HEART WISE EXERCISE Heart Wise Exercise A model

HEART WISE EXERCISE Heart Wise Exercise: A model for community exercise Jennifer Harris, Physiotherapist University of Ottawa Heart Institute

AGENDA 1 Background: Why ? 2 HWE Program : What is it? 3 Evolution/Evaluation : Who is it for? Does it work? 4 Implementation: How to access and/or how to deliver

Why? Source: Public Health Agency of Canada, using data the Economic Burden of Illness in Canada 2000. from

EXERCISE IS MEDICINE “ What if there was one prescription that could prevent and treat dozens of diseases, such as diabetes, hypertension and obesity? ” - Robert E. Sallis, M. D. , M. P. H. , FACSM, Exercise is Medicine™ Task Force Chairman

World Health Organization Policy makers and providers could promote physical activity by “providing exercise programs to address cardiorespiratory fitness, muscle strength and balance…particularly for the oldest old people and people recovering from acute health events. “ - World Health Organisation's 2015 World Report on Active Ageing and Health

Reflection • What types of patients/conditions come to mind when thinking about the need for ongoing community exercise programs. • What, if any, are some of the barriers to transition to community exercise settings for your patients and clients? • What, if any, are barriers for potential clients accessing your community exercise program? • What are some of the benefits you have seen or would expect to see from community exercise programs?

Why? Exercise: Powerful Prevention and Self Management Strategy • Exercise lowers risk for chronic conditions • Promotes self management strategies • Improves quality of life and independence • Social benefits!

Why? • Why we started Heart Wise Exercise

How? 2007 UNIVERSITY OF OTTAWA HEART INSTITUTE SURGERY CARDIAC REHAB 12 -WEEK PROGRAM EXERCISE IN COMMUNITY (HWE)

PURPOSE OF HWE • To identify exercise programs that allow our clients to feel comfortable exercising in their community • To share best practices • To facilitate transition from patients to clients to lifetime community exercisers • To promote selfmanagement • To develop strong community network

Heart Wise Exercise • • • Mission: The Heart Wise Exercise Program is a Canada-wide networkthat of HWE designated programs Identifies exercise programs allow clients to feel developed by comfortable the University of Ottawa Heart exercising in their community Institute. The network consists of a variety of Shares best practice knowledge community partners who provide safe, affordable, Facilitates transition from effective andtocommunity-based exercise programs patients to clients lifetime community exercisers for those wanting to prevent or manage their Promotes chronicself-management health condition such as heart disease, Develops strong community diabetes, stroke, cancer or respiratory disease. network

6 CRITERIA OF HWE • Hallmark of HWE • They allow us to IDENTIFY safe and appropriate exercise programs • Each program must meet these 6 criteria in order to be a designated HWE facility • The criteria are for the PARTICIPANT

6 CRITERIA OF HWE 1. Encourages daily, regular aerobic exercise

6 CRITERIA OF HWE 1. Encourages daily, regular aerobic exercise 2. Encourages and incorporates warm up, cool down and selfmonitoring with all exercise sessions

6 CRITERIA OF HWE 1. Encourages daily, regular aerobic exercise 2. Encourages and incorporates warm up, cool down and selfmonitoring with all exercise sessions 3. Allows participants to exercise at a safe level and offers options to modify intensity

6 CRITERIA OF HWE 4. Includes participants with chronic health conditions (physician approval may be required)

6 CRITERIA OF HWE 4. Includes participants with chronic health conditions (physician approval may be required) 5. Offers health screening for all participants

6 CRITERIA OF HWE 4. Includes participants with chronic health conditions (physician approval may be required) 5. Offers health screening for all participants 6. Has a documented emergency plan that is known to ALL exercise leaders, including the requirement of current CPR certification, phone access to local paramedic services and presence of an AED

6 CRITERIA OF HWE 1. Encourages daily, regular aerobic exercise 2. Encourages and incorporates warm up, cool down and self-monitoring with all exercise sessions 3. Allows participants to exercise at a safe level and offers options to modify intensity 4. Includes participants with chronic health conditions (physician approval may be required) 5. Offers health screening for all participants 6. Has a documented emergency plan that is known to ALL exercise leaders, including the requirement of current CPR certification, phone access to local paramedic services and presence of an AED

HWE Terms and Conditions • Meet the Criteria • Approved use of logo and appropriate explanation • Provide information about programs (for communicating to patients/clients) • Participate in quality control (audits and peer awareness) • Insurance • Waive liability • Renew q 2 years • Staff are trained

Sharing Best Practice: HWE Training Program

Heart Wise Exercise Training Program

Strong Community Network The HWE Network creates a relationship between the health care system and the fitness provider community. • Topics covered by HWE Training Program include: exercise with cardiac disease, COPD, diabetes, stroke, osteoporosis, early dementia and air quality. We are working on building modules related to OA and self-management. • The goal is to increase awareness of community fitness programs among health care providers in order to facilitate transition of patients from health care settings into participants in community fitness programs.

Community Connections

HWE REACH Number of communities served by HWE Sites Number of Regional Coordinating Centres Number of persons trained in HWE Training Program Number of free HWE programs >84 7 >2005 >50

HWE REACH: Regional Coordinating Centre

Does HWE work? HWE evaluation published in 2016: BMC Public Health • Based on surveys, the average was 60 years old, ranging up to 86, 86% female • Survey results confirmed that Heart Wise Exercise participants are highly satisfied with the program. • HWE sessions, with only a few exceptions, were found to me meet the six HWE criteria (evaluated using in-person audits) • HWE programs were found to be reaching the core user group of persons with chronic health conditions and/or with risk factors for heart disease. • Fitness Leader surveys indicated that they are confident and knowledgeable instructors in the area of exercise in chronic disease.

Mean Fitness Leader Satisfaction What do fitness leaders say? 5 4 3. 5 3 2. 5 2 1. 5 1 1. Knowledge 2. Confidence in 3. Comfort with 4. Confidence to about chronic having clients in redirect to conditions and ex class services 5. Value of training 6. Confidence to 7. Confidence to 8. Comfort with offer options encourage selfscreening monitor Heart Wise Exercise. Program Goals

Mean Exercise Participant Satisfaction What do participants say? 5 4 3 2 1 Location Program date & time Leader's knowledge of disease Leader's knowledge of exercise Exercise intensity Cost Heart Wise Exercise Program Element Social aspect

Age Total N=106 • Mean Age= 74. 5 Std. deviation = 7. 64 • Mean Age Male = 76. 0 • Mean Age Female = 74. 1 Gender

Frequency of Conditions NON-HWE Overall Heart disease 20. 9% 10. 3% 17. 0% Stroke 4. 5% 8. 3% 5. 7% Diabetes/pre-diabetes 16. 4% 8. 3% 13. 2% Lung disease 4. 5% 5. 1% 4. 7% Osteoporosis/osteopenia 36. 6% 35. 9% 35. 8% Arthritis 50. 7% 51. 3% 50. 9% Mental health condition 7. 6% 5. 1% 6. 6% Multiple Sclerosis 1. 5% 0% 0. 9% Traumatic brain/spinal chord injury 1. 5% 0% 0. 9% Parkinson’s 0% 0% 0% Alzheimer's 1. 5% 0% 0. 9% High blood pressure 43. 3% 35. 9% 40. 6% High cholesterol 29. 9% 20. 5% 26. 4% Overweight 28. 3% 33. 3% 26. 4% Orthopedic disorder 9. 8% 15. 4% 11. 3% Cancer 3. 1% 5. 1% 3. 8% Endocrine disorder 1. 5% 10. 3% 4. 7% Respiratory condition 1. 5% 7. 7% 3. 8% Cardiac disorder 1. 5% 2. 6% 1. 9% Gastrointestinal disorder 3. 1% 7. 7% 4. 7%

Number of Conditions Non-of Conditions HWE Overall Number HWE 1 condition 1 17. 9% condition 2+ conditions 2+ 77. 6% conditions 3+ 44. 8% conditions 4+ conditions 16. 1% 12. 8% 16. 1% 77. 4% 76. 9% 77. 4% 48. 1% 53. 8% 48. 1% 4+ 29. 8% conditions 30. 8% 30. 2%

Travel Time • Mean travel time = 14. 15 minutes Awareness • 35. 9% of HWE participants were unaware that they were a ‘Heart Wise Exercise’ class Walking Impairment Non-HWE Overall YES 24. 2% 23. 7% 24. 0% NO 75. 8% 76. 3% 76. 0%

What does it all cost? • 2007 -2015: $522, 560. 00 Total Grant Funding (Provincial grants) • Starting in 2014, the HWE Training Modules have helped to generate “sustainability” revenue • HWE Training Program: $99 (Renewal $35) • HWE Designation: $100/2 years (discount rate for multiple sites) • Volunteer teaching a free program: $0 • HWE Designation for volunteer run free programs: $0 • RCCs: Receive 75% of $ earned to support local initiative

Implementation: How to access • Are there Heart Wise Exercise programs in my community? • Heartwise. ottawaheart. ca • How do I refer to HWE programs? • No referral required • Prescription pads are a favourite (sample)

Implementation • Are there Heart Wise Exercise programs in my community?

Implementation

Who needs a logo? • Does a class need to have a formal endorsement for me to feel comfortable referring to it? -appropriate exercise classes are client specific -pretty much any exercise class/setting can work -endorsements/logos especially help those who need that extra facilitation Now watch this video from the perspective of a participant attending a class similar to yours.

FREQUENTLY ASKED QUESTIONS • Now that I have been to a workshop, can I teach Heart Wise Exercise classes?

FREQUENTLY ASKED QUESTIONS • Now that I have been to a workshop, can I teach Heart Wise Exercise classes? This workshop is not a certification, but intended merely to provide fitness professionals with some tools to be confident in having people with cardiac conditions in their classes – people who have attended the workshop, however, are ideal candidates for teaching Heart Wise Exercise classes.

FREQUENTLY ASKED QUESTIONS • How can I get my program to have the Heart Wise Exercise logo?

FREQUENTLY ASKED QUESTIONS • How can I get my program to have the Heart Wise Exercise logo? If you think your program meets all the Heart Wise Exercise criteria, you would email heartwise@ottawaheart. ca.

FREQUENTLY ASKED QUESTIONS • Are all Heart Wise Exercise programs group fitness?

FREQUENTLY ASKED QUESTIONS • Are all Heart Wise Exercise programs group fitness? No. At some of the Heart Wise Exercise facilities there may be specific staff/personal trainers that can assist people in performing individualized exercise programs in their gyms.