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Transforming Lives: Dr Edward Phillips' Presentation on Filling the Exercise Prescription
1. A presentation at Active Lives:
Transforming Ourselves and Our
Patients 11/10/12 (delivered by Dr Edward Phillips)
Stephan Esser MD
www.esserhealth.com
4. This Weekend
• Physical Activity and Fitness Assessment
• Exercise Prescription Implementation
• Physician Health
• Business of Lifestyle Medicine
– Filling the Exercise Prescription
• Motivation
5. You …….After this Weekend
• Inspired
• Motivated
• Ready to Change Lives
• A brain full of exciting new stuff
6. Possible Patient Concerns Remain
• I don’t know where to exercise
• I don’t know how to exercise
• I don’t have time to exercise
• It costs too much to exercise
7. Goal
• Action-able
• Rubber hits the Road
• Introduce you to ideas/opportunities
• Equip you with the tools to transform lives
• Stimulate your creative Juices
8. Day #1
• In the Clinic…3rd patient of the day
– Mr Yulepsi is a 62 y/o gentleman back for follow
up of his BP. He is feeling more fatigued, and
having some lightheadedness, but his BP’s are still
borderline.
– He says he wants other options than medx…..
9. Day #1
• Your mind RACES…..nutrition…exercise…stress
• You harness your motivational interviewing
skills and after more dialogue you know he is
in a preparation/action stage and would
prefer to start an exercise program while also
trying to eat a little better
• He has previously received appropriate ACSM
screening and is cleared for moderate
intensity activity
10. Day #1
• More mature individual
• Known cardiovascular dysfunction
• Was cleared with exercise stress test
• Motivated to start an exercise program
11. What do you do?
• What does he want to do ?
• What are his resources?
– What can you offer him?
• What are his options?
– Do you know your community options?
12. Our Goals
• Fill that Prescription
– People
– Programs
– Places
– Products
– Etc…..
13. People
• Structured:
– Your Office: Trainer, Wellness Coach
– Physical Therapy
– Training:
• Personal Trainers
• Group Classes
14. Physical Therapy
• Common:
– Post-injury/Pre or Post Surgery
– Therapeutic Exercise, Modalities
• Often Available:
– Therapeutic Exercise Training
– Use of Equipment
15. Physical Therapy
• Pros:
– Highly trained
– Significant Experience
– Certified/Insured/Credentialed
– Established mechanism of communication
• Cons:
– Require a medical diagnosis
– Co-Pays ($20-40)
– Limited # of visits paid by insurance
– Time/training in therapeutic exercise
17. Trainers
• Pros:
– Accessibility
– Variety
• Private sessions, group classes
• Strength training, Yoga, Kick-Boxing, Pilates…etc
– Price:
• Privates: Variable ($20-$200)
• Groups: included in memberships or $8-$15/hr
18. Trainers
• Cons:
– Cost: private pay
– Variable experience/knowledge
– Variable insured status
– No “established” method of communication
– Certification?
19. Trainer Certification
• Many Types:
– 7 Certified
– National Commission for Certifying Agencies NCCA
• American College of Sports Medicine (ACSM)
• American Council on Exercise (ACE)
• National Academy of Sports Medicine (NASM)
• National Strength and Conditioning Association (NSCA)
• National Council on Strength and Fitness (NCSF)
• National Federation of Professional Trainers (NFPT)
• National Exercise and Sports Trainers Association (NESTA)
20. Selecting a Trainer
• Certification
– ACSM > NASM > ACE > NSCA > NCSF > NFPT >
NESTA
• Affiliation
– Independent/National Gym
• Insured
• Interview
• Word of Mouth
• Patient Report
21. People
• Unstructured:
– Friends
– Family
– Work-Out Buddy
– Neighborhood: Pick up Ball, Park sports etc
– Meet up
23. Programs
• National Physical Activity Plan
– http://www.physicalactivityplan.org
– Collaborative: to achieve HP 2020, PA 2008 CDC
– “One day, all Americans will be physically active
and they will live, work, and play in environments
that facilitate regular physical activity.”
– Sectors: Business, Health Care, Industry,
Education, Media, Parks/Recreation, Public
Health, Transportation, Volunteer
28. Motorola
• Cost ≈ $6 mil/yr on wellness and work/life programs
• Offerings: Health Screenings, Education, gym access
etc
• Cost-effectiveness:
– ROI=$3.93
– Participating employees = 2.4% increase vs 18%
increase for non-participants
– $6.5 million yearly savings in medical expenses for
lifestyle-related diagnoses (e.g., obesity,
hypertension, stress)
29. DaimlerChrysler
• National Wellness Program
– Targeted education programs, one-time workshops, multi-session
classes, individual counseling, and self-directed modules, on-site
services
• Savings of: $16 per employee per month
• The more health assessment completed= the more saved
• Employees who had completed at least one health risk
assessment and participated in an additional wellness
activity had an average cost savings of $200.35 per year.
30. Union Pacific
• 1990: 29% spending on LR disease, $40mill.
• The “Health Track Program”: Health Risk Assessment, a
Smoking Cessation Program called Butt Out and Breathe,
over 500 contracted Fitness Facilities, an incentive
program
• 10 yr healthcare costs per employee decreased by 16%
• 10% decrease in Health Care Costs due to Lifestyle
Related Factors
31. Caterpillar
• Healthy Balance Program: health assessment, risk
stratification, individualized interventions, disease
management phone counseling; serial tracking, online
resources
• Projected healthcare cost savings of $700 million by 2015.
• Participants who completed the high-risk program reduced
their doctor office visits by 17%, and hospital days by 28%.
32. Northeast Utilities
• 17% healthcare costs = Lifestyle related disease
• WellAware program: financial incentives, employees and spouses
eligible, a health risk assessment, phone contact and Internet site
access at work and home, and a toll free hotline for materials and
questions.
• Participants demonstrated: 31% decrease in smoking, a 29% decrease
in lack of exercise, a 16% decrease in mental health risk, a 11%
decrease in cholesterol risk, an 10% improvement in eating habits, and
a 5% decrease in stress.
33. Common Ground
• Health Assessments
• Risk Stratification
• “High Touch”
• High Tech and Low Tech
• Family/Spouse Participation
• Incentivization
35. Web-Based Health Programs
• Virgin Health Mile: $5 for Employer
– HealthZone kiosks at Employer sponsored fitness
center (computer terminal that tracks weight, blood
pressure, & body fat)
– Go Zone pedometer (track online)
– LifeZone Website (track activity, questionniares)
– Challenges
– Employee receives gift cards (Target, Best Buy)
36. Virgin Health Miles
• Pros:
- A fun easy way to work toward improving
your health and earning money while doing it.
- Virgin Health Miles is quick to respond to
customer inquiries and sends items ordered
from their website within days of the request.
- Relatively easy with moderate activity to earn
back your investment.
37. Virgin Health Miles
• Cons:
- Pedometer reliability has been mixed.
- Walking style and user's size appear to
impact the ability of the pedometer to register
steps.
- HealthZone Kiosks are time consuming to use
and could be inconveniently located for you.
- GoZone Challenges haven't yet figured a way
to eliminate cheating.
39. Limeade
• Hired by Employer
• Establish Personal Health Goals
• Achieve them using
– Includes in-person meetings, webinars,
newsletters, home mailings on-site signage,
mobile apps & devices
• Offer rewards
40. Red-Brick Health
• www.redbrickhealth.com
• Health assessments
• Health coaching, resources, challenges
• Rewards: Reduced premiums, 401k deposits,
gift cards etc.
• Personalized Programs, & individual rewards.
41. Tangerine
• www.tangerinewellness.com
• Outsourced weight loss and health solutions
• Create advertisements to the employees
• Health Assessments
• Enroll employees in 3 month cycles
• Offer incentives and reimbursement for
success
44. Activity Desks
• Decreasing Sedentary Time
• Increase activity during and at work
• Up to 100kcal/hr
• Treadmill and Bikes
• Cost: $500-$2000
http://www.trekdesk.com/
47. Parks
• “Free”
• Various options
– Walking trails, “Heart Trails,” Sports fields, Tennis
and Basketball Courts, Open Fields, Pools
– Hiking Trails, Nature preserves, Bike trails etc.
52. Bailey’s Powerhouse Gym
• $25-$40/month
• 27 States
• Medium to Large
• Resistance/Cardiovascular Equipment
• Classes
53. Gold’s Gym
• $50- $150 Initiation Fee/ $10- $40 per month
• 37 States
• Pros: Low price, Plenty of equipment, Child
care
• Cons: Crowded, Small locker rooms, Lack of
customer service, Lack of cleanliness
54. Lifetime Fitness
- $190 Initiation Fee/ $60 per month
- 105 locations in US & Canada (some 24/7)
- Pros: Variety of Classes, Tennis, Basketball,
Squash, Mixed Combat Arts, Swimming
- Healthy Café, Spa & Salon
- Family oriented with child care, rock climbing,
swimming lessons, and camps
55. CrossFit
• Cost: $100-150/month unlimited group
classes
• Over 2,135 US locations
- “Old School”: weights, bars, balls, tires, boxes
- Pros: Minimal equipment (ropes, boxes,
bodyweight exercises)
- Cons: “Universal workouts for elderly
individuals with heart disease and
professional cage fighters”
56. 24 Hour Fitness
• 420 locations in 14 states
• Costs: Vary based on location & club type
(high-end Ultra Sport locations $150 Initiation
Fee/ $90 per month)
• Pros: Free weeklong pass; reduced rate
options for family members; many locations
open 24 hours; large exercise rooms; variety
of classes (Active Aging; Aqua; Mind/Body)
• Cons: No money-back guarantee
60. Fitness Pro
- Cost: Free
- Electronically log your workouts
- Offers tips for newbies on types of cardio and proper form
- Select exercises by individual muscle
- Can create a
personalized routine
- Need gym equipment
- Maps running
- Flexible way to add new
exercises to workouts
- Can be used with
nutritional apps for
weight loss
https://itunes.apple.com/us/app/fitness-pro/id336826731?mt=8
61. GymGoal ABC
-Cost: $0.99
- Free version offers 280 exercises with animations
- Provides proper form instruction for
newbies
- Can add your own images to any
exercise
- Calculates target heart rate, BMI,
BMR, and body fat percentage
- Integrated body map of muscles to
focus on exercises designed for that
muscle group
- Need gym equipment
- $2.99 to record and track workouts
62. Fitness Builder
- Cost: $9.99
- 5600+ images/videos, 750+targeted fitness routines as well as
individual exercises;
- Location (gym, hotel room) and goal (core, flexibility) oriented
- Tracks completed workouts
by date
- Includes a variety of
calculators and stat trackers
- Complex app with
slideshows
- Experienced fitness goers
who want a large variety of
fitness routines and the
feeling of using a personal
trainer
https://itunes.apple.com/us/app/fitnessbuilder/id306287984?mt=8
63. iTreadmill
- Cost: $0.99
- Similar to pedometer to tracks steps, distance, and
average speed while in a hand, strapped to an arm, or
carried in a pocket or purse
- Sensor and stride calibrators help you ensure the
utmost accuracy
- Includes a calorie counter
and a pacer for setting
speed goals
- Calorie counter is based
on weight alone
- Does not detect incline
64. Cleveland Clinic’s Tip of the Day
- Cost: Free
- Daily wellness reminders
-Example: Drink your juice cloudy! Apple juice with
more pulp has 4x as many disease-fighting
polyphenols (antioxidants) as clear apple juice. And
keeping your
brain healthy and
happy (by volunteering,
for example) makes
it more likely you'll
stick with that gym
routine.
67. Accelerometers
• Measure: change in velocity with respect to
time
• With Calculations…equations = usable data
• 1990’s: Increased interest, use, validation
• Pros: Portable
• Cons: Cost ($100-$300-1000+), On the waist
do not capture upper body movement or
cycling, and underestimate walking on an
incline or carrying heavy loads
http://www.cdc.gov/nchs/tutorials/under_constr6/PhysicalActivity/SurveyOrientation/images/DataOverview_accelerometer.jpg
68. Koko Fitness
• Cost: $70-90
• Fitness Studios
• Unique electronic set up/Virtual trainer
• Identify Goals/ Select Plan/ 30 minute
workouts
• Key-Fob: Plugs in to each machine, uploads
personalized goals, weights, monitors your
pace, coaches you etc..
http://www.kokofitclub.com/
69. Technogym Wellness Key
• Establish Personal Goals
• Select plans/Programs
• USB Key Fob: plugs into equipment, guides
user thru activity
http://www.technogym.com/gb/products/software-hardware/software-applications/wellness-system/682
70. Jawbone Up
• Cost: $99
• Wristband & iPhone, iPad or iPod Touch App work together to:
• Track Activity
- Steps, distance, calories burned, pace, intensity, level, GPS routes
- Active vs. inactive time: reminds you to move if inactive for too long
• Sleep Patterns
- Hours slept, deep vs. light sleep, awake time and overall sleep quality
- Smart Alarm: vibrates on wrist at the ideal moment in your natural sleep cycle
• Meals
- Snap a photo as a food journal and
respond with how you feel
• Challenges to reach goals
- Individual or team based to support,
compete, and collaborate
71. FitBit
• Cost: $99.95
• Clips onto pocket
• Activity:
- 3-D motion sensor tracks steps, distance,
calories burned
- Altimeter tracks floors climbed
• Sleep:
- Slip tracker into FitBit sleep wristband and
automatically uploads how many times and
how long you wake up during the night
• Logs workouts & meals:
- 100,000+ food items
-Yoga, Pilates, Elliptical, Boot Camp, Spinning,
Kickboxing & Wii Games
• Overall Stats:
- Sync with other apps (LoseIt! & RunKeeper)
- Daily and overall progress
- Individual score or compare with others in
your age and fitness range
- Track weight, blood pressure, glucose, & HR
72. Fitbug
• Fitbug Air
- Bluetooth with wireless to send to a desktop,
smartphone, tablet, iPhone & iPad
- Cost: $64.99 with 12 months of coaching or
$29.99 with first month’s coaching & $3.99/mth
• Fitbug Go
- USB connection to a desktop, smartphone or tablet
- Cost: $59.99 or $24.99 & $3.99/mth
• Pedometer tracks steps
• Individuals:
-85% of active members lost weight over the first
6 months
- Offers tailored set of goals in first week. Plus online daily
health tips and recipes
• Employers:
- 81% of employees made positive lifestyle changes
- 32% reduction in health insurance claims by users
- Create challenges for employees with rewards
73. Nike + Fuel Band
• Cost: $149
• Wristband displays your goal, calories,
steps, fuel, and local time
• Personalize your day with an emotion and
notes
• Accelerometer tracks running, walking,
dancing, basketball and everyday activities
• Syncs wirelessly to track overall progress,
share results and compete with others on
facebook and twitter
78. Our Goals
• Fill that Prescription
– People
– Programs
– Places
– Products
– Etc…..
79. Tomorrow
• You are Ready to Fill the Exercise Prescription
• Good ideas to support and empower your
patients and your self to achieve their/your
BEST health
80. Remember
• Ask what they want to do?
• Provide VALUE
• Develop Resources
• Follow up
• Adapt
A Challenge is designed for GoZone members (with an activated GoZone pedometer) to compete against each other for the greatest number of steps taken within a given time period. The Challenge can be designed to take place within a particular company or organisation or for individuals to compete against one another on teams and individually. The purpose of the Challenge is to encourage some healthy competition!
-Purpose: To Measurably improve well-being of the world by building happy, healthy, high-performance workforces. -Employer 3 year strategy with in-person meetings, webinars, newsletters, home mailings on-site signage, mobile apps & devices. -Swedish Medical Center: 3 months/ 86% of employees achieved their initial wellness program goals (preventative care examination & well-being assessment)