Health Promotion, Disease Prevention and Wellness in Rehabilitation Learning Objectives: · Define the terms health, health promotion, prevention, and wellness. · Differentiate between primary...

Health Promotion, Disease Prevention and Wellness in Rehabilitation
Learning Objectives:
· Define the terms health, health promotion, prevention, and wellness.
· Differentiate between primary prevention, secondary prevention and tertiary prevention
· Discuss the role of the PTA/OTA in supporting a wellness approach to rehabilitation.
Health:
According to the World Health Organization (WHO), health is not merely the absence of disease, but is a state of complete physical, social and mental well-being. Health is not the goal of living, health is a resource for living well.
Wellness:
While health is static and measured at one point in time, wellness is dynamic and consists of health-related habits and practices over time.
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Learning Activity #1:
The Satisfaction with Life Scale:
DIRECTIONS: Below are five statements with which you may agree or disagree. Using
t
he 1-7 scale below, indicate your agreement with each item by placing the appropriate
n
umber in the line preceding that item. Please be open and honest in your responding.
1 = Strongly Disagree
2 = Disagree
3 = Slightly Disagree
4 = Neither Agree or Disagree
5 = Slightly Agree
6 = Agree
7 = Strongly Agree
5
1. In most ways my life is close to my ideal.
6
2. The conditions of my life are excellent.
4
3.I am satisfied with life.
5
4. So far I have gotten the important things I want in life.
3
5. If I could live my life over, I would change almost nothing.
Consider you answers. What do they tell you about your own health and wellness?
I think I am in a balanced state of health. I am not cu
ently having any lifestyle related illnesses neither I am dissatisfied with my life. I have certain educational goals and I am working on them.
)
Health Promotion/ Wellness Approach to Rehabilitation
· The science and art of helping people move toward a state of optimal health
· Purposeful activities designed to enhance the health of oneself or others
· In rehabilitation, both people with disease or disability, and apparently healthy people can benefit from health promotion or a wellness approach
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Learning Activity #2
Can you think of possible examples of health promotion/ wellness for people with disease states?
Ans: One such example would include reproductive health promoting reproductive health in woman in their 40s, Promoting uses and benefits of IVF technology, egg freezing etc. Introducing new measures for promoting woman
’
s reproductive health and related technology is an ideal example.
What are examples of health promotion/ wellness for people who are apparently healthy?
Ans: Promoting mental health wellness, diet modification and mindful eating to prevent lifestyle related illnesses is a possible example for health promotion for healthy individuals.
)
Disease Prevention:
· Primary Prevention:
· Stopping disease before it starts
· Strategies designed to help people avoid the onset of unhealthy conditions, diseases or injuries
· Secondary Prevention:
· Early detection and treatment of illness, injury or disability to prevent or disrupt the disabling process
· Tertiary Prevention
· Efforts to decrease the degree of disability in clients with chronic and i
eversible disease
Influential Societal Factors in the Shift towards a Wellness Approach and Disease Prevention in Rehabilitation
· Aging of population
· Increased rates of chronic disease
· Soaring health care costs
· Increased rates of survival from pre-term births spinal cord injury, head injury & other traumas
Understanding Yourself and your Client:
Foundations of Professional Personal Training Chapter 1
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Learning Activity #3
Read the descriptions of personality types in your text (pp. 19-22). How would you describe yourself according to these traits?
I have a confident, overall positive and quite pleasing personality.
)Interacting with Different Personality Types
    Learning Activity #4: Case Study- Stages of Behaviour Change
Adopting an Exercise Program
Stage 1: __________________________________________________
Feb. 10
Eric is the PTA and Personal Training Specialist in a private clinic that is located in the YMCA. One of Eric’s clients, Antoine, is being treated for chronic low back pain with acupuncture, manual therapy and ergonomic changes to his home office and a few basic back exercises. The physiotherapist feels Antoine’s pain would be better managed if Antoine started a general fitness program, including cardiovascular exercise, strength training and stretching, and lost some weight. The physiotherapist asks Eric to talk to Antoine about starting an exercise program.
Antoine is an engineer who starting his own consulting business five years ago. He has been gaining weight since then and his doctor has said that he needs to exercise more or he will become obese. Antoine is 62, a large man weighing around 200 pounds, who really doesn't want to be told that he needs to exercise for his health.
When Eric approaches Antoine about starting an exercise program, Antoine says, “No way, I can’t exercise with this back pain. I hate exercise anyway. You can’t tell me what to do.”
Eric assures Antoine that no one is going to force him to exercise, the choice is completely his. Eric says, “You know, I totally see where you’re coming from, I wouldn’t want to exercise either if I had pain like yours.” Eric then gives Antoine a booklet of information, which outlines the benefits of fitness programs for people with back pain, and says “If you have a minute, take a look at this, and if you have any other questions, let me know.”
Questions:
1. How would you describe Antoine’s attitude towards exercise?
As Antoine’s has chronic backpain he feels that his condition can become worse due to exercise.
2. What strategies does Eric use to work with Antoine?
Cardiovascular exercise, strength training and stretching, and suggestions to loose some weight.
3. Is there anything else you would have done at this stage?
Appropriate diet modulations and mindfulness practice.
Stage 2: _____________________________________________________
Feb. 12
Antoine goes home and throws the information Eric gave him on the coffee table in his living room. He forgets all about it. Two days later, his wife is cleaning the living room and finds the information. After reading it, she inte
upts Antoine in his study where he is working at his computer. “Honey, did you take a look at this?” She asks. “It says walking or swimming regularly could really help your back pain. You used to go swimming all the time.”
Antoine sighs and rolls his eyes, but his wife is persistent. Antoine promises to take a look at the information to get her off his back.
Later that night, Antoine reads the information on exercise and back pain. The booklet is easy to read, and Antoine is impressed that the references are from scientific journals. He starts to think that maybe swimming at the YMCA after his therapy sessions wouldn’t be so bad.
At his next physiotherapist appointment, Antoine says to Eric. “Hey, I read that stuff you gave me about exercise and back pain. It was good, but I’m still not sure I want to do it.”
Eric sits down with Antoine and gives him more details about the benefits of an overall fitness program. He gets Antoine to talk about his likes and dislikes with exercise. When Antoine admits he likes swimming, Eric lets him know that swimming is a great choice, and there are specific recommendations he could give Antoine about swimming with back pain. Eric also says there are other clients in the clinic who have tried swimming to manage their pain and offers to introduce Antoine to them if he’d like.
Antoine says he’ll think about it.
Questions:
1. How would you describe Antoine’s attitude towards exercise now?
Antoine feels that he shall be able to do swimming to manage his back pain as this has also been proven to benefit other clients of his physiotherapist.
2. What strategies does Eric use to work with Antoine?
Eric choses to inform Antoine that swimming has proved to benefit individuals with chronic back pain to encourage him further.
3. Is there anything else you would have done at this stage?
I might have showed him pamphlets as to how swimming and other exercises has proved to ensure health benefits in clients (Eg: weight changes).
Stage 3: ______________________________________________________________
Feb. 19
Antoine has a very busy week the following week. He finishes four projects and meets with several new clients. Just before a very important business meeting, his back pain flares up. He’d like to take the pain meds his doctor prescribed, but he knows they will make him drowsy. He applies a TENS unit to his back to control the pain. Half way through the meeting, the batteries run out. Antoine has a difficult time concentrating during the meeting.
“That’s it.” Antoine decides. “This can’t go on. If a swimming program will help, I’ve just got to make it a priority.”
He meets with Eric the next day. Antoine says, “I’d really like to start swimming again, but I’m so busy with my business, I don’t know how I’m going to fit it in.”
Eric suggests starting with short swimming sessions of 15 minutes each right after the physiotherapy appointment. Eric asks the physiotherapist to come over to talk about a swimming schedule, and the therapist agrees that at this stage in the rehabilitation program, a fitness program should take the priority. The physiotherapist says she will shorten the time she spends with Antoine so he can use some of his regularly scheduled therapy time for swimming.
Eric helps Antoine develop the following S.M.A.R.T. goal: To reduce my back pain at the end of the day from 4/10 to 3/10 by March 20, 2014 I will swim three times a week, Monday, Wednesday and Friday at 11:30 am for 15 minutes each time.
Eric talks to Antoine about what supports he thinks he will need to follow through on his action plan. Antoine replies, “I’ll tell my wife what I’m doing, she’ll nag me to make sure I go through with it.”
Eric then gives Antoine some specific guidelines for his swimming technique. He tells him to focus on side stroke and back stroke, to make sure he keeps his abdominal muscles engaged throughout the swimming session, and when doing the
eaststroke to use a snorkel so he can keep his face in the water rather than lifting his head to take a
eath.
Questions:
1. How would you describe Antoine’s attitude towards exercise now?
Antoine seems focused on his exercise regime. He also seems encouraged enough to complete his swimming lessons in a timely manner.
2. What strategies does Eric use to work with Antoine?
Eric gives Antoine a schedule for his swimming lessons.
3. Is there anything else you would have done at this stage?
No the schedule seems fine enough.
Stage 4: __________________________________________________________________
March. 3 and March 5
Antoine has been swimming regularly three times a week, but last Friday, he just didn’t feel up to it and skipped the session. When he comes to his physio session, Eric notices that Antoine looks discouraged. He asks Antoine about his swimming program. Antoine admits he missed a session on Friday.
Eric says, “Don’t beat yourself up over it, sometimes that’s going to happen. You’re actually doing really well. What’s important is that you don’t give up. Can you think of anything else we can put in place to keep you motivated?”
Antoine replies. “You know, I remember you said there were other clients who were swimming to deal with their pain. Maybe if I had someone else who would go with me, I’d stick to it.”
At the next therapy session, Eric introduces Antoine to John, a 65 year old business man with arthritis. John and Antoine hit it off, and agree to meet twice a week to go swimming together.
Questions:
1. How would you describe Antoine’s attitude towards exercise now?
Antoine seems doing well. He might be slight discouraged.
2. What strategies does Eric use to work with Antoine?
Eric say a few words to keep him motivated and introduces him to John so that they can go for swimming together.
3. Is there anything else you would have done at this stage?
The solution seems appropriate
Stage 5: _________________________________________________________________
March 20 to Sept. 18
Antoine has been swimming regularly both on his own and with his friend John. He’s been able to lengthen his sessions to 20 minutes. He finds that his back pain is now around 2/10 at the end of the day, which is his worst time of the day. The physiotherapist has cut back Antoine’s appointments from three times per week to once per week.
On March 20, Eric congratulates Antoine on his success a reviews the original S.M.A.R.T goal they had written together. “Look at that,” Eric says “You’ve not only met your goal, you’ve exceeded it. Let’s talk about where you want to go from here.”
Antoine says he’s been feeling so good, he’d like to add some strength training to his program and try to lose about ten pounds. Eric replies, “It’s great that you can feel the difference exercise is making. Keep focusing on how you feel to keep yourself motivated. Some of my clients, like John, keep a journal to keep track of their improvements. I’ll give you the same guidelines I gave John, and I’m sure he’d be happy to talk to you about it too. Now, let’s set a couple more S.M.A.R.T. goals, and get your new plan started.”
Antoine and Eric develop two more S.M.A.R.T goals, and Eric shows Antoine three strengthening exercises to add to his program, as well as some basic stretches he can do right in the pool.
Six months later, Antoine is still exercising on his own. He swims, but has also started using the elliptical trainer, the treadmill, and he even takes the occasional exercise class to keep from getting bored. His back pain is down to 1/10 at the end of the day most days. He’s lost twenty pounds and feels great. He doesn’t need to see the physiotherapist anymore, but he has hired Eric to review and revise his exercise program every couple of months. Antoine is so used to exercising now, that he sees it as just part of his daily routine. He finds exercising regularly helps him clear his mind so that he is more efficient at work. He still keeps in touch with his swimming buddy John, and they play golf together every couple of weeks.
Questions:
1. How would you describe Antoine’s attitude towards exercise now?
Antoine is quite motivated towards his goal. He exceeded his routine exercise schedule.
2. What strategies does Eric use to work with Antoine?
Eric is reviewing and recising his exercise schedule every couple of months.
3. What strategies does Antoine use to keep himself motivated?
They create S.M.A.R.T. goals and adds up 3 strengthening exercise to his routine. He makes sure Antoine’s informed about his progress to keep him motivated.
4. Is there anything else you would suggest at this stage?
No. Antoine seems motivated enough.
Stage 6: Relapse
Many people who make major lifestyle changes go through periods of relapse in which they abandon the changes they have made. This often occurs when the client has gone through some kind of life change that throws off their routine.
Imagine that you are Antoine’s personal trainer. He stopped working with you six months ago because his wife’s mother became ill and he had to help take care of her. He’s gained twenty pounds and his back pain has flared up again. He is discouraged and feels all of his hard work has been for nothing.
He walks into your office today. What would you say to him to encourage him? What would you do to help him get back into an exercise routine?
Ans: I would inform him the progress he made in his previous sessions so that he feels motivated and gains confidence enough to restart his regime again.
Health and wellness in rehabilitation
Two important concepts in physiotherapy and occupational therapy that have been addressed in previous courses are client-centred care and the impact of the determinants of health. In order to assist clients in making in making life changes in support of their health goals, PTA/OTA’s need to: a) consider the impact of the determinants of health on their clients’ wellbeing, and b) apply the principles of client-centred care. Work with a partner to answer the following questions:
1. List three determinants of health that have an impact on Antoine’s well-being (either in a positive of a negative way) and justify your answer.
Ans: Antoine’s condition of chronic back pain, motivation and mental state, and his partner’s/wife’s support
Antoine was suggested swimming to deal with his condition. As he was not feeling motivated enough he was shown proofs that how swimming has helped with people with chronic back pain in the past. His physiotherapist also introduces him to a client of his, John. After this it was noted that he doesn’t miss a class and feels motivated enough to exercise according to the given schedule.
2. What principles of client-centred care do Eric (the PTA/Personal Trainer), and the physiotherapist use to help provide Antoine with the support he needs to adopt a fitness program?
Eric makes a strict exercise and swimming schedule for Antoine, create S.M.A.R.T. goals and uses an evidence based approach by showing him how previously swimming his helped people loose weight as well as manage chronic back pain.
    
SMART GOALS:
· Making a strict exercise and swimming regime for Antoine, for an hour, thrice a week
· Adding few more exercises in his regime as he completes his cu
ent regime
· Reviewing Antoine’s monthly progress
Principles for Optimal Health:
Foundations of Professional Personal Training Chapter 2
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Learning Activity #6
Matching
Match the following Components of Fitness with the co
ect definition.
Primary Component of Fitness
Definition
1.
Cardiorespiratory capacity (aerobic capacity)
Includes muscular strength, muscular endurance and muscular powe
(5)
2. Balance
✓
The proportion of fat free mass to fat mass
(4)
3.
Flexibility
The range of movement a joint is capable of performing
(3)
4.
Body composition
The ability of the body to take in oxygen, deliver it to cells, and use it at the cellular level to create energy for activity
(1)
5.
Muscular Capacity
Time required to respond to a specific stimulus
(10)
6. Mental Capability
✓
The ability to concentrate during exercise
(6)
7.
Agility

✓
The ability to maintain a specific body position in either a stationary or dynamic situation
(2)
8.
Power (explosive strength)

✓
The ability to move rapidly
(9)
9.
Speed

✓
The product of strength and speed
(8)
10.
Reaction Time

✓
The ability to change direction quickly
(7)
In the question above, circle th
e primary components of fitness, and put a check mark next to the secondary components of fitness.
)
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Learning Activity #7
Your instructor will assign you and a partner or small group one of the above training principles.
In your group, find the definition of the principle in your text.
Write the principle and its definition here: Individualization:
Programs and modifications must be made to accommodate every person’s individual needs
Put this principle into your own words and come up with an example of how this principle applies in fitness or rehabilitation.
In individualization, training is adjusted for each client according to
characteristics and needs
of each client
, such as age, gender, rate of progress, and previous experience
s
.
Matching
Match the training principle with the co
ect definition.
Training Principle
Definition
1. Individualization
If clients want to improve a certain aspect of their performance, they have to train that aspect (7)
2. Structural Tolerance
People who are well-developed through all components of fitness are less likely to sustain injury and more likely to perform better in sport and in life (5)
3. Reversibility
Programs and modifications must be made to accommodate every person’s individual needs (1)
4. Specificity
The strengthening of tendons, ligaments etc. will result in the
ability to sustain subsequently greater stresses without injury (2)
5. All-around development
Once training ceases, the body will gradually return to pre-training state (4)
6. Maintenance
Prevents clients from hitting a plateau, or worse, getting injured. (3)
7. Progressive Overload
Once a level of fitness is achieved, less work is required to sustain it than it took to attain it. (6)
)
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Assignment
– Lab #1
Section A – Background Information
Client Name:
XYZ
_______________
Client Age:
30
Client Gender:
M
F
Client Cu
ent Work and work Ba
ckground: Research Analyst
_______________________________________________________________________________________________________________________________________________________________
______________
Section B
– Understanding your Client:
Have your client complete the “physical activity stages of change questionnaire” on
p. 14 in the textbook
. What is your client’s cu
ent stage? List the intervention strategies that will be appropriate according to your client’s cu
ent stage (refer to p. 13
).
Yes. The client is a committed exerciser and works out 4 times a week. Pre and post workout intervention is required for the client as client is a committed exerciser and chooses high intensity interval training and cardiovascular exercise rather than long stretches and yoga.
What is your client’s physical activity profile?
Non exerciser: No habitual exercise (sendentary)
Occasional exerciser: Minimal cu
ent exercise
Recreational exerciser: Suboptimal exercise frequency/ Intensity (sporadic exercise)
Committed exerciser: Regular moderate to vigorous activity
Dedicated exerciser or elite athlete: Regular vigorous activity
Use the “Activity Preferences Forms”
to interview your client regarding their activity preferences, special interests and expectations, and summarize the key points below.
In the Activity preferences form filled by the client he is a committed exerciser and prefers HIIT and cardiovascular exercise as compared to yoga and other forms of aerobic exercises. Client also prefers strength such as dumb bell workouts to increase muscle mass and has a preference to increase/maintain muscular strength and not reducing weight, maintain a healthy BMI <28, and healthy fat/muscle ratio. The client also has a diet preference and plans to incorporate diet planning along with exercise routine.
)
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Assignment LAB #1 CONTINUED
Using the SMART approach to goal setting, work with your client to list one short-term goal and one long term goal for your client. Use the spaces to list/describe each goal.
Short Term Goal:
S: Client wishes to gain weight from 65 kgs to 80 kgs within a time span of 5-6 months
M: Working out 3-4 days a week
A: Goal seems achievable if the schedule is followed
R: Goal is realistic; commitment required
T: Gaining 15 kgs in 6 months seems achievable
Long Term Goal:
S: Gain 15 kgs and increase muscular strength
M: strength training 1h
day, three times a week, cardio 45 min a day 4 times a week
A: achievable, client committed; diet modulations required
R: realistic, client committed
T: with total commitment goal achievable within 6 months

Examine the personali
ty styles descriptions on p. 21
. Based on your interaction with your client so far, how would you describe his/her personality? How will you adjust your approach to suit your client’s personality?
Ans: Client is linear built with an average built, less muscular mass and weighs 65 kgs. To increase muscular endurance and to build muscles heavy cardiovascular aerobic and strength exercise is required. A schedule was shaped as per client’s requirements to gain 15 kgs, increase muscle mass and maintain muscle mass. Diet modification was suggested as follows: intake of 1.6-1.7 gram
ody weight of protein (vegan), no ca
ohydrates, fat intake of 50 gm/day.
5. List three potential obstacles you will need to help your client overcome on his way to achieving his goals and how you will help him with each obstacle:
Ans:
A main obstacle as observed includes increasing weight but not fat and diet changes. Appropriate diet modulations are an absolute necessity. Another obstacle includes maintaining kidney functions and liver function. Client has a previous history of renal grafting and as lower kidney function and previous history of type 2 hepatitis. Third obstacle is to maintain high muscle mass alongwith maintaining kidney function due to previous medical history. Timely meals are recommended to reach the desired goals.
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Nutrition Concepts for Personal Trainers: Foundations of Professional Personal Training Chapter 2
Bioenergetics: Foundations of Professional Personal Training Chapter 3
· Adenosine - P ~ P ~ P
· Chemical compound used for energy
· Produced in the mitochondria of cells
· Four energy systems produce ATP
· Anaerobic
· ATP-CP phosphagen system
· Anaerobic Glycolytic (or lactic acid system)
· Aerobic metabolism
· Aerobic glycolytic system
· Fatty acid oxydation
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Learning Activity #8
Work with a partner. For each type of energy system, think of a physical activity that would rely heavily on that energy system. Then using Program Variables in Table 3.3.
(p. 57-58)
, discuss how you would set up an interval training program to help your client develop the energy system needed for that activity.
ATP-CP anaerobic: Strenght workout,
epeats of up to 10-15 seconds
, 2 min rest
w repeats
Anaerobic Glycolytic:
3 sets of 10 repetitions of any resistance exercise performed relatively slowly (5 seconds per rep) with 2.5 minutes rest between sets. (1:3 ratio)
Aerobic Glycolytic: 30-45 min aerobics or cardiovascular exercise
Fill in the blank
ATP is created in the
mitochondria
of cells.
The fatty acid oxidation system produces
at least

14
ATP
for every unit of fatty acid
.
The
a
erobic glycolytic system produces
38
ATP.
The ATP-CP system produces

2

ATP.
The
Anaerobic glycolytic

system produces 2 or 3 ATP.
The supply of __
ATPs
__ is the limiting factor of extremely long duration exercise.
Lactic acid is a by-product of the
anaerobic
glycolytic system.
Byproducts of the aerobic systems include
Co2
and
wate
_.
The ...