1. Strong Bodies - Strong Minds Integrated Therapy An
Interactive e-Health Prescribed & Monitored PA Program for
Clinically Obese Geriatric Patients with Depression Robelyn Garcia,
PhD, MA, MS Arizona State University
_______________________________ Doctor of Behavioral Health Program
College of Health Solutions
2. NEED FOR INTERVENTION INTRODUCTION > Obesity is costing
the United States $605 billion annually, including over $200
billion in direct healthcare costs (Pianin & Ehley, 2014). >
More than one-third (78.6 Million) of American adults are obese
(Ogden, Carroll, Kit, & Flegal, 2014). > The highest rates
of obesity are found among senior adults (Hojjat, 2013; Smith et
al., 2011). > The most significant prevalence rate of comorbid
depression and obesity is 66% reported in obese older adults
(Preiss, Brennan, & Clarke, 2013).
3. CLINICAL SETTING North Scottsdale Primary Health Care Clinic
> Positioned in community with a large and growing demographic
of retirees, seniors aged 50-70 years, and older seniors aged
70-105 years (Scottsdale Senior Services, 2014). > Intervention
setting has availability of computer and adequate space for
presentation. > Standalone medical clinic with onsite laboratory
and integrated Behavioral Health Consultant (BHC).
4. POPULATION Clinically Obese Geriatric Patients with
Depression > By the year 2030, a 132 million Americans will be
older than 50 yrs (Housing Studies of Harvard University, 2014).
> It is projected that half of the elderly population will be
obese in 2030 (Hojjat, 2013). > The most significant increase in
depression and obesity in the U.S. has been among senior adults
(Older Americans Update, 2012; Preiss et al., 2013).
5. REVIEW OF LITERATURE > According to the Surgeon General
of the United States, lack of Physical Activity (PA) and exercise
is the number one health concern facing this country (U.S.
Department of Health, 2010). > Health professionals from
multiple disciplines concur on the myriad of mental health benefits
that a PA program can provide (Corbin, Welk, Corbin, & Welk,
2013; Dias, Dias, & Ramos, 2003). > PA has been shown as one
of the most effective treatments for obesity and depression in
elderly people (Dias et al., 2003; Garcia, 2011; Meltzer &
Jena, 2010; Smith et al., 2011).
6. REVIEW OF LITERATURE 8 week online PA class decreases
depression scale mean scores in Seniors (Garcia, 2011). GDS Scores
Normal >
7. REVIEW OF LITERATURE 8 week online PA class decreases
depression scale range scores in Seniors (Garcia, 2011).
8. REVIEW OF LITERATURE > Clinical obesity, one of the major
causes of preventable disease, has more than doubled in the last
three decades (Preiss et al., 2013). > The World Health
Organization labels obesity as a public health pandemic (epidemic
of world-wide proportions) and predicts that 700 million people
will be obese by the year 2015 (Hojjat, 2013). > 87 percent of
the United States population has Internet access (Pew Research,
2014a). > Based on review of literature, a monitored e-Health PA
program will have a beneficial effect on obesity and depression
among geriatric patients (Garcia, 2011; Ogden et al., 2014).
9. INTERVENTION DESIGN PROGRAM IMPLENTATION: TREATMENT
STEPS
10. INTERVENTION DESIGN > OBJECTIVE: The purpose of this 16
wk intervention is to access a BHC prescribed and monitored
e-Health PA program for the treatment of obesity and depression in
geriatric patients. > PATIENT SELECTION: Patients are referred
to the BHC by his/her Primary Care Physician (PCP) after they have
been diagnosed with clinical obesity and depression.
11. INTERVENTION DESIGN Cooperating Website: Senior University
> The online (e-Health) portion of the intervention is accessed
at Senior University online website. > The patient enters data
and receives feedback within 24 hours from the behavioral health
consultant via computer or smartphone browser. > This
organization serves older adults in the Scottsdale, Phoenix, and
Paradise Valley areas. www.SeniorUniversity.us
12. INTERVENTION DESIGN > Obesity is categorized by a Body
Mass Index (BMI) of 30 and above (Corbin et al., 2013; Cordes,
2014). > The presence and severity of obesity will be assessed
by using the BMI measurement of [weight (lb)/height (inches)2] X
703 (Cordes, 2014). > BMI will be measured at onset of
intervention, at the midpoint of intervention (8 weeks) and at the
conclusion of the intervention (16 weeks). > Patients can also
calculate his/her BMI at will using the e-Health interactive Strong
Bodies - Strong Minds BMI calculator via the Senior University
Website.
13. INTERVENTION DESIGN BMI population weight categories
Category BMI Underweight The presence and severity of depression
will be assessed by using THE MERCK MANUAL OF GERIATRICS (GDS)
Geriatric Depression Scale. Assessments will be performed at
baseline before and after the intervention PA program.
15. INTERVENTION DESIGN THE MERCK MANUAL OF GERIATRICS
Geriatric Depression Scale (GDS) QUESTIONNAIRE Circle the best
answer for how you have felt over the past week: 1. Are you
basically satisfied with your life? YES / NO 2. Have you dropped
many of your activities and interests? YES / NO 3. Do you feel that
your life is empty? YES / NO 4. Do you often get bored? YES / NO 5.
Are you in good spirits most of the time? YES / NO 6. Are you
afraid that something bad is going to happen to you? YES / NO 7. Do
you feel happy most of the time? YES / NO
16. INTERVENTION DESIGN THE MERCK MANUAL OF GERIATRICS (GDS) 8.
Do you often feel helpless? YES / NO 9. Do you prefer to stay at
home, rather than going out and doing new things? YES / NO 10. Do
you feel you have more problems with memory than most? YES / NO 11.
Do you think it is wonderful to be alive now? YES / NO 12. Do you
feel pretty worthless the way you are now? YES / NO 13. Do you feel
full of energy? YES / NO 14. Do you feel that your situation is
hopeless? YES / NO 15. Do you think that most people are better off
than you are? YES / NO
17. INTERVENTION DESIGN GERIATRIC DEPRESSION SCALE SCORING
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DEPRESSION CRITERIA: SCORE Normal: 3 Mildly depressed: 7 - 4
Moderately depressed: 8 - 11 Very depressed: 12
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(Adapted from Sheikh JI, Yesavage JA: "Geriatric depression (GDS)."
Edited by TL Brink, A Guide to Assessment and Intervention,
Clinical Gerontology, pp. 165 -173. Haworth Press Inc.,
Binghampton, N.Y., 1986.)
18. INTERVENTION DESIGN 16 wk e-Health PA program best
practices > Motivational Interviewing Design > Pre-Test /
Post-Test Design > One Treatment e-Health Therapy Design >
Interactive Design - Intervention website is optimized to be
accessed via computer or smartphone-mobile phone browser. >
Interactive Design - Patients can e-mail BHC anytime during
intervention program with questions. BHC will respond within 24
hrs.
19. INTERVENTION DESIGN Baseline: Before Intervention Program
Prior to participating in the treatment intervention PA program
patients complete the following: 1. The PAR-Q. 2. Adherence to PA
treatment contract. 3. A basic minimal risk consent form. 4. A
personal information patient form.
20. INTERVENTION DESIGN Intervention Treatment PA Program On
completion of the baseline assessments, patients complete the
following PA program, with a frequency of 5 times per week for 16
weeks: 1. Warm-up Flexibility Exercises 2. PA Prescription
Cardiovascular Endurance Activity (30 minutes) 3. Cool-down
Flexibility Exercises
22. INTERVENTION DESIGN STRONG BODIES - STRONG MINDS Exercise
Prescription: Cardiovascular Endurance PA Patients complete 30
minutes of one the following Cardiovascular Endurance Aerobic
Activities of choice: 1. Brisk Walking 2. Stationery Bicycle 3.
Elliptical Machine 4. Swimming *Frequency of 5 times per week for a
total of 150 minutes of PA each week per CDC guidelines (Corbin et
al., 2013).
23. RECOMMENDATIONS FOR FUTURE INTERVENTION > Future
intervention PA programs could incorporate a muscular strength
training exercise program in addition to the cardiovascular
training exercise program. > CDC recommends weight training
twice a week (Corbin et al., 2013).