1. Purpose Background References Acknowledgements Methods Results Discussion Evidence Based Practice: Implementing Physical Activity Interventions Lauren Christa Wright, BSN student Nearly fifty percent of adults in Pinellas are overweight, this being the highest indicator among Pinellas’ actual causes of death. Consequently, most of the health problems treated at the St. Petersburg Free Clinic are chronic conditions such as hypertension, diabetes, and cholesterol. This evidence presents a drastic need to improve the community’s self health management and meet the Healthy People 2020’s physical activity (PA) objective of increasing moderate aerobic activity to 150 minutes a week or vigorous activity to 75 minutes a week. Because PA lowers the risk of these prevalent and preventable health problems, implementing an evidence-based intervention is necessary to improve patient outcomes in this setting, leading to the clinical question: In underserved populations (such as outpatient free clinics), does assessment of physical activity and referral increase physical activity over a three-month period? The reviewed randomized control trials support PA assessment and referral as effective interventions and findings also show an incremental and sustained positive effect on quantity of motivation and self-efficacy in patients who received continuous PA counseling (Fortier, et al. 2011; Lowther, Mutrie, & Scott, 2002; Wilson, Evans, Williams, Sirard, & Pate, 2005). Community Preventive Services Task Force. (2002). Recommendations to increase physical activity in communities. Am J Prev Med [Internet], 22(4S), 67- 72. Retrieved from http://www.thecommunityguide.org/pa/pa-ajpm-recs.pdfhttp://www.thecommunityguide.org/pa/pa-ajpm-recs.pdf Enterprise Florida. (2010). Pinellas County Profile. Retrieved from http://www.floridacharts.com/charts/DisplayHTML.aspx?ReportType=1341&Coun ty=52&year=2011&tn=24 Finkelstein, EA, Trogdon, JG, Cohen, JW, and Dietz, W. (2009). Annual medical spending attributable to obesity: Payer- and service-specific estimates. Health Affairs; 28(5): w822-w831. Food Research and Action Center. (2010). Factors Contributing to Overweight and Obesity. Retrieved from http://frac.org/initiatives/hunger-and-obesity/what- factors-contribute-to-overweight-and-obesity/http://frac.org/initiatives/hunger-and-obesity/what- factors-contribute-to-overweight-and-obesity/ Fortier, M. S., Hogg, W., O’Sullivan, T. L., Blanchard, C., Sigal, R. J., Reid, R. D.,... & Culver, D. (2011). Impact of integrating a physical activity counsellor into the primary health care team: Physical activity and health outcomes of the Physical Activity Counselling randomized controlled trial. Applied Physiology, Nutrition, and Metabolism, 36(4), 503-514. Leijon, M. E., Bendtsen, P., Nilsen, P., Festin, K. & Ståhle, A. (2009). Does a physical activity referral scheme improve the physical activity among routine primary health care patients? Scandinavian Journal of Medicine & Science in Sports.19: 627–636. doi: 10.1111/j.1600-0838.2008.00820.xM. Lowther, M., Mutrie, N., & Scott E. M. (2002). Promoting physical activity in a socially and economically deprived community: A 12 month randomized control trial of fitness assessment and exercise consultation. Journal of Sports Sciences, 20:7, 577-588. doi: 10.1080/026404102760000071 Melnyk, B. M., & Fineout-Overholt, E. (2011). Evidence-Based Practice in Nursing & Healthcare (2nd ed.). Philadelphia, PA: Wolters Kluwer Lippincott Williams & Williams. U.S Department of Health and Human Services. (2012). Healthy People 2020: Physical Activity. Retrieved from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topic id=33 Wilson, D. K., Evans, A. E., Williams, J., Sirard, J. R., & Pate, R. (2005). A preliminary test of a student-centered intervention on increasing physical activity in underserved adolescents. Annals of Behavioral Medicine, 30(2), 119-124. To be determined when the St. Petersburg Free Clinic establishes their electronic medical record system. The implementation of this evidence based physical activity intervention will impact Pinellas County by addressing the priority health indicator of overweight as an actual cause of death while simultaneously addressing the needs of the underserved population in Pinellas by working with the St. Petersburg Free Clinic, where clients are unable to afford health insurance and suffer primarily from complications associated with being overweight. By testing the initiative’s effectiveness in Pinellas County, using the St.Petersburg Free Clinic for sample selection, the results will provide a framework to create a working set of interventions that addresses a national health epidemic. The goal is to increase the proportion of adults participating in Healthy People 2020’s physical activity guidelines while improving the health of the community by decreasing overweight and obesity rates while simultaneously improving the economy by reducing the $147 billion spent annually on this issue. Dr. Melissa Shelton, PhD, RN Dr. Jason Beckstead, PhD Ronda Russick, Director of St. Petersburg Free Clinic’s Health Center Tampa, Florida University of South Florida College of Nursing Tampa, Florida University of South Florida College of Nursing Given these findings, it is crucial to implement a PA assessment and referral to local fitness center and continuous PA counseling at the St. Petersburg Free Clinic, particularly because the population served here also gained the most benefit from the suggested interventions (Leijon, Bendsten, Nilsen, Festin, & Ståhle, 2009). Because the Free Clinic does not currently assess PA, the first step is documenting baseline PA minutes per week in the monthly sample size of approximately 600 patients on the clinic visit form. During this initial appointment, referral and resources to continuous PA counseling and the local YMCA’s scholarship application will be provided and three-month follow up scheduled. The community nurses role is to assess willingness of the patient to participate in physical activity, provide education, and inform the patient on how to utilize the resources. According to a systematic review developed by the Community Preventative Services Task Force (2002), “Implementing individually-adapted health behavior change programs are recommended based on strong evidence of their effectiveness in increasing physical activity and improving physical fitness among adults and children. Individually- adapted health behavior change programs to increase physical activity teach behavioral skills to help participants incorporate physical activity into their daily routines” The continuous PA counseling is proposed to be offered by a USF student based affiliate program, which the patients will have telephone access for support if they have questions. Once a week the student physical activity counselor will contact the participant to provide encouragement, work with the patient on an individualized exercise program, and assess progress. The student based PA counseling and YMCA’s scholarship application referral provide the population at the free clinic access to local fitness centers and support. Analysis During the follow up visit, the community health nurse would measure what percentage of participants met Healthy People’s objective of increasing moderate aerobic activity to 150 minutes a weeks or vigorous activity to 75 minutes a week during the three month time frame from baseline to follow up. Collected self reported PA baseline minutes will then be compared to those documented at follow up in the electronic medical record in order to determine the effectiveness of the interventions. The desired outcome is to increase the proportion of adults participating in physical activity to Healthy People 2020’s PA-2.1 objective, and if this is met at baseline, to increase physical activity participation in minutes by Healthy People’s target setting method of ten percent. These results are translatable to underserved communities, where it is imperative to find and implement effective patient centered PA interventions because underserved populations have been found less likely to visit their doctor. In turn, they receive less education on preventative health measures such as physical activity, explaining the larger percentage of underserved populations classed as sedentary with a much greater chance of suffering resulting chronic diseases.