Exercise is Medicine www.exerciseismedicine.org.au Introduce yourself, cover any housekeeping items, and do an icebreaker with the group if you wish. www.exerciseismedicine.org.au

For individuals that are sedentary, the good news is that even a modest increase in activity, for example from a sedentary lifestyle to low-level physical activity, can also reduce mortality. Each patient encounter is an opportunity for you to make a difference. Brief interventions in primary care settings are an effective way of increasing physical activity among adults. I will show you some tools and resource that are available to you that will support your endeavours to get your patients moving.

Australia’s inactivity Chronic disease is a major concern in our society and the rates of chronic disease are projected to increase significantly over the next twenty years. Increased physical activity has been shown time and time again to have a beneficial effect on a long list of conditions from cardiovascular disease to cancer to depression, and low fitness is a proven key indicator of health outcomes. In fact, merely meeting the guidelines for physical activity has been linked to a 36% reduction in mortality.

For more visit exerciseismedicine.org.au

For more visit exerciseismedicine.org.au

Inactivity: Effect of low cardio respiratory fitness (CRF) on mortality Professor Steven Blair is a member of the EIM Global Advisory Board that put together EIM in the United States, and presented his research at the launch of EIM Australia in 2010, and at several high profile events in Australia including the Sports Medicine Australia conference in 2012. His research focuses on the associations between lifestyle and health, with a specific emphasis on exercise, physical fitness, body composition, and chronic disease. It shows that LOW CARDIO RESPIRATORY FITNESS (CRF) accounts for significantly more deaths than other risk factors like smoking and high blood pressure. In fact, studies show that low Cardio Respiratory Fitness contributes to more deaths than obesity, smoking and diabetes combined. Br J Sports Med. 2009; 43:1-2.

Exercise is Medicine is not a 12 week challenge, or a weight loss program. Regardless of the condition of an individual, we advocate for appropriate physical activity that is sustained for the long term.

It’s not all about weight loss. Physical Activity Guidelines It’s not all about weight loss. Physical activity is very beneficial to an individual’s health, whether or not they lose weight. Blair S. (2009). 'Physical inactivity: the biggest public health problem of the 21st century', British Journal of Sports Medicine, 43:1-2. It is important to note that the greatest improvement in overall health occurs when a sedentary person merely MEETS the guidelines. There is no need to run marathons to gain the benefits. Most of the improvements in cardiovascular and metabolic health (cholesterol, blood sugar, blood pressure) are found to occur whether your body weight changes or not. In fact, overweight persons who are fit have a lower risk of premature death than normal-weight persons who are unfit.

Physical Activity Recommendations Physical activity and chronic conditions Physical Activity Recommendations Exercise is Medicine® Australia supports the Australian Physical Activity and Sedentary Behaviour Guidelines 2014

Intensity and type Moderate: working hard enough so you can talk but not sing e.g. Brisk walking (like you’re late for the bus!) , gentle swimming or cycling at a regular pace. Vigorous: generally means that a conversation cannot be maintained uninterrupted, and you are ‘huffing and puffing’. e.g. jogging, aerobics and cycling. Aerobic Activity (cardio): To improve blood pressure, cholesterol, heart health, mental health… the list goes on. Resistance (strength): To promote and maintain musculoskeletal health and physical independence Balance, stretching and flexibility exercises for falls prevention It should be noted that to lose weight or maintain weight loss, 60 to 90 minutes of moderate physical activity may be necessary. The 30-minute recommendation is for the average healthy adult to maintain health and reduce the risk for chronic disease. Intensities can be combined to meet recommendations E.g.: walk briskly for 45min three times each week and jog for 25min on three other days of the week

Referrals Accredited Exercise Physiologist (AEP) Qualification: Min 4 years University Accreditation: ESSA Profession: Allied Health Rebates: Medicare, DVA, WorkCover, Private Health Patient risk level: High Specialty: Chronic conditions and injuries, long term behaviour change, self-managed exercise programs Physiotherapist Qualification: Min 4 years University Accreditation: AHPRA Profession: Allied Health Rebates: Medicare, DVA, WorkCover, Private Health Patient risk level: High Specialty: Acute conditions and injuries, manual therapy Personal Trainer Qualification: Cert IV in as little as 6 weeks Accreditation: n/a Profession: Fitness Rebates: Private Health Patient risk level: Low Specialty: General fitness Where do I refer my patients? It can be difficult to identify which professional to refer your patient to. AEP: At risk populations, CHRONIC conditions, specialize in the delivery of exercise for the prevention and management of chronic diseases and injuries. Promote self-management for long term behavior change Physio: At risk populations, treat ACUTE patients with manual therapies. Once acute phase is over (e.g. following injury or surgery), it is common to refer to an AEP for ongoing care PT: Apparently healthy populations – LOW RISK

Accredited Exercise Physiologists AEPs are allied health professionals, providing exercise and lifestyle therapies for the prevention and management of chronic disease, injury and disability. University trained Allied health providers Specialise in exercise for prevention and management of chronic disease and injury Work with high-risk patients Recognised by Medicare, DVA, WorkCover and private health insurance In Australia, we have the unique situation where we’re working backwards. We have the existing resources and infrastructure including the specialised workforce of Exercise Physiologists and the Medicare subsidies which enable Australians to access these services, but we need to significantly increase our activity levels. Accredited Exercise Physiologists are allied health professionals, providing exercise and lifestyle therapies for the prevention and management of chronic disease, injury and disability. Working in collaboration with general practitioners, and with other allied health providers, AEPs will develop an exercise program based on your patient’s current medical status and musculoskeletal condition, to ensure that the exercise program is both safe and effective to achieve the required health goals – this may include a supervised one-on-one, or group exercise program. In addition, AEPs will work to ensure your patient has the necessary knowledge and skills to exercise safely and effectively, and to motivate and support them while they start out with an exercise program. ‘Find an EP’ directory: http://www.essa.org.au

Typical 12 week treatment model Support for better self-management 2-5 consultations over initial 12 weeks Multi-disciplinary approach Week 1 Initial Consultation & Assessment Report back to referring GP 2 Program follow-up 3 7/8 Program Review & progression 11/12

Rebates Rebates for AEP services are available to eligible patients through: Medicare Department of Veterans Affairs (DVA) WorkCover Private Health funds Rebates are available through Medicare (EPC items), Department of Veterans Affairs (DVA), WorkCover, and private health funds. Patients who have both a GP Management Plan (GPMP) and Team Care Arrangement (TCA) have access to allied health individual services on the Medicare Benefits Schedule. Eligible patients can claim a maximum of five (5) allied health services per calendar year. In addition, patients with a GPMP and type 2 diabetes can also access Medicare rebates for up to eight (8) allied health group services per calendar year. Group programs do not have to be limited to type 2 diabetes groups only. Relevant group programs for type 2 diabetes patients may include: Fitness or weight management group services; or Blood glucose monitoring services.

Visit www.exerciseismedicine.org.au for: Resources Visit www.exerciseismedicine.org.au for: Factsheet library exercising safely for 30 health conditions including diabetes, cancer, heart disease, arthritis, depression Screening tools identify patient risk levels and determine an appropriate action plan Education RACGP and APNA approved workshops to build confidence, knowledge and skills Practice Support Medical Software, waiting room materials, on the spot resources Action Guides and referral templates for Healthcare Providers Search the find an Accredited Exercise Physiologist directory Some patients will be ready for only encouragement; some will be prepared to read the Starting an Exercise Program patient handout, or the factsheet relevant to their condition/s; and some will be willing to get an exercise prescription from you or be referred for support in establishing an exercise program. FREE resources available – factsheets, action guides, referral information. the fact sheets on physical activity and chronic disease will be particularly useful for your patients. You may also want to review the ESSA position statements on exercise and chronic disease

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