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Rateofcounselingforphysicalac3vity
32%ofpeoplewhosawaphysicianin2010wereadvisedtoexerciseorcon3nuebeingphysicallyac3ve
©2013IntermountainHealthcare.Allrightsreserved.
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Clinician
Staff
Pa3ents
“Wesucceedwhenwethinkandactfromtheinsideout”SimonSinek
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Clinicians’LifestylePredic3ve
Physicianswhoarephysicallyac3veare2-53mesmorelikelytocounseltheirpa3entstobephysicallyac3ve.1,2
PhysicianswhohaveanormalBMIaremorelikelytocounseltheirpa3entsthanoverweight/obesephysicians(30%vs.18%).3
©2013IntermountainHealthcare.Allrightsreserved.
1. LobeloF,GarciaI.Theevidenceinsupportofphysiciansandhealthcareprovidersasphysicalac3vityrolemodels.AmJLifestyleMed.Inpress(hTp://newsroom.heart.org/news/physically-ac3ve-healthcare-providers-more-likely-to-give-physical-ac3vity-counseling)
2. StanfordFCJPrimPrev.2014Jun;35(3):193-2013. BleichSN.Obesity.2012May;20(5):999-1005
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Clinician
Staff
Pa3ents
2014HealthHeroes
DonnaBarhorst,MDMarkWardle,DO
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Clinician
Staff
Pa3ents
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EffectofbodyweightandphysicalacCvityonlifeexpectancy
©2013IntermountainHealthcare.Allrightsreserved.
Moore,PLoSMed2012
Planfor,andget,adequateexerciseReducesedentaryCme
150minutes(moderatetovigorous)aweek.Getupandmoveevery30-60minutes.
page12©2013IntermountainHealthcare.Allrightsreserved.
1. Onaverage,howmanydaysaweekdoyouperformphysicalac3vityorexercise?
2. Onaverage,howmanytotalminutesofphysicalac3vityorexercisedoyouperformonthosedays?days/weekXminutes/day=min/week(PAVS)
3.Describetheintensityofyourphysicalac3vityorexercise:light=casualwalkmoderate=briskwalk vigorous=jogging
PhysicalAcCvityVitalSigninHELP2iCentra
150
5
30
Light, moderate, vigorous
Start, increase, maintain
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Sedentarybehavior• SedentarybehaviorCmeisanindependentpredictorofmortality,evenforthosewhohaverecommendedlevelsofphysicalacKvity.1
• TakingacCvitybreaksmakesadifference.Astudyofsedentaryworkersshowedthatinterrup3ngsibngwithshortboutsoflight-tomoderate-intensitywalkingreducedpostprandialglucose(P<0.01)andinsulin(P<0.0001).2
©2013IntermountainHealthcare.Allrightsreserved.
1. vanderPloegH,etal.ArchInternMed.2012;172(6):494-500.
2. DunstanDW,etal.DiabetesCare.2012;35(5):976-983.
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ChildandAdolescentPAVs1• PAVs–Daysperweekof60minutesofmoderatetovigorousphysicalac3vity
• AddedPAAssessment–Mostdaysoftheweek(AmericanCollegeofSportsMedicine)
• Walkorbiketoschool• Par3cipateinphysicaleducaConclassatschool
• Par3cipateinanorganizedphysicalacCvityor30minutesormoreplayingoutside
• LESSthan2hoursofrecreaConalscreenCme
©2013IntermountainHealthcare.Allrightsreserved.
1. US Department of Health and Human Services (HHS). 2008 Physical ActivityGuidelines for Americans. Available at http://www.health.gov/paguidelines/guidelines/default.aspx
Getadequatesleep5
7-9hoursforadults
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SleepRecommendedhoursofsleep:
• Newborns 14-17hours• Infants 12-15hours• Toddlers 11-14hours • Pre-school 10-13hours• Schoolage 9-11hours• Teenagers 8-10hours• Adults 7-9hours• Olderadults 7-8hours
©2013IntermountainHealthcare.Allrightsreserved.
1. Na3onalSleepFounda3on
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SleepConsequencesofinadequatesleep:
• Children:Increaseddailycaloricintake(lowerlep3n)andriskofobesity.1,2
• Adults:Atfewerthan7hoursnightly:theshorterthesleep,thehighertheBMI.3
• Moresickdays4• Pa3entswithfewerthan5hoursnightly(comparedwiththosewhoget7to8hours):5
• Are2.53mesmorelikelytohavediabetes.• Have15%higherall-causemortalityrisk.
©2013IntermountainHealthcare.Allrightsreserved.
1. HartCN,etal.Pediatrics.2013Dec,132(6):e1473-80.2. ShakiraFS,etal.JournalofPediatrics.2014;165(4):750-754.3. NedelchevaAV,etal.AnnInternMed.2010;153(7):435-441.4. LallukkaT,etal.Sleep2014;37(9):1413-1425.5. ColtonHR,etal.Ins3tuteofMedicine;2006
PracCceHealthyEaCng
Eliminateaddedsugars–Sweeteneddrinks(vehicle)Overea3ngcalories(highlypalatablefoods)–subs3tutewithvegandfruit
Healthydiet–Mediterranean,DASH
3
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ToolstoevaluatepaCentandstartthediscussion• PAVs• LifestyleandHealth
RiskQuesKonnaire(adultandchild)
AddiConalpediatricevaluaContoolsinclude• BMIpercen3lechart• ParentalScreenand
FamilyRa3ngScale• SEEK
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iCentra
• EvaluaCngpaCent:• Enterdatathroughapre-structuredPowerForm
• LWMQuesConnaire:PhysicalAc3vity/Nutri3on/Sleep,MentalHealth,SocialSupport/Weight
• STOP-BANGsleepapneascreen• Enterdataintoclinicalnote
• Useapre-structuredTemplate
©2013IntermountainHealthcare.Allrightsreserved.
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ResourcesforPA,NutriCon,Sleep,StressandSocialSupport,WeightManagement:
• Toolsforcoachingincrementalbehaviorchange
• Mo3va3onalInterviewing• RxtoLiVe• Intermountain’sBehaviorChangeFramework
• ToolsforpaCenteducaCon• ToolsfortrackingandreporCng• Programsforreferral
• Die33ancounseling• WeightoHealthclasses
• CodingGuide
©2013IntermountainHealthcare.Allrightsreserved.
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Howarewedeliveringourmessage?
“Ifyouwanttofeelbe5er,youjustneedtolosesomeweightbyexercisingmoreandea<ngbe5er.Itwouldalsobegoodforyoutogetmoresleepandmanageyourstress.Let’sseeyoubackinacoupleofmonthsandyoucantellmehowyou’redoingwiththese
changes.”
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ResourcesforPA,NutriCon,Sleep,StressandSocialSupport,WeightManagement:
• Toolsforcoachingincrementalbehaviorchange
• Mo3va3onalInterviewing• Intermountain’sBehaviorChangeFramework
• ChildRxtoLiVe/MakingaChange• ToolsforpaCenteducaCon• ToolsfortrackingandreporCng• Programsforreferral
• Die33ancounseling• WeightoHealthclasses
• CodingGuide
©2013IntermountainHealthcare.Allrightsreserved.
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ResourcesforPA,NutriCon,Sleep,StressandSocialSupport,WeightManagement:WhereDoWeFindTheseResources?
• Website:• intermountain.net/lifestyle• Withinfirewall,justtype“lifestyle”
• Orderingfromwww.i-printstore.com:• Browseorsignin• ChoosePa3entandProviderEduca3onmaterials
• Menu—PrimaryCareandPreven3on–Lifestyle
• Orjustsearchfor“lifestyle”
©2013IntermountainHealthcare.Allrightsreserved.
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LearningModule:GetMoreCredit
• CompleteonlineCPU(CareProcessUpdate)
• ViewLWMCPMEduca3onalVideo
• ReadCareProcessModelandReviewTools
• Get2hoursCMEcredit
©2013IntermountainHealthcare.Allrightsreserved.
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GegngCredit–WheretoGoforeCME
• Gotointermountainphysician.org,clickCMEattoplep• ChooseIntermountainCMEfromdropdown• ChooseOnlineLearning(eCME)fromlepsidemenu
hTps://intermountainphysician.org/intermountaincme/Pages/ecme.aspx
• Themodule3tleis“LifestyleandWeightManagementCPM”inthePrimaryCareSec3on
• 2HoursCMEcredit
©2013IntermountainHealthcare.Allrightsreserved.
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Overview• Setgoals/planforincrementalchangesinhealthbehaviors–smallsuccesses
• You(andyourfamily)• Yourstaff(andtheirfamilies)• Yourpa3ents(andtheirfamilies)
• UsePAVsandtheLifestyleandWeightManagementQues3onnairetostartyourdiscussion
• Offerresourcestosupportpa3ent’sefforts• Tools• Referrals
• Learnmore–CMECPUmodule