Physical Activity

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Physical Activity Diabetes Getting Patients
Active

• Shirley OShea
• Senior Health Promotion Officer

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Overview

• Evidence of physical activity and type 2 diabetes
• National Physical Activity Guidelines
• Promoting Physical Activity in Primary Care
• How can patients be supported to become active?

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Key message Physical activity is for everyone
and any level is better for your health than none
For adults with disabilities Aim for guideline
or as much as ability allows.
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How do we measure physical activity?

• 1. I run around after the children all day
  long, am always on the go
• 2. I have a sedentary job but I cycle 3 times a
  week for up to 2 hours
• 3. I walk to town at lunch time a few days a
  week
• 4.I go to the gym twice a week for an hour each
  time

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Types of Activity

• 4 major domains for Activity in daily life
• For transport cycling or walking to work,
  school, shops
• At work manual labour
• At home housework, DIY, gardening
• Leisure time sport, exercise recreation

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What are the recommendations?

• How often?
• How hard?
• How long?
• What type?

F.I.T.T. Principle
Frequency Most days of the week Intensity
Moderate Level 60-80 M HR Time 30 minutes
Type Select activity that you enjoy is
convenient e.g. walking or cycling
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Moderate Intensity (pbts)

• Moderate Intensity Physical Activity is
• described as a level that causes your

Beat a little faster
Breathe deeper and faster (but not out of breath)
Brings a little sweat to your brow
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Evidence

• Participation in regular physical activity
• Improves blood glucose
• Prevent or delay Type 2 diabetes
• Positively affecting lipids
• Blood Pressure
• Cardiovascular events
• Mortality quality of life

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Limitation in role of Primary Care Staff

• Your own level of exercise
• Knowledge of current messages on physical
  activity
• Lack of time in consultation
• Lack of perceived importance of physical activity
• Lack of systems in place

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Better GP processes

• Within the practice
• Learn about PA
• GP/PN develop skills
• Practice-specific leaflets
• Prescription forms
• Peer counselling
• PA specialists for specific groups
• Referral/H-P clinics
• Opportunistic practice
• Follow-ups and feedback
• Modelling your own PA
• Using waiting room time
• Receptionists
• Longer consultations
• REWARDS?

Better patient outcomes
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Get Ireland Active

• The National Physical Activity Guidelines for
  Ireland provide clear, concise and user friendly
  guidance to support the public, professionals and
  policy makers to Get Ireland Active.
• Website
• Promoting the guidelines
• Benefits of PA
• Guidelines for children and young people, adults
  and older adults, people with disabilities and
  weight management.

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Brief intervention

• Involves opportunistic advice, discussion,
  negotiation or encouragement and are delivered
  by a range of primary and community care
  professionals. Varies from basic advice to more
  extended, individually focused attempts to
  identify and change factors that influence
  activity levels
• Discussion between individuals and GPs, nurses
  etc are effective and cost effective in
  encouraging individuals to be more active
• Ref Public Health Intervention Advisory Committee

NICE Public Intervention Guidance No.2, March 2006
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• 1 to 2 hours Physical Activity and Health
• Delivered to on site practices
• Free of charge
• Useful Resources for promoting PA in your practice

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PACE Programme Patient Assessment Counselling
for Exercise

• Based on stages of behaviour change
• Provides screening tools
• Appropriate advice and follow up for patients
• Addresses barriers, motivation, goal setting
• Ideal following Brief Intervention training

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• Provides a safe pathway for people with various
  health
• conditions to get them physically active, their
  way, everyday.
• You Recommend
• GP Refers
• Patient Meets Local Coordinator
• The patient then begins a twelve week physical
  activity programme
• Health professional handbook Caroline.kelleher_at_hse
  .ie

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Inclusion Exclusion Criteria
Patients must be Exclusion Criteria
currently sedentary over 18 years of age interested in becoming more physically active Cardiac Conditions Uncontrolled conditions
A fully detailed criteria list is available in
the Health Professionals Handbook
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Walking

• Walking for Health Workshops
• IHF Walking Leaders Training
• Community Walking Groups
• Meet nMingle Walks
• Walking Leaders Refresher Training
• Trail Walking Workshop
• IHF Walking Leaders Training 2

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HPD Training Calendar

• Physical Activity in Primary Care (2hrs)
• PACE- Patient Centred Assessment Counselling
  for Exercise (3 hrs)
• Promoting The National Physical Activity
  Guidelines for Ireland Get Ireland Active
  (2hrs)
• Obesity A Health Promotion Perspective (1 day)
• Supporting Change Skills for Health (formerly
  Brief Interventions) (2 days)

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Research..

• Prevention of type 2 diabetes mellitus by changes
  in lifestyle among subjects with impaired glucose
  tolerance. N Engl J Med
• Physical Activity, cardiovascular risk factors
  and mortality among Finnish adults with diabetes
• Diabetes and Physical Activity Joint position
  statement of Diabetes Australia on the role of PA
  and risk reduction of and management of diabetes
• A RCT of resistance exercise training to improve
  glycemic control in older adults with diabetes

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Further support and info

• Email - shirley.oshea_at_hse.ie
• Tel - 021 4921643
• www.healthpromotion.ie
• www.gpexercisereferral.ie
• www.getirelandactive.ie