Physical Activity - The Pharmacist s Role

Transcription

1 Physical Activity - The Pharmacist s Role Nicole Klosterman, PharmD Candidate 2005 Educational Clerkship Student Learning Objectives 1. Recognize the importance of physical activity in healthcare. 2. Describe the different types of physical activity important for certain disease states. 3. Make patient specific recommendations for physical activity. 4. Explain how physical activity can be incorporated into a therapeutic toolbox. 5. Describe how physical activity can be a specialized service in your pharmacy Case 1 Bob, a 38 year old Hispanic male with diabetes type II, comes in to your pharmacy for a cholesterol test. Tests reveal an LDL 139, HDL 32, and TC 230. He asks how he can bring down his cholesterol? Case 2 Mary, a 53 year old white female (BMI 17) is at your bone density screening. Tests show a t-score of She says she takes calcium, what else can she do to decrease her risk of a fracture?

2 CDC Recommendations Engage in moderate-intensity physical activity for 30+ minutes, 5 or more days a week. OR Engage in vigorous-intensity physical activity for 20+ minutes, 3 or more days per week. Moderate Activity: 3-6 MET s, burns 3.5 to 7 calories/min (e.g: walking briskly, mowing the lawn, swimming, or bicycling on level terrain) Vigorous Activity: 6+ MET s, burns 7+ calories/min (e.g: jogging, chopping wood, aerobics, or bicycling uphill) Statistics National 59% of adults never engage in physical activity lasting more than 10 minutes per week 35% of US adults are overweight and 23% are obese 33% of children under 18 years old did not participate in sufficient vigorous activity. 38% of children under 18 years old watch more than 3 hours of TV a day 1/3 of 500,000 deaths from cancer can be attributed to diet and lack of exercise (another 1/3 is from cigarette smoke) (Byers et al). Statistics from the National Health Interview Survey (1999) and MMWR (2004) * Statistics King County 73% of adults are completely sedentary or not fulfilling the CDC recommended guidelines. In % of King County s residents over 18 years old were overweight or obese. Obese people were more likely to rely on eating less (34%) vs. physical activity (11%) to lose weight. 1 in 4 obese people are completely sedentary. Between 1987 and 2001 the average weight increased 11 pounds but the height stayed relatively the same. Average BMI went from healthy to overweight. *Statistics from the Public Health Data Watch (2002)

3 U.S. Physical Activity Statistics 2001 State Summary Data The map below displays the prevalence of people in each state meeting physical activity recommendations (at least 5 days a week for 30 minutes a day of moderate intensity activity or at least 3 days a week for 20 minutes a day of vigorous intensity activity). What can we do??? Benefits of Physical Activity Aerobic exercise Increased longevity Decreased heart disease Decreased diabetes Improved glucose control Weight maintenance Sleep improvement Increased stamina Anaerobic exercise e.g. Strength training Arthritis relief Improved balance (decreased falls) Increased bone mass Healthy state of mind During exercise, cardiac arrest happens in 0.55 events/10,000 men per year (Maron et al)

4 When to refer? **Always caution your patient before initiating an exercise routine! They should always let their doctor know how they plan to exercise. Rx to Exercise 1. Find out what they already do for physical activity 2. Help the patient establish his/her goals and plan: start low go slow. 3. Make sure the patient feels comfortable with their plan (refer?). 4. Explain the basics to keep them safe while exercising Stay hydrated! 5-10 Warm Up (aerobic/low intensity) 5-10 Stretch (muscles that will be used) 20+ Activity (weight bearing or aerobic) 5-10 Cool Down (aerobic/low intensity) 5. Keep motivating the patient! People often say that motivation doesn't last. Well, neither does bathing - that's why we recommend it daily. (Zig Ziglar) Cardiovascular e.g: Hypertension, Hyperlipidemia, CHF Recommendation: Aerobic Exercise Precautions: Monitor heart rate and blood pressure frequently Exercise with defibrillators close Results: 1. Decreases TC, TG, and LDL 2. Increases HDL 3. Improves symptoms in CHF patients (Corvera- Tindel, et al) 4. Reduces mortality (Piepoli, et al) 5. Reduces blood pressure (by 10.5/8.6 mmhg)

5 Diabetes Recommendation: Aerobic exercise Precautions: 1. Hydration: 17oz of fluid 2 hours prior 2. Bring glucose tablets 3. Monitor glucose levels Avoid if fasting glucose levels are >250mg/dl with ketosis or if >300mg/dl without ketosis Avoid if <100mg/dl 4. Feet Silica gel insoles Polyester or blend cotton socks Results: 1. Reduced need for insulin and other diabetic medications 2. Increased blood glucose/insulin level control 3. Reduced heart disease risk Osteoporosis Recommendation: Weight-bearing exercises Precautions: 1. Make sure the patient is using correct form (trainer?) 2. Start low, go slow 3. Exercise a particular muscle group no more than every other day. Results: 1. Reduces the rate of bone loss in older American 2. Adds bone mass to younger people 3. Reduces the risk of fractures and collapse of bones of the spine. 4. Increases lean body mass/decreases body fat Obesity/Overweight Recommendation: Aerobic exercises are the best, but strength training can also increase the lean-to-fat body mass ratio. Advice: Ideally, people should seek professional help if they are obese or have other medical comorbidities. Overweight individuals should map out a diet and exercise regimen that they can dedicate themselves to. Avoid fad diets and focus on motivation! Suggest a support group. As a pharmacist: 1. Offer alternative forms of exercising 2. Suggest a pedometer 3. Educate them on reading food labels 4 Stay involved in their progress!

6 Exercising for Disabled/Elderly Patients "You don't stop exercising because you grow old. You grow old because you stop exercising." Anonymous Overall, 14% of adults had a difficult time with at least 1 of 9 physical activities. Solutions Arthritis: tai chi, yoga, pilates, swimming, or aquarobics Asthma: swimming, walking, yoga Lower body paralysis/amputation: skiing, basketball, hockey, canoeing, rafting, wakeboarding, hand cycling Elderly: gardening, brisk walking, vacuuming, skiing Examples of Pharmacy Programs Innovative Health Systems, Inc. (Metter, GA) is an independent pharmacy with a Wellness Center (2200 ft 2 ) for weight measurements, cholesterol screenings, and counseling rooms. Other pharmacies offer programs in weight management that usually include a physical activity component

7 Counseling Messages 1. Give the patients a clear idea of what they should focus on when creating their goals. 2. Help the patients structure how they would like to attain those goals 3. Refer to a specialist or offer basic exercise concepts (home videos? Cable TV? Gym? Support group?) 4. Most important: Keep in touch with the patient s progress! Case 1 Bob wants to lower his cholesterol, what should we tell him? Case 2 Mary wants to increase her bone strength, how can she do that?

8 Great Online Resources National Association for Health and Fitness Medline Articles on physical fitness alfitness.html The Presidents Council on Fitness: AHA Website: =2155 CDC Website: References National Health Interview Survey (NHIS) 2002 Youth Risk Behavior Surveillance MMWR, March 21, 2004 Vol 53 Byers, Tim, Nestle, Marion, McTiernan, Anne, et al. American Cancer Society Guidelines on Nutrition and Physical Acitivity for Cancer Prevention. CA Cancer J Clin 2002;52: Public Health Data Watch of Seattle and King Co. Vol 5, Number 1 (March 2002) Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med Feb 7;346(6): Maron, B.J., P.D. Thompson, J.C. Puffer, et al. Cardiovascular preparticipation screening of competitive athletes: a statement for health professionals from the American Heart Association. Circulation 94: , Ades PA, Savage PD, Cress ME, Brochu M, Lee NM, Poehlman ET. Resistance training on physical performance in disabled older female cardiac patients. Med Sci Sports Exerc Aug;35(8): Corvera-Tindel T, Doering LV, Woo MA, Khan S, Dracup K. Effects of a home walking exercise program on functional status and symptoms in heart failure. Am Heart J Feb;147(2): Piepoli MF, Davos C, Francis DP, Coats AJ. Exercise training meta-analysis of trials in patients with chronic heart failure BMJ Jan 24;328(7433):189. Epub 2004 Jan 16