PA: Stress & Depression

WebMD reports that stressed employees generate 46% more healthcare costs annually, and depressed staff members cost 70% more to insure and care for than non-sufferers. The University of Maryland reports that in a study of more than 46,000 employees, stressed and depressed staff members generated 147% higher healthcare costs than their coworkers. A Thomas Reuters study revealed that depression sufferers were more than twice as likely to use short-term disability leave than their healthier counterparts. Corporate Wellness Today reports that severely depressed employees generated five times higher short-term disability costs. Worse, those figures don’t address the lost productivity and absenteeism that accompany depression.

In contrast, obesity, smoking, high blood pressure, and lack of exercise each only raise costs by 21% or less. It’s clear that traditional wellness programs don’t address the most important contributors to healthcare costs.

Physical activity and exercise can go a long way toward taking the edge off stress and anxiety and helping with relaxation. Regular aerobic exercise can exhilarate and relax, provide stimulation and calm, counter depression, and dissipate stress. It’s a common experience among endurance athletes and has been verified in clinical trials that have successfully used exercise to treat anxiety disorders and clinical depression.

Behavioral factors also contribute to the emotional benefits of exercise. As a waistline shrinks and strength and stamina increase, a person’s self-image can improve. Benefits also include a sense of mastery and control, of pride and self-confidence.

Beyond the aerobic walk, bike ride or run:

Yoga: Yoga is considered a mind-body type of complementary and alternative medicine practice. Yoga brings together physical and mental disciplines to achieve peacefulness of body and mind, helping you relax and manage stress and anxiety. The potential health benefits of yoga are numerous and may include:

  • Stress reduction. With its quiet, precise movements, yoga draws your focus away from your busy, chaotic day and toward calm as you move your body through poses that require balance and concentration.
  • Increased fitness. As you learn and refine new poses, you may enjoy improved balance, flexibility, range of motion and strength. And this means you’re less likely to injure yourself in other physical endeavors or in your daily activities.
  • Management of chronic health conditions. Yoga might help with a variety of health conditions, such as cancer, depression, pain, anxiety and insomnia, by helping with sleep problems, fatigue and mood. Yoga also can help reduce heart rate and blood pressure.

Pilates: Clients come into a Pilates studio seeking the numerous physical benefits that are associated with the method. What they might not realize at first is that the physical benefits of a consistent and meaningful Pilates practice can go well beyond external body aesthetics. Stress reduction is a profound benefit of a regular Pilates practice. Pilates helps to ease the effects of stress through the implementation of its central principles: breathing techniques, body awareness, relaxation, concentration, mindfulness, balance and harmony.

Many professionals in the health industry—both medical and fitness—work with patients and clients that often express frustration with symptoms such as fatigue, weight gain, muscle loss, weakness and depression. A high-stress lifestyle and an inability to self-manage stress is a major contributing factor to these symptoms. It isn’t easy for the medical professional to stay current on which PA programs might provide benefit for a patient. It’s even more difficult to separate the more qualified and specifically trained professionals in a community. That is what the PA Pharmacy is designed to accomplish.

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PA for Arthritis

For adults aged 50 to 64, PA recommendations are different than for younger or older populations.  When a chronic condition like arthritis become a part of the patient profile, the recommendations change.  According to ACSM and the AHA, PA guidelines for patients over the age of 65 and those aged 50-64 with arthritis, moderate aerobic exercise for 30 minutes per day done at least 5 days per week is ideal. Moving that aerobic exercise to vigorous is something that should be included for 20 minutes at least 3 times a week.

The Challenge: In our communities a solid 85% are identified as being the least active. This demographic often seeks medical help for conditions that can be improved or alleviated by following guidelines for recommended PA. The challenge begins with the behaviors, habits and daily choices this group makes – and usually continues to make. Those choices and habits do not include following recommended PA guidelines. Motivating patients to make such changes, to enroll in PA and to continue participation fir the long (for the forever) term – and even knowing what to prescribe and where to send them is a daunting challenge. The PA Pharmacy can help.

Prescriptions for Arthritis: If your arthritic patient is at risk of falling he/she will need balance exercise (and the motivation to comply, along with support for proper practice). A mix of 8-10 strength exercises is also recommended. There are plenty of online, subscription and tech-delivered programs that provided well-tested and accurate information on what and how your patient should practice strength exercises.  The challenge is: the “least active” populations are least-likely to comply over time. That goes back to the challenge. Why prescribe the “exercise medicine” is, even when a patient “purchases” it he/she will not comply with the prescription or follow-up.

Social network and professional partners: The PA Pharmacy adds some important pieces to a PA Prescription the healthcare provider might write.  On site at the wellness destination is engagement-validation and administration software that engages the patient while communicating and connecting with wellness stakeholders,  The program and the wellness delivery professional are part of the prescription equation.  Options for including friends and family – the patient’s social network – to the mix is a crucial piece for long term compliance and behavior change.

Not only can the healthcare provider find “arthritis-specific” aerobic, strength and balance exercise programs available locally, they can be assured that option in the PA Pharmacy resource database provide the very important complementary added components of engagement, validation and administration.

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Power of Prescription Pads

According to a paper published in the Annals of Internal Medicine, 92 percent of patients agreed or strongly agreed with the statement: “If my doctor advised me to exercise, I would follow his or her advice.” What’s more, a public opinion survey conducted by the American College of Sports Medicine (ACSM) found that nearly two-thirds of patients (65%) would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

As a physician or other healthcare provider, you know better than anyone else how challenging it is to stay current on every aspect of your diverse roles.  We can provide a valuable resource in the form of top-quality reviews and resources around exercise programs you can feel confident prescribing.

You have access to people when they are most focused on their health and when they are most receptive to receiving information and messages about their health. This is a highly privileged and decisive point of access. With it comes an opportunity to encourage healthy behavior changes that will improve their well-being.

Physical activity practiced by a patient can be noted as a “vital sign” and we can establish physical inactivity as a treatable and preventable condition with profound health implications.  With the proper resource and support, you can play a tremendous role in changing the sedentary nature of current American culture.

In a country where nearly 40 percent of its adults spend the majority of the day sitting, together, we can promote prevention and champion exercise as a key component to staying well. The prescription pad is the ideal place to start.

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The PA Pharmacy Process

hysical Activity (PA) prescription cannot be dispensed lightly – no more lightly than prescribing conventional medication. Unless the “medicine” is developed by quality standards and manufactured/delivered in an approved, certified or consistent manner it should probably not be prescribed.  There are a number of national certifying groups for well-researched, tested and approved PA programs and professionals who deliver those programs.  From well-known and licensed programming to the high quality options many local professionals are providing, the PA Pharmacy can be a trusted database developed with hyper-local information.

The Process:   Healthcare and medical professional specialists in any geographic location need to know what physical activity programs are available and relevant to their patients.  Quality of both the program and the fitness/wellness professional delivering the program is equally important.

Team PPAL: The PA Pharmacy can provide a searchable database that lists the specially trained “Prescribed Physical Activity Leaders” (PPAL) teams local to your community.  Not only will locally available PA programming be analyzed for its relevance for the online PA Pharmacy resource, but the qualifications of the instructor, costs of the club or class, contact info and mapped location will be also be online.  In addition, an overview of the ideal target population for the class will be detailed at “PAPP Participant Info”  That area will be useful for both the patient/participant and the prescribing physician – employer or individual, if self-prescribed.

This online “Physical Activity Prescription Program (PAPP) Information and Access Resource,” the PA Pharmacy, will not be developed quickly.  A well-tested process must be developed.  The need is great, in local communities across the country.  It is important to have the PA Pharmacy as a model. As part of the PA Pharmacy pilot taking place in Central Oregon over the next 6-9 months, we will work closely with specially trained and certified local fitness professionals, host locations that provide physical activity programming that meets a quantified set of minimum standards.

The PA Pharmacy is neither a certification, certificate or accreditation organization. We include nationally recognized certificate and certifications, listing those that have been acquired by listed fitness/wellness professionals.  Aggregated and local information that is easy accessible and searchable is the key driver of the PA Pharmacy.

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The 65% Bucket

Preventive healthcare is inevitable!

With about 20% of the population in most communities  suffering from chronic (and expensive) conditions, lowering healthcare costs while improving productivity and quality of life is imperative. The “fit” 15% in most communities cannot drive a wellness culture change.  If we are to keep the “least active 65% from sliding into the “chronic conditions” bucket, one of the best preventive strategies is to prescribe a regular exercise regimen. (Research data: For more info, click here)
Prevention via wellness participation and population/need-specific programs is only as good as the local access and options – and awareness of that accessibility.
For those of you prescribing or delivering physical activity or wellness programming, you already believe that “participation in physical activity powers prevention”.
Imagine Allen, a de-conditioned 57 year old with some knee injuries that seem to be opening the door to arthritis and overweight due to a sedentary lifestyle. Allen does not want to move into the “chronic condition 20%” bucket, but research shows that he probably will.  Unless Allen can begin a specific PA program that is effective and enjoyable, long-term change is not likely to occur.
  1. The jump-start: A specific PA prescription
  2. To a trusted destination/program led by a qualified professional
  3. The fitness or wellness professional wants to work with clients like Allen (specific age bands, diseases, conditions or needs)
  4. Connection to the program is easy for the patient
  5. Communication and validation of the physical activity compliance is seamlessly delivered to the medical professionals (EMR/PHR)
  6. Outcomes from the PA participation are quantified and aggregated for reference by select providers and others
  7. Allen, the the “least active” like him enjoy a well-designed engagement experience that allows reflection, personalization and connection to their social network
Participation in physical activity is the first step toward a wellness lifestyle – and healthcare savings. It is neither simple or easy.
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Central Oregon Pilot

In June 1, 2011, the Physical Activity Pharmacy pilot program was begun in Central Oregon.  We are refining the processes and systems that will identify and qualify locally available Physical Activity Prescription Programs (PAPP) that are delivered by fitness and wellness professionals with advanced training and specific certification in some or all of the following areas:

  • At least one certification in fitness personal training, health fitness, or medical fitness by a nationally recognized accrediting body
  • Specific health, condition and age-band certification and certificate training recognized by national accreditation groups
  • Senior Fitness certification
  • Balance, Diabetes, Arthritis, and more
  • De-conditioned clients across all age-bands
  • Post-rehab and PT clientsFor fitness professionals and destinations, the ability to connect with the medical community is valuable:
    • Providing valuable “exercise as medicine” options
    • Gaining referrals and building relationships with wellness partners

Local healthcare providers wishing to prescribe specific PAPP (or “exercise meds,” as we call them) to their patients will be able to access the online P A Pharmacy database according to relevant categories. For instance, searching for “age 63, arthritic knees, Diabetes Type 2” will return a variety of programs that deliver options, access and enrollment locally at a wide range of:

  • Destinations (public or private fitness/wellness destinations where PROGRAMS/PAPP can be found)
  • Group, circuit and self-directed/guided PAPP
  • Employer programs
  • Self-directed activities validated via online and mobile apps
  • Local training opportunities for events and activities appropriate to age and condition

Engagement for long term participation in the PAPP options will be provided at destinations that are subscribed to the PA Pharmacy services.  Connecting an individual’s social network, motivation/incentive options and technology-rich tools is more than any one fitness professional or destination can afford.  Our network of partners consolidates everything for successful outcomes under one subscription model.

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Exercise as Medicine

Exercise is Medicine:  Health insurers and physicians know that regular and consistent exercise is the most effective way to reduce healthcare costs while improving patient quality of life.  Exercise is the one thing almost anyone can do every day to increase wellness and health, fight depression, relieve stress and improve the overall quality of life. For the least active (85% or more in almost every community) the connection to participation is specific prescription from a healthcare provider.

The general prescription: Just thirty minutes of healthy exercise a day can help prevent and treat a wide range of health problems. The problem: The least active , and most costly patients, in a community know this but the general advice is not enough to effect behavior and habit change.

Why do we need the PA Pharmacy?  Physicians do not have the time or access to information about locally available and specific exercise programs, professionals and where to send patients.

There has to be a way for the prescribing healthcare professional to understand the locally available and relevant “physical activity program products” – what they do, who delivers them, qualifications of the destination, fitness/wellness professional, and both what the “drug/PA program” does and the counter-indications.

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Active Wellness Engagement

Do you care about the quality of life, productivity, economic and healthcare impact of the world’s collective sedentary habits? Do you believe that engaging the least active populations in more physical activity makes good sense?  The actual process of engaging the 85% who do not choose to be physically active for the long term is another challenge altogether.

Many passionate and dedicated leaders in the health, wellness, technology, gamification and other verticals have invested energy and ideas toward increasing engagement in physical activity.

The most accurate discovery is that there is no single answer or solution to the challenge.  Yet, when we take a look at the challenge from the social network/social graph perspective some opportunities arise.  Through my work developing programs and processes around physical activity participation across many age bands and communities for the past several decades, I have been hit hard with the “engagement” challenge.  Over time, a route to a different focus and strategy finally became clear.

We often work at developing programs, motivation, rewards, gamification and incentives around “engaging the least active in physical activity participation.”  That strategy approaches the challenge from a “push” direction. For many “least active” it is opposite to what is most compelling to our target population.

At first glance it seems to make absolute sense to begin an exercise habit with “engagement” and the intent for connecting it to “physical activity” carried out by the individual.  Without a very deep understanding of what they choose to do with time, leisure, family and friends participation is much more temporary than “wellness” requiresActive Wellness Engagement (AWE) is designed to connect our interventions to the very empowering and engaging behavior opportunities that the greatest percentage of a population really seeks.

If long term participation, compliance with a prescription for PA and behavior change are important to you, please explore  AWE: Active Wellness Engagement. Hopefully, we can change lives and have fun in the process –

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Vision: The PA (Physical Activity) Pharmacy will be a local-to-community resource of physical activity programming specific to age band, disease state and/or conditions.

Imagine: The patient, an individual that does not currently participate in adequate physical activity for age, current condition or disease state, visits his/her physician – a specialist or primary care provider.  Most healthcare providers realize that a program of physical activity participation could help their patients while reducing insurance and other costs. Still, many physicians are at a loss when it comes to prescribing a specific regimen or program.

    • The details about medicines and prescription drugs available for specific patients needs is well-documented and those remedies are easy to prescribe
    • The details about age band or condition specific physical activity programs are not as readily available
    • The details about where a physician can prescribe a patient to go for the best programs and the most effective and qualified fitness/wellness professionals are not so readily available.
    • Confidence that a prescription for a specific physical activity program will be delivered appropriately is a concern
    • Validation of compliance and quantified outcome measures from the physical active are not consistently available.

Often, the default “more activity” or “walk when you can, maybe 30 minutes a few times a week” is the advice given.  We are becoming more well aware that physicians may enable inactive patients to increase their physical activity levels, producing significant results at population level  when specific physical activity is prescribed.

Time and again research proves that the prescription of a physical activity plan specifying the frequency, intensity, duration and progression over time delivers the most long term adherence and successful outcomes.  Physicians simply don’t have the access to appropriate resources to prescribe such programs – that is why we developed the Physical Activity Prescription PROGRAM resource. (PAPP)

Local and specially trained fitness/wellness professionals can provide a careful and independent review and assessment of Physical Activity Intervention Programming in any community.  If you currently are a wellness program host location, a fitness or wellness professional with specific training or have developed a program that could be prescribed, we want to hear from you.  The more resources we can provide within any community, the better that community will become in the process of creating a culture of wellness.  Local healthcare providers, employers, insurers and individuals need to have access to “the best in wellness programming” relevant to their needs.

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First Step vs Obesity

First Step vs Obesity

What if you took a “weight loss: pill and didn’t lose weight?

Can you “blame the doctors” if you, as a patient, aren’t losing weight?

According to Dr. Cynthia Ferrier, an internist at GreenField Health in Portland, OR, more than half of her patients are overweight or obese.  Ferrier says she spends a lot of time talking with them about their weight. Most are pretty savvy, she says — they know that high-fat, high-carb diets aren’t healthy.

Ferrier says there are a number of practical reasons why doctors don’t talk with patients about weight. With an average of eight minutes per office visit, many just don’t have time. And until recently, doctors weren’t reimbursed for weight counseling, only for treating conditions like diabetes and high blood pressure that result from being overweight.

And because doctors aren’t taught about obesity in medical school, many feel unprepared to bring up the sensitive topic. And with good reason, says Ferrier.

“I have had patients tell me that they have cancelled appointments with me because they have not lost enough weight,” Ferrier says. “So, I do have to be careful about how strongly I word recommendations so it doesn’t scare them off.”

Here at PA Pharmacy we talk to many physicians who subscribe to the philosophy and efforts of Exercise is Medicine (EIM). They agree that for many patients, the motivation they need is straight talk about the health risks they face from being obese.  On the other hand, weight loss may not be the first step toward wellness and prevention of the very chronic conditions that reduce quality of life while increasing the costs of healthcare. The EIM physicians and many other medical specialists realize that regular and long term behavior change that includes participation in an effective exercise program is the first step toward wellness.

For patients whose blood sugar goes up every year one day it will be near pre-diabetic range, then it is likely they will be diabetic. We are all aware of the  severe and costly complications around a Type 2 Diabetes condition. While that should, and could, be motivation enough, for the complex nature of human behavior it simply is not enough.  Physicians and patients need a turn-key network of resources and tools that can create a path toward prevention and wellness.  The PA Pharmacy can provide those tools.

Many doctors agree: This type of clear and direct approach may be exactly the prescription needed to begin to turn the tide in the battle against obesity.

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