Transcript Assessment - Hamilton Family Health Team

Guidelines for Dietitians
FITT and Other Principles
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Cardio-Respiratory Capacity
o The body's ability to take in oxygen, deliver it to the cells, and use it at the
cellular level to create energy for physical activity aka endurance, aerobic
capacity
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Flexibility
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Muscular Capacity - Three Aspects
o Amount of motion that a joint is capable of performing
o Muscular strength - or, the ability to generate force.
o Muscular capability is muscular endurance - or, the ability of your muscles to
apply force over a longer period of time.
o Muscular capability refers to muscular power, or the ability to generate strength
in an explosive way.
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Underlying principles that inform advice
provided to patients
Knowledge of principles enable RD to:
o Answer questions
o Provide appropriate direction
o Limit potential for harm
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Frequency (how often)
Intensity (how hard, how much weight)
Time (how long)
Type (type of exercise planned)
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Advice on exercise should be modified based
on individual needs and capabilities.
General advice about physical activity may
not be appropriate or helpful for all of our
patients.
For example, a very de-conditioned patient
should not be encouraged to immediately
meet Canada's physical activity
recommendations.
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Strengthening of tendons and ligaments and
increased vascularity and recruitment of
motor units will result in the ability to sustain
subsequently greater stresses with greater
resistance to injury.
Without structural tolerance, increasing
workload can result in injury.
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Improvement in an aspect of their
performance or fitness, only occur if a patient
trains specifically to achieve this.
Improvements in the three main aspects of
fitness (cardiovascular function, strength and
flexibility) require different types of training
Example - our patients should not expect
improvements in cardiovascular fitness or
strength by doing flexibility training.
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In order to improve, clients must continually
challenge their current fitness level.
The work performed must become progressively
harder as the client adapts to the current
workload.
When a workload or resistance is placed on a
muscle, the muscle is stimulated over time to
become larger and stronger.
A plateau or steady state will be reached where
there is no more growth unless a greater
stimulus is applied eg heavier weight, higher
repetitions.
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Recovery (usually rest) is necessary for a client to
return to the next workout as fit as the previous.
Rest above and beyond the normal requirements
for usual functioning is not terribly important in
very light physical activity, more important as
physical activity becomes more strenuous
Muscles that have been exposed to an overload
should be rested at least 24 hours before training
again. It is during this recovery period that the
actual growth and repair ( hypertrophy) occurs.
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People who are well developed in all aspects
of fitness have a lower likely hood of
becoming injured and have greater
performance in physical activity and sport.
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Once training ceases a client’s body will
gradually return to the pre-training state
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Once a level of fitness is achieved, it can be
maintained with less work than was needed
to reach it in the first place.
Work needed to achieve a specific fitness
level is greater than the work needed to
maintain it.
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Adequate rest for worked muscle (preferably 48
hours) is necessary for growth….but other muscle
groups may be exercised during the rest period
The key goal for new exercisers is to learn proper
form and to develop structural tolerance. After this
occurs goals such as metabolic management,
hypertrophy etc can may be reached.
Clients will usually see significant gains in strength,
changes in metabolic parameters at approximately 34 weeks after initiating training.
Changes plateau as training continues so it is
important that patients do not look for dramatic
changes
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Sandra is a 45 year old female who is over weight
(BMI of 29). She’s a mother of two and hasn’t put
much effort into her health the last few years.
She’s never followed a workout routine before.
Sandra has watched her friend have a lot of
success using a personal trainer 4x/week but she
wants to try things on her own because of the
cost. She plans to start a program of walking a
few times a week plus attend aqua fit and yoga
with her friend 1x/week for 60 minutes each at
the local community center.
What guidelines would you give Sandra?
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How often should Sandra go walking to
achieve the minimum recommendation?
Sandra wants to know how to tell if she is
working hard enough at each of her activities.
What would you tell her?
Any advice to give her for the first few weeks
of her program?
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Sandra has now been following her program
for about 3 months and at first was seeing
great results. She now has a BMI of 27 but
lately she’s not seeing any changes and she’s
getting frustrated. She’s contemplating giving
up.
What could you tell Sandra to help her?
Which of the principles of fitness might
explain what is going on?
Risk and Readiness to Increase
Activity
Evaluation
Pre-screening
Fitness
Assessment
RISK
Program
Development
Program
Implementation
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Known Disease
Signs and Symptoms of Disease That is Yet Dx
Increased Cardiac Risk
Age Risk
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Internal to Client
– Health conditions or diseases
– Physical abnormalities (eg/ weak muscles)
– Psychological (Not focused or high stress)
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External
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Inappropriate workout gear
Faulty equipment
Temperature and humidity
Spills or messes
Internal to Instructor
– Not being prepared
– Ignoring duty to warn or not monitoring clients
condition
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Must be done before any activity of any kind
occurs
– Safety
– Liability
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Common Pre-screening Tools
– PAR Q
– Health Screening Questionnaire
– CHD Risk Factors
– Lifestyle Assessment
– Readiness for Change
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Physical Activity Readiness Questionnaire
For clients ages15-69
Developed by the Canadian Society for
Exercise Physiology and Health Canada
Designed to identify people who require
medical clearance before participating in a
new exercise program
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Known Disease
Signs and Symptoms of Disease That is Yet Dx
Increased Cardiac Risk
Age Risk
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What forms of risk does the PAR Q cover?
– Known disease
– Signs and symptoms of disease
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If clients answer YES to one or more
questions on the PAR Q they should seek
medical advice before becoming more
physically active
Your legal responsibility to have a signed PAR
Q before giving out physical activity advice
Should be redone annually
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Supplements Information not captured on
PAR-Q. Not a standardized form.
Should include:
– Client details
– Current medical conditions
– Medications and allergies
– Current or past injuries
– Treatment from healthcare professionals
– Family history
– Past & present exercise history
– Past and present nutritional information
– Past and present work history
2. Signs and Symptoms
Lifestyle Assessment
Yes
No
Medical Referral
Yes
No
CHD Risk Factors
Health Screening Questionnaire
PARQ
1. Known Disease
3. Cardiac Risk
No
Yes
Vigorous
Activity
4. Age Risk
No
Yes
Cleared for Moderate to
Vigorous Physical Activity
Moderate Activity
Cleared for LowModerate Physical
Activity
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Physiotherapist
Kinesiology
Podiatrist
Doctor
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You cannot continue with client until they are
cleared by medical doctor
ParMedX should be reviewed by doctor
Should have a written note for clearance from
doctor
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PARmed-X is a 4-page physical activityspecific checklist to be used by a physician
with patients who have had positive
responses to the (PAR-Q)
There is a separate one for pregnancy
Important: If a patient is at risk and doesn’t
pass the PARQ and you train them without
clearance from their physician you are liable!
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Refer!
Most of us are only qualified to work with
beginner clients
Risk and Readiness to Increase
Activity
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Stage of change (pre-contemplation,
contemplation, preparation, action,
maintenance relapse)
Readiness, Importance Rating
Tools:
 Physical Activity and You*
 Motivational Interviewing
* In the Physical Activity Counselling Toolkit (PACT)
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Ask about current physical activity
Many people significantly over-report frequency, time
and intensity of physical activity…ask for details
Tools:
 Rapid Assessment of Physical Activity*
 Brief Physical Activity Assessment*
 Physical Activity and You*
* In the Physical Activity Counselling Toolkit (PACT)
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Ask permission to discuss benefits of PA and risks of
inactivity to all
Match advice to current motivational and physical readiness
to engage in more physical activity
Tools:
 Promoting Physical Activity*
 Brief Contact to Increase Physical Activity*
 Matching Counseling To Stages of Change*
 Physical Activity Counselling Tools*
 Physical Activity and Exercise (CDA)
* In the Physical Activity Counselling Toolkit (PACT)
Use FITT to prescribe physical activity, including
resistance training:
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Frequency: how often
Intensity: how hard
Time: duration
Type: what kind of exercise
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For each FITT element…start with where the patient
is based on assessment of risk, readiness and
current physical activity, then help patient move to
CDA physical activity targets
Balance principles of progressive resistance (it gets
harder) and structural tolerance (need to build a
base) and recovery
Exercise Counselling and Prescription
Tools:
 Diabetes and Physical Activity Your Exercise
Prescription (CDA)
 Prescription for an Active You*
 Canada’s Physical Activity Guide*
 Exercise Prescription for Special Populations*
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* In the Physical Activity Counselling Toolkit (PACT)
For Clients and Professionals
Professionals
Workshops/Courses
 CDA Physical Activity and Exercise workshop
 CANFIT PRO courses
Print
 Diabetes Physical Activity and Exercise Toolkit
(2nd ed)
 Exercise is Medicine http://exerciseismedicine.org/
Professionals
Online
 American College of Sports Medicine http://www.acsm.org/
 Canadian Society for Exercise Physiology www.csep.ca/
 Canadian Diabetes Association
 Physical Activity Counselling Toolkit
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Available on Hamilton Family Health
Team intranet http://www.hamiltonfht.ca/files/PACT2011_final.pdf
Patients and Professionals
Resistance Exercise Demonstration Websites:
 ExRx.net
 GymProfessor.com
 Critical Bench.com
Patients
Print
 Resistance Exercise for Diabetes Pamphlet
 Exercise to Do At Home
 Strengthening for Older Adults (Theraband)
Patients
Video
 Sweet Success Exercise DVD *
 Diabetes and Physical Activity Toolkit DVD
Patients
Apps
 Lose It – allows for tracking of physical activity and food,
and has an interactive forum (ipad/iphone)
 iPump – provides large exercise data base and exercise
videos showing proper execution (i pad, i phone)
 Nike Training Club App – wide variety of exercises for
different levels (iOS smartphones; Nike Boom (similar) for
Android)
 Workout Trainer – step by step video instruction to
address a range of goals(iOS smartphone or Android)
*** large number of physical activity apps available
Mapping of the Issues for RDs
Scope of Practice
As a Registered Dietitian, what is within your expertise
and scope of practice regarding physical activity
counseling and advice?
 General advice?
 Specific advice?
 Physical Activity Prescription?
 Specific Exercises?
 Specific Exercises with performance, repetition and
resistance instructions?
 Demonstration of Specific Exercises
 Leading patient through execution of specific
exercises
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Scope of Practice
There are risks attached to physical activity
counseling training:
Injury related to improper technique, load or
repetitions
Equipment Malfunction- falling plates, band
breakage
Pre-existing physical limitations/risks
As an RD what can you do:
 Make general physical activity
recommendations
 Talk about Canada’s Physical Activity
Guidelines
 Talk about physical activity principles and
benefits
 Help clients develop a FITT prescription
 Suggest types of exercise that may meet
client needs
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As an RD what you cannot do:
Lay out a specific, individualized exercise
plan that includes specifics of exercise type,
resistance, repetitions
Demonstrate specific exercises
Help clients execute specific exercises
Know your personal scope of practice:
 What is your personal experience with pa?
 What are your beliefs
 What additional training, education and certification
have you had?
 What is your comfort level?
 What is your physical activity counseling
experience?
Note that liability insurance carried by RD’s is for activities carried out within our scope of practice. Those
engaged in providing specific exercise programs to clients would require a different separate type of
liability insurance
What can you do to further integrate physical activity
counselling into your practice?
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Enhance your scope of practice – additional reading, training,
observation, mentorship, practice
Be familiar with physical activity recommendations and terminology
Talk to other health professionals in your practice about physical
activity
When completing a patient assessment, assess adequacy of current
physical activity. Are Canada’s recommendations being met?
Make use of professionally developed tools to augment current skill
set – patient hand-outs, videos, web sites
Refer to community programs, specialty programs, and exercise
professionals as necessary
Know that you don’t have to be the physical activity expert to start
the discussion and help increase the motivation
Refer to Your Handouts