clarian health health promotion inservice november 8, 2010
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Health Promotion for Physical Therapists:
Concepts and Practical Applications
Health Promotion for Physical Therapists:
Concepts and Practical Applications
Julie Gahimer PT, HSDAssociate Professor
Krannert School of Physical TherapyUniversity of Indianapolis
November 8, 2010
Julie Gahimer PT, HSDAssociate Professor
Krannert School of Physical TherapyUniversity of Indianapolis
November 8, 2010
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ObjectivesObjectivesObjectivesObjectives 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
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
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6 Dimensions of Wellness6 Dimensions of Wellness
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The Six Dimensions of Health
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My Six Dimensions of Health My Six Dimensions of Health
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My Six Dimensions of HealthMy Six Dimensions of Health1. Physical2. Emotional3. Spiritual4. Intellectual5. Psychological6. Social
1. Physical2. Emotional3. Spiritual4. Intellectual5. Psychological6. Social
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PhysicalPhysicalExercise/fitnessWeight/body fatDietCardiovascular/strength trainingDisease preventionLifestyle: active vs sedentaryPrevention and safety: helmets,
seatbelts, smoking, safe sex, drugs, alcohol
Exercise/fitnessWeight/body fatDietCardiovascular/strength trainingDisease preventionLifestyle: active vs sedentaryPrevention and safety: helmets,
seatbelts, smoking, safe sex, drugs, alcohol
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EmotionalEmotionalStress managementDepressionRelaxation timeOutletsSelf-esteemSupport of loved onesWorrying about things you cannot controlLearn from mistakes, not dwelling on themControl of anxiety
Stress managementDepressionRelaxation timeOutletsSelf-esteemSupport of loved onesWorrying about things you cannot controlLearn from mistakes, not dwelling on themControl of anxiety
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SpiritualSpiritualFaithValuesMoralsBeliefs
FaithValuesMoralsBeliefs
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IntellectualIntellectualJob/school fulfillment or successStressRelationships with co-workers, clients,
employerJob safetyGood attitudeMotivationFinancial security
Job/school fulfillment or successStressRelationships with co-workers, clients,
employerJob safetyGood attitudeMotivationFinancial security
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PsychologicalPsychologicalStress managementSelf esteemSocial interactionAttitudeOrganizationEnvironment
Stress managementSelf esteemSocial interactionAttitudeOrganizationEnvironment
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SocialSocialInteraction and relationships with
friends, family, significant othersCommunication- both verbal and
non-verbalExtracurricular activitiesActivities and events
Interaction and relationships with friends, family, significant others
Communication- both verbal and non-verbal
Extracurricular activitiesActivities and events
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Why Is Health Promotion So Why Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?
Why Is Health Promotion So Why 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
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
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10 Leading Causes of Death (increased longevity & lifestyle)
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
Heart disease (decreased)
Malignant neoplasms Cerebrovascular
disease COPD Accidents (including
MVA) Pneumonia & Influenza Diabetes Suicide Nephritis/Nephrosis Chronic Liver &
Cirrhosis
Shift fromcurative measures to preventative measures
Increased emphasis on personal responsibility for health
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Obesity and OverweightObesity and OverweightObesity 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
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
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Obesity and OverweightObesity 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.
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.
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Obesity Trends* Among U.S. AdultsBRFSS, 1990
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
Source: Behavioral Risk Factor Surveillance System, CDC
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Obesity Trends* Among U.S. AdultsBRFSS, 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
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Obesity Trends* Among U.S. AdultsBRFSS, 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
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Obesity Trends* Among U.S. AdultsBRFSS, 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
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Obesity* Trends Among U.S. AdultsBRFSS, 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
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Source: Behavioral Risk Factor Surveillance System, CDC
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Childhood Overweight/ObesityChildhood Overweight/ObesityChildhood Overweight/ObesityChildhood Overweight/Obesity
In the U.S., the prevalence of childhood In the U.S., the prevalence of childhood overweight tripled between 1980 & 2000.overweight tripled between 1980 & 2000.
In the U.S., the prevalence of childhood In 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
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The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health Status
The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health Status
Nearly 30% of Nearly 30% of adults 18-75 years adults 18-75 years old are classified as old are classified as “inactive”“inactive”
Report no leisure-Report no leisure-time physical time physical activity (vigorous or activity (vigorous or light/moderate) of at light/moderate) of at least 10 minutes least 10 minutes durationduration
Nearly 30% of Nearly 30% of adults 18-75 years adults 18-75 years old are classified as old are classified as “inactive”“inactive”
Report no leisure-Report no leisure-time physical time physical activity (vigorous or activity (vigorous or light/moderate) of at light/moderate) of at least 10 minutes least 10 minutes durationduration
National Health Interview Survey, National Center for Health Statistics, Health U.S. 2006
Nearly 50% Nearly 50% American adults do American adults do not get enough not get enough physical activity to physical activity to provide health provide health benefitsbenefits
Nearly 50% Nearly 50% American adults do American adults do not get enough not get enough physical activity to physical activity to provide health provide health benefitsbenefits
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Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines All adults perform 30 or more minutes of All 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 single in 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 day Or 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 of All 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 single in 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 day Or at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity
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National Center Health Statistics. Health, 2004
The State of Our Nation: Trends in Health StatusThe 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
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
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Source: Behavioral Risk Factor Surveillance System,CDC
2006 Nationwide Data shows Tobacco Use: 20% yes; 80% no
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The State of Our Nation: The State of Our Nation: Trends in Health StatusTrends in Health StatusThe 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 cholesterol30% 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
Adults aged 65 to 74 years (2001-2004):17% elevated cholesterol30% 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
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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 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 BlackFemale 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
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Percentage of Adults Who ReportedEating fewer Than Five Servings of Fruits and Vegetables a Day, by Sex, 2002
The State of Our Nation: Trends The State of Our Nation: Trends in Health Behaviorsin Health Behaviors
0%10%20%30%40%50%60%70%80%90%
MenWomenTotal0%
0%10%20%30%40%50%60%70%80%90%
MenWomenTotal0%
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
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Why Is Health Promotion So Why Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?
Why Is Health Promotion So Why Is Health Promotion So Important in Our Nation Today?Important in Our Nation Today?
95% of the US 95% of the US healthcare economy healthcare economy is allocated to direct is allocated to direct medical care medical care
Only 5% is allocated Only 5% is allocated to health to health improvementimprovement
95% of the US 95% of the US healthcare economy healthcare economy is allocated to direct is allocated to direct medical care medical care
Only 5% is allocated Only 5% is allocated to health to health improvementimprovement
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National Goals & National Goals & Objectives for HealthObjectives for Health
National Goals & National Goals & Objectives for HealthObjectives for Health
Healthy People followed by National Goals and Objectives
Healthy People 2000Nation’s health
agenda
Healthy People 2010http://healthypeople.gov
Healthy People followed by National Goals and Objectives
Healthy People 2000Nation’s health
agenda
Healthy People 2010http://healthypeople.gov
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Healthy People
2000, 2010
Healthy People
2000, 2010 A comprehensive set A comprehensive set of of national health national health objectivesobjectives for the for the decadedecade
Developed by a Developed by a collaborative processcollaborative process
Designed to Designed to measuremeasure progressprogress over time over time
A A public health public health documentdocument that is part that is part strategic plan, part strategic plan, part textbook on public textbook on public health prioritieshealth priorities
A comprehensive set A comprehensive set of of national health national health objectivesobjectives for the for the decadedecade
Developed by a Developed by a collaborative processcollaborative process
Designed to Designed to measuremeasure progressprogress over time over time
A A public health public health documentdocument that is part that is part strategic plan, part strategic plan, part textbook on public textbook on public health prioritieshealth priorities
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Healthy People 2010Healthy People 2010Coordinated ByCoordinated By
Healthy People 2010Healthy People 2010Coordinated ByCoordinated By
The Office of The Office of Disease Disease Prevention and Prevention and Health PromotionHealth Promotion
U.S. Department U.S. Department of Health and of Health and Human Services Human Services (USDHHS)(USDHHS)
The Office of The Office of Disease Disease Prevention and Prevention and Health PromotionHealth Promotion
U.S. Department U.S. Department of Health and of Health and Human Services Human Services (USDHHS)(USDHHS)
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Healthy People 2010Healthy People 2010Healthy People 2010Healthy People 2010
Two overarching Two overarching goalsgoals
28 focus areas28 focus areas 467 specific 467 specific
objectivesobjectives 10 Leading Health 10 Leading Health
IndicatorsIndicators
Two overarching Two overarching goalsgoals
28 focus areas28 focus areas 467 specific 467 specific
objectivesobjectives 10 Leading Health 10 Leading Health
IndicatorsIndicators
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Two Overarching Goals:Two Overarching Goals:Two Overarching Goals:Two Overarching Goals:
Increase quality Increase quality and years of and years of healthy lifehealthy life
Eliminate health Eliminate health disparitiesdisparities
Increase quality Increase quality and years of and years of healthy lifehealthy life
Eliminate health Eliminate health disparitiesdisparities
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Healthy People 201028 Focus Areas (14 apply directly to PT)
Healthy People 201028 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
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
HIV Maternal, Infant, and
Child Health Nutrition and
Overweight Occupational Safety
and Health Physical Activity and
Fitness Respiratory Diseases Tobacco Use
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Healthy People 2010Healthy People 201010 Leading Health Indicators10 Leading Health Indicators
Healthy People 2010Healthy People 201010 Leading Health Indicators10 Leading Health Indicators
Physical ActivityPhysical Activity Overweight and Overweight and
ObesityObesityTobacco UseSubstance AbuseResponsible Sexual
Behavior
Physical ActivityPhysical Activity Overweight and Overweight and
ObesityObesityTobacco UseSubstance AbuseResponsible Sexual
Behavior
Mental Health Injury and ViolenceEnvironmental
Quality ImmunizationAccess to Health
Care
Mental Health Injury and ViolenceEnvironmental
Quality ImmunizationAccess to Health
Care
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How Healthy is Indiana?How Healthy is Indiana?Indiana Healthy WeightINShape IndianaFit City
Indiana Healthy WeightINShape IndianaFit City
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Health Risk Appraisals (HRA’s)Health Risk Appraisals (HRA’s)
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Senior Fitness TestRoberta E Rickli, C Jessie JonesSenior Fitness TestRoberta E Rickli, C Jessie Jones
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The Role of the Physical TherapistThe Role of the Physical TherapistThe 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
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Roles of a Physical TherapistRoles of a Physical TherapistPathologiesMovement ScienceTraining PrinciplesDiverse PopulationsPsychosocial ResponsesScreening
PathologiesMovement ScienceTraining PrinciplesDiverse PopulationsPsychosocial ResponsesScreening
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Roles of a Physical TherapistRoles of a Physical TherapistNational goals include PTInherent credibilityViewed as advocates, problem-solversAccess to patient/client populationsAccess to facilities and resourcesAccess to the public
National goals include PTInherent credibilityViewed as advocates, problem-solversAccess to patient/client populationsAccess to facilities and resourcesAccess to the public
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American Physical Therapy Association
American Physical Therapy Association
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APTA Vision 2020 StatementAPTA Vision 2020 StatementBy 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.
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.
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APTA Video Podcasts on Health Promotion
APTA Video Podcasts on Health Promotion
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Center for Disease ControlCenter for Disease Control
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Screening ActivitiesScreening ActivitiesPhysiological parameters ScoliosisPostureCVD, PVDPulmonary functionSports healthOccupational healthFunctional performance
Physiological parameters ScoliosisPostureCVD, PVDPulmonary functionSports healthOccupational healthFunctional performance
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Health Promotion PracticeHealth Promotion PracticeGreater participation in community
health activitiesPublic Health projectsHealth FairsPrevention education programsConsultants for community agencies,
schools, businesses, health clubs etc.Professional conferences- community
health projects
Greater participation in community health activitiesPublic Health projectsHealth FairsPrevention education programsConsultants for community agencies,
schools, businesses, health clubs etc.Professional conferences- community
health projects
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Health Promotion PracticeHealth Promotion PracticeIntegration of health promotion and
preventive health services within traditional practiceScreening ReferralCollaborationClient education
Integration of health promotion and preventive health services within traditional practiceScreening ReferralCollaborationClient education
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Health Promotion PracticeHealth Promotion PracticeLinking with fitness centers, YMCA’s,
YWCA’s, health clubsPT practices located in these settingsConsultation with fitness personnel to
facilitate client recovery and rehabilitation
Prevention education programs
Linking with fitness centers, YMCA’s, YWCA’s, health clubsPT practices located in these settingsConsultation with fitness personnel to
facilitate client recovery and rehabilitation
Prevention education programs
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Health Promotion PracticeHealth Promotion PracticeTransition or Chronic Care Programs
Service to clients no longer in PTWell-suited for clients with chronic illness
or extended recoverySlows development of disorders, prevents
functional lossesGroup, individualized programs
Transition or Chronic Care ProgramsService to clients no longer in PTWell-suited for clients with chronic illness
or extended recoverySlows development of disorders, prevents
functional lossesGroup, individualized programs
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Health Promotion PracticeHealth Promotion PracticePT Private Practice
Combination PT and Health Promotion PT- Medical ModelHP- Client-centered care
Multidisciplinary Wellness centers
PT Private PracticeCombination PT and Health Promotion PT- Medical ModelHP- Client-centered care
Multidisciplinary Wellness centers
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Health Promotion Practice Health Promotion PracticeHealth Promotion and wellness
programming- Seniors:Long-term careAssisted living communitySenior housing communitiesCommunity groupsIn homes
Health Promotion and wellness programming- Seniors:Long-term careAssisted living communitySenior housing communitiesCommunity groupsIn homes
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Health Promotion PracticeHealth Promotion PracticeOther Health Promotion Niches:
KidsSchoolHome
Women’s Health Business HealthWorksite WellnessSports HealthMultidisciplinary wellness
Other Health Promotion Niches:Kids
SchoolHome
Women’s Health Business HealthWorksite WellnessSports HealthMultidisciplinary wellness
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APTA Position Statement on Health Promotion and Wellness
By PTs and PTAs
APTA Position Statement on Health Promotion and Wellness
By PTs and PTAs
The APTA recognizes that physical therapists are uniquely qualifieduniquely qualified to to assume leadershipleadership positions in efforts to prevent injury and prevent injury and disabilitydisability, , and fully supports the positive positive rolesroles that physical therapists and physical therapist assistants play in the promotion of promotion of healthy lifestyles, wellness and injury healthy lifestyles, wellness and injury preventionprevention..
The APTA recognizes that physical therapists are uniquely qualifieduniquely qualified to to assume leadershipleadership positions in efforts to prevent injury and prevent injury and disabilitydisability, , and fully supports the positive positive rolesroles that physical therapists and physical therapist assistants play in the promotion of promotion of healthy lifestyles, wellness and injury healthy lifestyles, wellness and injury preventionprevention..
HOD 06-93-25-50Efforts coordinated through APTA Department of Practice, Ken Harwood, PT, PhD, Director
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HOD 06-04-09-09
Priority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTA
Goal 1:Goal 1: Physical Physical therapists are therapists are universally universally recognized and recognized and promoted as the promoted as the practitioners of practitioners of choicechoice for persons for persons with conditions that with conditions that affect movement, affect movement, function,function, healthhealth, and wellnesswellness.
Goal 1:Goal 1: Physical Physical therapists are therapists are universally universally recognized and recognized and promoted as the promoted as the practitioners of practitioners of choicechoice for persons for persons with conditions that with conditions that affect movement, affect movement, function,function, healthhealth, and wellnesswellness.
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Priority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTAPriority Goals of the APTA Goal II:Goal II: Physical Physical
therapists are universally therapists are universally recognized and promoted recognized and promoted as providers of as providers of fitnessfitness, , health promotionhealth promotion, , wellnesswellness, and , and riskrisk reductionreduction programs to programs to enhance quality of life for enhance quality of life for persons across the life-persons across the life-span.span.
Goal II:Goal II: Physical Physical therapists are universally therapists are universally recognized and promoted recognized and promoted as providers of as providers of fitnessfitness, , health promotionhealth promotion, , wellnesswellness, and , and riskrisk reductionreduction programs to programs to enhance quality of life for enhance quality of life for persons across the life-persons across the life-span.span.
11/06HOD 06-04-09-09
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APTA Normative Model/Guide to APTA Normative Model/Guide to Physical Therapist Practice/Physical Therapist Practice/
CAPTE RequirementsCAPTE Requirements
APTA Normative Model/Guide to APTA 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 functionMinimize impairments, functional limitations,
disabilitiesMaintain healthMaintain health (prevent further deterioration or
future illness)Create appropriate environmental adaptationsenvironmental adaptations
to optimize independent function
Physical therapists involved in prevention, promoting health, wellness, fitness & health, wellness, fitness & screening activitiesscreening activities
Help patients/clients:Achieve & restore optimal functionMinimize impairments, functional limitations,
disabilitiesMaintain healthMaintain health (prevent further deterioration or
future illness)Create appropriate environmental adaptationsenvironmental adaptations
to optimize independent function
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The Big PictureThe Big Picture
Adapted from Health Promotion and Wellness: Expanding Your Adapted from Health Promotion and Wellness: Expanding Your Practice ParadigmPractice ParadigmAmerican 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 SecondarySecondaryPreventionPrevention
HealthHealthPromotionPromotion
HealthHealthProtectionProtection
PreventativePreventativeHealthHealth
ServicesServices
TertiaryTertiaryPreventionPrevention
Early dxEarly dx& prompt& prompttreatmenttreatment
Prior toPrior tosymptomssymptoms
DisabilityDisabilityLimitationLimitation
RehabilitationRehabilitation
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Health Promotion Natural Extension of PT’s Role Primary Care Practitioner
Examination
Evaluation
Diagnosis
Prognosis(Including PlanOf Care)
Intervention
Outcomes
Examples: Booth at Walmart; Lifelong PT, Annual ExamsExamples: Booth at Walmart; Lifelong PT, Annual Exams
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Screening
MedicalDisease Lifestyle
Behaviors(HRA)
Refer or Treat
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Physical Activity and Health: A Report of the Surgeon General, 1996
Physical Activity and Health: A Report of the Surgeon General, 1996
Commissioned by Secretary of Health Commissioned by Secretary of Health and Human Services in 1994and Human Services in 1994
Landmark review of the research on Landmark 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 agencyPresident’s Council on Physical Fitness President’s Council on Physical Fitness
and Sports (PCPFS)and Sports (PCPFS)
Commissioned by Secretary of Health Commissioned by Secretary of Health and Human Services in 1994and Human Services in 1994
Landmark review of the research on Landmark 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 agencyPresident’s Council on Physical Fitness President’s Council on Physical Fitness
and Sports (PCPFS)and Sports (PCPFS)
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Most Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM GuidelinesMost Recent CDC-ACSM Guidelines All adults perform 30 or more minutes of All 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 single and 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 day Or 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 of All 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 single and 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 day Or at least 3 days a week for 20 minutes a day of vigorous intensity activityof vigorous intensity activity
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An estimated 54 million persons in the United States,
or nearly 20% of the population currently live with
disabilities (McNeil 1997)
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Interaction of ConceptsInternational Classification of
Function (ICF, 2001)
Interaction of ConceptsInternational Classification of
Function (ICF, 2001)
Health Condition Health Condition ((disorder/diseasedisorder/disease))
Environmental Environmental FactorsFactors
Personal Personal FactorsFactors
Body Body function&structurefunction&structure
(Impairment(Impairment))
ActivitiesActivities(Limitation)(Limitation)
ParticipationParticipation(Restriction)(Restriction)
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Traditional Health PromotionTraditional Health Promotion “not to take care
of the sick and disabled, but
rather to prevent disease and disability in
the healthy”
“not to take care of the sick and disabled, but
rather to prevent disease and disability in
the healthy”
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Purpose of Health Promotion Programs for the DisabledPurpose 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
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
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Rimmer, 1999
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NCPADNCPADNCPAD 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
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
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NCPADNCPADComprehensive source for information
related to physical activity and disabilityWebsite contains: searchable databases
containing articles, citations, programs and facilities and equipment vendors.
Website contains: fact sheets, monographs, bibliographies
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
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ACSM Guide to Exercise Testing Durstine and Moore 2009ACSM 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
Endurance6 or12 min walk, arm/leg ergometer
Distance walked, time of exercise at 60% peak power
StrengthMmt with or without hand held dynomometer
Force generated on dynomometer
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ACSM Guide to Exercise Testing Durstine and Moore 2009ACSM Guide to Exercise Testing Durstine and Moore 2009
FlexibilityHand held goniometer
ROM in shoulder, elbow, wrist, knee, ankle and other joints of affected limbs
NeuromuscularGait analysis, Berg balance, functional reach, POMA
Gait speed, symmetry of movement
FunctionalDuke Mobility, FIM, Individualized criterion referenced tests
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ACSM Guide to Exercise Programming Durstine and Moore 2009ACSM Guide to Exercise Programming Durstine and Moore 2009
Modes Intensity/freq/duration
AerobicUpper 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)
StrengthIsometric exercise, weight machine
Free weights/dumbells, wrist weights, rickshaw, lat pull-downs, rowing
3 sets of 8-12 reps
2-4 days/week
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ACSM Guide to Exercise Programming Durstine and Moore 2009ACSM Guide to Exercise Programming Durstine and Moore 2009
Modes Intensity/freq/duration
Flexibilitystretching
2 days a week (before or after aerobic or strength activities)
NeuromuscularCoordination and balance activities
2 days/week (consider performing on same day as strength activities)
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Aerobic Training Equipment ExamplesAerobic Training Equipment Examples
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Aerobic Training AlternativesAerobic Training Alternatives
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Strength Training Equipment ExamplesStrength Training Equipment Examples
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Evidence-Based Community Programs and Outcomes for TBIEvidence-Based Community Programs and Outcomes for TBIGordon 1998 Retrospective
review of aerobic exercisers
decreased fatigue, decreased migraines, less depression, improved cognitive function, perception of health and social interaction.
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Evidence-Based Community Programs and Outcomes for SCIEvidence-Based Community Programs and Outcomes for SCIDitor (2003) 9 month exercise
interventionLess 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
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Helen M. Galvin Center for Health and Fitness 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
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
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An Emerging Market: Fitness Centers that Can Serve the DisabledAn 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.
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.