Medical Home’s Backyard A Place to Create Change

1. Medical Home’s Backyard A Place to Create Change Mark Cucuzzella MD FAAFP Professor of Family Medicine West Virginia University Lt. Col. US Air Force Reserves

2. Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

5. What is Nature?What Does Your Backyard Look Like?

6. What is Play?

7. Play -Stuart Brown MD My brother Neil Age 12 1981 “Play (by definition) is purposeless and all consuming. And most important its fun.” It is disconnected from outcomes

8. “What is the opposite of Play?” Work? Workouts? ……Depression

9. From Jogging by Bill Bowerman 1967 inspired by Arthur Lydiard New Zealand Fartlek- slow steady runs Swedish Fartlek- “speed play”, “you can play, fool around in this workout” “Train Don’t Strain” Lydiard

10. The first man to get Cardiac Patients Running Andy Steadman, 76 yrs, 3 coronaries “the heart’s just another muscle which needs to get fit with exercise”

11. Brain Science- Activity and Play Air National Guard Runner James Munnis Harpers Ferry Half Marathon In every walk with nature one receives far more than he seeks. -John Muir

12. Living Proof that Play can make up for other bad habits- the Stones 50 yrs later Mick on a hike

13. The Medical Home’s Backyard Maybe nature (by definition) is where play occurs? The original “Playstation” So how do we reconnect people to nature or the backyard? Harper’s Ferry Kids Run

14. Sam’s Story

15. Tiger on the Trail 2007-14 School Years 4000 students >10000 miles of trail

16. Purposeless

17. Play as if Your Life Depends on ItFrank Forencich

18. Play is the process. Fitness is the product. George Sheehan Harpers Ferry Students on a Hike

19. Play is being engineered out of our lives….Where’s your Monkeybars

20. “Man is most nearly himself when he achieves the seriousness of a child at play.”Heraclitus - Greek philosopher Barefoot Running with the Kids

21. “A child loves his play, not because it’s easy, but because it’s hard.” Dr. Benjamin Spock Shepherdstown Road Runners Club

22. Opportunity for All

23. “Play is hard to maintain as you get older. You get less playful. You shouldn’t, of course.”Richard Feynman Video Don Taylor Freedoms Run 2010

24. “Just play. Have fun. Enjoy the game.”Michael Jordan

25. “Play fosters belonging and encourages cooperation” Stuart Brown MD Natural Running in Shepherdstown, West Virginia

26. Building the Fitness Trail- Page Jackson Elementary School

27. “Roots to Shoots” SES Garden

28. “To say this is my home and I care enough about it is the essence of citizenship” Peter Forbes Trust for Public Land The Promise of Place Based Learning

29. Normal Aging

30. Coasting along on a gentle plateau

31. Getting Younger Next Year

32. Frank Buckles Age 110Last WW1 Vet You Must Stress the Body Never Be in a Hurry

34. “If you have a body you are an athlete” Bill Bowerman, Legendary Oregon Coach and co-founder of Nike Invented Jogging for the masses

35. The Goal I feel great. Is that normal?

36. "The strenuous life tastes better."William James, 19th Century Philosopher “If you can’t fly, then run. If you can’t run then walk. If you can’t walk then crawl. But Whatever you do keep moving.” Martin Luther King Jr "Life is motion" Aristotle “Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it.” Plato The Good Life

37. Quotes From the Dark Side • “Eat, drink, and be merry, for tomorrow we die.” Unknown • “Exercise is bunk. If you are healthy, you don't need it: if you are sick you should not take it.” Henry Ford • “Whenever I get the urge to exercise, I lie down until the feeling passes away.” Robert M. Hutchins, former President of the Univ of Chicago • “I get my exercise acting as a pallbearer to my friends who exercise.” Chauncey Depew

38. Quotes From the Dark Side • I refuse to spend my life worrying about what I eat. There is no pleasure worth forgoing just for an extra three years in the geriatric ward. • John Mortimer • What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. • George Dennison Prentice • Health nuts are going to feel stupid someday, lying in hospitals dying of nothing. • Redd Foxx

39. Humans Do Not Come in New and Improved Models • In health and prevention there is nothing new under the sun • Use it or lose it, but use it correctly • It’s not rocket science!

40. Drs Belloc and Breslow 7 rules: 1972 • Results: published 1972 J Pub Health • 7000 people surveyed and followed 9 yrs. Adherence to these associated with 11.5 more years of life • 1. Eat a Good Breakfast • wherever ever hard work is done a good breakfast is served • 2. Don’t Eat Between Meals • We are responding to messages that aren’t there

41. Breslow 7 rules • 3. Maintain Your Weight • What did you weigh when you graduated high school, were married, joined the military? • 4. Don’t Smoke • 5. Drink moderately • 6. Get a Good Night’s Sleep • 7. Exercise Regularly • Use large muscle groups for minimum of 30 minutes 4 times a week • pace should be comfortable- middle ground between hard and easy

42. The Talk Test • "Comfortable" - a pace determined by consulting your body is the training rate. It is the midpoint on the eight-step Borg scale of Perceived Exertion, which ranges from very, very light to very ,very hard. • Whatever the activity it should be done comfortably • Most people believe the opposite- To be of any value, exercise should be uncomfortable

43. IKARIA

44. Blue Zones Common Threads

45. Blue Zones Power 9 • Move Naturally. Be active by focusing on activities you love. • Eat Less. Cut calories by 20 percent. • Plant Slant. Avoid meat and processed food. • Grapes of Life. Drink red wine (in moderation). • Purpose Now. Articulate your life purpose. • Down Shift. Punctuate your days with calm. • Belong. Be a part of a spiritual community. • Loved Ones First. Make family a priority. • Right Tribe. Be surrounded by those who share Blue Zone values. The Blue Zones: Lessons for Living Longer From the People Who've Lived the Longest by Dan Beuttner

46. Age 109

47. Okinawa- Finding the True Shangri La...And Die of Old Age • 4x as many 100 yr olds as US • 18% of US Heart Disease Death Rate • 80% less breast and prostate cancer • 50% less ovarian and colon cancer • 60% less hip fracture • 50% less dementia • In a generation or two of modern (Western) living their rates catch up to us. • Okinawa Centenarian Study

48. Okinawa- Finding the True Shangri LaHow Do They Do It? • Huge amount of plant based food • Fish • Occasional Meat • They stay thin • Physical Activity • Spirituality • Community

49. Harry’s Rules 1. Exercise six days a week for the rest of your life.2. Do serious aerobic exercise four days a week for the rest of your life3. Do serious strength training, with weights, two days a week for the rest of your life.4. Spend less than you make.5. Quit eating crap.6. Care.7. Connect and commit. Younger Next Year by Harry Lodge MD

50. HALE Project JAMA 2004 Study of 2000+ elderly Europeans age 70-90 End point is death from heart disease or cancer • Mediterranean diet • physical fitness • moderate alcohol consumption • not smoking Individually, they reduced the chance of death by a quarter to a third; together, by close to two-thirds