Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise. Having a home workout program may prove to be beneficial to patients who don\u27t have access to a gym, equipment, or are otherwise constrained by time

Esteban, Justin L

English

Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise. Having a home workout program may prove to be beneficial to patients who don\u27t have access to a gym, equipment, or are otherwise constrained by time.https://scholarworks.uvm.edu/fmclerk/1939/thumbnail.jp

UVM ScholarWorks

University of Vermont UVM ScholarWorks Family Medicine Clerkship Student Projects Family Medicine Community 2022 Home Exercise for Patients With Limited Access and Resources Justin L. Esteban The University of Vermont Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Medical Education Commons, and the Primary Care Commons Recommended Citation Esteban, Justin L., "Home Exercise for Patients With Limited Access and Resources" (2022). Family Medicine Clerkship Student Projects. 805. https://scholarworks.uvm.edu/fmclerk/805 This Book is brought to you for free and open access by the Family Medicine Community at UVM ScholarWorks. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of UVM ScholarWorks. For more information, please contact schwrks@uvm.edu. Home Exercise for Patients With Limited Access and ResourcesUsing exercise to combat chronic disease in socioeconomically disadvantaged populationsJustin Esteban MS IIICentral Main Medical CenterLewiston, MESeptember, 2022Mentor: Dr. Lauren NadkarniProblem Identification & Description of Need  Focus Area: Social Determinants of Health 5 out of 6 chronic diseases in Maine can be mitigated with exercise [6].  Hypercholesterolemia Hypertension Arthritis Diabetes  Cardiovascular disease  Patients with limited resources and who are socioeconomically disadvantaged, don’t have the time or resources available to partake/pursue exercise, as reported anecdotally Mainers (and patients who are socioeconomically disadvantaged) need information and access to exercise Easily accessible Maintainable & sustainable Public Health Cost Chronic diseases could cost the state of Maine $8.7 billion in medical cost and an extra $3.5 billion annually in lost employee productivity (average per year 2016-2030) [4] People with diabetes have medical expenses approx. 2.3 times higher than those who do not have diabetes [5]Community Perspective Interview with detective of Lewiston Police Department/ advisor to the board of directors for New Beginnings (program for runaway and homeless youth and families) Many of the communities, especially Lewiston, are combating poverty Poverty makes addressing health concerns extremely difficult Lack of income/resources make it difficult to manage their health, let alone provide an opportunity to exercise Interview with community volunteer Time is a barrier when trying to begin/commit to exercising Feels that a home program would be beneficial to the community Interview with a community volunteer  After working with the community, has found anecdotally that access to resources is one of the many challenges that the community faces Feels that the community would benefit from an accessible resource for exerciseIntervention & Methodology Evidence supports moderate-intensity physical activity between 150-250 mins/week to be effective [3] Low frequency high intensity interval training (at least once weekly) improved cardiorespiratory fitness, body composition, and blood pressure in overweight/obese adults [1] Studies have shown that high intensity interval training and sprint interval training can be as enjoyable and preferable to moderate-intensity continuous training in inactive individuals [2] Resistance training does not enhance weight loss, but may increase fat-free mass and increase fat loss and is associated with reduction in health risk [3] Endurance physical activity or resistance physical activity without weight loss, still improves health risk [3]Intervention & Methodology  5 exercises: push up, body weight squat, shoulder press, row, TRX row Routine Do each exercise for 2 minutes, do as many as you can without compromising form Starting with push up → squat → shoulder press → row → TRX row Rest one minute in-between each exercise Once you finish the TRX row, start again at push ups, one more time through Push ups → squat → shoulder press → row → TRX row  Total of 30 mins Scaling Squat: start with standing and sitting from chair → progress to body weight Push up: start pushing up on inclined surface (wall → chair → on knees → on toes) Shoulder press: can use milk jugs and fill with water for weight, can start small (quart → gallon) Row: can use milk jugs and fill with water for weight, can start small (quart →gallon) TRX Row: use bed sheets/rope and secure to door frameInstruction & ResourcesCrossFit | The Push-Up [7] CrossFit | The Air Squat [7] CrossFit | The Dumbbell Push Press [7]The Dumbbell Row is a Classic Muscle-Building Exercise | BarBend [8]TRX Row Exercise: Strengthen Your Back – PopWorkouts [9]Results & Response Positive response from the community to the suggestion of an at home workout program Positive response from providers, in hopes of encouraging lifestyle modification Forms given to providers to determine best method to distribute to patients; whether as part of after visit summary, as an informational handout, or as an informational flyer in exam roomsEvaluation of Effectiveness & Limitations Effectiveness  Formal Study design Enroll patients with chronic disease that would benefit from increased exercise as treatment modality (diabetes, HTN, HLD,…etc) Assign patients into home program group versus no program/self program Have patients maintain fitness logs At 3 month intervals, obtain objective data (weight, BMI, BP, HbA1C, labs…) Perform T-test analysis to compare average change between program vs self program Limitations Patient adherence to program Many changes are needed to combat chronic disease, not just exercise If patient exercises, but continues to not alter daily diet or other habits, may not see any results Even if given a resource, patients may still be reluctant to exercise; need intrinsic motivation In the study evaluating HIIT, HR monitors were used, not accessible for patients with socioeconomic disadvantages Recommendations for future interventions/projects Survey patients who participate in home program and see if it has changed their level of activity Follow up in 1 year to re-assess intrinsic motivation to exercise Follow up in 1 year to assess if any injuries occur due to program, and alter accordingly Develop additional exercise programs that are accessible to patients Create DOT phrase that can be added to after visit summariesReferences 1. CHIN, EDWIN C.1; YU, ANGUS P.1; LAI, CHRISTOPHER W.2,3; FONG, DANIEL Y.4; CHAN, DERWIN K.1,5; WONG, STEPHEN H.6; SUN, FENGHUA7; NGAI, HEIDI H.8; YUNG, PATRICK S. H.9; SIU, PARCO M.1. Low-Frequency HIIT Improves Body Composition and Aerobic Capacity in Overweight Men. Medicine & Science in Sports & Exercise: January 2020 - Volume 52 - Issue 1 - p 56-66 doi: 10.1249/MSS.00000000000020972. STORK, MATTHEW J.1; GIBALA, MARTIN J.2; MARTIN GINIS, KATHLEEN A.1,3. Psychological and Behavioral Responses to Interval and Continuous Exercise. Medicine & Science in Sports & Exercise: October 2018 -Volume 50 - Issue 10 - p 2110-2121 doi: 10.1249/MSS.00000000000016713. DONNELLY, JOSEPH E. Ed.D (Chair); BLAIR, STEVEN N. PED; JAKICIC, JOHN M. Ph.D.; MANORE, MELINDA M. Ph.D., R.D.; RANKIN, JANET W. Ph.D.; SMITH, BRYAN K. Ph.D.. Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults. Medicine & Science in Sports & Exercise: February 2009 - Volume 41 - Issue 2 - p 459-471 doi: 10.1249/MSS.0b013e31819493334. What is the impact of chronic disease in Maine? Partnership to Fight Chronic Disease.PFCD_ME_FactSheet_FINAL1 (fightchronicdisease.org)5. The Burden of Diabetes in Maine. American Diabetes Association. Published 4, 2022 Microsoft Word -ADV_2022_State_Fact_sheets_all_rev_APR.docx (diabetes.org)6. State of Chronic Disease in Maine. Chronic Care Policy Alliance. Published June, 2021 CCPA-Maine-State-of-Chronic-Disease (chroniccarealliance.org)7. Crossfit Movements: Push Up, Air Squat, DB Press www.crossfit.com/essentials/movements8. The Dumbell Row The Dumbbell Row is a Classic Muscle-Building Exercise | BarBendhttps:://barbend.com/dumbbell-row/9. The TRX Row TRX Row Exercise: Strengthen Your Back - PopWorkoutsInterview Consent Form

Home Exercise for Patients With Limited Access and Resources

https://scholarworks.uvm.edu/cgi/viewcontent.cgi?article=1939&context=fmclerk

Home Exercise for Patients With Limited Access and Resources

Abstract

Similar works

Full text

Available Versions

UVM ScholarWorks