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After school program

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Alex Mackintosh

on 31 October 2013

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Transcript of After school program


After school specialist program, children age 12-15 (Eneli, Cunningham & Woolford 2008)
Referral via GP
Conducted in community health center (Level B)
2 hour weekly session x 10 weeks (Sothern et al. 2002)
Promoting healthy eating (Level B)
Focus on activity game-based participation (Level B)
Psychological support/behavioral modification (Level B)
Family & child education (Level C)
Facilitation to ongoing activity
Multi- / inter-disciplinary approach
Physiotherapists are one aspect of the functioning team

Acknowledges the role physiotherapists play in a multidisciplinary team
Supporting physical activity
Assisting mobility problems and disabilities

Canadian Medical Association guidelines for childhood obesity (Grade C/level 3)
UK NICE guidelines for childhood obesity

Expertise of physiotherapists are underutilised in paediatric obesity (Schlessman et al., 2011)
Physiotherapists believe their role in obesity treatment encompasses :
Exercise prescription (96%)
Mobility training (97%)
Cardiorespiratory rehabilitation (95%)
Education (You et al., 2012)
Physiotherapy and obesity
as a chronic condition
Barriers and Challenges
'Game on' = after school program for children with obesity

Physiotherapy plays a diverse role in managing paediatric obesity

Successful intervention involves many disciplines

Beneficial effects when parents attitudes and behaviours are targeted

Many barriers and challenges associated with access to 'Game On' including socio-economic status, parent attitudes and GP referrals.
'Game On' Program Overview
Obesity in Children
Australian children (ABS 2011-2012):
25% overweight
6% obese
1/3 5-19yo will be overweight/obese by 2025 (Haby et al. 2012)
Greater risk of:
cancer, cardiovascular, musculoskeletal, endocrine disorders
Premature mortality (WHO, 2012)
Low self-esteem/bullying (Friedlander et al. 2013)

Social Isolation/Bullying
Obese children more likely to be teased, socially excluded and discriminated against (Katz et al, 2008).
Participating in "Game On" may subject them to further ridiculing

Patient motivation shown to be a barrier to paediatric obesity management (Story et al., 2002).
Attitudes to physical activity correlate to physical activity levels (Graham, Sirad & Neumark-Sztainer, 2011).
GP Referral
GPs don't assess for BMI as frequently as guidelines recommend (Gerner et al., 2006)
Program dependent on GP: - assessment and referral - support and confidence
Parent Attitudes
Children with obese parents are more likely to be obese (Wardle et al, 2001).
Parents may not see this as a priority or health concern
Children replicate parent behaviour
Parental involvement important for obesity management (Story et al, 2002; Freeman et al, 2011).
Socioeconomic Status
Obesity is more prevalent in low socio-economic areas (NHMRC, 2013; AIHW, 2012).
Reduced access to resources, lower levels of education (Kimbro & Denney, 2013)
Cost barriers to transport, equipment and clothing (Sonneville et al, 2009)

No specific framework for obesity but recognises "excess weight" as a risk factors for several chronic diseases
Excess weight is recognised as a risk factor for several chronic diseases
Principles of prevention and management can be applied to a obesity setting

Obesity recognised as a health priority in 2008
Areas of Governmennt focus due to burden of disease caused

Doesn't recognise obesity as a chronic condition
Supports the role of physiotherapists in optimising physical activities, self management, goal setting, management of co-morbidities and health promotion
Advocates for the role of physiotherapists in multidisciplinary teams

Physiotherapy and obesity policy

Multidisciplinary approach for assessment referral and follow up
Areas outlined for potential physiotherapy input
Help promote physical activity and healthy eating in young people and families
Monitoring height and weight status
Assisting education and facilitating behaviour change

Recognises the importance of physiotherapists in primary healthcare settings
Actions areas for potential physiotherapy input
Education on reducing sedentary activity in the home environment
Educating parents to be role models

Better access to safe effective and affordable exercise and weight management programs is needed
Revision of Enhanced Primary Care items in the Medicare Benefits Scheme
Education and resources to families to promote physical activity

Multidisciplinary approach

Clinical practice guidelines for the management of overweight and obesity in adults, adolescents and children in Australia (NHMRC 2013)
Physiotherapists as part of a multidisciplinary approach to
adolescent obesity management
The view of physiotherapists
'Game On' physiotherapist role

Physiotherapy run intervention (Oude Liittikhuis et al. 2009- Cochrane review)(Sheridan, Curley, Roche, 2008)
Knowledge of exercise sport, psychological skills (Nowicka, 2005)
Goal setting (Nowicka, 2005)
Tailoring activity: gender, age, SES, physical limitation and preference (Nowicka, 2005)

Continuous monitoring by members of the multidisciplinary
team recommended ('The Guidelines)(NHMRC, 2013)
Physiotherapy specific activity monitoring (Hussey & Wilson, 2003)

Musculoskeletal: modify programs (APA, 2008)
Knee pain, SUFE, LBP, posture mal-alignment, risk of falls, fractures
Cardiorespiratory: cardiovascular performance, asthma (APA, 2008 )
Endocrine: Diabetes, improve body fat levels and glucose metabolism (APA, 2008)
1. Develop and run physical activities
2. Ongoing monitoring of obesity related co-morbidities
3. Knowledge and experience to treat obesity
related co-morbidities
'Game On' Physiotherapist Role Continued

Empower and provide with strategies (Norwicka, 2005)

Motivational techniques (Norwicka, 2005)
Time and stress management (Norwicka, 2005)
Addressing barriers/ lifestyle changes
Education for parents and adolescents
Psychosocial factors

4. Encourage physical activity outside contact time
5. Support behaviour change
National Chronic Disease Strategy (2005)
National Health Priorities (AIHW)
APA position statement on Chronic disease/conditions
Healthy Weight: The National Action Agenda for Children and
Young People and their Families
Australia: The Healthiest Country by 2020
APA Feedback to Australia: The Healthiest Country by 2020
Royal Children's hospital policy brief
Australian Bureau of Statistics. (2011-2012). Australian Health Survey 2011-2012. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/
Australian Institute of Health and Welfare 2012. A picture of Australia’s children 2012. Cat. no. PHE 167. Canberra: AIHW.
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