Transcript Slide 1

Exercise and Fitness as Part of
Treatment Planning
D. Littlefield 2010
Objectives for the Day
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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
Introductions
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Name and designation
Relationship with patients/clients
Experience both personal and profesional
We are all in this together
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Why You/ Why Them?
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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.**
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*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
The Heart of the Matter
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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
More to Consider
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The absence of PA is a major contributor to the global
and local burden of Disease including but no limited to:
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Type 2 Diabetes
Cardiovascular Disease
Poor mental health
Reduced functional Capacity
Absenteeism
Increased risk of injury
Benefits of Physical Activity: Lowers risk
of the following:
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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
The Lingo: Physical Activity
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What is it?
Standard Guidelines for PA*
F.I.T Principle
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Frequency
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Intensity
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How often
How hard
Time
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How Long
*US Dept HHS Guidelines for Americans 2008
Aerobic Vs Strength Training
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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.
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
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http://www.youtube.com/watch?v=HOUQ8bpBnFk
&feature=related
More on Moderate to Vigorous
Moderate Activities
•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)
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
Strength Training
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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
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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
Flexibility: the missing link?
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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
Be Flexible, it’s a mind body experience!
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Yoga
Chair stretches
Range of Motion
Joint articulation
Easy does it a little at a time
Daily is best
What works in Healthcare
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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
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Evidenced Clinical Strategies:
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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
Ex Rx
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Proven to be effective in increasing
compliance
Written goals and timelines
Baby steps identified by patient agreed on by
both parties
Practical Practice?
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Role Play
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Questions
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Evaluation
Thanks!