On The Move & Driving Change: Integrating an Exercise Education - - PowerPoint PPT Presentation

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On The Move & Driving Change: Integrating an Exercise Education - - PowerPoint PPT Presentation

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On The Move & Driving Change: Integrating an Exercise Education Program into your CHC Black Creek Community Health Centre June 2, 2015 Disclosure of Commercial Support Presenter Disclosure Presenter: Frederyck Franco Relationships with

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On The Move & Driving Change: Integrating an Exercise Education Program into your CHC

Black Creek Community Health Centre June 2, 2015

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Presenter Disclosure

Presenter: Frederyck Franco Relationships with commercial interests:

  • Grants/Research Support: None
  • Speakers Bureau/Honoraria: None
  • Consulting Fees: None
  • Other: None

Presenter Disclosure

Presenter: Jean Fraser Relationships with commercial interests:

  • Grants/Research Support: None
  • Speakers Bureau/Honoraria: None
  • Consulting Fees: None
  • Other: None

Disclosure of Commercial Support

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SLIDE 3

Presenter Disclosure

Presenter: Noah Wayne Relationships with commercial interests:

  • Grants/Research Support: None
  • Speakers Bureau/Honoraria: None
  • Consulting Fees: None
  • Other: None

Presenter Disclosure

Presenter: Cesar Calero Relationships with commercial interests:

  • Grants/Research Support: None
  • Speakers Bureau/Honoraria: None
  • Consulting Fees: None
  • Other: None

Disclosure of Commercial Support

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Overview of Presentation

  • Efficacy of Exercise
  • Kinesiology as an Integrated Clinical

Service for Chronic Disease Management and Prevention

  • Exercise Education Program at Black

Creek CHC

  • Readiness Assessment
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Efficacy of Exercise

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Efficacy of Exercise

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“Exercise helps control your blood glucose. It helps to lower your bad cholesterol. It helps to control your blood pressure. If all the ways that exercise helped you were replicated in a drug, it would be considered a miracle drug.”

  • Dr. Ian Blumer,

Stand up for Diabetes

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 Diabetes - Reduces HbA1c and related complications

(Sigal et al., 2007)

 Heart Disease - Increase cardiorespiratory fitness, the #1

risk factor for premature death

(Li & Siegrist, 2012)

 Falls - Increases balance and reaction time, decreasing risk

  • f falls

(Sherrington et al., 2011 – Systematic Review)

 Dementia – Increases BDNF & Neuroplasticity in Elderly

(Coleho, et al, 2013 – Systematic Review)

 Cancer - Post Surgical Recovery time for cancer reduced

(Gillis et al., 2014)

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Exercise & Chronic Disease Management

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Exercise & Chronic Disease Prevention

 Diabetes (Diabetes Prevention Program Research Group, 2011)  Cardiovascular Disease (Li & Siegrist, 2012)  Cancer (Campbell, 2007)  Dementia (Graff-Radford, 2011)  Overall Mortality (Gebel et al., 2015; Arem et al., 2015)

Public Health Agency of Canada: “Physical activity has been shown to reduce the risk of over 25 chronic conditions”

http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/02paap-eng.php

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Barriers to Safe & Effective Exercise

 Accessibility

  • Income disparity & poverty
  • Facility availability

 Skill & Knowledge

  • Technique, intensity

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Only 20% of Canadians meet recommended guidelines

(Colley et al., 2011) 20% 80% Active Sedentary

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Canada’s health care future is uncertain

  • Timely access to quality health services
  • Aging Population
  • Increasing rates of chronic disease
  • Sedentariness & poor eating habits
  • Rising costs are not sustainable

Ontario to spend $131.9 billion on healthcare (Ontario Budget, 2015)

Exercise as an integrated clinical service is sustainable

  • Reduced hospital admissions & healthcare use

(Sari, 2009)

Challenges to Canada’s health care system

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Kinesiology as an Integrated Clinical Service for Chronic Disease Management and Prevention

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Registered Kinesiologist

 Exercise is a fundamental component to

chronic disease management

 Registered Kinesiologists have the education,

training, autonomy and comprehensive clinical skills necessary to serve the clients with complex physical activity needs

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Kinesiology in Ontario

 April 2006 - Health Professions Regulatory Advisory

Council recommended to the MOHLTC to regulate kinesiology under the Regulated Health Professions Act (1991)

 June 2007 – Bill 171 achieved royal assent designating

kinesiology as a regulated health care profession

 April 2013 – The College of Kinesiology official began

registering exercise professionals as Kinesiologists in Ontario

Ontario is the FIRST jurisdiction world-wide to license Kinesiology as a regulated health profession

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Kinesiology in Ontario

 Approximately 1,500 Kinesiologists are currently

registered with the College of Kinesiologists of Ontario

 15 Universities in Ontario offer undergraduate

programs in Kinesiology granting approximately 1,000 degrees annually

 Courses include: Anatomy, physiology, biomechanics,

nutrition, sociocultural understanding in health, psychology, nutrition

 Ontario was the first jurisdiction world-wide to grant

degrees in Kinesiology (1970, University of Waterloo)

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About Kinesiology

Kinesiologists apply exercise to:

 Promote health and well-being  Prevent, manage and rehabilitate injury  Provide primary and secondary prevention and

management for illness and chronic disease

 Restore function, and optimize human performance

Scope of Practice: “assessment of human movement and performance and its rehabilitation and management to maintain, rehabilitate or enhance movement and performance” (Kinesiology Act, 2007, c. 10, Sched. O, s. 3.)

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Integration of RKins

 Member of the Provider Team

  • Provide the clinical exercise expertise (Cardiovascular

& Resistance Training)

  • Supplements current care model:

 Diet (Registered Dietitian)  Medication/general management (Registered Nurse/Nurse Practitioner/Physician)  Rehabilitation (Physiotherapist)  Foot care (Chiropodist)  Mental health (Registered Social Worker)

 Challenges?

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Exercise Prescription

 Patient centered exercise prescription based on

current health status/assessment:

  • Disease States
  • Medication Lists

 Monitoring of:

  • Heart Rate
  • Blood Pressure
  • Blood Glucose
  • Percent Oxygen Saturation
  • Perceived Exertion Level
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Environmental Scan

 57 FHTs offer exercise services (Moor et al., 2015)

“Physical activity and exercise are important means of preventing and managing diabetes, and diabetes educators are in a key position to promote and encourage these behaviours. However, lack of confidence, multiple barriers, and insufficient training in delivering physical activity and exercise counselling may limit their ability to do so.” (Dillman et al., 2010)

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AOHC Indicators

 In the near future, there will be new

indicators to measure physical activity of clients within CHCs

 Providers will be responsible for asking all

clients about physical activity

 It’s a good start…

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Exercise Education Program at Black Creek CHC

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EXERCISE EDUCATION PROGRAM

  • Risk Assessment
  • Exercise Prescription
  • Health Behavior Change
  • Chronic Disease Self-

Management

  • Physical Activity

Workshops

  • Community Outreach
  • Health Screenings
  • Partnering Organizations

CLINICAL EXERCISE HEALTH PROMOTION CHRONIC DISEASE REGISTERED KINESIOLOGIST

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Client Referral/Enrollment Physical Activity Assessment Medical Clearance Goal Setting & Self- Management Exercise Education and Prescription Physical Activity Workshop

INTAKE RISK ASSESSMENT HEALTH BEHAVIOR CHANGE

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Intake

 Referral Sources  Physical Activity Workshop

  • Benefits of active living and staying safe
  • Tracking: Basics of an exercise plan (FITT)
  • Motivation & SMART Goal Setting

 Challenges/barriers; overcoming them

 Thinking ahead: Chronic Disease Workshops/Diabetes

Conversation Map

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Risk Assessment

 Requires risk classification of the individual who may be

living with multiple conditions at various levels on the health continuum

 Transient  Client-centered care  Determine the most appropriate type of support most

suitable for client

 Distinguish between those who will need individual

support more immediately vs. those who may not

Low Risk Intermediate Risk High Risk

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Physical Activity Assessment/Screening

 Outlined in CHC-EEP Operations Manual

  • Conversation based
  • PAR-Q+ (medical clearance as needed)
  • Waiver & Lab request
  • Expectations
  • Current health & lifestyle behaviors and interests

with focus on physical activity

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Lifestyle & Health Behavior Change

 Goal setting & self-management

  • Frequency, type of contact (phone, OTN, etc)

 Exercise Education & Prescription

  • Education sessions (one-to-one)
  • Group classes
  • Walking groups
  • How to scale it up?

 Kinesiology placement students and volunteers

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Building individual capacity within their community

EEP Delivers on the Model of Health and Wellbeing

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Lets explore how ready your

  • rganization is to deliver an

Exercise Education Program…

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A few things to consider…

 Administrative

  • NOD charting, scheduling
  • Communication with staff, physicians and
  • ther health care practitioners

 Logistics

  • How many RKins, volunteers/students
  • Space
  • Equipment available? No equipment?
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THANK YOU!

Jean Fraser, BA, RKin Black Creek Community Health Centre Jean.fraser@bcchc.com Frederyck Franco, BSc, RKin Black Creek Community Health Centre Frederyck.franco@bcchc.com Cesar Calero, BSc (Cand.) York University caleroce@my.yorku.ca Noah Wayne, PhD (Cand.), RKin York University/University Health Network nwayne@yorku.ca