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 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 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
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
Efficacy of Exercise
Efficacy of Exercise “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 6
Exercise & Chronic Disease Management 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 of 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) 7
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 8
Barriers to Safe & Effective Exercise Accessibility ◦ Income disparity & poverty ◦ Facility availability 20% Active 80% Skill & Knowledge Sedentary ◦ Technique, intensity Only 20% of Canadians meet recommended guidelines (Colley et al., 2011) 9
Challenges to Canada’s health care system 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)
Kinesiology as an Integrated Clinical Service for Chronic Disease Management and Prevention
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
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
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)
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.)
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?
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
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)
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…
Exercise Education Program at Black Creek CHC
CHRONIC DISEASE REGISTERED KINESIOLOGIST CLINICAL EXERCISE HEALTH PROMOTION - Risk Assessment - Physical Activity EXERCISE - Exercise Prescription Workshops - Health Behavior Change - Community Outreach EDUCATION - Chronic Disease Self- - Health Screenings PROGRAM Management - Partnering Organizations
Client Physical Activity Referral/Enrollment Workshop INTAKE Physical Activity Medical Clearance RISK Assessment ASSESSMENT Goal Setting & Self- Management HEALTH BEHAVIOR CHANGE Exercise Education and Prescription
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
Risk Assessment Low Risk Intermediate Risk High Risk 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
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
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
Building individual capacity within their community EEP Delivers on the Model of Health and Wellbeing
Lets explore how ready your organization is to deliver an Exercise Education Program…
A few things to consider… Administrative ◦ NOD charting, scheduling ◦ Communication with staff, physicians and other health care practitioners Logistics ◦ How many RKins, volunteers/students ◦ Space ◦ Equipment available? No equipment?
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
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