3. WHO
• According to the World Health Organization (WHO),
one of the major challenges in the prevention of
noncommunicable diseases and in the promotion of
physical activity and other healthy lifestyle choices is
communicating the importance of action now in return
for future benefits.
• Despite the fact that prevention has been the major
contributor to health gains, including 30 added years of
life expectancy, in the past century, most studies of
health expenditures indicate that less than five percent
of resources are devoted to prevention.
• The WHO says that advocacy and policy are key
• .
4. Around 40% of the adult population is sedentary or
minimally active
Percentages by age group and risk factors. Men
100
90
80
70
PERCENTAGE
60
50
40
30
20
10
0
18-34 YEARS 35-54 YEARS 55-74 YEARS
GLOBAL HTA DM HCOL BMI>25
ESCA 2006. 18-74 years. Proportion of sedentary/minimally active men (normal Physical activity)
5. Around 40% of the adult population is sedentary or minimally
active
Percentages by age group and risk factors. Women
100
90
80
70
PERCENTAGE
60
50
40
30
20
10
0
18-34 YEARS 35-54 YEARS 55-74 YEARS
GLOBAL HTA DM HCOL BMI > 25
ESCA 2006. 18-74 years.
Proportion of sedentary/minimally active women (normal Physical activity)
6. Physical inactivity: a health risk
This is one of the 10 risk factors that contributes to the
appearance of chronic illnesses:
» Cardiovascular diseases
» Cancer
» Obesity
» Type 2 diabetes
These are the cause of 60% of all deaths and 47% of
the global burden from sickness
World Health Organisation (2002).
Report on world health 2002: reducing risks and promoting healthy
lifestyles
7. The benefits of regular exercise
Exercise and physical activity are important to health and prevention and
treatment of many chronic diseases
Prevention and control of:
Cardiovascular disease
Obesity / overweight
Type 2 diabetes
Cancer
Osteomuscular disease
Improved mental health
↓ Mortality
8. The benefits of regular exercise
• Exercise can also be a powerful
complement to traditional medical
intervention and, in many instances,
may alow physician to significantly
reduce a patient’s drug dose or
eliminate the need for medicine
altogheter .
9. The benefits of regular exercise
• Sport and health care professionals can
play an integral role in educating your
clients / patients about the medical
benefits of exercise and how they can
speak to MD, RN, PE about physical
activity.
10. Plan of Physical Activity,
Sport & Health (PAFES)
A joint programme of the
Department of Health
and
General Secretary for Sport
in the fight against
sedentary lifestyles
11. Physical Activity,
Sport & Health Plan (PAFES)
• Designed to help improve the health
and wellbeing of our population through
a regular physical activity prescription
from doctors and other healthcare
providers.
12. Overall global framework
WORLD HEALTH ORGANISATION (2004)
Global Food, Physical Activity & Health Strategy
EUROPEAN ECONOMIC COMMUNITY (2005)
Green book: “Promoting healthy eating and physical activity: a
European approach for preventing overweight, obesity and
chronic illnesses”.
SPAIN (2005)
Strategy for Nutrition, Physical Activity and the prevention of
Obesity (NAOS)
CATALONIA (2005)
Integrated plan for the promotion of health, through physical activity
and healthy eating (PAAS)
14. LOCAL INITIATIVES FOR PRESCRIBING
PHYSICAL EXERCISE IN CATALONIA
1993 2001 2002 2004 2004 2005 2006
GRANOLLERS TERRASSA REUS MARTORELL VILANOVA LLEIDA BARCELONA
Different Chronic Different Different
AFIS illness Caminem PPAF
programmes programmes programmes (“Let’s walk”)
workshop
…
Ajuntament de
Barcelona
UME
Hospital
Vilanova
15. CATALAN
FRAMEWORK 1 Community
centres City Council
Training workshops: City Council
Routes + labelling:
1 - Children Routes + labelling:
1 – Access to sports
2 - Adults 1 – Access to sports
Schools equipment
• Health education 2 equipment
– Programmes
• Schools menus 2 – Programmes
among the
• Promotion of physical among the
disadvantaged
activity disadvantaged
population
population
Primary
Primary Companies
Healthcare
Healthcare • Healthy menus
Service
Service • Promotion of
physical activity
PAFES
PAFES
Food Industry
• Code of Good
The Media Practices
Businesses
i and
Restaurants
• Menus
• Foods
16. CATALAN FRAMEWORK 2
Strategic direction:
Strategic direction:
Recognising sport’s role in society
Recognising sport’s role in society
Programme:
Programme:
Medical
Medical Sport &
Sport &
Services
Services
in the
Health
Health
in the Objective: to integrate
Sports
Sports Objective: to integrate
physical activity into
physical activity into
System
System the health system
PAFES
PAFES the health system
Sports
Sports
equipment
equipment Doping
Doping
17. OBJECTIVES OF PAFES
To incorporate prescribing and advising exercise as a therapeutic
tool in primary healthcare.
To update knowledge and skills of professionals involved through
training and retraining courses, in coordination with multidisciplinary
training teams that can provide the necessary tools for developing their
roles.
To coordinate the health care resources (primary health care and
specialist level) with regard to prescribing physical activity. sports
medicine doctor as a consultants
To strengthen the use of existing sports facilities in the community.
To establish communication channels within multidisciplinary teams.
To work together with professionals from sports facilities.
To work together with the different public organisations and sectors
involved
18. Health Sport
Connection:
Health - Sport PAFES
Office
Sports equipment
+
Health Centre Local authority
sport offering
Creating PAFES
Office PAFES
Programmes
19. General
Health
Secretary of
Department
Sport
Sports facilities
sports services
Healthcare
Centers
City Council
22. PAFES CHARACTERISTICS
• Target population: Sedentary adults with
cardiovascular risk (Hypertension, Dyslipemia,
Obesity and Diabetes type2 ).
• Entry point into the programme:
– Primary healthcare center
• Recommendations of physical activity
Advising on non-supervised physical activity
Advising and prescribing advised physical activity
Advising supervised physical activity (referrals to
sports facility)
23. NON-SUPERVISED
Programme
Advising on increasing progressive
exercise at low to moderate intensity.
Aimed at those without impediments to
doing physical activity
Healthy physical activity offered within the
city council area.
General advice on increasing
light/moderate physical activity without
supervision
Sedentary population with no
contraindication for PA.
24.
25.
26. ADVISED
Programme
Periodically advising on increasing
physical activity with progressive
objectives.
Aimed at people who need periodic
follow-up for doing physical activity
Stage of change: contemplation or
determination
Designing healthy walking routes for
each community area.
Sedentary population with risk factors
and some stable chronic illnesses.
27.
28.
29. SUPERVISED
Programme
Advising on taking physical exercise with
initial and final evaluation by a SMD.
Stage of change: contemplation or
determination
male>45 yo , female > 55 yo
2 CV risk factors
Groups led by a PE in sports facilities.
6 months’ duration
• Sedentary population with chronic illness
that may be controllable through exercise.
Require supervision when starting the
exercise.
30.
31.
32. ROLE OF LOCAL AUTHORITIES
Provide information, through the PAFES, on city council
sports services and also about healthy activities as ways of
promoting health (cultural routes, walks, games and leisure
activities, dances and others).
Arrange for city council sports facilities to be made
available as well as communicating with the facilities'
specialists in exercising for health (PE).
Promote the establishment of a “cheap” fee for
participants (the option for subsidies).
33. FUNCTIONS OF THE PAFES
To provide the logistical support to act as the link between
the Primary Healthcare Centres and sports facilities and
also with the local authorities’ healthy activities services.
To provide the necessary training on promoting health for
the sports facilities' physical exercise specialists
as well as local authority sports specialists.
To certify the training given as well as accrediting the
professionals who receive it.
To provide the professionals with knowledge in the area of
health promotion and establish a communication channel with
the primary healthcare centres at no cost to the local
authorities and sports administrators.
To create and drive a flow of users to the sports facilities,
with major possibilities for generating frequent users, once the
programme has ended.
34. Documents de
Referència
Metges de l’Esport LCAFE:
Professionals Sanitaris - als Ajuntaments
Equips d’Atenció Primària: - als Equipaments
- Centres de Salut i Centres Esportius
35. ROLE OF PRIMARY HEALTHCARE TEAMS
( MD, RN)
Integrate the following into care for patients with CV risk
factors:
• To coordinate the selection and overall
management of the patient
• To prescribe unsupervised and advised physical
activity
• Where necessary, refer patients for supervised
physical activity to SMD
36. HOW WILL BE THE INFORMATION
RECORDED?
The physical activity will be recorded in the medical history
START: Stage of change
Type of advice and prescription of physical
activity
FOLLOW-UP: Physical activity or not, prescription
IN A YEAR: Stage of change, Type of advice
The remaining necessary information for the evaluation is extracted
from what is already available in the “e-CAP” (patient characteristics
and clinical data)
37. ROLE OF SPORTS MEDICINE DOCTORS
• To participate in training courses aimed at
primary healthcare professionals
• To act as consultants for the professionals
involved
• To prescribe supervised physical activity for
patients referred from primary healthcare
center, with an initial evaluation and a further
evaluation after 6 months
38. ROLE OF
PHYSICAL ACTIVITY EDUCATOR (PE)
• To be responsible for carrying out supervised physical
activity programmes in designated centres (including
initial and final evaluation of patients)
• To coordinate with Primary Healthcare Centres and SMD
• To participate in training courses aimed at primary
healthcare professionals
39. PRIMARY HEALTHCARE TEAM
RESOURCES
Support material
• Professionals
– PEFS Guide
– Course material
• Patients Leaflets
Training workshop (8 hours)
• Train the trainers strategy at 3 levels:
CENTRAL
REGIONAL
PRIMARY HEALTHCARE CENTRES as a CLINICAL SESSION
• Ongoing training credits
Periodic consultations with Sports medicine physician
40. Sport professional TEAM
RESOURCES
Support material
• Professionals
– PEFS Guide
– Course material
• Patients Leaflets
Training workshop (20 hours)
• Train the trainers strategy at 2 levels:
CENTRAL
REGIONAL
• Ongoing training credits
Periodic consultations with Sports medicine physician