Be Part

Let’s Raise the Bar Together

MAXimize Potential

CREATE Rome Consensus Statement

Canadian Experience

Lessons Learned – Research,

Education, Programs/Models,

Community Engagement

Clara Fitzgerald – Director CCAA

Western University Friday October 17, 2014

Think about it…

In a recent British study – the question was asked

“if your life depended on it – Would you

Exercise”?

What percentage of the population said yes?

Thoughts….

Ok – Let’s get started

EUNAAPA Summer School Reflection …

Key Word – Tape Activity

• We are the converted – we need to

think like inactive older people…

and try to understand - do they

value exercise or physical activity?

Leaders in Physical Activity and Aging

Who We Are A research and education

centre within the Faculty of Health Sciences at Western University in London, Ontario, CA since 1989.

To develop, encourage and promote an active, healthy lifestyle for Canadian adults that will enhance the dignity of the aging process

Our Mission

CCAA Director with Hanna Spencer – Long time CCAA participant (over 20 years) and soon to be 100 Dec 2013

What We Do • Research

• Knowledge Translation

• Advocacy

• Education and Training

• Model Physical Activity Programs

• Program delivery to older people

• Fitness Appraisals

• Student placements and internships

• Evaluation • Social media strategies

The Faculty of Health Sciences

The Faculty of Health Sciences (FHS) is dedicated to being a leader in health,

health care, rehabilitation and physical activity, with the ultimate goal of improving

human health in the community, the country and around the globe through

teaching, research and service.

FHS delivers undergraduate programs in three areas and graduate programs in six

disciplines, while offering a unique learning experience that enables students to

develop a comprehensive understanding of health-related issues affecting people

in all corners of the world.

The Reality

Physiological Functional Decline 1% loss in S,B,F, CR and metabolism per ____ after the age of _____. __-35 10% 36-45 10% 46-55 10% 56-65 10% 66-75 10% 76-85 10% …. Functional decline is manageable. Need to work for the benefits – no pill to

provide fitness benefits….

The Basics

Ball Activity

MAXimize

POTENTIAL

Delay the onset of

disease

R2A

Knowledge translation is the practice of

closing the gap between what we know

and what we do.

“KT involves interaction between knowledge users and knowledge producers and results in mutual learning through the process of planning, producing, disseminating, and applying existing or new knowledge to enhance the health of Canadians.” (CIHR 2012)

Image source: Ian Graham et al. (2006). "Lost in Knowledge Translation: Time

for a Map?“ Journal of Continuing Education in the Health Professions, 26,

13–24.

What is the

EVIDENCE

teaching us and

how are we translating

it into practice???

EXERCISE PROGRAMING

1. One size fits all approach doesn’t work for this pop

2. Exercise is not contraindicated for any chronic condition

3. Exercise Prescription Principles – specificity, progressive overload, FITT, reversability – Dose Response

4. Small group programs with clients with like needs and abilities

5. FAM first – WHICH TOOLS AND WHY!

6. Various Program Models

7. Guidelines

The Process of Developing New Canadian Physical Activity

Guidelines

Abstract

Physical Activity. Vigorous. More is Better.

Words Older Canadians Should Embrace. S. Belfry2, D.H. Paterson1,2, C. Fitzgerald2. 1School of Kinesiology, 2Canadian Centre for Activity and Aging, Western University.

The Questions….The Evidence….

Knowledge Transfer Activities

150

minutes/week of

moderate- to

vigorous-

intensity

endurance

exercise

Balance

exercises

30% in risk of

morbidity,

mortality, loss

of

independence.

The purpose was to determine: the relationship between physical activity (PA) and

functional independence in older adults; the types, volumes, and intensities of PA

related to higher function; a dose-response relationship between total PA or intensity of

PA and the related functional outcomes. In 2006 the process to inform new activity

guidelines was initiated by the Canadian Society for Exercise Physiology. The

Canadian Centre for Activity and Aging (CCAA) conducted a systematic review to

examine the relationship between PA and health in older adults. Results showed

greater aerobic PA was associated with reduced risk of functional limitations, disability

and loss of independence. Exercise training interventions showed improvements in

physiology and function. There is a threshold of at least moderate-intensity activity and

higher levels and vigorous PA confer further benefit. The revised guidelines were

launched in January 2011. Healthy, community-dwelling individuals over age 65 should

engage in at least 150 minutes of moderate- or 90 minutes of vigorous-intensity

aerobic PA per week, and add resistance exercises twice weekly to reduce risk of

chronic disease, premature mortality, loss of function and disability, and possibly affect

some cognitive functions.

Muscle & bone

strengthening at

least 2 days/week

2008

• 5 systematic reviews commissioned.

• 2.5 day conference resulted in consensus on strength of evidence, gaps in literature, harmonizing

with international guidelines, and whether to update existing guidelines.

• Appraisal of Guidelines for Research Evaluation (AGREE) II instrument was chosen to guide the

project.

• 7 peer-reviewed papers resulted. Three age-specific (children/youth, adults, older adults Paterson

and Warburton, 2010 Int J Beh Nutr & Phys Act), two on constructing messages around

guidelines and behaviour change, one explaining development process behind the systematic

reviews, and 1 independent expert consensus and review paper (all published 2010).

2010

• September – guidelines drafted, with consideration of international guidelines (WHO, USA,

Australia, UK) for wording and format harmonization.

• Stakeholders (content experts, government, NGO, health care professionals, teachers,

caregivers) provided comments/input.

2011

• Guidelines launched in January.

More physical

activity can lead

to 60% risk

reduction

Q: Is there a relationship between physical activity and functional independence?

A: YES. Greater aerobic activity was associated with higher functional status and

functional independence.

Q: What types, volumes and intensities of physical activity are related to higher

function?

A: Types - Aerobic and resistance training. Volumes/Intensities – 150 minutes of

moderate- to vigorous- intensity exercise. Note: resistance training is in addition to

the 150 minutes of aerobic activity.

Q: Is there a dose-response relationship between total physical activity or intensity

and the related functional outcomes?

A: YES. Physical activities of moderate- to vigorous- intensity can lead to a 30-60%

reduced risk of functional limitation and disability.

Cardiorespiratory fitness

dose/response

relationship with CHD

and all-cause mortality

from the consensus of a

number of studies as

reviewed in Paterson et al. (2007)

The present health care system is not sustainable given the numbers of older

adults with chronic disease and loss of function (leading to functional

limitations and loss of independence). Increased physical activity of older

adults is perhaps the only intervention that will effectively prevent these

conditions.

• October 2011 – CCAA received CIHR prize to develop a video and

make it available for distribution to health promotion/fitness

organizations & practitioners, who are in the position to share the

message with older adults.

• The CCAA’s leadership courses, delivered nationally, certify fitness

instructors to lead evidence-based programming to seniors. Currently

the Seniors Fitness Instructors Course (SFIC) is being updated. All

newly certified professionals will have the knowledge of the new

guidelines.

• Guidelines are included in curriculum of Western Kinesiology and

Health Science students.

• Social media strategies such as Facebook, You Tube, Twitter.

Acknowledgements: Public Health Agency of Canada, Canadian Society for

Exercise Physiology, Canadian Institutes of Health Research.

Importance

2006

• Day long think tank in Halifax with experts in fields of exercise

physiology, psychosocial aspects of physical activity, social

marketing, epidemiology, and physical activity guideline

development. Steering committee appointed.

2007

• Steering Committee & Canadian Society for Exercise Physiology

(CSEP) commissioned 12 narrative reviews on current evidence on

physical activity and health (funded by Public Health Agency of

Canada).

• Published in Applied Physiology, Nutrition, and Metabolism, and

Canadian Journal of Public Health (Paterson et al, 2007).

Implications for Practice How do we

foster communities that engage older

adults to be more active and

ultimately have an impact at the

population health level

Physical Activity and Functional Limitations

in Older Adults: A Systematic Review

Related to Canada’s Physical Activity

Guidelines

By: Donald H Paterson, Darren ER Warburton

International Journal of Behavioral Nutrition and Physical

Activity: 2010, 7:38 (11 May 2010)

http://www.ijbnpa.org/content/7/1/38

Older Adults (65 years and older) Guidelines

• To achieve health benefits and improve functional

abilities, adults aged 65 years and older should

accumulate at least 150 minutes of moderate -to vigorous

- intensity aerobic physical activity per week, in bouts of

10 minutes or more.

• It is also beneficial to add muscle and bone

strengthening activities using major muscle groups, at

least 2 days per week.

• Those with poor mobility should perform physical

activities to enhance balance and prevent falls.

• More physical activity provides greater health benefits.

The New Physical Activity Guidelines Are evidence - based:

• based on systematic reviews of the best available

evidence following a rigorous and transparent

scientific process.

• are consistent with the previous Canadian

guidelines that “more is better”.

• the new guidelines presented should be viewed as

a minimal target.

www.csep.ca/guidelines

The New Physical Activity Guidelines Are endorsed by expert groups and consistent

with other jurisdictions: • The majority stakeholder respondents ‘completely agreed’

or ‘agreed’ with the proposed preamble and guideline for all

age groups (90.2%, 88.7% and 89.7% for children and youth,

adults, and older adults respectively).

• Are consistent and harmonized with other recent Physical

Activity Guidelines based on the same evidence.

• Are accepted by the Canadian Cardiovascular

Harmonization of National Guidelines Endeavour (C -

CHANGE).

Dissemination Promotion and dissemination plans in place between

CSEP in partnership with ParticipACTION and others.

Online :

• Official Guidelines and Guideline Development Report

• Information Sheets for Children (5--‐11), Youth (12--‐17),

Adults (18--‐64) and Older Adults (≥65)

• Web--‐based content (expanding on the Info Sheets)

• Backgrounder, Q&A’s

• Additional information materials on Public Health Agency

of Canada website

Dissemination Promotion and dissemination plans in place in partnership

with ParticipACTION and others.

• Additional supporting materials and tools

• Published papers in peer--‐reviewed Journals

• Presentations at conferences, symposia

www.csep.ca/guidelines

All NGOs and stakeholders are encouraged to download and use,

distribute the Canadian Physical Activity Guidelines and Canadian

Sedentary Behaviour Guidelines

There are no restrictions to downloading and printing copies to fulfill

your distribution needs.

If you are reproducing the Guidelines they must by unmodified, in their

entirety and their permission to use is to be credited to

csep.ca/guidelines

You may not sell the Guidelines or use the Guidelines in a publication

print or electronic that is made available for sale without the

expressed written permission of the Canadian Society for Exercise

Physiology (and payment of applicable licence fees).

The Canadian Society for Exercise Physiology reserves the right to

revoke or limit the rights to use the Guidelines.

Take It With You – Clara Fitzgerald

BALLS

Creating Direction to

Promote PA/Exercise?

Questions

For More Information:

Clara Fitzgerald

cfitzge4@uwo.ca

1-866-661-1603

http://www.uwo.ca/ccaa

FACEBOOK –

www.facebook.com/actage

Twitter @westernuCCAA