Let’s Get Moving!

  Home Physical Activity Program

My Story

I have always been active, as a child and an adult. Many of my happiest memories from childhood are of being active such as swimming and playing kickball with neighborhood friends in the summer, sledding and building snow forts in the winter, and putting our albums on the record player and dancing in the basement with family and friends when we had to stay in. When I went to school to initially to become a physical therapist I learned about all the possible disabilities that could result from chronic illnesses like cardiovascular disease and diabetes.  I became a strong advocate for health and wellness, for both myself and my patients, and physical activity became even more important as I learned how it could help prevent these chronic illnesses and help maintain good health.

For the past two and a half years I have had the opportunity to combine both my passion for being a pediatric physical therapist and promoting health and wellness while working at the Duke Healthy Lifestyles Program for childhood obesity.  I have been performing fitness assessments and working with families to create wellness plans to address any impairments they might have, barriers that exist that prevent children/families from being more active, and helping to find activities that would be both beneficial and fun for them.  I have found that so many of today’s children are not getting the activity they need to promote good health and are starting to develop these chronic illnesses that I had associated with older adults. Physical inactivity of youth is one factor that has contributed to the rise of childhood obesity and has also been linked to health risk factors for heart disease, such as high blood pressure, high cholesterol, type II diabetes, sleep apnea, as well as issues of the bones and joints, and psychological issues such as depression and poor self-esteem.  There are increased efforts to try to educate families, children, and school systems on the recommended levels of physical activity.  Among these efforts are formal exercise classes or programs designed for children to increase their overall fitness and promote increasing levels of daily physical activity.  Research has shown in adults that physical activity can improve an individual’s physical fitness, as well as reverse some risk factors of heart disease and chronic illnesses such as diabetes, high blood pressure, and high cholesterol.  Physical therapists have been involved in the care and treatment of these chronic conditions; however, this is not a traditional role of a pediatric physical therapist.  Pediatric physical therapists are finding a new role within this population of children and are becoming involved in helping develop and implement these programs.

 

My Research

Working at Duke Healthy Lifestyles is new role for me and I have focused a lot of my coursework throughout the tDPT program on finding information to enable me to best evaluate and treat this patient population.  The cost of managing the chronic conditions associated with obesity is growing and finding a way to effectively and efficiently manage these conditions is important to consider when looking at different therapeutic options.  The PICO question I developed this fall looked to compare formal exercise programs vs home exercise programs to improve fitness and overall health.  A home program would be convenient for families, as well as more cost effective for both families and health care facilities, than a formal exercise program. The purpose of the review of the literature was to determine which intervention was more effective at improving health and physical fitness levels of children ages 6-14 that were overweight/obese; a formal exercise program for strengthening and/or endurance or a home-based exercise program.

I learned that formal exercise programs are beneficial in improving fitness and overall health in these children, however, there was no literature to date on home exercise/physical activity programs for children ages 6-11 who were overweight or obese. The following is the evidence table from the literature review I completed.

Capstone Evidence Table

 

My Project

The objective for this project was to develop a home exercise program for children who are overweight/obese that would yield the same benefits of the formal exercise programs. My personal objective was to learn how to create a fun fitness video that would incorporate both aerobic and muscle strengthening activities that the children could perform at home with other siblings or parents that would encourage the family as a whole to be more active and improve their health and fitness.  I received guidance from an exercise physiologist at Duke who does physical activity counseling with patients on how to develop an exercise program to improve cardiovascular endurance and muscle strength.  Her main advice was to focus on making it fun with the goal of getting children up and moving.  I used resources such as children’s exercise books and children’s exercise videos to create exercises and activities that are age appropriate and fun.

With the help of my son, my friend and her two sons, and some wonderful Duke DPT students, I developed an exercise video demonstrating the exercises and activities as well as some educational components for the children and families to watch at home.  The age range that I focused on for this video is ages 8-12.

Here is the link to My Video

It is password protected and the password is: ashcapstone

I also created hand-outs with general information and guidelines for the program:

Home Exercise Program Final

As well as instructions and pictures of the exercises:

Bon Jovi – strengthening ex’s

What Doesn’t Kill You Makes You Stronger ex’s

Like a Diamond ex’s

Eye of the Tiger ex’s

 

My Evaluation and Hopes For Future Use of Video

I created an evaluation tool for my committee members to offer me feedback for the video as well as the written instructions and activities.   The input helped me change some things on the home program and was very positive in regards to the usefulness of the video.  I will also offer this evaluation tool to others in the clinic to offer feedback as I make some final edits so that we can implement it.  For this first video, getting “models” to do the activities and finding times for all to meet was the most challenging part.  My hope is to be able to recruit some different children, possibly from the Healthy Lifestyles program, to be part of the video, re-tape them doing the activities, and use the new video as the home program.  My future hope is to be able to add to the research literature on the success of such a program!

Home program and Video Evaluation tool

 

My Appreciation

There are a lot of people that have played very important roles in getting me to where I am today.  My appreciation goes to:

• My loving family who have been supportive and encouraging during the past 1 ½ years of this journey,  and especially over the past few weeks as I have spent much of my time in the Duke MPS studio creating and editing the video!
• My youngest son and his friend for taking part in the video – you all got that Gangnam style down!
•  My eldest son (digital native) gets a lot of kudos for helping interpret information for me (digital immigrant) as I was learning how to create the video and website.
• My friends (both professional and personal) for also encouraging me when things felt a bit overwhelming at times.
• All the professors at UNC have been wonderful and helpful in all the classes I have taken. This degree program has been an incredible learning and growing experience both personally and professionally and I have appreciated the feedback and guidance I have received along the way.
•  A special thanks to the DPT students at Duke who helped with some of the choreography and being willing to be part of the activities – you all look great! As well as my friend and her son for taking on the tasks of managing the camera and music.
• The VERY helpful and patient staff at the Duke MPS video lab – could not have done it without them!
• And last but certainly not least, all my co-workers at Duke Healthy Lifestyles who inspire me daily by their dedication and commitment to providing the best care for the children and families they treat.

 

Additional References

 

1. Get active series week 1 – building a strong foundation. [YouTube]. http://www.youtube.com/watch?v=uGw7WDVd29k: ; Sept 26, 2011.

2. APTA on physical therapy amd fitness and wellness. PT MAG PHYS THER. 2009;17(5):24-24. https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2010308708&site=ehost-live&scope=site.

3. American Heart Association. Physical activity and children. Physical Activity and Children Web site. http://www.heart.org/HEARTORG/GettingHealthy/Physical-Activity-and-Children_UCM_304053_Article.jsp. Updated March 31, 2011. Accessed 10/15, 2011.

4. Centers for Disease Control and Prevention. Childhood obesity facts. Childhood Obesity Facts Web site. www.cdc.gov/healthyyouth/obesity/facts.htm. Updated September 15, 2011. Accessed 10/11, 2011.

5. Centers for Disease Control and Prevention. Perceived exertion (borg rating of perceived exertion scale). Physical Activity for Everyone Web site. http://www.cdc.gov/physicalactivity/everyone/measuring/exertion.html. Updated 2011. Accessed Dec 5, 2011.

6. Duke Department of Pediatrics. Duke University School of Medicine. Healthy lifestyles program. Healthy Lifestyles Program Web site. http://pediatrics.duke.edu/divisions/healthy-lifestyles-program. Accessed 09/17, 2011.

7. Hills AP, Andersen LB, Byrne NM. Physical activity and obesity in children. Br J Sports Med. 2011;45(11):866-870. doi: 10.1136/bjsports-2011-090199.

8. Janssen I. Physical activity guidelines for children and youth. Can J Public Health. 2007;98:S109-21. https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009756804&site=ehost-live&scope=site.

9. Karen Latchana Kenney. Strength training for teen athletes
exercises to take you to the next level. North Mankato, Minnesota: Capstone Press; 2012:48.

10. M Yelling, K.L. Lamb, I.L. Swain. Validity of a pictorial perceived exertion scale for effort estimation and effort production during stepping exercise in adolescent children. http://chesterrep.openrepository.com/cdr/bitstream/10034/29374/1/ChesterRep%20EPER%20PCERT%202002.pdf. Accessed 10/05, 2011.

11. O’Neil M, Shewokis PA, John RS, Vaughn NA. Physical activity in children who are overweight: Indications for physical therapy. PEDIATR PHYS THER. 2008;20(1):118-119. https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009900740&site=ehost-live&scope=site.

12. Oude Luttikhuis H, Baur L, Jansen H, et al. Interventions for treating obesity in children. Cochrane Database Syst Rev. 2009(1). https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2009823852&site=ehost-live&scope=site. doi: 10.1002/14651858.CD001872.pub2.

13. Roberts SO. The role of physical activity in the prevention and treatment of childhood obesity. Pediatr Nurs. 2000;26(1):33. https://auth.lib.unc.edu/ezproxy_auth.php?url=http://search.ebscohost.com/login.aspx?direct=true&db=c8h&AN=2000035035&site=ehost-live&scope=site.

14. Simon Frost. Fitness for young people. New York: Sterling Publishing Co., Inc; 2003:94.

15. Thompson et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. American Heart Association: AHA Scientific statement Web site. http://circ.ahajournals.org/content/107/24/3109.full. Updated 2012. Accessed 11/09, 2012.