10/13/2010. Disclosure. Exercise is Medicine! Understanding the Evidence & Initiating the Client Conversation: The Role of the RD.

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1 Exercise is Medicine! Understanding the Evidence & Initiating the Client Conversation: The Role of the RD Linda M. Gigliotti MS, RD, CDE November 7, 2010 Disclosure Linda M. Gigliotti, MS, RD, CDE 2010 FNCE speaker expenses and honorarium underwritten by The Coca-Cola Company. Objectives EIM Goals Cite the rationale and main messages of the Exercise is Medicine initiative. List the parameters for physical activity being part of the dietitian s Scope of Practice Increase the confidence of the RD in integrating the Exercise is Medicine initiative into work with different types of clients, within a defined Scope of Practice and utilizing the Physical Activity Guidelines. Engage ALL healthcare professionals in its campaign Assess and review every client s physical activity level at every visit Who? ME? RD s must remain current on topics related to the treatment and management of patients with obesity, including the knowledge and skills that are required to counsel patients about physical activity. Position of the American Dietetic Association: Weight Management. J Am Diet Assoc. 2009;109, page

2 Food and nutrition professionals teach individuals how to make healthful food choices and how to fit physical activity into their daily lives. Position of the American Dietetic Association: The Roles of Registered Dietitians and Dietetic Technicians, Registered in Health Promotion and Disease Prevention. J Am Diet Assoc. 2006;106, page Additional Positions Stands & Statements Position of the American Dietetic Association: Total Diet Approach to Communicating Food and Nutrition Information Position of the American Dietetic Association: Individual-, Family-, School-, and Community-Based s for Pediatric Overweight Position of the American Dietetic Association: Nutrition and Lifestyle for a Healthy Pregnancy Outcome EAL National Nutrition Month themes Get Moving: How to Start an Exercise Plan Your registered dietitian (RD) can give you helpful tips about how to get active. The RD will also explain how exercise and healthy eating work together. What is the RD s Scope of Practice? What can the RD do? Assess client s current level of physical activity Educate/reinforce re: benefits of physical activity for disease/risk factor management Direct clients to current public health guidelines Refer to exercise specialists when indicated What is NOT within the RD s Scope of Practice? Exercise Prescription Detailed exercise plan tailored to client s fitness and health goals Uses client s current fitness level as assessed by objective fitness tests such as: Cardio-respiratory fitness Musculoskeletal strength Flexibility Body composition Provided by certified exercise professionals 2

3 Gaining confidence and competence Do what we already do best: Nutrition Care Process and Model (NCPM) practice standard established by ADA in In the future: EIM for Nutrition Professionals toolkit Currently in development process by WM /SCAN DPG s, ACSM, & ADA Nutrition Care Process and Model NCPM Nutrition Assessment Nutrition Diagnosis Problem>Etiology> Signs/Symptoms (PESS) Nutrition Nutrition Evaluation and Monitoring Nutrition Assessment Nutrition Diagnosis Problem>Etiology> Signs/Symptoms (PESS) Nutrition Nutrition Evaluation and Monitoring Assessment The recommended physical activity assessment components include: Current physical activity level Medical readiness to exercise Motivational readiness to change Assessment PA history Consistency Frequency/ Duration/ Intensity Type of PA Strength TV/ screen time Other sedentary activity 3

4 Determine patient/client s current level of activity and willingness to exercise. Assessment Is the client meeting the current recommendations of the Physical Activity Guidelines for Americans? If not, why not? Is the client willing to become more active? Medical Readiness Medical Readiness Medical Readiness Are You Ready? Stages of Change 4

5 Diagnosis Sample PES Statements Based on findings in Assessment step Problem/Diagnosis related to etiology as evidenced by signs and symptoms Nutrition diagnoses related to physical activity including: Physical inactivity (NB-2.1), Excessive exercise (NB-2.2), Poor nutrition quality of life (NQOL) (NB-2.5), Self-monitoring deficit (NB-1.4), Not ready for diet/lifestyle change (NB-1.3) Inadequate energy expenditure related to lack of physical activity as evidenced by obesity. Physical inactivity related to severe joint pain secondary to osteoarthritis as evidenced by medical history. May be brief or comprehensive depending on your patient s/client s stage of readiness and your level of physical activity expertise Client-driven and appropriate for the client Contemplation: Analyze pros and cons of beginning exercise program Preparation: Provide list of community resources Recommend self-monitoring strategies Guided by Physical Activity Guidelines for Americans 5

6 Public Action Guide The Public Action Guide provides you with a simple, fast and effective tool for using exercise as a medicine to help prevent or manage many of the most common chronic health conditions. It will also help you approach your health care provider to discuss physical activity as a part of a disease prevention and management strategy. Guide Highlights Meeting the Guidelines and Starting an Exercise Program My Exercise Plan Questions and Answers Exercise is Medicine Month Note to Health Care Providers Meeting the Guidelines and Starting an Exercise Program Follow these guidelines to meet the basic physical activity recommendations after consulting your health care professional. From the 2008 Federal Physical Activity Guidelines for Americans. For more information on these guidelines, visit My Exercise Plan The first step in meeting any recommendation for how much exercise to do is to simply get started with an activity that will work for you. These tools will help you in assessing your health, figuring out your barriers to exercise and working through some of the challenges to sticking with a program. Pre-Exercise Health Assessment Barriers to Exercise Assessment Exercise Time Finder Cost/Benefit Analyzer and more! Note to Health Care Providers Share this resource with your health care provider during your next annual checkup or scheduled visit. Additional Resources Your Prescription for Health Series Provides information and recommendations Includes titles such as: Exercising while Losing Weight Exercising with Cancer Exercising with Hyperlipidemia Exercising with Hypertension Exercising with Low Back Pain Exercising with Type 2 Diabetes All titles available for download at: 6

7 Decisional Balance Self-monitoring What am I really doing? The coordination of nutrition care part of the step is especially important with regard to physical activity. develop lists of: certified clinical fitness professionals certified health fitness professionals community resources Goal Setting & Examples Specific Measurable Action Realistic Time Monitoring and Evaluation Conclusion Progress made Evaluates goals/expected outcomes Changes in BMI, lean body mass or fat free mass, HTN, Cholesterol, BG Changes in readiness Self-image & self-efficacy Address challenges and obstacles Identify appropriate resolutions A learning phase Physical activity makes a difference in the quality of life and risk factor management of most of the clients we see. RDs have a role in promoting physical activity with most clients, but need to identify their own knowledge and skill level to stay within their scope of practice. RDs can use the Nutrition Care Process to identify physical activity needs and interventions for clients. 7