Physical Activity and Exercise Promotion

1. Physical Activity and Exercise Promotion Guidelines for Dietitians

2. Physical Activity Basics FITT and Other Principles

3. Primary Components of Fitness • Cardio-Respiratory Capacity • The body's ability to take in oxygen, deliver it to the cells, and use it at the cellular level to create energy for physical activity aka endurance, aerobic capacity • Flexibility • Amount of motion that a joint is capable of performing • Muscular Capacity - Three Aspects • Muscular strength - or, the ability to generate force. • Muscular capability is muscular endurance - or, the ability of your muscles to apply force over a longer period of time. • Muscular capability refers to muscular power, or the ability to generate strength in an explosive way.

4. Principles of Training • Underlying principles that inform advice provided to patients • Knowledge of principles enable RD to: • Answer questions • Provide appropriate direction • Limit potential for harm

5. F.I.T.T. • Frequency (how often) • Intensity (how hard, how much weight) • Time (how long) • Type (type of exercise planned)

6. Individualization • Advice on exercise should be modified based on individual needs and capabilities. • General advice about physical activity may not be appropriate or helpful for all of our patients. • For example, a very de-conditioned patient should not be encouraged to immediately meet Canada's physical activity recommendations.

7. Structural Tolerance • Strengthening of tendons and ligaments and increased vascularity and recruitment of motor units will result in the ability to sustain subsequently greater stresses with greater resistance to injury. • Without structural tolerance, increasing workload can result in injury.

8. Specificity • Improvement in an aspect of their performance or fitness, only occur if a patient trains specifically to achieve this. • Improvements in the three main aspects of fitness (cardiovascular function, strength and flexibility) require different types of training • Example - our patients should not expect improvements in cardiovascular fitness or strength by doing flexibility training.

9. Progressive Overload • In order to improve, clients must continually challenge their current fitness level. • The work performed must become progressively harder as the client adapts to the current workload. • When a workload or resistance is placed on a muscle, the muscle is stimulated over time to become larger and stronger. • A plateau or steady state will be reached where there is no more growth unless a greater stimulus is applied eg heavier weight, higher repetitions.

10. Recovery • Recovery (usually rest) is necessary for a client to return to the next workout as fit as the previous. • Rest above and beyond the normal requirements for usual functioning is not terribly important in very light physical activity, more important as physical activity becomes more strenuous • Muscles that have been exposed to an overload should be rested at least 24 hours before training again. It is during this recovery period that the actual growth and repair ( hypertrophy) occurs.

11. All-Round Development • People who are well developed in all aspects of fitness have a lower likely hood of becoming injured and have greater performance in physical activity and sport.

12. Reversibility • Once training ceases a client’s body will gradually return to the pre-training state

13. Maintenance • Once a level of fitness is achieved, it can be maintained with less work than was needed to reach it in the first place. • Work needed to achieve a specific fitness level is greater than the work needed to maintain it.

14. Resistance Training • Adequate rest for worked muscle (preferably 48 hours) is necessary for growth….but other muscle groups may be exercised during the rest period • The key goal for new exercisers is to learn proper form and to develop structural tolerance. After this occurs goals such as metabolic management, hypertrophy etc can may be reached. • Clients will usually see significant gains in strength, changes in metabolic parameters at approximately 3- 4 weeks after initiating training. • Changes plateau as training continues so it is important that patients do not look for dramatic changes

15. Using FITT Principle- Case Study • Sandra is a 45 year old female who is over weight (BMI of 29). She’s a mother of two and hasn’t put much effort into her health the last few years. She’s never followed a workout routine before. Sandra has watched her friend have a lot of success using a personal trainer 4x/week but she wants to try things on her own because of the cost. She plans to start a program of walking a few times a week plus attend aqua fit and yoga with her friend 1x/week for 60 minutes each at the local community center. • What guidelines would you give Sandra?

16. Using FITT Principle- Case Study • How often should Sandra go walking to achieve the minimum recommendation? • Sandra wants to know how to tell if she is working hard enough at each of her activities. What would you tell her? • Any advice to give her for the first few weeks of her program?

17. Using FITT Principle- Case Study • Sandra has now been following her program for about 3 months and at first was seeing great results. She now has a BMI of 27 but lately she’s not seeing any changes and she’s getting frustrated. She’s contemplating giving up. • What could you tell Sandra to help her? • Which of the principles of fitness might explain what is going on?

18. Assessment Risk and Readiness to Increase Activity

19. Stages of Physical Activity Prescription Evaluation RISK

20. Common Forms of Risk • Known Disease • Signs and Symptoms of Disease That is Yet Dx • Increased Cardiac Risk • Age Risk

21. Safety Concerns When Exercising • Internal to Client • Health conditions or diseases • Physical abnormalities (eg/ weak muscles) • Psychological (Not focused or high stress) • External • Inappropriate workout gear • Faulty equipment • Temperature and humidity • Spills or messes • Internal to Instructor • Not being prepared • Ignoring duty to warn or not monitoring clients condition

22. Pre-screening • Must be done before any activity of any kind occurs • Safety • Liability • Common Pre-screening Tools • PAR Q • Health Screening Questionnaire • CHD Risk Factors • Lifestyle Assessment • Readiness for Change

23. PAR-Q • Physical Activity Readiness Questionnaire • For clients ages15-69 • Developed by the Canadian Society for Exercise Physiology and Health Canada • Designed to identify people who require medical clearance before participating in a new exercise program

25. Common Forms of Risk • Known Disease • Signs and Symptoms of Disease That is Yet Dx • Increased Cardiac Risk • Age Risk

26. PAR Q • What forms of risk does the PAR Q cover? • Known disease • Signs and symptoms of disease • If clients answer YES to one or more questions on the PAR Q they should seek medical advice before becoming more physically active • Your legal responsibility to have a signed PAR Q before giving out physical activity advice • Should be redone annually

27. Health History Questionnaire • Supplements Information not captured on PAR-Q. Not a standardized form. • Should include: • Client details • Current medical conditions • Medications and allergies • Current or past injuries • Treatment from healthcare professionals • Family history • Past & present exercise history • Past and present nutritional information • Past and present work history

29. Tools Screening Action Yes No No No Medical Referral Yes Yes Vigorous Activity No Yes Moderate Activity Cleared for Low-Moderate Physical Activity

30. People You May Need To Refer To • Physiotherapist • Kinesiology • Podiatrist • Doctor

31. If a Patient is High Risk.... • You cannot continue with client until they are cleared by medical doctor • ParMedX should be reviewed by doctor • Should have a written note for clearance from doctor

32. Par MedX • PARmed-X is a 4-page physical activity-specific checklist to be used by a physician with patients who have had positive responses to the (PAR-Q) • There is a separate one for pregnancy • Important: If a patient is at risk and doesn’t pass the PARQ and you train them without clearance from their physician you are liable!

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

35. Assessment Risk and Readiness to Increase Activity

36. Assess for Motivation • Stage of change (pre-contemplation, contemplation, preparation, action, maintenance relapse) • Readiness, Importance Rating Tools: • Physical Activity and You* • Motivational Interviewing * In the Physical Activity Counselling Toolkit (PACT)

37. Assess for Current Physical Activity • Ask about current physical activity • Many people significantly over-report frequency, time and intensity of physical activity…ask for details Tools: • Rapid Assessment of Physical Activity* • Brief Physical Activity Assessment* • Physical Activity and You* * In the Physical Activity Counselling Toolkit (PACT)

38. Exercise Counselling and Prescription • Ask permission to discuss benefits of PA and risks of inactivity to all • Match advice to current motivational and physical readiness to engage in more physical activity Tools: • Promoting Physical Activity* • Brief Contact to Increase Physical Activity* • Matching Counseling To Stages of Change* • Physical Activity Counselling Tools* • Physical Activity and Exercise (CDA) * In the Physical Activity Counselling Toolkit (PACT)

39. Exercise Counselling and Prescription Use FITT to prescribe physical activity, including resistance training: • Frequency: how often • Intensity: how hard • Time: duration • Type: what kind of exercise

40. Exercise Counselling and Prescription • For each FITT element…start with where the patient is based on assessment of risk, readiness and current physical activity, then help patient move to CDA physical activity targets • Balance principles of progressive resistance (it gets harder) and structural tolerance (need to build a base) and recovery

41. Exercise Counselling and Prescription Exercise Counselling and Prescription Tools: • Diabetes and Physical Activity Your Exercise Prescription (CDA) • Prescription for an Active You* • Canada’s Physical Activity Guide* • Exercise Prescription for Special Populations* • * In the Physical Activity Counselling Toolkit (PACT)

43. Resources For Clients and Professionals

44. 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/

45. 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

46. Physical Activity Counselling Toolkit Available on Hamilton Family Health Team intranet - http://www.hamiltonfht.ca/files/PACT2011_final.pdf

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

48. 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)

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

50. 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) *** large number of physical activity apps available