05/03/2018 1 Dancing’s Role in Diabetes Prevention and Management Theresa Garnero, APRN, BC-ADM, MSN, CDE Founder, Executive Director Dance Out Diabetes Owner, Diabetes Catalysts, a virtual DSME practice UCSF Online Diabetes Education Certificate Program Author, cartoonist, dancer [email protected]1-800-259-9782 Share at least 1 best practice how you APPLY the being active AADE7 Self-Care behavior to your population (part 1) Compare outcomes of a monthly dance program called Dance Out Diabetes (DOD) to the Diabetes Prevention Program’s (DPP) intensive lifestyle adjustment arm (part 2) Evaluate personal joy quotient after an easy, simple 15-minute dance exercise (part 3) OBJECTIVES An idea is born Review AADE 7 Share best practice PART 1
Transcript
05/03/2018
1
Dancing’s Role in Diabetes Prevention and Management
Theresa Garnero, APRN, BC-ADM, MSN, CDEFounder, Executive Director Dance Out DiabetesOwner, Diabetes Catalysts, a virtual DSME practiceUCSF Online Diabetes Education Certificate ProgramAuthor, cartoonist, dancer
Share at least 1 best practice how you APPLY the being active AADE7 Self-Care behavior to your population (part 1)
Compare outcomes of a monthly dance program called Dance Out Diabetes (DOD) to the Diabetes Prevention Program’s (DPP) intensive lifestyle adjustment arm (part 2)
Evaluate personal joy quotient after an easy, simple 15-minute dance exercise (part 3)
OBJECTIVES
An idea is born
Review AADE 7
Share best practice
PART 1
05/03/2018
2
Exercise Used to Be Easy
The ContinuumHealth is an open process of being and becoming
Based on Nursing Theorist, Rosemarie Rizzo Parse, RN, PhD’s “Human Becoming Theory”
Life Death
Co-creating rhythmical patternsof relating in mutual process
Giving meaning through lived experience, constantly transforms
• Yet, as healthcare providers, how have we embraced the 7 self care behaviors as identified by the American Association of Diabetes Educators?
• What are the AADE7?
Mulcahy K, Marynuik M, Peeples M, Peyrot M, Tomky D, Weaver T, Yarborough. Technical review of the diabetes self-management education core outcomes. Diabetes Educator. 2003;Vol29:No5.
AEROBIC / MODERATE 30 min-5 days/week or 2.5 hours/week: increase pulse/breathing but can still talk normally: brisk walking, dancing, swimming, OR 75 mins of vigorous intensity aerobic activity, like jogging weekly, OR a mix
+STRENGTH* 2 or more days/week
8-10 exercises with 8-10 repetitions with weights for major muscle groups (legs, hips, back, abdomen, chest, shoulders, and arms)
*Except for heart, eye, kidney & nerve problems+
BALANCE for older adults
Exercise Guidelines /Adults 18-65
05/03/2018
12
A 2 Question Assessment
1. How many days a week do you engage in moderate to strenuous exercise?
2. How many minutes at that level?
Endocrine Today Jan 2015 / Young DR. Prev Chronic Dis. 2014
Health Benefits with Time Spent on Physical Activity
2008 health.gov/paguidelines/guidelines
Exercise Also Helps These Issues
05/03/2018
13
Guidelines for Older Adults?
• Avoid inactivity: some is better than none• Do aerobics: in episodes of at least 10 mins• Strengthen muscles: resistance bands or wts.• Be as physically active as their abilities and
conditions allow.• Do balance exercises to prevent
falls.
THE SAME AS FOR ADULTS
Adults Meeting the Guidelines?
National Health Interview Survey 2016 (per CDC) shows adults 18 and over meeting guidelines:• 51.7% for aerobic activity • 21.7% for both aerobic &
muscle strengthening
How much time do you dedicate to Being Active?
Is it mostly in the cognitive domain?
Do you have onsite options to exercise?
Have an exercise physiologist?
Diabetes Education = 10 hours
05/03/2018
14
Sharing Best Practices
Barriers Similar for Adult with & without Abnormal Glucose Metabol?
According to Hume et al, yes! (Diab. Educ. 2010)
• Boring• Takes effort• No time• Pain• Physical limitations• NOT FUN• What is the alternative?
Dance Out Diabetes, bringing the clinic to the dance floor x 5 years
Check www.danceoutdiabetes.comfor videos and free educational materials
05/03/2018
15
Dance Out Diabetes (DOD): a Monthly Intervention
• Monthly dances with health screenings by CDEs
• Integrated safety measures• $277 in services at no charge
(incentivized even with carrot cash)• Published outcomes
• Fun!
DOD Metrics, Access & Safety
• BG before and after dance• A1C, BP, BMI,
waist circumference• Consultation with
diabetes educators• Dance instructor and
room safety• $10 “carrot cash” rewards per dance
From the Certified Diabetes Educator Station
05/03/2018
16
Side Effects of Dance Out Diabetes
• FUN• Connection• Community• Reliable info• Access to care• Get paid to exercise• Prevent & manage diabetes
No special equipment needed. All ages and abilities welcome.
How this Creative 501 (c)(3)Model of Medical Fitness Works
• No staff. Volunteer based.• Grants, donors, participants
Our First Intern Was from UWSP!
• Kenzie Kujawski teaching a class• Health Promotion/Wellness
major and nutrition minor• Now a Health Coash at Aspirus
05/03/2018
17
Cultural Odyssey of Dances for the Non-dancer!
And, the Music…
DJ CHARIS!
Scenes from the Dance Floor
05/03/2018
18
A Belly Dancing Moment
Dancing is a Break from Thinking Like a Pancreas!
Dancing Protects Against Dementia!
• Playing golf, 0%• Bicycling and swimming, 0%• Crossword puzzles at least 4 days a
week, 47%• Dancing at least 4 days a week had
76% lower risk for dementia than those who danced weekly
Dance often!
05/03/2018
19
Compare outcomes ofDance Out Diabetes to the Diabetes Prevention Program (DPP) – intensive lifestyle adjustment arm.
First – let’s review DOD data
PART 2
DOD Outcomes
• 165 participants, 122 of which had demographics AND program, biometric data… N = 122
0
10
20
30
40
50
60
Participant Friend Volunteer Health CareProvider
60
44
18
7
2014
Participant Details
89
28
1 1
Female
Male
Transgendered
Intersex
75%
24%
1%
05/03/2018
20
Diabetes Status
0
5
10
15
20
25
30
35
40
45
Self-identifieswith Diabetes
Self-identifies "No DM" but
A1C≥5.7
Self-identifies"No DM" with
A1C<5.7
Self-identifies"No DM" with no
A1C data
25%
31%34%
10%
Diabetes Self-Identity
• Type 2 = 21%• Type 1 = 5%• Prediabetes = 12%• Gestational = 3%• Unknown = 3%, none = 40%• Self-identified HTN = 15%; High cholesterol = 13%
Self-identifies type 1
Self-identifies type 2
Self identifies "None"
Self identifies "Unknown"
Self identifies "Pre-diabetes"
Self identifies "Gestational"
Participant Ethnicity
32% 20% 19% 16% 10%
05
1015202530354045
3% 3% 2%
05/03/2018
21
Special Characteristics
0
2
4
6
8
10
12
14
16
18
ESL Visually Impaired LGBT Hearing Impaired Uses a cane Uses a wheelchair
9%
4%3%
Previous years
• 68% reported none of these• 10 participants listed 2 special characteristics
14%
10%
Return Rate
• 52% came to one class• 20% to 2 classes• 7% to 4 classes• 22% returned between 4 and 10 classes
0.0%10.0%20.0%30.0%40.0%50.0%60.0%
At 3, 6, 9, 12 Mo. Follow-up Sessions
0
10
20
30
40
50
60
3 month 6 month 9 month 12 month
05/03/2018
22
Exercise Frequency
• Only 51 of 122 responded to, “During the last 7 days, how many days were you physically active for at least 30 minutes?” and responses decreased throughout the year
• Baseline was 2.86 days a week• Gradual increase in exercise frequency for those
who returned and responded:4.34 days/week at 3 months (n = 54)4.39 days/week at 6 months (n = 26)4.64 days/week at 9 months (n = 15)
• Limited paired data at key intervals
A1C for PWD – Overall
PWD all data N Mean Minimum Maximum
Baseline 27 6.84 5.3 10.2
3 months 12 6.99 5.0 9.3
6 months 8 6.40 4.9 7.4
9 months 3 6.07 5.2 7.7
12 months 0
PWD w/baseline <7, PAIRED data Mean Mean change N p
Pair 1 3mo f/u A1C 6.730.00
91.000
Baseline A1C 6.73 9
Pair 2 6mo f/u A1C 6.40‐0.16
80.385
Baseline A1C 6.56 8
Pair 3 9mo f/u A1C 6.070.27
30.595
Baseline A1C 5.80 3
A1C change: PWD w/Baseline ≥ 7%
• A1C went down for PWD >7%; limited paired data.
PWD & Baseline >=7.0 N Mean Minimum Maximum
Baseline 8 8.30 7.1 10.2
3 months 3 7.90 7.1 8.8
6 months 2 7.25 7.1 7.4
9 and 12 months 0
PAIRED Data of PWD& Baseline >=7.0 Mean
Mean change N p
Pair 1 3mo f/u A1C 7.90‐0.27
30.668
Baseline A1C 8.17 3
Pair 2 6mo f/u A1C 7.25‐0.55
20.272
Baseline A1C 7.80 2
05/03/2018
23
A1C baseline: “No DM” but A1C ≥5.7
• 9.1% and no diabetes?
“No DM” but baseline ≥5.7 N Mean Minimum Maximum
Baseline 35 6.189 5.7 9.1
3 months 9 6.656 5.9 8.3
6 months 8 6.213 5.1 7.7
9 months 1 6.280 5.1 8.0
12 months 5.500 5.1 5.5
A1C paired change: “No DM” but A1C ≥5.7
• A1C remained less than 7% for paired data, although N is small.
PAIRED Data of "No DM" but A1C>=5.7 MeanMean change N p
Pair 1 3mo f/u A1C 6.9170.80
60.138
Baseline A1C 6.117 6
Pair 2 6mo f/u A1C 6.1800.20
50.632
Baseline A1C 5.980 5
Pair 3 9mo f/u A1C 6.2250.28
40.657
Baseline A1C 5.950 4
Pair 4 12mo A1C 5.500‐0.30
1aNA
Baseline A1C 5.800 1a
BP for PWD
• Limited data… but BP went up for all PWD
People with Diabetes Mean SBP Minimum Maximum N
Baseline 127.58 96 190 31
3 months 131.29 96 182 17
6 months 127.00 93 153 8
9 months 127.50 112 157 4
People with Diabetes MeanMean SBP Change N p
Pair 13 months 131.29
4.1717
0.430Baseline 127.12 17
Pair 26 months 127.00
7.138
0.315Baseline 119.88 8
Pair 39 months 127.50
3.254
0.835Baseline 124.25 4
05/03/2018
24
Change in “Adherence”
Participants who said they took meds were asked,
“During the last 7 days, did you skip or forget to take at least one of these pills or injections?”
We compared non-adherence at baseline, to remaining non-adherence
to becoming and staying adherent at 3, 6, 9, 12 months
Change in Waist and Weight: theonly significant biomarker finding
Paired Change in Waist &Weight Mean Mean Change p N Lower Upper
Pair 13mo f/u Waist 38.73
‐0.44 .32335
Waist.1 39.16 35
Pair 26mo f/u Waist 38.68
‐1.40 .03117
‐2.65 ‐0.15Waist.1 40.07 17
Pair 39mo f/u Waist 37.90
0.15 .77612
Waist.1 37.75 12
Pair 412mo Waist 31.00
‐1.42 .0933
Waist.1 32.42 3
Pair 53mo f/u Weight 176.71
0.92 .42641
Wt.1 175.78 41
Pair 66mo f/u Weight 172.74
1.82 .32222
Wt.1 170.92 22
Pair 79mo f/u Weight 169.90
‐0.39 .82613
Wt.1 170.29 13
Pair 812mo Weight 131.73
‐0.13 .9123
Wt.1 131.87 3
Inspired Change
“What has DOD inspired you to change or maintain?”
0
10
20
30
40
50
60
70
80
90
100
Dance andexercise
Health eating,FarmersMarket
Weightcontrol
Better health,risk reduction
Better BGcontrol
Feel good Community Medication
13%11%
6%4%
2%0.5%
203 comments with 245 topics mentioned!
38%
26%
05/03/2018
25
Detail of Inspired Change, Mo. 4
blood sugar maintenance. Keep the appropriate blood pressure. Be healthy by doing exercise and dances
exercise more and build into my schedule more oftenexercise-danceexercise, diet
Farmers Marketfun!
I want to be a certain weight and have a good diet. DOD has helped me with this.
keep moving/exercising, eat better foodskeep my diet
lose weight, take control of memaintaining and recording my blood sugar
more danceMore movement
my eating, paying attention to my activity. It inspires me to take control of my life. You have created a great community to learn about diabetes.
over all healthstay away from sweets
to be more active
Compared to DPP
0
200
400
600
800
1,000
1,200
DPP DOD
Lifestyle participants
0
10
20
30
40
50
60
DPP DOD
Mean age
BMI
• DPP: 1,079 participants, 27 centers for 16 weeks, well-funded; mean age 50.6 and BMI 33.9
• DOD had 165 participants in 1 location for monthly intervention, barely funded; mean age 54 and BMI 30.9, incentivized
Compared to DPP part 2
• DPP: 68% women, 46% minority groups, wt loss goal 7%• DOD: 75% women, 54% minority group, wt loss goal not set
Standard Ballroom & Latin Dance Program Improves Fitness PWD T2 & in Obesity
• 6-month study in Bologna, Italy• Low impact dance 2x/week (120 mins each
session) in the clinic or a self-selected program• Total of 100 people (47 with T2, 53 w/obesity), 52
males, 48 females, mean age 59, A1C <8.5% and/or obesity > 30 (only 9% with normal wt)
• 77% participation
Mangeri F et al. A standard ballroom and Latin dance program to improve fitness and adherence to physical activity in individuals with type 2 diabetes and in obesity. Diab & Metabolic Syn 2014: 6:74.
Dance as Effective as Home Programs (going to the Gym, etc. with Less Attrition Rates)
At 6 months, odds ratio of wt loss targets were not different btw groups whereas the 10 MET-hour/week (energy expenditure) targets 10% higher with dance group
Mangeri F et al. A standard ballroom and Latin dance program to improve fitness and
adherence to physical activity in individuals with type 2 diabetes and in obesity. Diabetology &
Metabolic Syndrom 2014: 6:74.
05/03/2018
29
Dance Improves Diabetes Outcomes
• 12-week study in a community-based outpt. clinic• Low impact dance 2x/week (60 mins total: 5 mins
warm-up, 45 min. dance, 10 min. cool down)• Total of 46 African American women, 26 to 83 y/o.
24 went in dance group vs 22 in usual care group• Peer support via semi structured discussions for the
women in the dance group• Expressed support as camaraderie, enjoyment, and
laughter which fostered attendance.Murrock, CM, Higgins, PA, Killion, C. Dance and Peer Support to Improve Diab Outcomes in African
American Women. Diab Educ. 2009 Nov-Dec;35(6):995-1003
Dance Improves Diab. Outcomes (part 2)
Dance group vs. Usual care:• A1C decreased 0.5 vs. increased 0.3• Weight decreased 4.9 vs. 3.7• Body fat decreased 2.8 vs. increased 0.8• SBP decreased 8.8 vs. increased 4.1• DBP decreased 10.2 vs decreased 1.4
Note: wt about 210 in both groups, no significant difference in mean # years dx, entire sample on meds (78% on orals and 22% on orals/insulin), 76% treated for HTN, 71% for cholesterol, 17% smoked. 4 dropped out of both groups do to job change, lost to follow-up and one died in usual care group.
Deaths from Lack of Exercise Doubles Those from Obesity
• Even modest increases in activity by inactive individuals could bring significant health benefits
• Cohort of 334,161 European men and women were studied over 12.4 years to assess relationship between physical inactivity and premature death.
• Just 20 minutes would make a difference.
Ekelund U, et al. Am J Clin Nutr. 2015. Deaths from lack of exercise double those from obesity.
05/03/2018
30
Evaluate personal joy quotient after participating in an easy, simple 15-minute dance exercise
PART 3
Joy Quotient
Let’s do a mini-study and experience the effect first hand.
RIGHT NOW – how joyful do you feel on a 1 to 5 scale.1= I feel great or quite joyous2= I feel pretty good3= I’m so-so4= I’m annoyed, or a little angry, or just not feeling it5= I am very annoyed or angry
Write this number down secretly
The Child Inside You
05/03/2018
31
About the Music…
Now, Some Free Dance!
Joy Quotient – part 2
What number are you now? Let’s compare
RIGHT NOW – how joyful do you feel on a 1 to 5 scale.1= I feel great or quite joyous2= I feel pretty good3= I’m so-so4= I’m annoyed, or a little angry, or just not feeling it5= I am very annoyed or angry
Compare your first number
05/03/2018
32
With consistent levels of being active
The best chance of exercising tomorrow is planning it tonight -Dr. Najeh Ahmed
Increasing & Maintaining Our Joy
Walking (or Dancing) the Talk
Adapted from Rosemarie Rizzo Parse, RN, PhD’s “Human Becoming Theory”
Life Death
Co-creating rhythmical patternsof relating in mutual process
Giving meaning through lived experience, constantly transforms
Health
Disease
.
If you can walk, you can dance
If you can’t walk, you can chair dance
If you have an idea to help PWD or those at risk for it to be active, do it!
