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Education Strategy for Increasing Physical Activity: Community and and Health Care Professionals

The potential health gain by increasing population physical activity levels is arguably today’s best bet in public health. J.Morris

Physical activity, healthy eating and living tobacco free are cornerstones in the prevention and management of chronic diseases such as Type 2 Diabetes, heart disease, hypertension, some cancers, osteoporosis, and obesity.

Evidence has shown that with modest behaviour changes such as

increasing physical activity, choosing healthier foods, moderate weight loss, and improving social supports, the incidence of chronic conditions and/or complications can be prevented or delayed. There are also social and cultural conditions that shape and constrain health - particularly for those with limited resources.

This strategy will provide VCH staff with the resources to assist their clients in building self-efficacy and increasing their physical activity.

Contents:Strategy Overview 21-2-3- Move! 4Group Interventions 51:1 Counseling 6

Healthy Living Program-Active Living Coordinator

Vancouver: Mary Clark 604.267.4430

Why do we need a

Strategy for staff?

There are many barriers that prevent health care professionals from discussing and encouraging clients to be physically active.1. Many don’t see physical activity as a priority.

2. There is a perception that smoking and nutrition are easier to address than physical activity.

3. Priority of time.Health care professionals focus on the specific issue they are seeing the client for ie. wound care, prescriptions.

4. Many health care professionals don’t perceive they have a role to play in behavioural change.

5. The referral criteria or public recreation access protocols are confusing.

From: “Toolkit for the Design, Implementation, and Evaluation of Exercise Referral Schemes”, Loughborough University, 2009.

Overview:This strategy responds to evidence of growing levels of physical inactivity

and the corresponding impact on the health and well-being of British Columbians. Using the 21 Core Programs as reference, it aims to increase the awareness and understanding of the health and related benefits of participation in physical activity, and provides the structure and tools that will assist in developing the skills, resources, and supports central to a physically active lifestyle.

This strategy is part of the overall improvement needed in public policy for physical activity. The promotion, development, and support for policy that facilitates and encourages physical activity happens at the population health level and can be supported by the work of all VCH staff.

The main goal is to increase the health sector’s capacity for sustained and coordinated action on physical activity by:

• strengthening staff skills• strengthening staff competencies• conveying information and influencing community attitudes and knowledge • building a supportive VCH system and infrastructure for physical activity as part

of health care delivery, including leadership development.

VCH staff are potentially well placed to provide assessment, practical information, support, and interventions for people who may need assistance to get started or to maintain physical activity.

It is recognized that VCH staff face limitations on what can be done given pressures of time, knowledge, and scope. This strategy attempts to address this issue by having 3 levels of training and intervention techniques offered and supported. These levels are: 1-2-3 Move!, Group Interventions, and 1:1 Physical Activity Counseling.

Once this overall strategy is approved, specific indicators and timelines will be developed as part of the implementation plan.

Fact: Being physically inactive has many costs: • 31% of all premature

deaths, • 59% of deaths from

Cardiovascular disease,• 21% of deaths from

cancer, and • costs the Canadian

taxpayer over $211 million dollars annually in direct health care costs.

1-2-3-Move! Group Interventions

1:1 Physical Activity Counseling

Brief InterventionIntervention techniques training given to all interested VCH staff and community workers/professionals. 1 hour of staff training.

1 HourIntervention techniques training given to all VCH professionals and interested community professionals*. 2 hours of staff training.

1 HourIntervention and leisure counseling training given to interested VCH professionals. 3 hours of staff training.

Goal:Reach all VCH Clients.Reach target population through training non VCH service providers.

Goal:Reach “High Risk” VCH Clients and people in the community who would benefit from group support.

Goal:Reach “High Risk” VCH clients who require 1:1 interventions and support.

Outcomes:Reach high numbers of people. Increased physical Activity. Reduction in Chronic Diseases.

Outcomes:Reach approx. 750 people per year. Increased physical Activity. Reduction in Chronic Diseases.

Outcomes:Reach approx. 250 people per year. Increased physical Activity. Reduction in Chronic Diseases.

Fact: Being physically inactive is as bad for you as smoking.

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Fact: The greatest health benefit goes to those who are currently inactive becoming active.

Physical Activity

Facts:

Fact: Adults should aim for 60 minutes of moderate activity, most days of the week. Health Canada

Fact: Physical inactivity (and poverty) is higher among:women,older persons,persons with disabilities, aboriginal peoples, and persons who are members of ethnic groups.

Fact: Less than 3% of people with a diagnosed disability meet Health Canada’s Physical Activity Guidelines.

Description: Using the VCH tobacco reduction

strategies as a model, this component teaches interested VCH staff and

community members how to introduce behavioural change support to their clients using brief motivational interviewing techniques.

Initially led by VCH Active Living coordinators, there will be a train-the-trainers component for interested staff to become trainers of their colleagues and co-workers.

Target Audience:Front line VCH staff, including

recreation therapists, dietitians, nurses, occupational therapists, social workers, physiotherapists, drug and alcohol counsellors, and physicians.

Community service providers who work with the HLP target populations.

A training plan would need to be developed that includes targeted staff, targeted community groups, train the trainer opportunities, etc.

Outcomes:• Increased awareness and

understanding of the health and related benefits of participation in physical activity

• Uniformity and consistency in methods being used to assess physical activity and readiness for change

• Support individuals and families to overcome barriers to physical activity

• Increased levels of physical activity• Reduction in risks for chronic disease

Next Steps:• Needs assessment of VCH

professionals re: their level of understanding of physical activity and their perception of the Heath Authority’s role in its improvement

• Development of Project Plan, including the outcomes, evaluation plan, course content, Train-the Trainers Course.

Timeline:Training and pilot to begin in

November, 2009.

Movement for

Change

Strategies 1-2-3 Move!

Physical Activity

Facts:

Fact: Being overweight and active is healthier than being a normal weight and inactive (see graph).

Fact: Less than 47% of people in Vancouver meet Health Canada’s Physical Activity Guidelines.

Fact: Many people find it hard to maintain changes in physical activity unless it is part of their daily routine.

Description: This training gives interested

clinicians and community workers the necessary tools to provide effective interventions to increase physical activity among the at-risk groups they work with. Using the Stages of Readiness model with specifically designed tools and group intervention strategies, these sessions can be run in a variety of settings and with all ages and abilities.

Target Audience:• VCH staff, focussing on professional

groups that have experience facilitating groups.

• Community based professionals.

Outcomes:• Increased awareness and

understanding of the health and related benefits of participation in physical activity

• Uniformity and consistency in methods being used to assess physical activity and readiness for change

• Individuals and families overcome barriers to physical activity

• Increased levels of physical activity• Develop skills to be active as part of

daily life• Reduction in risks for chronic disease

Next Steps:• Offer Phase 2 training in Fall, 2009• Group sessions offered across VCH, to

primary care clinics, CHC’s, and at other community venues.

Movement for

Change

Strategies

Physical Activity Group Interventions

Physical Activity

Facts:

Fact: Poverty is bad for your health. Low income, social status, and low educational attainment are associated with poor health.

Fact: Ensuring access to physical activity for people living in poverty will help reduce negative health impacts that are linked to socioeconomic disparities.

Fact: 10 minutes of moderate physical activity at a time is fine!

Description: For clinicians and community workers who have completed Group Interventions, concepts of the “Developmental/Behavioural” Leisure Counseling protocol will be introduced.

It is best suited for Recreation Therapists working with clients who required more intensive interventions or who do not benefit from groups. This level of training will be

offered once per year.

Target Audience:Therapists who have completed the

Group Intervention Training.

Outcomes:• Increased awareness and

understanding of the health and related benefits of participation in physical activity

• Individuals and families overcome barriers to physical activity

• Increased levels of physical activity• Develop skills to be active as part of

daily life • Reduction in risks for chronic disease

Next Steps:Develop project plan with course

content. Training to begin in February, 2010.

Movement for

Change

Strategies

1:1 Physical Activity Counseling

Fact: Increasing physical activity helps with adherence to healthcare treatments for issues such as:• clinical depression• pre-diabetes• smoking cessation• addictions• physical rehabilitation