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    

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Toolkit implementation Research component

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

Physical Activity & Exercise Toolkit

Progress from 2008  

Summer 2008 Initiated re-design of Handouts  

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Held ten regional workshops, June-Nov 2008  

Received feedback for update of Toolkit and materials, distributed bands

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Incorporated feedback, revised, printed and distributed 26,000 brochures

Completed Phase 1 data collection    

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Received pre-post questionnaires n=58, analyzed data to be presented at IDF 2009 Initiated phase 2 data collection March 2009

Produced a Resistance training video!!  

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Presented Pre data (n=105) at CDA, Montreal 2008

REB’s completed for Phase 2 – 4 DHA’s (NS), NB (2), NFld  

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New photos, materials integrated, diabetes specific

Funding from Lawson, Acadia, DCPNS

Currently discussion with CDA, CIHR, RHA’s for wide distribution  

Currently applying to CIHR for funding

Physical Activity & Exercise Tool-kit

Diabetes Educator Case Study (Appeared in DCPNS newsletter; January 2009)  

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

Solution: “Lets Band together”  

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“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 Physical Activity & Exercise Tool-kit

Other DC’s Physical Activity Initiatives  

Arichat        

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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        

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Truro      

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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 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!!

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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 “

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“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 Why? To determine: 1) 

2) 

impact of the Toolkit on DEs’ ability to counsel and prescribe PAE, and outcomes of this initiative on patients’ diabetes

Phase 1 – begun April 2008, end Nov 2008 • DE

attitudes, confidence, practices of counseling clients on lifestyle modifications

Phase 2 – begun Spring 2009 • 

Patient attitudes, confidence, participation, and diabetes outcomes Physical Activity & Exercise Tool-kit

Initial Results – Phase 1 Dillman, Shields, Fowles et al., CDA 2008  

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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  

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Time, lack of knowledge, lack of resources

Reported positive attitudes toward PA & exercise (4.2/5) Perceived client attitudes as negative (2.8/5) Physical Activity & Exercise Tool-kit

Key Learnings Dillman, Shields, Fowles et al., in progress

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Implementation into standard practice key to promoting clients’ physically active lifestyles At Pre:  

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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)  b)  c) 

directing PAE discussion (59%); helping design program (37%) making referral choices (4%) Physical Activity & Exercise Tool-kit

Challenges

Dillman, Shields, Fowles et al., in progress

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

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Nature of barriers changed in intervention group        

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Confidence went from 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 Physical Activity & Exercise Tool-kit

Phase 2 Data Collection    

Testing the clients! Now, again in six months Five centres in NS:          

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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    

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Continued collaboration with Kinesiologists-CEP’s  

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CEP’s as part of community health care teams

Project follow-up        

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group classes, home study (video), refreshers, Coordinator “Physical Activity Corner” in DCPNS newsletter

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….. Physical Activity & Exercise Tool-kit

Acknowledgements The Team   Co-investigators      

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Arlene Perry

DCPNS staff        

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Chris Shields Rene Murphy Carrie Dillman

Project/Research Coordinator  

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This project supported through generous contributions of:

Peggy Dunbar Bev Harpell Brenda Cook Lynne Harrigan

Reviewers    

Pilot reviewers Academic reviewers Physical Activity & Exercise Tool-kit

Thank you

Questions?