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1 LiVe Well MoVe More: The Importance of Physical Activity for Health and Wellness Elizabeth Joy, MD, MPH Medical Director, Community Health and Clinical Nutrition President, American College of Sports Medicine

Why are we talking about Exercise Is Medicine today?

be given to recommending the accumulation of 30 minutes a day of moderate intensity physical

2 Why are we talking about Exercise Is Medicine today? The medical community needs to lead in communicating the importance of physical activity for health and weight maintenance. Just as weight is addressed in some manner at nearly every physician visit, so should attention be given to recommending the accumulation of 30 minutes a day of moderate intensity physical activity at least 5 days of the week. The fitness, obesity, and health equation: is physical activity the common denominator? Steve Blair, PED; Tim Church, MD, PhD CIRCLE OF TRUST Blair, S. JAMA. 2004;292: page 2

3 Epidemic of Physical Inactivity

4 How Active Are Americans?

5 U.S. Children & Adolescents 6 19 yo Who Achieve 60 Min/Day of Physical Activity All Boys Girls Troiano RP. MSSE 2008 page 5

6 Percentage of time spent in sedentary behaviours, by age and gender, United States, Matthews, C. E. et al. Am. J. Epidemiol : ; doi: /aje/kwm390

7 Physical Activity & Screen Time 60% of children get > 2 hours of screen time each day

8 Physical Inactivity and All-Cause Mortality Physical inactivity causes nearly 1 in 10 premature deaths. If inactivity decreased by 25%, more than 1.3 million deaths worldwide could be averted every year. Lee I-Min. Lancet July 2012 page 8

9 Physical inactivity: the biggest public health problem of the 21st century Steven N Blair Low cardiorespiratory fitness (CRF): 16% of all deaths more than obesity, smoking, or diabetes All-cause mortality: Blair SN; Br J Sports Med. 2009;43(1):1-2. page 9

10 Fit versus Fat At each BMI level, those with higher cardiorespiratory fitness have lower CVD mortality risk. Obese patients with moderate to high fitness have a LOWER rate of CVD mortality than those at normal weight but with low CRF. Blair SN; Br J Sports Med. 2009;43(1):1-2. page 10

11 If exercise could be packed in a pill, it would be the single most widely prescribed and beneficial medicine in the nation. Robert N. Butler, M.D. Director, National Institute on Aging

12 We sit a lot.. and it s killing us!

13 Can sitting increase mortality? Leisure time spent sitting in relation to total mortality in a prospective cohort of US adults Large prospective study of US adults Time spent sitting and physical activity were queried by questionnaire on 53,440 men and 69,776 women who were disease-free at enrollment 14-year follow-up After adjustment for smoking, BMI, and other factors, time spent sitting (>6 hours versus <3 hours daily) was associated with mortality in both men and women Patel. Am J Epi August. page 13

14 Is sitting the new smoking? Wen CP. Lancet. 2012; July 21; 380(9838):192-3.

15 How Much is Enough? Regular exercise: 150 min/wk moderate exercise, or 75 min/wk vigorous exercise Out of their chair & off the couch Active living: Walk the dog Active transportation Gardening

16 Minimal Amount of Exercise to Prolong Life: To Walk, to Run, or Just Mix It Up? Figure Legend: Comparison of Benefits Between Walking and Running A 5-min run generates the same benefits as a 15-min walk, and a 25-min run is equivalent to a 105-min walk. J Am Coll Cardiol. 2014;64(5):

18 Physical Activity Vital Sign in HELP2 1. On average, how many days a week do you perform physical activity or exercise? 2. On average, how many total minutes of physical activity or exercise do you perform on those days? days/week X minutes/day = min/week (PAVS) 3. Describe the intensity of your physical activity or exercise: light = casual walk moderate = brisk walk vigorous = jogging Light, moderate, vigorous Start, increase, maintain 2013 Intermountain Healthcare. All rights reserved. page 18

19 Physical Activity Vital Sign (Adults, Pregnancy, Pediatrics) 19

23 Strength Training 2 times per week, working major muscle groups page 23

day, including work/school When sitting, take an activity break (2 to 3

24 Reducing sedentary behavior recommendations Aim for less than 2 hours screen time in addition to work/school Aim for less than 6 hours total sitting per day, including work/school When sitting, take an activity break (2 to 3 minutes) every 30 to 60 minutes 2013 Intermountain Healthcare. All rights reserved. page 24

27 The role of healthcare providers in physical activity counseling Lobelo. Br J Sports Med 2009;43

Summary Conclusive evidence that 150 minutes/week of MVPA reduces

Fitness matters more than fatness Time spent sitting is an

The NEW EXERCISE PRESCRIPTION: 60 minutes 150 minutes of moderate of

28 Summary Conclusive evidence that 150 minutes/week of MVPA reduces all-cause mortality None is bad, some is good, more is better Fitness matters more than fatness Time spent sitting is an independent predictor of mortality For Kids. The NEW EXERCISE PRESCRIPTION: 60 minutes 150 minutes of moderate of MVPA to weekly vigorous + PA movement EVERY throughout DAY 7 days/week!!! the to avoid prolonged sitting page 28

29 Exercise is medicine Sitting is the new smoking Walking (not the dog!) is man s best friend The risk of doing nothing far exceeds any risk from a brisk walk

30 Resources for the RDN: the Physical Activity Toolkit Kary Woodruff, MS, RDN, CSSD Sports Dietitian Salt Lake LiVe Well Center

31 Today: Why the RDN should address exercise? The Toolkit: what it is Role of the RDN Scope of Practice Tools & Resources page 31

32 Why should RDN s address physical activity? Physical activity: core component of a healthy lifestyle 2016 AND Weight Management Position Paper EAL Recommendation: For weight loss the RDN should encourage physical activity as part of a comprehensive weight-management program, individualized to gradually accumulate 150 to 420 minutes or more of physical activity per week, depending on intensity, unless medically contraindicated. (Rating: Consensus, Imperative) Patients are asking! page 32

33 The Toolkit Based upon: The 2008 Physical Activity Guidelines for Americans (UDHHS) Exercise is Medicine (EIM) from ACSM and AMA A set of resources for promoting PA in the prevention, treatment, and management of many common chronic conditions page 33

34 The Toolkit Help RDN s integrate PA into weight management plans Provide basic PA guidelines for patients of all ages Utilized in diverse settings, including: Inpatient Outpatient Wellness program Community page 34

35 The Toolkit : Contents Rec s from 2008 Physical Activity Guidelines & EIM initiative Definitions of PA, PA guidance, exercise Rec s for RDN s to address PA in accordance with NCP Case studies & scenarios Downloadable resources and tools for patients Additional links & resources for RDN s page 35

36 Role of the RDN in EIM Evaluate PA habits and restrictions of patient using the PA Assessment Form, PA History, and Preparticipation Flow Chart Request PA clearance Address benefits of PA: prevention & treatment of chronic disease Address adding/increasing PA in accordance with PA Guidelines Refer patient to certified fitness professional when appropriate page 36

37 Physical Activity Assessment Form page 37

38 Physical Activity Assessment page 38

39 Preparticipation Flow Chart page 39

40 Clearance & Readiness/Recommendation Forms page 40

41 Scope of Practice Limitations of the RDN: Fitness assessment Exercise prescription Design of specific exercise routines Supervised PA or fitness training schedules Refer to Scope of Dietetics Practice Framework Refer to a certified exercise specialist page 41

42 What the RDN can do Encourage increased baseline activity None is bad, some is good, more is better Dr. Joy Activities of daily living Start slowly, increase slowly Educate on the overall benefits of physical activity page 42

43 Promote PA What the RDN can do Fun Social engagement with family/friends Improves fitness Support selection of activities appropriate for their level of fitness page 43

44 What the RDN can do Focus on safety: PA is safe for almost everyone benefits fat outweigh risks Use appropriate gear and protective equipment Those with chronic conditions or symptoms should consult provider about appropriate types and amount page 44

45 Integrating EIM into Practice: 3 Step Algorithm 1. Assess current exercise habits Is the patient currently exercising? If yes, move to Step 2 If not, are they willing to include or increase PA? If yes, move to Step 2 If not, explains benefits of PA Moving More: What s in it for Me? Appendix C Your Prescription for Health Flyer Series Appendix E page 45

46 page 46

47 3-Step Algorithm 2. Assess PA Readiness: Physical Activity Readiness Questionnaire, PAR-Q page 47

48 3-Step Algorithm 3. Stages of Readiness to Change Determine their stage Use this to take action in diagnosis, intervention, and monitoring & evaluation steps page 48

Do not set goals to engage in PA Contemplation Start with small steps

49 Stages of Change: a Valuable Tool Precontemplation Health benefits Moving More: What s In It for Me? Do not set goals to engage in PA Contemplation Start with small steps Decisional Balance Sheet Starting and Exercise Program handout Provide list of community PA resources page 49

51 Stages of Change: a Valuable Tool Preparation Starting an Exercise Program handout Recommend planning & self-monitoring strategies List of community resources and to appropriate classes/facilities/certified fitness professionals Action/Maintenance Encourage continued PA Develop contingency plans Resources for enhancement/variety in plan page 51

Measurable Actionable Realistic Time-bound I will add 10 minutes each

52 Goal Setting Scope of practice Exercise prescription outside of scope: frequency, intensity, duration Document SMART goals: Specific Measurable Actionable Realistic Time-bound I will add 10 minutes each day to my current weekly walking session on Monday, Wednesday and Thursday. page 52

53 Case Study: Client with several CVD risk factors page 53

54 Case Study: J.P. page 54

55 Case Study: J.P. page 55

56 Case Study: J.P. page 56

57 Case Study: J.P. page 57

58 Additional Resources Certified clinical fitness professionals ACSM CEP* ACSM CCEP* ACSM RCEP* Certified health fitness professionals ACSM HFS Certified fitness professionals ACSM CPT Find through ACSM ProFinder: page 58

59 Additional Resources Physical Therapy Silver Sneakers Example free access to all basic YMCA amenities Intermountain Healthcare: TOSH TOSH FIT ArthroFit LiVe Well Centers Move Well Classes: SL LiVe Well St. George LiVe Well page 59

60 content/uploads/2014/12/wm-eim- Toolkit2013FINAL.pdf page 60

The EIM Solution. Rodolfo F. Florentino, MD, PhD* Nutrition Foundation of the Philippines, Inc.

The EIM Solution. Rodolfo F. Florentino, MD, PhD* Nutrition Foundation of the Philippines, Inc. The EIM Solution Rodolfo F. Florentino, MD, PhD* Nutrition Foundation of the Philippines, Inc. *I declare no conflict of interest with respect to this presentation and to my participation in the Panel