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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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Clarian health  health promotion inservice  november 8, 2010
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Clarian health  health promotion inservice  november 8, 2010
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Clarian health  health promotion inservice  november 8, 2010
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Clarian health  health promotion inservice  november 8, 2010
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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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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
  • Transcript

    • 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. Objectives
      • 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. 6 Dimensions of Wellness
    • 4. The Six Dimensions of Health
    • 5. My Six Dimensions of Health
    • 6. My Six Dimensions of Health
      • 1. Physical
      • 2. Emotional
      • 3. Spiritual
      • 4. Intellectual
      • 5. Psychological
      • 6. Social
    • 7.  
    • 8. 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
    • 9.  
    • 10. 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
    • 11.  
    • 12. Spiritual
      • Faith
      • Values
      • Morals
      • Beliefs
    • 13.  
    • 14. Intellectual
      • Job/school fulfillment or success
      • Stress
      • Relationships with co-workers, clients, employer
      • Job safety
      • Good attitude
      • Motivation
      • Financial security
    • 15.  
    • 16. Psychological
      • Stress management
      • Self esteem
      • Social interaction
      • Attitude
      • Organization
      • Environment
    • 17.  
    • 18. Social
      • Interaction and relationships with friends, family, significant others
      • Communication- both verbal and non-verbal
      • Extracurricular activities
      • Activities and events
    • 19.  
    • 20.  
    • 21. Why Is Health Promotion So 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
    • 22.  
    • 23. 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
    • 24. Obesity 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
    • 25. 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.
    • 26. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14%
    • 27. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19%
    • 28. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% ≥20
    • 29. 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
    • 30. 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
    • 31.  
    • 32. Source: Behavioral Risk Factor Surveillance System, CDC
    • 33. Childhood Overweight/Obesity
      • In the U.S., the prevalence of childhood overweight tripled between 1980 & 2000.
      Circulation: Journal of the AHA downloaded 7/15/07
    • 34. The State of Our Nation: Trends in Health Status
      • Nearly 30% of adults 18-75 years old are classified as “inactive”
      • Report no leisure-time physical activity (vigorous or light/moderate) of at least 10 minutes duration
      • Nearly 50% American adults do not get enough physical activity to provide health benefits
      National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006
    • 35. Most Recent CDC-ACSM Guidelines
      • All adults perform 30 or more minutes of moderate-intensity physical activity on most, and preferably all, days--- either in a single session or “accumulated” in multiple bouts , each lasting at least 8-10 minutes.
      • Or at least 3 days a week for 20 minutes a day of vigorous intensity activity
    • 36.  
    • 37.  
    • 38. 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
      National Center Health Statistics. Health, 2004
    • 39.  
    • 40. Source: Behavioral Risk Factor Surveillance System,CDC 2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no
    • 41. The State of Our Nation: Trends 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
    • 42. 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, CDC. White Black Asian Hispanic * Total Age-adjusted rate per 1,000 population 1997-99 2000-02 2003-05 2010 Target: 3.8 * 5 10 15 0 20 Obj. 5-2 New Cases of Diabetes, Among Adults Decrease desired
    • 43. Percentage of Adults Who Reported Eating fewer Than Five Servings of Fruits and Vegetables a Day, by Sex, 2002 The State of Our Nation: Trends in Health Behaviors 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
    • 44. Why Is Health Promotion So Important in Our Nation Today?
      • 95% of the US healthcare economy is allocated to direct medical care
      • Only 5% is allocated to health improvement
    • 45. National Goals & Objectives for Health
      • Healthy People followed by National Goals and Objectives
      • Healthy People 2000
        • Nation’s health agenda
      • Healthy People 2010
      • http://healthypeople.gov
    • 46. Healthy People 2000, 2010
      • A comprehensive set of national health objectives for the decade
      • Developed by a collaborative process
      • Designed to measure progress over time
      • A public health document that is part strategic plan, part textbook on public health priorities
    • 47. Healthy People 2010 Coordinated By
      • The Office of Disease Prevention and Health Promotion
      • U.S. Department of Health and Human Services (USDHHS)
    • 48. Healthy People 2010
      • Two overarching goals
      • 28 focus areas
      • 467 specific objectives
      • 10 Leading Health Indicators
    • 49. Two Overarching Goals:
        • Increase quality and years of healthy life
        • Eliminate health disparities
    • 50. 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
    • 51. Healthy People 2010 10 Leading Health Indicators
      • Physical Activity
      • Overweight and Obesity
      • Tobacco Use
      • Substance Abuse
      • Responsible Sexual Behavior
      • Mental Health
      • Injury and Violence
      • Environmental Quality
      • Immunization
      • Access to Health Care
    • 52.  
    • 53. How Healthy is Indiana?
      • Indiana Healthy Weight
      • INShape Indiana
      • Fit City
    • 54.  
    • 55.  
    • 56.  
    • 57.  
    • 58.  
    • 59. Health Risk Appraisals (HRA’s)
    • 60. Senior Fitness Test Roberta E Rickli, C Jessie Jones
    • 61.  
    • 62. The 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)
      11/06
    • 63. Roles of a Physical Therapist
      • Pathologies
      • Movement Science
      • Training Principles
      • Diverse Populations
      • Psychosocial Responses
      • Screening
    • 64. 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
    • 65. American Physical Therapy Association
    • 66. 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.
    • 67.  
    • 68. APTA Video Podcasts on Health Promotion
    • 69.  
    • 70.  
    • 71. Center for Disease Control
    • 72. Screening Activities
        • Physiological parameters
        • Scoliosis
        • Posture
        • CVD, PVD
        • Pulmonary function
        • Sports health
        • Occupational health
        • Functional performance
    • 73.  
    • 74. 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
    • 75. Health Promotion Practice
      • Integration of health promotion and preventive health services within traditional practice
        • Screening
        • Referral
        • Collaboration
        • Client education
    • 76. 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
    • 77. 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
    • 78. Health Promotion Practice
      • PT Private Practice
        • Combination PT and Health Promotion
        • PT- Medical Model
        • HP- Client-centered care
      • Multidisciplinary Wellness centers
    • 79. Health Promotion Practice
      • Health Promotion and wellness programming- Seniors:
        • Long-term care
        • Assisted living community
        • Senior housing communities
        • Community groups
        • In homes
    • 80. Health Promotion Practice
      • Other Health Promotion Niches:
        • Kids
          • School
          • Home
        • Women’s Health
        • Business Health
        • Worksite Wellness
        • Sports Health
        • Multidisciplinary wellness
    • 81. APTA Position Statement on Health Promotion and Wellness By PTs and PTAs
      • The APTA recognizes that physical therapists are uniquely qualified to assume leadership positions in efforts to prevent injury and disability , and fully supports the positive roles that physical therapists and physical therapist assistants play in the promotion of healthy lifestyles, wellness and injury prevention .
      HOD 06-93-25-50 Efforts coordinated through APTA Department of Practice, Ken Harwood, PT, PhD, Director
    • 82. Priority Goals of the APTA
          • Goal 1: Physical therapists are universally recognized and promoted as the practitioners of choice for persons with conditions that affect movement, function, health , and wellness .
      HOD 06-04-09-09
    • 83. Priority Goals of the APTA
      • Goal II: Physical therapists are universally recognized and promoted as providers of fitness , health promotion , wellness , and risk reduction programs to enhance quality of life for persons across the life-span.
      11/06 HOD 06-04-09-09
    • 84. APTA Normative Model/Guide to Physical Therapist Practice/ CAPTE Requirements
      • Physical therapists involved in prevention, promoting health, wellness, fitness & screening activities
      • Help patients/clients:
        • Achieve & restore optimal function
        • Minimize impairments, functional limitations, disabilities
        • Maintain health (prevent further deterioration or future illness)
        • Create appropriate environmental adaptations to optimize independent function
    • 85. The Big Picture Adapted from Health Promotion and Wellness: Expanding Your Practice Paradigm American Physical Therapy Association (APTA) Bezner, Black, Ingman Pre-pathogenic Period Period of Pathogenesis Primary Prevention Secondary Prevention Health Promotion Health Protection Preventative Health Services Tertiary Prevention Early dx & prompt treatment Prior to symptoms Disability Limitation Rehabilitation
    • 86. 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 Exams
    • 87. Screening Medical Disease Lifestyle Behaviors (HRA) Refer or Treat
    • 88. Physical Activity and Health: A Report of the Surgeon General, 1996
      • Commissioned by Secretary of Health and Human Services in 1994
      • Landmark review of the research on physical activity and health
      • Joint Venture of Agencies:
        • CDC lead federal agency
        • President’s Council on Physical Fitness and Sports (PCPFS)
    • 89. Most Recent CDC-ACSM Guidelines
      • All adults perform 30 or more minutes of moderate-intensity physical activity on most, and preferably all, days---either in a single session or “accumulated” in multiple bouts, each lasting at least 8-10 minutes.
      • Or at least 3 days a week for 20 minutes a day of vigorous intensity activity
    • 90. An estimated 54 million persons in the United States, or nearly 20% of the population currently live with disabilities (McNeil 1997)
    • 91. Interaction of Concepts International Classification of Function (ICF, 2001) Health Condition ( disorder/disease ) Environmental Factors Personal Factors Body function&structure (Impairment ) Activities (Limitation) Participation (Restriction)
    • 92. Traditional Health Promotion
      • “ not to take care of the sick and disabled, but rather to prevent disease and disability in the healthy”
    • 93. 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
    • 94. Rimmer, 1999
    • 95. 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
    • 96. 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
    • 97. 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
    • 98. 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
    • 99. 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
    • 100. 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)
    • 101. Aerobic Training Equipment Examples
    • 102. Aerobic Training Alternatives
    • 103. Strength Training Equipment Examples
    • 104. 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.
    • 105. 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
    • 106. 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
    • 107. 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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