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Filling the Exercise Prescription


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Filling the Exercise Prescription

  1. 1. A presentation at Active Lives:Transforming Ourselves and Our Patients 11/10/12 (delivered by Dr Edward Phillips) Stephan Esser MD
  2. 2. Filling the Exercise Prescription Stephan Esser USPTA, MD November 2012
  3. 3. Disclosures• Co-creator of
  4. 4. This Weekend• Physical Activity and Fitness Assessment• Exercise Prescription Implementation• Physician Health• Business of Lifestyle Medicine – Filling the Exercise Prescription• Motivation
  5. 5. You …….After this Weekend• Inspired• Motivated• Ready to Change Lives• A brain full of exciting new stuff
  6. 6. Possible Patient Concerns Remain• I don’t know where to exercise• I don’t know how to exercise• I don’t have time to exercise• It costs too much to exercise
  7. 7. Goal• Action-able• Rubber hits the Road• Introduce you to ideas/opportunities• Equip you with the tools to transform lives• Stimulate your creative Juices
  8. 8. Day #1• In the Clinic…3rd patient of the day – Mr Yulepsi is a 62 y/o gentleman back for follow up of his BP. He is feeling more fatigued, and having some lightheadedness, but his BP’s are still borderline. – He says he wants other options than medx…..
  9. 9. Day #1• Your mind RACES…..nutrition…exercise…stress• You harness your motivational interviewing skills and after more dialogue you know he is in a preparation/action stage and would prefer to start an exercise program while also trying to eat a little better• He has previously received appropriate ACSM screening and is cleared for moderate intensity activity
  10. 10. Day #1• More mature individual• Known cardiovascular dysfunction• Was cleared with exercise stress test• Motivated to start an exercise program
  11. 11. What do you do?• What does he want to do ?• What are his resources? – What can you offer him?• What are his options? – Do you know your community options?
  12. 12. Our Goals• Fill that Prescription – People – Programs – Places – Products – Etc…..
  13. 13. People• Structured: – Your Office: Trainer, Wellness Coach – Physical Therapy – Training: • Personal Trainers • Group Classes
  14. 14. Physical Therapy• Common: – Post-injury/Pre or Post Surgery – Therapeutic Exercise, Modalities• Often Available: – Therapeutic Exercise Training – Use of Equipment
  15. 15. Physical Therapy• Pros: – Highly trained – Significant Experience – Certified/Insured/Credentialed – Established mechanism of communication• Cons: – Require a medical diagnosis – Co-Pays ($20-40) – Limited # of visits paid by insurance – Time/training in therapeutic exercise
  16. 16. Trainers• Personal Trainers• Group Trainers• Heath Coaches• Life Coaches
  17. 17. Trainers• Pros: – Accessibility – Variety • Private sessions, group classes • Strength training, Yoga, Kick-Boxing, Pilates…etc – Price: • Privates: Variable ($20-$200) • Groups: included in memberships or $8-$15/hr
  18. 18. Trainers• Cons: – Cost: private pay – Variable experience/knowledge – Variable insured status – No “established” method of communication – Certification?
  19. 19. Trainer Certification• Many Types: – 7 Certified – National Commission for Certifying Agencies NCCA• American College of Sports Medicine (ACSM)• American Council on Exercise (ACE)• National Academy of Sports Medicine (NASM)• National Strength and Conditioning Association (NSCA)• National Council on Strength and Fitness (NCSF)• National Federation of Professional Trainers (NFPT)• National Exercise and Sports Trainers Association (NESTA)
  20. 20. Selecting a Trainer• Certification – ACSM > NASM > ACE > NSCA > NCSF > NFPT > NESTA• Affiliation – Independent/National Gym• Insured• Interview• Word of Mouth• Patient Report
  21. 21. People• Unstructured: – Friends – Family – Work-Out Buddy – Neighborhood: Pick up Ball, Park sports etc – Meet up
  22. 22. Programs
  23. 23. Programs• National Physical Activity Plan – – Collaborative: to achieve HP 2020, PA 2008 CDC – “One day, all Americans will be physically active and they will live, work, and play in environments that facilitate regular physical activity.” – Sectors: Business, Health Care, Industry, Education, Media, Parks/Recreation, Public Health, Transportation, Volunteer
  24. 24. Programs• The President’s Challenge – – Online resources, testing, awards• Let’s Move –
  25. 25. Programs• Walk With A Doc:
  26. 26. Programs• Silver Sneakers:• Physical Activity insurance benefit to seniors• Provides gym memberships and fitness classes at 11,000 locations• Multiple Insurance providers involved
  27. 27. Worksite Wellness
  28. 28. Motorola• Cost ≈ $6 mil/yr on wellness and work/life programs• Offerings: Health Screenings, Education, gym access etc• Cost-effectiveness: – ROI=$3.93 – Participating employees = 2.4% increase vs 18% increase for non-participants – $6.5 million yearly savings in medical expenses for lifestyle-related diagnoses (e.g., obesity, hypertension, stress)
  29. 29. DaimlerChrysler• National Wellness Program – Targeted education programs, one-time workshops, multi-session classes, individual counseling, and self-directed modules, on-site services• Savings of: $16 per employee per month• The more health assessment completed= the more saved• Employees who had completed at least one health risk assessment and participated in an additional wellness activity had an average cost savings of $200.35 per year.
  30. 30. Union Pacific• 1990: 29% spending on LR disease, $40mill.• The “Health Track Program”: Health Risk Assessment, a Smoking Cessation Program called Butt Out and Breathe, over 500 contracted Fitness Facilities, an incentive program• 10 yr healthcare costs per employee decreased by 16%• 10% decrease in Health Care Costs due to Lifestyle Related Factors
  31. 31. Caterpillar• Healthy Balance Program: health assessment, risk stratification, individualized interventions, disease management phone counseling; serial tracking, online resources• Projected healthcare cost savings of $700 million by 2015.• Participants who completed the high-risk program reduced their doctor office visits by 17%, and hospital days by 28%.
  32. 32. Northeast Utilities• 17% healthcare costs = Lifestyle related disease• WellAware program: financial incentives, employees and spouses eligible, a health risk assessment, phone contact and Internet site access at work and home, and a toll free hotline for materials and questions.• Participants demonstrated: 31% decrease in smoking, a 29% decrease in lack of exercise, a 16% decrease in mental health risk, a 11% decrease in cholesterol risk, an 10% improvement in eating habits, and a 5% decrease in stress.
  33. 33. Common Ground• Health Assessments• Risk Stratification• “High Touch”• High Tech and Low Tech• Family/Spouse Participation• Incentivization
  34. 34. Web based programs
  35. 35. Web-Based Health Programs• Virgin Health Mile: $5 for Employer– HealthZone kiosks at Employer sponsored fitness center (computer terminal that tracks weight, blood pressure, & body fat)– Go Zone pedometer (track online)– LifeZone Website (track activity, questionniares)– Challenges– Employee receives gift cards (Target, Best Buy)
  36. 36. Virgin Health Miles• Pros: - A fun easy way to work toward improving your health and earning money while doing it. - Virgin Health Miles is quick to respond to customer inquiries and sends items ordered from their website within days of the request. - Relatively easy with moderate activity to earn back your investment.
  37. 37. Virgin Health Miles• Cons: - Pedometer reliability has been mixed. - Walking style and users size appear to impact the ability of the pedometer to register steps. - HealthZone Kiosks are time consuming to use and could be inconveniently located for you. - GoZone Challenges havent yet figured a way to eliminate cheating.
  38. 38. Limeade
  39. 39. Limeade• Hired by Employer• Establish Personal Health Goals• Achieve them using – Includes in-person meetings, webinars, newsletters, home mailings on-site signage, mobile apps & devices• Offer rewards
  40. 40. Red-Brick Health•• Health assessments• Health coaching, resources, challenges• Rewards: Reduced premiums, 401k deposits, gift cards etc.• Personalized Programs, & individual rewards.
  41. 41. Tangerine•• Outsourced weight loss and health solutions• Create advertisements to the employees• Health Assessments• Enroll employees in 3 month cycles• Offer incentives and reimbursement for success
  42. 42. Web-based programs• Free Programs (exercise, fitness etc) – – – – – Kids: –
  43. 43. Real Time Decreasing Sedentary Time
  44. 44. Activity Desks• Decreasing Sedentary Time• Increase activity during and at work• Up to 100kcal/hr• Treadmill and Bikes• Cost: $500-$2000
  45. 45. Places
  46. 46. Parks• “Free”• Various options – Walking trails, “Heart Trails,” Sports fields, Tennis and Basketball Courts, Open Fields, Pools – Hiking Trails, Nature preserves, Bike trails etc.
  47. 47. Gyms
  48. 48. What your patient wants• Cost• Location• Hours• Size• Amenities – Pool, Sauna, Climbing Wall, Raquetball Courts• Classes• Other: Childcare
  49. 49. Planet Fitness• $10/month• Resistance/Cardiovascular Equipment• No group classes
  50. 50. Bailey’s Powerhouse Gym• $25-$40/month• 27 States• Medium to Large• Resistance/Cardiovascular Equipment• Classes
  51. 51. Gold’s Gym• $50- $150 Initiation Fee/ $10- $40 per month• 37 States• Pros: Low price, Plenty of equipment, Child care• Cons: Crowded, Small locker rooms, Lack of customer service, Lack of cleanliness
  52. 52. Lifetime Fitness- $190 Initiation Fee/ $60 per month- 105 locations in US & Canada (some 24/7)- Pros: Variety of Classes, Tennis, Basketball, Squash, Mixed Combat Arts, Swimming- Healthy Café, Spa & Salon- Family oriented with child care, rock climbing, swimming lessons, and camps
  53. 53. CrossFit• Cost: $100-150/month unlimited group classes• Over 2,135 US locations- “Old School”: weights, bars, balls, tires, boxes- Pros: Minimal equipment (ropes, boxes, bodyweight exercises)- Cons: “Universal workouts for elderly individuals with heart disease and professional cage fighters”
  54. 54. 24 Hour Fitness• 420 locations in 14 states• Costs: Vary based on location & club type (high-end Ultra Sport locations $150 Initiation Fee/ $90 per month)• Pros: Free weeklong pass; reduced rate options for family members; many locations open 24 hours; large exercise rooms; variety of classes (Active Aging; Aqua; Mind/Body)• Cons: No money-back guarantee
  55. 55. Boutique/Unique• Tru Fit Personal Fitness• Boxing Bunnies Women’s Boxing Club• Focus Fitness
  56. 56. Apps
  57. 57. Map my run
  58. 58. Fitness Pro - Cost: Free - Electronically log your workouts - Offers tips for newbies on types of cardio and proper form - Select exercises by individual muscle - Can create a personalized routine - Need gym equipment - Maps running - Flexible way to add new exercises to workouts - Can be used with nutritional apps for weight loss
  59. 59. GymGoal ABC-Cost: $0.99- Free version offers 280 exercises with animations- Provides proper form instruction fornewbies- Can add your own images to anyexercise- Calculates target heart rate, BMI,BMR, and body fat percentage- Integrated body map of muscles tofocus on exercises designed for thatmuscle group- Need gym equipment- $2.99 to record and track workouts
  60. 60. Fitness Builder - Cost: $9.99 - 5600+ images/videos, 750+targeted fitness routines as well as individual exercises; - Location (gym, hotel room) and goal (core, flexibility) oriented - Tracks completed workouts by date - Includes a variety of calculators and stat trackers - Complex app with slideshows - Experienced fitness goers who want a large variety of fitness routines and the feeling of using a personal trainer
  61. 61. iTreadmill- Cost: $0.99- Similar to pedometer to tracks steps, distance, andaverage speed while in a hand, strapped to an arm, orcarried in a pocket or purse- Sensor and stride calibrators help you ensure theutmost accuracy- Includes a calorie counterand a pacer for settingspeed goals- Calorie counter is basedon weight alone- Does not detect incline
  62. 62. Cleveland Clinic’s Tip of the Day- Cost: Free- Daily wellness reminders-Example: Drink your juice cloudy! Apple juice withmore pulp has 4x as many disease-fightingpolyphenols (antioxidants) as clear apple juice. Andkeeping yourbrain healthy andhappy (by volunteering,for example) makesit more likely youllstick with that gymroutine.
  63. 63. Devices
  64. 64. Pedometers
  65. 65. Accelerometers • Measure: change in velocity with respect to time • With Calculations…equations = usable data • 1990’s: Increased interest, use, validation • Pros: Portable • Cons: Cost ($100-$300-1000+), On the waist do not capture upper body movement or cycling, and underestimate walking on an incline or carrying heavy loads
  66. 66. Koko Fitness• Cost: $70-90• Fitness Studios• Unique electronic set up/Virtual trainer• Identify Goals/ Select Plan/ 30 minute workouts• Key-Fob: Plugs in to each machine, uploads personalized goals, weights, monitors your pace, coaches you etc..
  67. 67. Technogym Wellness Key • Establish Personal Goals • Select plans/Programs • USB Key Fob: plugs into equipment, guides user thru activity
  68. 68. Jawbone Up• Cost: $99• Wristband & iPhone, iPad or iPod Touch App work together to:• Track Activity - Steps, distance, calories burned, pace, intensity, level, GPS routes - Active vs. inactive time: reminds you to move if inactive for too long• Sleep Patterns - Hours slept, deep vs. light sleep, awake time and overall sleep quality - Smart Alarm: vibrates on wrist at the ideal moment in your natural sleep cycle• Meals - Snap a photo as a food journal and respond with how you feel• Challenges to reach goals - Individual or team based to support, compete, and collaborate
  69. 69. FitBit• Cost: $99.95• Clips onto pocket• Activity: - 3-D motion sensor tracks steps, distance, calories burned - Altimeter tracks floors climbed• Sleep: - Slip tracker into FitBit sleep wristband and automatically uploads how many times and how long you wake up during the night• Logs workouts & meals: - 100,000+ food items -Yoga, Pilates, Elliptical, Boot Camp, Spinning, Kickboxing & Wii Games• Overall Stats: - Sync with other apps (LoseIt! & RunKeeper) - Daily and overall progress - Individual score or compare with others in your age and fitness range - Track weight, blood pressure, glucose, & HR
  70. 70. Fitbug• Fitbug Air - Bluetooth with wireless to send to a desktop, smartphone, tablet, iPhone & iPad - Cost: $64.99 with 12 months of coaching or $29.99 with first month’s coaching & $3.99/mth• Fitbug Go - USB connection to a desktop, smartphone or tablet - Cost: $59.99 or $24.99 & $3.99/mth• Pedometer tracks steps• Individuals: -85% of active members lost weight over the first 6 months - Offers tailored set of goals in first week. Plus online daily health tips and recipes• Employers: - 81% of employees made positive lifestyle changes - 32% reduction in health insurance claims by users - Create challenges for employees with rewards
  71. 71. Nike + Fuel Band• Cost: $149• Wristband displays your goal, calories,steps, fuel, and local time• Personalize your day with an emotion andnotes• Accelerometer tracks running, walking,dancing, basketball and everyday activities• Syncs wirelessly to track overall progress,share results and compete with others onfacebook and twitter
  72. 72. Stuff
  73. 73.
  74. 74. Pen and Paper
  75. 75. Old Fashioned• Handouts• Tracking Logs• Calendars• Sticky Notes…
  76. 76. Our Goals• Fill that Prescription – People – Programs – Places – Products – Etc…..
  77. 77. Tomorrow• You are Ready to Fill the Exercise Prescription• Good ideas to support and empower your patients and your self to achieve their/your BEST health
  78. 78. Remember• Ask what they want to do?• Provide VALUE• Develop Resources• Follow up• Adapt
  79. 79. Thank You!