Increasing PA across different setting: Part I

1. Increasing PA across different setting: Part I Chapter 9

2. Where are the interventions delivered? • Home • Family based • Church based • Medical community-based • School • Worksite • Hospital sponsoring a PA facilities • Private facilities (YMCA’s, Lifetime, etc.) • Community centers

3. Home based PA programs • Attractive to the target population (Wilbur et al., 2003) • Women with small children • Older adult • Low-income people • Rural residence • Injured or diseased • Home based programs were designed by the medical community to improve post surgery recovery, prevent hypokinetic disease or was seen as a means to lower one’s medical cost.

4. Home • Dependent on home based equipment • Accessible • Flexible scheduling • Supervised programs for inexperienced exercisers is better than unsupervised programs • Exercise prescription may not match the individual current fitness level

5. Barriers of home-based PA programs • Lack of knowledge • Lack of time • Lack of social connectivity

6. Addressing the lack of knowledge issue • Personal trainer or PT need to describe the training sessions prior to exercising at home. • Provide program details via CDs, DVDs, or web cams • Ask for a reasonable time commitment(30-60 minutes per day) • Teach participants to negotiate role balance • Other spouse or significant other watches the children • Doing household task, making supper etc. • Provide follow-up by phone or email

7. Home based programs and exercise adherence • Low adherence rates in people who exercise at home are those that • Fail to focus on intrinsic motivation • Their program lacks variety • Transition from Supervised to Unsupervised exercise (Morey et al., 2003; Marcus, et al, 1999) • Most people move from a supervised program to a home based based program, especially older adults • Men are more successful in unsupervised home based programs than women (Marcus, et al, 1999) • Adherence is stable in supervised home based programs

8. Successful home-base PA programs • Home based activity program (HBAP) • Moving forward • Preoperative preparation

9. Family Based PA Programs • Family is a powerful agent of change • Target at least two-related people who live in the same household • Originally designed to strengthen families to prevent substance abuse, facilitate family bonding, and improve conflict resolution. • Recently used to lower heart disease risk (Tromso Family Study & British Family Heart Study) in men.

10. Factors related to Successful Family Based PA programs • Encourage families to model active behavior • Make interventions low cost • Consider using the family systems theory • Encourage families to replace media use with PA • Teach Parents to create a healthy home environment

11. Barriers to Family-Based PA programs • Families prefer to engage in sedentary activities • Family schedules are typically busy

12. Successful family based programs • American on the Move • Family fitness • La Diabetes Y La Union Familliar

13. Church-based PA Programs • Most successfully used with older adults and African American populations • PA program in church are unique but logical settings because (Ransdall & Rehling, 1996): • Physical resources • Their mission is to promote mental and physical health • Large group of volunteers • Spiritual influence on the members • Media access • Strong social networking • Ability to reach people

14. Factor related to successful church based PA programs • Form community partnerships • Build on the church mission of serving and caring for others • Encourage church leaders to support programs • Form a wellness ministry

15. Barriers to church based programs • Time commitments of volunteers • Facility scheduling • Mostly Church programs have yet to be studied to determine it effectiveness

16. Church Programs • Aerobic fitness & stretch N Health programs • Faith on the move • Health-e-AME

17. End of Part I

18. Increasing PA across different setting: Part II Chapter 9

19. Medical Community-Based PA Program • Delivered by doctors, nurses, or other health professions (i.e., Physical Therapist and Athletic Trainers). • 80% of clients said they would exercise if the doctor advised it (Amani-Golshani, 2006) • New but important strategy to reach inactive population group.

20. Factors related to successful medical community PA programs • Considers patients characteristics • Promote and support PA guidelines and policies • Advise patients on PA behaviors • Recommend walking • Provide PA materials that a patient can easily understand and use

21. Barriers • Most MD’s lack knowledge in prescription of PA or exercise • Lack of time • Lack of financial incentives

22. Successful Medical Community PA programs • 10,000 Steps Rockhampton • Physical Activity Prescription Programme (PAPP)

23. Health Care Sites • Touches both healthy and CV diseased population • Of all the other sites, health care sites have the greatest, positive physical activity effect on their members. • Highest retention • Highest adherence • Health care sites provides more employment opportunities for qualified fitness graduates than private or worksite facilities.

24. RE-AIM Framework • Strategy used by many site based programs (RE-AIM) • Reach to client (i.e., email, phoning, fliers, face to face) • Effectivness (i.e., delivered by competent, well trained staff;PA resources & facilities) • Adoption (i.e., based on proven principles, policies; interventions) • Implementation (i.e., scheduling, PA resources, target group) • Maintenance (i.e, continuous contact with clients, follow-ups, program evaluation)

25. Work Sites • Industry assumes that there is a link between worker productivity and fitness • To date work site PA interventions have had low-moderate impact on exercise adherence in their employees. • They do have a great effect on absenteeism, sick leave, employee turnover, employee recruitment, and lowing health care costs(Wynee & Clearkin, 1992; Addley et al, 2001). • Work site program on an average will only attract 20 to 30% of the workforce (Dishman et al., 1998)

26. Low attendance rates are linked to: • they do not want to increase their stress level • embarrassment to workout in the presence of other co-workers • people do not prefer to workout or socialize at work, and • workers have other competing interests (family, etc).

27. Economic Benefits of a Worksite Program • The Coors Brewing Company found that, in 1990, it returned $6.15 for every dollar spent on its corporate fitness program. This was the sixth year of its fitness program with annual returns ranging from $1.24 to $8.33. (Wellness Councils of America 1991) • Kennecott Copper Company showed that, over four years, for every dollar invested in its corporate fitness program the company returned $5.78. (American Institute of Preventative Medicine 1991) • Equitable Life Assurance realized a return on investment of $5.52 : $1 • In the first year of its TriHealthalon employee fitness program, General Mills, received a payback of $3.10 per dollar invested. In its second year, the payback increased to $3.90 : $1. (American Journal of Health Promotion 1989) • Motorola returned $3.15 per dollar from its employee fitness program. (Fitness Systems 1990) • PepsiCo found its corporate fitness program had a 300% return on investment: $3 for every $1 invested. (Fitness Systems 1990) • Over a six-year period, DuPont had a return of $2.05 for every $1 invested in its employee fitness program. (Health Behaviors 1992) • Prudental Life Insurance found, in a five year study, it returned $1.91 per dollar invested in its employee fitness program. (American Institute of Preventative Medicine 1991) • Johnson and Johnson averaged a 30% return on investment from its Live For Life employee fitness program over a 12 year period, 1978-1990. (Preventative Medicine 1990) • Blue Cross Blue Shield of Indiana found that its corporate fitness program had a 250% return on investment; $2.51 for every $1 invested over a five-year period. (American Journal of Health Promotion 1991)The Economic Benefits of Regular Exercise, IRSA, 1992

28. Factors related to successful worksite PA Programs • Need support of management • Programs focus should be on PA factors that they know they can change • What are the characteristics of the workers? • Use behavior modification strategies

29. MESA Work Site Program • 30,000 sq. ft. wellness facility, and a corporate wellness program that makes optimal use of it. • cholesterol screenings and health fairs on site, • fitness evaluations, and guest lecturers. • stress management • nutrition& weight loss, • infant care, and proper use of the health care system. • Mesa's wellness program is available to all employees, not just executives. • The program is also available to spouses, and children over 12 years of age. • An employee and his family can win up to $700 per year for exercising thirteen times a month and reaching certain goals. • Plus the following cash incentives include: • * $6 for each full month of total abstention from the use of tobacco products. This includes ex-smokers as well as those who never started. Verification is done through an "honor system," with employees signing forms certifying that they are smoke-free. • * $60 semi- annually for no absenteeism under the disability policy. • * $72 semi- annually for having no employee major medical claims.

30. School Sites • Offered through Physical Education • School today offer few PE classes • Duration of PE classes are usually short • School-based interventions have shown • Improve knowledge and attitudes toward PA • Does increase one level of PA in school • Emphasis should be on after school program • School based Spark (sport, play and active recreation for kids) and CATCH (child and adolescent trail for cardiovascular health) interventions has shown out-of-school PA increases.

31. Modifying Policy and Curriculum in School-Based Physical Education • Increase the weekly number of PE classes that are offered • Offer new classes that appeal more to those students who are opting out of PE • Change the activities performed during PE classes to increase the amount of time spent performing moderate/vigorous exercise • Educate PE teachers on how to design classes that decrease instruction and “standing around” time • Change the PE curriculum

32. Private Health Clubs • Usually YMCA and fitness clubs (e.g. lifetime fitness) • Low to moderate effect on physical activity • Usually modeled after IAR (Institute of Aerobic Research)

33. FACT • Twelve to 13% is a widely accepted throughout the fitness industry as the percentage range of people in the United States who have a membership to a private fitness facility, whether for-profit or nonprofit. "That number hasn't changed significantly over the past 10 or 12 years," says Graham Melstrand, vice president of operations for the nonprofit American Council on Exercise, which serves the industry through education and certification programs.(September 2009)

34. Distance between homes & exercise Facilities (Sallis et al, 2006) • Study involved 6000 adults in San Diego. • Half of sample indicated that they exercised at home. • If the facility was within 1 Km from home was significant factor if one will use the facilities. • Second factor is if one had to pay to use the physical facility • Interventions that increase the availability of exercise facilities at a low cost relates to higher exercise adherence.

35. Community Sites • City community centers • Usually involves the healthy population • Specific activities or sports • E.g., swimming, hockey or tennis centers. • Young males and females, white collar worker, middle or high income. • Short term positive effects but no long term changes in exercise adherence

36. Summary • All sites seem to have a low to moderate positive effect size on exercise adherence “If we built it, they will come may not always hold true” • Most of studies and research about facilities show short term positive changes in exercise adherence. • Adherence and retention is greatest in the healthy population group not disease population groups (e.g., diabetic, cardio vascular, or high blood pressure) • Little research has been dedicated to long term (longer than 6 months) effects of these sites on people’s exercise patterns.