healthy practices - smscs · jm chan et al. diabetes care1 2 g colditz et al. ann intern med...

HEALTHY PRACTICES

WANT TO

SHOULD DO

MUST DO

AVOID MUST DO DYSFUNCTIONAL

Resource Allocation

• Financial resources • only so much money, misdirected funds, what is your

health worth?

• Mental resources • cognitive load and devotion of mind to tasks/goals

• Time resources • Just in time life, scheduling efficacy, lap time analysis

• Resource Hierarchy, Resource Shortfall

Fitness

Physical

Literacy

Participation

Nutrition

The

Healthy

Puzzle

Maladaptive behaviours – stop bullshit

Get real sleep, alcohol, chew tobacco, etc.

0

20

40

60

80

100

120

140

0 10 20 30 40 50

BMI

Ris

k o

f D

isease

BMI = weight (kg) / ( height (m) * height (m) )

< 18.5 underweight

18.5–24.9 normal weight

25.0–29.9 overweight

30.0–34.9 class I obesity

35.0–39.9 class II obesity

≥ 40.0 class III obesity

BMI Classification

BMI ≥ 35 or 40 is severe obesity

BMI of ≥ 35 or 40–44.9 or 49.9 is morbid obesity

BMI of ≥ 45 or 50 is super obesity

Overweight and Obese Adult Canadians

0

10

20

30

40

50

60

70

ABC OW OB OW+OB

Pe

rce

nta

ge

65%

Morbid Obesity

• 1993 to 2006

– 1.8 to 6.1 per thousand participants was found (increase >200%).

– Morbid obesity prevalence higher in women.

• 4% increase in prevalence per year in women

• 12% per year in men

What percentage of people are active enough?

Age Males Females

6–11 48.9 34.7

12–15 11.9 3.4

16–19 10 5.4

20–59 3.8 3.2

60+ 2.5 2.3

So after 12, 95% are “derailed lifestyles”

– treatment mode not prevention.

LAPS

Or maximize your lap time!

What % of Canadians get 30 minutes of moderate PA per day?

0

10

20

30

40

50

60

1 2 3 4 5

Days a week

Pe

rce

nta

ge

Guide

line

11,462.8 11,326.8 8,416.0 7,883.4 11,480.9 10,982.3

-

2,000.0

4,000.0

6,000.0

8,000.0

10,000.0

12,000.0

14,000.0

Day of Week

Ste

ps/

day

Tuesday Wednesday Thursday Friday Saturday Sunday

Weekday Weekend

7000 steps shy of target 4000 steps shy of target

In one generation we have eradicated a human behaviour

Walking to School

2000 Steps/day gone

21 steps per kcal

The function of protecting and

developing health must rank even

above

that of restoring it when impaired

Hippocrates

Sleep

Work

Food

Screen

Exercise

Sleep

Work

Food

Screen

Exercise

Average Canadian

Daily Activity Inventory

24 min/day of MVPA

1.6% of the day

Ideal Canadian

Daily Activity Inventory

60 min/day of MVPA

4.2% of day Minimum Canadian

Daily Activity Inventory

30 min/day of MVPA

2.1% of the day

PA Dysfunction Index

• Self-Reported Physical Activity – The majority report meeting the physical activity guidelines (52.5%)

• Actual Physical Activity – 4.8% get 30 min a day for 5 to 7 days per week.

– 15.4% get 150 minutes per week

– 34.% get over 10,000 steps/day

• Dysfunction Index – Self-report/Actual

– 52.5/4.8 = 10.9X

Kruger Report 2010

• Physical inactivity combined with obesity and smoking cost Manitobans $1.62 billion in 2008; the economic burden will ↑ by $4.7 billion by 2026.

Osteoporosis

Cancer

Diabetes

Depression Osteoarthritis

BMI 1 JM Chan et al. Diabetes Care 2 G Colditz et al. Ann Intern Med 17:961-969, 1994 122:481-486, 1995

Obesity is a Major Risk Factor for Type 2 Diabetes

50 100

0

10

20

30

40

1.0 2.2

12

42

<23 25 31 35

Men1

0

25

50

75

1.0 8.1

40

93

<22 25 31 35

Women2

Physical Activity & Cancer

National Cancer Institute 2011

Colon

Breast

Prostate

Endometrium

Lung

Convincing

Convincing

Probable

Probable

Probable

30 – 40 %

20 - 80 %

0 %

20 – 40 %

20 %

Cancer Evidence Risk Reduction

Studies

> 50

> 60

> 36

> 20

> 20

CT of the femur

– the shape changes with activity!

Active

Control

Sedentary

• The shape of the bone is very important in strength

• Activity and inactivity dramatically change shape!!

1 3 4 5 6 7 2

1 3 4 5 6 7 2

A lifestyle intervention

involving diet combined with

initial or delayed initiation of

physical activity results in

clinically significant weight

loss and favorable changes

in cardiometabolic risk

factors

10 kg per year

½ lb per week

Scheduling Efficacy

Walk through a week with them. ID barriers to participate, slot in times that work and cant work.

Find work around for barriers. 20+ minutes is not uncommon.

Accountability Framework

• Weekly meetings

• Weekly updates of programming success

• Weekly submission of information

– Pedometer counts

– Weight, circumference

• Training Partner or group

• Family support

Successful Interactions - Individual

• AIM: behaviour change

– Mindful eating

– Elimination of over-consumption episodes

– Caloric maximums per day

– Regular PA

• PA in schedule, PA for caloric expenditure, PA for cv fitness

The Five R’s (3+2)

Regular Physical Activity & Real Nutrition

Reading wRiting aRithmetic Relationships

The 5th R

Adherence Grade 6 Manitoba

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<30.0 30.0-59.9 60.0-89.9 ≥90.0

Activity Time (min/d)

M

F

52.2% accumulated <30.0 min,

31.1% accumulated 30.0 to 59.9 min,

12.7% accumulated 60.0 to 89.9 min

4.0% accumulated ≥90.0 min.

(Wittmeier, Mollard and Kriellaars, 2007)

Manitoba Children

Combined Boys Girls

Height (cm) 136.4 (7.7) 136.7 (7.8) 136.1 (7.7)

Mass (kg) 34.5 (9.7) 33.8 (9.1) 35.3 (10.3)

Body Fat

(%) 21.3 (8.0) 19.2 (8.0)* 23.5 (7.4)

BMI (kg/m2) 18.5 (4.1) 17.9 (3.6)* 19.1 (4.5)

MPA (min/d) 29.0 (19.1) 33.3 (20.0)* 24.5 (17.0)

VPA (min/d) 6.8 (8.0) 8.7 (9.4)* 4.9 (5.6)

Moderate Physical

Activity Time (min)

Body Composition

Non-

overweight* Overweight* Overweight* Obese*

**<20% 20-25%** 25-30%** >30%**

< 30 21.1 12.4 6.8 12.0

30 – 59.99 17.1 5.2 4.0 4.9

60 – 89.99 8.8 2.0 0.4 1.6

≥ 90 2.8 0.8 0.4 0

Manitoba Children

Park kids

– children not yet overweight or obese but very inactive

- primary prevention possible with this group

Only 16.8% > 60 min

52% below 30 min

Parental Influence – Role Model

Parental Energy Index (Lytle et al, 1999)

How often do you talk about this issue with your child?

1. School work

2. Chores

3. Getting along with the family

4. Safety-helmets, seatbelts

5. Avoiding cigarettes

6. Avoiding alcohol, marijuana and other drugs

7. Avoiding violence

8. Friends they choose

9. Eating habits

10. Getting more physically active

16 week rivalry based pedometer intervention (Grade 6, n=77, three countries): 4198 steps/day increase! 10 children lost more than 10 lbs.

Average Steps/Day Between Schools

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Time in program (start, mid, end)

Ste

ps/d

ay

-a

y

Pedometer Interventions Aid - but can’t be used all the time.

AM

Recess

(min)

Lunch

Recess

(min)

PM

Recess

(min)

PE Class

(min)

Daily

Total

(min)

Total/Week

(min)

School

1

15 35 15 40

(x 5 days /

week)

105 525

School

2

15 25 15 30

(x 2 days /

cycle)

55-85 335

Steps/day School 1 - 12100 School 2 - 9975

Body Fat School 1 – 21.4% School 2- 22.2%

BMI School 1 – 17.6 School 2- 18.7

0

1000

2000

3000

4000

5000

6000

7000

8000

School 1 School 2

Ste

p C

ou

nts

In School

Out of School

Self – Esteem

• Self-esteem "the disposition to experience

oneself as competent to cope with the challenges of life and as deserving of happiness"

• Improve self-esteem

– Dream Big – Make expectations realistic – Achieve small goals – Create success

The Facebook Mom

Towards An Ability Model

“Inverted” WHO ICF

Physical Literacy, Fitness,

Nutrition

Ability Model

LTAD LTPD

Curricular

(school & recreation)

Beat Self Sabotage

It is not weakness of person, but lack of resolve toward the goal. Motivation needs fueling!

Motivation = intrinsic, extrinsic, reminders, focus, peer support, inspiration, worth

Silent & Sneaky Calories

• Large coffee, double double – 230 kcals – 3 times a day = 690 kcals – 7 days a week = 1.38 lbs fat per week

• Large coffee black – 0 kcals

Same story with • apple juice • pop • lattes • wine or beer

Calories In Calories Out

Breaking Up with Miss Vickie

Don’t picket McDonalds – picket the people who drive through!

Otherwise picket the furniture manufacturers.

Caloric Balance – THE FIRST LAW!

• INPUT over OUTPUT stays PUT

– Whether it comes from

• FAT – Fat food don’t make you fat

• Carbohydrates – carbs don’t make you fat

• Protein – protein doesn’t make you fat

• Overconsumption does! • Portion control, Episodic over-consumption

Caloric Balance

Energy Expenditure Energy Intake

1. Exercise

2. Activity of Daily Living

3. Resting Metabolic Rate

1. Over-consumption

2. Recommended Caloric Intake

+ 150 kcals/day

15.5 lbs fat/year

Caloric Balance “Lifestyle Intervention”

1. Exercise

2. Activity of Daily Living

3. Resting Metabolic Rate

1. Over-consumption

2. RDA Caloric Intake

Energy Expenditure Energy Intake

3500-7000 kcals/week

1-2 lbs fat

5-7 lbs weight/week

water

INPUT over OUTPUT stays PUT

Food/Junk

ADL Activity

Fuel

Active Lifestyle

& Exercise

Mindful Eating / Increase Work Capacity Negative balance: caloric restraint & activity Sustainable Mindful Eating & Maintained PA Break up with Ms. Vickie

Personal choices … focus on fat .. – don’t be dysfunctional

Male athlete, 22 y.o., 180 lbs, 7% body fat, 3700 kcal/d

protein: 17% = 161 g/d

fat: 26% = 106 g

CHO: 57% = 527 g

Female, 57 y.o., 180 lbs, 39% fat, 1700 kcal/d

protein: 31% = 131 g/d

fat: 30% = 57 g

CHO: 39% = 166 g

Know how to estimate caloric expenditure.

V02 V02 Energy

Expended Workout Intensity

ml/kg/min ml/min Kcals/min 55% of Max

3.5 192.5 0.96

15 825 4.1

36 1980 9.9 5.4

50 2750 13.8

65 3575 17.9

88 4840 24.2 13.3

For every litre of oxygen consumed – 5 kcals of energy are liberated.

5.4 kcals/min X 20 min X 3 times per week = 324 kcals (two granola bars)

1 MET

Average Canadian

Most Fit Person

One night out a week.

• Pre-game (a bevie or two and some chips)

• A few more bevies and an appetizer.

• Designated driver drives to McDonalds.

• 240 + 650

• 600 + 500

• 1450

• 3440 Calories

Input > Output STAYS PUT

= 1 lb of fat! Overnight.

10 X during summer = 10 new lbs!

We are knowledgeable … … but we are not yet enlightened.

A Healthy Lifestyle?

THE GOOD LIFE

• in search of the good life (Consumerism)

• … in search of an easier life (Conveniences)

• … in search of a life that is good (Wealth)

• CCW

• …in search of a healthy lifestyle …

Bones need physical activity!

Inactivity makes bones shrink!

Active

Control

Sedentary

1 3 4 5 6 7 2

1 3 4 5 6 7 2

Immobile Active

Healthy Bones = activity plus in the presence of calcium and vitamin D

Bone loss reduced = adequate calcium and vitamin D

Bone loss accelerated = inadequate calcium and vitamin D

Healthy = Good Nutrition and Good Activity

Healthy ≠ Good Nutrition

Moderate Physical

Activity Time (min)

Body Composition

Non-

overweight* Overweight* Overweight* Obese*

**<20% 20-25%** 25-30%** >30%**

< 30 21.1 12.4 6.8 12.0

30 – 59.99 17.1 5.2 4.0 4.9

60 – 89.99 8.8 2.0 0.4 1.6

≥ 90 2.8 0.8 0.4 0

Risk Model: Physical activity and body composition

Park - not yet overweight or obese but very inactive - primary prevention possible with this group

Only 16.8% > 60 min 52% below 30 min

Parental Energy Index (Lytle et al, 1999)

How often do you talk about this issue with your child? 1. School work 2. Chores 3. Getting along with the family 4. Safety-helmets, seatbelts 5. Avoiding cigarettes 6. Avoiding alcohol, marijuana and other drugs 7. Avoiding violence 8. Friends they choose 9. Eating habits 10. Getting more physically active

Adherence Grade 6 Manitoba

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

<30.0 30.0-59.9 60.0-89.9 ≥90.0

Activity Time (min/d)

M

F

52.2% accumulated <30.0 min, 31.1% accumulated 30.0 to 59.9 min, 12.7% accumulated 60.0 to 89.9 min 4.0% accumulated ≥90.0 min.

(Wittmeier, Mollard and Kriellaars, 2007)

Parental Influence – Role Model

52.2% accumulated <30.0 min, 31.1% accumulated 30.0 to 59.9 min, 12.7% accumulated 60.0 to 89.9 min 4.0% accumulated ≥90.0 min.

Windows of Opportunity.

The task force recommends that the government

mandate physical education/health education

(phys ed/health) from kindergarten to Senior 4.

Implementation will vary according to grade to

provide maximum flexibility to involve parents,

students and schools in the promotion of physical

activity for children and youth. provision

Our Manitoba Children

Combined Boys Girls

Height (cm) 136.4 (7.7) 136.7 (7.8) 136.1 (7.7)

Mass (kg) 34.5 (9.7) 33.8 (9.1) 35.3 (10.3)

Body Fat

(%) 21.3 (8.0) 19.2 (8.0)* 23.5 (7.4)

BMI (kg/m2) 18.5 (4.1) 17.9 (3.6)* 19.1 (4.5)

MPA (min/d) 29.0 (19.1) 33.3 (20.0)* 24.5 (17.0)

VPA (min/d) 6.8 (8.0) 8.7 (9.4)* 4.9 (5.6)

TARGET: 90 minutes

60

30

Intensity Duration

(min/d)

BMI

(overweight*)

Body Fat

(≥20%)

Body Fat

(≥25%)

OR P OR P OR P

Moderate

>= Brisk

walk

>45 1.00 1.00 1.00

>45 ≤45 1.52 0.19 3.15 <0.001 1.97 0.07

>45 ≤30 1.49 0.21 3.51 <0.001 2.16 <0.05

>45 ≤15 2.04 0.07 4.20 <0.001 3.04 <0.01

Vigorous

>= Slow

run

>15 1.00 1.00 1.00

>15 ≤15 4.45 <0.01 3.23 <0.01 2.23 0.08

>15 ≤10 4.63 <0.01 3.26 <0.01 2.58 <0.05

>15 ≤5 5.21 <0.01 4.03 <0.001 2.90 <0.05

What amount of PA?

77

Measures SCSP (n=44) Non-SCSP (n=57) r

PA (# steps) 9996 (3859) <NS 10806 (3429) .007

CVF (ml/kg/min)

49.82 (6.21) >**

42.64 (6.54) .72**

AS (# reps) 81.93 (19.38) >** 62.76 (26.80) .49**

PU (# reps) 22.63 (8.73) >** 15.71 (10.18)

SU (# reps) 43.00 (9.29) >** 35.64 (11.32)

MPU (#reps) 16.30 (7.68) >** 11.42 (7.93)

Age (years) 16.14 (0.71) >NS 15.96 (0.72)

Height (m) 1.73 (0.09) >NS 1.72 (0.08)

Mass (kg) 64.86 (10.06) <NS 67.68 (15.60)

BMI (kg/m2) 21.64 (1.92) <NS 22.80 (4.76)

BF (%) 18.99 (5.58) <** 24.65 (11.29) -.56**

WC (cm) 75.49 (6.43) <* 80.43 (11.94)

Sport vs Non-Sport

78

Measures SCSP (n=44) Non-SCSP (n=57)

GPA 76.28 (7.40) >NS 74.96 (8.74)

Physical Self-Description Questionnaire (PSDQ) (maximum of 6)

Health 4.93 (0.68) >NS 4.60 (1.03)

Coordination 4.82 (0.81) >** 4.08 (0.94)

Physical activity 5.37 (0.69) >** 4.14 (1.32)

Body fat 5.37 (0.83) >** 4.32 (1.53)

Sports competence 4.93 (0.80) >** 3.73 (1.33)

GP self-concept 5.24 (0.71) >** 4.10 (1.20)

Appearance 4.83 (0.78) >* 4.28 (0.94)

Strength 4.66 (0.99) >** 3.74 (1.13)

Flexibility 4.21 (1.13) >NS 3.81 (1.20)

Endurance/fitness 4.89 (0.98) >** 3.57 (1.27)

Global self-esteem 5.44 (0.46) >** 4.87 (0.81)

Self-description of competence

79

IN, OUT and CONTROL GROUPS

25% C ore-Online

OUT

Student-Directed

75% P A Practicum

IN

Teacher-Directed

25% C ore-Online

OUT

Student-Directed

75% P A Practicum

OUT

Student-Directed

No PE Course

IN (n=22)

CONTROL (n=14)

OUT (n=65)

Assessments

• Physical Activity – 14 day pedometry – DAILY Activity Logs (4 MONTHS)

• Cardiovascular Fitness – Shuttle Run (20 m) – 1 mile Walk (HR and time)

• Strength and Endurance – Chest, Back and Core – Aggregate Strength

• Body Composition – Waist circumference – BMI – Body Fat

• Self Concept and Self-Esteem

Psychology

Physical Activity

Strength &

Endurance

Body Composition

CV Fitness

81

METHODS Physical self-description questionnaire (PSDQ)

Composed of 70 questions, 11 subscales. 6-point Likert scale (1=false, 6=true).

SUBSCALE DESCRIPTION

1. Strength Perceived physical strength

2. Body Fat Perceived body fat

3. Physical Activity Levels of physical activity in which one

has engaged

4. Endurance/Fitness Perceived physical endurance/fitness

5. Sport Competence Perceptions of one’s own sporting ability

6. Coordination Perceived physical coordination

7. Health Perceptions of one’s own physical health

8. Appearance Perceptions of own physical appearance

9. Flexibility Perceived physical flexibility

10. General Physical Self-Concept Global physical self-concept

11. Self-Esteem Global self-esteem

Design

• Baseline Assessment n=101 – September – two weeks

• HE/PE Natural Experiment (10 weeks)

• 1st Semester Assessment n=101 – December – two weeks

• HE/PE Natural Experiment

• 2nd Semester Assessment n=31 – June – two weeks

What do we need to see?

• Mandatory: A change in the right direction for each group over semester.

• Nice: A difference between groups after semester.

• Ideal: A long term change – 3 years.

– physical activity

• climate dependent,

• stimulus to drive CVF and body composition changes

– cardiovascular fitness – most important as related to disease

– body composition – why we are doing it in the

84

Pedometry

PA by Pedometry

Cardiovacular fitness

87

Body Fat

88

Strength