Prescription for Physical Activity

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Sponsored by The National Council on the Aging
and CareSource
Healthy Aging Briefing Series
Prescription for Physical Activity
WELCOME
This session will begin promptly at 130pm
ESTPlease mute your phonePersonal
introductions are not necessaryThe moderator
will be on the line shortly
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Moving Research Into Clinical PracticeThe
Physical Activity Prescription

• Chris (Himes) Fordyce MD
• Family Practitioner/Geriatrician
• Medicare Medical Director
• Group Health Permanente
• Seattle, Washington
• HIMES.C_at_GHC.ORG

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Overview of the Session

• Review research on aging and the physical
  activity imperative
• Behavior change/motivational models
• Prescriptions for physical activity
• Examples of best practices
• Connection to the national movement to increase
  physical activity and its resources

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The one and only statistically significant
intervention found to improve overall health
outcomes and QOL in the Medicare population is
regular physical activity.
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Aging and Health

• 88 of over 65 have at least one chronic health
  condition
• 21 of over 65 have chronic disabilities.
• The first appropriate intervention for virtually
  all chronic diseases and disabilities is
  increasing physical activity.

Source NIA, 2000
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PA Recommendations

• Endurance moderate aerobic activity 5 days a
  week for at least 30 minutes
• Flexibility stretch every day
• Strength training 2-3 days per week

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Increasing Physical Activity is the FIRST and
most important prescription for virtually ALL
chronic diseases

• Diabetes
• COPD
• OA
• Heart disease
• Mood disorders
• Fibromyalgia
• Chronic Fatigue

• Chronic Pain
• Cancer
• Worried well

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Barriers to PA POOR HEALTH PAIN

• Environment sidewalks, parks, recreation
  centers, weather, crime, transportation
• Time
• Safety
• Too old self image
• Lack of knowledge health effects and how to
• Cognitive changes

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Principles of Behavior Change

• Social Cognitive Theory personal, social and
  environmental factors
• Self-efficacy
• Active choices
• Assurances of safety
• Positive reinforcement

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Self Efficacy

• Perceived ability to achieve a certain behavior
• Expected success the behavior will provide
• 4 major sources of information performance
  experience, observing the experience of others,
  verbal persuasion, and emotional/physiologic
  states.

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Initiation and Maintenance of PA Behavior Change

• Self efficacy beliefs critical in initiation
• Pleasure, satisfaction, and self regulatory
  skills (goal setting and monitoring) are most
  important in sustaining PA behavior

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Social Cognitive Theory Barriers become
Motivators

• Improve health
• Decrease pain
• Individualized programs
• Never too old to improve function
• Improved cognition

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Motivators.

• Balance
• Mood
• Prevention
• Medication decrease
• Being able to do what I havent done in years

• Never too late to start, no matter if couch
  potato all your life
• Use it or loose it /body, mind and spirit
• Nerve regeneration
• MD Rx and f/u

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The Physical Activity Rx

• Written, individualized program based on patient
  abilities, needs and goals
• Include cardiorespiratory, strengthening,
  flexibility, and balance
• Activity logs with regular follow-up
• Start where the patient is, make it fun and part
  of every day activities

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Once you believe the evidence

• The story of the Dancing Ladies and A Few Good
  Men
• 5 years later everyone still in class who is
  still living
• They are now willing to go out to CCRCs to
  spread the word and tell their story AND lead a
  few classes!

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Group Health Cooperatives COOP IN MOTION Program

• 4 components
• Clinic based chair exercise program (BeSAFE)
• Trained volunteer instructors
• Preprinted provider prescriptions for PA and
  online Active Aging Toolkit promotion
• 10,000 STEPS program for staff

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Volunteer Instructors

• Based on successful Self-Management of Chronic
  Disease model
• 12 hour training in 4 sessions with F/U sessions
  at 1 and 3 months
• 6 month commitment/3 instructors per site
• Prescription for Life exercise video as the
  basis.

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CIM Final Evaluation

• All leaders came to every training with
  increasing enthusiasm and ownership.
• 2 clinics had to begin 2nd classes.
• Greater than 90 sign up of staff at the
  clinics.
• Total costs projected to continue program and
  expand to 14 clinics is 5000/year.
  

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Group Health Cooperative Diabetes Intervention

• 3 month PA intervention before beginning or
  changing medications
• Prescription for The First Step to Active Health
  Program and pedometer with instructions to
  increase steps by 10 every week.
• Exercise and blood sugar logs
• F/U with RN/MD as usual for medication start.

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Practicing what we preach

• You must BE the change you wish to see in the
  world!
• Gandhi

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• In May, 2001, a coalition of 50 organizations
  released a major national planning document that
  addresses physical activity aging
• www.agingblueprint.org

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• Funded by Robert Wood Johnson Foundation
• Active Aging Partnership (Steering Committee)
• AARP
• ACSM
• AGS
• CDC
• NCOA
• NIA

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Blueprint Barriers

• The National Blueprint identified many
• barriers to physical activity, including
• Research
• Home Community
• Workplace
• Public Policy
• Medical Systems

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2002- 2005 Strategies to Increase Physical
Activity
JAPA, 2003
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Home and Community Strategy

• Establish and provide technical assistance to
  national, regional, and local partnerships among
  health, aging, urban/community planning,
  transportation, environmental, recreation, social
  service, and private sector organizations.
• (National Blueprint Office)

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Medical Systems Strategy

• Develop resources for clinicians to use in making
  personalized physical activity recommendations/
  prescriptions for their patients.
• (American Geriatrics Society)

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• National Blueprint Partners developed the Active
  Aging Toolkit in 2003.
• Therapists, Physicians Researchers developed
  and refined the document

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• The Active Aging Toolkit contains
• The AAT White Paper
• Provider Manual
• First Step to Active Health Program
• Patient Kit
• Training program for professionals
• www.FirstSteptoActiveHealth.com

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Physical Activity Aging

• Because of their low functional status and high
  incidence of chronic disease, there is no segment
  of the population that can benefit more from
  exercise than the elderly.
• American College of Sports Medicine

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THANK YOU! QUESTIONS? Himes.c_at_ghc.org
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Dont Forget Your Free Copy of Aging in Stride
NCOA and Caresource are pleased to offer
first-time registrants for this Healthy Aging
Briefing Series a complimentary copy of the book,
Aging in Stride. To receive your copy, please
visit www.AgingInStride.org/NCOAoffer. Or just
email service_at_caresource.com with your name,
title, organization, mailing address, phone
number, and date of the Briefing you participated
in. One free copy per registrant, please.