Plan of Physical Activity, Sport & Health

DEFINITIONDEFINITION

Health-promotion programme for

primary health-care services,

based on prescribing and advising

physical activity

WHO• According to the World Health Organization (WHO),

one of the major challenges in the prevention of noncommunicable diseases and in the promotion of physical activity and other healthy lifestyle choices is communicating the importance of action now in return for future benefits.

• Despite the fact that prevention has been the major contributor to health gains, including 30 added years of life expectancy, in the past century, most studies of health expenditures indicate that less than five percent of resources are devoted to prevention.

• The WHO says that advocacy and policy are key

• .

Around 40% of the adult population is sedentary or minimally active

Percentages by age group and risk factors. Men

0

10

20

30

40

50

60

70

80

90

100P

ER

CE

NT

AG

E

18-34 YEARS 35-54 YEARS 55-74 YEARS

GLOBAL HTA DM HCOL BMI>25

ESCA 2006. 18-74 years. Proportion of sedentary/minimally active men (normal Physical activity)

Around 40% of the adult population is sedentary or minimally active

Percentages by age group and risk factors. Women

0

10

20

30

40

50

60

70

80

90

100P

ER

CE

NT

AG

E

18-34 YEARS 35-54 YEARS 55-74 YEARS

GLOBAL HTA DM HCOL BMI > 25

ESCA 2006. 18-74 years.

Proportion of sedentary/minimally active women (normal Physical activity)

Physical inactivityPhysical inactivity:: a health riska health risk

This is one of the 10 risk factors that contributes to the appearance of chronic illnesses:

» Cardiovascular diseases

» Cancer

» Obesity

» Type 2 diabetes

These are the cause of 60% of all deaths and 47% of the global burden from sickness World Health Organisation (2002).

Report on world health 2002: reducing risks and promoting healthy lifestyles

The benefits of regular exerciseThe benefits of regular exerciseExercise and physical activity are important to health and prevention and

treatment of many chronic diseases

� Prevention and control of:

�Cardiovascular disease

�Obesity / overweight�Type 2 diabetes�Cancer �Osteomuscular disease

� Improved mental health

� ↓ Mortality

The benefits of regular exerciseThe benefits of regular exercise

• Exercise can also be a powerful complement to traditional medical intervention and, in many instances, may alow physician to significantly reduce a patient’s drug dose or eliminate the need for medicine altogheter .

The benefits of regular exerciseThe benefits of regular exercise

• Sport and health care professionals can play an integral role in educating your clients / patients about the medical benefits of exercise and how they can speak to MD, RN, PE about physical activity.

Plan of Physical Activity, Plan of Physical Activity, Sport & Health Sport & Health (PAFES)(PAFES)

A joint programme of the

Department of Health

and

General Secretary for Sport

in the fight against

sedentary lifestyles

Physical Activity, Physical Activity, Sport & Health Plan Sport & Health Plan (PAFES)(PAFES)

• Designed to help improve the health and wellbeing of our population through a regular physical activity prescription from doctors and other healthcare providers.

Overall global frameworkOverall global framework

WORLD HEALTH ORGANISATION (2004)

Global Food, Physical Activity & Health Strategy

EUROPEAN ECONOMIC COMMUNITY (2005)

Green book: “Promoting healthy eating and physical activity: a European approach for preventing overweight, obesity and chronic illnesses”.

SPAIN (2005)

Strategy for Nutrition, Physical Activity and the prevention of Obesity (NAOS)

CATALONIA (2005)

Integrated plan for the promotion of health, through physical activity and healthy eating (PAAS)

Global Strategieson Physical Activity for Health

LOCAL INITIATIVES FOR PRESCRIBING LOCAL INITIATIVES FOR PRESCRIBING PHYSICAL EXERCISE IN CATALONIAPHYSICAL EXERCISE IN CATALONIA

PPAF

BARCELONA

2006

Ajuntament de

Barcelona

Caminem

(“Let’s walk”)

LLEIDA

2005

Different

programmes

VILANOVA

20042004

UME

Hospital

Vilanova

MARTORELL

20042004

Different

programmes

REUS

Chronic

illness

workshop

20022002

…

Different

programmes

TERRASSA

20012001

AFIS

GRANOLLERS

19931993

i

Schools• Health education• Schools menus

• Promotion of physical activity

Community centres

�Training workshops:

1 - Children2 - Adults

The Media Businesses and

Restaurants• Menus

• Foods

Companies• Healthy menus• Promotion of

physical activity

Food Industry• Code of Good

Practices

City CouncilRoutes + labelling:1 – Access to sports

equipment

2 – Programmes among the

disadvantaged

population

City CouncilRoutes + labelling:1 – Access to sports

equipment

2 – Programmes among the

disadvantaged

population

Primary Healthcare

Service

PAFESPAFESPAFESPAFES

Primary Healthcare

Service

PAFESPAFESPAFESPAFES

CATALAN CATALAN FRAMEWORK 1FRAMEWORK 1

CATALAN FRAMEWORKCATALAN FRAMEWORK 22

Programme:

Sport &

HealthObjective: to integrate

physical activity into

the health system

Programme:

Sport &

HealthObjective: to integrate

physical activity into

the health system

Medical Services

in the Sports System

Medical Services

in the Sports SystemPAFESPAFESPAFESPAFES

Sports

equipment

PAFESPAFESPAFESPAFESPAFESPAFESPAFESPAFESSports

equipment

Strategic direction:

Recognising sport’s role in society

Strategic direction:

Recognising sport’s role in society

DopingDoping

OBJECTIVES OF PAFESOBJECTIVES OF PAFES

� To incorporate prescribing and advising exercise as a therapeutic

tool in primary healthcare.

���� To update knowledge and skills of professionals involved through

training and retraining courses, in coordination with multidisciplinary

training teams that can provide the necessary tools for developing their

roles.

���� To coordinate the health care resources (primary health care and

specialist level) with regard to prescribing physical activity. sports

medicine doctor as a consultants

���� To strengthen the use of existing sports facilities in the community.

���� To establish communication channels within multidisciplinary teams.

� To work together with professionals from sports facilities.

�To work together with the different public organisations and sectors

involved

Connection: Health - SportConnection: Connection: Health Health -- SportSport PAFES

Office

Health Sport

Health Centre

Sports equipment

+

Local authority

sport offering

PAFESPAFESPAFESPAFESPAFESPAFESPAFESPAFES

Programmes

Creating PAFES Office

Creating PAFES Creating PAFES OfficeOffice

City Council

Healthcare

Centers

Sports facilities

sports services

Health

Department

General

Secretary of

Sport

PROFESSIONALS INVOLVEDPROFESSIONALS INVOLVED

� Primary healthcare Physician (MD)

� Nurse (RN)

� Sports Medicine Physician (SMD)

� Physical Activity Educator (PE)

PAFES CHARACTERISTICS

• Target population: Sedentary adults with cardiovascular risk (Hypertension, Dyslipemia,

Obesity and Diabetes type2 ).

• Entry point into the programme:– Primary healthcare center

• Recommendations of physical activity Advising on non-supervised physical activity

Advising and prescribing advised physical activity

Advising supervised physical activity (referrals to sports facility)

NONNON--SUPERVISEDSUPERVISEDProgrammeProgramme

Advising on increasing progressive exercise at low to moderate intensity.

Aimed at those without impediments to

doing physical activity

Healthy physical activity offered within the city council area.

General advice on increasing light/moderate physical activity without supervision

� Sedentary population with no contraindication for PA.

ADVISEDADVISEDProgrammeProgramme

Periodically advising on increasing physical activity with progressive objectives.

Aimed at people who need periodic follow-up for doing physical activity

Stage of change: contemplation or determination

Designing healthy walking routes for each community area.

� Sedentary population with risk factors and some stable chronic illnesses.

SUPERVISEDSUPERVISEDProgrammeProgramme

Advising on taking physical exercise with initial and final evaluation by a SMD.

Stage of change: contemplation or determination

male>45 yo , female > 55 yo2 CV risk factors

Groups led by a PE in sports facilities.

6 months’ duration

• Sedentary population with chronic illness

that may be controllable through exercise.

Require supervision when starting the

exercise.

� Provide information, through the PAFES, on city council sports services and also about healthy activities as ways of promoting health (cultural routes, walks, games and leisure activities, dances and others).

� Arrange for city council sports facilities to be made available as well as communicating with the facilities' specialists in exercising for health (PE).

� Promote the establishment of a “cheap” fee for participants (the option for subsidies).

ROLE OF LOCAL AUTHORITIESROLE OF LOCAL AUTHORITIES

� To provide the logistical support to act as the link between the Primary Healthcare Centres and sports facilities and also with the local authorities’ healthy activities services.

� To provide the necessary training on promoting health for the sports facilities' physical exercise specialistsas well as local authority sports specialists.

� To certify the training given as well as accrediting the professionals who receive it.

� To provide the professionals with knowledge in the area of health promotion and establish a communication channel with the primary healthcare centres at no cost to the local authorities and sports administrators.

���� To create and drive a flow of users to the sports facilities, with major possibilities for generating frequent users, once theprogramme has ended.

FUNCTIONS OF THE PAFESFUNCTIONS OF THE PAFES

LCAFE: - als Ajuntaments

- als Equipaments

i Centres Esportius

Metges de l’EsportProfessionals Sanitaris

Equips d’Atenció Primària:- Centres de Salut

Documents de Documents de ReferReferèènciancia

ROLE OF PRIMARY HEALTHCARE TEAMS( MD, RN)

Integrate the following into care for patients with CV risk factors:

• To coordinate the selection and overallmanagement of the patient

•• To prescribe unsupervised and advised physical To prescribe unsupervised and advised physical activityactivity

• Where necessary, refer refer patients for supervised physical activity to SMD

HOW WILL BE THE INFORMATION RECORDED?

The physical activity will be recorded in the medical history

START: Stage of change

Type of advice and prescription of physical

activity

FOLLOW-UP: Physical activity or not, prescription

IN A YEAR: Stage of change, Type of advice

The remaining necessary information for the evaluation is extracted

from what is already available in the “e-CAP” (patient characteristics

and clinical data)

ROLE OF SPORTS MEDICINE DOCTORS

• To participate in training courses aimed at primary healthcare professionals

• To act as consultants for the professionals involved

• To prescribe supervised physical activity for patients referred from primary healthcare center, with an initial evaluation and a further evaluation after 6 months

ROLE OF PHYSICAL ACTIVITY EDUCATOR (PE)

• To be responsible for carrying out supervised physical

activity programmes in designated centres (including

initial and final evaluation of patients)

• To coordinate with Primary Healthcare Centres and SMD

• To participate in training courses aimed at primary healthcare professionals

Support material• Professionals

– PEFS Guide– Course material

• Patients Leaflets

Training workshop (8 hours)• Train the trainers strategy at 3 levels:

CENTRAL

REGIONAL

PRIMARY HEALTHCARE CENTRES as a CLINICAL SESSION

• Ongoing training credits

Periodic consultations with Sports medicine physician

PRIMARY HEALTHCARE TEAM

RESOURCES

Support material• Professionals

– PEFS Guide– Course material

• Patients Leaflets

Training workshop (20 hours)• Train the trainers strategy at 2 levels:

CENTRAL

REGIONAL

• Ongoing training credits

Periodic consultations with Sports medicine physician

Sport professional TEAM

RESOURCES