Lifestyle Prescription for Dangerous Dan Kerry Ann Deanna

Lifestyle Prescription for Dangerous Dan Kerry Ann, Deanna, Renee, Emily 11/24/2020

Dan’s Health Objectives Increase Overall Physical Health Status £Reduce Coronary Heart Disease Risk Factors £Change Nutritional Habits £Rehabilitate Old Injuries £Increase Physical Activity £Decrease Smoking 11/24/2020 1

Behavioural Prescription Choices l Smoking cessation followed theory of reasoned action as motivation 2 Ways: * Smoking causes Emily’s asthma to worsen - if I smoke I make my daughter sick * Smoking increases my chance of getting coronary heart disease if I smoke I might die like other relatives l l l The theory of planned behavior will model how he achieves this goal Increasing physical activity followed the self-efficacy theory * Dan’s behavioral expectations suggest that he can put his mind to it and become active like he was in college because Dan has a love of recreational activities Changes in nutritional habits also followed theory of reasoned action * Coronary risk factors can be caused by eating fatty foods - my cholesterol is high because I eat a poor diet, I am overweight because I eat too much 11/24/2020

Previously Completed Components Initial interviews provided: Dan’s overall objectives Par Q Med X l 11/24/2020 We are presenting session 3 of 4

To Increase Dan’s Physical Health Status We Will Look At: Nutrition Rehabilitation Physical Activity Smoking Cessation 11/24/2020

Coronary Heart Disease Risk Factors Smoking Diets Rich in Saturated Fats Physical Inactivity Stress A Family History of Heart Disease ½ Package Daily Self Admitted Doesn’t Consider 5 male relatives affected Over ideal weight 165 lbs Being Overweight Also Medical Conditions, such as: High Blood Pressure High Blood Cholesterol (LDL) Obesity Diabetes 11/24/2020 130/94= borderline hypertensive Physician Assessed= Borderline BMI= 34. 3 1 st Class Obesity N/A

Nutritional Prescription l Examine Dan’s Food Diary Change types of food and portion sizes to fit with Canada’s Food Guide for Healthy Eating 11/24/2020

Dan’s Daily Intake Log breakfast Snack lunch snack super snack Day 1 3 eggs, 4 slices of greasy bacon, 2 slices of white bread with butter and jam, 2 glasses of fruit punch drink 3 cooki es Can of coke 1 apple, 1 chocola te chip granola bars Mc. Donald’s double cheese burger, fries, and medium coke, donut with frosting 1 cup of coffee with cream and sugar, 2 cookies 1 large T-bone steak with BBQ sauce and seasoning, 6 grilled mushrooms in butter, 2/3 cup of whipped potatoes with salt and pepper and butter, large slice of chocolate cake with frosting, 1 glass of red wine 2 cups of seasoned popcorn with extra butter, water Day 2 1 large bowl of honey nut cheerios with 2% milk, 2 slices of white toast with butter and jam 1 bottle of Fruito pia juice nothing Subway 12” cold cut sandwich with mayo, sub sauce, tomatoes, onions, peppers, lettuce, extra cheese, a cookie, and medium Nestea 1 apple 1 cup of Caesar salad with extra dressing, bacon bits, and cheese, 1 med. pork chop with a cream sauce, ¼ cup of cooked broccoli smothered in melted cheese, 1 large baked potato with 3 tbsp of full fat sour cream, banana split dessert with 3 balls of French vanilla ice cream, peanuts, caramel sauce, and 2 cherries, 1 glass of red wine, water nothing 11/24/2020

Suggested Intake Log - 2 Day example breakfast snack lunch snack super Day 1 ¾ cup of oatmeal with ½ cup skim milk and tsp sugar, 250 ml of orange juice 1 yogurt cup, water Garden salad with pieces of cold roasted chicken breast, 1 tbsp salad dressing, a piece of fruit, 500 ml of skim milk, water 1 cup of coffee with skim milk and no sugar, 1 raison bran muffin ½ medium t-bone steak cooked on BBQ, ½ cup of steamed green beans with butter, 1 cup of steamed rice with soy sauce, ½ cup of red wine, banana muffin Day 2 Toasted whole wheat bagel with butter, 1 cup of fruit salad, 250 ml of skim milk water Roast beef whole wheat pita with lettuce, tomatoes, and cheese, 10 carrot celery sticks, yogurt, 250 ml grape juice, water 1/3 cup of trail mixed nuts, water Lasagna (lean ground beef seasoned with herbs only, light mozzarella cheese), garden salad with dressing, fruit smoothie (frozen fruits, water, skim milk) 11/24/2020

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Workplace Applications l Pack meals to re-heat at the office or pack a brown bag meal i. e. sandwich/pita, fruit/fruit salad, yogurt, salad, vegetables, juice, water l Snacks should consist of healthy choices also i. e. fruit, trail mix, yogurt, vegetables, etc l Always have a bottle of water to drink to replace eating unneeded snacks 11/24/2020

Tips and Tricks to Stay on Track l Modify preparation methods in meals l i. e. more vinegar sauces and herbs instead of creamy sauces with many preservatives and salt l Follow serving and portion sizes recommended by the Canadian Food Guide l When a craving arrives wait 20 minutes: l l If craving does not go away then have a serving of a healthy snack Or if just ate then have a drink water l Stop eating after super l Have three balanced meals a day, with a snack in between l Drink as much water as you want 11/24/2020

Relapse Concerns l The occasional fatty/salty foods are acceptable l Make up for the unhealthy foods in the next meal For Example If you have a hamburger and fries, then the next meal have a salad with chicken and a vinegar dressing, or a stir fry with lean steak and rice. l This is a lifestyle choice for heart health so it’s important he attempt to stick with the plan 11/24/2020

Rehabilitation Prescription • Shoulder ROM Exercises for Rotator Cuff Injury • Core Strengthening Exercises to Decrease Back Pain • Foot Pronation Referral 11/24/2020

Range of Motion Exercises for Shoulder 11/24/2020

Low Back Flexibility Exercises 11/24/2020

Core Strengthening Exercises 11/24/2020

Referrals Pedorthist for orthotics to correct right foot pronation and gait variation This may also positively affect the referred pain in his right hip 11/24/2020

Physical Activity Prescription GOAL accumulate 60 minutes of physical activities EVERY DAY! Time needed depends on effort – as you progress to moderate activities you can cut down to 30 minutes 4 times weekly Canada’s Guide to Physical Activity Put on fridge as a constant reminder of tips! 11/24/2020 5

Help Build Physical Activity Into Your Routines At Work l Leave the car in a parking lot 10 minutes from work and walk the rest l of the way If your job involves a lot of driving, plan several short stops in your day. Get out of the car and walk for 10 minutes or more wherever l l l you can Take stretch breaks during meetings Have a "walking" meeting - grab your colleague and discuss business while taking a walk. Take the stairs. Pretend the elevator is out of service. Contract your stomach and back muscles while sitting in your chair Take a brisk walk before lunch for about 10 minutes Roll your shoulders and stretch your neck when sitting in front of the computer. 11/24/2020

At Home & On the Weekend l l l Create a new morning routine. Start your day with 10 minutes of movement some stretching can really help your morning back pain! Park the car 10 minutes away from the store you are going to. Trade in your power mower for a push mower. Make a personal or family commitment to try a new activity each season: snowshoe, curl, hike, bike, dance, bowl, fish, camp, ice-skate, ski, swim, in-line skate, walk, run, skip rope, play tag with your kids, or play ball in the park. Get in the garden and dig, prune, rake and weed Play catch or fly a kite with your kids 11/24/2020

Specific Recommendations • • • On fishing trips; try fly fishing and off shore casting for increased activity. Hike into the location of the river/lake Continue golfing! But walk the course (excellent exercise!) Low Impact Family Exercises: Swimming Walking Cycling Plan activities into weekly routine (every week) with family will help increase fitness level of whole family… prevent children for being high risk for coronary disease and help with Emily’s Asthma. 11/24/2020

To Stay Motivated and Keep Track Log book for each day’s accumulated amount of physical activity Fill in: * Type of activity * Duration Help to identify weather daily objectives are being met. Also will assess progress and identify if changes to program need to be made. 11/24/2020

Example Log Book: Time of Day 8: 30 am Activity Duration Shoulder ex’s 8 min 8: 40 am Back stretches 7 min 10: 30 am Core strengthening Walking around job site 8 min 2: 30 pm Shoulder ex’s 8 min 7: 30 pm Family cycle 25 min 1: 30 pm 10 min Total Exercise Accumulation For the Day: 66 minutes 11/24/2020

Smoking Cessation Prescription Dan had in Session 1 Agreed to stop smoking as well as recorded smoking habits 6 11/24/2020

Typical day of smoking for Dan (previously self recorded) Smokes half pack a day – 10 cigarettes -right after eating breakfast -on the drive to work -constant smoke breaks throughout the day -after eating lunch -on drive home from work -after eating dinner -smokes a couple while watching TV before bed 11/24/2020

Goals for Cessation of Dan’s smoking habit Short term – effective immediately: NO more smoking in the house, detrimental to children and wife, especially Emily since she is asthmatic Long term - gradually reduce the amount of cigarettes smoked daily over a 6 week period until eventually stop smoking completely 11/24/2020

6 week Smoking cessation program Week 1 -No smoking allowed in the house or around children, second hand smoke detrimental to their health -Smoke outdoors only Week 2 -cut out smoking after meals -instead of smoking after meals chew on sugarless gum or nicoderm Week 3 -down to approx 6 cigarettes daily, cut out 2 more Week 4 -cut out 2 more cigarettes -keep busy during times where you would usually smoke Week 5 -down to approx 2 cigarettes daily -continue to chew gum whenever craving should arise Week 6 -No more smoking! Throw out all cigarettes and ashtrays -whenever feel like lighting up think of consequences on health and the effect of second hand smoke on family -if extra help needed then refer to pharmacologist for nicotine supplements 11/24/2020

Tips to be Successful in Following Prescription: l l l l Stop smoking indoors immediately Dispose of all ashtrays, lighters and cigarettes Try to be busy at times when you would ordinarily light up Try to increase time spent with nonsmokers Get teeth cleaned to remove any tobacco residue and stains Put money that would usually be spent on cigarettes in a jar and save up for a family trip or a fishing/golfing trip Avoid smokers on breaks, situations where around cigarette smoke Keep busy to reduce concentration on cravings 11/24/2020

Stress Management l l l Try to avoid stressful situations Engage in stress reduction strategies such as deep breathing and muscle relaxation Avoid undertaking any stressful loads within first few weeks Referrals l l Pharmacologist for nicotine patch if needed Psychoeducation interventions can also be used along with counseling - secondary approach 11/24/2020

Relapse Techniques l l l Understand steps that led to smoking as to effectively avoid relapse Visualize oneself achieving goal, relate to someone who has successfully quit Carry around handout on negative effects of smoking and read when feel like lighting up Nutritional Prescription l l l Avoid increasing food consumption to replace cravings Increase intake of juice and water Maintain a stable p. H balance by eating more fruits and vegetables this cuts down on nicotine cravings 11/24/2020