HEALTHY PRACTICES
WANT TO
SHOULD DO
MUST DO
AVOID MUST DO DYSFUNCTIONAL
Resource Allocation
• Financial resources • only so much money, misdirected funds, what is your
health worth?
• Mental resources • cognitive load and devotion of mind to tasks/goals
• Time resources • Just in time life, scheduling efficacy, lap time analysis
• Resource Hierarchy, Resource Shortfall
Fitness
Physical
Literacy
Participation
Nutrition
The
Healthy
Puzzle
Maladaptive behaviours – stop bullshit
Get real sleep, alcohol, chew tobacco, etc.
0
20
40
60
80
100
120
140
0 10 20 30 40 50
BMI
Ris
k o
f D
isease
BMI = weight (kg) / ( height (m) * height (m) )
< 18.5 underweight
18.5–24.9 normal weight
25.0–29.9 overweight
30.0–34.9 class I obesity
35.0–39.9 class II obesity
≥ 40.0 class III obesity
BMI Classification
BMI ≥ 35 or 40 is severe obesity
BMI of ≥ 35 or 40–44.9 or 49.9 is morbid obesity
BMI of ≥ 45 or 50 is super obesity
Overweight and Obese Adult Canadians
0
10
20
30
40
50
60
70
ABC OW OB OW+OB
Pe
rce
nta
ge
65%
Morbid Obesity
• 1993 to 2006
– 1.8 to 6.1 per thousand participants was found (increase >200%).
– Morbid obesity prevalence higher in women.
• 4% increase in prevalence per year in women
• 12% per year in men
What percentage of people are active enough?
Age Males Females
6–11 48.9 34.7
12–15 11.9 3.4
16–19 10 5.4
20–59 3.8 3.2
60+ 2.5 2.3
So after 12, 95% are “derailed lifestyles”
– treatment mode not prevention.
LAPS
Or maximize your lap time!
What % of Canadians get 30 minutes of moderate PA per day?
0
10
20
30
40
50
60
1 2 3 4 5
Days a week
Pe
rce
nta
ge
Guide
line
11,462.8 11,326.8 8,416.0 7,883.4 11,480.9 10,982.3
-
2,000.0
4,000.0
6,000.0
8,000.0
10,000.0
12,000.0
14,000.0
Day of Week
Ste
ps/
day
Tuesday Wednesday Thursday Friday Saturday Sunday
Weekday Weekend
7000 steps shy of target 4000 steps shy of target
In one generation we have eradicated a human behaviour
Walking to School
2000 Steps/day gone
21 steps per kcal
The function of protecting and
developing health must rank even
above
that of restoring it when impaired
Hippocrates
Sleep
Work
Food
Screen
Exercise
Sleep
Work
Food
Screen
Exercise
Average Canadian
Daily Activity Inventory
24 min/day of MVPA
1.6% of the day
Ideal Canadian
Daily Activity Inventory
60 min/day of MVPA
4.2% of day Minimum Canadian
Daily Activity Inventory
30 min/day of MVPA
2.1% of the day
PA Dysfunction Index
• Self-Reported Physical Activity – The majority report meeting the physical activity guidelines (52.5%)
• Actual Physical Activity – 4.8% get 30 min a day for 5 to 7 days per week.
– 15.4% get 150 minutes per week
– 34.% get over 10,000 steps/day
• Dysfunction Index – Self-report/Actual
– 52.5/4.8 = 10.9X
Kruger Report 2010
• Physical inactivity combined with obesity and smoking cost Manitobans $1.62 billion in 2008; the economic burden will ↑ by $4.7 billion by 2026.
Osteoporosis
Cancer
Diabetes
Depression Osteoarthritis
BMI 1 JM Chan et al. Diabetes Care 2 G Colditz et al. Ann Intern Med 17:961-969, 1994 122:481-486, 1995
Obesity is a Major Risk Factor for Type 2 Diabetes
50 100
0
10
20
30
40
1.0 2.2
12
42
<23 25 31 35
Men1
0
25
50
75
1.0 8.1
40
93
<22 25 31 35
Women2
Physical Activity & Cancer
National Cancer Institute 2011
Colon
Breast
Prostate
Endometrium
Lung
Convincing
Convincing
Probable
Probable
Probable
30 – 40 %
20 - 80 %
0 %
20 – 40 %
20 %
Cancer Evidence Risk Reduction
Studies
> 50
> 60
> 36
> 20
> 20
CT of the femur
– the shape changes with activity!
Active
Control
Sedentary
• The shape of the bone is very important in strength
• Activity and inactivity dramatically change shape!!
1 3 4 5 6 7 2
1 3 4 5 6 7 2
A lifestyle intervention
involving diet combined with
initial or delayed initiation of
physical activity results in
clinically significant weight
loss and favorable changes
in cardiometabolic risk
factors
10 kg per year
½ lb per week
Scheduling Efficacy
Walk through a week with them. ID barriers to participate, slot in times that work and cant work.
Find work around for barriers. 20+ minutes is not uncommon.
Accountability Framework
• Weekly meetings
• Weekly updates of programming success
• Weekly submission of information
– Pedometer counts
– Weight, circumference
• Training Partner or group
• Family support
Successful Interactions - Individual
• AIM: behaviour change
– Mindful eating
– Elimination of over-consumption episodes
– Caloric maximums per day
– Regular PA
• PA in schedule, PA for caloric expenditure, PA for cv fitness
The Five R’s (3+2)
Regular Physical Activity & Real Nutrition
Reading wRiting aRithmetic Relationships
The 5th R
Adherence Grade 6 Manitoba
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<30.0 30.0-59.9 60.0-89.9 ≥90.0
Activity Time (min/d)
M
F
52.2% accumulated <30.0 min,
31.1% accumulated 30.0 to 59.9 min,
12.7% accumulated 60.0 to 89.9 min
4.0% accumulated ≥90.0 min.
(Wittmeier, Mollard and Kriellaars, 2007)
Manitoba Children
Combined Boys Girls
Height (cm) 136.4 (7.7) 136.7 (7.8) 136.1 (7.7)
Mass (kg) 34.5 (9.7) 33.8 (9.1) 35.3 (10.3)
Body Fat
(%) 21.3 (8.0) 19.2 (8.0)* 23.5 (7.4)
BMI (kg/m2) 18.5 (4.1) 17.9 (3.6)* 19.1 (4.5)
MPA (min/d) 29.0 (19.1) 33.3 (20.0)* 24.5 (17.0)
VPA (min/d) 6.8 (8.0) 8.7 (9.4)* 4.9 (5.6)
Moderate Physical
Activity Time (min)
Body Composition
Non-
overweight* Overweight* Overweight* Obese*
**<20% 20-25%** 25-30%** >30%**
< 30 21.1 12.4 6.8 12.0
30 – 59.99 17.1 5.2 4.0 4.9
60 – 89.99 8.8 2.0 0.4 1.6
≥ 90 2.8 0.8 0.4 0
Manitoba Children
Park kids
– children not yet overweight or obese but very inactive
- primary prevention possible with this group
Only 16.8% > 60 min
52% below 30 min
Parental Influence – Role Model
Parental Energy Index (Lytle et al, 1999)
How often do you talk about this issue with your child?
1. School work
2. Chores
3. Getting along with the family
4. Safety-helmets, seatbelts
5. Avoiding cigarettes
6. Avoiding alcohol, marijuana and other drugs
7. Avoiding violence
8. Friends they choose
9. Eating habits
10. Getting more physically active
16 week rivalry based pedometer intervention (Grade 6, n=77, three countries): 4198 steps/day increase! 10 children lost more than 10 lbs.
Average Steps/Day Between Schools
0
2000
4000
6000
8000
10000
12000
14000
16000
18000
Time in program (start, mid, end)
Ste
ps/d
ay
-a
y
Pedometer Interventions Aid - but can’t be used all the time.
AM
Recess
(min)
Lunch
Recess
(min)
PM
Recess
(min)
PE Class
(min)
Daily
Total
(min)
Total/Week
(min)
School
1
15 35 15 40
(x 5 days /
week)
105 525
School
2
15 25 15 30
(x 2 days /
cycle)
55-85 335
Steps/day School 1 - 12100 School 2 - 9975
Body Fat School 1 – 21.4% School 2- 22.2%
BMI School 1 – 17.6 School 2- 18.7
0
1000
2000
3000
4000
5000
6000
7000
8000
School 1 School 2
Ste
p C
ou
nts
In School
Out of School
Self – Esteem
• Self-esteem "the disposition to experience
oneself as competent to cope with the challenges of life and as deserving of happiness"
• Improve self-esteem
– Dream Big – Make expectations realistic – Achieve small goals – Create success
The Facebook Mom
Towards An Ability Model
“Inverted” WHO ICF
Physical Literacy, Fitness,
Nutrition
Ability Model
LTAD LTPD
Curricular
(school & recreation)
Beat Self Sabotage
It is not weakness of person, but lack of resolve toward the goal. Motivation needs fueling!
Motivation = intrinsic, extrinsic, reminders, focus, peer support, inspiration, worth
Silent & Sneaky Calories
• Large coffee, double double – 230 kcals – 3 times a day = 690 kcals – 7 days a week = 1.38 lbs fat per week
• Large coffee black – 0 kcals
Same story with • apple juice • pop • lattes • wine or beer
Calories In Calories Out
Breaking Up with Miss Vickie
Don’t picket McDonalds – picket the people who drive through!
Otherwise picket the furniture manufacturers.
Caloric Balance – THE FIRST LAW!
• INPUT over OUTPUT stays PUT
– Whether it comes from
• FAT – Fat food don’t make you fat
• Carbohydrates – carbs don’t make you fat
• Protein – protein doesn’t make you fat
• Overconsumption does! • Portion control, Episodic over-consumption
Caloric Balance
Energy Expenditure Energy Intake
1. Exercise
2. Activity of Daily Living
3. Resting Metabolic Rate
1. Over-consumption
2. Recommended Caloric Intake
+ 150 kcals/day
15.5 lbs fat/year
Caloric Balance “Lifestyle Intervention”
1. Exercise
2. Activity of Daily Living
3. Resting Metabolic Rate
1. Over-consumption
2. RDA Caloric Intake
Energy Expenditure Energy Intake
3500-7000 kcals/week
1-2 lbs fat
5-7 lbs weight/week
water
INPUT over OUTPUT stays PUT
Food/Junk
ADL Activity
Fuel
Active Lifestyle
& Exercise
Mindful Eating / Increase Work Capacity Negative balance: caloric restraint & activity Sustainable Mindful Eating & Maintained PA Break up with Ms. Vickie
Personal choices … focus on fat .. – don’t be dysfunctional
Male athlete, 22 y.o., 180 lbs, 7% body fat, 3700 kcal/d
protein: 17% = 161 g/d
fat: 26% = 106 g
CHO: 57% = 527 g
Female, 57 y.o., 180 lbs, 39% fat, 1700 kcal/d
protein: 31% = 131 g/d
fat: 30% = 57 g
CHO: 39% = 166 g
Know how to estimate caloric expenditure.
V02 V02 Energy
Expended Workout Intensity
ml/kg/min ml/min Kcals/min 55% of Max
3.5 192.5 0.96
15 825 4.1
36 1980 9.9 5.4
50 2750 13.8
65 3575 17.9
88 4840 24.2 13.3
For every litre of oxygen consumed – 5 kcals of energy are liberated.
5.4 kcals/min X 20 min X 3 times per week = 324 kcals (two granola bars)
1 MET
Average Canadian
Most Fit Person
One night out a week.
• Pre-game (a bevie or two and some chips)
• A few more bevies and an appetizer.
• Designated driver drives to McDonalds.
• 240 + 650
• 600 + 500
• 1450
• 3440 Calories
Input > Output STAYS PUT
= 1 lb of fat! Overnight.
10 X during summer = 10 new lbs!
We are knowledgeable … … but we are not yet enlightened.
A Healthy Lifestyle?
THE GOOD LIFE
• in search of the good life (Consumerism)
• … in search of an easier life (Conveniences)
• … in search of a life that is good (Wealth)
• CCW
• …in search of a healthy lifestyle …
Bones need physical activity!
Inactivity makes bones shrink!
Active
Control
Sedentary
1 3 4 5 6 7 2
1 3 4 5 6 7 2
Immobile Active
Healthy Bones = activity plus in the presence of calcium and vitamin D
Bone loss reduced = adequate calcium and vitamin D
Bone loss accelerated = inadequate calcium and vitamin D
Healthy = Good Nutrition and Good Activity
Healthy ≠ Good Nutrition
Moderate Physical
Activity Time (min)
Body Composition
Non-
overweight* Overweight* Overweight* Obese*
**<20% 20-25%** 25-30%** >30%**
< 30 21.1 12.4 6.8 12.0
30 – 59.99 17.1 5.2 4.0 4.9
60 – 89.99 8.8 2.0 0.4 1.6
≥ 90 2.8 0.8 0.4 0
Risk Model: Physical activity and body composition
Park - not yet overweight or obese but very inactive - primary prevention possible with this group
Only 16.8% > 60 min 52% below 30 min
Parental Energy Index (Lytle et al, 1999)
How often do you talk about this issue with your child? 1. School work 2. Chores 3. Getting along with the family 4. Safety-helmets, seatbelts 5. Avoiding cigarettes 6. Avoiding alcohol, marijuana and other drugs 7. Avoiding violence 8. Friends they choose 9. Eating habits 10. Getting more physically active
Adherence Grade 6 Manitoba
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<30.0 30.0-59.9 60.0-89.9 ≥90.0
Activity Time (min/d)
M
F
52.2% accumulated <30.0 min, 31.1% accumulated 30.0 to 59.9 min, 12.7% accumulated 60.0 to 89.9 min 4.0% accumulated ≥90.0 min.
(Wittmeier, Mollard and Kriellaars, 2007)
Parental Influence – Role Model
52.2% accumulated <30.0 min, 31.1% accumulated 30.0 to 59.9 min, 12.7% accumulated 60.0 to 89.9 min 4.0% accumulated ≥90.0 min.
Windows of Opportunity.
The task force recommends that the government
mandate physical education/health education
(phys ed/health) from kindergarten to Senior 4.
Implementation will vary according to grade to
provide maximum flexibility to involve parents,
students and schools in the promotion of physical
activity for children and youth. provision
Our Manitoba Children
Combined Boys Girls
Height (cm) 136.4 (7.7) 136.7 (7.8) 136.1 (7.7)
Mass (kg) 34.5 (9.7) 33.8 (9.1) 35.3 (10.3)
Body Fat
(%) 21.3 (8.0) 19.2 (8.0)* 23.5 (7.4)
BMI (kg/m2) 18.5 (4.1) 17.9 (3.6)* 19.1 (4.5)
MPA (min/d) 29.0 (19.1) 33.3 (20.0)* 24.5 (17.0)
VPA (min/d) 6.8 (8.0) 8.7 (9.4)* 4.9 (5.6)
TARGET: 90 minutes
60
30
Intensity Duration
(min/d)
BMI
(overweight*)
Body Fat
(≥20%)
Body Fat
(≥25%)
OR P OR P OR P
Moderate
>= Brisk
walk
>45 1.00 1.00 1.00
>45 ≤45 1.52 0.19 3.15 <0.001 1.97 0.07
>45 ≤30 1.49 0.21 3.51 <0.001 2.16 <0.05
>45 ≤15 2.04 0.07 4.20 <0.001 3.04 <0.01
Vigorous
>= Slow
run
>15 1.00 1.00 1.00
>15 ≤15 4.45 <0.01 3.23 <0.01 2.23 0.08
>15 ≤10 4.63 <0.01 3.26 <0.01 2.58 <0.05
>15 ≤5 5.21 <0.01 4.03 <0.001 2.90 <0.05
What amount of PA?
77
Measures SCSP (n=44) Non-SCSP (n=57) r
PA (# steps) 9996 (3859) <NS 10806 (3429) .007
CVF (ml/kg/min)
49.82 (6.21) >**
42.64 (6.54) .72**
AS (# reps) 81.93 (19.38) >** 62.76 (26.80) .49**
PU (# reps) 22.63 (8.73) >** 15.71 (10.18)
SU (# reps) 43.00 (9.29) >** 35.64 (11.32)
MPU (#reps) 16.30 (7.68) >** 11.42 (7.93)
Age (years) 16.14 (0.71) >NS 15.96 (0.72)
Height (m) 1.73 (0.09) >NS 1.72 (0.08)
Mass (kg) 64.86 (10.06) <NS 67.68 (15.60)
BMI (kg/m2) 21.64 (1.92) <NS 22.80 (4.76)
BF (%) 18.99 (5.58) <** 24.65 (11.29) -.56**
WC (cm) 75.49 (6.43) <* 80.43 (11.94)
Sport vs Non-Sport
78
Measures SCSP (n=44) Non-SCSP (n=57)
GPA 76.28 (7.40) >NS 74.96 (8.74)
Physical Self-Description Questionnaire (PSDQ) (maximum of 6)
Health 4.93 (0.68) >NS 4.60 (1.03)
Coordination 4.82 (0.81) >** 4.08 (0.94)
Physical activity 5.37 (0.69) >** 4.14 (1.32)
Body fat 5.37 (0.83) >** 4.32 (1.53)
Sports competence 4.93 (0.80) >** 3.73 (1.33)
GP self-concept 5.24 (0.71) >** 4.10 (1.20)
Appearance 4.83 (0.78) >* 4.28 (0.94)
Strength 4.66 (0.99) >** 3.74 (1.13)
Flexibility 4.21 (1.13) >NS 3.81 (1.20)
Endurance/fitness 4.89 (0.98) >** 3.57 (1.27)
Global self-esteem 5.44 (0.46) >** 4.87 (0.81)
Self-description of competence
79
IN, OUT and CONTROL GROUPS
25% C ore-Online
OUT
Student-Directed
75% P A Practicum
IN
Teacher-Directed
25% C ore-Online
OUT
Student-Directed
75% P A Practicum
OUT
Student-Directed
No PE Course
IN (n=22)
CONTROL (n=14)
OUT (n=65)
Assessments
• Physical Activity – 14 day pedometry – DAILY Activity Logs (4 MONTHS)
• Cardiovascular Fitness – Shuttle Run (20 m) – 1 mile Walk (HR and time)
• Strength and Endurance – Chest, Back and Core – Aggregate Strength
• Body Composition – Waist circumference – BMI – Body Fat
• Self Concept and Self-Esteem
Psychology
Physical Activity
Strength &
Endurance
Body Composition
CV Fitness
81
METHODS Physical self-description questionnaire (PSDQ)
Composed of 70 questions, 11 subscales. 6-point Likert scale (1=false, 6=true).
SUBSCALE DESCRIPTION
1. Strength Perceived physical strength
2. Body Fat Perceived body fat
3. Physical Activity Levels of physical activity in which one
has engaged
4. Endurance/Fitness Perceived physical endurance/fitness
5. Sport Competence Perceptions of one’s own sporting ability
6. Coordination Perceived physical coordination
7. Health Perceptions of one’s own physical health
8. Appearance Perceptions of own physical appearance
9. Flexibility Perceived physical flexibility
10. General Physical Self-Concept Global physical self-concept
11. Self-Esteem Global self-esteem
Design
• Baseline Assessment n=101 – September – two weeks
• HE/PE Natural Experiment (10 weeks)
• 1st Semester Assessment n=101 – December – two weeks
• HE/PE Natural Experiment
• 2nd Semester Assessment n=31 – June – two weeks
What do we need to see?
• Mandatory: A change in the right direction for each group over semester.
• Nice: A difference between groups after semester.
• Ideal: A long term change – 3 years.
– physical activity
• climate dependent,
• stimulus to drive CVF and body composition changes
– cardiovascular fitness – most important as related to disease
– body composition – why we are doing it in the
84
Pedometry
PA by Pedometry
Cardiovacular fitness
87
Body Fat
88
Strength