Will we ever get Americans active? Rethinking interventions as experiences.
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1 Will we ever get Americans active? Rethinking interventions as experiences. Chris Sciamanna, MD, MPH Professor of Medicine and Public Health Sciences Chief, Division of General Internal Medicine Penn State College of Medicine Penn State Milton S. Hershey Medical Center
2 How did I get here? Med School: Jefferson Residency (Internal Med): Pitt Fellowship/MPH: Hopkins Junior Faculty: Brown
3 What I learned? MY BIASES If a behavior is regular, intervention use should be as well. Few interventions are effective long term because people stop. Most interventions are not enjoyable and few people seek them Behavior is modifiable at scale, companies do it every day. Interventions are easier to study than to disseminate. The calvary (health plans, employers, CDC, feds) is not coming.
4 A comparison of Internet and print-based physical activity interventions. Arch Intern Med May 14;167(9):944-9
5 Use of behavioral interventions fades with time Tate DF, et.al., A randomized trial comparing human counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med Aug 14-28;166(15):
6 Sometimes very quickly Finley CE, Barlow CE, et.al., Retention rates and weight loss in a commercial weight loss program. Int J Obes (Lond). 2007;31(2):292-8.
7 But not all interventions Marzolini S, Mertens DJ, et.al., Self-reported compliance to home-based resistance training in cardiac patients. Eur J Cardiovasc Prev Rehabil. 2010;17(1):35-41.
8 The Intervention progression: Face to face Phone Internet Text
9 What percentage of US adults are active and are we making any headway?
10 Carlson, et. al., Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. Am J Prev Med 2012.
11 Troiano, et.al., Physical activity in the United States measured by accelerometer Med Sci Sports Exerc. 40(1); 181-8
12 Does it matter?
13 Wen CP, et.al., Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet Oct 1;378(9798):
14 Yamada M, Arai H, et. al., Community-based exercise program is cost-effective by preventing care and disability in Japanese frail older adults. J Am Med Dir Assoc. 2012;13(6):
15 How much do you agree or disagree with this statement: I ENJOY PHYSICAL ACTIVITY Strongly agree Agree Neutral Disagree Strongly Disagree
16 70 Percent of adults who like physical activity? Agree/Strongly Agree Neutral/Disagree
17 What percentage of 65 year olds have trouble walking ¼ mile, pushing a sofa or carrying 10 pounds?
18 Schoenborn CA, Heyman KM. Health characteristics of adults aged 55 years and over: United States, Natl Health Stat Report. 2009(16):1-31.
19 Source: Gapminder
20 What percentage of nursing home patients are there because of dementia?
21 QuickStats: Ten Most Common Chronic Conditions Among Persons Living in Residential Care Facilities, United States, Morbidity and Mortality Weekly Report. 2012;31:603.
22 In 12 weeks, frail elders can increase their strength by what %?
23 Effects of High-Intensity Strength Training on Multiple Risk Factors for Osteoporotic Fractures. JAMA. 1994;272:
24 Fiatarone, NEJM, Exercise training and nutritional supplementation for physical frailty in very elderly people
25 Short-Term Heavy Resistance Training Eliminates Age-Related Deficits in Muscle Mass and Strength in Healthy Older Males. J Strength Cond Res 25(2): , 2011
26
27 Adherence to home-based strength training Marzolini S, Mertens DJ, et.al., Self-reported compliance to home-based resistance training in cardiac patients. Eur J Cardiovasc Prev Rehabil. 2010;17(1):35-41.
28 Would you consider participating in any of the following programs, if they were provided FREE to you? A group program to increase your muscle strength? 55 Doing a short (5km or less) walk or run to raise money to cure a 49 health condition? (such as diabetes, hearing loss, cancer, etc.) An online program and pedometer to help increase your walking? 48 A community event where people played play games together, 44 such as bocce, volleyball and others? A community garden where you and others could grow plants? 41 A program to learn to cook in a healthy way? 39 A group walking program? 36 Sciamanna CN, et.al., A strength training program for primary care patients, central Pennsylvania, Prev Chronic Dis Jun 26;11:E107.
29 Percentage of people with NO close friends McPherson M, Smith-Loving L, Brashears ME, Social Isolation in America: Changes in Core Discussion Networks over Two Decades. American Sociological Review, Vol 71 (June: )
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35 Making Behavior Treatments Standard of Care: The Chasm
36 Successful Efficacy Trial Insurance Coverage
37 Successful Efficacy Trial Other successful trials Positive meta analysis Positive Effectiveness Trial Dissemination Partner Coverage Determination Politics Insurance Coverage
38 Successful Efficacy Trial Other successful trials Positive meta analysis Positive Effectiveness Trial Dissemination Partner Coverage Determination Politics Insurance Coverage
39 Efficacy Trials: Ideal circumstances (Explanatory) Effectiveness Trials: Usual Conditions (Pragmatic)
40 The Competition
41 Why do people do what they do, like NOT exercise? I believe that every human mind feels pleasure in Seligman doing M, Flourish good to another.
42 POSITIVE EMOTIONS
43 ENGAGEMENT I believe that every human mind feels pleasure in doing good to another.
44 POSITIVE RELATIONSHIPS
45 MEANING
46 ACCOMPLISHMENT I believe that every human mind feels pleasure in doing good to another.
47 I believe that every human mind feels pleasure in doing good to another.
48 What we do differently if we decided to charge admission?
49 Experience Engineering
50 The Diabetes Prevention Program: Knowler WC et.al., Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med Feb 7;346(6):
51 I believe that every human mind feels pleasure in doing good to another.
52 I believe that every human mind feels pleasure in doing good to another.
53 I believe that every human mind feels pleasure in doing good to another.
54 Experience Engineering
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60 Experience Engineering Decisions Taking turns counting say name Time to talk no music Volunteer Leaders Chairs v. Ovals Clapping for those who increased No bands at home
61 I thought I would because I lost my wife and I thought it d be a good thing to get moving..
62 come out and try it because you ve got a light band you start out with and then you can move right up the ladder I'm 80 something years old I really enjoy this
63 ..there are other people to help you get along and they socialize, kid with each other, tell jokes, laugh..
64 ... it s not like work I look forward to coming just to see the people and laugh with them as we do our little exercise
65 When guests pick out exactly the right stuffed animal they want from our thirty-odd assortment, by the time they themselves stuff it to just the right amount, take a heart and then close their eyes to make a wish on it, and then choose clothing and accessories in concert with our associates, they are so connected to their stuffed animal that they become friends for life. Maxine Clark CEO, Build-A-Bear Workshop
66 We're not in the education business. We're in the transformation business. We expect everyone who participates in - whether it's for three days or for two years - to be transformed by the experience. John Quelch, Former Dean, Harvard Business School
67 I believe that every human mind feels pleasure in doing good to another.
68 Thank you! Chris Sciamanna, MD, MPH Professor of Medicine and Public Health Sciences Chief, Division of General Internal Medicine Penn State College of Medicine Penn State Milton S. Hershey Medical Center
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