Physical Activity & Diabetes: Getting Patients Active

Shirley O’Shea

Senior Health Promotion Officer

Overview

• Evidence of physical activity and type 2 diabetes

• National Physical Activity Guidelines

• Promoting Physical Activity in Primary Care

• How can patients be supported to become active?

•

Key message

Physical activity is for everyone and any level is better for your health than none

For adults with disabilities – Aim for guideline or as much as ability allows.

How do we measure physical activity?

• 1. “ I run around after the children all day long, am always on the go”

• 2. “I have a sedentary job but I cycle 3 times a week for up to 2 hours”

• 3. “I walk to town at lunch time a few days a week”

• 4.”I go to the gym twice a week for an hour each time”

Types of Activity

• 4 major domains for Activity in daily life

• For transport – cycling or walking to work, school, shops

• At work – manual labour

• At home – housework, DIY, gardening

• Leisure time – sport, exercise & recreation

What are the recommendations?

1. How often?

2. How hard?

3. How long?

4. What type?

Frequency Most days of the week

Intensity Moderate Level 60-80% M HR

Time 30 minutes

Type Select activity that you enjoy & is convenient e.g. walking or cycling

F.I.T.T. Principle

Moderate Intensity (pbt’s)

Moderate Intensity Physical Activity is

described as a level that causes your:

Beat a little faster

Breathe deeper and faster (but not out of breath)

Brings a little sweat to your brow

Evidence

Participation in regular physical activity

• Improves blood glucose

• Prevent or delay Type 2 diabetes

• Positively affecting lipids

• Blood Pressure

• Cardiovascular events

• Mortality & quality of life

Limitation in role of Primary Care Staff

• Your own level of exercise• Knowledge of current messages on physical

activity• Lack of time in consultation• Lack of perceived importance of physical activity• Lack of systems in place

Within the practiceWithin the practiceLearn about PALearn about PA

GP/PN develop skillsGP/PN develop skills

Practice-specific leafletsPractice-specific leaflets

‘‘Prescription’ formsPrescription’ forms

Peer counsellingPeer counselling

PA specialists for specific groupsPA specialists for specific groups

Referral/H-P ‘clinics’Referral/H-P ‘clinics’

Opportunistic practiceOpportunistic practice

Follow-ups and feedbackFollow-ups and feedback

‘‘Modelling’ your own PAModelling’ your own PA

Using waiting room timeUsing waiting room time

ReceptionistsReceptionists

Longer consultationsLonger consultations

REWARDS?REWARDS?

•

Get Ireland Active• The National Physical Activity Guidelines

for Ireland provide clear, concise and user friendly guidance to support the public, professionals and policy makers to Get Ireland Active.

• Website:– Promoting the guidelines– Benefits of PA– Guidelines for children and young people, adults

and older adults, people with disabilities and weight management.

Brief intervention

Involves opportunistic advice, discussion, negotiation or

encouragement and are delivered by a range of primary and

community care professionals. Varies from basic advice to more

extended, individually focused attempts to identify and change

factors that influence activity levels

Discussion between individuals and GPs, nurses etc are effective

and cost effective in encouraging individuals to be more active

Ref: Public Health Intervention Advisory Committee

NICE Public Intervention Guidance No.2, March 2006

•1 to 2 hours Physical Activity and Health

•Delivered to on site practices

•Free of charge

•Useful Resources for promoting PA in your practice

PACE Programme – Patient Assessment & Counselling for

Exercise

•Based on stages of behaviour change

•Provides screening tools

•Appropriate advice and follow up for patients

•Addresses barriers, motivation, goal setting

•Ideal following Brief Intervention training

Provides a safe pathway for people with various health

conditions to get them physically active, their way, everyday.

You Recommend • GP Refers • Patient Meets Local Coordinator• The patient then begins a twelve week physical activity

programme• Health professional handbook Caroline.kelleher@hse.ie

Patient Request(website, publicity, word-of-mouth)

GP Recommend Health Prof.Recommend(brief intervention)

GP-Patient Consultation

Referral Form receivedby Local Coordinator

Initial Assessment

Mid-way Assessment

Final Assessment

Exit, 6, 12 & 24 Month Follow-up & Aftercare

Workshops(healthy eating, smoking cessation, stress management)

Local Events(health walks, cycle days)

Signposting(condition-specific pathways, local support networks)

Ongoing Support(telephone, email, website, facility staff)

Inclusion & Exclusion Criteria

Patients must be Exclusion Criteria

currently sedentary

over 18 years of

age

interested in

becoming more

physically active

× Cardiac Conditions

× Uncontrolled

conditions

A fully detailed criteria list is available in the Health Professionals Handbook

Walking• Walking for Health Workshops• IHF Walking Leaders Training • Community Walking Groups• Meet n’Mingle Walks• Walking Leaders Refresher Training

• Trail Walking Workshop• IHF Walking Leaders Training 2

HPD Training Calendar

• Physical Activity in Primary Care (2hrs)

• PACE- Patient –Centred Assessment & Counselling for Exercise (3 hrs)

• Promoting The National Physical Activity Guidelines for Ireland “Get Ireland Active” (2hrs)

• Obesity: A Health Promotion Perspective (1 day)

• Supporting Change: Skills for Health (formerly Brief Interventions) (2 days)

Research…..

• Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med

• Physical Activity, cardiovascular risk factors and mortality among Finnish adults with diabetes

• Diabetes and Physical Activity: Joint position statement of Diabetes Australia on the role of PA and risk reduction of and management of diabetes

• A RCT of resistance exercise training to improve glycemic control in older adults with diabetes

Further support and info

• Email - shirley.oshea@hse.ie

• Tel: - 021 4921643

• www.healthpromotion.ie

• www.gpexercisereferral.ie

• www.getirelandactive.ie