Wellness Centers: An Ounce of Prevention

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Wellness Centers An Ounce of Prevention

• CDR Jeff Fultz, DC, PT, OCS, MPH
• Chief Therapist, Four Corners Regional Health
  Center
• Red Mesa, Arizona

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Four Corners Wellness Center
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Four Corners Wellness Center
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Four Corners Wellness Center
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Four Corners Wellness Center
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Four Corners Wellness Center
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Quality of Life Improvements

• Not from medical miracles of the late 20th
  century
• Attributable to Public Health advances safe
  water, food, housing vaccinations improved
  sanitation
• Great killers of humanity, infectious diseases,
  have largely been eliminated (notable
  exceptions)
• Historically, most premature death came from
  things people did not choose
• infectious disease
• work
• war
• Now premature deaths come from choices people
  make
• smoking
• not wearing seatbelts
• drinking
• poor choices in diet
• inactivity

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Epidemic Obesity

• Overweight/Obesity
• Adults US - 67 are overweight or obese
• Obesity attributable mortality estimates (2000)
• 400,000 to 639,000
• WHO (2000)-Obesity replacing under-nutrition
  infectious disease as the most significant
  contributors to ill health
• Navajo adults overweight/obesity
• 74.3 Men (39.9OW 34.4OB)
• 80.4 Women (35.1OW 45.3 OB)
• Overweight US youth
• gt17 of children and adolescents ages 6 -19
• Overweight Navajo youth
• 41 Boys
• 60 Girls

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Obesity is a Dis-ease

• Result of long-term imbalance between energy
  intake and expenditure through physical activity
• Adults conventionally defined through calculation
  of
• BMI weight (kilos) divided by square of height
  (meters)
• Classification BMI Measures
• Underweight lt18.5
• Normal 18.5-24.9
• Overweight 25.0-29.9
• Obese I 30.0-34.9
• Obese II 35.0-39.9
• Obese III 40.0

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Obesity in Youth

• Children and Adolescents Overweight
  Classifications
• At Risk for Overweight BMI 85 - lt95 for
  age/gender
• Overweight BMI gt or 95 for age/gender

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Risk Factors for Obesity

• Individual
• Sedentary Lifestyle
• Mother obese during pregnancy
• Obesity as child
• Parental obesity
• Genetic
• Poor Diet
• Increased TV viewing
• High Fructose Beverages
• Community
• Limited Environmental Infrastructure
• Few Opportunities for Healthy Physical
  Activities
• Safety Concerns
• Low Socioeconomic Status
• Limited utilities/refrigeration

• Interpersonal
• Inactive Parents/Siblings/Peers
• Obese overweight parents
• Low Socioeconomic Status
• Food Insecurity
• Family Diet
• Number of TVs in household
• Organizational/Institutional
• Limited PE in schools
• No policies for encouraging fitness behaviors
• Poor Medical System support for community members
  physical activity
• Commodity Foods

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Overweight/Obesity - Health Effects

• Consequences
• Psychosocial issues-(particularly in youth)
• Low self-esteem
• Eating disorders
• Social stigma/isolation
• Increased risk of adult-onset disease from
  overweight/obesity in childhood/adolescence
• Type 2 Diabetes
• Heart disease
• Hypertension
• Osteoarthritis
• Cancer- 20 of all cancer deaths in women, 14 in
  men
• Depression
• Higher all-cause morbidity and mortality

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Epidemic Diabetes

• Diabetes
• Almost 10 of US adults have Type II Diabetes
• 54 million US Adults (40 to 74) had pre-Diabetes
  in 2002
• Navajo adults have a 33 prevalence of Diabetes
• Teenagers and young adults

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Diabetes - Health Effects

• Consequences
• 4X greater risk of Heart Disease
• Neuropathy
• Peripheral
• Autonomic
• Main cause of
• Kidney failure
• Limb amputation
• New-onset blindness
• Impairs quality of life
• Decreases life expectancy

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Physical Inactivity

• gt60 of adults do not meet recommended levels of
  physical activity
• gt25 of US adults participate in no physical
  activity
• Inactivity is a risk factor for
• overweight/obesity
• diabetes
• Sedentary living is responsible for 33 of deaths
  due to coronary heart disease, colon cancer and
  diabetes
• Inactivity is a risk factor for all-cause
  mortality

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Physical Activity Prevention

• All cause mortality
• Cardiovascular disease
• Diabetes
• Stroke
• Metabolic Syndrome
• Health and function in older adults
• Obesity
• Cancer
• Cognitive impairment/dementia
• Musculoskeletal disorders
• Neuromuscular disorders

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Dose-Response Relationship

• Dose
• Volume of exercise or physical activity reflected
  by the total energy expenditure
• Higher dose Higher benefit
• Recognize limits
• Structural and physiologic limitations
• Risk of injury
• Not everyone responds the same way

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• Timeline of a Diseases Natural History

No Disease
Disease Onset
Symptom Onset
Diagnosis
Morbidity
Death
Primary Prevention
Secondary Prevention
Tertiary Prevention
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ACSM Definitions of Fitness

• Physical Fitness
• Physiologic, health-related and skill-related
  characteristics associated with the performance
  of physical activity
• Health-Related Physical Fitness
• The ability to perform daily activities with
  vigor, and the possession of traits and
  capacities that are associated with a low risk of
  premature development of hypokinetic diseases
  (those associated with physical inactivity)

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Physical Fitness Therapy Practice

• Therapists are uniquely qualified to address
  physical fitness because of expertise
• Human structure and function related to movement
• Relationship between movement and quality of life
• Exercise principles and application
• Ability to consult with other health
  professionals on a peer basis

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Health-Related Physical Fitness and
the Guide to PT Practice

• 1. Body Composition
• Anthropometric Characteristics (Guide)
• 2. Cardiovascular Fitness
• Aerobic Capacity and Endurance (Guide)
• 3. Muscular Strength and Endurance
• Muscle Performance (Guide)
• 4. Flexibility
• Range of Motion (Guide)

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Physical Activity GuidelinesHealthy Adults

• Recommendations from USDHHS, CDC, NIH, ACSM
• Combined total of 30 minutes of moderate
  intensity physical activity (brisk walking) most
  days per week
• These are for health benefits reduced CV
  disease, DM, etc.
• 150 minutes per week
• Recommendations from Institutes of Medicine
• 60 minutes of moderate physical activity most
  days per week
• (with some time spent in vigorous activity)
• These are for promoting healthy body weight
  and additional health benefits
• 300 minutes per week
• ACSM/AHA also recommends
• 8-10 strength training exercises twice a week
  with 8-12 repetitions

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Physical Activity GuidelinesAdults gt65 or
50-64 Chronic Conditions

• ACSM/AHA recommends
• Same cardiovascular fitness activity level 30 min
  5/week
• 8-10 strength training exercises 2-3X a week with
  10-15 repetitions
• Activity Plan in consultation with Primary Care
  Provider
• Balance Exercises (if at risk for fall)

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Strategies to Increase Physical Activity

• Creation and/or enhanced access to places for
  Physical Activity
• Social Support - Family others
• Individually-adapted Health Behavior Change
  Programs
• Environmental and Policy Approaches
• Point of Decision Prompts
• Medical Systems Policy
• School Physical Education

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Strategies to Increase Physical Activity

• Wellness Centers
• Create opportunities for Physical Activity
• Provide training in use of equipment
• Source of behavioral education
• Perform risk factor screening
• Refer to physicians or other services
• Provide Social support

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Running is the Diné way

• Elders tell of how they used to awake at dawn,
  run toward the sunrise, and pray with corn pollen
• Running is how the Diné traditionally maintain
  physical and spiritual strength

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What Works to Change Behavior?

• MOTIVATION is the key to success
• Group/Partner support sustains behavior change
• Build on small successes
• Balance Priorities Must make time
• The practice of healthy lifestyles is a lifelong
  pursuit

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Individual Success Improves IF

• Promotion of physical activity/exercise
  emphasizes desirable outcomes instead of health
  benefits
• fat loss
• stress reduction
• clothes fit comfortably
• feel better
• People are in different stages of readiness for
  change

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Stages of Change
Precontemplation
Contemplation Maintenance
Preparation Action
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Stages of Change Physical Activity

• Stage of Readiness for Physical Activity Behavior
• Pre-contemplation 14
• Contemplation 13.9
• Preparation 28.6
• Action 7.4
• Maintenance 36

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Physical Fitness - Therapists

• Therapists Role-Wellness Center
• Coordinator-Physical Activity component of
  program
• Support/Professional Consultation
• Individualized physical activity programs
• Injury evaluation/treatment
• Therapists Role-Clinical Setting
• Ask about physical activity level
• Educate regarding guidelines and recommendations
• Encourage problem-solving means to make time to
  be active
• Provide positive support and encouragement

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Wellness CenterConcept of Operation (IHS)

• Wellness Center is part of the HP/DP initiative
• Emphasis is to help clients with behavior
  modification
• Based on the Stages of Change model
• Targeted audience in the stages of changes are
  preparation and action while not ignoring the
  other stages of change
• Provide activities in the center and community
• Achieve behavior modification through health
  education, nutrition, physical activity
• Methods classes, exercise groups,
  demonstrations, individual consultations,
  personal activity involvement

Courtesy CAPT Shelton
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Wellness CenterScope of Service (IHS)

• Each location will develop a customized scope of
  services
• IHS Recommended Minimum services
• Physical Fitness Activities
• Weight Management
• Diabetes program
• Nutritional program
• Stress management
• Tobacco prevention
• Risk management
• Change process

Courtesy CAPT Shelton
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Scope of Services Cont.(IHS)

• Additional Services possibilities
• Traditional healing
• Walking clubs
• Walking paths
• Cooking demonstrations
• Grocery shopping training

Courtesy CAPT Shelton
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Wellness Center Resource Requirement
Methodology RRM

• Staff
• Director and Deputy Director
• HPDP Director
• Deputy Director at 6000 user population
• Physical Activity/Outreach Technicians
• Increase by formula based on hours of operation
  and population stages
• Facility and Outreach Technicians
• Receptionist and Administrative Assistant
• Receptionist added at 4000 user population and
  increased as hours of operation increase
• Administrative assistant added at 10,000 user
  population

Courtesy CAPT Shelton
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Wellness Center Management

• Ideally will have multidisciplinary program
• Depends on who is interested available
• Health Promotion
• Rehabilitation Services
• Dietary
• Health Education
• Diabetes Prevention

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Physical Activity Screening

• Physical Activity Readiness Questionnaire (PAR-Q)
• 1. Has your doctor ever said that you have a
  heart condition AND that
• you should only do physical activity recommended
  by a doctor? Yes No
• 2. Has your doctor ever told you that you have
  diabetes? Yes No
• 3. Do you feel pain in your chest when you do
  physical activity? Yes No
• 4. In the past month, have you had chest pain
  when you were
• not doing physical activity? Yes No
• 5. Do you lose your balance because of dizziness
  or do you ever
• lose consciousness? Yes No
• 6. Do you have a bone or joint problem that could
  be made worse
• by more physical activity? Yes No
• 7. Is your doctor currently prescribing drugs
  (for example, water pills)
• for your blood pressure or heart
  condition? Yes No

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Wellness Centers on Navajo Nation

• Fort Defiance
• Chinle
• Tsaile
• Gallup
• Crownpoint
• Shiprock (2)
• Window Rock
• Tuba City
• Luepp
• Kayenta
• Rockpoint
• Round Rock
• Two Grey Hills
• Red Mesa

in process
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Wellness Centers

• Equipment Recommendations Cardiovascular Fitness
  Training
• Treadmills
• Bikes - Recumbant or others (spinning)
• Elliptical Trainers
• Nordic Ski
• Rowing Machines
• Versi-climber
• Indoor Track
• Swimming Pool
• Steps (aerobics)
• Mats (Yoga-Pilates)

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Wellness Centers

• Equipment Recommendations Strength Training
• Individual machines for specific muscle
  groups/muscle actions
• Cybex, Nautilus, Samson
• Combination machines
• Total Gym, Bowflex
• Free Weights
• Resistive Bands
• Mats - Pilates/Yoga/Core work
• Against Body Weight
• Balls - stability, core, medicine, BOSUs
• Body bars

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Wellness Centers

• Equipment Recommendations Other considerations
• Body Fat Analysis-Tanita Device
• Mirrors
• Sound System Receiver, CD player, I-Pod
  connection, Speakers
• Televisions Broadcast Vision
• Floor surface
• Water supply
• Educational Posters/Pictures
• Borg Perceived Exertion
• Information Display
• AED

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Partners 4 Wellness
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Partners 4 Wellness
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Partners 4 Wellness
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Partners 4 Wellness
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Partners 4 Wellness
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Partners 4 Wellness
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Partners 4 Wellness
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• THANK YOU!
• I appreciate the opportunity to speak with you.
  Please contact me if
• you would like more information
• Jeff Fultz [phone] jeffrey.fultz_at_ihs.gov