Physiotherapy, Exercise and Physical Activity Course - Evaluation Report

Original Editor - Username Top Contributors - Vidya Acharya and Kim Jackson
Physiotherapy Exercise and Physical Activity Image.png

Summary

In July/August 2016 Physiopedia successfully delivered the Physiotherapy, Exercise and Physical Activity Open Online Course (PEPA MOOC) via the Physiopedia Plus online learning platform.

Course Type - Open, Online Course Reference – PEPA

Course Co-ordinators - Ann Gates, Rachael Lowe

Collaborating Partners – Exercise Works and Physiopedia

About this course - This online course develops participant’s knowledge of Physical Activity.

Who was invited to take part - Physiotherapy and Physical Therapy professionals, clinicians, students and assistants; other interested healthcare professionals interested in this subject were invited to participate.

Date that it ran – 4 July to 15 August 2016

Time commitment - approximately 24 hours over 6 weeks

Requirements – Participants were required to complete online learning activities, engage with additional resources, take part in the conversation online and complete the course evaluation.

Assessment - Pass a final quiz with a mark of 80% (plus an optional case study on physical activity to be awarded a course distinction).

Awards - Completion certificate plus Physiopedia Plus (PP+) points.

Accreditation - The course was accredited by the South African Society of Physiotherapy (SASP)

Acknowledgements

The PEPA MOOC was developed as a collaboration between Physiopedia and Exercise Works and funded by Physiopedia.

Key content contributions were made by:

  • Exercise Works

Course co-ordinators:

Course facilitators:

  • Fiona Moffat, PT, School of Health Sciences, The University of Nottingham, UK
  • Nancy Rollinson, PT, Northern Devon Healthcare NHS Trust, UK
  • Dr Brian Johnson, Honorary Advisor to Public Health Wales

Introduction

During July and August 2016 Physiopedia ran their fourth Massive Open Online Course titled Physiotherapy, Exercise and Physical Activity (PEPA MOOC). The PEPA MOOC was developed and delivered as a collaboration between Physiopedia and Exercise Works (UK). This course was designed to help healthcare professionals understand the scale of the problem of physical inactivity in populations globally, the role of physical inactivity in the prevalence of a number of conditions, the benefits of exercise in treatment and prevention, and to encourage those who access the course to perform and evaluate interventions to increase physical activity in their settings. The course also aimed to inspire and support all healthcare professionals to lead on physical activity advocacy and action within their practice, in contexts varying from local to global. The content of the course was designed to be appropriate for physiotherapists in any global context, in addition, all healthcare workers were invited to participate. Being open for anyone to participate the course facilitated a global conversation around the topic and enabled peer-to-peer learning across contexts and experiences. The six-week course presented a different topic each week and involved a variety of learning activities to suit all learning styles. The required learning activities each week were designed to take between 4-6 hours and optional activities were also provided should the participant wish to take part in additional learning. A two week orientation period before the course provided participants with an opportunity to become familiar with the delivery platform and the topic via open access to the course textbooks. The course was delivered through the Physiopedia Plus (PP+) online learning platform, an innovative website specifically developed to deliver online education and provide learners with a learning log and a personalised learning dashboard. Each week the course activities were released on a dedicated course page and participants were notified by email and social media. As participants engaged with each learning activity it was recorded and displayed in their own personal learning dashboard and activity log. To complete the course, participants were required to contribute to the online discussion each week, complete the pre and post course competency tools, complete a course evaluation form and pass a final quiz. On meeting all these requirements the participants could download a completion certificate and also export a record of their learning from their activity log. Participants were also offered an optional assignment to describe a physical activity related intervention to be awarded a course distinction. This report evaluates the experiences and engagement of the participants that took part in the 2017 PEPA MOOC.

Aim of the Course

This course was designed to help healthcare professionals understand the scale of the problem of physical inactivity in populations globally, the role of physical inactivity in the prevalence of a number of conditions, the benefits of exercise in treatment and prevention, and to encourage those who access the course to perform and evaluate interventions to increase physical activity in their settings. The course also aimed to inspire and support all healthcare professionals to lead on physical activity advocacy and action within their practice, in contexts varying from local to global.

Course Learning Objectives

At the end of this course, participants should be able to: 1. Describe the basic principles of the relationship between exercise and health 2. Identify issues surrounding physical activity locally and globally 3. Explain the role of physical activity in chronic illness 4. Explain the role of physical activity in certain medical conditions 5. Communicate the importance of influencing physical activity opportunities for both patients and the public 6. Demonstrate appropriate selection of physical activity options for personal and workplace wellness 7. Identify appropriate physical activity quantification methods 8. Design services with better access to exercise, physical activity and leisure time opportunities for patients and the public.

Intended Audience

This course is suitable for any Physiotherapy or Physical Therapy professionals including clinicians, assistant or students who have a good understanding of the key principles of physiotherapy but wish to understand more about including physical activity in their clinical practice. It will also be of interest to any healthcare professionals (e.g. nurses, occupational therapists, medical doctors, fitness professionals, community outreach workers) motivated to upgrade his/her knowledge on physical activity for health.

Cost to participants

The course was free to all participants.

Course Structure

Participants will be given a number of tasks each week to complete, namely:

1. Complete between 5 and 10 learning activities each week

2. Review at additional readings, videos and resources

3. Complete a short quiz

4. Contribute to an online conversation hosted on the Physiopedia Plus discussion forum

Demographics of the participants

Country

8482 participants formally registered for the course before the end date of 04 July 2016. They represented 157 countries (see Appendix 1). The most represented countries were:

India 1158
United Kingdom 1150
 Egypt 741
Nigeria 450
United States 424
Canada 389
Australia 375
Saudi Arabia 225
Pakistan 185
South Africa 172

Profession

86% were physiotherapists / physical therapists.

Physiotherapy / Physical Therapy 7258
Other 552
Fitness Industry 278
Medical Doctor 209
Occupational Therapy 114
[null Nurse] 71

Role

59% were clinicians and 19% were students.

Clinician 5010
Student 1643
Educator 603
Other 374
Assistant 361
Researcher 269
Manager 222

Platform

The course was promoted on a public page on Physiopedia (http://www.physio-pedia.com/Physiotherapy,_Exercise_and_Physical_Activity_Course). This page has viewed a total of 11,229 times before the final date of the supported course on 4 July 2016. This page directed participants to set up an account on the Physiopedia Plus platform where the course was delivered. Participants had to log in to their account on this site to access the course.

Unique individuals that accessed at least one learning activity: 2525

Total learning activities logged: 77489

Course textbooks

There was one-course textbook. The copyright owners made online access to this book free for the duration of the course:

Buckley JP. Exercise Physiology in Special Populations: A volume in Advances in Sport and Exercise Science Series. Elsevier Health Sciences 2008.

Participants were particularly grateful for this aspect of the course. The publishers have reported that their experience has shown that making books freely available online during a popular online course has a significant impact on subsequent sales of the hard copy version of the book.

Discussion Forum

Participants were required to participate in the course discussion forum on a weekly basis. This was a requirement as these activities provide a rich learning experience through promoting self-reflection and exposure to global discussions about physiotherapy, exercise and physical activity. This was the task that many participants found most difficult to complete.

The discussion forum was hosted on the Physiopedia Plus platform where participants were asked to comment on the weekly guided discussion topics. It was clear that not all people engaging with the course participated in these discussion topics.

Number of people who introduced themselves in the forum: 1600

Number of people that contributed on a weekly basis (median): 561

Total number of discussion posts: 10799

Quizzes

Each week participants were given the opportunity to assess their knowledge and understanding of the topic through multiple-choice quizzes. Participants received immediate feedback on right and wrong responses making this a formative learning experience. In the final week, participants were invited to attempt the final multiple-choice quiz. This quiz was designed to assess knowledge and no feedback was given. The pass mark was 80% and they could attempt the quiz multiple times.

Number of quiz attempts 1050

Number of passes 859

Final Assignment

Reflecting on their learning and using the knowledge gained throughout the course participants had the additional option to submit an assignment on a physical activity related intervention. For this, the course participants would receive 6 more PP+ points and a distinction on their certificate.

Number of completed assignments 21

Participants were able to choose from 3 different assignment topics which allowed for different contexts, academic skills and interests. The patient case study and the exercise programme were the most popular assignments:

Patient case study 14 Community intervention case study 3 Physiopedia page 4

The low number of assignments submitted related to the optional nature of this assignment. In previous courses where assignments were required to complete the course, there have been significantly more submissions.

Certificates

On the successful completion of this course, each participant was provided with a Physiopedia certificate of completion and PP+ points (which are equivalent to CPD points/CEUs). These were awarded if the participant met the following course requirements:

1. Logged all required learning activities as completed

2. Contributed to the online discussion each week

3. Completed the pre and post course competency tool

4. Passed the final course quiz with a score of 80% or more

5. Completed a course evaluation form

Course Accreditation

The course was accredited by the South African Society of Physiotherapy.

Course Evaluation

Participants were asked to complete an online course evaluation at the end of the course (see specific responses in Appendix 2). The number of participants who completed the evaluation 559 In general participants responded very positively about the course (see Appendix 3). Aspects of the course identified for praise included the:

  • Global perspective - sharing ideas and recommendations
  • Global discussions, research and evidence.
  • Relevant topics and course materials
  • Motivational interviewing
  • Evidence-based support for exercise promotion
  • Patient videos
  • Mix of activities

Difficulties relating to course participation identified by some participants included the (see Appendix 4):

  • Duration and quality of some of the videos
  • Time involved in required reading activities
  • Process of activity logging
  • Navigation through the website
  • Inability to download course materials
  • Delivery during the summer period
  • Length of the course

Impact on clinical practice

Many participants specifically stated that their clinical practice had changed as a result of the course (see Appendix 5).

Future

This course remains available to all Physiopedia Plus users to be completed on their own schedule.

Contact details

For further information, please contact:

Rachael Lowe [email protected]

Appendix 1 – Course participants countries

India 1158 Afghanistan 52 Suriname 13
United Kingdom 1150 United Arab Emirates 50 Iran, Islamic Republic of 13
Egypt: 741 Portugal 49 Uruguay 13
Nigeria 450 Greece 44 Kuwait 12
United States 424 Switzerland 37 Iceland 12
Canada 389 Kenya 37 Zambia 12
Australia 375 Netherlands 36 Zimbabwe 11
Saudi Arabia 225 Germany 35 Estonia 11
Pakistan 185 Costa Rica 29 Croatia 11
South Africa 172 Indonesia 29 Jordan 11
Jamaica 161 Sudan 27 Bosnia and Herzegovina 11
Ireland 157 Nepal 24 Guyana 10
Malaysia 145 Trinidad and Tobago 23 Hungary 9
New Zealand 116 Colombia 22 Tanzania, United Republic 9
Italy 104 Poland 21 Iraq 9
France 100 Hong Kong 21 Denmark 9
Brazil 91 Argentina 18 Lithuania 8
Israel 86 Finland 18 Japan 8
Spain 85 Belgium 18 Ukraine 8
Sri Lanka 85 Korea, Republic of 18 Ecuador 8
Malta 85 Norway 18 Cameroon 8
Palestinian Territory 82 Rwanda 18 Fiji 8
Myanmar 76 Uganda 18 China 8
Singapore 67 Oman 17 Antigua and Barbuda 8
Chile 66 Bangladesh 16 Cyprus 7
Mexico 65 Romania 16 Peru 7
Vietnam 63 Austria 16 Namibia 7
Qatar 63 Syrian Arab Republic 15 Serbia 7
Thailand 56 Ethiopia 14 Albania 6
Ghana 56 Czech Republic 14 Mauritius 6
Philippines 55 Lebanon 14 Madagascar 6
Turkey 55 Venezuela 14 Malawi 6
Sweden 55 Bulgaria 13 Swaziland 6
Barbados 5 Cayman Islands 1 Reunion 5
Taiwan, Republic of China 5 Aruba 1 Morocco
Bahamas 5 Tunisia 1 Macao
Papua New Guinea 5 Pitcairn 1 Libya
Somalia 4 Eritrea 1
Saint Lucia 4 American Samoa 1
Montenegro 4 New Caledonia 1
El Salvador 4 United States Minor Outlying 1
Islands
Brunei Darussalam 3 Senegal 1
Maldives 3 Macedonia, The Former Yugoslav Republic of 1
Burundi 3 Bermuda 1
Bhutan 3 Central African Republic 1
Russian Federation 3 Benin 1
Puerto Rico 3 Heard Island and Mcdonald 1
Islands
Equatorial Guinea 3 Chad 1
Cambodia 3 Seychelles 1
Botswana 3 Kazakhstan 1
Bahrain 2 Slovakia 1
Tajikistan 2 Sierra Leone 1
Grenada 2 Haiti 1
Congo, The Democratic Republic of the 2
Guatemala 2
Turks and Caicos Islands 2
Isle of Man 2
Yemen 2
Jersey 2
Guadeloupe 2
Latvia 2
Togo 2
Dominica 1
Cook Islands 1
Burkina Faso 1
Mali 1
Azerbaijan 1

Appendix 2 – Course evaluation: specific responses

General impressions of the course

General impression Graph.png

Appendix 3 – Course evaluation: what were the best elements of the course (selected responses)

I enjoyed engaging with healthcare professionals worldwide and learning about other countries struggles and barriers to increasing physical activity levels and the strategies that are being enforced globally to make people more active.

It is hard choosing the best part of this course. The course materials were so spot on and revealing for me. As a physical therapist clinician, there were a lot of things I even took for granted but this course has brought that to my attention. Although I engage in physical activity myself, I realize, from this course that there's the need to involve and engage other stakeholders. Getting materials that give details as to how physical activity influences various non-communicable diseases and even during pregnancy was also a high point for me.

The course was really an eye-opener. I have been able to learn not only about clinical aspect but health promotion and population health. Promoting PA in special population and use of motivational interview to help clients make better decisions about their physical activity. It was also interesting learning from my colleagues round the globe about various challenges their client people face that prevent them from being active. Most of these barriers are the same everywhere.

All topics were relevant, but looking at how to motivate, or approach and work with people where they are at is most relevant. I think we know the general aspects of benefits - how do we help change the culture.

This is the second course I am doing with Physiopedia. What I found interesting is the amount of valid information given about the relevant topic. Furthermore, I never had the opportunity to study abroad and share ideas and recommendations by other physios from different countries. In this way, this is achieved in the comfort of my own home in my own time.

The multi-media aspect to it - really interesting hearing the opinions of other experts in the field.

Even though most of the information were well known to me. this course highlighted them. and gave me a push to encourage myself first then my patients to be active. The idea of making every contact count was totally new to me. I was focusing completely in the patients' medical conditions and how to improve their functional levels but never thought to exceed that to encourage being physically active in general. Also, thinking about the community and how to encourage them was something interesting!! I loved it!!

I really enjoyed the content every single week. However, the motivational interviewing struck a cord with me. As I analyze why this happened, I came to the realization that no matter how hard we can work with a client, it is not until the client (he/himself) comes to realize what you are trying so hard to get through to him... all of your work is quite useless.

Evidence-based support for exercise promotion. Good to see the big picture of the benefits of exercise including government down to individual level.

Good ideas for motivational interviewing.

I really enjoyed the part of obesity because I personally have to work on weight management. I also liked the motivational interviewing and how to apply all the course contents in my daily practice whether at a personal level or with family members and patients. I really enjoyed this course as it brought all the information, recent research and evidence about the benefits to physical activity in one place. It also gives me the confidence to address the benefits of physical activity to my patients, helps find ways to tackle barriers and show them physical activity doesn't have to be going to the gym, running or walking but can be as simple as moving more around the house and garden. The course has also opened my eyes to the social determinants of health which I would never have given much credence to before.

I really loved the videos of the patients view and benefits of exercise.

I liked that there was a real mix of activities e.g. Articles/presentations/websites to read, quizzes, discussion forums. It kept it really interesting. IT was great that you could complete the task in your own time each week. It's also been really helpful to have the extra couple of weeks to complete everything at the end because I went on holiday and it's allowed me to catch up. There's clearly been a lot of time and effort put in by all the course organisers and facilitators and it's really been appreciated. It's so great to have a course of such a high standard on offer for free. It's been very clinically relevant and has really challenged my knowledge and perceptions of the importance of physical activity. Thanks for all your hard work.

Being qualified for 20 something years, it was good to have the information, evidence and guidelines about physical activity recommendations and their role in good health. I found the Exercise Works powerpoints really helpful in delivering messages. The short visual videos were punchy and interesting. I think the weekly reflections and quiz were important in guiding my study and to ensure I was thorough with my reading.

I have been working on a programme in this area for about 4 years, and have already worked with a great deal of this type of content already. This programme gave me great confidence in what I am doing and made me realise that I was quite correct when I decided to work towards helping clients to become physically active.

Really enjoyed all aspects of the course. Well structured course. Six weeks a good length time. Sustainable within normal routine for 6 weeks of focus. Thank you very much. Excellent course. Well put together with lot info shared.

In my opinion the best elements of this course were the many different experts and leaders in their field recruited to put forward their focus on physical activity. The skype discussions were excellent and a great way to introduce that weeks topic of focus.

The constant reminders about the importance of PA for our patients, and the community as a whole - seems to me that so many of the health system problems can be fixed this way. Also the more intense focus on exercise prescription per condition and the assumption of leader roles in promoting new activity practices. GREAT COURSE!!!

This topic is highly relevant to my clinical work at present and I have found it inspiring and informative. I have myself become more active as a result and in particular wanting to be an active role model for my daughters. It is important to me that they keep active - which they are very active at present.The best elements are the clear guidance and contraindications for varying conditions. Also, to give me clear points to read up on and improve my knowledge formally.

I found it's more interesting that as Physiotherapist we have an opportunity to give the society ample scope of health benefit regarding preventing and fighting several diseases and at the end we can play as the leadership.

The extent to which the topic on physical activity was covered- from a system approach to the clinical setting. Key messages were repeated which was really useful in aiding understanding. I enjoyed the fact that information was delivered through such a wide variety of mediums. It was a lot of work but well worth it!! The forums would have been useful if my time management had been better since the start of the course in July. A lot of the references I will refer back to when we take forward our work on physical activity and health improvement in work. Many thanks for providing this excellent learning opportunity for free!!

I enjoyed weeks 5 - 6 most because it brought the information being taught into the clinic. It helped me to focus more on my patients, to show them the importance of being physically active. And I saw the results, they came back and told me that they had started to make changes to their activities so as to be more physically active. For myself, because it is difficult to do exercises once I am home I set aside time at work, and even in between patients to do some exercises and I have found it very beneficial. I'm not as tired and I feel more upbeat.

The part about NCD's, especially what is appropriate for some diseases but also at depression and pregnancy. The information about medication and the influences of that during PA.

Presentations; multimedia content; motivational interviewing.

Balance of learning materials (good mix of videos - always my favourite, readings, audio, discussions etc). Great worldwide perspective and opportunity to research more about the countries we live in and their specific health problems.

I enjoyed every week, the content was appropriate and relevant and stimulated more creative thinking regards how to combat further physical inactivity. The supporting literature was also very useful and some of it I will save and use to support more of my practice in years to come. The behavioural change and the theory and practice behind motivational interviewing was my favourite though as I have a curiosity for further strengthening/honing in on this subject as I am a firm believer in changing thinking and habits by making individuals aware of their activity choices and levels and thus hopefully having a positive impact on their overall quality of life by working towards moderation, balance and variety.

The best elements of the course was the fact that it had a variety of learning resources including, forum discussions, videos, readings etc. I personally think the forum discussions were the best because it goes beyond what is in textbooks and research. Everybody's personal encounters and experiences open our minds to many new and different strategies.

I found this course extremely helpful in broadening my knowledge of a topic I felt I previously had know a lot about. This course has highlighted gaps in my knowledge in an informative and engaging experience. I enjoyed the power point presentations and the quizzes at the end of each topic. I also found the forums interesting to include a global perspective. I also really enjoyed the Skype/Youtube interviews as it allowed me to hear information explained in a more interesting method than only reading from the screen.

Appendix 4 – Course evaluation: how could this course be improved (selected responses)

I found it hard to update my activity log and found limited amount of help to fix it, in fact, I haven't fixed it yet!

I found the discussion boards difficult to keep track of and hard to individually ask questions to others on the course.

Include more video classes and exercises.

Felt like there was often a lot of repetition from one presentation/resource to another each week but the topics covered each week were great and interesting.

Will appreciate if some of the resource material can be made available on pdf for future references.

It's my first online course and I don't have experience from the past. So, my main problem is especially with videos with poor sound or when the colleagues talked too fast.

English is my second language ..... So I found myself to spending more time on the course than their predicted ( very important information that I need to absorb all the knowledge they provide ) ...... So instead of 6 weeks I will extend to 8 weeks.

In the quizzes, with multi options. Is it possible to give an indication of how many boxes to tick as it is disheartening if you have ticked too many/too few.

I strongly believe that is already a very interesting course for those who are interested in physical activity and exercise. No improvements are needed in my opinion. Well done.

The web pages aren't always easy to move through - particularly when you have to sign off what you have done.

It was a bit challenging to access some of the videos. I was really happy when transcripts were provided for some videos. It would be better if transcripts are provided for all the videos or optionally if the videos can be made downloadable (I think it is better and cheaper than streaming the videos especially in my part of the world).

More bite sized learning components- so less text and more visuals. Greater diversity and extended global scope of presenters/facilitators and videos.

More social media friendly learning eg via Twitter or SnapChat- maybe something to explore.

I loved everything the home page, and the contents and it's diversity between ppt to videos to audios .. great!

I would like to see perhaps more videos,I found these especially helpful.

Dynamic live classes with teachers.

More audio visual will be more effective as a learning tool for me. Reading too long and too many repetitive articles.

I don't think the course can be improved in content I thought it was simply brilliant. The only thing that I would mention is the activity log, it would be useful to have a link after each piece of work where you could link straight to this. I found that I got so engrossed with reading all the material that I forgot about the activity log until right at the end of the weeks worth of material. I then found myself having to re-read some information in order to make notes.

Slightly tricky website. Don't always know which parts I have finished. More space for notes when logging activities finished.

I had problems downloading the exercise works presentations. They would often take a long time or some pages would never download so I would read everything that I could. I would have liked some printable information with clear information on it as every time I wanted to look up a fact to be sure to tell my patient, I had to spend a long time downloading the presentation.

The discussion forum was hard to interact on, ie. Some other MOOCs have used closed group on FB, which probably has different challenges but obviously a very user-friendly and easy way to comment, like and discuss issues.

1. By replacing the interviews with transcripts.

2. By making the resources concise and easily accessible during and after the course duration.

Some of the podcasts/videos were too long, same person talking for 30 minutes straight with just a video of themselves. Could have been more dynamic and engaging. Overall could have included many more high quality case studies, highlighting what works well and what does not especially in terms of whole system approaches and community interventions.

If possible putting each weeks reading/ links into separate folders/ links as I seemed to spend long time scrolling back down to get to the next article.

The course work was way more than 6 hours per week. to be able to cover the material and be able to go through optional information the course should have been closer to 8 weeks long.

Deadlines to ensure that participants keep up to date with work, otherwise they may tend to leave the course work for too long and fall too far behind.

There is nothing more I would do to improve this course - I found it excellent.

Explicit explanation should be given, so as to understand how to make use of the site, especially the area of logging in the activity for the week.

I found the forums a bit difficult as there were so many people posting on there. I could not read everyone's, which is a shame as some of them were very interesting.

It is an excellent course, but a lot of reading work to do after work or even between patients some days! Maybe giving some of reading as extra option and being available to access even after course has ended. Possible to access physiopedia power point presentations after closing of course?

As I'm a student and we don't get enough time to go through the entire articles and text sometimes, so if there is a summary of articles journals and text at the end of that topic then it can help us out a lot.

Watching the videos was a challenge for me as the cost of mobile data in my country is high.

Maybe there could be more specific questions on the forum rather than one big discussion. It was easy to become overwhelmed trying to follow the conversation.

Fewer introductory videos. Attention to length and quality of videos. I felt some were too long.

I should suggest that each uncompleted tasks be displaced on the activity page at the end of each week so that the student will see and know his or her outstanding tasks before the next week classes.

Some weeks, depending on my clinical workload, it was a lot of material to get through. Perhaps the duration of the course could be extended.

The weekly schedule needs to be sectionalised, instead of having to scroll through everything already done to get to desired topics. Eg. Scrolling through weeks 1-4 to get to week 5.

The content for week 3 seemed much larger than all other weeks and probably could have been divided up a bit more. The forums were a little hard to navigate and it would have been nice to be able to add replies to others posts to increase networking opportunities.

To include community practical workshops.

For those who are not from English speaking countries, it is very helpful when subtitles are provided within the video file. More global examples as opposed to majority NHS

I found this course extremely interesting, and I feel that I have benefitted from taking part tremendously, so would like to thank you for this.

The time of year was difficult as the course runs over school summer holidays, with the tight time scale this meant I had to fit in studies with my family holiday, which was tough.

As this is the first time you have run the course (I really hope you can repeat it), as a manager/ lead I was unable to advise staff as to the usefulness of the content or likely time commitment or understand how much support I should provide them with time. It would be great If you re-ran this course - now I have completed it I would be able to promote it & also help support staff with time to complete it productively.

This course was promoted to me through my work. When I started it, I did not realise how much work was involved which was probably good because given the number of hours per week I don't think I would have committed to it during the summer and within the 6 week period.

My one suggestion would be to have tabs across the home page of the course to take you straight to the appropriate week's content; I did find it laborious to scroll through the content until reaching the section I needed.

Maybe with a live chat with any of the facilitators...

Well thought through. Perfect. Recommendable!

Appendix 5 - Course evaluation: Please describe any way in which this course has changed your clinical practice

In a lot of ways; empathy toward patients, motivational interviewing, the multi- sector involvement in promoting physical activity...to mention a few. The course was highly informative and educative with a rich combination of resources. Being a physiotherapist and educator it has taken my confidence and passion to educate people to another level. Thank you.

It gave me more confidence to recommend physical activity to patients for instance with Rheumatoid arthritis. The Motivational Interview is definitely something I want to explore as well as the stickers, reminding people to be active. I will prepare a roll up for my Clinic room promoting physical activity as 80 % of my patients are sedentary (the other ones come because of sports injuries:). This is how I found out that I need to know more about training as the actual sports trainers don't seem to know anything about rehabilitation training.

Have already recommended your webpage, resources, courses etc. Got me thinking a lot about my practice and have already made some changes. Utilising every interaction to invite persons to discuss physical activity. To promote PA in the most general sense possible. To explore options / consider small goals when working with patients. Messages to move more ... even a little more is good, to decrease sedentary behaviours a little, to consider PA at a community level.

Going through the many different topics of this course has reinforced with me the absolute necessity to make each contact count with patients. It's easy to approach giving your advice/knowledge/opinion etc. in the same way to every patient and it's good to be reminded that every patient is different and that the ideal outcome is not always realistic, or desirable for the patient involved. making progress towards that ideal is realistic and invariably, in some way, desirable for the patient. Thank you.

I am very passionate about exercise and physical activity so I was already using my patient contact time to promote physical activity but thanks to this course I realized that my interventions were too persuasive in nature. Now I started practicing motivational interviewing and I noticed that it is more effective.

It has helped me to be more confident in prescribing exercise for more people no matter their conditions. Just knowing the proper frequency, dosage, intensity, time can help them to be healthier.

I have always asked my patients during the assessment about their level of involvement in physical activity but this was to help me establish goals for getting them back to their normal functional level. Now I have a different motive for asking because I am now interested in getting everybody to the standards set by WHO for physical activity.

Thank you for providing this most valuable education about not only physical activity and why it is beneficial, but also about how to interact with patients and society to implement change. While physical therapists know so much about exercise and health, we do not always know how to engage with our patients to facilitate adherence. We can create a fantastic exercise program, but it is useless if the patient won't do it. This course will forever change how I practice on a daily basis and how I educate future physical therapists about the impact they will have on the health of their patients and the populations in which they live. I have no doubt that this course will have a ripple affect across the world. Thank you for all you did to create this course!

I am more aware of the importance of PA and the global PI issues. I am able to talk about this course with my clients, thereby encouraging them to be more active. I try ECC (Every contact count) and promote "sit less and move more" whenever I have a chance.

The course has improved my knowledge of activity/inactivity so I can better inform clients, friends and family. It has also clarified my thinking on the role of physios in public health and my own interest in being more involved in this than just clinical work.

It gave me a lot of resources and information to work with. It gave me statistic facts to use with my patients about NCD, tools to be more emphatic and work with them, information about social and political ways for improve lifestyle, physical activity and health. And one simple fact, to make every contact count.

The approach used is different. Motivational interview is being used to convince patients for physical activity. Listening skills and interactions have increased, encouraging patient participation in physical activity planning.

This has changed my clinical practice significantly. I am less flippant about advising and guiding pt and more active in establishing pts stage of change. It has all seemed to come together as our service is beginning to implement self-referral, and I have been accepted to complete a research project on pt engagement, I feel that I can use this information positively, using recommended outcome measures and reporting measures.

I now ask my patients about their physical activity levels much more frequently. I am also more understanding about their contributions, consciously refraining from lecturing patients, but rather including more active listening and motivational interviewing.

It has really opened my eyes to the importance of physical activity and made me more aware of the problem of physical inactivity globally. I will now make every contact count and play my role as a healthcare professional in reducing the burden of diseases nationally and globally.

I make more of an effort to raise physical activity with more of my patients but in a different way - rather than persuading them and telling them the information, trying to use some of the motivational interviewing techniques covered on the course. I feel more confident in prescribing physical activity and the advice that I give out regarding how much to do etc.

Provided with excellent resources to utilise, developed understanding of condition-specific exercise prescription in areas which aren't my specialty, provided inspiration for quality improvement projects at my work and will update the current Physical Activity and Exercise information that we routinely give to our patients.

It will inform our work on promoting physical activity through each patient contact and also through linking with local public and voluntary agencies. The key message for me personally is a shift from thinking about exercise and rehabilitation to physical activity. I also found the advice on cautions and CI for different NCD really useful and this will increase my confidence in promoting PA with these patient groups.

This course has enhanced my knowledge of physical activity and the prevention and treatment of specific diseases. I have reassured confidence in what I previously knew is supported by evidence and many successful examples and facts support the benefits of PA. This course has also helped inform my practice by encouraging me to promote PA to my patients and other health professional colleagues whose knowledge of PA and exercise may be limited. I feel inspired to be a physical activity leader and on my next placement will consider doing a presentation on physical activity promotion for other health care professional students.

As a physiotherapy student coming from the most obese country in the EU, I feel that this course would be essential when working with patients, especially when I come across physically inactive patients. Whilst before I would have imagined merely passing on knowledge about the importance of physical activity (and perhaps even judging patients for not incorporating physical activity into their lifestyle) I would now take a better approach using motivational interviewing and allowing the patient to come up with alternatives.

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Final Report