the dcpns physical activity & exercise...

The DCPNS Physical Activity & Exercise Toolkit

Jonathon Fowles, Ph.D., CSEP-CEP René Murphy, Ph.D. Chris Shields, Ph.D. Shayne Fryia, BKin, CSEP-CEP Arlene Perry, BSN & Kin, CSEP-CEP Carrie Dillman, BKin (Hon) candidate

Overview of the Presentation

  Process to date   Toolkit implementation   Research component

  Questionnaire!   Video Release!!   Key findings thus far   Next steps

Physical Activity & Exercise Toolkit

Physical Activity & Exercise Tool-kit

Progress from 2008   Summer 2008 Initiated re-design of Handouts

  New photos, materials integrated, diabetes specific   Held ten regional workshops, June-Nov 2008

  Received feedback for update of Toolkit and materials, distributed bands   Incorporated feedback, revised, printed and distributed 26,000 brochures

  Completed Phase 1 data collection   Presented Pre data (n=105) at CDA, Montreal 2008   Received pre-post questionnaires n=58, analyzed data to be presented at IDF

2009

  REB’s completed for Phase 2 – 4 DHA’s (NS), NB (2), NFld   Initiated phase 2 data collection March 2009

  Produced a Resistance training video!!   Funding from Lawson, Acadia, DCPNS

  Currently discussion with CDA, CIHR, RHA’s for wide distribution   Currently applying to CIHR for funding

Diabetes Educator Case Study

  “Many of us struggle with the understanding and implementation of resistance exercise.”

  Solution: “Lets Band together”   “We added resistance bands to the

classes we offer”. Once/month for 90 minutes, 4-11 per class.

  Lessons learned/Future Ideas   Practice makes perfect   Exercise isn’t so hard after all….   Problem solving shared with other DE’s


(Appeared in DCPNS newsletter; January 2009)

Other DC’s Physical Activity Initiatives   Arichat

  Hosted two community workshops in town hall   Well received   Word is spreading, more demanded!   Do individual and group exercise instruction in clinic as time

permits

  Windsor   Holding Theraband classes ~ every three weeks   Patients really enjoy classes!   Working on scheduling regular, ongoing classes   Working with other departments (physio, respiratory therapy, etc.)

to partner and start joint exercise programs

Physical Activity Initiatives – cont’d   Kentville

  Holding Theraband classes ~ 2x/month   Patients love it!   DEs also do individual exercise instruction as time permits   Increasing referrals of individuals with diabetes to AVH cardiac

rehab/diabetes exercise program   Truro

  Implemented the Tool-kit by partnering with Physio dept (who already does a class based on Tool-kit program)

  Now having monthly PA/exercise classes   Developed some centre-specific tools that compliment what is in

the Tool-kit   Musquodoboit Harbour

  Using the tool on an individual basis   Doing group sessions on Physical activity using the tool kit   Holding Theraband classes

Resistance Exercise for Diabetes

  Video Release!!

  But first, a few minutes of your time for a questionnaire…   Random draw for $100 gift certificate to Sport

Chek

Physical Activity & Exercise Toolkit

CDA 2008 Recommendations   “People with diabetes should accumulate a minimum of

150 minutes of moderate- to vigorous-intensity aerobic exercise each week, spread over at least 3 days of the week, with no more than 2 consecutive days without exercise “

  “People with diabetes (including elderly people) should also be encouraged to perform resistance exercise 3 times per week in addition to aerobic exercise”   “Initial instruction and periodic supervision by an exercise

specialist are recommended.”

Studies in older women and middle aged individuals with and without T2Dm demonstrate that higher intensity activity is associated with a dose-response improvement in insulin sensitivity

Message: People who participate in higher intensity activity are more insulin sensitive and less likely to develop T2DM

CDA 2008 Key Message   “Structured physical activity counselling by healthcare

personnel effective at increasing physical activity, improving glycemic control, reducing the need for oral antihyperglycemic agents and insulin, and producing modest but sustained weight loss.” (CDA CPG’s 2008).

  Be persistent with the message   Progress over time   Support and reward successes, build confidence


Evaluating Effectiveness

Phase 2 – begun Spring 2009 •  Patient attitudes, confidence, participation, and diabetes outcomes

Phase 1 – begun April 2008, end Nov 2008 • DE attitudes, confidence, practices of counseling clients on lifestyle modifications

Why? To determine: 1)  impact of the Toolkit on DEs’ ability to counsel and

prescribe PAE, and 2)  outcomes of this initiative on patients’ diabetes

Initial Results – Phase 1

  Most DE’s had little training on PAE (77% ≤ 1 form)

  DE’s not confident in their abilities, or those of clients

  Reported multiple barriers to PA counseling   Time, lack of knowledge, lack of

resources

  Reported positive attitudes toward PA & exercise (4.2/5)

  Perceived client attitudes as negative (2.8/5)


Dillman, Shields, Fowles et al., CDA 2008


Key Learnings

  Implementation into standard practice key to promoting clients’ physically active lifestyles

  At Pre:   84% of DE’s reported spending less than 25% on PAE

  At 6 mos:   75% DE’s spending up to 50% of time on PAE   Used Toolkit with 3.7 clients/week   81% described clients as inactive, but ready to be   Toolkit seen as helpful in

a)  directing PAE discussion (59%); b)  helping design program (37%) c)  making referral choices (4%)

Dillman, Shields, Fowles et al., in progress


Challenges

  Overall positive rating of the Toolkit and its use (5.8 /7), an interesting interaction:

  Nature of barriers changed in intervention group   Confidence went from <50% to >75%   Lack of ability went from 18% to 10%   Lack of resources went from 16% to 10%   Time remained #1 barrier but represented

30% at time 1 and 45% at time 2

  Suggests while feel have more confidence, ability and resources, additional “requirements” put further push on limited time for counseling

Dillman, Shields, Fowles et al., in progress

Phase 2 Data Collection   Testing the clients! Now, again in six months   Five centres in NS:

  Twin Oaks Memorial Hospital (Musquodoboit Harbour)   Soldier’s Memorial Hospital (Middleton)   Queen’s Hospital (Liverpool)   Dartmouth General Hospital (Dartmouth)   Glace Bay Healthcare Facility (Glace Bay)

  Control sites – NL & NB:   Upper River Valley Hospital (Waterville, NB)   Eastern Health (St. John’s, NL)


What is to come in the future?   Further Integration into Standard Practice

  Continued support for PAE at DC’s   group classes, home study (video), refreshers, Coordinator   “Physical Activity Corner” in DCPNS newsletter

  Continued collaboration with Kinesiologists-CEP’s   CEP’s as part of community health care teams

  Project follow-up   Client Evaluations (finish fall 2009)   Feedback & Focus Groups (feedback from users)   Update of Tool-kit Contents (Summer 2009)   Final Reports (April 2010)

  Dissemination of Tool-kit elsewhere…..


Acknowledgements The Team   Co-investigators

  Chris Shields   Rene Murphy   Carrie Dillman

  Project/Research Coordinator   Arlene Perry

  DCPNS staff   Peggy Dunbar   Bev Harpell   Brenda Cook   Lynne Harrigan

  Reviewers   Pilot reviewers   Academic reviewers

This project supported through generous contributions of:

Thank you

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