Lynn JS, C Winters, J Urda, L Marriner, C Fengl, and S Buckenheimer

1. Successful Implementation of Exercise is Medicine™ at the Worksite Lynn JS, C Winters, J Urda, L Marriner, C Fengl, and S Buckenheimer Department of Exercise & Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA Abstract Summary of Program Program Impact Organization: Slippery Rock University (SRU) offers a variety of undergraduate and graduate programs for about 8,850 students. Approximately 950 faculty, staff, and administration are employed at SRU. SRU has a relatively new wellness commission which provides a variety of health and wellness initiatives. Summary of the Primary Program: Utilizing the Exercise is Medicine™ model, employees and students are referred by their Personal Care Physician or the Student Health Center. Once referred, a qualified exercise professional provides motivational interviewing, comprehensive pre/post fitness assessments, and individualized exercise prescription, focused on creating SMART goals to initiate behavior change and improve self-efficacy. Explanation of the evaluation plan: Adherence to the exercise program, pre/post fitness assessment outcomes, self-efficacy, and behavior change were measured over a 6-week period. Summary of the program impact: Twenty participants (age = 24.6 ± 12.6; 4 males, 16 females) with no regular exercise program completed the intervention. Participant compliance was 85% within 6-weeks. One hundred percent of participants reported feeling more confident about exercising regularly, and 100% had a plan in place to continue to exercise. The program was successful to increase physical activity, self-efficacy, and positive behavior change. Additionally, participants established a plan to continue a regular exercise program. • 1. Develop a relationship with health care provider(s) • The health care providers at the student health center were educated about the Exercise is Medicine™ ideologies. They agreed to embed “physical activity” into their electronic medical record so that students who were being seen for non-urgent conditions were screened for their volume of physical activity as a 6th vital sign. • Students not accumulating 150 minutes of physical activity per week were given the option of receiving a brochure on fun ways to exercise or being referred to the one-on-one exercise program. • Local physicians were contacted about the program and are encouraged to refer their patients to the program. • For a corporate wellness program, contacts would be made with health care providers caring for the employees. • 2. Establish the venue or facility for physical activity interventions • In the present case, the program has full access to the on-campus recreation center. Students do not pay extra to use the facilities, but referrals from off-campus physicians must purchase a membership. • A corporate site with a fitness facility has a built in venue, but local fitness facilities or university facilities could be approached to host the exercise program. • 3. Provide qualified exercise professionals to accept the referrals and run program • Exercise Science students at the end of the curriculum provided the one-on-one • exercise/wellness programming and reported to faculty. • Interns collected referrals and contacted the patients/participants • Participants completed an initial wellness questionnaire including health history and physical activity history and interests related to wellness • Initial visit included wellness coaching and motivational interviewing to establish a plan • Individualized programs were undertaken for 6 weeks, meeting twice per week • The exercise professional focused on building a relationship with the participant • A variety of motivational techniques and communication efforts were used including text messages and shared lunches at the cafeteria to discuss healthy eating opportunities • Pre and post fitness assessments were encouraged • A questionnaire was completed at the end of six weeks which included questions about plans to continue exercise and a program evaluation • During the 6-week analysis period, 90% of student health center office visits included “Exercise” screening/counseling • Of the patients who did not accumulate 150 minutes of physical activity per week, 10% accepted the referral to the program • Twenty participants (age = 24.6 ± 12.6; 4 males, 16 females) with no regular exercise program completed the program • 100% of participants completed at least 12 prescribed sessions, and 85% of the sessions were completed within the 6-week time period • 100% of participants reported increased exercise self efficacy • 100% of participants had a detailed plan to continue exercise at the end of the program • 100% of the participants changed behavior by increasing physical activity • Qualitative feedback from participants and exercise professionals is below Background • Exercise is Medicine (EIM)™ is a global initiative created by the American College of Sports Medicine (ACSM), the American Medical Association (AMA), and numerous global partners with interests in health and wellness. • The goals of EIM include: • Making exercise an important part of the accepted medical paradigm • Bridging the gap between clinicians and exercise specialists to increase physical activity • Making physical activity and exercise an integral part of the individual’s daily routine to help prevent and manage disease • Research evidence supports the premise that the success rate of health behavior change programs is higher when the physician is involved. • Effective Strategies Cited by the Exercise Professionals: • Build the relationship first, then take care of the exercise prescription. • Motivational interviewing and wellness coaching are keys to success. The plan must be the participant’s, not yours. • Link participants to their own social support network when possible (friends, family) • It’s not all about the gym. Participant meetings were at the art gallery, the cafeteria, and outside on the walking path • Statements from Participants: • “It acts as stress relief and allows me to set goals and develop holistically.” • “The program has given me all the tools I need to stay active and healthy when I’m done.” • “EIM has motivated me to be physically active again after stopping for a long time.” • “I lost 5 pounds…I have more confidence in myself…I loved working with my trainer.” • “EIM program is not just for people who are overweight or unhealthy, it’s for everyone.” • “The trainers are knowledgeable, helpful, and professional and make the most out of the experience. I love EIM.” Organization Slippery Rock University includes numerous buildings situated on a 660-acre campus in a rural area 80 km north of Pittsburgh, PA. The university offers over 60 undergraduate and 20 graduate programs to 8,850 students. Students have access to a student health center which employs nurse practitioners, nurses, and a medical doctor. The university has an 82,000 foot comprehensive recreation center which is available to all students from 6:00am to 11:00pm. In addition to the facility, the recreation team offers group fitness classes, intramural sports, outdoor adventures, and aquatic programs. The Exercise Science Program at SRU prepares students to work one-on-one with clients or patients in a variety of settings. The curriculum includes intensive training in wellness coaching, motivational interviewing, and exercise prescription for healthy and special populations. In the penultimate semester, students have a class in which they are assigned a client for whom they must conduct assessments, shape wellness/fitness goals, create goal driven comprehensive exercise prescriptions, and guide the program twice per week for 12 weeks. The final semester includes a 12-week (480 hour) internship. Examples of texts between participants and the exercise professional Evaluation Plan • The number of patient screenings was quantified to examine the ability of the health care providers to conduct screenings during office visits • Participant compliance was analyzed for the 6-week program • A comparison of participant exercise self efficacy at the beginning and end of the program was made • Changes in volume of physical activity from pre-program to the end of the program were evaluated • Observation and anecdotal reports from participants and exercise professionals were carefully documented to qualitative review