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 Health Professionals Promoting Physical Activity How can patients be supported to become active?

4. Reduction in CHD, hypertension, type 2 diabetes, some cancers, Reduce risk of musculoskeletal conditions osteoarthritis, back pain, osteoporosis Mental health benefits, lower levels of anxiety, managing stress increase self esteem Supports weight loss and weight management Health Benefits of Physical Activity

5. Diabetes Some studies show that Physical activity can possibly cause the reversal of early insulin resistance, therefore, reducing the risks of developing type 2 diabetes.

6. Evidence for activity 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

7. Not active enough Very inactive population- 3 out of 4 Irish adults do not meet the National Guidelines for physical activity 4 out of 5 Irish children do not meet the guidelines Physical Inactivity – fourth leading risk factor for global mortality (WHO 2010 Global recommendations on physical activity for health)

8. 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 Guidelines for children and young people, adults and older adults, people with disabilities and weight management.

10. 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.

11. Recommendations for Weight Loss and Prevention of Weight Regain Levels greater than the minimum (150 mins) amount of activity recommended per week are important for weight loss. Aim to get participants to burn 300 kcal per day in an activity session. 45 minutes walk at 12-15 minute per mile pace. Progress overweight/obese adults to 200-300 min of activity per week, gradually and over time. Significant improvements to health by achieving minimum recommendation.

12. American Diabetes Association PA Recommendations, 2006 Info given as preventative as follows: Patients with Impaired Glucose Tolerance should partake in > 150 mins per week of moderate or vigorous activity The physical activity should be distributed over at least 3 days per week, with no more than 2 consecutive days without physical activity. Unless contraindicated, people with type II diabetes should be encouraged to perform resistance exercise 3 times per week, targeting all major muscle groups. This should progress to 3 sets of 8 to 10 repetitions at a weight that cannot be lifted more than 8 to 10 times (ACSM)

13. Risk Factors Associated with PA and Diabetes Hypoglycaemia needs to be prevented by patients who take insulin and thus capillary blood glucose before, after and several hours after a session of physical activity. Until normal glycemic responses to activity can be predicted. If patients are prone to hypoglycaemia after exercise, measures can be taken to avoid it after exercise: -Reduce dosage of insulin before PA -Consume carbs before/during exercise or both if possible.

15. 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”

16. Physical Activity Discuss What are your current activity levels? (Activities of daily living & planned activity Tell me about what you used to participate in and specific interests, likes, dislikes you have? What is stopping you becoming more active? (barriers) What would you like to achieve? (client own goals) Who can support you in this change? (social support) How confident are you in becoming more active (self efficacy)

17. 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

19. 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

20. 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

21. Limitation in role of Health Care Professionals 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

22. Traditional advice giving: Powers of Persuasion

23. It’s about Acceptance Human nature resists being told what to do!

24. Brief intervention to increase activity levels 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

25. MOVE.EAT.TREAT.

27. MI is…. a client centred, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence

28. Or…… a collaborative, goal-oriented style of communication with particular attention to the language of change. It is designed to strengthen personal motivation for and commitment to a specific goal by eliciting and exploring the person’s own reasons for change within an atmosphere of acceptance and compassion

29. ICGP- Promoting Physical Activity eLearning Module Developed by ICGP in collaboration with HSE PAC group, Faculty of Sports & Exercise Medicine, Irish Practice Nurses Association Aim: support HP in routinely promoting PA in their practice Free to participate Competence credits Distance learning Module Content: 1.Evidence base for health benefits of regular exercise 2.National PA Guidelines for PA 3.Motivational Interviewing, exercise prescription and GP Referral 4.Practical suggestions, resources, Insert partner logos here

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