Health Promotion for
Physical Therapists:
Concepts and Practical
Applications
Julie Gahimer PT, HSD
Associate Professor
Kr...
ObjectivesObjectives
 6 Dimensions of Health
 Blue Zones- Dan Buettner
 Health Issues in America
 Obesity and overweig...
6 Dimensions of Wellness
The Six Dimensions of Health
My Six Dimensions of Health
My Six Dimensions of Health
1. Physical
2. Emotional
3. Spiritual
4. Intellectual
5. Psychological
6. Social
Physical
Exercise/fitness
Weight/body fat
Diet
Cardiovascular/strength training
Disease prevention
Lifestyle: active...
Emotional
Stress management
Depression
Relaxation time
Outlets
Self-esteem
Support of loved ones
Worrying about thi...
Spiritual
Faith
Values
Morals
Beliefs
Intellectual
Job/school fulfillment or success
Stress
Relationships with co-workers, clients,
employer
Job safety
Goo...
Psychological
Stress management
Self esteem
Social interaction
Attitude
Organization
Environment
Social
Interaction and relationships with
friends, family, significant others
Communication- both verbal and
non-verbal
...
Why Is Health Promotion SoWhy Is Health Promotion So
Important in Our Nation Today?Important in Our Nation Today?
 Histor...
10 Leading Causes of Death
(increased longevity & lifestyle)
 Heart disease (decreased)
 Malignant neoplasms
 Cerebrova...
Obesity and OverweightObesity and Overweight
61% adults in
U.S. are
overweight or
obese (BMI>25)
13% children
aged 6-11 ...
Obesity and Overweight
 Increase the risk of
morbidity from:
 Hypertension
 Dyslipidemia
 Type 2 diabetes
 Coronary h...
Obesity Trends* Among U.S. Adults
BRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Sou...
Obesity Trends* Among U.S. Adults
BRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” per...
Obesity Trends* Among U.S. Adults
BRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4”...
Obesity Trends* Among U.S. Adults
BRFSS, 2001
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%
(*BMI ≥30, or ~ 30 lbs overweight ...
Obesity* Trends Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data <10% 10%–14% 15%...
Source: Behavioral Risk Factor Surveillance System, CDC
Childhood Overweight/ObesityChildhood Overweight/Obesity
 In the U.S., the prevalence of childhoodIn the U.S., the preval...
The State of Our Nation:The State of Our Nation:
Trends in Health StatusTrends in Health Status
 Nearly 30% of adultsNear...
Most Recent CDC-ACSM Guidelines
 All adults perform 30 or more minutes ofAll adults perform 30 or more minutes of
moderat...
National Center Health Statistics. Health, 2004
The State of Our Nation:
Trends in Health Status
 19% adult women
and 23%...
Source: Behavioral Risk Factor Surveillance System,CDC
2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no
The State of Our Nation:The State of Our Nation:
Trends in Health StatusTrends in Health Status
 Adults aged 65 to 74 yea...
Native
Hawaiian/
Pacific Islander
Am. Indian/
Alaska Native
I = 95% confidence interval. *Data are statistically unreliabl...
Percentage of Adults Who Reported
Eating fewer Than Five Servings of
Fruits and Vegetables a Day,
by Sex, 2002
The State o...
Why Is Health Promotion SoWhy Is Health Promotion So
Important in Our Nation Today?Important in Our Nation Today?
 95% of...
National Goals &National Goals &
Objectives for HealthObjectives for Health
 Healthy People
followed by National
Goals an...
Healthy People
2000, 2010  A comprehensive setA comprehensive set
ofof national healthnational health
objectivesobjective...
Healthy People 2010Healthy People 2010
Coordinated ByCoordinated By
 The Office ofThe Office of
DiseaseDisease
Prevention...
Healthy People 2010Healthy People 2010
 Two overarchingTwo overarching
goalsgoals
 28 focus areas28 focus areas
 467 sp...
Two Overarching Goals:Two Overarching Goals:
Increase qualityIncrease quality
and years ofand years of
healthy lifehealth...
Healthy People 2010
28 Focus Areas
(14 apply directly to PT)
 Access to Quality
Health Services
 Arthritis, Osteoporosis...
Healthy People 2010Healthy People 2010
10 Leading Health Indicators10 Leading Health Indicators
 Physical ActivityPhysica...
How Healthy is Indiana?
Indiana Healthy Weight
INShape Indiana
Fit City
Health Risk Appraisals (HRA’s)
Senior Fitness Test
Roberta E Rickli, C Jessie Jones
The Role of the Physical TherapistThe Role of the Physical Therapist
 Vision 2020: By 2020, physical therapy will be
prov...
Roles of a Physical Therapist
Pathologies
Movement Science
Training Principles
Diverse Populations
Psychosocial Respo...
Roles of a Physical Therapist
National goals include PT
Inherent credibility
Viewed as advocates, problem-solvers
Acce...
American Physical Therapy
Association
APTA Vision 2020 Statement
By 2020, physical therapy will be provided by
physical therapists who are doctors of
physical ...
APTA Video Podcasts on
Health Promotion
Center for Disease Control
Screening Activities
Physiological parameters
Scoliosis
Posture
CVD, PVD
Pulmonary function
Sports health
Occupatio...
Health Promotion Practice
Greater participation in community
health activities
Public Health projects
Health Fairs
Pre...
Health Promotion Practice
Integration of health promotion and
preventive health services within
traditional practice
Scr...
Health Promotion Practice
Linking with fitness centers, YMCA’s,
YWCA’s, health clubs
PT practices located in these setti...
Health Promotion Practice
Transition or Chronic Care Programs
Service to clients no longer in PT
Well-suited for client...
Health Promotion Practice
PT Private Practice
Combination PT and Health Promotion
PT- Medical Model
HP- Client-centere...
Health Promotion Practice
Health Promotion and wellness
programming- Seniors:
Long-term care
Assisted living community
...
Health Promotion Practice
Other Health Promotion Niches:
Kids
School
Home
Women’s Health
Business Health
Worksite W...
APTA Position Statement on Health
Promotion and Wellness
By PTs and PTAs
The APTA recognizes that physical
therapists are...
HOD 06-04-09-09
Priority Goals of the APTAPriority Goals of the APTA
Goal 1:Goal 1: PhysicalPhysical
therapists aretherap...
Priority Goals of the APTAPriority Goals of the APTA
 Goal II:Goal II: PhysicalPhysical
therapists are universallytherapi...
APTA Normative Model/Guide toAPTA Normative Model/Guide to
Physical Therapist Practice/Physical Therapist Practice/
CAPTE ...
The Big Picture
Adapted from Health Promotion and Wellness: Expanding YourAdapted from Health Promotion and Wellness: Expa...
Health Promotion Natural Extension
of PT’s Role Primary Care Practitioner
Examination
Evaluation
Diagnosis
Prognosis
(Incl...
Screening
Medical
Disease Lifestyle
Behaviors
(HRA)
Refer or Treat
Physical Activity and Health: A Report of the
Surgeon General, 1996
Commissioned by Secretary of HealthCommissioned by Se...
Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelin...
An estimated 54 million persons
in the United States, or nearly
20% of the population currently
live with disabilities
(Mc...
Interaction of Concepts
International Classification of
Function (ICF, 2001)
Health ConditionHealth Condition
((disorder/d...
Traditional Health Promotion
 “not to take care
of the sick and
disabled, but
rather to
prevent disease
and disability in...
Purpose of Health Promotion
Programs for the Disabled
 Reduction of secondary
conditions (obesity,
hypertension, pressure...
Rimmer,
1999
NCPAD
NCPAD established in 1999 through a
grant through the CDC and Prevention’s
Disability and Health Branch
Establishe...
NCPAD
Comprehensive source for information
related to physical activity and disability
Website contains: searchable data...
ACSM Guide to Exercise Testing Durstine
and Moore 2009
Methods Measures
Aerobic-
Cycle and wheelchair ergometer,
tradition...
ACSM Guide to Exercise Testing Durstine
and Moore 2009
Flexibility
Hand held goniometer
ROM in shoulder, elbow,
wrist, kne...
ACSM Guide to Exercise Programming
Durstine and Moore 2009
Modes Intensity/freq/duration
Aerobic
Upper and lower body ergo...
ACSM Guide to Exercise Programming
Durstine and Moore 2009
Modes Intensity/freq/duration
Flexibility
stretching
2 days a w...
Aerobic Training Equipment Examples
Aerobic Training Alternatives
Strength Training Equipment Examples
Evidence-Based Community
Programs and Outcomes for TBI
Gordon 1998 Retrospective
review of aerobic
exercisers
decreased
fa...
Evidence-Based Community
Programs and Outcomes for SCI
Ditor (2003) 9 month exercise
intervention
Less pain, stress,
incre...
Helen M. Galvin Center for Health
and Fitness
 Located at the Rehabilitation Institute of Chicago
 Made possible by priv...
An Emerging Market: Fitness Centers that
Can Serve the Disabled
 Linkages between
rehabilitation facilities and
community...
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
Clarian health  health promotion inservice  november 8, 2010
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  • Over the last century, public health concerns have shifted
    Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
    mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
    Increased life expectancy by 30 years from beginning of 20th century
  • Mortality rates today are much more common to that of “diseases of behavior or lifestyle” and those that occur as a result of living into older years
    -heart disease (became #1 in 1921)
    -Cancer (top 10 early, worked its way up #2 in 1933)
    - Stroke, intracranial vascular lesion (worked way up #3 1938)
    COPD entered top 10 in 1974, now #4
    Accidents, MVA (entered top 10 in 1926, worked way up)
    Diabetes (entered top 10 in 1932)
  • Over the last century, public health concerns have shifted
    Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
    mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
    Increased life expectancy by 30 years from beginning of 20th century
  • Over the last century, public health concerns have shifted
    Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
    mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
    Increased life expectancy by 30 years from beginning of 20th century
  • Healthy People followed by release of first set of health goals and objectives for the nation
    Have been several generations of these, most current is Healthy People 2010 (objectives set for each decade)
  • Leading Health Indicators reflect the major public health concerns in the U.S. And were chosen based on their ability to
    - motivate action
    - availability of data to measure progress
    - their relevance as broad public health issues
  • Recent correspondence with Janet Bezner, Vice President of APTA and health promotion specialist
    Stated that the APTA has played an active role since HP 2000 was created in 1990
    Continues to be a part of the coalition of individuals and groups associated with HP2010
    Recently met individually with the surgeon general to discuss APTA and physical therapist’s role in promoting fitness and wellness
    Representatives were at the press conference when the new dietary guidelines were announced -
    we were the only providers there relative to exercise.
    These efforts are currently coordinated by the Department of Practice - the director is Ken Harwood, PT, PhD
  • Clarian health health promotion inservice november 8, 2010

    1. 1. Health Promotion for Physical Therapists: Concepts and Practical Applications Julie Gahimer PT, HSD Associate Professor Krannert School of Physical Therapy University of Indianapolis November 8, 2010
    2. 2. ObjectivesObjectives  6 Dimensions of Health  Blue Zones- Dan Buettner  Health Issues in America  Obesity and overweight, smoking, diabetes  How Healthy Is Indiana?  Health Risk Appraisals  Human Kinetics Senior Fitness Test  Real Age  Healthy People 2010/2020  Role of the APTA  Role of the Physical Therapist  Fitness Following Disability
    3. 3. 6 Dimensions of Wellness
    4. 4. The Six Dimensions of Health
    5. 5. My Six Dimensions of Health
    6. 6. My Six Dimensions of Health 1. Physical 2. Emotional 3. Spiritual 4. Intellectual 5. Psychological 6. Social
    7. 7. Physical Exercise/fitness Weight/body fat Diet Cardiovascular/strength training Disease prevention Lifestyle: active vs sedentary Prevention and safety: helmets, seatbelts, smoking, safe sex, drugs, alcohol
    8. 8. Emotional Stress management Depression Relaxation time Outlets Self-esteem Support of loved ones Worrying about things you cannot control Learn from mistakes, not dwelling on them Control of anxiety
    9. 9. Spiritual Faith Values Morals Beliefs
    10. 10. Intellectual Job/school fulfillment or success Stress Relationships with co-workers, clients, employer Job safety Good attitude Motivation Financial security
    11. 11. Psychological Stress management Self esteem Social interaction Attitude Organization Environment
    12. 12. Social Interaction and relationships with friends, family, significant others Communication- both verbal and non-verbal Extracurricular activities Activities and events
    13. 13. Why Is Health Promotion SoWhy Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?  Historical Movement from Infectious Disease to Chronic Diseases  30 year increase life expectancy since 1900’s  Diseases of longevity, lifestyle, & health behaviors  More people living longer with chronic disease associated pain & disability
    14. 14. 10 Leading Causes of Death (increased longevity & lifestyle)  Heart disease (decreased)  Malignant neoplasms  Cerebrovascular disease  COPD  Accidents (including MVA)  Pneumonia & Influenza  Diabetes  Suicide  Nephritis/Nephrosis  Chronic Liver & Cirrhosis Shift from curative measures to preventative measures Increased emphasis on personal responsibility for health
    15. 15. Obesity and OverweightObesity and Overweight 61% adults in U.S. are overweight or obese (BMI>25) 13% children aged 6-11 years 14% adolescents aged 12-19 years National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006
    16. 16. Obesity and Overweight  Increase the risk of morbidity from:  Hypertension  Dyslipidemia  Type 2 diabetes  Coronary heart disease  Stroke  Gallbladder disease  Osteoarthritis  Sleep apnea and respiratory problems  Endometrial, breast, prostate, and colon cancers. National Heart, Blood, & Lung Institute, Clinical Guidelines: Obesity An estimated total cost of obesity in U.S. in 2000 was about $117 billion.
    17. 17. Obesity Trends* Among U.S. Adults BRFSS, 1990 No Data <10% 10%–14% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC
    18. 18. Obesity Trends* Among U.S. Adults BRFSS, 1995 No Data <10% 10%–14% 15%–19% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC
    19. 19. Obesity Trends* Among U.S. Adults BRFSS, 2000 No Data <10% 10%–14% 15%–19% ≥20 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC
    20. 20. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC
    21. 21. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC
    22. 22. Source: Behavioral Risk Factor Surveillance System, CDC
    23. 23. Childhood Overweight/ObesityChildhood Overweight/Obesity  In the U.S., the prevalence of childhoodIn the U.S., the prevalence of childhood overweight tripled between 1980 & 2000.overweight tripled between 1980 & 2000. Circulation: Journal of the AHA downloaded 7/15/07
    24. 24. The State of Our Nation:The State of Our Nation: Trends in Health StatusTrends in Health Status  Nearly 30% of adultsNearly 30% of adults 18-75 years old are18-75 years old are classified asclassified as “inactive”“inactive”  Report no leisure-Report no leisure- time physicaltime physical activity (vigorous oractivity (vigorous or light/moderate) of atlight/moderate) of at least 10 minutesleast 10 minutes durationduration National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006  Nearly 50%Nearly 50% American adults doAmerican adults do not get enoughnot get enough physical activity tophysical activity to provide healthprovide health benefitsbenefits
    25. 25. Most Recent CDC-ACSM Guidelines  All adults perform 30 or more minutes ofAll adults perform 30 or more minutes of moderate-intensity physical activity on most,moderate-intensity physical activity on most, and preferably all, days---and preferably all, days---eithereither in a singlein a single session orsession or “accumulated” in multiple bouts“accumulated” in multiple bouts,, each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.  Or at least 3 days a week for 20 minutes a dayOr at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity  All adults perform 30 or more minutes ofAll adults perform 30 or more minutes of moderate-intensity physical activity on most,moderate-intensity physical activity on most, and preferably all, days---and preferably all, days---eithereither in a singlein a single session orsession or “accumulated” in multiple bouts“accumulated” in multiple bouts,, each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.  Or at least 3 days a week for 20 minutes a dayOr at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity
    26. 26. National Center Health Statistics. Health, 2004 The State of Our Nation: Trends in Health Status  19% adult women and 23% men current smokers in 2004, strongly associated with educational level  22% high school students reported smoking, slight decline in upward trend began in 1990’s
    27. 27. Source: Behavioral Risk Factor Surveillance System,CDC 2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no
    28. 28. The State of Our Nation:The State of Our Nation: Trends in Health StatusTrends in Health Status  Adults aged 65 to 74 years (2001-2004): 17% elevated cholesterol 30% hypertension  Diagnosed or undiagnosed Diabetes (FBG of 126 mg/dl or over)  10% persons 20 yrs of age and older  20% of the U.S. Population, aged 60 years and older National Center Health Statistics. Health, 2006
    29. 29. Native Hawaiian/ Pacific Islander Am. Indian/ Alaska Native I = 95% confidence interval. *Data are statistically unreliable and are suppressed. NOTE: Data are for adults aged 18-84 years and are age-adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For data prior to 1999, respondents reported one or more races and identified one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), NCHS, White BlackAsian Hispanic * Total Age-adjusted rate per 1,000 population 1997-99 2000-02 2003-05 2010 Target: 3.8 * Decrease desired 5 10 15 0 20 Total White Hispanic Black Female 7.4 (0.4) 6.3 (0.5) 12.1 (1.1) 10.8 (1.3) Male 7.5 (0.5) 7.0 (0.5) 7.4 (1.1) 9.7 (1.7) Obj. 5-2 New Cases of Diabetes, Among Adults
    30. 30. Percentage of Adults Who Reported Eating fewer Than Five Servings of Fruits and Vegetables a Day, by Sex, 2002 The State of Our Nation: TrendsThe State of Our Nation: Trends in Health Behaviorsin Health Behaviors 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Men Women Total 0% Dietary Factors Associated 4 of the 10 leading causes of death: - CHD - Cancer - Stroke - DM II Source: CDC, At A Glance: Phys. Activity & Good Nutrition
    31. 31. Why Is Health Promotion SoWhy Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?  95% of the US95% of the US healthcare economyhealthcare economy is allocated to directis allocated to direct medical caremedical care  Only 5% is allocatedOnly 5% is allocated to healthto health improvementimprovement
    32. 32. National Goals &National Goals & Objectives for HealthObjectives for Health  Healthy People followed by National Goals and Objectives  Healthy People 2000 Nation’s health agenda  Healthy People 2010 http://healthypeople.gov
    33. 33. Healthy People 2000, 2010  A comprehensive setA comprehensive set ofof national healthnational health objectivesobjectives for thefor the decadedecade  Developed by aDeveloped by a collaborative processcollaborative process  Designed toDesigned to measuremeasure progressprogress over timeover time  AA public healthpublic health documentdocument that is partthat is part strategic plan, partstrategic plan, part textbook on publictextbook on public health prioritieshealth priorities
    34. 34. Healthy People 2010Healthy People 2010 Coordinated ByCoordinated By  The Office ofThe Office of DiseaseDisease Prevention andPrevention and Health PromotionHealth Promotion  U.S. DepartmentU.S. Department of Health andof Health and Human ServicesHuman Services (USDHHS)(USDHHS)
    35. 35. Healthy People 2010Healthy People 2010  Two overarchingTwo overarching goalsgoals  28 focus areas28 focus areas  467 specific467 specific objectivesobjectives  10 Leading Health10 Leading Health IndicatorsIndicators
    36. 36. Two Overarching Goals:Two Overarching Goals: Increase qualityIncrease quality and years ofand years of healthy lifehealthy life Eliminate healthEliminate health disparitiesdisparities
    37. 37. Healthy People 2010 28 Focus Areas (14 apply directly to PT)  Access to Quality Health Services  Arthritis, Osteoporosis, and Chronic Back Conditions  Cancer  Chronic Kidney Disease  Diabetes  Disability and Secondary Conditions  Heart Disease and Stroke  HIV  Maternal, Infant, and Child Health  Nutrition and Overweight  Occupational Safety and Health  Physical Activity and Fitness  Respiratory Diseases  Tobacco Use
    38. 38. Healthy People 2010Healthy People 2010 10 Leading Health Indicators10 Leading Health Indicators  Physical ActivityPhysical Activity  Overweight andOverweight and ObesityObesity Tobacco Use Substance Abuse Responsible Sexual Behavior Mental Health Injury and Violence Environmental Quality Immunization Access to Health Care
    39. 39. How Healthy is Indiana? Indiana Healthy Weight INShape Indiana Fit City
    40. 40. Health Risk Appraisals (HRA’s)
    41. 41. Senior Fitness Test Roberta E Rickli, C Jessie Jones
    42. 42. The Role of the Physical TherapistThe Role of the Physical Therapist  Vision 2020: By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. HOD 06-00-24-35 (Program 01)  Vision 2020: By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health. HOD 06-00-24-35 (Program 01) 11/06
    43. 43. Roles of a Physical Therapist Pathologies Movement Science Training Principles Diverse Populations Psychosocial Responses Screening
    44. 44. Roles of a Physical Therapist National goals include PT Inherent credibility Viewed as advocates, problem-solvers Access to patient/client populations Access to facilities and resources Access to the public
    45. 45. American Physical Therapy Association
    46. 46. APTA Vision 2020 Statement By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.
    47. 47. APTA Video Podcasts on Health Promotion
    48. 48. Center for Disease Control
    49. 49. Screening Activities Physiological parameters Scoliosis Posture CVD, PVD Pulmonary function Sports health Occupational health Functional performance
    50. 50. Health Promotion Practice Greater participation in community health activities Public Health projects Health Fairs Prevention education programs Consultants for community agencies, schools, businesses, health clubs etc. Professional conferences- community health projects
    51. 51. Health Promotion Practice Integration of health promotion and preventive health services within traditional practice Screening Referral Collaboration Client education
    52. 52. Health Promotion Practice Linking with fitness centers, YMCA’s, YWCA’s, health clubs PT practices located in these settings Consultation with fitness personnel to facilitate client recovery and rehabilitation Prevention education programs
    53. 53. Health Promotion Practice Transition or Chronic Care Programs Service to clients no longer in PT Well-suited for clients with chronic illness or extended recovery Slows development of disorders, prevents functional losses Group, individualized programs
    54. 54. Health Promotion Practice PT Private Practice Combination PT and Health Promotion PT- Medical Model HP- Client-centered care  Multidisciplinary Wellness centers
    55. 55. Health Promotion Practice Health Promotion and wellness programming- Seniors: Long-term care Assisted living community Senior housing communities Community groups In homes
    56. 56. Health Promotion Practice Other Health Promotion Niches: Kids School Home Women’s Health Business Health Worksite Wellness Sports Health Multidisciplinary wellness
    57. 57. APTA Position Statement on Health Promotion and Wellness By PTs and PTAs The APTA recognizes that physical therapists are uniquely qualifieduniquely qualified toto assume leadershipleadership positions in efforts to preventprevent injury and disabilityinjury and disability,, and fully supports the positive rolespositive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellnesspromotion of healthy lifestyles, wellness and injury preventionand injury prevention.. HOD 06-93-25-50 Efforts coordinated through APTA Department of Practice, Ken Harwood, PT, PhD, Director
    58. 58. HOD 06-04-09-09 Priority Goals of the APTAPriority Goals of the APTA Goal 1:Goal 1: PhysicalPhysical therapists aretherapists are universallyuniversally recognized andrecognized and promoted as thepromoted as the practitioners ofpractitioners of choicechoice for personsfor persons with conditions thatwith conditions that affect movement,affect movement, function,function, healthhealth, and wellnesswellness.
    59. 59. Priority Goals of the APTAPriority Goals of the APTA  Goal II:Goal II: PhysicalPhysical therapists are universallytherapists are universally recognized and promotedrecognized and promoted as providers ofas providers of fitnessfitness,, health promotionhealth promotion,, wellnesswellness, and, and riskrisk reductionreduction programs toprograms to enhance quality of life forenhance quality of life for persons across the life-persons across the life- span.span. 11/06HOD 06-04-09-09
    60. 60. APTA Normative Model/Guide toAPTA Normative Model/Guide to Physical Therapist Practice/Physical Therapist Practice/ CAPTE RequirementsCAPTE Requirements Physical therapists involved in prevention, promoting health, wellness, fitness &health, wellness, fitness & screening activitiesscreening activities Help patients/clients: Achieve & restore optimal function Minimize impairments, functional limitations, disabilities  Maintain healthMaintain health (prevent further deterioration or future illness) Create appropriate environmental adaptationsenvironmental adaptations to optimize independent function
    61. 61. The Big Picture Adapted from Health Promotion and Wellness: Expanding YourAdapted from Health Promotion and Wellness: Expanding Your Practice ParadigmPractice Paradigm American Physical Therapy Association (APTA)American Physical Therapy Association (APTA) Bezner, Black, IngmanBezner, Black, Ingman Pre-pathogenic PeriodPre-pathogenic Period Period of PathogenesisPeriod of Pathogenesis Primary PreventionPrimary Prevention SecondarySecondary PreventionPrevention HealthHealth PromotionPromotion HealthHealth ProtectionProtection PreventativePreventative HealthHealth ServicesServices TertiaryTertiary PreventionPrevention Early dxEarly dx & prompt& prompt treatmenttreatment Prior toPrior to symptomssymptoms DisabilityDisability LimitationLimitation RehabilitationRehabilitation
    62. 62. Health Promotion Natural Extension of PT’s Role Primary Care Practitioner Examination Evaluation Diagnosis Prognosis (Including Plan Of Care) Intervention Outcomes Examples: Booth at Walmart; Lifelong PT, Annual ExamsExamples: Booth at Walmart; Lifelong PT, Annual Exams
    63. 63. Screening Medical Disease Lifestyle Behaviors (HRA) Refer or Treat
    64. 64. Physical Activity and Health: A Report of the Surgeon General, 1996 Commissioned by Secretary of HealthCommissioned by Secretary of Health and Human Services in 1994and Human Services in 1994 Landmark review of the research onLandmark review of the research on physical activity and healthphysical activity and health Joint Venture of Agencies:Joint Venture of Agencies: CDC lead federal agencyCDC lead federal agency President’s Council on Physical FitnessPresident’s Council on Physical Fitness and Sports (PCPFS)and Sports (PCPFS)
    65. 65. Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines  All adults perform 30 or more minutes ofAll adults perform 30 or more minutes of moderate-intensity physical activity on most,moderate-intensity physical activity on most, and preferably all, days---either in a singleand preferably all, days---either in a single session or “accumulated” in multiple bouts,session or “accumulated” in multiple bouts, each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.  Or at least 3 days a week for 20 minutes a dayOr at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity
    66. 66. An estimated 54 million persons in the United States, or nearly 20% of the population currently live with disabilities (McNeil 1997)
    67. 67. Interaction of Concepts International Classification of Function (ICF, 2001) Health ConditionHealth Condition ((disorder/diseasedisorder/disease)) EnvironmentalEnvironmental FactorsFactors PersonalPersonal FactorsFactors BodyBody function&structurefunction&structure (Impairment(Impairment)) ActivitiesActivities (Limitation)(Limitation) ParticipationParticipation (Restriction)(Restriction)
    68. 68. Traditional Health Promotion  “not to take care of the sick and disabled, but rather to prevent disease and disability in the healthy”
    69. 69. Purpose of Health Promotion Programs for the Disabled  Reduction of secondary conditions (obesity, hypertension, pressure sores)  Maintain functional independence  Provide opportunity for leisure and enjoyment  Enhance quality of life by reducing environmental barriers to good health
    70. 70. Rimmer, 1999
    71. 71. NCPAD NCPAD established in 1999 through a grant through the CDC and Prevention’s Disability and Health Branch Established to synthesize and disseminate research and programmatic information on physical activity and disability Provides a model that attempts to bridge the gap between rehabilitation and community based health promotion
    72. 72. NCPAD Comprehensive source for information related to physical activity and disability Website contains: searchable databases containing articles, citations, programs and facilities and equipment vendors. Website contains: fact sheets, monographs, bibliographies
    73. 73. ACSM Guide to Exercise Testing Durstine and Moore 2009 Methods Measures Aerobic- Cycle and wheelchair ergometer, traditional or wheelchair treadmill, combo arm and leg ergometer, seated stepper, arm ergometer BP, HR, RPE Endurance 6 or12 min walk, arm/leg ergometer Distance walked, time of exercise at 60% peak power Strength Mmt with or without hand held dynomometer Force generated on dynomometer
    74. 74. ACSM Guide to Exercise Testing Durstine and Moore 2009 Flexibility Hand held goniometer ROM in shoulder, elbow, wrist, knee, ankle and other joints of affected limbs Neuromuscular Gait analysis, Berg balance, functional reach, POMA Gait speed, symmetry of movement Functional Duke Mobility, FIM, Individualized criterion referenced tests
    75. 75. ACSM Guide to Exercise Programming Durstine and Moore 2009 Modes Intensity/freq/duration Aerobic Upper and lower body ergometer cycle ergometer, treadmill, wheelchair ergometer, wheelchair treadmill, arm ergometer, swimming seated stepper, seated aerobics, free wheeling RPE 13-20 50-80% peak HR 3-5 days/week 20-60 min session (or multiple 10 min sessions) Strength Isometric exercise, weight machine Free weights/dumbells, wrist weights, rickshaw, lat pull-downs, rowing 3 sets of 8-12 reps 2-4 days/week
    76. 76. ACSM Guide to Exercise Programming Durstine and Moore 2009 Modes Intensity/freq/duration Flexibility stretching 2 days a week (before or after aerobic or strength activities) Neuromuscular Coordination and balance activities 2 days/week (consider performing on same day as strength activities)
    77. 77. Aerobic Training Equipment Examples
    78. 78. Aerobic Training Alternatives
    79. 79. Strength Training Equipment Examples
    80. 80. Evidence-Based Community Programs and Outcomes for TBI Gordon 1998 Retrospective review of aerobic exercisers decreased fatigue, decreased migraines, less depression, improved cognitive function, perception of health and social interaction.
    81. 81. Evidence-Based Community Programs and Outcomes for SCI Ditor (2003) 9 month exercise intervention Less pain, stress, increase in quality of life Manns(1999) Relationship between fitness, physical activity, subjective quality of life, and handicap Persons who were more fit, were generally less handicapped
    82. 82. Helen M. Galvin Center for Health and Fitness  Located at the Rehabilitation Institute of Chicago  Made possible by private donations  4000 sq foot facility specifically created for people with physical disabilities  Free to the participants  Provides an arena for persons to develop, maintain and improve their physical well being  Monthly attendance has averaged 1850 visits over the past 2 years
    83. 83. An Emerging Market: Fitness Centers that Can Serve the Disabled  Linkages between rehabilitation facilities and community based fitness centers  Fitness centers are a logical extension of the rehabilitation continuum by offering a location in the person’s natural environment  Involvement in nutrition seminars, relaxation classes, and health fairs.

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