Physical Activity and Exercise Promotion

1. Physical Activity and Exercise Promotion Guidelines for Dietitians

2. Today’s Agenda • Dietitian’s role in teaching physical activity • Class 4 ‘How To’s’ • Important information to provide patients • Demonstration of exercises • Safety concerns • Helpful resources

3. Boundaries Mapping of the Issues for RDs

4. Scope of Practice • There are risks attached to physical activity counseling and training: • Injury related to improper technique, load or repetitions • Equipment Malfunction- falling plates, band breakage • Pre-existing physical limitations/risks

5. Scope of Practice As an RD what can you do: • Make general physical activity recommendations • Talk about Canada’s Physical Activity Guidelines • Talk about physical activity principles and benefits • Help clients develop a FITT prescription • Suggest types of exercise that may meet client needs

6. Scope of Practice • As an RD what you cannot do: • Lay out a specific, individualized exercise plan that includes specifics of exercise type, resistance, repetitions • Demonstrate specific exercises • Help clients execute specific exercises

7. Things to Consider If Teaching Physical Activity Education • Because it is not a controlled act you may still teach these activities just not as an RD • You must be certain that you competent to teach the exercises or activities in a safe and appropriate manner • Unless otherwise qualified refer to yourself as an “exercise enthusiast”

8. Scope of Practice Know your personal scope of practice: • What is your personal experience with physical activity? • What are your beliefs? • What additional training, education and certification have you had? • What is your comfort level? • What is your physical activity counseling experience? Note that liability insurance carried by RD’s is for activities carried out within our scope of practice. Those engaged in providing specific exercise programs to clients would require a different separate type of liability insurance

9. Overall • You are permitted to educate on physical activity as part of a care plan in dietetics • Any additional education such as demonstrations or programs where clients are being active is not considered dietetics and should not be labelled as so • Physical activity is not a protected act. However, the dietitian must ensure that they are competent to teach • It is important to identify to the client that you are no longer providing advice as a dietitian when you educate on physical activity

10. Teaching Class 4 of Healthy You Advice, Demonstrations and Safety

11. Slides 1-16 • All within scope of being an RD • No real concerns with these slides • Discuss benefits of physical activity • Explain the difference between physical activity and exercise • Get the group discussing ways to be more active • Introduce activity guidelines

12. Slide 17-22 Aerobic Activity IMPORTANT! • Make sure before you get to these slides that patients have either completed the Par-Q or identified any physical limitations to you.

13. Slide 17-22 Aerobic Activity • Assume chronic health conditions are present • Keep activities low impact • Remind patients that they do not have to participate but can just watch if they are more comfortable • Follow the chair walking exercise as explained in the notes of slide 19. • Remind patients to breath steadily while doing any activity • Talk about adaptation (changing routine)

14. Safety and Aerobics • Ensure proper shoes and clothing for the activity • Start slow and gently increase duration and intensity over time to reduce the risk of injury • Those with joint injuries in the lower body may benefit from lower impact exercise such as the recumbent bike or swimming. • Note: People must take care with joint and back pain but lack of activity may be part of the cause.

15. Slides 23-28 Resistance Activity • Assume chronic health conditions are present • Keep activities low impact • Keep activities below the shoulder (hypertension) • Inform anyone with specific joint pain to avoid exercises being demonstrated that use that joint • Remind patients that they do not have to participate but can just watch if they are more comfortable

16. Slides 23-28 Resistance Activity • Use water bottles in the class • Shows patients how to use objects from their own home • Are only a few pounds so risk of injury is low • Easy to grip • Demonstrate the activity first, then have patients try. Walk around the room and ensure proper form to avoid injury. • Any exercises done should have the opposing muscle done after. • Explain the meaning of balanced muscle groups

17. Slides 23-28 • Body weight exercises • Requires no equipment • Keep exercises low impact • Wall push up • Leg Lifts • Sit Ups

18. Slides 23-28 • Resistance bands • Low impact and inexpensive • Emphasize good placement of the band to avoid ‘rebounding’ • Demonstrate first, then walk around and observe. • Explain colours and tensions of bands

19. Resistance Exercise Safety • Always start light with higher number of reps • Advise patients to start with 1 set of 8-15 reps. Then increase to up to 3 sets over time. Can gradually increase weight as it gets easier • Remind them to breath! • Avoid over the head exercises with heavy weights if you have hypertension

20. Slides 29-34: Balance/Flexibility • Emphasize that stretching should be a daily practice • Focus on stretches that can be done standing on both feet, with a support or from their chair • Remind them to breath and avoid bouncing • Explain that a stretches should be done to tension and not to pain

21. Slides 36-41 Resources and Summary • Review all the footnotes from Healthy You for this section • Create an open discussion if possible here as many patients will have their own resources to share

22. Resources For Clients and Professionals

23. Credible Resistance Training Information for Patients and Professionals Professionals Workshops/Courses CDA Physical Activity and Exercise workshop CANFIT PRO courses Print Diabetes Physical Activity and Exercise Toolkit (2nd ed) Exercise is Medicine - http://exerciseismedicine.org/

24. Credible Resistance Training Information for Patients and Professionals Professionals Online American College of Sports Medicine - http://www.acsm.org/ Canadian Society for Exercise Physiology - www.csep.ca/ Canadian Diabetes Association Physical Activity Counselling Toolkit

25. Physical Activity Counselling Toolkit Available on Hamilton Family Health Team intranet - http://www.hamiltonfht.ca/docs/privatedocuments/physical-activity-counselling-toolkit-%28pact%29 HFHT Search Bar: Physical Activity Toolkit

26. Credible Resistance Training Information for Patients and Professionals Patients and Professionals Resistance Exercise Demonstration Websites: ExRx.net GymProfessor.com Critical Bench.com

27. Credible Resistance Training Information for Patients and Professionals Patients Print Resistance Exercise for Diabetes Pamphlet Exercise to Do At Home Strengthening for Older Adults (Theraband)

28. Credible Resistance Training Information for Patients and Professionals Patients Video Sweet Success Exercise DVD * Diabetes and Physical Activity Toolkit DVD

29. Credible Resistance Training Information for Patients and Professionals Patients Apps Lose It – allows for tracking of physical activity and food, and has an interactive forum (ipad/iphone) iPump – provides large exercise data base and exercise videos showing proper execution (i pad, i phone) Nike Training Club App – wide variety of exercises for different levels (iOS smartphones; Nike Boom (similar) for Android) Workout Trainer – step by step video instruction to address a range of goals(iOS smartphone or Android) Map My Run- Can be used for multiple activities. Tracks distance, speed and provides suggested routes. *** large number of physical activity apps available

30. When In Doubt • Ask or Refer! • Most of us are only qualified to work with beginner clients

31. Questions?