A wide array of barriers exist which prevent many geriatric patients from engaging in regular physical activity. This project addresses the barriers unique to Vermont\u27s population of geriatric patients and explores potential solutions.https://scholarworks.uvm.edu/fmclerk/1631/thumbnail.jp

Udawatta, Stephanie

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University of Vermont ScholarWorks @ UVM Family Medicine Clerkship Student Projects Larner College of Medicine 2020 Addressing Barriers to Physical Activity in Vermont's Geriatric Population Stephanie Udawatta University of Vermont Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk  Part of the Community Health and Preventive Medicine Commons, Geriatrics Commons, Medical Education Commons, Preventive Medicine Commons, Primary Care Commons, and the Sports Medicine Commons Recommended Citation Udawatta, Stephanie, "Addressing Barriers to Physical Activity in Vermont's Geriatric Population" (2020). Family Medicine Clerkship Student Projects. 561. https://scholarworks.uvm.edu/fmclerk/561 This Book is brought to you for free and open access by the Larner College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact donna.omalley@uvm.edu. Addressing Barriers to Physical Activity in Vermont’s Geriatric PopulationStephanie UdawattaFamily Medicine Rotation, February 2020Mentor: Dr. Jacob Shaw, MD, South End Community Health Clinic1The IssueI encountered a large number of geriatric patients during my family medicine rotation, many of whom would deny participation in physical activity during their health maintenance appointments. They commonly cited one or more of the following reasons as barriers to participating in regular exercise:• Chronic pain (from arthritis, a “bad back”, etc.)• Cold weather (many patients enjoy walking outside for exercise)• Safety (the icy winter sidewalks prevent older patients from walking outside safely; patients also mentioned that the risk of falls/other injuries prevent them from being physically active other times of the year)• Financial Resources (e.g., being able to afford a gym membership)• Transportation Resources (being able to drive a car or living close enough to a bus line which stops near fitness facilities)• Not seeing an obvious need to exercise or fully understanding its benefits2Public Health Perspective• Physical Inactivity is the fourth leading underlying cause of mortality worldwide (Pratt et al., “The Cost”)• The WHO estimates that over 3 million people die each year as a direct result of physical inactivity (Pratt et al., “The Cost”)• Increasing participation in regular, moderate-intensity physical activity is predicted to reduce annual national medical expenditures by over $76 billion (Pratt et al., “Higher”)• An osteoporosis-related hip fracture results in about $90,000 in health care costs per fracture; one in seven Vermont men and one in three Vermont women over the age of fifty will suffer an osteoporosis-related fracture in their lifetime (United Way)3Community PerspectiveWhen asked the following question, “What, in your experience, have been the most common barriers listed by your geriatric patients in regard to participating in physical activity?” the following responses were given:“The biggest is the fear of falling…so many people can have a truly serious injury [from exercise]. Barriers can include frailty from COPD, vision impairment, arthritis. People in senior groups with access to big gyms [may also] feel intimated…it can be intimidating and embarrassing for some patients to navigate [complex] exercise equipment.”–Dr. Stephanie Bellomo, MD, South End Community Health Center“Pain and fear. Fear that doing these exercises will make them worse, make them sore….Transportation [is an] issue as well.”–Andrew Filion, ATC, Long Trail Physical Therapy4Intervention and MethodologyI wanted to adequately understand and address the community’s barriers to healthcare, so I:• Asked geriatric patients about unique barriers to exercise at their health maintenance visits (slide 2)• Asked healthcare providers what they had observed to be barriers to exercise for their geriatric patients (slide 4)• Researched solutions to the barriers noted, along with the latest evidence on physical activity importance and public health impact • Planned out an exercise guide that would summarize the results of my research, and which would be distributed to providers at South End Community Health Clinic for their  geriatric patients experiencing barriers to physical activity5ResultsThe result of this research was a 6-page, large-print exercise guide (below) which included:• Facts about exercise from evidence-based resources• Senior-friendly, at-home exercises with images and explanations• Tips on incorporating physical activity in non-traditional ways• A list of local resources for low-cost, group exercise options6Evaluation of Effectiveness and LimitationsIn order to effectively gauge the impact of the intervention, it would be helpful to:1) Distribute the exercise guide to all geriatric patients who state “no exercise” for their physical activity level at appointments; keep a record of which patients have received the guide.2) Follow up with these patients at future appointments to see how their exercise routines have changed, and…-if yes, how so? Were there specific recommendations or exercises from the guide that were particularly useful? Which parts of the guide could be elaborated upon?-if not, why not? Was the guide understandable? Were the resources listed easy to access? Were there other barriers to exercise not fully addressed in the guide which prevented participation in physical activity?7Recommendations for Future Projects• Explore barriers to physical activity in unique environments, such as nursing homes with pre-established group fitness classes and gyms• Arrange a group exercise class that addresses the needs and concerns of geriatric patients (e.g., a class held in a well-lit room with lots of space and stable supports)• Give a community presentation to a retirement home explaining the benefits of regular physical activity; consider doing this with a doctor and/or physical therapist so that a Q&A may be held afterward• Explore barriers to physical activity in a separate patient population, such as children from lower-resource neighborhoods8References• Pratt, Michael et al. “Higher Direct Medical Costs Associated with Physical Inactivity.” The Physician and Sports Medicine. Vol. 28, Issue 10. 2000. https://www.tandfonline.com/doi/abs/10.3810/psm.2000.10.1237. Accessed 29 Feb 2020.• Pratt, Michael et al. “The Cost of Physical Inactivity: Moving into the 21st Century.” British Journal of Sports Medicine. Vol 48, Issue 3. https://bjsm.bmj.com/content/48/3/171.short. Accessed 1 March 2020.• “Strength for Healthy Aging.” United Way of Northwest Vermont. https://unitedwaynwvt.org/bone-builders. Accessed 1 March 2020. 9

Addressing Barriers to Physical Activity in Vermont\u27s Geriatric Population

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Addressing Barriers to Physical Activity in Vermont\u27s Geriatric Population

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