Introduction: Since 1999, the Burlington YMCA has offered a free aerobics class to members of the community with diabetes. Additionally, the class regularly monitors participants’ health status. These data support the well-established benefit of exercise in diabetes. Medical Monitoring •hemoglobin A1C •blood pressure •resting pulse rate (before and after each twelve week session) About the Program •Began in 1999 •Free •Physician’s referral required •2h aerobics, twice per week: 1h land + 1h waterhttps://scholarworks.uvm.edu/comphp_gallery/1001/thumbnail.jp

Antell, Nicholas

Cangiano, Michelle

Deane, Jessica

Farnham, Pam

Hatin, Kevin

Lin, Chris

Martin, Rebecca

Schlein, Sarah

Zinke, Richard

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University of VermontScholarWorks @ UVMPublic Health Projects, 2008-present Public Health Projects, University of VermontCollege of Medicine1-21-2008Enhancing Attendance of the Greater BurlingtonYMCA Diabetes Fitness ProgramNicholas AntellMichelle CangianoJessica DeaneChris LinRebecca MartinSee next page for additional authorsFollow this and additional works at: http://scholarworks.uvm.edu/comphp_galleryPart of the Community Health and Preventive Medicine Commons, and the Health ServicesResearch CommonsThis Article is brought to you for free and open access by the Public Health Projects, University of Vermont College of Medicine at ScholarWorks @UVM. It has been accepted for inclusion in Public Health Projects, 2008-present by an authorized administrator of ScholarWorks @ UVM. For moreinformation, please contact donna.omalley@uvm.edu.Recommended CitationAntell, Nicholas; Cangiano, Michelle; Deane, Jessica; Lin, Chris; Martin, Rebecca; Schlein, Sarah; Zinke, Richard; Farnham, Pam; andHatin, Kevin, "Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness Program" (2008). Public Health Projects,2008-present. Book 2.http://scholarworks.uvm.edu/comphp_gallery/2AuthorsNicholas Antell, Michelle Cangiano, Jessica Deane, Chris Lin, Rebecca Martin, Sarah Schlein, Richard Zinke,Pam Farnham, and Kevin HatinThis article is available at ScholarWorks @ UVM: http://scholarworks.uvm.edu/comphp_gallery/2“[I would refer patients], but I need to know more about the program so I can select and encourage patients appropriately.”~A Local Healthcare Provider“This program needs an instructor who knows what kind of a program is necessary and will stay with it. Lately it has been haphazard. For the last weeks we have had an instructor whose training is suspect. The intensity is not hard enough.”~ A current participant“I would need transportation, it is too far to walk.”“I am on oxygen and don’t know if I can participate.”~Diabetics on barriers to the program.“ [I would return if] there were better communication between doctors and the program.”“I don’t believe the people in charge [of the program] really care if the program is successful.”~Two past participantsBackground: Participants of the YMCA Diabetes Fitness Program have benefited in their health and well being since 1999. Despite these benefits, however, enrollment and retention rates remain low. Objective and Methods: We explored the barriers to participation and retention by surveying current and past program participants, non-participating diabetic patients, and healthcare providers in the community.Results: Major barriers to participation included parking/ transportation, time of day, and location, as well as lack of knowledge about the program. Physician’s also cited lack of motivation as a major barrier to exercise. Conclusions: We formulated a series of recommendations to assist the YMCA in overcoming participation/ retention barriers. Our results highlighted the importance of adequate communication between the YMCA Diabetes Fitness Program and the medical community.Since 1999, the Burlington YMCA has offered a free aerobics class to members of the community with diabetes. Additionally, the class regularly monitors participants’ health status. These data support the well-established benefit of exercise in diabetes.We surveyed 3 specific populations of interest:• Physicians• Online Survey Software used to gather data.• Current and Past Participants • A survey was mailed out to all past and current participants• Potential Participants • Survey’s were made available at the Community Health Center of Burlington and VT Regional Diabetes Center.The enrollment and retention rates in the YMCA Diabetes Fitness Program have been disappointingly low. By surveying local primary care physicians, current and past Y.M.C.A. program participants, and non-participating diabetes patients, we hope to explore reasons behind this trend.From our data we will formulate recommendations, from which the YMCA can better serve its population. Consequently, we hope the full potential of this program may be fully realized.Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness ProgramNicholas Antell1, Michelle Cangiano1, Jessica Deane1, Chris Lin1, Rebecca Martin1, Sarah Schlein1, Richard Zinke1, Pam Farnham RN2, Kevin Hatin3University of Vermont1, Fletcher Allen Health Care2, Greater Burlington YMCA3Medical Monitoring• hemoglobin A1C• blood pressure• resting pulse rate (before and after each twelve week session)Only 57% of physicians had heard of the class; however, 100% of physicians stated that they will refer patients to the program now that they are aware.Figure 6: Past participants cited that parking, weight loss, increased fitness level, no required referral, and more frequent classes would be incentives to return to the program. Location was not a cited barrier for past participants.Figure 5:  According to class participants, benefits of the program included reduced HbA1c levels, improved fitness, social support, weight loss, and self confidence.Figure 4:  The most important factors in joining a fitness program are time of day, location, support groups, and a personalized program.010203040506070ReducedHbA1cImprovedfitnessSocial support Weight loss SelfconfidenceImprovedglucoseReducedstressDecreasemedsOverall feelingbetter*Insulin FreePercent* Added to survey by participantParticipants:  Benefits of YMCA Diabetes Fitness Program010203040506070Parking Weight loss IncreasedfitnessNo requirementof referralMore often* Pool Too Cold* Time of day Location Day of the week IncentivesPercent* Added to survey by participantPast Participants:  Changes That Would Promote Return to the Program05101520253035404550Time of day Location SupportgroupsPersonalizedprogramPersonaltrainingTransportation Length ofcourseFriends inclassProgramincentivesAssociatededucationPercentNon-Participants:  Most Important Factors in Joining a Fitness ProgramBarriers to the Fitness Class According to Doctors and Non-Participants0102030405060708090Lack of motivationTransp/PkingTime of dayLocationNo Hx exerciseLack of timeEmbarrassedSession durationPrefer indvl exerciseExercise not beneficialFear of failureSession frequencyLack of educationPt doesn't know anyoneLack of incentivesCo-edUnaware of benefitsCost*Time for travel*PercentDoctor Non-participant * Added to survey by participantFigure 1:  Decreasing HbA1C levels of participants, measured before and after each 12 week sessionFigure 2:  Decreasing blood pressure of the participants, measured before and after each 12 week sessionAbout the Program• Began in 1999• Free• Physician’s referral required• 2h aerobics, twice per week:1h land + 1h waterFigure 3:  Barriers to joining exercise fitness programs.  Physicians:  lack of motivation followed by transportation, time of day, and location. Diabetic patients: time of day, location, transportation/ parking.Only 1/4 of the non-participants had heard of the program (via their physicians offices and the Burlington Free Press).  3/4 of respondents would be interested in a program like the YMCA provides.In addition to attendance, retention is a problem: Of the participants that were questioned, only 40% were currently enrolled in the program.  The principal reasons for no longer participating were parking issues and preferring individual exercise.How did participants hear about the program?Through their doctor, family/friend, newspaper, or YMCA brochure. Would they recommend it? 100% of participants say that would recommend the program given the opportunity; 86.7% have already recommendedthe program.“I keep from taking any medication by doing water aerobics everyday. Doctors who treat diabetics should insist that their patients join this program.”~A current participantREFERENCES1. L.M. Bell, et al. Exercise reduces insulin resistance in obese children J. Clin. Endocrinol. Metab. 92:4230 2007.2. Oh, KS, et al. Swim training improves leptin receptor deficiency-induced obesity and lipid disorder by activating uncoupling proteins. Exp and molecular med. 35:3:395 2007. 3. Snoek, FJ. Breaking the barriers to optimal glycaemic control--what physicians need to know from patients' perspectives. Int J Clin Pract Suppl. 129:80 2002.1. The class works: the average hemoglobin A1C level for the participants has decreased every year since 1999 as a result of the YMCA Diabetes Fitness Program.2. Roughly 43% of surveyed practitioners had never heard of the YMCA Diabetes Fitness class.  This highlights the importance of improved communication between the program directors and healthcare providers in the community.3. It is essential that providers not let personal bias or assumptions interfere with recommending the fitness class to their diabetic patients.  Encourage enthusiasm through advertisements• Establish a visible link on web site•Create vibrant advertisement in seasonal YMCA publication• Ensure visibility to elder populationsIncrease Accessibility• Weekend option; add additional class• Provide transportation: Bus from parking lot of CHC/ Diabetes Center • Provide free parking• Provide referral sheets that can be faxed directly to and from physicians’offices to relieve pts of this burdenSupport the Individual• Ensure dependable, consistent, enthusiastic instructional staff. • Educate instructors on diabetes/ exercise benefits• Personalize the program (intensity level options, additional incentives) Increase awareness within the medical community• Advertise to doctors on regular basis • Spread information at physician gatherings/ meetings (Grand Rounds)• Supply quick info handouts to physicians (Rx pads)Increase Awareness• Continue ads in Burlington Free Press• Include all pertinent information: no cost, transportation information, and physical accommodations possible• Add program information to Seasonal YMCA Publication and WebsiteEmpower the individual• Physicians must not assume lack of motivation on pt’s part• Ask directed questions• Create personalized plan around individual’s barriersSPECIAL THANKSWe would like to thank the Greater Burlington YMCA, University of Vermont  College of Medicine Office of Medical Education,  UVM Med Photo, Community Health Center of Burlington, VT Regional Diabetes Center,  Jan Carney, Thomas Delaney, Pam Farnham, and Kevin Hatin for all their work and cooperation which allowed this project to be completed.5.65.866.26.46.66.877.27.47.61999 2000 2001 2002 2003 2004 2005 2006 2007Year of ProgramHBA1C Pre- and Post-12 week Exercise SessionsHBA1C pre -programHBA1C post-programChanges in Hemoglobin A1C From Beginning to End of Diabetes Fitness Program0204060801001201401601999 2000 2001 2002 2003 2004 2005 2006 2007Year of ProgramMM of mercurySBP pre-program SBP post-programDBP pre-program DBP post-programChanges in Blood Pressure From Beginning to End of Diabetes Fitness ProgramINTRODUCTIONOBJECTIVEMETHODSLESSONS LEARNEDRECOMMENDATIONSABSTRACT RESULTS

Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness Program

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Enhancing Attendance of the Greater Burlington YMCA Diabetes Fitness Program

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