Partnerships to Promote Partnerships to Promote Health and Prevent Disease Health and Prevent Disease

through through Physical ActivityPhysical Activity

Roseann M. Lyle, PhDRoseann M. Lyle, PhD Lakshmi Lakshmi JosyulaJosyula

Professor, Public Health Professor, Public Health PhD Candidate PhD Candidate

Purdue UniversityPurdue University

Health and Kinesiology DepartmentHealth and Kinesiology Department

Outline• National Blueprint/Coalition for Living

Well after 50• Greater Lafayette Survey of Exercise

Related Patterns• Healthcare provider physical activity

prescription intervention• Future recommendations

RESEARCH

WORK PLACE

Barriers

HOME/COMMUNITY

MEDICALSYSTEMS

MARKETING

PUBLICPOLICY

Physical InactivityPhysical Inactivity

Source: NIA, 2000

Fewer than 50% of Fewer than 50% of older adults ever older adults ever receive a suggestion receive a suggestion to exercise from their to exercise from their physiciansphysicians

Home and Community Home and Community StrategiesStrategies

• Provide funding and implement PA programs for Provide funding and implement PA programs for older adults through existing community facilitiesolder adults through existing community facilities

• Establish partnerships among health, aging, Establish partnerships among health, aging, urban/community planning, transportation, urban/community planning, transportation, environmental groups, recreation, social service, environmental groups, recreation, social service, and the private sector. Encourage these groups and the private sector. Encourage these groups to work together to define, create, promote and to work together to define, create, promote and sustain communities that support lifelong PAsustain communities that support lifelong PA

Health Departments

Aging Organizations

Physician Groups

Researchers

Activity Experts

Parks & Recreation

Transportation

Hospital Systems

City Government

Faith Communities

Service Organizations

Community Centers

Advocates

Fitness Centers

Neighborhood Associations

Volunteers

Policy Makers

Employers

Health Plans

Greater Lafayette Survey ofGreater Lafayette Survey ofExercise-related Patterns & Exercise-related Patterns &

NeedsNeedsof Older Adults of Older Adults

Tippecanoe County Tippecanoe County

Initial community needs assessmentInitial community needs assessmentIndiana State Department of Health Indiana State Department of Health

Hyner G, Lyle R, McKenzie S, Seehafer R, Sipe C & Hyner G, Lyle R, McKenzie S, Seehafer R, Sipe C & Hurley K.Hurley K.

Cardiovascular ExerciseCardiovascular Exercise

NO = 38.5%NO = 38.5%

Yes = 61.5%Yes = 61.5%

TypesTypes• Brisk walkingBrisk walking• RunningRunning• BikingBiking• HikingHiking• SwimmingSwimming• RowingRowing• MachinesMachines

cv_exer

cv_exer

RefusedNoYes

Per

cent

70

60

50

40

30

20

10

0

Body Mass IndexBody Mass Index BMI

Freq

uenc

y

70

60

50

40

30

20

10

0

Std. Dev = 5.21

Mean = 27.2

N = 301.00

BMIBMI Weight Weight StatusStatus

Below 18.5 Below 18.5 UnderweighUnderweight t

18.5 – 24.9 18.5 – 24.9 Normal Normal

25.0 – 29.9 25.0 – 29.9 Overweight Overweight

30.0 and 30.0 and Above Above Obese Obese

BMI=24

Health Related Health Related MedicalMedical AdviceAdvice

37% reported that in the last year their doctor had 37% reported that in the last year their doctor had advised them to “exercise more” and “reduce advised them to “exercise more” and “reduce fat in their diet”.fat in their diet”.

Has your Dr. ever…Has your Dr. ever…

• Helped plan PA? Helped plan PA? NONO = = 84%84%• Provided exercise info? Provided exercise info? NONO = = 82%82%• Given you a referral for PA? Given you a referral for PA? NONO = =

88%88%• Followed up on progress?Followed up on progress? NONO = =

86%86%

PHYSICAL ACTIVITY PHYSICAL ACTIVITY QUESTIONS 2005QUESTIONS 2005

In the last 12 months, did you talk with a doctor or other health provider about your level of exercise or physical activity?

In the last 12 months, did a doctor or other health provider advise you to start, increase, or maintain your level of exercise or physical activity? For example, in order to improve your health, your doctor may advise you to start taking the stairs, increase walking from 10 to 20 minutes every day, or to maintain your current exercise program.

Activity Can Decrease Activity Can Decrease CostsCosts  

Medical Care Costs: Medical Care Costs: $ 24,438,646$ 24,438,646Workers Comp Costs: Workers Comp Costs: $ 476,208$ 476,208Lost Productivity costs: Lost Productivity costs: $ 129,280,746$ 129,280,746Total Costs: $ 154,195,600Total Costs: $ 154,195,600

    If as little as 5% of inactive people in If as little as 5% of inactive people in Tippecanoe CountyTippecanoe County became physically became physically active, it could save an estimated active, it could save an estimated $7,709,780/year$7,709,780/year

Physical Inactivity Cost CalculatorPhysical Inactivity Cost Calculatorhttp://www.ecu.edu/picostcalc/http://www.ecu.edu/picostcalc/

Harnessing the primary care setting…

• Healthcare provider physical activity prescription intervention– Design– Status

• Inferences

• Possibilities

BulletinBulletin

“ “The USPSTF found The USPSTF found insufficient evidenceinsufficient evidence to to

determine whether counseling patients in primary determine whether counseling patients in primary

care settings to promote physical activity leads to care settings to promote physical activity leads to

sustained increases in physical activity among sustained increases in physical activity among

adult patients.” adult patients.”

(http://www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.pdf)(http://www.ahrq.gov/clinic/3rduspstf/physactivity/physactrr.pdf)

Influential initiatives

• “Americans in Motion”- American Academy of Family Physicians

• Encourage “fitness role models”.• Utilize and enhance “family physicians’ unique

ability to promote fitness within their communities”.

• “Exercise is Medicine” - American College of Sports Medicine

• “We're trying to get every physician to prescribe exercise at every visit.”

President Robert E. Sallis, M.D., FACSM  

• RationaleRationale– Inadequately active Inadequately active

populationpopulation (CDC, 2006)

– Credibility (and Credibility (and access) of healthcare access) of healthcare providersproviders

(Active for Life® National Program Office, 2004; Sattler & Doniek, 1997; USDHHS, 2002; Jimmy & Martin, 2004)

– Inadequate Inadequate counseling regarding counseling regarding physical activityphysical activity

(Cohen, Davis, and Mikkelsen, 2004)

• ObjectiveObjective– Examine the impact Examine the impact

of healthcare of healthcare providers’ providers’ recommendations recommendations of physical activity of physical activity on patients’ on patients’ physical activity physical activity levelslevels

Healthcare provider physical Healthcare provider physical activity prescription interventionactivity prescription intervention

Participants, methods and Participants, methods and materialsmaterials

– Adult patients on Adult patients on preventive care visits preventive care visits • Proposed N = 450Proposed N = 450

– Assessments Assessments • Self-report Self-report

(questionnaires) and (questionnaires) and fitness testingfitness testing

– Timeline: Timeline: • 6 months6 months

– InterventionsInterventions

• PrescriptionPrescription

• Prescription + Thera-Prescription + Thera-Band® Exercise ToolkitBand® Exercise Toolkit

• Prescription + Active Prescription + Active Living GuideLiving Guide

BarriersBarriers

• For providers For providers

– Lack of reimbursement Lack of reimbursement and timeand time

(Ainsworth & Youmans, 2002; Manson et al, 2004)

– Inadequate knowledge of Inadequate knowledge of physical activity physical activity recommendations and recommendations and resources resources

((Walsh, Swangard, Davis, and Mc Phee, 1999)

– Lack of confidence in Lack of confidence in impact on patientsimpact on patients

(Guo, Gottlieb, Smith, Huang, and Huang, 2002)

• For administrative For administrative personnelpersonnel

– More workMore work

– No compensationNo compensation

BarriersBarriers

• For researchersFor researchers– Constrained access to Constrained access to

participantsparticipants• Mailing through Mailing through

officesoffices• Time lagTime lag

– Limited fundsLimited funds• Reliance on Reliance on

volunteersvolunteers• (Weak) incentive of (Weak) incentive of

lucky drawlucky draw

• For patientsFor patients

““Junk mail”Junk mail” Low priority –slips Low priority –slips

throughthrough ““No pay – no play”No pay – no play” Reluctance to take Reluctance to take

on on

“ “ any more”any more” (Un)healthy fear of (Un)healthy fear of

“exercise”, even “exercise”, even “physical activity”“physical activity”

– Reimbursement to providersReimbursement to providers

– Education and provision of resources to Education and provision of resources to providersproviders

– Improved access to participant populations for Improved access to participant populations for researchersresearchers

– Funding for research and participant-Funding for research and participant-compensationcompensation

Solutions?Solutions?

Future Possibilities• Health Communication

– Best messages

• Economics– Incentive approach

• Health and Kinesiology– Exercise programs

• Biomedical Engineering– Monitoring devices

• Institutional Review Board– Most efficient design

• Insurance – Reimbursement to

providers– Incentives for clients

• Community Exercise Facilities– Discounts

THANK YOUTHANK YOU

Roseann M. Lyle, PhDRoseann M. Lyle, PhD Lakshmi Lakshmi JosyulaJosyula

Professor, Public Health Professor, Public Health PhD Candidate PhD Candidate

Purdue UniversityPurdue University

Health and Kinesiology DepartmentHealth and Kinesiology Department