We acknowledge the Aboriginal Custodians (past and present) of the land, where we meet today. The Cannalgal Clan of the Garigal Nation. The experience of living with HIV has changed. In the western world HIV is now largely viewed as a chronic manageable condition. Many people living long-term with HIV are beginning to re-engage with life and looking to plan ahead for a future that was unexpected. In order for people to re-engage they need to ensure that they have optimal health and sound life-skills to utilise. The Healthy Life Plus program aims to address the former requirement. Thus . . . .Wellness with HIV
Today my presentation will cover the following topics: Why HL+? What is HL+? – a brief overview of the program Program Adherence – the perennial issue What changes have been made with what results Some suggestions for those planning on starting similar programs
So why do we run a Healthy Life Plus program? As we all know, since the emergence of highly active anti-retroviral therapy, PLWA are living longer. However as they live longer so they become affected by related health issues such as inflammation, body shape changes, cognitive impairment, stigma and premature ageing. Studies by Finch and Roubenoff have shown favourable results using a combination of exercise and dietary interventions to combat the emerging side effects of treatments. In response to these findings the Healthy Life Plus program was developed, aimed at improving the health outcomes of these people.
Let’s take a look at the program. It’s a health and wellness program targeted at all HIV positive people who meet certain selection criteria. More about the selection criteria in a minute. The program focus’s on two key ingredients of being well – exercise and diet. The program runs for 12 weeks or roughly one quarter, and we run two programs per annum.
There are 3 main strands to the program. Firstly there’s the training – that takes place in a Gym under the supervision of a dedicated Personal Fitness Trainer who customises a training program to meet the goals of each participant within their know capabilities. The second piece of the pie are the weekly presentations, on a range of exercise and diet related topics plus a few general sessions that provide some context to the journey on which these people are about to embark. And the third element is the health screening and assessment that takes place before and after the program. Lets look at each stream in detail.
Central to the training is the appointment of a dedicated Personal Fitness Trainer. This person plays a key and central role in the weekly development of the participants training regime. The program provides for an initial assessment plus two further appointments. Our current trainer has generously increased his commitment to the program by offering an additional appointment per month effectively giving participants access to his services each fortnight. Each participant had a unique program developed to help meet their specific and stated goals eg weight gain or weight loss or toning etc. During the 12 week program participants are given complimentary membership of the gym which includes unlimited use of the gym plus access to whatever classes the would like to join.
Turning to the weekly seminars. We run 9 of these, each Tuesday evening from 6.30 till 8.30 at the PLC in Surry Hills. We utilise the services of qualified subject knowledge specialists who generously volunteer their time to come and present to the group. We encourage participation in many forms – demonstrations and exercises involving participants, note taking, questions and experiences shared. We aim to have two members of the HP team present at all sessions to provide ongoing peer support. We also use these sessions to motivate and encourage participants, as well as hold one-on-one sessions to gather progress and deal with any of their issues. Topics covered include: (read from list) Goal setting and Body Image are held early on in the piece and combined due to their inter-relatedness.
Some of our presenters and the topics they present on
The third leg is the Health Screening component which is undertaken through our long standing partner in the program, the Nutrition Division at the Albion Street Centre. They undergo an initial assessment during which baseline data is gathered. This covers such areas as (read from list) Data is gathered at the conclusion of the 12 weeks to provide the basis for comparisons and a detailed report by the Nutrition Division.
Briefly the selection criteria are: Pos Their must be stated evidence of social isolation (ascertained during intake) There must be evidence of financial duress – again ascertained during intake. For example somebody working full time would be deemed unsuitable. The must be some form of impairment from HIV itself or treatment. This tends to skew the intake to people who have been diagnosed longer but this works in our favour as we often find that those who are recently diagnosed have enough issues to deal with and committing to a proram of 12 weeks duration is beyond them
The perennial issue that has dogged the program from inception is that of adherence. How do we ensure that those who are eligible and appear committed from day one last the distance and see the program through. This issues underscores the value of detailed and relevant program evaluation. We can only fix the things that are broke if we know they are broke. And whilst we aim to deal with situations that arise during the program as best we can, we need to lock the program in for the duration so there is sense of certainty and a known entity. After 3 years the Spring (August) 2004 program had a 42% completion rate, with past program adherence averaging just above 50%. It was time to make some changes.
And these are the changes that were made: (Read from list)
And the results were impressive. In the prom immediately following the changes, we enjoyed a 100% adherence to all appointments, measures and evaluations. Seminar attendance was only 62% though. Seminar sessions were changed back to weekly which is how they operate now ( there just weren’t enough opportunities at a fortnightly interval to cover all the required topics) plus having one week on and one week off makes for too many opportunities to give the attendance a miss. Adherence started to deteriorate again dropping to an average of 63% over the past tow years. The chart of the page tells the story.
Following the Spring 2009 program with adherence at 67%, it was decided to make further changes to the program. Our thinking was around the pre-engagement period where potential members are initially enthusiastic and committed. The aim was to try to tap into that state of mind by doing two things: Stating in the program documentation more explicitly our requirements of them in regard to attendance and the effect of non-attendance (3 strikes and you’re out). The holding of an “Expectations Night’ two weeks before that launch of program during which our expectations of them and their obligations are clearly spelled out. The documentation is gone through in detail and all aspects of communication and attendance are covered. We have also increased the level of communication with our participants. This includes ongoing weekly communication around seminar attendance and gym/nutritionist appointments. It includes a pre-seminar session update on the program, as well as a post-seminar reminder of what’s coming up, things to do etc.
The results are encouraging. After 9 of the 12 weeks, adherence is at 93% across the board. All participants have attended all scheduled appointments to date. We have suffered one casualty being a recently diagnosed client who although he met the criteria, in hindsight just had too much to deal with and his life got overtaken by events and something had to give and it was HL+. Our participants remain enthusiastic and committed to the program. Last Tuesday we had 100% attendance on a night when quite frankly most people would prefer to be tucked up in bed with a warm drink. We aim to make all sessions and enjoyable and pleasant experience. We tell jokes, give them fascinating tidbits of information – did you know that it takes 17 muscles to smile – and offer incentives such as food and drinks and prize giveaways. Above all we encourage all participants to participate and share their stories and insights into the topics under discussion.
Whilst we are pleased with the changes we’ve recently made we have identified another issue that potentially impact on adherence. This is the identification of significant pre-existing health conditions that could negatively affect a participants ongoing participation in the training component of the course. For example, we discovered one week into the program that the emphysema that one of the participants had was chronic and far more significant than he’d originally alluded to. The assessment by the trainer was that he would need to attend remedial breathing classes before he could participate in gym work comfortably.
Finally I’d like to share some pointers to holding a similar program: 1. Find reliable partners especially Gym and Trainer. Also a Nutrition dept that can support you with the pre and post health screens 2. Make sure you have the internal resources to devote to the program. It requires plenty of enthusiasm and energy in planning and delivering consistently over 3 moths. 3. Develop your selection criteria and rigorously adhere to them. 4. Keep up the communication – talk often and with passion. You should be engaging with participants at least twice each week. 5. And of course the golden rules of Plan the work and work the plan. Thank you.
Wellness with HIV: A presentation on the Healthy Life Plus (HL+) program conducted by the HIV Men’s Health Promotion team at ACON
Wellness with HIV A presentation on the Healthy Life Plus (HL+) program conducted by the HIV Men’s Health Promotion team at ACON Andrew Buchanan Team Leader, HIV Health Promotion, ACON
Overview <ul><li>Why HL+? What is HL+? </li></ul><ul><li>Issue of Adherence </li></ul><ul><li>Changes and Results </li></ul><ul><li>Planning your Program </li></ul>
Why HL+? <ul><li>With HAART, people with HIV living longer </li></ul><ul><li>Side effects + lifestyle issues </li></ul><ul><li>Studies* shown favourable results combining exercise and diet </li></ul><ul><li>HL+ Program developed in response </li></ul><ul><li>* Finch et.al 2006; Roubenoff et.al 2002 </li></ul>
HL+ - What is it? <ul><li>Health and Wellness program targeted specifically at HIV positive people who meet certain criteria </li></ul><ul><li>Focus on exercise and diet </li></ul><ul><li>Runs over 12 weeks </li></ul>
HL+ - What is it? <ul><li>Comprises 3 streams: </li></ul><ul><li>Individualised training programs with a Personal Fitness Trainer </li></ul><ul><li>Weekly presentations on health topics in seminar format with peer-group discussion </li></ul><ul><li>Pre- and post-program health screening and assessment </li></ul>
Fitness Training <ul><li>Appointment of a dedicated Personal Fitness Trainer </li></ul><ul><li>Initial then fortnightly appointments </li></ul><ul><li>Development of a personalised program </li></ul><ul><li>12 week’s complimentary membership at a centrally located gym </li></ul><ul><li>Unlimited use of the gym and classes </li></ul>
Weekly Seminars <ul><li>Qualified specialist presenters as volunteers </li></ul><ul><li>Peer support and group discussion </li></ul><ul><li>Topics include: </li></ul><ul><ul><li>Nutrition & Food Labeling/choice </li></ul></ul><ul><ul><li>Goal Setting & Body Image </li></ul></ul><ul><ul><li>Supplements and Vitamins </li></ul></ul><ul><ul><li>Core Stability </li></ul></ul><ul><ul><li>Cardio-vascular issues with HIV </li></ul></ul><ul><ul><li>Complementary Therapies eg Shiatsu </li></ul></ul><ul><ul><li>Yoga </li></ul></ul>
Presenters and Topics Supplements Kira Sutherland B.Sc Awareness Institute Goal Setting Rob Derbyshire ISC Dip Health Trio Core Stability Craig Osborne B.Sc Thrive Chiropractic Cardiovascular System and HIV Dr David Baker East Sydney Doctors
Health Screening <ul><li>Undertaken by Albion Street Centre, Nutrition Development Division </li></ul><ul><li>Baseline data gathered includes: </li></ul><ul><ul><li>Anthropometry eg height, weight, waist, LBM etc </li></ul></ul><ul><ul><li>Fitness – BP and heart rate </li></ul></ul><ul><ul><li>Strength test </li></ul></ul><ul><ul><li>Biochemistry test results supplied </li></ul></ul><ul><li>Final data gathered at conclusion of program </li></ul><ul><li>Comparison against original goals/objectives to determine effectiveness </li></ul>
Selection Criteria <ul><li>HIV positive </li></ul><ul><li>Affected by social isolation </li></ul><ul><li>Financially disadvantaged </li></ul><ul><li>Experiencing some form of physical/psychological impairment due to HIV disease process or medication side effects, and co-morbidities </li></ul>
Issue: Adherence <ul><li>Spring 2004 program had a 42% completion rate </li></ul><ul><li>Participant adherence averaged 53% over initial 3 years </li></ul>
Adherence - Changes <ul><li>Changes made in 2005 included: </li></ul><ul><ul><li>Introduction of personalised fitness program </li></ul></ul><ul><ul><li>Instructor with specialist HIV and health knowledge </li></ul></ul><ul><ul><li>Move to fortnightly seminars </li></ul></ul><ul><ul><li>Provision of additional financial assistance/support through BGF </li></ul></ul>
Adherence - Results <ul><li>Initial results indicated changes were effective in improving adherence </li></ul><ul><ul><li>100% compliance in appointments, measures and evaluations </li></ul></ul><ul><ul><li>62% compliance in seminar attendance </li></ul></ul><ul><li>Gradual deterioration to an average of 63% adherence over past 2 years </li></ul>
Adherence – New Changes <ul><li>Stronger and clearer up-front approach to client commitment and buy-in via: </li></ul><ul><ul><li>Explicit statement of attendance requirements reinforced through clear wording in documentation </li></ul></ul><ul><ul><li>‘ Expectations Night’ held before the program commences outlining expectations and obligations </li></ul></ul><ul><li>Increased communication with participants </li></ul>
Results to date <ul><li>After 75% completion, we have a healthy 93% adherence rate across all activities </li></ul><ul><li>1 drop-out due to unforeseen circumstances </li></ul><ul><li>Enthusiastic and committed participants </li></ul><ul><li>Fun and participative sessions </li></ul>
Proposed Change <ul><li>Improve the ability to identify significant pre-existing health conditions via GP/Clinician clearance </li></ul><ul><li>Example – TR has chronic Emphysema and requires breathing training and exercises before being able to do gym work </li></ul>
If you’re planning a program . . . <ul><li>Find reliable Gym and Trainer (preferably with understanding of HIV issues) </li></ul><ul><li>Ensure internal capacity to sustain commitment to the program </li></ul><ul><li>Rigorous compliance with selection criteria </li></ul><ul><li>Communicate – often and enthusiastically </li></ul><ul><li>Plan Execute Evaluate </li></ul>