What is p.r.e.p. · What is p.r.e.p.® p.r.e.p.® is a 60-day physician referred exercise program...

What is p.r.e.p.® p.r.e.p.® is a 60-day physician referred exercise program that introduces patients to exercise. p.r.e.p.® participants meet with medical fitness professionals twice per week in small group settings and have full access to all of The Alaska Club’s amenities. The p.r.e.p.® team communicates with patients on a regular basis via email, phone, and in-person contact to monitor attendance, progress, and well-being throughout the program. The p.r.e.p.® team is a resource for exercise instruction, education, and support.

The most important aspect of p.r.e.p.® is that it takes down all barriers to exercise and welcomes patients in a non-intimidating, comforting environment.

p.r.e.p.® can be divided into three key phases: intake, implementation and reassessment.

Intake The first appointment p.r.e.p.® participants have is the intake. During the intake, the nurse reviews medical history, health condition(s), lifestyle, and physician recommendations. The nurse also evaluates biometrics: BMI, weight, and blood pressure. Together the patient and the nurse set specific goals to achieve during the program and develop a physical activity plan based on those goals.

Implementation After the p.r.e.p.® team develops an exercise program specific to the participant’s needs, abilities, and goals, they devise an expected schedule of physical activity. Schedules include p.r.e.p.® sessions, which are small group trainings consisting of 4-6 people; group exercise classes; and independent exercise. Throughout the 60 days in the program, the p.r.e.p.® team serves as a resource for exercise instruction, education, and accountability in a supportive, social environment.

Reassessment Towards the end of the p.r.e.p.® program, we measure progress and reshape the physical activity plan to help patients continue a physically active lifestyle. At this point, we also report progress and attendance back to the referring health care professional. Upon completion of the program, we encourage patients to continue exercise at The Alaska Club or elsewhere.

thealaskaclub.com/prep | 907-330-0120

We improve community health and wellness by integrating the fitness community with local health care providers and increasing the number of patients who choose a healthier lifestyle.

We carry out this mission by offering an inexpensive, non-intimidating program that introduces providers’ patients to basic exercise and nutrition.

With instruction, education, accountability, and support, we enable patients to successfully assimilate a healthier lifestyle and achieve their health goals.

MISSION STATEMENT


In 2010, Regina M. Benjamin, MD, MPH, the United States Surgeon General, delivered a public address on the state of this nation’s health.

During this address she discussed the problems of obesity, poor lifestyle choices, and lack of exercise. She pointed to the impact these problems

have on our nation’s productivity, health care costs, and overall individual life satisfaction.

She stated, “…That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient’s interaction with a health clinician.

“Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action:

• Policy makers are asked to change policies to support physical activity as a major component of health.

• Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction.

• Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being.

• Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity.

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BACKGROUND


BACKGROUND, CONTINUED

“As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward – something

more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each

day and live their lives to the fullest – without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.”

The idea for an introductory level exercise program that physicians could prescribe for their patients was first conceived in 2003 by acac (Atlantic Coast Athletic Clubs) owner Phil Wendel and his management team. acac took a leading role in the fitness industry and began the process of integrating fitness into the healthcare arena. acac’s commitment to this concept is epitomized by its fundamental program for introducing exercise to patients referred from health care providers: p.r.e.p. (Physician Referred Exercise Program).

The p.r.e.p. concept was presented to the acac board of medical advisors, and the idea took root. In collaboration with the acac fitness team, this group developed what became the 60/60 program. Over time the program has evolved into the current p.r.e.p. model. The program remains an inexpensive, sound introductory program to nutrition, exercise and lifestyle change. It has been successfully implemented at all of the acac clubs and also licensed for sale and distribution to other clubs and fitness organizations.

The medical community has embraced p.r.e.p.. Numerous lives have been dramatically changed. Biologic metric data has been gathered throughout the course of the program. Without question, the most impressive piece of data is that 40% of patients transition from p.r.e.p. into a full club membership. Recognizing that a certain percentage of patients in the program will choose to continue exercise on their own rather than in the club, we estimate that 55 to 60% of program participants adopt significant lifestyle changes.

The program continues to grow and mature as physicians from many specialties have embraced the concept and verbalized their needs and desires. Our organization and forward-thinking members of the fitness community will move into their new role as the first line of health care providers, integrating fully into the health care model.


Diabetes BenefitsRegular exercise helps with weight control, improves the body’s ability to use

insulin, improves blood glucose control, and positively impacts the long term effects of diabetes including heart disease, retinopathy, neuropathy, and kidney problems.

Heart diseaseMany people with known cardiac disease are fearful that exercise may cause an adverse cardiac event. Research has shown that, in the right patients, a safe exercise program, combined with proper nutritional choices will improve cardiac health and minimize the chance for heart attacks and or stroke. Lowered cholesterol and an improved HDL/LDL ratio are proven benefits of regular exercise which have a positive impact on cardiac health.

HypertensionThere remains controversy over the combined effort of exercise and weight reduction in reducing BP. Both have been shown to help independently, yet a comprehensive review by Hagberg and colleagues (2000) concluded from the gathered evidence that exercise training and dietary weight loss are independent, and that exercise can be effective in lowering BP without concomitant reductions in body weight. Other reviews maintain this idea but also reinforce the recommendation of the combination of diet and exercise as effective means to facilitate weight loss (Bacon et al. 2004). Therefore, if weight loss is desired in addition with BP pressure reductions, then diet should be modified accordingly.

Wait! Can Exercise Prevent Hypertension?The encouragement of regular exercise is not only useful as a treatment method for individuals with hypertension, but should also be advocated as a means for prevention. Predictors that may be examined to evaluate the risk of developing hypertension include resting BP, family history, and physical activity levels. Higher physical activity levels have shown an inverse relationship to the development of hypertension. As well, Barengo and associates (2005) presented evidence that European men doing equal to and greater than 4 hours per week of leisure-time physical activities (e.g. recreational sports, skiing, gymnastics, heavy gardening, hunting, fishing and walking/jogging) had reduced risk of hypertension. Thus physical activity and regular exercise can protect against hypertension.

As hypertension is associated with an increase in risk for cardiovascular disease, it is vital that effective interventions are advocated to reduce overall morbidity and mortality. Although pharmacological treatments can be costly and necessary for treating some BP conditions, lifestyle modifications should also be implemented whenever possible. The role of exercise has been shown to be consequential in lowering both systolic and diastolic BP. Both aerobic and resistance training

have been shown to facilitate anti-hypertensive responses, although aerobic exercise has been more largely studied. Specifics concerning optimal intensity and length of the exercise program are yet to be fully determined, however, moderate intensity exercise

performed for at least 30 minutes on most days of the week still remains to be the ‘minimal’ yet effective recommendation necessary for prevention and treatment of

hypertension, as well as for promoting overall health.

EXERCISE BENEFITS


Exercise is medicine. Everyone knows by now that exercise is good for you. For a lot of people, exercise involves weight loss or weight management. And we’ve all experienced it at some point, you put

your heart and soul into a new diet, you exercise like a fiend, but that darn scale just won’t budge! Your motivation is crushed and you think well “why bother…what’s the point”. It’s all about the number on the scale right? Wrong.

Yes, exercise is a major player in weight control – whether trying to lose or just maintain. But there are plenty of other numbers fighting for your attention and other benefits of exercise that are just as important to your health. Here, I’m going to give you 7 positive “side-effects” of exercise.

1. Heart health – regular physical activity can decrease your risk of many heart related diseases like high blood pressure, high cholesterol, atherosclerosis, stroke, etc. No matter what the number on the scale says, being active increases high-density lipoprotein (HDL) or good cholesterol and lowers triglycerides.

• Know these numbers and follow them - get your blood pressure and cholesterol checked, or ask your doctor what these were at your last checkup.

• Normal blood pressure is 120/80 and your total cholesterol should be less than 200

2. Blood sugar – Exercise helps manage blood sugar levels whether you have diabetes or not. If you have diabetes, or are pre-diabetic, physical activity can help you control the disease so you need less medication or potentially reverse the disease.

• Know your numbers and follow them. Normal blood sugar levels are 80-100. If you are diabetic, according to the American Diabetes Association, target blood sugar range before a meal should be 70-130, or A1C levels of 7% or less.

3. Mood – Regular physical activity is an all-natural, no pills needed, mood enhancer. Exercise releases endorphins and other feel good brain chemicals which will give you an emotional boost and help decrease stress. It doesn’t have to be an intense workout either – take a quiet walk, garden, or take a yoga class.

4. Energy – It may sound contradictory, but regular exercise will give you more energy. Building your endurance or stamina will improve the efficiency of how hard your body works to get things done. The more efficient your heart and lungs work, the more energy you have to spare.

5. Sleep – Who doesn’t want to sleep better? People who exercise have a better quality of sleep – it is easier to fall asleep, to stay asleep, and sleep deeper.

• Know your numbers and follow them. How long do you lay in bed before catching some zzz’s? How many hours a night are you clocking? Do you wake up regularly? Target numbers should be approximately 10-20 min to fall asleep and aim to get 7-9 hours each night.

6. Brain function – Regular physical activity helps enhance learning, can fend off memory loss and cognitive decline as you get older. Research shows that exercise boosts production of cells in the hippocampus, a part in your brain which is responsible for memory and learning. Keep that noggin sharp and get moving!

7. Bone density – Although osteoporosis is most commonly associated with women, men also lose bone density with age. Certain types of exercise have been proven to help slow bone loss and can even help prevent the onset of osteoporosis. These exercises include weight-bearing activities like walking, jogging, or climbing stairs, as well as resistance or strength training using

bands, dumbbells, or machines.

The list could go on and on. The bottom line is, weight should not be the ONLY focus, the ONLY motivator, when beginning an exercise program. It’s a good one, but should be one among many. Next time you step on the scale and think you’re hard work isn’t paying off, remember this list and know that you’re doing great things for your body.

BENEFITS OF EXERCISEIT’S NOT ALL ABOUT THE WEIGHT


The Centers for Disease Control and Prevention has published the following statistics concerning arthritis:

• 1 in 2 people will develop symptomatic osteoarthritis of the knee by age 85• 2 out of 3 obese people will develop symptomatic arthritis in their lifetime• 50 million people in the US have been diagnosed with some form of arthritis and it is estimated that half

that many are never formally diagnosed• 22% of adults over 21 have been diagnosed• 50% of adults over 65 carry the diagnosis• By 2030 , an estimated 67 million Americans over the age of 18 are projected to have physician

diagnosed arthritis of some form• 16% of under/normal weight adults have arthritis• 22% of overweight and 32% of obese adults have the disease• 66% of adults with physician diagnosed arthritis are overweight/obese• 22 million US adults report significant arthritis related activity restriction• Health Related Quality of Life Reports – adults with arthritis report two to four times as many unhealthy

days per month than those without arthritis. • Weight loss of as little as 11 lbs reduces the risk of developing knee arthritis by as much as 50%• In 2003 the cost attributed to arthritis in the US was 128 billion dollars.

There are a number of misconceptions about exercising in the face of arthritis. It is commonly believed that regular exercise will lead to accelerated wear and tear on the joints and progression of the arthritis. Many people believe this will lead to increased stiffness and pain. Finally, many believe that regular exercise, by “accelerating” the wear and tear on joints will lead to increased rates of joint replacement surgery.

The facts are very different. Numerous studies have shown the benefits of a “smart”, regular program of aerobic conditioning, strength training, and flexibility exercises. Patients who follow sensible guidelines have been shown to actually decrease joint pain and stiffness and improve range of motion.

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ARTHRITIS FACTS & BENEFITS OF EXERCISE


Increased strength and flexibility improve the ability to perform activities of daily living and can decrease disease activity by improving overall health. At least one study has shown that arthritic patients who exercise regularly have less joint replacement surgery on average than those who don’t. It has actually been shown that reducing activity will lead to an increase in symptoms and diminished functional levels. It may even speed up the breakdown within the joint. Additionally, the weight loss associated with regular exercise lessens the load on the joints.

The American College of Sports Medicine has come out with a position statement recommending a program of regular exercise which includes aerobic conditioning, resistance training, and flexibility activities. It is recommended that the aerobic activity be low impact (walking, cycling, swimming, elliptical, etc. ) and be performed for 30-60 minutes 3-5 days per week. Strength training should include one set of repetitions for major muscle groups two times per week. Flexibility training should be done daily and focus on gentle stretching and maintenance of range of motion for all joints including the spine.

There is no question that arthritis patients have special needs and precautions compared to nonaffected population. The following are guidelines to ensure safe and beneficial exercise and to limit the potential for “flaring” affected joints.

• Discuss your outlined plan with your doctor and trainer

• Start with supervision from a qualified therapist or trainer

• Stretch and warm up with gentle range of motion exercises

• Consider applying heat to sore joints or to affected joints before exercise

• Consider using cold packs following exercise to minimize any rebound inflammatory response

• Start strengthening slowly with light weights and be very strict with proper form to prevent injury

• Progress slowly

• Read your body’s signals. Ease off if joints are painful, inflamed, or red

• Respect your need for recovery days and let your body rather than your schedule determine when you need a break

• Remember that cardio doesn’t all need to be done at one time. Three 15 minute sessions is as beneficial as one 45 minute session as long as the effort is moderate.

ARTHRITIS & EXERCISE, CONTINUED


Regular activity midlife doubles your chance of reaching age 85

University of Texas study finds remaining physically fit during midlife & beyond increases life expectancy

Now that the baby boomers have passed the age of 65, they’re seeking to live longer, eat healthier, and fight the battle against aging.

A study from the University of Texas Southwestern Medical Center finds that one of the important strategies for surviving to 85 and beyond is to remain physically fit in your midlife and beyond. “If you’re not fit in your 50s, your projected life span is eight years shorter than if you are fit,” says Dr. Jarrett Berry.

National guidelines recommend at least 30 minutes of moderate exercise five times a week to maintain fitness, along with weight training sessions to strengthen muscles. Surveys say, however, that only about half of Americans report following these guidelines. It’s been found that the biggest benefit from this exercise regimen happens when someone moves from a sedentary lifestyle to a regular moderate exercise routine.

The p.r.e.p. program at acac Fitness and Wellness Centers, also called the physician referred exercise program, allows individuals to experience exercise and gain the knowledge they

Study Highlights1,444 men and 321 women were a part of this study from ages 50-69 until they reached their 85th year. Men were nearly 1.8 times as likely to reach age 85 if they were fit. Women were 2.2 times as likely to reach age 85 if they were fit.

Activities that qualified as moderate intensity exercise included walking at a brisk pace, mowing the lawn, ballroom dancing, and doubles tennis.

Vigorous exercise options were walking or jogging at 4.5 miles per hour or more, playing basketball, and cross country skiing.

The study found that the combination of being physically fit and active, along with not smoking or having high blood pressure, was a powerful predictor of longevity.

need to make fitness a part of their daily lives.

acac’s on-site nurse and exercise physiologists oversee the customized program, and participants gain access to medical fitness specialists in a small group setting.

Since the p.r.e.p. program began in 2004, more than 22,000 people have enrolled, and 60% percent of the participants who completed the program have continued to make exercise a part of their routine. According to Dr. Donald M. Lloyd-Jones, cardiologist at Northwestern University, exercise has the potential to “become a fountain of youth for your heart,” resulting in lower cholesterol, blood pressure, and blood sugar, all weapons in the fight against disease. With a physician referral, patients can experience this low cost, low commitment program at acac (60 days for $60) and lead longer, healthier lives.

From The Alaska Club p.r.e.p. Medical Director, Teresa Bormann, MD


Participants receive:

• nutrition education classes

• full access to all The Alaska Club fitness facilities

• group exercise classes

• indoor aquatics

• access to an online video education portal

Physician Referred Exercise Programis The Alaska Club’s guided introduction to

exercise where participants meet with medical

fitness professionals in small groups twice per

week for 60 days.

Teresa Bormann, MDMedical Director The Alaska Club p.r.e.p.


Thank you for participating in The Alaska Club’s Physician Referred Exercise Program, also known as p.r.e.p.® In order for you to make the most of this program, we would like to share some

basic information about the program.

1. We recommend you attend two (2) one-hour group sessions per week. 30 minutes will be spent in a supervised small group training session, and the remaining 30 minutes will be spent in an independent cardio session.

2. Session times* are listed on the back. Your session days and times can vary from week to week as needed based on your schedule. We recommend that you sign up for sessions well in advance as sessions fill quickly.

3. You may work out independently at any time outside of these sessions.

4. We may have other people scheduled for sessions before and after your scheduled appointment time. Please arrive at the p.r.e.p.® area on time and ready to exercise.

5. Please wear closed toe shoes, preferably tennis shoes or sneakers.

6. Please check in at the desk where you have been instructed to meet at the time of your appointment.

7. You will have access to an online video education portal. We recommend that you complete one educational activity per week. We encourage you to access this valuable resource frequently.

8. With p.r.e.p.® you receive:- nutrition seminars with The Alaska Club experts - access to all group exercise classes - access to fitness amenities at all The Alaska Club clubs- access to an online video education portal

We look forward to working with you and helping you reach your goals.

The Alaska Club p.r.e.p.® Team

welcome!

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PATIENT INTAKE FORM

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p.r.e.p. Physician Referred Exercise Program® is a registered trademark of Legacy Management Group, Inc.

Over the last two weeks All of the time

Most of the time

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of the time

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the time

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At no time

1 I have felt cheerful and in good spirits 5 4 3 2 1 0

2 I have felt calm and relaxed 5 4 3 2 1 0

3 I have felt active and vigorous 5 4 3 2 1 0

4 I woke up feeling fresh and rested 5 4 3 2 1 0

5 My daily life has been filled with things interesting to me 5 4 3 2 1 0

progress notes

INTAKE FORMCONTINUED


We provide the expertise, the right accessories, and the warm water.

Together, we make working out pain-free and fun!

• aquatic exercise classes

• underwater running belts

• underwater weights

• resistance equipment

p.r.e.p.® OFFERS A GUIDEDAQUATIC EXERCISE OPTION

Do you have patients who would benefit from non-weight bearing activity?

thealaskaclub.com/prep | 907-330-0120p.r.e.p. Physician Referred Exercise Program® is a registered trademark of Legacy Management Group, Inc.

Welcome to The Alaska Club’s p.r.e.p. - Your introduction to exercise and lifestyle change. Your physician has identified you as a person who would benefit from some basic nutritional counseling and instruction in a safe exercise program. Either you or your physician has also identified you as a person who would benefit from the advantages of a water-based rather than land-based exercise program. Our aquatics program can help with weight loss, strength, flexibility, and cardiovascular health while placing limited stress on your joints. This program will incorporate aerobic conditioning, core strengthening, resistance training, and flexibility exercise.

Buoyancy is the upward thrust exerted by water on a body. This upward thrust counters the force of gravity and supports a significant percentage of the body’s weight. This allows for exercise with reduced impact and greater flexibility. As a result this type of exercise can reduce the strain and possible injury on the body’s weight-bearing joints, muscles, tendons, and ligaments. Additionally, the viscosity and drag forces of water provide resistance which is proportional to the effort exerted against it. Depending on the speed of movement the resistance of water can range from four to 42 times greater than the resistance of air. As a result the pool becomes a resistance training machine which is instantly adjustable. Additionally this resistance is present in all directions allowing for safe resistance training in all planes of motion. Resistance can be increased even more through the use of water fitness equipment such as webbed gloves, aquatic footwear, or buoyant dumbbells.

The water is also an excellent medium for improving your cardiovascular health because of its unique properties. When submerged, the hydrostatic pressure of water pushes equally on the entire submerged surface area. This assists the heart and the circulation of your blood volume by assisting with blood flow back to the heart. Studies have shown that blood pressure and heart rate tend to remain lower during deep water exercise when compared with similar exercise on land.

Unlike our other p.r.e.p. tracks, the aquatics track does not require the use of any machinery and therefore requires minimal direct oversight to ensure safety. This does give you greater flexibility with regard to the scheduling of your sessions if you should choose to exercise independently. When you arrive for your first session you will be given one-on-one, or potentially small group instruction in the basic pool exercise routine. This one routine will incorporate cardio, core strengthening, resistance training, and flexibility. After you have been signed off on the exercise program you will be free to perform this program independently. At your intake session you will receive a paper copy of the program with illustrations of the routine. Upon arrival at the club on your workout days you may pick up laminated copies at the p.r.e.p. desk to allow you to visualize them at the poolside. You will also, however, be encouraged to participate in our formal aquatics classes scheduled through our group exercise program. We also encourage you, whenever possible, to schedule your individual sessions during normal scheduled p.r.e.p. hours. This will allow our team members to check in with you before, during, or after your session to discuss your progress and answer any questions which you may have.

WELCOME TO AQUATICS TRACK


For your safety and convenience we do have poolside lifts available for those persons who require assistance getting in or out of the water. Please make that need known to your prep team at your intake session. We do have complementary towels available for your convenience. We strongly encourage appropriate poolside footwear to prevent slips and ensure your safety.

Another significant advantage of exercise in water is that there is no specific limit to how frequently you can perform this exercise. Most other forms of resistance training require a recovery day following a day of exercise. With aquatic exercise your body is your guide. If you feel overly fatigued or sore then we recommend one or two days of recovery. If however, you are feeling good and energized you may participate as often as you would like. Since your p.r.e.p. membership allows you full and unrestricted access to the club facility we strongly encourage you to get in some form of exercise as frequently as your body allows.

Please remember that you will only achieve the desired effects of this program if you are consistent with your exercise and you continue a program of regular exercise after you have completed your 60 days with our team.

We also want to stress that exercise alone will not help you to achieve your ultimate health goals. Nutrition is a critical component of any lifestyle change program. We strongly encourage you to take advantage of our in-house nutrition classes and education videos.

Finally we want to emphasize that are prep team is here to help. If you ever have concerns or questions please seek us out. If we don’t know the answer we will find it out for you.

Congratulations on taking the first and most important step to a new and healthier lifestyle.

C O N T I N U E D F R O M O T H E R S I D EAQUATICS TRACK


Welcome to The Alaska Club’s p.r.e.p.—your introduction to exercise and lifestyle change. Your physician has identified you as a person who would benefit from instruction in a safe exercise program to help improve your arthritis symptoms and to help delay or stop the progression of your arthritis. Many people mistakenly believe that regular exercise, particularly resistance training and weight bearing activity, is bad for their arthritis. In point of fact, research has shown the exact opposite to be true. A well-designed program of regular aerobic activity and resistance training can (if performed properly) actually lead to decreased symptoms, improved function, and delay the progression of your arthritis.

Our program is based on the guidelines proposed by the American College of Sports Medicine for exercising with arthritis. It will include the recommended aerobic conditioning (30-60 minutes, 5 days a week), resistance training (one set for each major muscle group twice weekly), and flexibility activities. We may recommend modifications to your program based on the type and severity of your arthritis as well as your doctor’s specific recommendations and restrictions.

If you have a systemic, or inflammatory type of arthritis, your immune system is affected by the disease and possibly by your medications. This may lead to the need for more frequent rest during your exercise periods. We generally recommend low-impact cardio activities such as brisk walking, cycling, or elliptical training to reduce joint impact. Many arthritis patients are able to jog for cardio, but we recommend discussing this with your physician.

Specific recommendations for all arthritis patients:

• Consider starting slowly with 2-3 short cardio sessions in a day to help with conditioning and acclimation without increasing your joint pain.

• Always exercise in good shoes and use any prescribed braces or splints for support.When resistance training, avoid explosive or uncontrolled movements. Keep your speed even and smooth throughout your repetitions.

• If machine exercises consistently cause joint symptoms, ask your trainer to help you substitute body weight exercises.

• When doing flexibility exercises, remember to stretch gently without bouncing. If your arthritic joint is unstable, ensure that you do not go beyond the “normal” range for that joint.

• Consider some of our low-impact class options that incorporate all exercise components (cardio, strength, and flexibility), such as yoga, tai chi, or water classes.

• Make sure you warm up and cool down properly. Start with small, slow movements and increase the range and intensity as you warm up. Doing range of motion exercise prior to aerobic or resistance training is a good way to get the joints ready for heavier activity.

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WELCOME TO ARTHRITIS TRACK


Specific recommendations for all arthritis patients, continued:

• Consider using heat on your joints prior to exercise to help warm up the joints and cool packs following exercise to minimize any inflammation.

• It is important to be self-aware and listen to your body. It is okay to exercise in the face of a mild flare—just decrease the intensity accordingly.

• Remember that some soreness and aching are normal byproducts of good exercise but sharp pain or swelling are indicators that you are doing too much.

• The most important thing to remember is that you will only see the benefits of this exercise program if you are consistent with your routine.

• Please remember that our team is here to help and guide you. If you have questions or concerns (even on days when you are not doing a “scheduled session”) don’t hesitate to seek out your p.r.e.p. team.

• We also cannot emphasize enough that we would like you to take advantage of all our facility has to offer outside of p.r.e.p. Group classes include yoga and aquatic exercise, which would be excellent choices for an arthritis patient.

Finally, please bear in mind that proper nutrition is a critical part of any program and weight control is especially important in helping decrease stress on the joints. Please take advantage of our nutrition counseling and educational videos to help enrich your program experience.

C O N T I N U E D F R O M O T H E R S I D EARTHRITIS TRACK


Welcome to The Alaska Club’s p.r.e.p.—your introduction to exercise and lifestyle change. Your physician has asked us to be a partner on your journey to a healthier lifestyle. Our goal will be to help you incorporate a safe exercise program into your overall weight loss program. As you are well aware, achieving your desired weight loss and, most importantly, maintaining that weight loss requires much more than just surgical intervention. Active and sustained lifestyle change are critical to your long-term success.

Two of the most important areas of your lifestyle change involve a focus on nutrition and a commitment to lifelong exercise and movement. We are here to help teach you how to exercise safely and how to progress and maintain your exercise program. Additionally, we support the nutritional programming discussed with you by your bariatric team through our educational video library and by giving you access to our nutrition classes.

Rapid weight loss inevitably results in muscle loss. Muscle helps control our metabolism so it is important to regain and maintain lean muscle mass. Studies have shown that bariatric surgery patients who engage in regular exercise lose more weight, keep it off more effectively, suffer from less depression and anxiety, and have higher general health scores.

Our goal is to help you learn to exercise safely both before and after surgery. Equally important is our desire to help you find the type of exercise you view as fun and pleasurable, rather than work. We will offer you opportunities to exercise on land or in the water, and you’ll have the opportunity to share this journey with others who are also new to this lifestyle.

Excess body weight often restricts your movement and makes exercise difficult. Our job will be to help you work around these difficulties to begin (and later sustain) the exercise program necessary to facilitate weight loss.

The following are some general guidelines we will follow to help you safely begin your program:

• Increase your routine daily activities outside the club. Examples could include cleaning your house, parking further away, or using the stairs when safe and appropriate.

• Start slow and break your exercise up into small segments, completing six 10-minute sessions is as good as one 60-minute session when starting out.

• Avoid exercise that creates excessive stress on your joints like jogging or jumping. Use the pool when necessary to take stress off your joints.

• If you have trouble with weight-bearing exercise, perform resistance training from a seated position or in the pool.

• Aerobic activity should be of low to moderate intensity.

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WELCOME TO BARIATRIC TRACK


Guidelines, continued:

• Duration is more important than intensity for your weight loss goals. Start slowly and build up to 60 minutes a day, 5-6 days a week.

• Strength training is important for maintaining lean muscle mass, and it should consist of 2-3 sets of 12-15 repetitions. The goal is to maintain lean mass, not to bulk up.

• The timing and restrictions of your post-operative exercise will be determined by your bariatric surgeon.

Just like your bariatric team, our team of fitness professionals is here to help and support you along the way. They will be using guidelines and restrictions recommended by your surgeon and will communicate with your physician about your progress and any concerns. We hope you will take advantage of the opportunity to follow this 90- day program with our 60-day postoperative program to continue your success.

Your success is our top priority, and we are excited to have this opportunity to help you on your journey to a new and healthier lifestyle.

C O N T I N U E D F R O M O T H E R S I D EBARIATRIC TRACK


Welcome to The Alaska Club’s p.r.e.p.—your introduction to exercise and lifestyle change. Your physician has identified you as someone who would benefit from instruction in a safe exercise program to help control your diabetes and minimize its long-term effects on your body. Our well-designed exercise program can help with weight control, improve your body’s ability to use insulin, improve blood glucose control, and positively impact the long-term effects of diabetes, including heart disease, retinopathy, neuropathy, and kidney problems. This program will incorporate aerobic conditioning, resistance training and flexibility exercise.

Our program is based on guidelines proposed by the American College of Sports Medicine for exercise and diabetes. It includes the recommended moderate aerobic conditioning (30-60 minutes 5 days a week), resistance training (one set for each major muscle group twice weekly), and flexibility activities.

One common concern among patients is the fear of a hypoglycemic reaction during or after exercise. For diabetics who are not on medication for glucose control, the risk is very minimal—even with intense exercise. Diabetics who require insulin or oral medications can still exercise safely with minimal risk of hypoglycemic events if they follow some simple guidelines.

Precautions for people on insulin or oral medications for diabetes:

• Check your blood sugar prior to exercise. If your blood level is less than 100, eat a carbohydrate snack prior to beginning exercise (20-30 gms, such as a fruit or several crackers).

• Check to see if your blood sugar dips below 70 after exercise. If this happens consistently, discuss with your physician. You may need to modify your medication on exercise days.

• Always carry a fast-acting carbohydrate food, such as glucose tablets, when exercising in case your blood sugar drops too low and hypoglycemia symptoms develop during exercise.

• For long duration or high-intensity exercise sessions, plan extra carbohydrate snacks during the activity. Consumption of additional carbohydrates is suggested for every 30 - 60 minutes of exercise (e.g. hiking, biking, skating, etc.).

• Wear a form of ID (e.g. medicalert) that identifies you as a diabetic so others may help you appropriately in the event of a severe hypoglycemic event.

continued >>

WELCOME TO DIABETES TRACK


Precautions, continued:

• If you have foot problems or neuropathy, discuss your shoe wear with your doctor or podiatrist. Inspect your feet daily for signs of friction or pressure sores.

• If your blood sugar is above 240 but less than 300, you should restrict your exercise to low/moderate level activity. Intense activity can cause a temporary rise in blood sugar after exercise that could place you at risk for ketoacidosis.

• If your blood sugar is 300 or greater, do not exercise that day.

• Please remember that you will achieve the desired effects of this program only if you are consistent with your exercise and continue a program of regular exercise after you complete your 60 days with our team.

We also want to stress that exercise alone will not help you achieve the best control of your diabetes. Nutrition is a critical component of your program. We strongly encourage you to take advantage of our in-house nutrition counseling and our education videos on nutrition.

Finally, we want to emphasize that our p.r.e.p. team is here to help. If you ever have concerns or questions, please seek us out.

Congratulations on taking the first and most important step towards a healthier lifestyle and better control of your diabetes.

C O N T I N U E D F R O M O T H E R S I D EDIABETES TRACK


Welcome to The Alaska Club’s p.r.e.p.—Your physician has identified you as someone who would benefit from instruction in a safe exercise and nutrition program to improve your cardiovascular health. Many people with known cardiac disease are fearful that exercise may cause an adverse cardiac event. Research has shown that, in the right patients, a safe exercise program, combined with proper nutritional choices will improve cardiac health and minimize the chance for heart attacks and/or stroke. Your physician has cleared you for this program and it is our goal to help lead you down the path to a healthier lifestyle.

Our program is based on the guidelines proposed by the American College of Sports Medicine and the American Heart Association. It will include the recommended aerobic conditioning (30-60 minutes at moderate intensity, 5 days per week), resistance training (one set for each major muscle group twice weekly), and flexibility exercises. We may recommend modifications to your program and/or specific heart rate restrictions based on your doctor’s recommendations.

Specific recommendations for all Healthy Hearts patients include:

• Maintain a healthy body weight- This requires a balance of caloric intake and calories burned through physical activity- Our p.r.e.p. team will help you learn to calculate these parameters

• Consume an overall healthy diet- It is not only the number of calories consumed which is important, it is also the type of

calories and their heart health value that is important • Achieve and maintain normal blood pressure

- The risk of cardiovascular disease increases progressively as blood pressure increases, so any improvements can have significant benefits

• Achieve a normal glucose level (less than 100mg/dl)- Increased glucose levels are associated with insulin resistance and a number of

cardiovascular complications• Avoid use of or exposure to tobacco products• Participate in a regular exercise program

continued >>

WELCOME TO HEALTHY HEARTS TRACK


Recommendations, continued:

• Consume a “heart healthy” diet- Rich in vegetables and fruits- Whole grain, high-fiber foods- Oily fish (or fish oil) twice per week- Limit intake of saturated fat, trans fat, and cholesterol- Limit salt intake with your food- Remember that exercise, while important, cannot overcome poor nutritional habits

Exercise Precautions:

• 4 Warning signs: if any of these occur, discontinue exercise and seek medical attention

- Chest pain/pressure, jaw pain, discomfort radiating down either arm, or pain across the shoulders

- Unaccustomed shortness of breath- Dizziness or lightheadedness- Irregular heart rate

• High risk activities

- Sudden stop-and-go activities- Extremely heavy lifting activities

The most important thing for you to remember is that your success and improved health is dependent on your commitment to a balanced, regular program of exercise and good nutritional choices. Our team is here to help and guide you. If you have questions or concerns (even on days when you are not doing a “scheduled” session), seek out your p.r.e.p. team and don’t hesitate to ask for help.

We also cannot emphasize enough that we would like you to take advantage of all our facilities have to offer outside of p.r.e.p. Group classes include yoga and aquatic exercise which are low-impact, low-stress alternatives for you.

Finally, please bear in mind that proper nutrition is a critical part of your program and weight control is integral to decreasing your cardiovascular risk. Please take advantage of our nutritional counseling and our educational videos to help round out your program. We will be including for your benefit a nutritional package with information on heart-healthy diets and food choices.

C O N T I N U E D F R O M O T H E R S I D EHEALTHY HEARTS TRACK


PRE/POSTNATAL EXERCISE TRACK

The Alaska Club offers programs for new & expecting parents through p.r.e.p.®

The Alaska Club Gold membership including prenatal yoga, pilates

& aquatics

two small group training sessions a week

participation in an exercise program approved by

your obstetrician

Ask your doctor to prescribe p.r.e.p.® today


Welcome to The Alaska Club’s p.r.e.p.—your introduction to exercise and a healthier lifestyle. Your physician has identified you as someone who would benefit from instruction in a safe exercise program to keep you and your baby healthy during your pregnancy. Regular exercise can help you appropriately control weight gain, increase your energy, improve your mood, reduce backache and constipation, and help prevent or treat gestational diabetes. Additionally, regular exercise during pregnancy can help make your post-partum recovery and return to exercise easier. Finally, recent studies have shown that regular exercise during pregnancy can help with your baby’s brain development.

Our program is based on guidelines proposed by the American College of Obstetrics and Gynecology and the American College of Sports Medicine. This program includes the recommended balance of aerobic exercise, resistance training and flexibility activities. It is recommended that pregnant women participate in cardio activities for 30 minutes a day on most, and preferably all, days of the week. Resistance training, using low weights for 10 - 12 repetitions and working each major muscle group, is recommended twice per week. Flexibility exercises should be performed throughout the pregnancy but taking care to not exceed normal range of motion. This will protect your joints, which become hyperlax during pregnancy.

Precautions

• Avoid exercise where there is a high risk of falling. Remember that carrying additional weight in front changes your normal body mechanics and can affect your balance.

• If you have been sedentary before pregnancy, start slowly and progress gradually, as your body allows.

• Avoid overheating. Wear loose, cool, comfortable clothing and be aware of your hydration level.

• Wear a well-fitting, supportive bra to protect your breasts.• Consume the extra calories you need daily during pregnancy, and always ensure that you

have eaten something prior to exercise.• After the first trimester avoid doing any exercises lying flat on your back.• Remember that during pregnancy you carry additional weight and have loose ligaments.

Avoid high-impact activity (except those you were doing regularly before becoming pregnant) and be mindful of your low back and joints. If an exercise causes joint or back pain, find an alternative exercise.

continued >>

WELCOME TO PREGNANCY TRACK


Warning Signs to Stop Exercising:

• Vaginal bleeding• Dizziness or feeling faint• Increased shortness of breath• Chest pain• Headache• Muscle weakness• Calf pain or swelling• Uterine contractions• Decreased fetal movement• Fluid leaking from vagina• Elevated blood pressure – this will be defined by your doctor

Since our goal is to help you exercise every day, we encourage you to check with p.r.e.p. team members about our group exercise programs that are specifically designed for pre-natal women, as well as other appropriate classes.

Please remember that exercise alone is not enough to tend to your health and the health of your child. Proper nutrition throughout your pregnancy is critical. We strongly encourage you to take advantage of our nutrition counseling and our nutrition education videos as part of your p.r.e.p. experience.

Congratulations for taking this step towards a healthier lifestyle! Pregnancy is a physically and emotionally demanding time in your life, and we are honored to be part of your journey. We encourage you to discuss our postpartum program with your doctor and hope that we may continue to help you realize optimal health and wellness.

C O N T I N U E D F R O M O T H E R S I D EPREGNANCY TRACK


Welcome to The Alaska Club’s p.r.e.p.—your introduction to exercise and a healthier lifestyle. Your physician has identified you as someone who would benefit from instruction in a safe exercise program to help you recover from the effects of your pregnancy and prepare for the physical challenges of caring for a newborn. Regular exercise can help you achieve a safe and desirable postpartum weight, improve your energy, maintain your bone density while breast feeding, and decrease your chance of postpartum depression.

Our program is based on the guidelines proposed by the American College of Obstetrics and Gynecology and the American College of Sports Medicine. These guidelines apply to women who are breastfeeding as well as those who are not. It is recommended that postpartum women, when given clearance from their doctors, resume a program that includes aerobic conditioning, resistance training, and flexibility exercises. Cardio and flexibility training should be performed at least three days a week, but daily activity is preferable. Resistance training should involve all major muscle groups and should be performed twice per week.

There are a number of myths and misconceptions which, in the past, have prevented women from exercising after pregnancy:

MYTH: Exercise will impair milk production and compromise neonatal weight gain.

• There are no studies to support this claim. In fact, studies show that moderate weight reduction while nursing is safe and does not compromise neonatal growth.

MYTH: Ligament laxity persists after delivery and predisposes one to joint injury.

• While the physiologic effects of pregnancy, including joint laxity, often persist for 4 - 6 weeks after delivery, there is no evidence that demonstrates increased injury is related to this.

MYTH: Resistance training is unhealthy for nursing mothers.

• Studies have shown that resistance training can reduce bone mineral density loss in nursing women.

MYTH: The energy expended during exercise will leave women (already tired and often sleep deprived) with insufficient energy to handle duties of parenting.

• Studies have indicated that there is a subjective increase in energy associated with exercise, as well as a decreased incidence of postpartum depression.

continued >>

WELCOME TO POSTPARTUM TRACK


Precautions:

• The timing of return to exercise varies from individual to individual and is best determined by the physician who has followed you through your pregnancy.

• Even if you have exercised throughout your pregnancy, some degree of de-conditioning occurs. Your return to full exercise should be gradual, particularly where high-impact activities are involved.

• Fornursingmothers,itisimportanttoensurethatfluidandnutritionalintakeisadequatetobalancetraining-inducedlosses.Thiswillensurethatmilkproductionandneonatalgrowthare not compromised due to activity.

• Nursing women should consider feeding infants before exercise in order to avoid the discomfort of engorged breasts.

• Nursingbeforeexerciseavoidsthepotentialproblemofincreasedacidityofmilkrelatedtoany buildup of lactic acid.

It is important to recognize that exercise alone is only part of a complete lifestyle program. Proper nutrition is critical to re-establish your overall health and the health of your nursing child. We stronglyencourageyoutotakeadvantageofournutritioncounselingandournutritioneducationvideos as part of your p.r.e.p. experience.

Congratulations on the birth of your child! We appreciate the opportunity to help you recover from your pregnancy and prepare you for wonderful, yet physically demanding, times ahead.

Remember that our p.r.e.p. team is here to help and we encourage you to approach them with anyquestionsorconcerns.Itisanamazingexperiencetocareforandnurturethehealthofyournewbornchild.Thankyouforallowingustohelpyoucareforyourownhealthasyouembarkonthis incredible journey.

C O N T I N U E D F R O M O T H E R S I D EPOSTPARTUM TRACK


You will first meet for an intake with a professional at The Alaska Club, such as a nurse, certified trainer or exercise physiologist. The assessment will follow an established protocol to review your medical history, exercise history, surgeon’s instructions, and any specific recommendations.The Alaska Club will then evaluate your balance, flexibility and mobility to determine appropriate training methods and modalities:

• Balance: single leg stance near a wall or other potential assist • Flexibility: sit and reach • Mobility: observation of your current quality of movement e.g. walking or swimming

At that point your conditioning program will be customized to meet your specific abilities and pain tolerance in order to prepare you for surgery.

You will follow a tailored conditioning program 2x/week supervised by a medical fitness professional to improve:

• Strength• Balance• Muscle Endurance• Flexibility

Exercises will focus on developing strength in your quadriceps, hamstrings, glutes and core, as well as your upper extremity muscles. Upper extremity conditioning is critical to prepare you for the use of a cane, walker or crutches, and for assisting with transfers from seated to standing positions.We encourage you to work out a minimum of 3x/week for 8 weeks. You will have full access to all The Alaska Club fitness facilities throughout the 60-day program for only 60 dollars. Each week a p.r.e.p. team member will provide you with 2 structured workouts in small group settings. We recommend that you also try other club activities, such as yoga, aquatic exercise or NIA®.

60 days prior to surgery

during the program

ASK YOUR DOCTOR TODAY.

Prepares pre-surgical patients for the demands of recoveryImproves patient outcomesSpeeds post-surgical recovery process

What is p.r.e.p. · What is p.r.e.p.® p.r.e.p.® is a 60-day physician referred exercise program...

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