Clarian health health promotion inservice november 8, 2010

Health Promotion for Physical Therapists:

Concepts and Practical Applications

Health Promotion for Physical Therapists:

Concepts and Practical Applications

Julie Gahimer PT, HSDAssociate Professor

Krannert School of Physical TherapyUniversity of Indianapolis

November 8, 2010

Julie Gahimer PT, HSDAssociate Professor

Krannert School of Physical TherapyUniversity of Indianapolis

November 8, 2010

ObjectivesObjectivesObjectivesObjectives 6 Dimensions of Health Blue Zones- Dan Buettner Health Issues in America

Obesity and overweight, smoking, diabetes

How Healthy Is Indiana? Health Risk Appraisals

Human Kinetics Senior Fitness Test Real Age

Healthy People 2010/2020 Role of the APTA Role of the Physical Therapist Fitness Following Disability

6 Dimensions of Health Blue Zones- Dan Buettner Health Issues in America

Obesity and overweight, smoking, diabetes

How Healthy Is Indiana? Health Risk Appraisals

Human Kinetics Senior Fitness Test Real Age

Healthy People 2010/2020 Role of the APTA Role of the Physical Therapist Fitness Following Disability

6 Dimensions of Wellness6 Dimensions of Wellness

The Six Dimensions of Health

My Six Dimensions of Health My Six Dimensions of Health

My Six Dimensions of HealthMy Six Dimensions of Health1. Physical2. Emotional3. Spiritual4. Intellectual5. Psychological6. Social

1. Physical2. Emotional3. Spiritual4. Intellectual5. Psychological6. Social

PhysicalPhysicalExercise/fitnessWeight/body fatDietCardiovascular/strength trainingDisease preventionLifestyle: active vs sedentaryPrevention and safety: helmets,

seatbelts, smoking, safe sex, drugs, alcohol

Exercise/fitnessWeight/body fatDietCardiovascular/strength trainingDisease preventionLifestyle: active vs sedentaryPrevention and safety: helmets,

seatbelts, smoking, safe sex, drugs, alcohol

EmotionalEmotionalStress managementDepressionRelaxation timeOutletsSelf-esteemSupport of loved onesWorrying about things you cannot controlLearn from mistakes, not dwelling on themControl of anxiety

Stress managementDepressionRelaxation timeOutletsSelf-esteemSupport of loved onesWorrying about things you cannot controlLearn from mistakes, not dwelling on themControl of anxiety

SpiritualSpiritualFaithValuesMoralsBeliefs

FaithValuesMoralsBeliefs

IntellectualIntellectualJob/school fulfillment or successStressRelationships with co-workers, clients,

employerJob safetyGood attitudeMotivationFinancial security

Job/school fulfillment or successStressRelationships with co-workers, clients,

employerJob safetyGood attitudeMotivationFinancial security

PsychologicalPsychologicalStress managementSelf esteemSocial interactionAttitudeOrganizationEnvironment

Stress managementSelf esteemSocial interactionAttitudeOrganizationEnvironment

SocialSocialInteraction and relationships with

friends, family, significant othersCommunication- both verbal and

non-verbalExtracurricular activitiesActivities and events

Interaction and relationships with friends, family, significant others

Communication- both verbal and non-verbal

Extracurricular activitiesActivities and events

Why Is Health Promotion So Why Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?


Historical Movement from Infectious Disease to Chronic Diseases

30 year increase life expectancy since 1900’s

Diseases of longevity, lifestyle, & health behaviors

More people living longer with chronic disease associated pain & disability

Historical Movement from Infectious Disease to Chronic Diseases

30 year increase life expectancy since 1900’s

Diseases of longevity, lifestyle, & health behaviors

More people living longer with chronic disease associated pain & disability

10 Leading Causes of Death (increased longevity & lifestyle)

10 Leading Causes of Death (increased longevity & lifestyle)

Heart disease (decreased)

Malignant neoplasms Cerebrovascular

disease COPD Accidents (including

MVA) Pneumonia & Influenza Diabetes Suicide Nephritis/Nephrosis Chronic Liver &

Cirrhosis

Heart disease (decreased)

Malignant neoplasms Cerebrovascular

disease COPD Accidents (including

MVA) Pneumonia & Influenza Diabetes Suicide Nephritis/Nephrosis Chronic Liver &

Cirrhosis

Shift fromcurative measures to preventative measures

Increased emphasis on personal responsibility for health

Obesity and OverweightObesity and OverweightObesity and OverweightObesity and Overweight

61% adults in U.S. are overweight or obese (BMI>25)

13% children aged 6-11 years

14% adolescents aged 12-19 years

61% adults in U.S. are overweight or obese (BMI>25)

13% children aged 6-11 years

14% adolescents aged 12-19 years

National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006

Obesity and OverweightObesity and Overweight Increase the risk of

morbidity from: Hypertension Dyslipidemia Type 2 diabetes Coronary heart

disease Stroke Gallbladder disease Osteoarthritis Sleep apnea and

respiratory problems Endometrial, breast,

prostate, and colon cancers.

Increase the risk of morbidity from: Hypertension Dyslipidemia Type 2 diabetes Coronary heart

disease Stroke Gallbladder disease Osteoarthritis Sleep apnea and

respiratory problems Endometrial, breast,

prostate, and colon cancers.

National Heart, Blood, & Lung Institute, Clinical Guidelines: Obesity

An estimated total cost of obesity in U.S. in 2000 was about $117 billion.

Obesity Trends* Among U.S. AdultsBRFSS, 1990

No Data <10% 10%–14%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)

Source: Behavioral Risk Factor Surveillance System, CDC


No Data <10% 10%–14% 15%–19%




No Data <10% 10%–14% 15%–19% ≥20




No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



Obesity* Trends Among U.S. AdultsBRFSS, 2003


No Data <10% 10%–14% 15%–19% 20%–24% ≥25%



Childhood Overweight/ObesityChildhood Overweight/ObesityChildhood Overweight/ObesityChildhood Overweight/Obesity

In the U.S., the prevalence of childhood In the U.S., the prevalence of childhood overweight tripled between 1980 & 2000.overweight tripled between 1980 & 2000.

In the U.S., the prevalence of childhood In the U.S., the prevalence of childhood overweight tripled between 1980 & 2000.overweight tripled between 1980 & 2000.

Circulation: Journal of the AHA downloaded 7/15/07

The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health Status

The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health Status

Nearly 30% of Nearly 30% of adults 18-75 years adults 18-75 years old are classified as old are classified as “inactive”“inactive”

Report no leisure-Report no leisure-time physical time physical activity (vigorous or activity (vigorous or light/moderate) of at light/moderate) of at least 10 minutes least 10 minutes durationduration

Nearly 30% of Nearly 30% of adults 18-75 years adults 18-75 years old are classified as old are classified as “inactive”“inactive”

Report no leisure-Report no leisure-time physical time physical activity (vigorous or activity (vigorous or light/moderate) of at light/moderate) of at least 10 minutes least 10 minutes durationduration

National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006

Nearly 50% Nearly 50% American adults do American adults do not get enough not get enough physical activity to physical activity to provide health provide health benefitsbenefits

Nearly 50% Nearly 50% American adults do American adults do not get enough not get enough physical activity to physical activity to provide health provide health benefitsbenefits

Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines All adults perform 30 or more minutes of All adults perform 30 or more minutes of

moderate-intensity physical activity on most, moderate-intensity physical activity on most, and preferably all, days---and preferably all, days---eithereither in a single in a single session orsession or “accumulated” in multiple bouts“accumulated” in multiple bouts, , each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.

Or at least 3 days a week for 20 minutes a day Or at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity

All adults perform 30 or more minutes of All adults perform 30 or more minutes of moderate-intensity physical activity on most, moderate-intensity physical activity on most, and preferably all, days---and preferably all, days---eithereither in a single in a single session orsession or “accumulated” in multiple bouts“accumulated” in multiple bouts, , each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.


National Center Health Statistics. Health, 2004

The State of Our Nation: Trends in Health StatusThe State of Our Nation: Trends in Health Status

19% adult women and 23% men current smokers in 2004, strongly associated with educational level

22% high school students reported smoking, slight decline in upward trend began in 1990’s

19% adult women and 23% men current smokers in 2004, strongly associated with educational level

22% high school students reported smoking, slight decline in upward trend began in 1990’s

Source: Behavioral Risk Factor Surveillance System,CDC

2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no

The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health StatusThe State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health Status

Adults aged 65 to 74 years (2001-2004):17% elevated cholesterol30% hypertension

Diagnosed or undiagnosed Diabetes (FBG of 126 mg/dl or over)

10% persons 20 yrs of age and older

20% of the U.S. Population, aged 60 years and older

Adults aged 65 to 74 years (2001-2004):17% elevated cholesterol30% hypertension

Diagnosed or undiagnosed Diabetes (FBG of 126 mg/dl or over)

10% persons 20 yrs of age and older

20% of the U.S. Population, aged 60 years and older

National Center Health Statistics. Health, 2006

Native Hawaiian/

Pacific Islander

Am. Indian/Alaska Native

I = 95% confidence interval. *Data are statistically unreliable and are suppressed. NOTE: Data are for adults aged 18-84 years and are age-adjusted to the 2000 standard population. The black and white categories exclude persons of Hispanic origin. Persons of Hispanic origin may be any race. For data prior to 1999, respondents reported one or more races and identified one race as best representing their race. For 1999 and later years, respondents were asked to select one or more races. Data for the single race categories shown are for persons who reported only one racial group. SOURCE: National Health Interview Survey (NHIS), NCHS, CDC.

White BlackAsian Hispanic

*Total

Age-adjusted rate per 1,000 population 1997-99 2000-02 2003-05

2010 Target: 3.8

*

Decrease desired

5

10

15

0

20

Total White Hispanic BlackFemale 7.4 (0.4) 6.3 (0.5) 12.1 (1.1) 10.8 (1.3)Male 7.5 (0.5) 7.0 (0.5) 7.4 (1.1) 9.7 (1.7)

Obj. 5-2

New Cases of Diabetes, Among Adults

Percentage of Adults Who ReportedEating fewer Than Five Servings of Fruits and Vegetables a Day, by Sex, 2002

The State of Our Nation: Trends The State of Our Nation: Trends in Health Behaviorsin Health Behaviors

0%10%20%30%40%50%60%70%80%90%

MenWomenTotal0%

0%10%20%30%40%50%60%70%80%90%

MenWomenTotal0%

Dietary Factors Associated 4 of the 10 leading causes of death:

- CHD- Cancer- Stroke- DM II

Source: CDC, At A Glance: Phys. Activity & Good Nutrition



95% of the US 95% of the US healthcare economy healthcare economy is allocated to direct is allocated to direct medical care medical care

Only 5% is allocated Only 5% is allocated to health to health improvementimprovement

95% of the US 95% of the US healthcare economy healthcare economy is allocated to direct is allocated to direct medical care medical care

Only 5% is allocated Only 5% is allocated to health to health improvementimprovement

National Goals & National Goals & Objectives for HealthObjectives for Health

National Goals & National Goals & Objectives for HealthObjectives for Health

Healthy People followed by National Goals and Objectives

Healthy People 2000Nation’s health

agenda

Healthy People 2010http://healthypeople.gov

Healthy People followed by National Goals and Objectives

Healthy People 2000Nation’s health

agenda

Healthy People 2010http://healthypeople.gov

http://healthypeople.gov/

http://healthypeople.gov/

Healthy People

2000, 2010

Healthy People

2000, 2010 A comprehensive set A comprehensive set of of national health national health objectivesobjectives for the for the decadedecade

Developed by a Developed by a collaborative processcollaborative process

Designed to Designed to measuremeasure progressprogress over time over time

A A public health public health documentdocument that is part that is part strategic plan, part strategic plan, part textbook on public textbook on public health prioritieshealth priorities

A comprehensive set A comprehensive set of of national health national health objectivesobjectives for the for the decadedecade

Developed by a Developed by a collaborative processcollaborative process

Designed to Designed to measuremeasure progressprogress over time over time

A A public health public health documentdocument that is part that is part strategic plan, part strategic plan, part textbook on public textbook on public health prioritieshealth priorities

Healthy People 2010Healthy People 2010Coordinated ByCoordinated By

Healthy People 2010Healthy People 2010Coordinated ByCoordinated By

The Office of The Office of Disease Disease Prevention and Prevention and Health PromotionHealth Promotion

U.S. Department U.S. Department of Health and of Health and Human Services Human Services (USDHHS)(USDHHS)

The Office of The Office of Disease Disease Prevention and Prevention and Health PromotionHealth Promotion

U.S. Department U.S. Department of Health and of Health and Human Services Human Services (USDHHS)(USDHHS)

Healthy People 2010Healthy People 2010Healthy People 2010Healthy People 2010

Two overarching Two overarching goalsgoals

28 focus areas28 focus areas 467 specific 467 specific

objectivesobjectives 10 Leading Health 10 Leading Health

IndicatorsIndicators

Two overarching Two overarching goalsgoals

28 focus areas28 focus areas 467 specific 467 specific

objectivesobjectives 10 Leading Health 10 Leading Health

IndicatorsIndicators

Two Overarching Goals:Two Overarching Goals:Two Overarching Goals:Two Overarching Goals:

Increase quality Increase quality and years of and years of healthy lifehealthy life

Eliminate health Eliminate health disparitiesdisparities

Increase quality Increase quality and years of and years of healthy lifehealthy life

Eliminate health Eliminate health disparitiesdisparities

Healthy People 201028 Focus Areas (14 apply directly to PT)

Healthy People 201028 Focus Areas (14 apply directly to PT)

Access to Quality Health Services

Arthritis, Osteoporosis, and Chronic Back Conditions

Cancer Chronic Kidney Disease Diabetes Disability and

Secondary Conditions Heart Disease and

Stroke

Access to Quality Health Services

Arthritis, Osteoporosis, and Chronic Back Conditions

Cancer Chronic Kidney Disease Diabetes Disability and

Secondary Conditions Heart Disease and

Stroke

HIV Maternal, Infant, and

Child Health Nutrition and

Overweight Occupational Safety

and Health Physical Activity and

Fitness Respiratory Diseases Tobacco Use

HIV Maternal, Infant, and

Child Health Nutrition and

Overweight Occupational Safety

and Health Physical Activity and

Fitness Respiratory Diseases Tobacco Use

Healthy People 2010Healthy People 201010 Leading Health Indicators10 Leading Health Indicators

Healthy People 2010Healthy People 201010 Leading Health Indicators10 Leading Health Indicators

Physical ActivityPhysical Activity Overweight and Overweight and

ObesityObesityTobacco UseSubstance AbuseResponsible Sexual

Behavior

Physical ActivityPhysical Activity Overweight and Overweight and

ObesityObesityTobacco UseSubstance AbuseResponsible Sexual

Behavior

Mental Health Injury and ViolenceEnvironmental

Quality ImmunizationAccess to Health

Care

Mental Health Injury and ViolenceEnvironmental

Quality ImmunizationAccess to Health

Care

How Healthy is Indiana?How Healthy is Indiana?Indiana Healthy WeightINShape IndianaFit City

Indiana Healthy WeightINShape IndianaFit City

Health Risk Appraisals (HRA’s)Health Risk Appraisals (HRA’s)

Senior Fitness TestRoberta E Rickli, C Jessie JonesSenior Fitness TestRoberta E Rickli, C Jessie Jones

The Role of the Physical TherapistThe Role of the Physical TherapistThe Role of the Physical TherapistThe Role of the Physical Therapist

Vision 2020: By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

HOD 06-00-24-35 (Program 01)

Vision 2020: By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

HOD 06-00-24-35 (Program 01)11/06

Roles of a Physical TherapistRoles of a Physical TherapistPathologiesMovement ScienceTraining PrinciplesDiverse PopulationsPsychosocial ResponsesScreening

PathologiesMovement ScienceTraining PrinciplesDiverse PopulationsPsychosocial ResponsesScreening

Roles of a Physical TherapistRoles of a Physical TherapistNational goals include PTInherent credibilityViewed as advocates, problem-solversAccess to patient/client populationsAccess to facilities and resourcesAccess to the public

National goals include PTInherent credibilityViewed as advocates, problem-solversAccess to patient/client populationsAccess to facilities and resourcesAccess to the public

American Physical Therapy Association

American Physical Therapy Association

APTA Vision 2020 StatementAPTA Vision 2020 StatementBy 2020, physical therapy will be provided by

physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

By 2020, physical therapy will be provided by physical therapists who are doctors of physical therapy, recognized by consumers and other health care professionals as the practitioners of choice to whom consumers have direct access for the diagnosis of, interventions for, and prevention of impairments, functional limitations, and disabilities related to movement, function, and health.

APTA Video Podcasts on Health Promotion

APTA Video Podcasts on Health Promotion

Center for Disease ControlCenter for Disease Control

Screening ActivitiesScreening ActivitiesPhysiological parameters ScoliosisPostureCVD, PVDPulmonary functionSports healthOccupational healthFunctional performance

Physiological parameters ScoliosisPostureCVD, PVDPulmonary functionSports healthOccupational healthFunctional performance

Health Promotion PracticeHealth Promotion PracticeGreater participation in community

health activitiesPublic Health projectsHealth FairsPrevention education programsConsultants for community agencies,

schools, businesses, health clubs etc.Professional conferences- community

health projects

Greater participation in community health activitiesPublic Health projectsHealth FairsPrevention education programsConsultants for community agencies,

schools, businesses, health clubs etc.Professional conferences- community

health projects

Health Promotion PracticeHealth Promotion PracticeIntegration of health promotion and

preventive health services within traditional practiceScreening ReferralCollaborationClient education

Integration of health promotion and preventive health services within traditional practiceScreening ReferralCollaborationClient education

Health Promotion PracticeHealth Promotion PracticeLinking with fitness centers, YMCA’s,

YWCA’s, health clubsPT practices located in these settingsConsultation with fitness personnel to

facilitate client recovery and rehabilitation

Prevention education programs

Linking with fitness centers, YMCA’s, YWCA’s, health clubsPT practices located in these settingsConsultation with fitness personnel to

facilitate client recovery and rehabilitation

Prevention education programs

Health Promotion PracticeHealth Promotion PracticeTransition or Chronic Care Programs

Service to clients no longer in PTWell-suited for clients with chronic illness

or extended recoverySlows development of disorders, prevents

functional lossesGroup, individualized programs

Transition or Chronic Care ProgramsService to clients no longer in PTWell-suited for clients with chronic illness

or extended recoverySlows development of disorders, prevents

functional lossesGroup, individualized programs

Health Promotion PracticeHealth Promotion PracticePT Private Practice

Combination PT and Health Promotion PT- Medical ModelHP- Client-centered care

Multidisciplinary Wellness centers

PT Private PracticeCombination PT and Health Promotion PT- Medical ModelHP- Client-centered care

Multidisciplinary Wellness centers

Health Promotion Practice Health Promotion PracticeHealth Promotion and wellness

programming- Seniors:Long-term careAssisted living communitySenior housing communitiesCommunity groupsIn homes

Health Promotion and wellness programming- Seniors:Long-term careAssisted living communitySenior housing communitiesCommunity groupsIn homes

Health Promotion PracticeHealth Promotion PracticeOther Health Promotion Niches:

KidsSchoolHome

Women’s Health Business HealthWorksite WellnessSports HealthMultidisciplinary wellness

Other Health Promotion Niches:Kids

SchoolHome

Women’s Health Business HealthWorksite WellnessSports HealthMultidisciplinary wellness

APTA Position Statement on Health Promotion and Wellness

By PTs and PTAs

APTA Position Statement on Health Promotion and Wellness

By PTs and PTAs

The APTA recognizes that physical therapists are uniquely qualifieduniquely qualified to to assume leadershipleadership positions in efforts to prevent injury and prevent injury and disabilitydisability, , and fully supports the positive positive rolesroles that physical therapists and physical therapist assistants play in the promotion of promotion of healthy lifestyles, wellness and injury healthy lifestyles, wellness and injury preventionprevention..

The APTA recognizes that physical therapists are uniquely qualifieduniquely qualified to to assume leadershipleadership positions in efforts to prevent injury and prevent injury and disabilitydisability, , and fully supports the positive positive rolesroles that physical therapists and physical therapist assistants play in the promotion of promotion of healthy lifestyles, wellness and injury healthy lifestyles, wellness and injury preventionprevention..

HOD 06-93-25-50Efforts coordinated through APTA Department of Practice, Ken Harwood, PT, PhD, Director

HOD 06-04-09-09

Priority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTA

Goal 1:Goal 1: Physical Physical therapists are therapists are universally universally recognized and recognized and promoted as the promoted as the practitioners of practitioners of choicechoice for persons for persons with conditions that with conditions that affect movement, affect movement, function,function, healthhealth, and wellnesswellness.

Goal 1:Goal 1: Physical Physical therapists are therapists are universally universally recognized and recognized and promoted as the promoted as the practitioners of practitioners of choicechoice for persons for persons with conditions that with conditions that affect movement, affect movement, function,function, healthhealth, and wellnesswellness.

Priority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTA Goal II:Goal II: Physical Physical

therapists are universally therapists are universally recognized and promoted recognized and promoted as providers of as providers of fitnessfitness, , health promotionhealth promotion, , wellnesswellness, and , and riskrisk reductionreduction programs to programs to enhance quality of life for enhance quality of life for persons across the life-persons across the life-span.span.

Goal II:Goal II: Physical Physical therapists are universally therapists are universally recognized and promoted recognized and promoted as providers of as providers of fitnessfitness, , health promotionhealth promotion, , wellnesswellness, and , and riskrisk reductionreduction programs to programs to enhance quality of life for enhance quality of life for persons across the life-persons across the life-span.span.

11/06HOD 06-04-09-09

APTA Normative Model/Guide to APTA Normative Model/Guide to Physical Therapist Practice/Physical Therapist Practice/

CAPTE RequirementsCAPTE Requirements

APTA Normative Model/Guide to APTA Normative Model/Guide to Physical Therapist Practice/Physical Therapist Practice/

CAPTE RequirementsCAPTE Requirements

Physical therapists involved in prevention, promoting health, wellness, fitness & health, wellness, fitness & screening activitiesscreening activities

Help patients/clients:Achieve & restore optimal functionMinimize impairments, functional limitations,

disabilitiesMaintain healthMaintain health (prevent further deterioration or

future illness)Create appropriate environmental adaptationsenvironmental adaptations

to optimize independent function

Physical therapists involved in prevention, promoting health, wellness, fitness & health, wellness, fitness & screening activitiesscreening activities

Help patients/clients:Achieve & restore optimal functionMinimize impairments, functional limitations,

disabilitiesMaintain healthMaintain health (prevent further deterioration or

future illness)Create appropriate environmental adaptationsenvironmental adaptations

to optimize independent function

The Big PictureThe Big Picture

Adapted from Health Promotion and Wellness: Expanding Your Adapted from Health Promotion and Wellness: Expanding Your Practice ParadigmPractice ParadigmAmerican Physical Therapy Association (APTA)American Physical Therapy Association (APTA)Bezner, Black, IngmanBezner, Black, Ingman

Pre-pathogenic PeriodPre-pathogenic Period Period of PathogenesisPeriod of Pathogenesis

Primary PreventionPrimary Prevention SecondarySecondaryPreventionPrevention

HealthHealthPromotionPromotion

HealthHealthProtectionProtection

PreventativePreventativeHealthHealth

ServicesServices

TertiaryTertiaryPreventionPrevention

Early dxEarly dx& prompt& prompttreatmenttreatment

Prior toPrior tosymptomssymptoms

DisabilityDisabilityLimitationLimitation

RehabilitationRehabilitation

Health Promotion Natural Extension of PT’s Role Primary Care Practitioner

Examination

Evaluation

Diagnosis

Prognosis(Including PlanOf Care)

Intervention

Outcomes

Examples: Booth at Walmart; Lifelong PT, Annual ExamsExamples: Booth at Walmart; Lifelong PT, Annual Exams

Screening

MedicalDisease Lifestyle

Behaviors(HRA)

Refer or Treat

Physical Activity and Health: A Report of the Surgeon General, 1996

Physical Activity and Health: A Report of the Surgeon General, 1996

Commissioned by Secretary of Health Commissioned by Secretary of Health and Human Services in 1994and Human Services in 1994

Landmark review of the research on Landmark review of the research on physical activity and healthphysical activity and health

Joint Venture of Agencies:Joint Venture of Agencies:CDC lead federal agencyCDC lead federal agencyPresident’s Council on Physical Fitness President’s Council on Physical Fitness

and Sports (PCPFS)and Sports (PCPFS)

Commissioned by Secretary of Health Commissioned by Secretary of Health and Human Services in 1994and Human Services in 1994

Landmark review of the research on Landmark review of the research on physical activity and healthphysical activity and health

Joint Venture of Agencies:Joint Venture of Agencies:CDC lead federal agencyCDC lead federal agencyPresident’s Council on Physical Fitness President’s Council on Physical Fitness

and Sports (PCPFS)and Sports (PCPFS)

Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines All adults perform 30 or more minutes of All adults perform 30 or more minutes of

moderate-intensity physical activity on most, moderate-intensity physical activity on most, and preferably all, days---either in a single and preferably all, days---either in a single session or “accumulated” in multiple bouts, session or “accumulated” in multiple bouts, each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.


All adults perform 30 or more minutes of All adults perform 30 or more minutes of moderate-intensity physical activity on most, moderate-intensity physical activity on most, and preferably all, days---either in a single and preferably all, days---either in a single session or “accumulated” in multiple bouts, session or “accumulated” in multiple bouts, each lasting at least 8-10 minutes.each lasting at least 8-10 minutes.


An estimated 54 million persons in the United States,

or nearly 20% of the population currently live with

disabilities (McNeil 1997)

Interaction of ConceptsInternational Classification of

Function (ICF, 2001)

Interaction of ConceptsInternational Classification of

Function (ICF, 2001)

Health Condition Health Condition ((disorder/diseasedisorder/disease))

Environmental Environmental FactorsFactors

Personal Personal FactorsFactors

Body Body function&structurefunction&structure

(Impairment(Impairment))

ActivitiesActivities(Limitation)(Limitation)

ParticipationParticipation(Restriction)(Restriction)

Traditional Health PromotionTraditional Health Promotion “not to take care

of the sick and disabled, but

rather to prevent disease and disability in

the healthy”

“not to take care of the sick and disabled, but

rather to prevent disease and disability in

the healthy”

Purpose of Health Promotion Programs for the DisabledPurpose of Health Promotion Programs for the Disabled

Reduction of secondary conditions (obesity, hypertension, pressure sores)

Maintain functional independence

Provide opportunity for leisure and enjoyment

Enhance quality of life by reducing environmental barriers to good health

Reduction of secondary conditions (obesity, hypertension, pressure sores)

Maintain functional independence

Provide opportunity for leisure and enjoyment

Enhance quality of life by reducing environmental barriers to good health

Rimmer, 1999

NCPADNCPADNCPAD established in 1999 through a

grant through the CDC and Prevention’s Disability and Health Branch

Established to synthesize and disseminate research and programmatic information on physical activity and disability

Provides a model that attempts to bridge the gap between rehabilitation and community based health promotion

NCPAD established in 1999 through a grant through the CDC and Prevention’s Disability and Health Branch

Established to synthesize and disseminate research and programmatic information on physical activity and disability

Provides a model that attempts to bridge the gap between rehabilitation and community based health promotion

NCPADNCPADComprehensive source for information

related to physical activity and disabilityWebsite contains: searchable databases

containing articles, citations, programs and facilities and equipment vendors.

Website contains: fact sheets, monographs, bibliographies

Comprehensive source for information related to physical activity and disability

Website contains: searchable databases containing articles, citations, programs and facilities and equipment vendors.

Website contains: fact sheets, monographs, bibliographies

ACSM Guide to Exercise Testing Durstine and Moore 2009ACSM Guide to Exercise Testing Durstine and Moore 2009

Methods Measures

Aerobic- Cycle and wheelchair ergometer, traditional or wheelchair treadmill, combo arm and leg ergometer, seated stepper, arm ergometer

BP, HR, RPE

Endurance6 or12 min walk, arm/leg ergometer

Distance walked, time of exercise at 60% peak power

StrengthMmt with or without hand held dynomometer

Force generated on dynomometer

ACSM Guide to Exercise Testing Durstine and Moore 2009ACSM Guide to Exercise Testing Durstine and Moore 2009

FlexibilityHand held goniometer

ROM in shoulder, elbow, wrist, knee, ankle and other joints of affected limbs

NeuromuscularGait analysis, Berg balance, functional reach, POMA

Gait speed, symmetry of movement

FunctionalDuke Mobility, FIM, Individualized criterion referenced tests

ACSM Guide to Exercise Programming Durstine and Moore 2009ACSM Guide to Exercise Programming Durstine and Moore 2009

Modes Intensity/freq/duration

AerobicUpper and lower body ergometer

cycle ergometer, treadmill, wheelchair ergometer, wheelchair treadmill, arm ergometer, swimming

seated stepper, seated aerobics, free wheeling

RPE 13-20

50-80% peak HR

3-5 days/week

20-60 min session (or multiple 10 min sessions)

StrengthIsometric exercise, weight machine

Free weights/dumbells, wrist weights, rickshaw, lat pull-downs, rowing

3 sets of 8-12 reps

2-4 days/week

ACSM Guide to Exercise Programming Durstine and Moore 2009ACSM Guide to Exercise Programming Durstine and Moore 2009

Modes Intensity/freq/duration

Flexibilitystretching

2 days a week (before or after aerobic or strength activities)

NeuromuscularCoordination and balance activities

2 days/week (consider performing on same day as strength activities)

Aerobic Training Equipment ExamplesAerobic Training Equipment Examples

Aerobic Training AlternativesAerobic Training Alternatives

Strength Training Equipment ExamplesStrength Training Equipment Examples

Evidence-Based Community Programs and Outcomes for TBIEvidence-Based Community Programs and Outcomes for TBIGordon 1998 Retrospective

review of aerobic exercisers

decreased fatigue, decreased migraines, less depression, improved cognitive function, perception of health and social interaction.

Evidence-Based Community Programs and Outcomes for SCIEvidence-Based Community Programs and Outcomes for SCIDitor (2003) 9 month exercise

interventionLess pain, stress, increase in quality of life

Manns(1999) Relationship between fitness, physical activity, subjective quality of life, and handicap

Persons who were more fit, were generally less handicapped

Helen M. Galvin Center for Health and Fitness Helen M. Galvin Center for Health and Fitness Located at the Rehabilitation Institute of Chicago Made possible by private donations 4000 sq foot facility specifically created for people

with physical disabilities Free to the participants Provides an arena for persons to develop, maintain

and improve their physical well being Monthly attendance has averaged 1850 visits over the

past 2 years

Located at the Rehabilitation Institute of Chicago Made possible by private donations 4000 sq foot facility specifically created for people

with physical disabilities Free to the participants Provides an arena for persons to develop, maintain

and improve their physical well being Monthly attendance has averaged 1850 visits over the

past 2 years

An Emerging Market: Fitness Centers that Can Serve the DisabledAn Emerging Market: Fitness Centers that Can Serve the Disabled Linkages between

rehabilitation facilities and community based fitness centers

Fitness centers are a logical extension of the rehabilitation continuum by offering a location in the person’s natural environment

Involvement in nutrition seminars, relaxation classes, and health fairs.

Linkages between rehabilitation facilities and community based fitness centers

Fitness centers are a logical extension of the rehabilitation continuum by offering a location in the person’s natural environment

Involvement in nutrition seminars, relaxation classes, and health fairs.

Clarian health health promotion inservice november 8, 2010

Health & Medicine

health behaviors

infectious disease

america obesity

obesity trends

overweight increase

national heart

lbs overweight

dimensions of wellness