rate of counseling for physical ac3vity · “if you want to feel be5er, you just need to lose some...

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Rateofcounselingforphysicalac3vity

32%ofpeoplewhosawaphysicianin2010wereadvisedtoexerciseorcon3nuebeingphysicallyac3ve

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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

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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

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Moore,PLoSMed2012

Planfor,andget,adequateexerciseReducesedentaryCme

150minutes(moderatetovigorous)aweek.Getupandmoveevery30-60minutes.

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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

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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

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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

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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.

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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

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ResourcesforPA,NutriCon,Sleep,StressandSocialSupport,WeightManagement:

•  Toolsforcoachingincrementalbehaviorchange

•  Mo3va3onalInterviewing•  RxtoLiVe•  Intermountain’sBehaviorChangeFramework

•  ToolsforpaCenteducaCon•  ToolsfortrackingandreporCng•  Programsforreferral

•  Die33ancounseling•  WeightoHealthclasses

•  CodingGuide

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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

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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”

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LearningModule:GetMoreCredit

•  CompleteonlineCPU(CareProcessUpdate)

•  ViewLWMCPMEduca3onalVideo

•  ReadCareProcessModelandReviewTools

•  Get2hoursCMEcredit

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GegngCredit–WheretoGoforeCME

•  Gotointermountainphysician.org,clickCMEattoplep•  ChooseIntermountainCMEfromdropdown•  ChooseOnlineLearning(eCME)fromlepsidemenu

hTps://intermountainphysician.org/intermountaincme/Pages/ecme.aspx

•  Themodule3tleis“LifestyleandWeightManagementCPM”inthePrimaryCareSec3on

•  2HoursCMEcredit

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Overview•  Setgoals/planforincrementalchangesinhealthbehaviors–smallsuccesses

•  You(andyourfamily)•  Yourstaff(andtheirfamilies)•  Yourpa3ents(andtheirfamilies)

•  UsePAVsandtheLifestyleandWeightManagementQues3onnairetostartyourdiscussion

•  Offerresourcestosupportpa3ent’sefforts•  Tools•  Referrals

•  Learnmore–CMECPUmodule