Lifestyle Prescription for Dangerous Dan

1. Lifestyle Prescription for Dangerous Dan Kerry Ann, Deanna, Renee, Emily

2. Dan’s Health Objectives Increase Overall Physical Health Status Reduce Coronary Heart Disease Risk Factors Change Nutritional Habits Rehabilitate Old Injuries Increase Physical Activity Decrease Smoking 1

3. Behavioural Prescription Choices • Smoking cessation followed the theory of reasoned action as motivation 2 Ways: * Smoking causes Emily’s asthma to worsen - if I smoke I make my daughter sick * Smoking increases my chance of getting coronary heart disease - if I smoke I might die like other relatives • The theory of planned behavior will model how he achieves this goal • Increasing physical activity followed the self-efficacy theory * Dan’s behavioral expectations suggest that he can put his mind to it and become active like he was in college because Dan has a love of recreational activities • Changes in nutritional habits also followed the theory of reasoned action * Coronary risk factors can be caused by eating fatty foods - my cholesterol is high because I eat a poor diet, I am overweight because I eat too much

4. Previously Completed Components Initial interviews provided: Dan’s overall objectives Par Q Med X • We are presenting session 3 of 4

5. To Increase Dan’s Physical Health Status We Will Look At: Nutrition Rehabilitation Physical Activity Smoking Cessation

6. Coronary Heart Disease Risk Factors Smoking ½ Package Daily Diets Rich in Saturated Fats Self Admitted Physical Inactivity Self Admitted Stress Doesn’t Consider A Family History of Heart Disease 5 male relatives affected Being Overweight Over ideal weight 165 lbs Also Medical Conditions, such as: High Blood Pressure 130/94= borderline hypertensive High Blood Cholesterol (LDL) Physician Assessed= Borderline Obesity BMI= 34.3 1st Class Obesity Diabetes N/A

7. Nutritional Prescription • Examine Dan’s Food Diary Change types of food and portion sizes to fit with Canada’s Food Guide for Healthy Eating

8. Dan’s Daily Intake Log

9. Suggested Intake Log - 2 Day example

12. Workplace Applications • Pack meals to re-heat at the office or pack a brown bag meal i.e. sandwich/pita, fruit/fruit salad, yogurt, salad, vegetables, juice, water • Snacks should consist of healthy choices also i.e. fruit, trail mix, yogurt, vegetables, etc • Always have a bottle of water to drink to replace eating unneeded snacks

13. Tips and Tricks to Stay on Track • Modify preparation methods in meals • i.e. more vinegar sauces and herbs instead of creamy sauces with many preservatives and salt • Follow serving and portion sizes recommended by the Canadian Food Guide • When a craving arrives wait 20 minutes: • If craving does not go away then have a serving of a healthy snack • Or if just ate then have a drink water • Stop eating after super • Have three balanced meals a day, with a snack in between • Drink as much water as you want

14. Relapse Concerns • The occasional fatty/salty foods are acceptable • Make up for the unhealthy foods in the next meal For Example If you have a hamburger and fries, then the next meal have a salad with chicken and a vinegar dressing, or a stir fry with lean steak and rice. • This is a lifestyle choice for heart health so it’s important he attempt to stick with the plan

15. Rehabilitation Prescription • Shoulder ROM Exercises for Rotator Cuff Injury • Core Strengthening Exercises to Decrease Back Pain • Foot Pronation Referral

16. Range of Motion Exercises for Shoulder

17. Low Back Flexibility Exercises

18. Core Strengthening Exercises

19. Referrals • Pedorthist for orthotics to correct right foot pronation and gait variation • This may also positively affect the referred pain in his right hip

20. Physical Activity Prescription GOAL accumulate 60 minutes of physical activities EVERY DAY! Time needed depends on effort – as you progress to moderate activities you can cut down to 30 minutes 4 times weekly Canada’s Guide to Physical Activity Put on fridge as a constant reminder of tips! 5

21. Help Build Physical Activity Into Your Routines At Work • Leave the car in a parking lot 10 minutes from work and walk the rest of the way • If your job involves a lot of driving, plan several short stops in your day. Get out of the car and walk for 10 minutes or more wherever you can • Take stretch breaks during meetings • Have a "walking" meeting - grab your colleague and discuss business while taking a walk. • Take the stairs. Pretend the elevator is out of service. • Contract your stomach and back muscles while sitting in your chair • Take a brisk walk before lunch for about 10 minutes • Roll your shoulders and stretch your neck when sitting in front of the computer.

22. At Home & On the Weekend • Create a new morning routine. Start your day with 10 minutes of movement some stretching can really help your morning back pain! • Park the car 10 minutes away from the store you are going to. • Trade in your power mower for a push mower. • Make a personal or family commitment to try a new activity each season: snowshoe, curl, hike, bike, dance, bowl, fish, camp, ice-skate, ski, swim, in-line skate, walk, run, skip rope, play tag with your kids, or play ball in the park. • Get in the garden and dig, prune, rake and weed • Play catch or fly a kite with your kids

23. Specific Recommendations • On fishing trips; try fly fishing and off shore casting for increased activity. • Hike into the location of the river/lake • Continue golfing! But walk the course (excellent exercise!) Low Impact Family Exercises: Swimming Walking Cycling Plan activities into weekly routine (every week) with family will help increase fitness level of whole family… prevent children for being high risk for coronary disease and help with Emily’s Asthma.

24. To Stay Motivated and Keep Track Log book for each day’s accumulated amount of physical activity Fill in: * Type of activity * Duration Help to identify weather daily objectives are being met. Also will assess progress and identify if changes to program need to be made.

25. Example Log Book: Total Exercise Accumulation For the Day: 66 minutes

26. Smoking Cessation Prescription Dan had in Session 1 Agreed to stop smoking as well as recorded smoking habits 6

27. Typical day of smoking for Dan(previously self recorded) Smokes half pack a day – 10 cigarettes -right after eating breakfast -on the drive to work -constant smoke breaks throughout the day -after eating lunch -on drive home from work -after eating dinner -smokes a couple while watching TV before bed

28. Goals for Cessation of Dan’s smoking habit Short term – effective immediately: NO more smoking in the house, detrimental to children and wife, especially Emily since she is asthmatic Long term - gradually reduce the amount of cigarettes smoked daily over a 6 week period until eventually stop smoking completely

29. 6 week Smoking cessation program Week 1 -No smoking allowed in the house or around children, second hand smoke detrimental to their health -Smoke outdoors only Week 2 -cut out smoking after meals -instead of smoking after meals chew on sugarless gum or nicoderm Week 3 -down to approx 6 cigarettes daily, cut out 2 more Week 4 -cut out 2 more cigarettes -keep busy during times where you would usually smoke Week 5 -down to approx 2 cigarettes daily -continue to chew gum whenever craving should arise Week 6 -No more smoking! Throw out all cigarettes and ashtrays -whenever feel like lighting up think of consequences on health and the effect of second hand smoke on family -if extra help needed then refer to pharmacologist for nicotine supplements

30. Tips to be Successful in Following Prescription: • Stop smoking indoors immediately • Dispose of all ashtrays, lighters and cigarettes • Try to be busy at times when you would ordinarily light up • Try to increase time spent with nonsmokers • Get teeth cleaned to remove any tobacco residue and stains • Put money that would usually be spent on cigarettes in a jar and save up for a family trip or a fishing/golfing trip • Avoid smokers on breaks, situations where around cigarette smoke • Keep busy to reduce concentration on cravings

31. Stress Management • Try to avoid stressful situations • Engage in stress reduction strategies such as deep breathing and muscle relaxation • Avoid undertaking any stressful loads within first few weeks Referrals • Pharmacologist for nicotine patch if needed • Psychoeducation interventions can also be used along with counseling - secondary approach

32. Relapse Techniques • Understand steps that led to smoking as to effectively avoid relapse • Visualize oneself achieving goal, relate to someone who has successfully quit • Carry around handout on negative effects of smoking and read when feel like lighting up Nutritional Prescription • Avoid increasing food consumption to replace cravings • Increase intake of juice and water • Maintain a stable pH balance by eating more fruits and vegetables this cuts down on nicotine cravings