Mecosta County The need for increased physical activity

1. Mecosta CountyThe need for increased physical activity MarylynnAdamski, Nathon Kelly, Dena Bailey, Katherine France & Marijo Johnson

2. Assessment Population in 2009 Michigan 9,969,727 Mecosta County 41,775 Leading cause of death 2008 Michigan Heart Disease 23.5 Mecosta county Heart Disease 25.2 Death by heart disease is much higher in Mecosta County than the State of Michigan

3. Assessment • Obesity is the leading cause of Heart Disease • Obesity is Body Mass Index (BMI) > 30 • Mecosta Obesity 26.2% • Michigan Obesity 29.4% Mecosta county has less people but they have almost same the obesity rate as the State of Michigan.

4. What group is most effected • Obese adults had a higher prevalence of coronary heart disease, arthritis, high blood pressure, high cholesterol, asthma, stroke, heart attack, diabetes and inadequate sleep compared with non obese adults.

5. Resources for physical activity Mecosta County • Parks 18 • Golf courses – Public 4 • Golf courses – Private 3 • Fitness Centers/Gyms 4 • Walking/Biking/Hiking Trails 4 City of Big Rapids Recreation • 50+ Exercise Tuesdays 1:00 Evergreen Community Building • 50+ Dance Tuesdays 1:00 Evergreen Community Building • 50+ Water Areobic Monday Wednesday & Friday • 8:30am-9:30am and 10:00 am-11:00 am Ferris State University Pool

6. Resources con’t • LET’S WALK BIG RAPIDS - is a non-competitive walking program that offers exercise while spending quality time on Big Rapids parks and trails. Let’s Walk Big Rapids is a free program for all ages. Walks are held in the Spring and Fall months. • Big Rapids Bike Club

7. Scope of Community Nursing Practice • Community health nurses will be taking care of clients who have the diseases associated with the lack of physical activity. • It is a community wide problem. • Community health nursing will work to get clients to increase physical activity. • Community health nurses will inform various groups about what they can do to increase physical activity.

8. Community Groups that can help promote physical activity • Chippewa Lake Lions Club • Commission on Aging and Senior Center • Big Rapids Lions Clubs • Barryton Lions Club

9. Diagnosis • Risk for heart disease among adults related to lack of physical activity secondary to obesity

10. Plan • Primary Prevention: • Must start at a young age. • Emphasis on exercise and healthy eating habits. • Establish healthy habits from a young age to reduce obesity later in life. • Continued support of physical activity throughout life. • Secondary Prevention: • Establish a diet and exercise program. • Screen for medical causes of obesity and treat.

11. Primary Prevention - Children The first step in increasing physical activity and decreasing obesity is with children. The primary care physician (pcp) should be one of the greatest advocates for physical activity. Young et al. (2010) establish a need for pcp’s to advise parents on ways to increase physical activity and promote healthy eating habits.

12. Primary Prevention - Adult PCP’s play an important role in promoting health and physical activity in normal weight adults. Normal weight adults are least likely to receive education on healthy habits when they are the ones that would most benefit from it. Nawal et al. (2007) found that on 2.6% of normal weight adults received primary prevention.

13. Secondary Prevention • Focus on addressing lack of physical activity and unhealthy eating habits. • The PCP is the prime candidate for this but all healthcare workers should work to address lack of physical activity. • Kirksick et al. (2010) found that even moderate decreases in caloric intake and moderate increases in physical activity can result in weight loss.

14. Outcomes Outcomes will be measured using national and state data on obesity in adults and children in Mecosta county. Self reported exercise and food journals will be utilized to monitor physical activity and caloric intake. These can be followed by the PCP. PCP’s will weigh and record BMI at all visits to monitor for changes and provide education at needed.

15. Interventions • Encourage nutritious, satisfying meals. • Teach about low-calorie, nutritious foods. • Encourage exercise such as walking, jogging, aerobics, or swimming appropriate to age and physical condition. • Provide teaching and pamphlets on cholesterol and hypertension. • Encourage patient to take prescribed medications for cholesterol, hypertension and diabetes if needed. • Teach the importance of medication compliance

16. Interventions, Cont. • Encourage the use of food journals • Teach children about nutritious snacks and meals • Teach parents the importance of physical activity for children

17. Factors Positively Associated with Adult Physical Activity • Postsecondary education • Higher income • Enjoyment of exercise • Expectation of benefits • Belief in ability to exercise (self-efficacy) • History of activity in adulthood • Social support from peers, family, or spouse • Access to and satisfaction with facilities • Enjoyable scenery • Safe neighborhoods (U.S. Department of Health and Human Services, Understanding physical activity)

18. Barriers to Increasing Physical Activity • Advancing age • Low income • Lack of time • Low motivation • Rural residency • Perception of great effort needed for exercise • Overweight or obesity • Perception of poor health • Being disabled (U.S. Department of Health and Human Services, Understanding Physical Activity)

19. Evaluation • Evidence Based Practice has shown that by starting young, teaching and providing healthy foods to children can increase the amount of healthy food that children will eat. “A 2-year randomized control trial of a school-based environmental intervention that increased the availability of lower-fat foods in cafeteria à la carte areas indicated that sales of lower-fat foods increased among adolescents attending schools exposed to the intervention” (Khan, Sobush, Keener, Goodman, Lowry, Kakietek, Zaro, 2009). • Teaching parents about the importance of physical activity and having children inrcrease the amount of physical activity does make a difference. “Modifying school PE curricula was effective in increasing physical activity across racial, ethnic, and socioeconomic populations, among males and females, in elementary and high schools, and in urban and rural settings” (Khan et al., 2009). • Physical activity is known to reduce your risk of heart disease and obesity. The Center for Disease Control states “Regular physical activity can also lower your blood pressure and improve your cholesterol levels” (CDC, 2011).

20. Evaluation • Education, such as providing pamphlets on cholesterol and teaching on medication management proved to be an effective intervention in a study done by the CDC. Patient outcomes included a reduction in both weight gain and blood pressure.(CDC, 2010). • “Interventions in community settings to promote physical activity have emerged as a critical piece of an overall strategy to increase physical activity in the United States” (Zaza, Briss, & Harris, 2005, p. 81). EBP shows that these interventions can help to encourage and educate the people in the community to understand how important it is to be physically active and eat a healthy diet. Implementing these interventions can reduce the risk of heart disease and obesity.

21. Other Interventions that are recommended by EBP are: • Making sure there is access to healthy food • Restrict the sales of less healthy food • Provided smaller portions in public venues • Lower the amount of hours that are spent watching television and on the computer (Khan et al., 2009).

22. Policy Development

23. Policies to Enhance Physical Activity Increasing physical activity in adults requires both resources and motivation of the individual. Mecosta County has several community infrastructures available but barriers may continue to exist. Federal and State governments have demonstrated increased awareness of the need for increased physical activity by addressing physical activity goals in Healthy people 2020 and Healthy Michigan 2010.

24. Policies to Enhance Physical Activity Increasing physical activity requires a consistent message from the media, government and educational systems. Successful policies will include an assessment and plan to eliminate barriers. Although the target group for this presentation is adults, research has demonstrated that developing physical activity habits at a young age is more likely to increase physical activity as an adult.

25. U.S. National Physical Activity Plan • “comprehensive set of policies, programs, and initiatives that aim to increase physical activity and create a national culture that supports physically active lifestyles, improve health, prevent disease and disability, and enhance quality of life” • “Vision: One day, all Americans will be physically active and they will live, work, and play in environments that facilitate regular physical activity”. (National Physical Activity plan, 2010, para. 2-3)

26. Plan Initiatives Business and Industry Education • Identify evidence based practice and interventions in the workplace • Encourage business to increase physical activity opportunities in the workplace • Provide education to business owners on the positive effects of physical activity • Assist with policy development • Provide access and opportunity for high quality physical activity programs in schools • Develop state and district school policies and regulations • Provide access to physical activity programs • Develop partnerships with private sector to link opportunities in the school and community

27. Plan Initiatives (Continued) Health Care Mass Media • Make physical activity a “vital sign” • Establish physical activity as treatable and preventable • Prevent and treat physical inactivity • Reduce disparities to access to physical activities • Include physical activity training in the education of health care professionals • Assist with local, state and institutional policy development • Encourage partnerships to promote themes in physical activity • Sustain a mass media campaign • Develop mass media messages • Identify funding for research to develop evidence related to the use of existing and emerging technologies for increasing physical activity

28. Plan Initiatives (Continued) Parks, Recreation, Fitness and Sports Public Health • Promote programs and facilities where people work, learn, live, play and worship • Enhance the existing parks, recreation, fitness, and sports infrastructure • Increase funding and resources for parks, recreation, fitness, and sports programs and facilities in areas of high need.  • Create, maintain, and leverage cross-sector partnerships and coalitions that implement effective strategies to promote physical activity • policy development to elevate the priority of physical activity in public health practice, policy, and research • Disseminate tools and resources important to promoting physical activity

29. Plan Initiatives (Continued) Transportation, Land Use and Community Design Volunteer and Not for Profit • Prioritize resources and provide incentives to increase active transportation and other physical activity through community • Increase connectivity and accessibility to essential community destinations to increase active transportation and other physical activity • Advocate to local, state and national decision makers for policies and system changes identified in the National Physical Activity Plan • Conduct outreach to non-profit groups’ members, volunteers, and constituents to change their own behaviors and advocate for policy and system changes National Physical Activity Plan, 2010.

30. Healthy Michigan 2010 • Initiatives to promote health and physical activity to ensure the wellness and productivity of the workforce • 200 Community Health employees worked to develop initiatives • Michigan Healthy People 2010 included goals to increase physical activity in adults and adolescents. (Surgeon General Report, 2004, p. 55)

31. Community Physical Fitness Support Groups • Mecosta County Medical Center: produced several community news letters with significant information on the benefits of increased physical activity • Mecosta Medical Center: Assists cardiac rehab patients with initiating a phase 1 and 2 rehab program which includes a physical fitness program • Mecosta County Youth Center: after school sports and activities • Mecosta County Area on Aging: fitness classes- A Matter of Balance, EnhanceFitness; also offer transportation to activities

32. Conclusion Physical activity can decrease the incidence of obesity and therefore decrease the incident of heart disease. Mecosta County has a significant number of overweight individuals and may benefit from implementation of the initiatives represented in the U.S. National Physical Activity Plan Early physical activity habits are more likely to carry on into adult life. This signifies the importance of early education and physical activity programs.

33. References • Center for Disease Control. The Guide to Community Preventative Services. 2010. Retrieved from: http://www.thecommunityguide.org/obesity/Multicomponent.html • City of Big Rapids Recreation. (2010). Retrieved from: http://www.ci.big-rapids.mi.us/pdfs/Recreation_Programs_Offered.pdf • Department of Health and Human Services. Healthy people 2020. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33 • Kerksick, C., Wismann-Bunn, J., Fogt, D., Thomas, A., Taylor, L., Campbell, B., & ... Kreider, R. (2010). Changes in weight loss, body composition and cardiovascular disease risk after altering macronutrient distributions during a regular exercise program in obese women. Nutrition Journal, 959. Retrieved from EBSCOhost. • Khan, L. K. Sobush, K. Dana Keener, D. Goodman, K. Lowry, A.Kakietek, J. Zaro, S. Recommended community strategies and measurements to prevent obesity in the United States. Center for Disease Control and Prevention. 2009. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm • Leading causes of death, 2008 Mecosta County. (2011). In Michigan Department of Community Health. Retrieved from http://www.michigan.gov/mdch.

34. References – cont. • Lutfiyya, M., Nika, B., Ng, L., Tragos, C., Won, R., & Lipsky, M. (2008). Primary prevention of overweight and obesity: an analysis of national survey data. Journal Of General Internal Medicine, 23(6), 821-823. Retrieved from EBSCOhost • Mecosta County Clubs and Organizations Retrieved from: http://www.americantowns.com/mi/mecosta-county/organizations/clubs- and-organizations • Michigan Department of Community Health. (2009) Cardiovascular disease Retrieved from: http://www.michigan.gov/documents/mdch/09_HeartDis_198879_7.pdf • Michigan Department of Community Health. (2009) Overweight and Obesity in Michigan: Surveillance Report Series. Retrieved from: http://www.michigan.gov/documents/mdch/Obesity_chapter_283600_7.pdf

35. References • MI Home Town Locator. (2011).Retrieved from http://michigan.hometownlocator.com/features/cultural,class,park,scfi ps,26107.cfm • Ralph, S., Taylor, C. (2008). Nursing diagnosis reference manual. (Seventh ed.) Lipponcott Williams & Wilkins, Ambler, PA. • U.S. National Physical Activity Plan. (2010). The plan. Retrieved from : http://www.physicalactivityplan.org/theplan.php • Wisdom, K. (2004, April 8). Healthy Michigan 2010. Retrieved from: http://www.michigan.gov/documents/Healthy_Michigan_2010_1_88117_7.p df • Young, P., DeBry, S., Jackson, W., Metos, J., Joy, E., Templeman, M., & Norlin, C. (2010). Improving the prevention, early recognition, and treatment of pediatric obesity by primary care physicians. Clinical Pediatrics, 49(10), 964-969. Retrieved from EBSCOhost.

36. References – cont. • Zaza, S. Briss, P.A. Harris, K.W. The Guide to Community Preventive Services: What Works to Promote Health? Atlanta (GA): Oxford University Press;2005. 80-113.