Strategies for Promoting Physical Activity in Primary Care Settings

Transcription

1 Information Day for Medical & Health Professionals 1 June 2007 Strategies for Promoting Physical Activity in Primary Care Settings ABN Accredited Exercise Physiologist B.Ed (PE; Ex. Phys.); AEP; MAAESS Certificate IV Fitness; Diploma of Massage Mobile: j.basri@bigpond.net.au

2 Background Role of an Exercise Physiologist (EP) Special interests Cardiorespiratory Metabolic Role of a Physiotherapist

3 To quote Sir William Bragg: The important thing in science is not so much to obtain new facts as to discover new ways of thinking about them I recognised my need for better skills in behaviour change, not necessarily better skills as an EP

4 Work setting Independent Contractor for a Melbourne based publicly listed company providing health care solutions from Primary Care Settings Cardiovascular Diagnostic Testing Allied Health Services Co-consult with a Dietitian from various Medical Clinics in the outer South Eastern suburbs

5 Scope of work Provide a 40 minute joint initial consultation to patients under an Enhanced Primary Care (EPC) plan 20 minutes for Dietitian 20 minutes for Exercise Physiologist Review joint consultation around minutes combined See between 10 & 15 patients per day Use techniques

6 Demographics One of Melbourne s most socially and economically disadvantaged municipalities Low income Low educational attainment High unemployment Low skilled occupations SEIFA index of relative socio-economic disadvantage

7 Municipality - increase in type 2 diabetes (one of Victoria s Hot Spots) % increase Diabetes Australia Victoria

8 First Krispy Kreme Donut outlet in Victoria (opened June 2006) in the municipality

9 TV series Kath & Kim modeled on behaviours in the municipality

10 Terminology Physical activity any bodily movement produced by skeletal muscles that result in energy expenditure Exercise the systematic execution of physical activity for a specific purpose National Heart Foundation

11 Language & Images Diet Eating Food Energy In Exercise Activity Movement Energy out

12 Promoting movement in stages 1. Inactive or sedentary 2. Incidental activity only 3. Physical activity for health benefits (30 minutes moderateintensity most days) 4. Exercise for fitness 5. Exercise for performance

13 How we do it 1. Get Practice Manager and staff on board Experience and understand what we do as a Dietitan and Exercise Physiologist using in consultations 2. Sell concept to GP s & patients 3. Positive health gains for practice staff and patients If they can do it, I can do it

14 Old dialogue instructing & solving Dr Smith wants us to work with you to improve your diet, exercise and health

15 Coaching dialogue - motivating and inspiring Thank you for coming in to see us today. Well done taking an interest in your health. What would you like to get out of this session today?

16 Case Study Initial Consultation with Sue Presenting Issues Newly diagnosed type 2 diabetes BMI = 48 Weight kg Waist 142 cm Inactive Poor and irregular food intake

17 Case Study Initial Consultation with Sue (continued) Client Issues Surprised, angered and overwhelmed by diabetes diagnosis fearful of new responsibilities fearful of injecting insulin desire to avoid injecting insulin

18 techniques used: Motivational interviewing - patient identified as low readiness to change (lots of yes but ) Barriers to health behaviour change Agenda Setting Goal setting, action planning, thought and emotion management (self talk), relapse prevention

19 Agenda Setting 1. Thinking 2. Planning 3. Energy In (food) 4. Energy Out (movement)

20 Healthy Goal Setting My goal is.. How will I do it? How often will I do it? When will I do it? When will I start? How will I monitor it? How will I review progress? How important is it? How confident am I?

21 Healthy Goal Setting My goal is.. How will I do it? How often will I do it? When will I do it? When will I start? How will I monitor it? How will I review progress? To exercise re diabetes Borrow an exercise bike Every day, 20 minutes Morning & afternoon Monday next week Record minutes each day With Jo in 6 weeks How important is it? Very important 8/10 How confident am I? Very confident 7/10

22 Action Planning In order to achieve my health goal, I choose to: 1 Go to bed early so I can get up earlier Tick when completed 2 Set my alarm each night 3 Find some runners at home 4 Call daughter to borrow the exercise bike in the garage 5 Go and get the bike from my daughters and tell her about my goal (support) 6 Get hold of a BGL monitoring diary and use it every day

23 Self Talk (from Dietary consultation) I just can t eat vegetables and fruit, I hate the taste. I want to throw up when I eat any fruit and vegetables Automatic Negative Thought (ANT s) I have chosen a healthier lifestyle and to manage my diabetes as best I can. Fruit and vegetables are part of a healthy diet and I will get used to the taste of them. Performance Enhancing Thought (PET s)

24 Relapse is a normal part of the change process Lapses I may have: Too tired Boring Feel sore How I will manage them: Be in bed by 10 pm Put exercise bike in front of TV (distraction) Stretch after cycling

25 Review Consultation with Sue (6 weeks later) Process Goals (Behavioural) Active had borrowed an exercise bike for home and was cycling 20 minutes twice a day Better food choices and regular food intake Daily activity, food, medication and BGL diary

26 Review Consultation with Sue (6 weeks later) - continued Outcome Goals (Physiological) BGL between 4 6 m/mol (well controlled) BMI = 43.2 Weight kg (loss of 7.4 kg) Waist 139 cm (loss of 3 cm)

27 Sample of non goal sheet

28 Need more motivation? Photo from Growing Old is not for Sissies II

29 Quality of Life at 79 years Photo from Growing Old is not for Sissies II

30 Motivational Reading