11/16/2013

Objectives

The Role of Physical Therapy
in Prevention, Wellness,
& Disease Management
What All PTs &PTAs Need to Know
At the end of this presentation you will be
able to:
• Describe the similarities and differences in
the terms prevention, wellness, and
disease management as applied to
physical therapy.

1 2

Objectives
• Indentify the incorporation of prevention,
wellness and disease management in the
American Physical Therapy Association’s
2013 Strategic Plan
• Be aware of the research in these areas.
Objectives
• Describe the value of prevention, wellness
and disease management strategies for
your patients and clients.
• Explain how the concepts of referral and
collaboration are integral to these topics.

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Objectives Used to Promote this Presentation

• Do not miss the opportunity to understand and
• Plan to effectively and efficiently include apply the value of prevention, health promotion,
these strategies in your plans of care. and chronic disease management in your
professional practice.
• Learn why these are important
• Identify sources of additional information
– to your patients,
and education.
– to you as a clinician and
• What APTA is doing to align your future with the
future of healthcare.

5 6

Language Language
• The great thing about human language is • Prevention
that it prevents us from sticking to the • Wellness
matter at hand. • Disease Management
~Lewis Thomas
• Health Promotion
• Population Health - later
• Our language is funny - a fat chance and
slim chance are the same thing.
~J. Gustav White

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Prevention Prevention
• Primary
Prevention Activities are Directed toward – Prevention of disease in a susceptible or potentially
 Achieving and restoring optimal functional susceptible population through specific measures such as
capacity, general health promotion efforts.
 Minimizing impairments, functional limitations, • Secondary
and disabilities – optimizing activities and – Efforts to decrease the duration of illness, severity of
participation diseases, and sequelae through early diagnosis and prompt
intervention.
 Maintaining health (thereby preventing further
deterioration or future illness) • Tertiary
– Efforts to limit the degree of disability and promote
 Creating appropriate environmental adaptations rehabilitation and restoration of function in patients/clients
to enhance independent function. with chronic and irreversible diseases.
Guide to Physical Therapist Practice. Second Edition.
American Physical Therapy Association. Phys Ther. Guide to Physical Therapist Practice. Second Edition.
2001 Jan;81(1):9-746. 9
American Physical Therapy Association. Phys Ther.
10
2001 Jan;81(1):9-746.

Prevention Prevention
• Tertiary Prevention
• Primary Prevention
– Tertiary prevention targets the person who already
– Primary prevention aims to prevent the disease from occurring; It
reduces both the incidence and prevalence of a disease. has symptoms of the disease. The goals of tertiary
prevention are to:
• prevent damage and pain from the disease
• Secondary Prevention • slow down the disease
– after the disease has occurred, but before the person notices • prevent the disease from causing other problems (These are
that anything is wrong. called "complications.")
• give better care to people with the disease
• make people with the disease healthy again and able to do
what they used to do
CDC, Levels of Disease Prevention.
www.cdc.gov/excite/skincancer/mod13.htm, accessed 11/6/13
CDC, Levels of Disease Prevention.
www.cdc.gov/excite/skincancer/mod13.htm, accessed 11/6/13
11 12

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Wellness Wellness Dimensions

• Emotional
• Wellness: A multidimensional state of • Intellectual
being describing the existence of positive • Physical
health in an individual as exemplified by • Occupational
quality of life and a sense of well-being.
• Social
• Spiritual
• National Wellness Institute,
» PHYSICAL FITNESS, WELLNESS, AND HEALTH www.nationalwellness.org/
DEFINITIONS BOD Y03-06-16-39

13 14

Wellness WHOQOL instruments

• Emotional • World Health Organization QOL Major
• Intellectual (Cognitive) Components
• Physical – Physical
– Psychological
• Professional/Vocational (Occupational)
– Level of independence
• Social
– Social relations
• Spiritual – Environment
• (Environmental) – Spirituality/religion/personal beliefs

15 16

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Wellness Lifestyle Medicine

Cleveland Clinic
Cleveland Clinic
• Wellness Institute • Cleveland Clinic's Center for Lifestyle
– Learn about Cleveland Clinic initiatives to Medicine uses a broad range of evidence-
prevent illness and foster health.
based nutrition, exercise, stress-
– …quality wellness programs to change management and other interventions to
unhealthy behaviors and to make healthy life
promote optimal physical, psychological
choices.
and social well-being.
» http://my.clevelandclinic.org/wellness/default.aspx

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Wellness
University of Maryland
• …the ongoing process of making deliberate
CHOICES to enhance the quality of your life…
• It’s a deliberate, holistic and proactive approach
to achieving optimum health and not just the
absence of disease…
• Involves adopting behaviors to care for yourself
physically, emotionally, socially, intellectually,
spiritually, and vocationally.
Wellness
University of Maryland
• Living well - behaviors to care for yourself
physically, emotionally, socially,
intellectually, spiritually, and vocationally.
• Learn more about these six dimensions of
wellness and how to make good choices
while at Maryland.
– http://crs.umd.edu/cms/wellness/WhatisWellness.aspx

19 20

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Wellness Disease management

• Healthy behaviors/choices • Disease management is an approach to patient

care that emphasizes

• Supportive environment – coordinated, comprehensive care,

– along the continuum of disease, and
– across health care delivery systems.
• Multi-dimensional/sectoral

• Ellrodt G, Cook DJ, Lee J, et al. Evidence-Based Disease Management.

JAMA. 1997;278(20):1687-1692.

21 22

Disease management ICF

• National Committee for Quality Assurance
(NCQA) standardized performance measures:
– asthma
– diabetes
– chronic obstructive pulmonary disease (COPD)
– heart failure
– ischemic vascular disease (IVD)

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State-specific Estimates of
So What is the Problem?
Diagnosed Diabetes Among Adults
Age-Adjusted Prevalence of Diagnosed Diabetes per
100 Adult Population 1994 and 2005
Let’s start here:
• One Specific Focus – Physical Inactivity
and Diabetes

National Diabetes Surveillance System

25
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Obesity Trends* Among U.S. Adults

BRFSS, 1990, 1999, 2008 Trends in Obesity & Diabetes
(*BMI 30, or about 30 lbs. overweight for 5’4” person)

1990 1999

2008

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

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Number and Percentage of U.S. Population with

Diagnosed Diabetes, 1958-2008 How many Americans have
7 20

18
diabetes and pre-diabetes?
• Pre-diabetes is a condition where blood
6 Percent with Diabetes

Numer with Diabetes (Millions)

16
Number with Diabetes
5
glucose levels are higher than normal but
Percent with Diabetes

14

12
4
10
not high enough to be called diabetes.
3
8

2 6
• Studies have shown that by losing weight
4
1
2
and increasing physical activity people can
0 0 prevent or delay pre-diabetes from
1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06

Year
progressing to diabetes.
• ndep.nih.gov/diabetes-facts/index.aspx#cost30
CDC’s Division of Diabetes Translation. National Diabetes Surveillance
System available at http://www.cdc.gov/diabetes/statistics
29 30

How many Americans have How many Americans have

diabetes and pre-diabetes? diabetes and pre-diabetes?
• 25.8 million Americans have diabetes — • The number of people diagnosed with
8.3 percent of the U.S. population. Of diabetes has risen from 1.5 million in 1958
these, 7 million do not know they have the to 18.8 million in 2010, an increase of
disease. epidemic proportions.

• In 2010, about 1.9 million people ages 20 • It is estimated that 79 million adults aged
or older were diagnosed with diabetes. 20 and older have pre-diabetes.

• ndep.nih.gov/diabetes-facts/index.aspx#cost31 • ndep.nih.gov/diabetes-facts/index.aspx#cost32

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How much does diabetes

cost the nation?
• Total health care and related costs for the
treatment of diabetes run ~ $174 billion/yr.
• Of this total, direct medical costs (e.g.,
hospitalizations, medical care, treatment
supplies) account for ~$116 billion.
• The other $58 billion covers indirect costs
such as disability payments, time lost from
work, and premature death.
• ndep.nih.gov/diabetes-facts/index.aspx#cost33

34

35 36

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All-Cause Mortality
100

95
Survival Rate
%
BMI Category kg/m

90 18 – 24.9

25 – 29.9

> 30
85
2 4 6 8 10 12 14 16 18 20
Follow up Years
80
Wei et al. Relationship between low cardiorespiratory
37
fitness and mortality in normal weight, overweight, 38
and obese men. JAMA 282;1547,1999 (n=25,714)

Physical Fitness and Health Conclusions

• Compelling evidence has shown that CRF is a strong & independent
predictor of all-cause and cardiovascular disease mortality
• Of note, our results indicate that a healthy
• CRF is often overlooked compared with risk factors such as
hypertension, diabetes, smoking, or obesity. diet and regular physical activity have
• Several prospective studies indicate that CRF is at least as important important health benefits independent of
as the traditional risk factors, and is often more strongly associated
with mortality. reducing adiposity.
• Previous studies report that CRF appears to attenuate the increased
risk of death associated with obesity.
• Several biological mechanisms suggest that CRF improves insulin
sensitivity, blood lipid profile, body composition, inflammation, and
blood pressure.

Lee DC, Artero EG, Sui X, et, al. Mortality trends in the general population: the • Rob M van Dam RM, Li T, Spiegelman D. Combined
importance of cardiorespiratory fitness. J Psychopharmacol. 2010 Nov;24(4 Impact of lifestyle factors on mortality: prospective cohort
Suppl):27-35 study in US women. BMJ2008;337:a1440
39 40

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Inactivity Evidence
• Physical inactivity is the fourth leading • Perceived physical fitness &
cause of death worldwide. functional capability was an I risk
factor for mortality from CVD, CHD or
• Kohl HW, Craig CL, Lambert EV. The pandemic
of physical inactivity: global action for public all causes combined
health. Lancet. 2012 Jul 1;380(9838):294-305.

• BMI not I risk factor

Int J Obes Relat Metab Disord. 2000 Nov;24(11):1465-74.

41 42

HHS
Physical Activity Guidelines

• Advisory Panel Report

• Guideline Released 10/7/08
• PA remains significant indicator of health
• Considering disabled populations

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HHS PAG Research Report PAG-AC Charge

• Advisory Panel Research Report, eg: • The primary focus of the PAGAC scientific review was
research on primary prevention and health/fitness
– Cardiorespiratory health promotion.
– Metabolic health
• The charge to the was to review existing scientific
– Energy balance literature to identify where sufficient evidence exists to
develop comprehensive public health PA
– Relationship to energy balance recommendations to target as necessary specific
– Adverse events segments of the population.
– Understudied populations Physical Activity Guidelines Advisory Committee. Physical Activity
Guidelines Advisory Committee Report, 2008. Washington, DC:
http://health.gov/PAGuidelines/ U.S. Department of Health and Human Services, 2008.

45 46

PAG-AC Charge HHS PAG Messages

• Strong, consistent observational evidence indicates
• PAG-AC recognized many of the health benefits of that mid-life and older adults who participate in
physical activity for the general population also
pertained to populations or health condition that regular physical activity have reduced risk of
typically excludes them from physical activity and moderate or severe functional limitations and role
health research. limitations.
• The PAG-AC decided to conduct a separate review of
the scientific literature focusing on these three – 150 min of vigorous activity
populations: – 75 minutes of moderate activity
– People with various disabilities,
– Women during pregnancy and the postpartum period,
– And races and ethnicities other than non-Hispanic whites.

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HHS PAG Messages HHS Physical Activity Guidelines

Moderate Evidence
Health-care providers can provide useful A lower risk of:
personalized advice on how to reduce risk of
injuries. For people who wish to seek the advice • Hip fracture
of a health-care provider, it is particularly • Lung cancer
appropriate to do so when contemplating • Endometrial cancer
vigorous-intensity activity, because the risks of And the positive effects of:
this activity are higher than the risks of
moderate-intensity activity. • Weight maintenance after weight loss
http://health.gov/PAGuidelines/
• Increased bone density
• Improved sleep quality
49 50

HHS Physical Activity Guidelines HHS Physical Activity Guidelines

Moderate to Strong Evidence Strong Evidence
• A lower risk of:
• Better functional health (for older adults)
– early death
• Reduced abdominal obesity – coronary heart disease
– stroke
– high blood pressure
– adverse blood lipid profile
– type 2 diabetes
– metabolic syndrome

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HHS Physical Activity Guidelines

Strong Evidence (cont’)
• A lower risk of:
– colon cancer
– breast cancer
What is Needed to Reap
• In addition to: These Health Benefits?
– Weight loss, particularly when combined with
reduced caloric intake
– Improved cardiorespiratory & muscular fitness
– Prevention of falls
– Reduced depression
– Better cognitive function for older adults

53 54

Children & adolescents (6-17 yrs) Adults (18-64)yrs per week

– 60 min of physical activity a day, moderate or
vigorous
– Three of these days should be vigorous
– Muscle and bone strengthening 3 times a
week
• 150 min moderate-intensity or 70 min of vigorous-
intensity aerobic physical activity, or an equivalent
combination.
• Should be performed in bouts of at least 10
minutes, preferably spread throughout the week.
• Additional health benefits are provided by
increasing to (300 minutes) of moderate-intensity
aerobic physical activity, or 150 min a week of
vigorous-intensity physical activity, or equivalent
combination.
• Strengthening of all major muscle groups
performed on 2 or more days per week.

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Aging Adults (65 & up)/week Endurance – Relative Intensity

Intensity % VO2R % HRR %HRMAX RPE*
• Follow the adult guidelines. Very Light <20 <50 <10

• If limited due to chronic conditions, older Light

Moderate
20-39
40-59
50-63
64-76
10-11
12-13
adults should be as physically active as Hard 60-84 77-93 14-16
their abilities allow. Very Hard >85 >94 17-19
Maximal 100 100 20
• They should avoid inactivity.
• Older adults should do exercises that
maintain or improve balance if they are at
risk of falling.
*Borg RPE 6-12 scale
57 58

Resistance – Relative Intensity

Intensity % 1 RM
Very Light <30
Light 30-49 What About
Moderate
Hard
50-69
70-84
People with Disabilities?
Very Hard >85
Maximal 100

59 60

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Data Points HHS PAG Messages

Type of Disability RTCs Non-RTCs Pre/Post Test w/o
Control Group
Stroke 17 0 6
SCI 5 4 9 People with chronic conditions and symptoms
MS 11 2 5 should consult their health-care provider about
PD 5 3 6 the types and amounts of activity appropriate for
MD 5 2 5 them.
CP 5 1 5
TBI 3 0 1
Amputee 10 3 2
Combined 1 1 2

Cognitive not included separately but may be included in

Combined.
61 62

HHS PAG Messages 1st Major Take Away

• “When adults with disabilities are not able to • Inactivity in hazardous to your health
meet the above Guidelines, they should • A little is better than none
engage in regular physical activity according • A lot is best, if done safely/appropriately
to their abilities and should avoid inactivity.”

• “Adults with disabilities should consult their • Our role?

health-care providers about the amounts and – Know the Guidelines and how to apply to your
types of physical activity that are appropriate patient population, refer, provide educational
for their abilities.” materials or just ask the first question.

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Increasing Activity Beyond Function

• How to you see your current role?

Inactivity is hazardous to
your health
• How might you change that view?

• Consider how setting and payment affect

your view.

65 66

Health Behavior Change Health Behavior Change

• Lifestyle changes is central to much of • Internal, eg self efficacy
prevention, most of wellness and for • Skills
physical therapy a significant part of • Environment
disease management.
• Motivators
• Lifestyle change involves choices by the
patient or client • Resources
• Change is often multi-dimensional

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Impact of lifestyle factors

on mortality
Now Let Us Look • Study of 77,782 middle aged US women
• 24 year follow-up.
More Broadly • Markedly lower mortality
– Never smoking
– engaging in regular physical activity,
– eating a healthy diet
– avoiding becoming overweight

69 70

Impact of Impact of lifestyle factors

Lifestyle Factors on Mortality on mortality
• Lifestyle risk factors
• Prospective cohort study in US women – Cigarette smoking (ever)
• Age 34-59 – Lack of physical activity (<30 min/day
• Free from CVD and cancer in 1980 moderate to vigorous intensity activity)
– Low diet quality (lowest three fifths of healthy
diet score)
» Rob M van Dam RM, Li T, Spiegelman D. Combined
– Alcohol intake of 0 or ≥15 g/day
Impact of lifestyle factors on mortality: prospective cohort – Overweight (body mass index ≥25)
study in US women. BMJ2008;337:a1440
– Rob M van Dam RM, Li T, Spiegelman D. Combined Impact of lifestyle
factors on mortality: prospective cohort study in US women.
BMJ2008;337:a1440
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Impact of lifestyle factors Age standardised all cause, cancer, and cardiovascular mortality during 24 years of follow -up
by number of lifestyle risk factors.

on mortality
• Of 8882 deaths, estimates:
– 55% of all cause mortality
– 44% of cancer mortality
– 72% of cardiovascular mortality during follow-
up
• Could have been avoided by adherence to
lifestyle changes.
• Rob M van Dam RM, Li T, Spiegelman D. Combined
Impact of lifestyle factors on mortality: prospective cohort
study in US women. BMJ2008;337:a1440 Dam R M v et al. BMJ 2008;337:bmj.a1440

73 74
©2008 by British Medical Journal Publishing Group

The Impact of Mobility on Quality Population Health

of Life Among Older Persons
• Large longitudinal study (n=2473) of older persons • Working Definition of Population Health:
moving into retirement Realizing that there is not uniform
• Total health conditions not found to make a agreement on the definition of population
significant direct contribution to QOL prediction. health, the [IOM] Roundtable will use the
• Mobility had significant direct and indirect QOL following definition to guide its initial
• Satisfaction with functional capacity with greater conversations.
total association with QOL – On June 13, 2013, the IOM Roundtable on Population
• Mobility interventions designed to enhance QOL Health Improvement held a workshop to explore the
likely impact on population health improvement of
should address satisfaction with functional capacity various provisions within the ACA.
as well.
• J Aging Health August 2013 vol. 25 no. 5 723-736 75 76

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Population Health
• Population Health is "the health outcomes
of a group of individuals, including the
distribution of such outcomes within the
group" (Kindig and Stoddart, 2003).
77
APTA’s Strategic Plan
• Goals 2: Patient- & Client-Center Care
Across the Lifespan
– Objective A: Increase the prevalence of
physical therapists providing prevention
(primary, secondary, and tertiary) and
wellness services
• Strategies address both individuals and
populations
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Population Health
• While not a part of the definition itself, it is
understood that such population health
outcomes are the product of multiple
determinants of health, including medical
care, public health, genetics, behaviors,
social factors, and environmental factors.
– On June 13, 2013, the IOM Roundtable on Population
Health Improvement held a workshop to explore the
likely impact on population health improvement of
various provisions within the ACA.
78
APTA’s Strategic Plan
• Goals 2: Patient- & Client-Center Care
Across the Lifespan
– Objective B: Promote implementation of
innovative models of practice that target
patient- and client-centered care
• Integrating prevention and health
promotion services in collaborative models
of delivery
80
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APTA Task Force
• Task Force to Define the Role of Physical
Therapists in Prevention, Wellness, Fitness, &
Disease Management for Public Policy Purposes
• Charged with developing and presenting to the
APTA BoD a description of the role of physical
therapists in prevention, wellness, and disease
management both for individuals and for
populations. (2013 Task Force Charge)
81
PT Annual Visit
Development and Implementation of
Standardized Elements for an Annual
Physical Therapy Examination (RC 24-11)
That the American Physical Therapy Association
support the promotion and implementation of
Annual Visit with a Physical Therapist by
coordinating the development and promulgation
of at least the following:
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APTA Task Force
• Describe the unique role and value of
physical therapists in primary, secondary,
and tertiary prevention for individuals and
for populations. Analysis of these roles
should focus on efficient and effective
utilization of resources, including human
resources and payment. (2013 Task Force Charge)
82
PT Annual Visit
• Standardized elements of an annual physical
therapy examination that would meet the needs
of all individuals
• Resources and tools to support the physical
therapist in tracking outcomes across the lifespan
• A marketing and implementation plan to enhance
public recognition of the need for, & the benefit of,
an annual physical therapy examination
84
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APTA Vision
• APTA BOD will be sending a new Vision to How You Practice
the 2013 HOD for consideration:

– Vision Statement: The physical therapy

profession will transform society by optimizing
movement for all people of all ages to improve
the human experience.

85 86

Your Current Clinical Practice Key Concepts

• Prevention? • Healthy lifestyle choices
• Wellness? • Multi-dimensional determinants
• Disease management? • Collaboration, Consultation, and &
Referral
• Routinely?

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Re-framing the PT Role

• Ask
– What are the physical activities to which you And How Do You Practice
would you like to return, if any? If appropriate,
talk about their long term life goals. To Support Healthy Lifestyles?
• Determine
– What are the barriers – what is the PT role in
that patient’s or client’s vision
• Plan
– How can adequate levels of physical activity and
a health lifestyle be incorporated into that
vision?

89 90

Scope & Competency Scope & Competency

Exam
Exam Eval Dx Prog Intervene Screen
Screen
Collaboration

Refer
Refer

91 92

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Scope & Competency Scope & Competency

• Rolodex!
Exam
Screen
• Rolodex!!

Refer • Rolodex!!!

93 94

2nd Important Take-away

• The need to work with a team
– Face to face - Focused
– Virtually - Coordinated goals
- Teamwork
– Patient centric

95 96

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So What is Really Happening
Out There?
97
Accountable Care Organizations
• ACOs are groups of doctors, hospitals, and
other health care providers, who come
together voluntarily to give coordinated high
quality care to their Medicare patients.
• To ensure that patients, especially the
chronically ill, get the right care at the right
time, avoiding unnecessary duplication of
services and preventing medical errors.
ACO. www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/ACO/index.html?redirect=/ACO/. Accessed 11/5/2013
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Accountable Care Act
• To identify and solve the problems that contribute to poor
health.
• A growing recognition that the health care delivery
system is responsible for only a modest proportion of
what makes and keeps Americans healthy
• Health care providers and organizations could accept
and embrace a richer role in communities, working in
partnership with public health agencies, community-
based organizations, schools, businesses, and many
others
– Summary. IOM Roundtable on Population Health Improvement. June
13, 2013 98
Accountable Care Organizations
• When an ACO succeeds both in both
delivering high-quality care and spending
health care dollars more wisely, it will share
in the savings it achieves for the Medicare
program.
ACO. www.cms.gov/Medicare/Medicare-Fee-for-Service-
Payment/ACO/index.html?redirect=/ACO/. Accessed 11/5/2013
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Goal of Integrated Care Health Care Reform's Triple Aim

Triple Aim
• Improve the health of the population;
Better Care • Improve the patient experience, including
(Individuals) quality; and
• Improve the affordability of care by
decreasing per capita costs.
Lower
Better Health
Growth in
(Populations)
Expenditures
– Berwick, et al. in Health Affairs (May 2008, Vol. 27, No. 3,
759-769

102

Nature, Health & Wellness Nature, Health & Wellness

American Public Health Association
• New policy calls on public health, medical
and other health professionals to raise
awareness among patients and the public
at-large about the health benefits of
spending time in nature and of nature-
based play and recreation;
American Public Health Association
• Urges such professionals to form
partnerships with relevant stakeholders,
such as parks departments, school
districts and nature centers;
• and calls for promoting natural
landscaping.
• http://www.apha.org/advocacy/policy

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How to Facilitate Healthy

Lifestyles

• US National Physical Activity Plan

• APTA on the Coordinating Committee
• Opportunities for your clinic, facility or
APTA component to get involved.
• www.physicalactivityplan.org

105 106

National Physical Activity Plan

• Business and Industry
• Education -Transportation
• Health Care -Seatbelt
-Motivation
• Mass Media
• Parks, Recreation, Fitness and Sports
• Public Health
• Transportation, Land Use, and Community
Design
• Volunteer and Non-Profit

107 108

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For Prevention, For Prevention,

What Else Do You Need to Know?
– Individual with family history of cardiovascular
disease
– Currently works full time in an office
– Is a single mom
What Else Do You Need to Know?
• Individual with type 2 diabetes
• Paresthesia of feet
• Functionally independent at an ambulatory
level
• Currently using insulin

109 110

For Prevention,
Advocacy for Physical Activity
What Else Do You Need to Know?
• Individual s/p SCI; C6-7 quadriplegia • As individuals
• Functionally independent in wheelchair – Friends and family
mobility • As a clinical professional
• Assistance needed with some ADL and – Patients/clients
IADL • In your community
– Local initiatives
• For your profession
– APTA activities at the state, Section,
Assembly, caucus, or at the national level
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2

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2008 Physical Activity Guidelines

for Americans
• Provides resources and clear guidance for the general
public

Resources • Fact Sheet for Professions:

• Full guidelines for policymakers and health

professionals

• Advisory Report (close to 700 pages)

• www.health.gov/paguidelines

113 114

Exercise is Medicine
The National Center on
• Asks all health providers to ask about level of
Physical Activity and Disability activity as a “vital sign.”
• APTA participating in an NCPPA grant • A main target is physicians
• APTA has been a supporting organization from the
• Jointly developed a co-branded brochure start.
• APTA now on Practice Committee
• Addresses PTs role in the transition from
• Provides resources you may be able to use to
the medical model to the community. market your services to MDs.
• www.ncpad.org • www.exerciseismedicine.org

11 11
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Additional Resources
• www.apta.org/pfsp
• Educational Opportunities, • www.apta.org/PreventionWellness
Publications & Other Resources • www.apta.org/pfsp
• Pocket Guides • www.apta.org/PatientCare/BehaviorChange
– Stroke
– Falls
– Diabetes
– Pulmonary Pathology
– SCI

11 11
7 8

Questions, Comments?

• Lisa L Culver, PT, DPT, MBA

• Senior Specialist, Clinical Practice
• American Physical Therapy Association
• 800/999-2782, ext 3172
• lisaculver@comcast.net

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