Clarian health health promotion inservice november 8, 2010
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
2. ObjectivesObjectives
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
18. Social
Interaction and relationships with
friends, family, significant others
Communication- both verbal and
non-verbal
Extracurricular activities
Activities and events
19.
20.
21. Why Is Health Promotion SoWhy 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
22.
23. 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
Shift from
curative measures
to preventative measures
Increased emphasis on personal
responsibility for health
24. Obesity 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
National Health Interview Survey, National Center for
Health Statistics, Health U.S. 2006
25. Obesity 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.
National Heart, Blood, & Lung Institute, Clinical Guidelines: Obesity
An estimated total cost of obesity in U.S. in 2000 was about $117 billion.
26. Obesity Trends* Among U.S. Adults
BRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC
27. Obesity Trends* Among U.S. Adults
BRFSS, 1995
No Data <10% 10%–14% 15%–19%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC
28. Obesity Trends* Among U.S. Adults
BRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC
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
33. Childhood Overweight/ObesityChildhood Overweight/Obesity
In the U.S., the prevalence of childhoodIn 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
34. The State of Our Nation:The State of Our Nation:
Trends in Health StatusTrends in Health Status
Nearly 30% of adultsNearly 30% of adults
18-75 years old are18-75 years old are
classified asclassified as
“inactive”“inactive”
Report no leisure-Report no leisure-
time physicaltime physical
activity (vigorous oractivity (vigorous or
light/moderate) of atlight/moderate) of at
least 10 minutesleast 10 minutes
durationduration
National Health Interview Survey, National Center for
Health Statistics, Health U.S. 2006
Nearly 50%Nearly 50%
American adults doAmerican adults do
not get enoughnot get enough
physical activity tophysical activity to
provide healthprovide health
benefitsbenefits
35. Most Recent CDC-ACSM Guidelines
All adults perform 30 or more minutes ofAll 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 singlein 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 dayOr 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 ofAll 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 singlein 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 dayOr at least 3 days a week for 20 minutes a day
of vigorous intensity activityof vigorous intensity activity
36.
37.
38. National Center Health Statistics. Health, 2004
The 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
39.
40. Source: Behavioral Risk Factor Surveillance System,CDC
2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no
41. The 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 cholesterol
30% 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
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,
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 Black
Female 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
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: TrendsThe State of Our Nation: Trends
in Health Behaviorsin Health Behaviors
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Men
Women
Total
0%
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
44. Why Is Health Promotion SoWhy Is Health Promotion So
Important in Our Nation Today?Important in Our Nation Today?
95% of the US95% of the US
healthcare economyhealthcare economy
is allocated to directis allocated to direct
medical caremedical care
Only 5% is allocatedOnly 5% is allocated
to healthto health
improvementimprovement
45. National Goals &National Goals &
Objectives for HealthObjectives for Health
Healthy People
followed by National
Goals and Objectives
Healthy People 2000
Nation’s health
agenda
Healthy People 2010
http://healthypeople.gov
46. Healthy People
2000, 2010 A comprehensive setA comprehensive set
ofof national healthnational health
objectivesobjectives for thefor the
decadedecade
Developed by aDeveloped by a
collaborative processcollaborative process
Designed toDesigned to measuremeasure
progressprogress over timeover time
AA public healthpublic health
documentdocument that is partthat is part
strategic plan, partstrategic plan, part
textbook on publictextbook on public
health prioritieshealth priorities
47. Healthy People 2010Healthy People 2010
Coordinated ByCoordinated By
The Office ofThe Office of
DiseaseDisease
Prevention andPrevention and
Health PromotionHealth Promotion
U.S. DepartmentU.S. Department
of Health andof Health and
Human ServicesHuman Services
(USDHHS)(USDHHS)
48. Healthy People 2010Healthy People 2010
Two overarchingTwo overarching
goalsgoals
28 focus areas28 focus areas
467 specific467 specific
objectivesobjectives
10 Leading Health10 Leading Health
IndicatorsIndicators
49. Two Overarching Goals:Two Overarching Goals:
Increase qualityIncrease quality
and years ofand years of
healthy lifehealthy life
Eliminate healthEliminate health
disparitiesdisparities
50. Healthy People 2010
28 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
HIV
Maternal, Infant, and
Child Health
Nutrition and
Overweight
Occupational Safety
and Health
Physical Activity and
Fitness
Respiratory Diseases
Tobacco Use
51. Healthy People 2010Healthy People 2010
10 Leading Health Indicators10 Leading Health Indicators
Physical ActivityPhysical Activity
Overweight andOverweight and
ObesityObesity
Tobacco Use
Substance Abuse
Responsible Sexual
Behavior
Mental Health
Injury and
Violence
Environmental
Quality
Immunization
Access to Health
Care
52.
53. How Healthy is Indiana?
Indiana Healthy Weight
INShape Indiana
Fit City
62. The 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
63. Roles of a Physical Therapist
Pathologies
Movement Science
Training Principles
Diverse Populations
Psychosocial Responses
Screening
64. Roles of a Physical Therapist
National goals include PT
Inherent credibility
Viewed as advocates, problem-solvers
Access to patient/client populations
Access to facilities and resources
Access to the public
66. APTA Vision 2020 Statement
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.
74. Health Promotion Practice
Greater participation in community
health activities
Public Health projects
Health Fairs
Prevention education programs
Consultants for community agencies,
schools, businesses, health clubs etc.
Professional conferences- community
health projects
75. Health Promotion Practice
Integration of health promotion and
preventive health services within
traditional practice
Screening
Referral
Collaboration
Client education
76. Health Promotion Practice
Linking with fitness centers, YMCA’s,
YWCA’s, health clubs
PT practices located in these settings
Consultation with fitness personnel to
facilitate client recovery and
rehabilitation
Prevention education programs
77. Health Promotion Practice
Transition or Chronic Care Programs
Service to clients no longer in PT
Well-suited for clients with chronic illness
or extended recovery
Slows development of disorders, prevents
functional losses
Group, individualized programs
78. Health Promotion Practice
PT Private Practice
Combination PT and Health Promotion
PT- Medical Model
HP- Client-centered care
Multidisciplinary Wellness centers
79. Health Promotion Practice
Health Promotion and wellness
programming- Seniors:
Long-term care
Assisted living community
Senior housing communities
Community groups
In homes
80. Health Promotion Practice
Other Health Promotion Niches:
Kids
School
Home
Women’s Health
Business Health
Worksite Wellness
Sports Health
Multidisciplinary wellness
81. APTA Position Statement on Health
Promotion and Wellness
By PTs and PTAs
The APTA recognizes that physical
therapists are uniquely qualifieduniquely qualified toto assume
leadershipleadership positions in efforts to preventprevent
injury and disabilityinjury and disability,, and fully supports the
positive rolespositive roles that physical therapists and
physical therapist assistants play in the
promotion of healthy lifestyles, wellnesspromotion of healthy lifestyles, wellness
and injury preventionand injury prevention..
HOD 06-93-25-50
Efforts coordinated through APTA Department of Practice,
Ken Harwood, PT, PhD, Director
82. HOD 06-04-09-09
Priority Goals of the APTAPriority Goals of the APTA
Goal 1:Goal 1: PhysicalPhysical
therapists aretherapists are
universallyuniversally
recognized andrecognized and
promoted as thepromoted as the
practitioners ofpractitioners of
choicechoice for personsfor persons
with conditions thatwith conditions that
affect movement,affect movement,
function,function, healthhealth, and
wellnesswellness.
83. Priority Goals of the APTAPriority Goals of the APTA
Goal II:Goal II: PhysicalPhysical
therapists are universallytherapists are universally
recognized and promotedrecognized and promoted
as providers ofas providers of fitnessfitness,,
health promotionhealth promotion,,
wellnesswellness, and, and riskrisk
reductionreduction programs toprograms to
enhance quality of life forenhance quality of life for
persons across the life-persons across the life-
span.span.
11/06HOD 06-04-09-09
84. APTA Normative Model/Guide toAPTA 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 function
Minimize impairments, functional limitations,
disabilities
Maintain healthMaintain health (prevent further deterioration or
future illness)
Create appropriate environmental adaptationsenvironmental adaptations
to optimize independent function
85. The Big Picture
Adapted from Health Promotion and Wellness: Expanding YourAdapted from Health Promotion and Wellness: Expanding Your
Practice ParadigmPractice Paradigm
American 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 SecondarySecondary
PreventionPrevention
HealthHealth
PromotionPromotion
HealthHealth
ProtectionProtection
PreventativePreventative
HealthHealth
ServicesServices
TertiaryTertiary
PreventionPrevention
Early dxEarly dx
& prompt& prompt
treatmenttreatment
Prior toPrior to
symptomssymptoms
DisabilityDisability
LimitationLimitation
RehabilitationRehabilitation
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 ExamsExamples: Booth at Walmart; Lifelong PT, Annual Exams
88. Physical Activity and Health: A Report of the
Surgeon General, 1996
Commissioned by Secretary of HealthCommissioned by Secretary of Health
and Human Services in 1994and Human Services in 1994
Landmark review of the research onLandmark 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 agency
President’s Council on Physical FitnessPresident’s Council on Physical Fitness
and Sports (PCPFS)and Sports (PCPFS)
89. Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines
All adults perform 30 or more minutes ofAll 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 singleand 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.
Or at least 3 days a week for 20 minutes a dayOr at least 3 days a week for 20 minutes a day
of vigorous intensity activityof vigorous intensity activity
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 ConditionHealth Condition
((disorder/diseasedisorder/disease))
EnvironmentalEnvironmental
FactorsFactors
PersonalPersonal
FactorsFactors
BodyBody
function&structurefunction&structure
(Impairment(Impairment))
ActivitiesActivities
(Limitation)(Limitation)
ParticipationParticipation
(Restriction)(Restriction)
92. Traditional Health Promotion
“not to take care
of the sick and
disabled, but
rather to
prevent disease
and disability in
the healthy”
93. Purpose 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
95. NCPAD
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
96. NCPAD
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
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)
104. Evidence-Based Community
Programs and Outcomes for TBI
Gordon 1998 Retrospective
review of aerobic
exercisers
decreased
fatigue,
decreased
migraines, less
depression,
improved
cognitive
function,
perception of
health and
social
interaction.
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
106. 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
107. An 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.
Notas do Editor
Over the last century, public health concerns have shifted
Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
Increased life expectancy by 30 years from beginning of 20th century
Mortality rates today are much more common to that of “diseases of behavior or lifestyle” and those that occur as a result of living into older years
-heart disease (became #1 in 1921)
-Cancer (top 10 early, worked its way up #2 in 1933)
- Stroke, intracranial vascular lesion (worked way up #3 1938)
COPD entered top 10 in 1974, now #4
Accidents, MVA (entered top 10 in 1926, worked way up)
Diabetes (entered top 10 in 1932)
Over the last century, public health concerns have shifted
Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
Increased life expectancy by 30 years from beginning of 20th century
Over the last century, public health concerns have shifted
Early 1900’s controlling infectious disease such as tuberculosis, pneumonia and influenza, diarrhea, enteritis, nephritis, premature births, sanitation, immunization that were threats to mortality
mid 1900’s discovery of penicillin, antibiotics, improvements in prenatal care, many of these causes of disease diminished or disappeared (still some concerns HIV, etc)
Increased life expectancy by 30 years from beginning of 20th century
Healthy People followed by release of first set of health goals and objectives for the nation
Have been several generations of these, most current is Healthy People 2010 (objectives set for each decade)
Leading Health Indicators reflect the major public health concerns in the U.S. And were chosen based on their ability to
- motivate action
- availability of data to measure progress
- their relevance as broad public health issues
Recent correspondence with Janet Bezner, Vice President of APTA and health promotion specialist
Stated that the APTA has played an active role since HP 2000 was created in 1990
Continues to be a part of the coalition of individuals and groups associated with HP2010
Recently met individually with the surgeon general to discuss APTA and physical therapist’s role in promoting fitness and wellness
Representatives were at the press conference when the new dietary guidelines were announced -
we were the only providers there relative to exercise.
These efforts are currently coordinated by the Department of Practice - the director is Ken Harwood, PT, PhD