Physicians Packet
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What is p.r.e.p.® p.r.e.p.® is a 60-day physician referred exercise program that introduces patients to exercise. p.r.e.p.® participants meet with medical fitness professionals twice per week in small group settings and have full access to all of The Alaska Club’s amenities. The p.r.e.p.® team communicates with patients on a regular basis via email, phone, and in-person contact to monitor attendance, progress, and well-being throughout the program. The p.r.e.p.® team is a resource for exercise instruction, education, and support. The most important aspect of p.r.e.p.® is that it takes down all barriers to exercise and welcomes patients in a non-intimidating, comforting environment. p.r.e.p.® can be divided into three key phases: intake, implementation and reassessment. Intake The first appointment p.r.e.p.® participants have is the intake. During the intake, the nurse reviews medical history, health condition(s), lifestyle, and physician recommendations. The nurse also evaluates biometrics: BMI, weight, and blood pressure. Together the patient and the nurse set specific goals to achieve during the program and develop a physical activity plan based on those goals. Implementation After the p.r.e.p.® team develops an exercise program specific to the participant’s needs, abilities, and goals, they devise an expected schedule of physical activity. Schedules include p.r.e.p.® sessions, which are small group trainings consisting of 4-6 people; group exercise classes; and independent exercise. Throughout the 60 days in the program, the p.r.e.p.® team serves as a resource for exercise instruction, education, and accountability in a supportive, social environment. Reassessment Towards the end of the p.r.e.p.® program, we measure progress and reshape the physical activity plan to help patients continue a physically active lifestyle. At this point, we also report progress and attendance back to the referring health care professional. Upon completion of the program, we encourage patients to continue exercise at The Alaska Club or elsewhere. MISSION STATEMENT We improve community health and wellness by integrating the fitness community with local health care providers and increasing the number of patients who choose a healthier lifestyle. We carry out this mission by offering an inexpensive, non-intimidating program that introduces providers’ patients to basic exercise and nutrition. With instruction, education, accountability, and support, we enable patients to successfully assimilate a healthier lifestyle and achieve their health goals. thealaskaclub.com/prep | 907-330-0120 BACKGROUND In 2010, Regina M. Benjamin, MD, MPH, the United States Surgeon General, delivered a public address on the state of this nation’s health. During this address she discussed the problems of obesity, poor lifestyle choices, and lack of exercise. She pointed to the impact these problems have on our nation’s productivity, health care costs, and overall individual life satisfaction. She stated, “…That is why I am asking healthcare organizations across this country to join the Exercise is Medicine initiative. Exercise is Medicine is a multinational, multiorganizational initiative. It brings physical activity to the forefront of disease prevention and treatment, by making exercise a part of every patient’s interaction with a health clinician. “Exercise is Medicine strives to provide the essential connection between clinicians, fitness professionals, and the public, so that everyone can receive the guidance they need to stay healthy and active. All the partners in this initiative are dedicated to the idea that exercise is the new medicine. Partners are asked to continue to build, support, and advocate for physical activity as an essential element of global health and well-being by committing to action: • Policy makers are asked to change policies to support physical activity as a major component of health. • Clinicians and fitness professionals are asked to integrate exercise into every patient and client interaction. • Communities, workplaces, and schools are asked to promote physical activity as an essential part of health and well-being. • Members of the public are asked to educate and empower themselves to seek appropriate counseling on physical activity. continued >> thealaskaclub.com/prep | 907-330-0120 BACKGROUND, CONTINUED “As health professionals, we should remember that patients are more likely to change their behavior if they have a meaningful reward – something more than reaching a certain weight or dress size. The reward has to be something that each person can feel, enjoy, and celebrate. The reward is optimal health that allows people to embrace each day and live their lives to the fullest – without disease, disability, or lost productivity. I hope you will join the Exercise is Medicine initiative. Together, America can become a Healthy and Fit Nation.” The idea for an introductory level exercise program that physicians could prescribe for their patients was first conceived in 2003 by acac (Atlantic Coast Athletic Clubs) owner Phil Wendel and his management team. acac took a leading role in the fitness industry and began the process of integrating fitness into the healthcare arena. acac’s commitment to this concept is epitomized by its fundamental program for introducing exercise to patients referred from health care providers: p.r.e.p. (Physician Referred Exercise Program). The p.r.e.p. concept was presented to the acac board of medical advisors, and the idea took root. In collaboration with the acac fitness team, this group developed what became the 60/60 program. Over time the program has evolved into the current p.r.e.p. model. The program remains an inexpensive, sound introductory program to nutrition, exercise and lifestyle change. It has been successfully implemented at all of the acac clubs and also licensed for sale and distribution to other clubs and fitness organizations. The medical community has embraced p.r.e.p.. Numerous lives have been dramatically changed. Biologic metric data has been gathered throughout the course of the program. Without question, the most impressive piece of data is that 40% of patients transition from p.r.e.p. into a full club membership. Recognizing that a certain percentage of patients in the program will choose to continue exercise on their own rather than in the club, we estimate that 55 to 60% of program participants adopt significant lifestyle changes. The program continues to grow and mature as physicians from many specialties have embraced the concept and verbalized their needs and desires. Our organization and forward-thinking members of the fitness community will move into their new role as the first line of health care providers, integrating fully into the health care model. thealaskaclub.com/prep | 907-330-0120 EXERCISE BENEFITS Diabetes Benefits Regular exercise helps with weight control, improves the body’s ability to use insulin, improves blood glucose control, and positively impacts the long term effects of diabetes including heart disease, retinopathy, neuropathy, and kidney problems. Heart disease Many people with known cardiac disease are fearful that exercise may cause an adverse cardiac event. Research has shown that, in the right patients, a safe exercise program, combined with proper nutritional choices will improve cardiac health and minimize the chance for heart attacks and or stroke. Lowered cholesterol and an improved HDL/LDL ratio are proven benefits of regular exercise which have a positive impact on cardiac health. Hypertension There remains controversy over the combined effort of exercise and weight reduction in reducing BP. Both have been shown to help independently, yet a comprehensive review by Hagberg and colleagues (2000) concluded from the gathered evidence that exercise training and dietary weight loss are independent, and that exercise can be effective in lowering BP without concomitant reductions in body weight. Other reviews maintain this idea but also reinforce the recommendation of the combination of diet and exercise as effective means to facilitate weight loss (Bacon et al. 2004). Therefore, if weight loss is desired in addition with BP pressure reductions, then diet should be modified accordingly. Wait! Can Exercise Prevent Hypertension? The encouragement of regular exercise is not only useful as a treatment method for individuals with hypertension, but should also be advocated as a means for prevention. Predictors that may be examined to evaluate the risk of developing hypertension include resting BP, family history, and physical activity levels. Higher physical activity levels have shown an inverse relationship to the development of hypertension. As well, Barengo and associates (2005) presented evidence that European men doing equal to and greater than 4 hours per week of leisure-time physical activities (e.g. recreational sports, skiing, gymnastics, heavy gardening, hunting, fishing and walking/jogging) had reduced risk of hypertension. Thus physical activity and regular exercise can protect against hypertension. As hypertension is associated with an increase in risk for cardiovascular disease, it is vital that effective interventions are advocated to reduce overall morbidity and mortality. Although pharmacological treatments can be costly and necessary for treating some BP conditions, lifestyle modifications should also be implemented whenever possible. The role of exercise has been shown to be consequential in lowering both systolic and diastolic BP. Both aerobic