Exercise and Fitness as Part of Treatment Planning

D. Littlefield 2010

Objectives for the Day

Clarify roles and understand relationship client/clinician: We are all in this together

Discuss rational and reasoning for approach to treatment: Getting to the Heart of the Matter

Identify commonly used terminology, programs, strategies and tools: We really are speaking the same Language!

Interactive practical application: Making in Real

Introductions

Name and designation Relationship with patients/clients Experience both personal and profesional

We are all in this together Why You/ Why Them?

Patients overwhelmingly would like their physicians to discuss diet and physical activity with them.*

Every month an estimated 20% of the U.S. population visits a physicians office

Maine Adults with frequent Mental Distress or Depression are more likely to be smokers, obese, physically inactive and have higher rates of tobacco use, as well as chronic medical conditions such as asthma and diabetes.**

*Gans KM, Ross E, Barner CW, Wylie-Rosett J, McMurray, J, Eaton C Reap and Wave: New tools to rapidly assess/discuss nutrition with Patients. J Nutr. 2003;133:556S-62S.

** Maine Behavioral Risk Factor Surveillance System

The Heart of the Matter Obesity is a common, serious, and costly epidemic In Maine as in the nation

http://www.cdc.gov/obesity/data/trends.html#State Physical Inactivity is one of the greatest health risks

facing all of the developed nations* 95% of the populations in both England and US do

not meet the modest recommended amounts of weekly PA (30 mins’ of moderate to vigorous PA on at least 5 days a week)**

1 in 5 Maine adults are affected by depression or other mental health issues***

*Head to Head, BMJ 2010;340:c2603*CDC’s 2008 PA Guidelines for Americans***MCDC’s BRFSS Report Data, 2009

More to Consider

The absence of PA is a major contributor to the global and local burden of Disease including but no limited to:

Type 2 Diabetes Cardiovascular Disease Poor mental health Reduced functional Capacity Absenteeism Increased risk of injury

Benefits of Physical Activity: Lowers risk of the following:

Early Death Heart Disease Stroke Type 2 Diabetes High Blood Pressure Adverse Blood Lipid profiles Metabolic Syndrome Colon and Breast cancers Prevention of weight gain Weight Loss when combined with healthy dietary intake Reduced depression Better Cognitive functioning

The Lingo: Physical Activity

What is it? Standard Guidelines for PA* F.I.T Principle

Frequency How often

Intensity How hard

Time How Long

*US Dept HHS Guidelines for Americans 2008

Aerobic Vs Strength Training

Both are important to patients/clients At least 10 mins at a time for activities are the

recommendations Do a little more each time is the key(FIT) Aerobic activity when done moderately can be done

daily but no less than three days a week for that total of 2 hrs and 30 mins; vigorously 1 hr 15 mins a week

Muscle Strengthening Activities should be done at least 2 days a week and include all the major muscle groups as well as incorporate 8-12 repetions per set.

Aerobic Exercise: Talk the talk, walk the walk Moderate vs. Vigorous Physical Activity Moderate: Talk Test, patients can talk while

performing activities (but cannot sing) Vigorous: Patients can only say a few words

without stopping to catch their breath Moderate to Vigorous: somewhere in

between, where folk can at least break a sweat (light)

Practice: Instant Recess http://www.youtube.com/watch?v

=HOUQ8bpBnFk&feature=related

More on Moderate to VigorousModerate Activities Vigorous Activities•Ballroom Dancing•Biking on level ground•Canoeing•General gardening, raking, etc…•Sports where you catch and throw•Tennis (doubles)•Using a manual wheelchair•Hand cyclers-ergometers•Walking briskly•Water aerobics (lower intensity)

•Aerobic dance•Biking faster than 10mph•Fast dancing•Heavy gardening (digging/hoeing) •Hiking uphill•Jumping rope•Martial arts (karate)•Race walking, jogging, or running•Sports with a lot of running (basketball, hockey, soccer)•Swimming fast or laps•Tennis singles

Strength Training

These incorporate specific muscle groups Should be performed 2-3 times a week Sets are one type of exercise vs Reps the

amount of times the exercise is performed Weight training…Dumbbell curls, bench press Calisthenics… pushups, situps Resistance training such as bands and body

weight… exercise bands, weighted balls, lever systems, Yoga and other mindful resistance exercises

Flexibility: the missing link?

Often overlooked by patients/general population

Key component to overall fitness Much more than touching the floor Should be done daily Reach for maximum stretch Full range of motion Mind body experience

Be Flexible, it’s a mind body experience!

Yoga Chair stretches Range of Motion Joint articulation Easy does it a little at a time Daily is best

What works in Healthcare Adopt standards of practice and clinical

guidelines from Adult: Clinical Guidelines for Identification, Evaluation, and

treatment of Overweight and Obese Adults, National Heart, Lung, and Blood Institute.

http://nhibi.nih.gov/guidelines/obesity/ob home.htm Adult: US Preventative Services Task Force Screening and

Interventions to Prevent Obesity in Adults. http://www.ahrg.gov/clinic/uspsf/uspsobes.htm

Children and Adolescents: Pediatric position statement from the American Academy of Pediatrics (AAP)

http://pediatrics.aappublications.org/cgi/reprint/102/3/e29.pdfEvaluation and treatment recommendations:http://aappolicy.aappublications.org/cgi/reprints/pediatrics;112/2/424.pdf

Evidenced Clinical Strategies: Wait Time and Office Environments Screen at least annually, more for those

actively in a weight loss program Ask Assess Advise/Recommend Provide tools Follow-up

Ex Rx

Proven to be effective in increasing compliance

Written goals and timelines Baby steps identified by patient agreed on by

both parties

Practical Practice?

Role Play

Questions

Evaluation

Thanks!