Table 1. Overview of the aims and intervention components for each of the four clinical pathways involved in the Active Hospital pilot at OUHFT.

Pathway	Aims	Intervention components
Maternity	i) Increase PA behaviour of pregnant women attending the Silver Star and gestational diabetes management (GDM) services.	Demonstrate types of activities that are safe in pregnancy (i.e. provision of Chief Medical Officers’ PA guidelines for pregnant women) during clinical appointments and through educational resources (i.e. posters in waiting areas).
		Goal setting and motivational interviewing (including identifying motivators and barriers to PA) offered to patients who are flagged as high risk.
		Provide sensible advice regarding how PA can be built into daily life, signpost and promote opportunities locally.
		Increasing knowledge and awareness by educating patients on the benefit of PA during their pregnancy.
		Use of positive imagery to motivate women to increase their PA, for example, display case studies in posters and This girl can posters in Maternity waiting areas.
	ii) Increasing the frequency of PA brief advice interventions for pregnant women given by staff.	A PA calculator was integrated into the Maternity booking form on the electronic patient record. This triggered on screen prompts to ask about PA vital signs and then patients were given a leaflet on PA.
		Key members of staff trained by the central OUHFT Active Hospital pilot team (see Table 2) to deliver brief PA advice to pregnant women using motivational interviewing and goal setting during consultations.
		Education on the local PA resources, common barriers to PA and how to address them. Observation session to encourage staff to maintain change in practice. Feedback from patients regarding delivery of motivational interviewing session or brief intervention. Support Service for staff with email advice and drop-in sessions for challenging cases.
		System designed to support HCPs who have limited time and need the resources to hand to signpost patients on for more support. This consisted of the provision of PA infographic in clinical rooms.
		Explore opportunities for a reward system for those staff attending training sessions and delivering PA advice (e.g. PA champion of the month and ‘I have had my PA training’ badge.
Enablement	i) Encourage PA by providing patients access to a PA class and a peer support group for medical amputees.	A group-based PA class to support the physiotherapy rehabilitation programme that is open to medical amputees and their partners. The class incorporates exercises that can be taught in a gym-based setting and transferred to a home-based setting. Classes consist of demonstration of simple exercises in a safe environment with the opportunity for feedback and assistance.
		Classes could accommodate up to five patients. Each class was led by the PA champion and a Physiotherapist. A second physiotherapist was available if required. The classes were delivered in a circuit format and involved rotating around different activities.
		Patient facing PA resources (e.g. posters) displaying positive imagery of PA in gyms and clinic rooms and messages on the Enablement ward such as on-screen prompts and posters to prompt staff to engage with discussions regarding PA.
		Identify motivators and barriers to PA amongst patients and their partners before, during and after the classes and provide personalised exercises and goals.
		Integrate exercises involving readily available items to facilitate PA and supply patients with the equipment required to complete the class at home where necessary.
		Educational messages regarding the benefits/importance of PA delivered during classes.
		Attendance monitoring and participants encouraged to keep a PA diary.
		N.B. The intention was to development of peer support group with education sessions. However, no formal peer mentors were recruited or trained within the lifecycle of this study. At the time of concluding this study, two patients had been approached to become peer mentors and the Enablement team were awaiting a response.
	ii) Impart staff with the knowledge regarding the importance of PA and empower them to integrate PA advise into their routine practice.	Key members of staff in the Enablement pathway trained by the central OUHFT Active Hospital pilot team (see Table 2) to deliver brief PA advice using motivational interviewing and goal setting.
		Develop educational materials regarding PA with Enablement staff and distribute to patients. Staff in the Oxford Centre for Enablement received PA training delivered by SEM registrar and Consultant. They also had motivational interviewing training through active conversations class. Staff were involved in the development of the Amputee Moving Medicine module and development of the patient information resources. Patients were given an information leaflet about the benefits of PA for people with amputation (this was developed alongside the amputee Moving Medicine module). The exercise class programme was available as a patient information leaflet and a patient workbook was used to support motivational interviewing conversations.
		Develop on screen prompts for staff to discuss PA.
		Distribute positive feedback regarding PA discussions from patients to staff. Informally–verbal feedback, compliments, and examples of patients with positive outcomes from PA interventions were shared during team meetings, planning meetings and governance meetings. Formally–positive feedback was shared in presentations about the pathway delivered by SEM Registrar and in poster presentations for conferences.
Renal	i) Develop an activity permissive environment (active ward) and a social support network to foster peer-to-peer support to increase the PA of in-patients on the Renal ward.	Development of a PA permissive culture by encouraging twice daily walking in and around the ward with other patients, family and where available staff.
		Walking was encouraged through the provision of signed routes, seating in long corridors for rest stops and the removal of barriers such as locked doors.
		Educate patients on the benefits of being physically active both on their general health and active symptoms. Extending this knowledge and permission to families and friends.
		Identify and manage patients’ psychological barriers to increasing PA on the ward.
		Minimise times when patients are expected to be confined to their rooms.
		Posters and patient information on the benefits of PA as well as how and where to be active on the ward.
		N.B. Social network to foster peer-to-peer support. This element of the pathway proved difficult to implement and no peer mentors were recruited within the study lifecycle because no patients were willing to be peer mentors.
	ii) Impart staff with the knowledge regarding the importance of PA and empower them to integrate PA advise into their routine practice.	Key members of staff in the Renal pathway (i.e. transplant nurses and ward staff) trained by the central OUHFT Active Hospital pilot team (see Table 2) to deliver brief PA advice using motivational interviewing and goal setting.
		Support the development of a ward and clinical environment that supports promotion of PA.
		Develop tools and ward systems to support frequent conversations about PA between HCPs and patients.
		Develop prompts to encourage professional to asks the PA vital sign and provide ongoing brief PA advice and consistent messaging to patients.
Complex Medical Unit (CMU)	i) implement a patient centred PA intervention to increase the amount of PA patients do during their stay on the ward.	PA champion encouraged patients who had a stable Early Warning Score and were not on an end of life pathway to be more physically active using motivational interviewing.
		A patient workbook was used during motivational interviews to give consistent structure to the conversation, help patients set their ambitions and plan how to achieve their goals.
		Bed-based, chair-based and standing exercise programme booklets were available for patients depending on their physical ability.
		Development and implementation of the ‘I CAN’ tool that documents each patients’ physical capability so ward staff are aware of what the patient can do. The intention of the ‘I CAN’ tool is to overcome risk aversion by giving permission for patient to move more rather than traditional bed rest. Further information about the ‘I CAN’ tool can be found here https://movingmedicine.ac.uk/active-hospitals/find-resources/
	ii) Impart staff with the knowledge regarding the importance of PA and empower them to integrate PA advise into their routine practice.	Key members of staff in the CMU pathway trained by the central OUHFT Active Hospital pilot team (see Table 2) to deliver brief PA advice using motivational interviewing and goal setting.
		All conversations regarding PA were documented in the patient’s Electronic Patient Record.