research questions.Methods: Forty people with multi-morbidity participated in discussion forums. Themes from the forums were summarised and presented in a format to inform the aims of future service co-design. Results: People with multi-morbidity were interested in involvement in the re-design of NHS rehabilitation services. People felt the NHS could and should do much more to support people to exercise because the barriers and motivators for exercise are inextricably linked to the symptoms of illness. Traditional NHS models of rehabilitation were challenged and participants suggested novel and exciting ideas about potential service design. Conclusions and discussion: Participants understand the potential value of exercise and are motivated to exercise. Motivation is thwarted by perceived barriers to competence, autonomy and cultural and social relatedness. Service users have novel and exciting ideas about how the NHS could improve exercise rehabilitation services in order to improve acceptability and accessibility to all. Together with ongoing service user involvement, these ideas can form the aims of a co-design project and ultimately will be developed into research questions in an evaluation of a new complex exercise rehabilitation intervention.