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Elevate the Profession Through Collaboration Brent Bauer, MD Stephen N. Blair, P.E.D. Dale Healey, DC Adam Perlman, MD, MPH Cynthia Ribeiro. Title by Presenter Name. Brent A. Bauer, MD. Director, Complementary and Integrative Medicine – Mayo Clinic Brief overview of work at Mayo

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  1. Elevate the Profession Through Collaboration Brent Bauer, MDStephen N. Blair, P.E.D. Dale Healey, DCAdam Perlman, MD, MPH Cynthia Ribeiro Title by Presenter Name

  2. Brent A. Bauer, MD • Director, Complementary and Integrative Medicine – Mayo Clinic • Brief overview of work at Mayo • How massage therapy is an integral part of this work

  3. Massage therapy quiet relaxation vs Decreased Massage Therapy – Mayo ClinicPilot Trial 58 cardiac surgery patients Pain Anxiety Tension Cutshall, Comp. Therap.Clin. Practice, 2009

  4. Massage Therapy after CV Surgery Control group (n=28) Massage group (n=30) 10 10 8 8 6 6 V A S 4 4 2 2 0 0 Before After Before After Anxiety Level

  5. Massage Therapy after CV Surgery Control group (n=28) Massage group (n=30) 10 10 8 8 6 6 V A S 4 4 2 2 0 0 Before After Before After Pain level

  6. Massage Therapy – Mayo ClinicRandomized – Controlled Trial • 113 cardiac surgery patients • MT therapy days 2,4 vs. quiet relaxation • Decreased pain P<0.001 • Decreased anxiety P<0.001 • Decreased tension P<0.001 • Increased relaxation P<0.001 Bauer, Comp. Therap. Clin. Practice, 2010

  7. Massage Therapy at Mayo ClinicOther Studies • MT for colo-rectal surgery patients 2009 • MT prior to cardiac interventions 2009 • MT for thoracic surgery patients 2011 • MT for breast cancer surgery pts 2012 • MT for cardiologists and nurses 2010 • MT for cardiac ultrasonographers 2011 • MT for in-patient nurses 2012

  8. Massage Therapy at Mayo ClinicThe Impact • Massage therapy now routine at MC • Domino effect • Small investment > “snowball” returns • 48 hospitals in US • 7 international hospitals • Australia, Austria, China, Ireland, Switzerland, Turkey

  9. Massage Therapy at Mayo ClinicThe Vision Massage therapy routinely available to all Hospitalized patients at Mayo Clinic Family members Staff Continue to use the Mayo experience to transform health care in the U.S. and around the world

  10. Steven N. Blair, P.E.D • Departments of Exercise Science & Epidemiology/Biostatistics Arnold School of Public Health University of South Carolina • Physical Activity and Health • How that impacts you and your practice

  11. Disclosures • Medical/Scientific Advisory Boards • Jenny Craig, Inc • Alere • Technogym • Cancer Foundation for Life • Santech • Clarity Project • Research Funding • NIH • Body Media • Coca Cola • Department of Defense • Royalties • Human Kinetics

  12. Non-Communicable Diseases (NCDs) Changing patterns in leisure and work have led to a health crisis NCDs cause 65% of all deaths worldwide 36.1 million deaths from CVD, Stroke, Diabetes, Cancer & Respiratory diseases. Physical inactivity causes 3.2 million deaths/year • WHO. Mortality and burden of disease estimates for WHO Member States in 2008. Geneva: World Health Organization, 2010.

  13. Question • Rank the following exposures by the number of deaths caused worldwide. • Tobacco use • Obesity • High blood pressure • Physical inactivity • High blood glucose

  14. Results of Google Search-February 12, 2012 Inactivity—3 million hits Physical inactivity—2.98 million hits Sedentary behavior—2.35 million hits Eating too much—393 million hits Obesity—90 million hits Diet and obesity—65.8 million hits Inactivity and obesity—708,000 hits Physical inactivity and obesity—945,000 hits

  15. Lancet Physical Activity Series More of the same is not enough

  16. Global perspective 33 researchers, 16 countries

  17. Findings • Between 6-10% of the world’s major NCDs is attributable to inactivity • By eliminating inactivity, >5.3 million deaths/y may be prevented • This leads to an increase of 0.68 years in the world’s life expectancy (For perspective: smoking causes 5 million deaths/y worldwide)

  18. Aerobics Center Longitudinal Study

  19. Design of the ACLS 1970 More than 80,000 patients 2005 Cooper Clinic examinations--including history and physical exam, clinical tests, body composition, EBT, and CRF Mortality surveillance to 2003 More than 4000 deaths 1982 ‘86 ‘90 ‘95 ’99 ‘04 Mail-back surveys for case finding and monitoring habits and other characteristics

  20. All-Cause Death Rates by CRF Categories—3120 Women and 10 224 Men—ACLS Blair SN. JAMA 1989

  21. Cardiorespiratory Fitness, Risk Factors and All-Cause Mortality, Men, ACLS # of risk factors Risk Factors current smoking SBP >140 mmHg Chol >240 mg/dl Cardiorespiratory Fitness Groups *Adjusted for age, exam year, and other risk factors Blair SN et al. JAMA 1996; 276:205-10

  22. CRF and Other Health Outcomes

  23. CRF and Breast Cancer Mortality Odds Ratio 14,551 women, ages 20-83 years Completed exam 1970-2001 Followed for breast cancer mortality to 12/31/2003 68 breast cancer deaths in average follow-up of 16 years Odds ration adjusted for age, BMI, smoking, alcohol intake, abnormal ECT, health status, family history, & hormone use p for trend=0.04 Sui X et al. MSSE 2009; 41:742

  24. Activity, Fitness, and Mortality in Older Adults

  25. Cardiorespiratory Fitness and All-Cause Mortality, Women and Men ≥60 Years of Age • 4060 women and men ≤60 years • 989 died during ~14 years of follow-up • ~25% were women • Death rates adjusted for age, sex, and exam year All-Cause death rates/1,000 PY Age Groups Sui M et al. JAGS 2007.

  26. Cardiorespiratory Fitness and Health Outcomes in Various Population SubgroupsSuch as People Who Are Overweight or Obese or Those with Chronic Disease

  27. Age and exam year adjusted rates of total CVD events by levels of CRF and severity of HTN in 8147 hypertensive men CVD incidence/1000 man-years P <.001 P <.001 P =.048 CRF: Controlled HTN Stage 1 HTN Stage 2 HTN Severity of HTN Sui X et al. Am J Hyptertension. 2007

  28. Joint Associations of CRF and % Body Fat with All-cause Mortality, ACLS Adults 60+ Death rate/1,000 person-years Deaths 15119029 72 Rates adjusted for age, sex and exam year Sui M et al. JAMA 2007; 298:2507-16

  29. 2008 Physical Activity Guidelines for AmericansAt-A-Glancewww.health.gov/PAGuidelines/ U.S. Department of Health and Human Services

  30. 4 Key Adult Guidelines • Avoid inactivity • Substantial health benefits from medium amounts of aerobic activity • More health benefits from high amounts of aerobic activity • Muscle-strengthening activities provide additional health benefits

  31. WHO PA Recommendation • Released by WHO in December 2010 • PA recommendations • 5-17 yr—60 min MVPA/day, vigorous intensity, including muscle and bone strengthening 3 X week • 18-64 yr—each week accumulate in bouts of at least 10 min, 150 min moderate intensity, 75 min vigorous intensity, or combination of both; and resistance training 2 X week • 65 yr & older—same as 18-64 yr, those with poor mobility should also do balance exercises, and take health conditions into account

  32. How Can We Get Sedentary Adults to Become and Stay More Physically Active?

  33. Track Record of Lifestyle PA Interventions • Successfully implemented in many different populations and settings • Men and women of all ages • African-American men and women, Hispanic women • Prostate cancer survivors • Worksites, YMCA’s, public heath departments, recreation facilities, senior centers, churches

  34. Behavioral Approaches to Physical Activity Interventions • Theoretical foundations • Social Learning Theory • Stages of Change Model • Environmental/Ecological Model • Methods • Problem solving • Self-monitoring • Goal setting • Social support • Cognitive restructuring • Incremental changes • Manipulating the environment

  35. 90% of What You Need to Know about Exercise Prescription Sitting is hazardous Some activity is better than none More activity is better than less A reasonable target is 150 minutes of moderate intensity activity/week Should be in bouts of at least 10 minutes

  36. What Is the Best Exercise? • The one you will do regularly • No matter how excellent the exercise is or how effective the program might be, it will not produce any benefits for you if you do not do it

  37. Dale Healey, DC • Dean College of Undergraduate Health Sciences at Northwestern Health Sciences University • PhD Student at the University of Minnesota – dissertation focused on the integration of CAM topics into Medical School Curriculum • COMTA Commissioner • ACCAHC Board Member • MTF Best Practices Committee

  38. Institute of Medicine The U.S. health care system is in need of a fundamental change…. Health care today harms too frequently, and fails to deliver its potential benefits routinely. As medical science and technology have advanced at a rapid pace, the health care delivery system has foundered. Between the care we have and the care we could have lies not just a gap, but a wide chasm. Crossing the quality chasm: A new health care system for the 21st century.2001

  39. National Health Expenditures(1),1980 – 2018(2) Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released February 23, 2009. (1) Years 2008 – 2018 are projections. (2) CMS completed a benchmark revision in 2006, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see http://www.cms.hhs.gov/NationalHealthExpendData/downloads/benchmark.pdf.

  40. National Supply and Demand Projections for RNs,2000 – 2020 Shortage of over 1,000,000 nurses in 2020 Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration. (2004). What Is Behind HRSA’s Projected Supply, Demand, and Shortage of Registered Nurses? Link: ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf.

  41. Collaboration Can Help • Not new idea – “Educating for the Health Team” - Institute of Medicine, 1972 • More important now than ever: • Baby Boomers • Obesity epidemic • Rising costs • Provider shortages • System inefficiencies

  42. A Role for Massage Therapy • Lots of you (300,000) • Positive image with the public • Patients like you - helps with compliance • Patients talk to you and trust you • You see most of the patient’s body • You touch most of the patient’s body • You spend considerably more time with patients than most providers

  43. What is Needed • Education Reform • A “Flexner Report” for Massage Therapy • Programmatic Accreditation with supporting competencies • Interprofessional Practice Skills • Evidence Informed Practice • Expansion of Scope (e.g. health screening procedures) • Participation in the conversation outside the massage therapy community

  44. IPEC • Interprofessional Education Collaborative • Expert Panel from the education associations of following six professions: • Nursing • Osteopathy • Pharmacy • Dentistry • Medicine • Public Health • 38 Core Competencies for interprofessional collaborative practice spread over 4 domains

  45. ASPA • Association of Specialized and Professional Accreditors • ASPA is working (struggling) to get interprofessional competencies into accreditation standards. • A recent meeting of the ASPA focused on how to encourage the accrediting agencies to catch up with the Interprofessional Education movement. • Education tends to lag behind practice.

  46. CAHCIM • Consortium of Academic Health Centers for Integrative Medicine • Began in 1999 with 8 institutions • Now consists of 51 Academic Health Centers • “Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal” Academic Medicine, Vol. 79, No. 6/June, 2004

  47. ACCAHC • Academic Consortium for Complementary and Alternative Healthcare – formed in 2004 • Five licensed CAM professions plus Traditional World Medicines and Emerging Professions • Center for Optimal Integration – aggregate useful information, organize activity, online courses, stimulate leadership • Competencies for Optimal Practice in Integrated Environments – adopted and added to IPEC competencies • Participation on IOM panels and initiatives

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