Exercise and Fitness as Part of Treatment Planning

1. Exercise and Fitness as Part of Treatment Planning D. Littlefield 2010

2. 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

3. Introductions • Name and designation • Relationship with patients/clients • Experience both personal and profesional

4. 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

5. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. More on Moderate to Vigorous Moderate Activities Vigorous Activities • 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 • 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)

13. 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

14. 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

15. 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

16. 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.pdf Evaluation and treatment recommendations: http://aappolicy.aappublications.org/cgi/reprints/pediatrics;112/2/424.pdf

17. 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

18. Ex Rx • Proven to be effective in increasing compliance • Written goals and timelines • Baby steps identified by patient agreed on by both parties

19. Practical Practice? • Role Play • Questions • Evaluation

20. Thanks!