9/26/2019 WELLNESS 360: HEALTH AND WELLNESS MODEL FOR THE PHYSICAL - - PDF document
9/26/2019 WELLNESS 360: HEALTH AND WELLNESS MODEL FOR THE PHYSICAL THERAPY CLINIC 1 WELLNESS 360: WELLNESS AND LIFESTYLE ENHANCEMENT EDUCATION Third shift in health care: overview/future of health care Population Health Wellness
WELLNESS 360: WELLNESS AND LIFESTYLE ENHANCEMENT EDUCATION
▪ Third shift in health care: overview/future of health care ▪ Population Health ▪ Wellness 360! (Research, Wellness Recipe, Patient Examples)
EARLY HEALTHCARE: HEALTHCARE CENTERED AROUND ACUTE MANAGEMENT OF INJURY AND DISEASE. EXAMPLES: WAR INJURIES, SAVING/REMOVING LIMBS, ETC… SECOND SHIFT IN HEALTHCARE: ACUTE INJURY TREATMENT AND DISEASE MANAGEMENT. EXAMPLES: INFECTION, TRAUMA, DISEASE. 1900 THE MAIN CAUSES OF PREMATURE DEATH: PNEUMONIA INFLUENZA TB DIARRHEA 2015 THE MAIN CAUSES OF PREMATURE DEATH: HEART DISEASE CANCER COPD STROKE DIABETES
POPULATION HEALTH
A HEALTHCARE SHIFT IS CHARACTERIZED BY A SHIFT IN WHERE “HEALTHCARE” DOLLARS ARE SPENT. WHERE HAVE OUR HEALTHCARE DOLLARS BEEN GOING??
$327 BILLION HEALTH CARE DOLLARS SPENT ON DIABETES, $237 BILLION ON DIRECT COSTS, $90 BILLION ON INDIRECT COSTS. 90‐95% IS TYPE 2 DM. TOTAL COST OF OBESITY TO BE ESTIMATED AT $147 BILLION ANNUALLY. STROKE AND HEART DISEASE COST THE HEALTHCARE SYSTEM $199 BILLION PER YEAR AND $131 BILLION IN LOST PRODUCTIVITY. ESTIMATES $117 BILLION RELATED TO INACTIVITY HEALTHCARE COSTS. SMOKING: $170 BILLION IN DIRECT MEDICAL COSTS. EXCESSIVE ALCOHOL CONSUMPTION: $249 BILLION IN 2010.
AN INDIVIDUALS HEALTH OUTCOMES MEASURED VIA “LENGTH OF LIFE” AND “QUALITY OF LIFE.” HEALTH FACTORS. ONLY 20% OF AN INDIVIDUALS HEALTH CAN BE ATTRIBUTED TO THEIR “CLINICAL CARE.” THIS INCLUDES ACCESS AND QUALITY OF CARE. CHILDHOOD OBESITY AND PROXIMITY TO URBAN PARKS AND RECREATIONAL RESOURCES: A LONGITUDINAL COHORT STUDY
HEALTH PLACE. AUTHOR MANUSCRIPT; AVAILABLE IN PMC 2015 MAR 31. PUBLISHED IN FINAL EDITED FORM AS: HEALTH PLACE. 2011 JAN; 17(1): 207–214. PUBLISHED ONLINE 2010 OCT 15. DOI: 10.1016/J.HEALTHPLACE.2010.10.001 PMCID: PMC4380517 NIHMSID: NIHMS253636 PMID: 21075670 CHILDHOOD OBESITY AND PROXIMITY TO URBAN PARKS AND RECREATIONAL RESOURCES: A LONGITUDINAL COHORT STUDY JENNIFER WOLCH,A,* MICHAEL JERRETT,B KIM REYNOLDS,C ROB MCCONNELL,D ROGER CHANG,D NICHOLAS DAHMANN,D KIRBY BRADY,E FRANK GILLILAND,D JASON G. SU,B AND KIROS BERHANED
THE IMPACT OF INTERVENTIONS TO PROMOTE PHYSICAL ACTIVITY IN URBAN GREEN SPACE: A SYSTEMATIC REVIEW AND RECOMMENDATIONS FOR FUTURE RESEARCH.
SOC SCI MED. 2015 JAN;124:246‐56. DOI: 10.1016/J.SOCSCIMED.2014.11.051. EPUB 2014 NOV 26. THE IMPACT OF INTERVENTIONS TO PROMOTE PHYSICAL ACTIVITY IN URBAN GREEN SPACE: A SYSTEMATIC REVIEW AND RECOMMENDATIONS FOR FUTURE RESEARCH. HUNTER RF1, CHRISTIAN H2, VEITCH J3, ASTELL‐BURT T4, HIPP JA5, SCHIPPERIJN J6.
SPACES PROMOTE INCREASED ACTIVITY LEVELS
EFFECTIVENESS OF PHYSICAL ACTIVITY INTERVENTIONS IN ACHIEVING BEHAVIOURCHANGE MAINTENANCE IN YOUNG AND MIDDLE AGED ADULTS: A SYSTEMATIC REVIEWAND META‐ ANALYSIS.
SOC SCI MED. 2017 NOV;192:125‐133. DOI: 10.1016/J.SOCSCIMED.2017.09.021. EPUB 2017 SEP 19. EFFECTIVENESS OF PHYSICAL ACTIVITY INTERVENTIONS IN ACHIEVING BEHAVIOUR CHANGE MAINTENANCE IN YOUNG AND MIDDLE AGED ADULTS: A SYSTEMATIC REVIEW AND META‐ ANALYSIS. MURRAY JM1, BRENNAN SF2, FRENCH DP3, PATTERSON CC4, KEE F5, HUNTER RF6.
PHYSICAL ACTIVITY INTERVENTIONS HAVE BEEN PROVEN TO INCREASE ACTIVITY LEVEL PARTICULARLY WHEN COMBINED WITH “BEHAVIORAL CHANGE TECHNIQUES.”
CURRENTLY THE MAJORITY OF OUR HEALTHCARE DOLLARS GO TO “CLINICAL CARE!”
ONLY 5.8 – 7.7% OF HEALTHCARE DOLLARS SPENT ON PRIMARY CARE (OR “PREVENTATIVE CARE”)
RECALL, ONLY 20% OF OUR HEALTH CAN BE ATTRIBUTED TO CLINICAL CARE WHICH INCLUDES TERTIARY AND SECONDARY
HEALTH BY ABOUT 20%. ACCORDING TO MEDICALECONOMICS.COM: “DELIVERING VALUE IN HEALTHCARE STARTS WITH INCREASED PRIMARY CARE INVESTMENT”GLEN STREAM, MD, FAAFP, MBI. MICHAEL TUGGY, MD. AUG 6, 2018. HTTP://WWW.MEDICALECONOMICS.COM/HEALTH‐LAW‐AND‐POLICY/DELIVERING‐VALUE‐HEALTHCARE‐STARTS‐INCREASED‐ PRIMARY‐CARE‐INVESTMENT:
“EVERY $1 INVESTED IN PRIMARY CARE, $13 IS SAVED IN DOWNSTREAM COSTS.” (EXAMPLE: HUMANA PAYS YOU FOR MAKING IT TO THE GYM “X” NUMBER OF DAYS/MONTH, WILL PAY FOR GYM MEMBERSHIP, AND WILL PAY YOU FOR GETTING YOUR ROUTINE CHECK UP)
TODAY WE FIGHT TOOTH AND NAIL TO MAINTAIN THE STATUS CUE: LEGISLATION AND LEGAL BATTLES TO MAINTAIN OUR REIMBURSEMENT AND ARGUE OUR WORTH. THIS RESEARCH IS WHY IT MAY SEEM AT TIMES WE ARE FIGHTING AN UPHILL BATTLE.
COST OF DELIVERING CARE
REIMBURSEMENT
WHERE WE ARE TODAY
TODAY WE VALUE OUR HEALTH MORE THAN EVER, SO WHY THE REDUCTION IN REIMBURSEMENT FOR HEALTH SERVICES?? SHIFT FROM “FEE‐FOR‐SERVICE” TO “VALUE‐BASED” REIMBURSEMENT. SOCIETY DEMANDING A BIGGER BANG FOR THE HEALTHCARE BUCK.
FOR MOST PEOPLE SEEKING PHYSICAL THERAPY, A SINGLE JOINT OR MUSCULOSKELETAL CONDITION IS ONLY A MINOR PIECE OF THE PUZZLE:
SIGNIFICANT LINK BETWEEN PERSISTENT PAIN IN OBESITY NOT ONLY IN ADULTS BUT CHILDREN AND ADOLESCENTS AS WELL:
1) PERSISTENT PAIN AND COMORBIDITY AMONG OPERATION ENDURING FREEDOM/OPERATION IRAQI FREEDOM/OPERATION NEW DAWN VETERANS. HIGGINS DM, KERNS RD, BRANDT CA, HASKELL SG, BATHULAPALLI H, GILLIAM W, GOULET JL PAIN MED. 2014 MAY; 15(5):782‐90 2) MUSCULOSKELETAL PAIN IN OVERWEIGHT AND OBESE CHILDREN. SMITH SM, SUMAR B, DIXON KA INT J OBES (LOND). 2014 JAN; 38(1):11‐5. 3) OBESITY IS A RISK FACTOR FOR MUSCULOSKELETAL PAIN IN ADOLESCENTS: FINDINGS FROM A POPULATION‐BASED COHORT. DEERE KC, CLINCH J, HOLLIDAY K, MCBETH J, CRAWLEY EM, SAYERS A, PALMER S, DOERNER R, CLARK EM, TOBIAS JH
INCREMENTAL INCREASES IN PAIN IN CONJUNCTION WITH INCREASES IN BMI (ALSO SHOWS A FOUR‐FOLD HIGHER COMPLAINT OF PAIN IN OBESE COMPARED TO NON‐OBESE:
COMORBIDITY OF OBESITY AND PAIN IN A GENERAL POPULATION: RESULTS FROM THE SOUTHERN PAIN PREVALENCE STUDY. HITT HC, MCMILLEN RC, THORNTON‐NEAVES T, KOCH K, COSBY AG J PAIN. 2007 MAY; 8(5):430‐6.
SUBSTANTIAL EVIDENCE TO DESCRIBE LINK BETWEEN OBESITY AND LOW BACK PAIN, HEADACHES, FIBROMYALGIA/CHRONIC WIDESPREAD PAIN, AND ABDOMINAL PAIN:
CHRONIC PAIN, OVERWEIGHT, AND OBESITY: FINDINGS FROM A COMMUNITY‐BASED TWIN REGISTRY. WRIGHT LJ, SCHUR E, NOONAN C, AHUMADA S, BUCHWALD D, AFARI N J PAIN. 2010 JUL; 11(7):628‐35.
OBESE INDIVIDUALS ARE ALSO FAR MORE LIKELY TO DEVELOP NEUROPATHIC PAIN:
1) PREVALENCE AND COMORBIDITY OF CHRONIC PAIN IN THE GERMAN GENERAL POPULATION. OHAYON MM, STINGL JC J PSYCHIATR RES. 2012 APR; 46(4):444‐50. 2) OBESITY AND PERIPHERAL NEUROPATHY RISK: A DANGEROUS LIAISON. MISCIO G, GUASTAMACCHIA G, BRUNANI A, PRIANO L, BAUDO S, MAURO A J PERIPHER NERV SYST. 2005 DEC; 10(4):354‐8
OSTEOARTHRITIS IS ONE OF THE MOST COMMON MUSCULOSKELETAL PAIN COMPLAINTS IN THE UNITED STATES AND THERE IS A CONSIDERABLE AMOUNT OF RESEARCH THAT DESCRIBES THE ASSOCIATION BETWEEN OBESITY AND OSTEOARTHRITIS PAIN INCLUDING PRESENCE, PROGRESSION, AND SEVERITY: (DO PHYSICAL THERAPISTS TREAT JOINTS WITH OSTEOARTHRITIS?):
1) BODY MASS INDEX ASSOCIATED WITH ONSET AND PROGRESSION OF OSTEOARTHRITIS OF THE KNEE BUT NOT OF THE HIP: THE ROTTERDAM STUDY. REIJMAN M, POLS HA, BERGINK AP, HAZES JM, BELO JN, LIEVENSE AM, BIERMA‐ZEINSTRA SM ANN RHEUM DIS. 2007 FEB; 66(2):158‐62. 2) OBESITY AND KNEE OSTEOARTHRITIS. LEE R, KEAN WF
3) LOHMANDER LS, GERHARDSSON DE VERDIER M, ROLLOF J, NILSSON PM, ENGSTROM G. INCIDENCE OF SEVERE KNEE AND HIP OSTEOARTHRITIS IN RELATION TO DIFFERENT MEASURES OF BODY MASS: A POPULATION‐BASED PROSPECTIVE COHORT STUDY. ANN RHEUM DIS. 2009;68(4):490–496. 4) LEE S, KIM TN, KIM SH. SARCOPENIC OBESITY IS MORE CLOSELY ASSOCIATED WITH KNEE OSTEOARTHRITIS THAN IS NONSARCOPENIC OBESITY: A CROSS‐SECTIONAL STUDY. ARTHRITIS
RESEARCH SHOWS THAT AS BMI INCREASES, REPORTS OF CHRONIC PAIN ALSO INCREASE. IN ADDITION, OBESE INDIVIDUALS HAVE BEEN FOUND TO EXPERIENCE PAIN IN GENERAL MORE INTENSELY THAN INDIVIDUALS OF NORMAL
GIVEN PAINFUL ELECTRICAL OR MECHANICAL STIMULUS REPORTED A MORE INTENSE PAINFUL SENSATION THAN INDIVIDUALS OF A MORE NORMAL BODY COMPOSITION IN VARIOUS BODY REGIONS (OKIFUJI, 2015).
WE ARE LEARNING THAT PAIN INVOLVES SO MUCH MORE THAN JUST TISSUE DAMAGE OUR INJURY.
TROJAN HORSE RECALL, 2 OUT OF 3 OF US ARE OBESE OR OVERWEIGHT…THIS INCLUDES HEALTHCARE WORKERS!! EXERT FROM MONTANA CHAPTER OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEWSLETTER, WINTER 2018, MIKE TRAN, DPT:
WE ARE BEING CHALLENGED BY OUR ASSOCIATION AND SOCIETY IN GENERAL TO ADAPT TO THE NEEDS OF SOCIETY AND WHERE SOCIETY SPENDS THEIR DOLLARS REFLECTS WHAT SOCIETY VALUES. SOCIETY HAS NOT CHANGED HOW WE VALUE OR HEALTH. SOCIETY IS SIMPLY LEARNING AND BECOMING MORE AWARE THAT, WHAT WE HAVE HISTORICALLY BELIEVED IMPACTED OUR HEALTH HAS ONLY BEEN A SMALL PIECE OF THE PUZZLE. HOW SOCIETY IS ALLOCATING HEALTH CARE FUNDS IS SHIFTING TO MATCH THIS NEW UNDERSTANDING. WHAT DOES THIS MEAN FOR US AS PHYSICAL THERAPISTS. WHAT THIS MEANS IS SIMPLY THAT WE NEED TO ADAPT AND EVOLVE TO MEET THE NEEDS OF OUR SOCIETY. INSTEAD OF FIGHTING TOOTH AND NAIL TO MAINTAIN THE STATUS QUO, WE MUST MEET THIS CHALLENGE HEAD ON. WE MUST ADAPT AND DO OUR PART ALONG WITH THE REST OF THE HEALTH CARE COMMUNITY TO ADDRESS SOME OF THE MAJOR HEALTH CONCERNS OF OUR TIME WHICH INCLUDES OBESITY, CHRONIC ILLNESS SUCH AS DIABETES AND CARDIOVASCULAR DISEASE, SMOKING, AND OUR COUNTRIES RELIANCE ON OPIOIDS. WE ARE CONSIDERED THE EXPERTS AND LEADERS IN OUR COUNTRY WHEN IT COMES TO MOVEMENT AND
BY THE CONTINUAL REDUCTION IN REIMBURSEMENT WE MUST SHIFT AS WELL AND MEET THE CHALLENGE OF DEVELOPING INNOVATIVE APPROACHES TO ADDRESSING SDH'S. WE NEED TO BE ON THE PLANNING COMMITTEES THAT ARE DESIGNING THESE NEW PARKS THAT ARE POPPING UP, AND ON THE DEVELOPMENT TEAMS WORKING ON NEW CONSTRUCTION AND WORKSITES TO COME UP WITH CREATIVE WAYS WE CAN KEEP PEOPLE MOVING AT WORK, AND WE NEED TO RETOOL AND REIMAGINE HOW WE PROVIDE DIRECT PATIENT CARE. WHEN WE CAN DEMONSTRATE OUR VALUE IN ADDRESSING SDH'S THEN WE WILL CONTINUE TO FLOURISH AS A PROFESSION. TAKE TYPE 2 DIABETES FOR EXAMPLE, ONE OF THE LARGEST HEALTH CARE BURDENS ON OUR
THAT IS DIET AND EXERCISE. WHY AREN'T WE SEEING EVERY PATIENT THAT HAS BEEN DIAGNOSED WITH TYPE 2 DIABETES OR PRE‐DIABETES, OR BETTER YET, WHY AREN'T WE SEEING EVERY SINGLE PERSON WHO IS AT RISK FOR DEVELOPING DIABETES. WE ALREADY HAVE MANY OF THE TOOLS TO DEMONSTRATE OUR VALUE IN ADDRESSING THE COUNTRIES MAJOR HEALTH ISSUES. I AM EXCITED FOR THIS SPECIAL OPPORTUNITY OUR PROFESSION HAS AT THIS SPECIFIC TIME IN OUR COUNTRY AND CAN'T WAIT TO BE INSPIRED BY THE CREATIVE AND INNOVATIVE WAYS WE COME UP WITH TO TRULY TRANSFORM OUR POPULATION.
OT ST CHIROPRACTIC HEALTH COACH NUTRITIONIST ETC
PHYSICIAN REFERRAL PHYSICAL THERAPIST SELECTED
DEVELOPING A LIFE VISION.
EDUCATION: WHY IS EDUCATION IMPORTANT WHEN LOOKING AT MAKING HEALTHY AND MEANINGFUL CHANGES? EDUCATION: HOW DO PEOPLE LEARN BEST? ANALOGIES, PICTURES, DIAGRAMS, DESCRIPTIONS, AND QUIZZING (IE. REFLECTION OF THE MATERIAL AND APPLICATION TO ONES LIFE). EXAMPLE: GIVING DIRECTIONS… WELLNESS 360: WELLNESS EDUCATION AND LIFESTYLE ENHANCEMENT WORKBOOK CHAPTER: 1. BMI 2. STROKE 3. CARDIOVASCULAR DISEASE 4. DIABETES 5. NUTRITION: FATS 6. NUTRITION: PROTEIN AND CARBOHYDRATES 7. NUTRITION 8. EXERCISE 9. CANCER PREVENTION AND LIFESTYLE ENHANCEMENT.
Two Types of Stroke There are two different types of stroke. One type is called "Ischemic Stroke" and the less frequent type is called "Hemorrhagic Stroke." As mentioned earlier, oxygen is very important to the brain to maintain its functions. With both types of stroke, lack of oxygen is ultimately what results in damage to the brain. Question: Oxygen is very important to our brains. What delivers oxygen to your brain? ________________________ If you answered blood in the last question you are correct. Blood is pumped from the heart to our brains through tubes called arteries. In both types
does not reach the brain. Though blood does not reach the brain in both types of stroke, what happens in the artery to prevent the blood from getting to the brain is different. Ischemic Stroke According to the CDC, ischemic stroke accounts for 87% of all strokes. With ischemic stroke, the lack of blood flow through an artery to the brain is caused by a blockage in the artery which essentially "clogs" the artery blocking the flow of blood to the brain. The “clog” is caused by Blood Clots which are fatty deposits that build up around the inside of the arteries' walls, a process called atherosclerosis. These fatty deposits (blood clots) are formed in larger arteries in the top of the chest, neck, or heart. The fatty deposit (blood clot) can also develop in the inside of the actual artery in the brain as well. If Atherosclerosis (or the build up of fatty tissue) occurs in the carotid artery located within the neck, a piece of this fatty build-up can break off and travel into the brain until it gets to an area it is too large to pass through. This is when stroke results - See diagram on the following page.
Question: Let's look at it this way. Our arteries can become clogged just like the drain in your sink can become clogged. Some of the things that can result in your arteries becoming clogged are listed above. Please list 4 of things that contribute to arteries becoming clogged: _________________________________________________________________________ _________________________________________________________________________ _____________________________________ Question: How do the things you listed above relate to you personally? Do you believe your arteries could be getting clogged from the things you listed above? Please explain: _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _
STRESS Stress has been linked to either contributing or exacerbating essentially every adverse health condition imaginable. It has been shown to result in increased emotional activity with higher cognitive controls becoming inhibited resulting in overeating. In other words, stress can inhibit your ability to control how much or what you eat, a condition known as "emotional eating" (Dallman, 2010). Psychological health and stress, including chronic and acute stressors, have been associated with a variety of heart problems including heart attack
blood flow to the heart), among others (Dimsdale, 2008). Question: Do you feel that stress may be playing a role in the quality of your current health and wellness? _____________________________________________________________ _____________________________________________________________ Question: What are your stress levels like? What are the things that cause you stress in your life? What situations do you have going on in your life that may be contributing to your stress levels? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: Are you currently doing anything with the specific goal of managing your stress? Please explain why or why not. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ The American Psychological Association provides five tips for managing our stress levels:
Exercise: Let's look at each of these tips from the American Psychological Association individually. Describe one specific situation in your life currently that you feel causes you stress. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
Take a break from the stressor: Are you able to take a break from the specific situation causing you stress. This could may include taking a break from even thinking about the stressor. At times we can find yourselves in a situation that we are unable to even stop thinking about. Please explain if you can take a break from your stressor even if it's the ability to stop thinking about the stressor. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Exercise: Research shows that as little as 20 minutes of brisk walking can significantly reduce stress for hours according to the American Psychological Association. What are your current activity levels like? Please describe how often and how you are active throughout the day. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ When is the last time you enjoyed a walk? Please describe where you walked, what you enjoyed about it, and how you felt the rest of the day. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Please describe 2 places that you could easily have access to for a 20-minute walk and when you could include this in your schedule today or tomorrow. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Smile and laugh: When is the last time you had a really good laugh, who were you with, and what were you laughing about? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ List 3 things that typically make you smile and laugh. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Get Social Support: Do you have a support network? Who in your life do you feel comfortable telling about what's going on in your life and how you are feeling? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Do you believe that talking to someone about what's going on in your life could be helpful in your situation? Please explain why or why not. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Have you discussed your stressor that you listed above with anyone? If so, what was that like, if not, what do you think it would be like? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Think about people you know that have a lot of social support. Describe where or how they get their social support? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
Meditation: You may have been hearing a lot about meditation recently, and for good reason. There has been a massive amount of research coming
American Psychological Association asserts that even brief periods of meditation have been shown to reduce stress similarly to that of exercise. Research has shown that meditation may have positive affects on anxiety, depression, and pain (Ospina, 2007). Meditation has also been shown to reduce pain perception (Niroki, 2014). Do you currently experience pain? If so, please describe your pain including where it is, how long you've had it and how it has affected your life. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ What do you think would improve about your life if you were able to reduce your pain? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Do you believe reducing your stress would improve the stressful situation you listed above in anyway? Explain why or why not. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ When could you schedule in 5-10 minutes of meditation into your day today
_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: List 3 whole foods that would be low on the Glycemic index. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: Imagine you have a loved one, it could be a parent, a child, a close friend. You are concerned with their health risks and based upon what you have learned are concerned that your friend could be at risk for developing diabetes or cardiovascular disease. You have witnessed your friend eat a lot of processed carbohydrates such as cookies, brownies, and
consequences could be if they continue to eat this way and how these types
_____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: Many individuals struggle with limiting their processed carbohydrate consumption. Before we know it we are eating a sugary desert after every meal and it has become a habit. You have learned the potential consequences of over-eating processed carbohydrates. Processed carbohydrates come in the form of sugary treats that we associate with birthday parties, celebrations, graduations and essentially every holiday. Why do you think as a society we associate sugary treats with celebration and gatherings even though the majority of us struggle with over eating these foods resulting in weight gain?
EDUCATION: WHY IS EDUCATION IMPORTANT WHEN LOOKING AT MAKING HEALTHY AND MEANINGFUL CHANGES? EDUCATION: HOW DO PEOPLE LEARN BEST? ANALOGIES, PICTURES, DIAGRAMS, DESCRIPTIONS, AND QUIZZING (IE. REFLECTION OF THE MATERIAL AND APPLICATION TO ONES LIFE).
“POSITIVE QUESTIONING” VS “NEGATIVE QUESTIONING” OR…CONVERSATION FOCUSED ON WHAT CAN BE GAINED VS. WHAT YOU FEAR TO LOSE. SPORTS PSYCHOLOGY: WHICH TEAM PLAYS THEIR BEST GAME, THE ONE DOWN BY SEVERAL POINTS AND ONLY A COUPLE MINUTES LEFT TO PLAY, OR THE TEAM UP BY SEVERAL POINTS? DEVELOPING A LIFE VISION…MANY PEOPLE OPERATE FROM A POSITION OF BEING MOTIVATED BY REVERSING A “NEGATIVE HEALTH CONSEQUENCE.”
Question: Imagine you were able to adopt habits and a lifestyle which minimized your risk for having a stroke and were able to maintain your mobility and function for many years to come. What would your life be like? Describe what activities you would be doing, where you would be going on vacation, what you would be doing with family and friends, what hobbies and adventures you would be involved in. __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ _____________________ Question: On a scale of 0-10, “0” being not important at all and “10” being the most important, how important is it for you to improve your health and wellness? (Circle one) 1 2 3 4 5 6 7 8 9 10 Based on what number you selected, why isn’t your health and wellness less important to you? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
“IF YOU WEIGHED 200LB LESS TOMORROW, WHAT WOULD YOU DO?” “IF YOU WERE PHYSICALLY ABLE TO COMPLETE A HALF MARATHON TOMORROW, WHAT WOULD YOU DO WITH YOUR LIFE WITH ALL THAT FUNCTIONAL CAPACITY?” THESE QUESTIONS ARE ALONG THE LINES OF, “IF YOU WON THE LOTTERY TOMORROW, WHAT WOULD YOU DO?” REGAINING PHYSICAL FUNCTION, STAMINA, ENERGY, AND MOTIVATION IS BETTER THEN WINNING THE LOTTERY IN MANY WAYS…
EDUCATION: WHY IS EDUCATION IMPORTANT WHEN LOOKING AT MAKING HEALTHY AND MEANINGFUL CHANGES? EDUCATION: HOW DO PEOPLE LEARN BEST? ANALOGIES, PICTURES, DIAGRAMS, DESCRIPTIONS, AND QUIZZING (IE. REFLECTION OF THE MATERIAL AND APPLICATION TO ONES LIFE). “POSITIVE QUESTIONING” VS “NEGATIVE QUESTIONING” OR…CONVERSATION FOCUSED ON WHAT CAN BE GAINED VS. WHAT YOU FEAR TO LOSE. SPORTS PSYCHOLOGY: WHICH TEAM PLAYS THEIR BEST GAME, THE ONE DOWN BY SEVERAL POINTS AND ONLY A COUPLE MINUTES LEFT TO PLAY, OR THE TEAM UP BY SEVERAL POINTS?
DEVELOPING AN “INTRINSIC LOCUS OF CONTROL” AND “COUNTER‐FACTUAL” REFLECTION.
INTRINSIC LOCUS OF CONTROL ASSOCIATED WITH GREATER SUCCESS WITH WEIGHT LOSS EFFORTS. EXTRINSIC LOCUS OF CONTROL: “MY SPOUSE GROCERY SHOPS SO I CAN’T CHANGE MY DIET”, “I’M TOO BUSY TO EXERCISE”, “I CAN’T AFFORD A GYM MEMBERSHIP SO I CAN’T EXERCISE”, “MY BACK HURTS SO I CAN’T EXERCISE”, ETC… INTRINSIC LOCUS OF CONTROL: “MY SPOUSE DOES THE GROCERY SHOPPING SO I WILL HAVE TO START GORCERY SHOPPING FOR MYSELF”, “I‘LL HAVE TO ADJUST MY SCHEDULE TO FIGURE OUT A TIME I CAN DO MY EXERCISE”, “I’LL HAVE TO EXERCISE AT HOME OR OUTSIDE UNTIL I CAN AFFORD A GYM MEMBERSHIP”, “I NEED TO EXERCISE SO I’LL HAVE TO WORK AROUND MY BACK PAIN.”
Anastasiou CA, Fappa E, Karfopoulou E, Gkza A, Yannakoulia M. Weight loss maintenance in relation to locus of control: the MedWeight study. Behav Res Ther. 2015;71:40–44. [PubMed]
Question: According to the National Stroke Association, 80% of strokes can be prevented. The National Stroke Association highlights 4 specific areas which you can control or lower your risk of suffering a stroke including diet, activity, tobacco use, and alcohol consumption. Do you believe that you are responsible for what you eat and how active you are? If so, why do you believe you have control over these areas? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ If you believe you do not have control over what you eat and how active you are, then who does? List 3 ways you can gain more control. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ If you smoke, what would improve about your life if you were able to quit? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ What about your alcohol consumption? Is alcohol having a negative effect
improve about your life if you were to reduce your alcohol consumption if you believe you consume too much alcohol?
THERE IS MUCH BENEFIT IN ANY BEHAVIORAL CHANGE EFFORT TO REFLECT AND IMAGINE WHERE VARIOUS BEHAVIORS MAY POTENTIALLY LEAD, GOOD OR BAD. ANOTHER INTERESTING POINT IS THAT THE FEELING OF REGRET IS ONE OF THE MOST IMPACTFUL HUMAN EXPERIENCES. This also plays a role in developing a “life vision…”
Markman KD, McMullen MN. A reflection and evaluation model of comparative thinking. Personality and Social Psychology Review. 2003;7:244–267. [PubMed] Roese NJ. The functional basis of counterfactual thinking. Journal of Personality and Social
Roese NJ. Counterfactual thinking and decision making. Psychonomic Bulletin and Review. 1999;6:570–578. [PubMed] Saffrey C, Summerville A, Roese NJ. Praise for regret: People value regret above other negative emotions. Motivation and Emotion. 2008;32:46–54. [PMC free article] [PubMed]
Module 1: Food for Thought Question: A common mindset in our culture is “you only live once.” You may have heard this reference from a friend or family member when deciding what to order for dinner or whether to have that second helping of
experience something much more fulfilling in the future. What are some potential long term consequences of the mindset "you only live once" to eating habits and health? Describe 3 different potentially future consequences to this mindset. Be as specific as possible, the more detail you can imagine the more affective this exercise will be for you. For example, individuals have written about their experience of developing debilitating pain due to weight gain and how this has affected their life. Others have described the experience of being limited while on vacation and spending time with grandchildren or children. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
What are some things you might be able to experience later by denying yourself immediate satisfaction in the moment as it relates to food and lifestyle? Be creative, there are no right or wrong answers. Come up with at least 3 benefits to denying yourself in the moment for future fulfillment that personally attract you to a healthier future. Some examples people have written about are activities such as being able to play with their grandchildren or being able to experience more activities and sites while on vacation or on weekends. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
Question: Think about what your life is like now and what you would like it to be like eventually. If you were to suffer a stroke which resulted in paralysis of the right side of your body and leaving you unable to walk without a cane or on uneven ground, how would it affect your life now and how you envision your life? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: Remembering that the CDC has found that the majority of strokes are preventable. Can you think of any events in your life for which you wish you could have prevented? Please list 2 things in your life you wish you could have prevented and describe what it felt like after each of these situations. For example, one patient described visiting the Great Wall
described how it felt to not be able to enjoy his vacation as well and how it seemed like others were able to get around much easier and were able to do much more than he was able to. Another example was a patient that described what it felt like to have someone offer to buy their house but he held out for more money and then the 2008 recession happened and he ended up selling their house for much less than what had already been
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Question: Knowing what you now know about stroke and thinking back to the person or people you know that have had a stroke, how do you think it would feel to suffer a stroke after learning that in the majority of cases it could have been prevented? _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ Question: Imagine you were able to adopt habits and a lifestyle which minimized your risk for having a stroke and were able to maintain your mobility and function for many years to come. What would your life be like? Describe what activities you would be doing, where you would be going on vacation, what you would be doing with family and friends, what hobbies and adventures you would involved in. _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________ _____________________________________________________________
WHAT CAN A PATIENT EXPECT FROM A TYPICAL LIFESTYLE CHANGE JOURNEY? IT IS POSSIBLE! EDUCATION IS NOT ENOUGH! IT INVOLVES MORE THAN DIET AND EXERCISE! IT TAKES TIME!
WEIGHT‐LOSS MAINTENANCE FOR 10 YEARS IN THE NATIONAL WEIGHT CONTROL REGISTRY.THOMAS JG, BOND DS, PHELAN S, HILL JO, WING RR AM J PREV MED. 2014 JAN; 46(1):17‐23.
LONG‐TERM WEIGHT LOSS MAINTENANCE IN THE UNITED STATES.KRASCHNEWSKI JL, BOAN J, ESPOSITO J, SHERWOOD NE, LEHMAN EB, KEPHART DK, SCIAMANNA CN INT J OBES (LOND). 2010 NOV; 34(11):1644‐54.
ACCOMPLISH 10% OR GREATER LONG‐TERM WEIGHT LOSS.
LOOK AHEAD (ACTION FOR HEALTH IN DIABETES): DESIGN AND METHODS FOR A CLINICAL TRIAL OF WEIGHT LOSS FOR THE PREVENTION OF CARDIOVASCULAR DISEASE IN TYPE 2 DIABETES.RYAN DH, ESPELAND MA, FOSTER GD, HAFFNER SM, HUBBARD VS, JOHNSON KC, KAHN SE, KNOWLER WC, YANOVSKI SZ, LOOK AHEAD RESEARCH GROUP. CONTROL CLIN TRIALS. 2003 OCT; 24(5):610‐28.
“INTENSIVE LIFESTYLE INTERVENTION”
1) A DESCRIPTIVE STUDY OF INDIVIDUALS SUCCESSFUL AT LONG‐TERM MAINTENANCE OF SUBSTANTIAL WEIGHT LOSS.KLEM ML, WING RR, MCGUIRE MT, SEAGLE HM, HILL JO AM J CLIN NUTR. 1997 AUG; 66(2):239‐46 2) LONG‐TERM WEIGHT LOSS MAINTENANCE.WING RR, PHELAN S AM J CLIN NUTR. 2005 JUL; 82(1 SUPPL):222S‐225S.
FOR MEDICAL REASONS OR HAVING A FAMILY MEMBER WITH A HEART ATTACK.
A NEW COGNITIVE BEHAVIOURAL APPROACH TO THE TREATMENT OF OBESITY.COOPER Z, FAIRBURN CG BEHAV RES THER. 2001 MAY; 39(5):499‐511
INTERVENTION. 1) THE ROLE OF SELF‐EFFICACY, COPING, AND LAPSES IN WEIGHT MAINTENANCE.LATNER JD, MCLEOD G, O'BRIEN KS, JOHNSTON L EAT WEIGHT DISORD. 2013 DEC; 18(4):359‐66. 2) ANASTASIOU CA, FAPPA E, KARFOPOULOU E, GKZA A, YANNAKOULIA M. WEIGHT LOSS MAINTENANCE IN RELATION TO LOCUS OF CONTROL: THE MEDWEIGHT STUDY. BEHAV RES
CONFIDENCE IN YOUR ABILITY AND KNOWLEDGE IS KEY
1) THE QUOVADIS STUDY: FEATURES OF OBESE ITALIAN PATIENTS SEEKING TREATMENT AT SPECIALIST CENTERS.MELCHIONDA N, MARCHESINI G, APOLONE G, CUZZOLARO M, MANNUCCI E, GROSSI E, QUOVADIS STUDY GROUP. DIABETES NUTR METAB. 2003 APR; 16(2):115‐24. 2) THE INFLUENCE OF COGNITIVE FACTORS IN THE TREATMENT OF OBESITY: LESSONS FROM THE QUOVADIS STUDY.DALLE GRAVE R, CALUGI S, MARCHESINI G BEHAV RES THER. 2014 DEC; 63():157‐61
THROUGH THE RESEARCH, DATA AND INFORMATION.
ATTACHMENT STYLE CONTRIBUTES TO THE OUTCOME OF A MULTIMODAL LIFESTYLE
W, DETER HC, KALLENBACH‐DERMUTZ B BIOPSYCHOSOC MED. 2012 FEB 2; 6(1):3.
1) WING RR, TATE DF, GORIN AA, RAYNOR HA, FAVA JL. A SELF‐REGULATION PROGRAM FOR MAINTENANCE OF WEIGHT LOSS. N ENGL J MED. 2006;355(15):1563–1571. 2) SVETKEY LP, STEVENS VJ, BRANTLEY PJ, ET AL. COMPARISON OF STRATEGIES FOR SUSTAINING WEIGHT LOSS: THE WEIGHT LOSS MAINTENANCE RANDOMIZED CONTROLLED TRIAL. JAMA. 2008;299(10):1139–1148. 3) PERRI MG, LIMACHER MC, DURNING PE, ET AL. EXTENDED‐CARE PROGRAMS FOR WEIGHT MANAGEMENT IN RURAL COMMUNITIES: THE TREATMENT OF OBESITY IN UNDERSERVED RURAL SETTINGS (TOURS) RANDOMIZED TRIAL. ARCH INTERN MED. 2008;168(21):2347–2354. 4) SIMPSON SA, MCNAMARA R, SHAW C, ET AL. A FEASIBILITY RANDOMISED CONTROLLED TRIAL OF A MOTIVATIONAL INTERVIEWING‐BASED INTERVENTION FOR WEIGHT LOSS MAINTENANCE IN ADULTS. HEALTH TECHNOL ASSESS. 2015;19(50):V–VI. XIX–XXV, 1–378.
AMOUNT OF WEIGHT LOSS AND LONG‐TERM.
“WELLNESS RECIPE”
1. WELLNESS EDUCATION 2. “POSITIVE QUESTIONING VS NEGATIVE QUESTIONING.” DEVELOPING A LIFE VISION. 3. DEVELOPING INTRINSIC LOCUS OF CONTROL 4. “COUNTER‐FACTUAL THINKING/REFLECTION”
PATIENT JW:
(OFF BP MEDICATION 6WKS).
D/C: 1626’, 138BPM, 108BPM 2MIN POST.
D/C: ABLE TO WALK AT THE FAIR FOR MULTIPLE HOURS, THEN GO TO HOME GOODS STORE WITHOUT BACK PAIN.
PATIENT GG:
WITH PCP TO DISCONTINUE INSULIN COMPLETELY.
INTENSITY PHYSICAL ACTIVITY/WK. IMPROVED SLEEP HYGIENE, REGULAR SLEEP SCHEDULE.
THE ROLE NUTRITION AND ACTIVITY, SLEEP, STRESS, LIFESTYLE PLAY IN CHRONIC DISEASE PREVENTION AND QOL.
AND GOING TO WATER AEROBICS TOGETHER.
PATIENT BJ:
(NO BACK PAIN).
POST 64BPM).
D/C: 26REPS, 30SEC., 18IN SEAT HEIGHT.
SPOUSE STARTED WORKING ON TREADMILL AT HOME.
“…WHERE OUR PAST WAS SHAPED WITH SHARP ELBOWS, OUR FUTURE MUST BE SHAPED WITH OPEN ARMS. WHERE OUR ORIGINS SITUATED OUR PROFESSION IN RECOVERY AND TREATMENT OF DISORDER, OUR FUTURE WILL BE CHARACTERIZED BY AN INCREASED ROLE IN SUSTAINING HEALTH AND PROACTIVELY PREVENTING DISABILITY AND DISEASE…WE CANNOT TRANSFORM SOCIETY THROUGH JUDGMENT. OUR VISION CHARGES US NOT TO STAND AT A DISTANCE AND POINT OUR FINGERS AT OUR NATION’S ILLS BUT INSTEAD TO ACCEPT A PERSONAL RESPONSIBILITY TO TRY TO MAKE A DIFFERENCE.” SHARON DUNN, PT, PHD 2018 HOUSE OF DELEGATES MEETING.
MIKE TRAN, DOCTOR OF PHYSICAL THERAPY, DIRECTOR OF MEMBERSHIP MONTANA CHAPTER OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION EMAIL: MTRAN@COMMUNITYMED.ORG PH: (406)327‐4050