1. Health Promotion for Physical Therapists: Concepts and Practical Applications Julie Gahimer PT, HSD Associate Professor Krannert School of Physical Therapy University of Indianapolis November 8, 2010

3. 6 Dimensions of Wellness

4. The Six Dimensions of Health

5. My Six Dimensions of Health

26. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14%

27. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19%

28. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC No Data <10% 10%–14% 15%–19% ≥20

29. Obesity Trends* Among U.S. Adults BRFSS, 2001 No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) Source: Behavioral Risk Factor Surveillance System, CDC

30. Obesity* Trends Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% Source: Behavioral Risk Factor Surveillance System, CDC

32. Source: Behavioral Risk Factor Surveillance System, CDC

40. Source: Behavioral Risk Factor Surveillance System,CDC 2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no

42. 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 Black Asian Hispanic * Total Age-adjusted rate per 1,000 population 1997-99 2000-02 2003-05 2010 Target: 3.8 * 5 10 15 0 20 Obj. 5-2 New Cases of Diabetes, Among Adults Decrease desired

43. Percentage of Adults Who Reported Eating fewer Than Five Servings of Fruits and Vegetables a Day, by Sex, 2002 The State of Our Nation: Trends in Health Behaviors 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

59. Health Risk Appraisals (HRA’s)

60. Senior Fitness Test Roberta E Rickli, C Jessie Jones

65. American Physical Therapy Association

68. APTA Video Podcasts on Health Promotion

71. Center for Disease Control

85. The Big Picture Adapted from Health Promotion and Wellness: Expanding Your Practice Paradigm American Physical Therapy Association (APTA) Bezner, Black, Ingman Pre-pathogenic Period Period of Pathogenesis Primary Prevention Secondary Prevention Health Promotion Health Protection Preventative Health Services Tertiary Prevention Early dx & prompt treatment Prior to symptoms Disability Limitation Rehabilitation

86. Health Promotion Natural Extension of PT’s Role Primary Care Practitioner Examination Evaluation Diagnosis Prognosis (Including Plan Of Care) Intervention Outcomes Examples: Booth at Walmart; Lifelong PT, Annual Exams

87. Screening Medical Disease Lifestyle Behaviors (HRA) Refer or Treat

90. An estimated 54 million persons in the United States, or nearly 20% of the population currently live with disabilities (McNeil 1997)

91. Interaction of Concepts International Classification of Function (ICF, 2001) Health Condition ( disorder/disease ) Environmental Factors Personal Factors Body function&structure (Impairment ) Activities (Limitation) Participation (Restriction)

94. Rimmer, 1999

97. ACSM 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 Endurance 6 or12 min walk, arm/leg ergometer Distance walked, time of exercise at 60% peak power Strength Mmt with or without hand held dynomometer Force generated on dynomometer

98. ACSM Guide to Exercise Testing Durstine and Moore 2009 Flexibility Hand held goniometer ROM in shoulder, elbow, wrist, knee, ankle and other joints of affected limbs Neuromuscular Gait analysis, Berg balance, functional reach, POMA Gait speed, symmetry of movement Functional Duke Mobility, FIM, Individualized criterion referenced tests

99. ACSM Guide to Exercise Programming Durstine and Moore 2009 Modes Intensity/freq/duration Aerobic Upper 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) Strength Isometric exercise, weight machine Free weights/dumbells, wrist weights, rickshaw, lat pull-downs, rowing 3 sets of 8-12 reps 2-4 days/week

100. ACSM Guide to Exercise Programming Durstine and Moore 2009 Modes Intensity/freq/duration Flexibility stretching 2 days a week (before or after aerobic or strength activities) Neuromuscular Coordination and balance activities 2 days/week (consider performing on same day as strength activities)

101. Aerobic Training Equipment Examples

102. Aerobic Training Alternatives

103. Strength Training Equipment Examples

105. Evidence-Based Community Programs and Outcomes for SCI Ditor (2003) 9 month exercise intervention Less 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