Exercise is Medicine. Capital Health Network. Eva Boland. Accredited Exercise Physiologist AES AEP MESSA

Transcription

1 Exercise is Medicine Capital Health Network Eva Boland Accredited Exercise Physiologist AES AEP MESSA

2 If we had a pill that conferred all the confirmed health benefits of exercise, would we not do everything humanly possible to see to it that everyone had access to this wonder drug? Would it not be the most prescribed pill in the history of mankind? (Sallis, 2009)

3 The Real Polypill Fiuza-Luces et al. (2013). Exercise is the real polypill. Physiology. 28(5):330-58

4 Exercise is Medicine Australia Global program lead and funded in Australia by Exercise & Sports Science Australia (ESSA) Empowers primary healthcare providers to effectively counsel patients about physical activity leading to sustained behaviour change Promotes evidence based screening to easily identify when and how to refer patients to appropriately trained allied health professionals to deliver exercise treatment services.

5 Section 1 Evidence for EIM Dr Mike Evans sets the scene Australian doctors receive between hours of PA training across the entire medical curriculum The AMA highlights the role of medical doctors as key facilitators and providers of PA in primary care Research and GP clinical guidelines recommend PA for the prevention and treatment of disease

6 Anita Green, Craig Engstrom and Peter Friis. Med J Aust 2018; 208 (6):

7 Australia s inactivity More than 80% of adults do not meet the current physical activity guidelines Physical inactivity accounts for 9% of premature mortality per year

8 For more visit exerciseismedicine.org.au

9 For more visit exerciseismedicine.org.au

10 Inactivity: Effect of low cardio respiratory fitness (CRF) on mortality Its not all about weight loss, physical activity is beneficial to a person s health whether or not they lose weight Contributing factors for All-Cause deaths Men Women Br J Sports Med. 2009; 43:1-2.

11 Move it!

12 Test Your Self! Single leg balance eyes open Single leg balance eyes closed yrs: 10 sec yrs: 7 sec 50+: 5 sec Sit to Stand in 30 secs

13 Section 2: Physical activity and chronic conditions Exercise is Medicine Australia supports the Australian Physical Activity and Sedentary Behaviour Guidelines 2014

14 Intensity and type Moderate: working hard enough so you can talk but not sing e.g. Brisk walking (like you re late for the bus!), gentle swimming or cycling at a regular pace. Vigorous: generally means that a conversation cannot be maintained uninterrupted, and you are huffing and puffing. e.g. jogging, aerobics and cycling. Aerobic Activity (cardio): To improve blood pressure, cholesterol, heart health, mental health the list goes on. Resistance (strength): To promote and maintain musculoskeletal health and physical independence Balance, stretching and flexibility exercises for falls prevention

15 Intensity Classification

16 Exercise for Osteoporosis 66 per cent of people over 50 have poor bone health (osteoporosis or osteopenia) Specific exercise can reduce fracture risk by 51% Moderate to high impact weight bearing activities in varied direction can maintain or increase BMD by 1-4% in older adults Exercise causes bones to modify their shape and size so they are stronger and better protected from injury In healthy active adults, vigorous exercise helps to prevent typical age-related bone loss. Think IMPACT! Exercise increases muscle strength and improves balance, which in turn reduces the risk of falling

17 Exercise for Type 2 Diabetes Studies show that exercise can: help prevent or delay T2DM; improve control of blood glucose; decrease the proportion of body fat; decrease the risk of heart disease; and increase heart and lung fitness in people with T2DM

18 Exercise for Depression Exercise benefits A lower risk of depression, now and in the future Effective strategy to manage weight gain, comorbidities, medication side effects Effective in reducing symptoms of depression for people experiencing other mental disorders The aim is to meet the Australian Physical Activity Guidelines. Ideally, exercise participation should be ongoing; however a minimum program length of 9 weeks is suggested.

19 Exercise and Aged Care Individuals who maintain high fitness into their 80+ years have approximately the same rate of mortality as those individuals with high fitness in the age range Strength and balance exercises are key

20 Exercise for Falls Prevention One-third of community-living Australians aged 65 years and over fall every year, with even higher rates for people in aged-care facilities and hospitals Exercise prevents falls in older people, by addressing key risk factors: muscular strength balance balance confidence walking speed

21 Accredited Exercise Physiologists AEPs are allied health professionals, providing exercise and lifestyle therapies for the prevention and management of chronic disease, injury and disability. University trained Allied health providers Specialise in exercise for prevention and management of chronic disease and injury Work with high-risk patients Recognised by Medicare, DVA, WorkCover and private health insurance

22 Referrals Accredited Exercise Physiologist (AEP) Qualification: Min 4 years University Accreditation: ESSA Profession: Allied Health Rebates: Medicare, DVA, WorkCover, Private Health Patient risk level: High Specialty: Chronic conditions and injuries, long term behaviour change, self-managed exercise programs Physiotherapist Qualification: Min 4 years University Accreditation: AHPRA Profession: Allied Health Rebates: Medicare, DVA, WorkCover, Private Health Patient risk level: High Specialty: Acute conditions and injuries, manual therapy Personal Trainer Qualification: Cert IV in as little as 6 weeks Accreditation: n/a Profession: Fitness Rebates: Private Health Patient risk level: Low Specialty: General fitness

23 Rebates Rebates for AEP services are available to eligible patients through: Medicare Department of Veterans Affairs (DVA) WorkCover Private Health funds A report released in 2016 by Deloitte Access Economics showed that for the average Australian living with a chronic condition, such as cardiovascular disease, patients could save $5938 per year For every dollar spent on AEP interventions you get $10.50 in improved health, productivity and reduced out of pocket expenses The value of accredited exercise physiologists to consumers in Australia, 2016

24 GPMP (721) /TCA (723) Eligible for 5 allied health consultations in a calendar year if they have a chronic (>6mo) condition Need both a GPMP and TCA. Indicate your desired number of sessions for Exercise Physiology (10953) on the plan Your patient can then book in with the AEP and bring their paper work on the day

25 Group Services for T2D Need a GPMP, but do not need a TCA if being referred under pr only To access group allied health services, patients must be referred by their GP to an eligible allied health provider for an initial assessment Patients eligible for 8 group services per calendar year

26 Typical 12 week treatment model Support for better self-management 2-5 consultations over initial 12 weeks Multi-disciplinary approach Week 1 Initial Consultation & Assessment Report back to referring GP 2 Program follow-up 3 Program follow-up 7/8 Program Review & progression 11/12 Program Review & progression Report back to referring GP

27 Case study Dean is a 52 year old male who was diagnosed with Myotonic Muscular Dystrophy in 2016 Dean has signs and symptoms of skeletal muscle weakness (both proximal and distal muscles) He has difficulty in performing manual work tasks as a trades assistant and is starting to have minor difficulty with activities of daily living Dean has been previously diagnosed with cardiac arrhythmia - Supra Ventricular Tachycardia (SVT) and is obese

28 Case study TEST TYPE RESULTS CLASSIFICATION Balance 1 Leg Stance (RS) 1 Leg Stance (LS) Functional Capacity Timed Up and Go Timed Supine to Stand Muscular Strength Pelvic Core Wall Squat Modified Push ups in 60s 9.1s 8.3s 10.94s 8.64s Level s 34 Poor (< 10s) Poor (< 10s) Below Average (>10s) Below Average (>6s) Poor (<level 5) Poor (<25s) Patient exhibits difficulty maintaining exercise posture. Score is good for modified knee push up norms. Aerobic Capacity 6 Minute Walk 450m Poor (<600m) Peak Exercise HR:95 bpm Peak Exercise RPE: Moderate Dean s GP identifies that exercise could slow down or possibly reverse the deterioration in muscle function of Myotonic Muscular Dystrophy patients, so refers him to an Accredited Exercise Physiologist (AEP) to improve his strength, balance, flexibility and aerobic capacity The table shows some of Dean s baseline results, after an initial consultation and assessment with an AEP (Low exercise peak heart rate probably due to beta blocker medication)

29 Case study TEST TYPE RESULTS CLASSIFICATION Balance 1 Leg Stance (RS) 1 Leg Stance (LS) Functional Capacity Timed Up and Go Timed Supine to Stand Muscular Strength Pelvic Core Wall Squat Modified Push ups in 60s 20.5s 19.3s 7.5s 6.4s Level s 36 Below average (< 25s) Below average (< 25s) Marginal (7-10s) Below Average (>6s) Poor (<level 5) Poor (<25s) Patient maintains good exercise posture. Score is good for modified knee push up norms. After a 12 week intervention, monitored and reviewed by an AEP, his initial measures had improved After 12 weeks, Dean also reported having an improved quality of life and was generally feeling more positive Aerobic Capacity 6 Minute Walk 600m Poor (<600m) Peak Exercise HR:90 bpm Peak Exercise RPE: Moderate (Low exercise peak heart rate probably due to beta blocker medication) Now I can actually walk around the backyard and pass the football with my son without feeling tired and fatigued

30 Quiz 1. Exercise is not recommended in cases of patients with a high risk of falls T/F 2. Patients with a GPMP are entitled to a maximum of allied health services per calendar year 3. How many minutes of physical activity should adults accumulate per week at: a. moderate intensity or b. vigorous intensity 4. Low fitness is a major risk factor for early death T/F

31 Move it!

32 Section 3 EIM in Practice Refer to your EIM Healthcare Provider Action Guide

33 EIM Framework One or two minutes Step 1: Ask More time Step 1: Ask Step 2: Screen Step 5: Information Step 3: Customise advice Step 4: Refer effectively Step 5: Provide information EIM Healthcare Provider Action Guide

34 Exercise: The 5 th vital sign How can you clinically measure physical activity? Two questions On average, how many days per week do you take part in moderate to vigorous exercise? On average, how many minutes do you engage in exercise at this level? Less than one minute to administer Minimal effort from clinic staff Br J Sports Med. (2011) (45)6

35 Medical Software Physical Activity assessment tools are available in Medical Director and Best Practice to help you assess and track your patients activity levels over time

36 Best Practice Access the Physical Activity Prescription item in the Clinical dropdown menu

37 Medical Director Open patient record and click on running man icon Click assessment to begin a new physical activity record

38 Engaging your patient Interventions that present with increased barriers and compliance issues, like exercise, require counselling strategies to engage the patient for better self-management The physical activity stage of change assessment tool outlines strategies that can be used with patients to promote sustainable behaviour change

39 Conversation starters Start with your menu items Follow up with How much do you know about exercise and..? If you were to start exercising, what would work for you? How would you start? What is one small step you could commit to today?

40 Bust the myths Need to use a gym to get fit Too old to begin structured physical activity Need to use sophisticated equipment to perform strength training What else?

41 Provide options Physical activity advice (factsheets) AND Specific exercise prescription OR Referral

42 AEP Search

43 ACT Options Heart Foundation Walking groups Arthritis ACT Strength and balance classes Hydrotherapy in all major pools in the ACT Thai Chi classes Floor and chair yoga

44 ACT Options Pryme Movers (YMCA Chifley) Strength and balance Men with Guts and Weight Loss for Women (12 week diet and exercise program) Uniting Seniors Gym (Gordon) Personalised gym programs for >60s

45 ACT Options University Of Canberra Faculty Of Health Clinics (Bruce) Variety of classes Bone Health Lungs In Action Function Focus Heart Health Cancer Rehabilitation

46 ACT Search Engine

47 Ambivalence is normal Provide patient with brief information (personalised message) regarding benefits of physical activity plant the seed! Ask what the benefits for them might be? Suggest a pedometer Doing any physical activity is better than none. Even moving from sedentary to low-level activity can have benefits.

48 Further information exerciseismedicine.org.au/healthcare-providers/

49 Join the EIM Network Promote your dedication to safe physical activity Build your referral network Access exclusive network resources Build networks in your community and across the nation Share your success Learn from others

50 Contact me Eva Boland Higher Function Physiotherapy and Clinical Pilates P: E: A: 23 Petrie Plaza, Canberra City

51 Ready? Web: facebook.com/eimaustralia Telephone: (07)