1. Physical Activity & Diabetes: Getting Patients Active Shirley O’Shea Senior Health Promotion Officer

2. Overview Evidence of physical activity and type 2 diabetes National Physical Activity Guidelines Promoting Physical Activity in Primary Care How can patients be supported to become active?

4. Key message Physical activity is for everyone and any level is better for your health than none For adults with disabilities – Aim for guideline or as much as ability allows.

6. How do we measure physical activity? 1. “ I run around after the children all day long, am always on the go” 2. “I have a sedentary job but I cycle 3 times a week for up to 2 hours” 3. “I walk to town at lunch time a few days a week” 4.”I go to the gym twice a week for an hour each time”

7. Types of Activity 4 major domains for Activity in daily life For transport – cycling or walking to work, school, shops At work – manual labour At home – housework, DIY, gardening Leisure time – sport, exercise & recreation

9. What are the recommendations? 1.How often? 2.How hard? 3.How long? 4.What type? Frequency Most days of the week Intensity Moderate Level 60-80% M HR Time 30 minutes Type Select activity that you enjoy & is convenient e.g. walking or cycling F.I.T.T. Principle

10. Moderate Intensity (pbt’s) Moderate Intensity Physical Activity is described as a level that causes your: Beat a little faster Breathe deeper and faster (but not out of breath) Brings a little sweat to your brow

11. Evidence Participation in regular physical activity Improves blood glucose Prevent or delay Type 2 diabetes Positively affecting lipids Blood Pressure Cardiovascular events Mortality & quality of life

12. Limitation in role of Primary Care Staff Your own level of exercise Knowledge of current messages on physical activity Lack of time in consultation Lack of perceived importance of physical activity Lack of systems in place

13. Within the practice Learn about PA GP/PN develop skills Practice-specific leaflets ‘Prescription’ forms Peer counselling PA specialists for specific groups Referral/H-P ‘clinics’ Opportunistic practice Follow-ups and feedback ‘Modelling’ your own PA Using waiting room time Receptionists Longer consultations REWARDS?

15. Get Ireland Active The National Physical Activity Guidelines for Ireland provide clear, concise and user friendly guidance to support the public, professionals and policy makers to Get Ireland Active. Website: –Promoting the guidelines –Benefits of PA –Guidelines for children and young people, adults and older adults, people with disabilities and weight management.

16. Brief intervention Involves opportunistic advice, discussion, negotiation or encouragement and are delivered by a range of primary and community care professionals. Varies from basic advice to more extended, individually focused attempts to identify and change factors that influence activity levels Discussion between individuals and GPs, nurses etc are effective and cost effective in encouraging individuals to be more active Ref: Public Health Intervention Advisory Committee NICE Public Intervention Guidance No.2, March 2006

17. 1 to 2 hours Physical Activity and Health Delivered to on site practices Free of charge Useful Resources for promoting PA in your practice

18. PACE Programme – Patient Assessment & Counselling for Exercise Based on stages of behaviour change Provides screening tools Appropriate advice and follow up for patients Addresses barriers, motivation, goal setting Ideal following Brief Intervention training

19. Provides a safe pathway for people with various health conditions to get them physically active, their way, everyday. You Recommend GP Refers Patient Meets Local Coordinator The patient then begins a twelve week physical activity programme Health professional handbook Caroline.kelleher@hse.ie

20. Patient Request (website, publicity, word-of-mouth) GP RecommendHealth Prof. Recommend (brief intervention) GP-Patient Consultation Referral Form received by Local Coordinator Initial Assessment Mid-way Assessment Final Assessment Exit, 6, 12 & 24 Month Follow-up & Aftercare Workshops (healthy eating, smoking cessation, stress management) Local Events (health walks, cycle days) Signposting (condition-specific pathways, local support networks) Ongoing Support (telephone, email, website, facility staff)

21. Inclusion & Exclusion Criteria Patients must beExclusion Criteria currently sedentary over 18 years of age interested in becoming more physically active × Cardiac Conditions × Uncontrolled conditions A fully detailed criteria list is available in the Health Professionals Handbook

22. Walking Walking for Health Workshops IHF Walking Leaders Training Community Walking Groups Meet n’Mingle Walks Walking Leaders Refresher Training Trail Walking Workshop IHF Walking Leaders Training 2

23. HPD Training Calendar Physical Activity in Primary Care (2hrs) PACE- Patient –Centred Assessment & Counselling for Exercise (3 hrs) Promoting The National Physical Activity Guidelines for Ireland “Get Ireland Active” (2hrs) Obesity: A Health Promotion Perspective (1 day) Supporting Change: Skills for Health (formerly Brief Interventions) (2 days)

24. Research….. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med Physical Activity, cardiovascular risk factors and mortality among Finnish adults with diabetes Diabetes and Physical Activity: Joint position statement of Diabetes Australia on the role of PA and risk reduction of and management of diabetes A RCT of resistance exercise training to improve glycemic control in older adults with diabetes

25. Further support and info Email - shirley.oshea@hse.ieshirley.oshea@hse.ie Tel: - 021 4921643 www.healthpromotion.ie www.gpexercisereferral.ie www.getirelandactive.ie