# Presentation: 136984

## NANCY WELLMAN, PhD, RD

**NANCY WELLMAN, PhD, RD**
**NATIONAL POLICY & RESOURCE CENTER ****ON  NUTRITION & AGING**
**Florida International University**
**with the US ADMINISTRATION ON AGING**

## EATING  BETTER

**EATING  BETTER**
**	****	****	****&**
**                             ****MOVING  MORE**

## HealthierUS 

**President Bush’s very simple formula: *****Every little bit of effort counts!!***
**4 keys to a Healthier America: **
***Be Physically Active Every Day***
***Eat a Nutritious Diet***
***Get Preventive Screenings***
***Make Healthy Choices***

**www.whitehouse.gov/infocus/fitness/toc.html**

## www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/slide

**www.cdc.gov/nccdphp/dnpa/obesity/trend/maps/slide**

## US Trends in Obesity

**Overweight: BMI >25**
**Adults: 55%; 97M (>20 yrs)**
**F:  50%; 47M**
**M: 59%; 50M**
** ****Obese: BMI >29 **
**Adults: 22%; 39.8M **
**F:  25%; 23M **
**M: 19%; 17M **
**14%: children & adolescents**

**www.niddk.nih.gov/health/nutrit**

## % Overweight & Obese by Age Groups

| BMI >25 | 20-29 | 30-39 | 40-49 | 50-59 |
| --- | --- | --- | --- | --- |
| Men | 43.1 | 58.1 | 65.5 | 73.0 |
| Women | 33.1 | 47.0 | 52.7 | 64.4 |
| Total | 38.3 | 52.6 | 59.0 | 68.5 |
| BMI >30 |  |  |  |  |
| Men | 12.5 | 17.2 | 23.1 | 28.9 |
| Women | 14.6 | 25.9 | 26.9 | 35.6 |
| Total | 13.5 | 21.5 | 25.0 | 32.3 |

## % Overweight & Obese by Age Groups

| BMI >25 | 60-69 | 70-79 | 80+ |
| --- | --- | --- | --- |
| Men | 70.3 | 63.1 | 50.6 |
| Women | 64.0 | 57.9 | 50.1 |
| Total | 66.9 | 60.1 | 50.3 |
| BMI >30 |  |  |  |
| Men | 24.8 | 20.0 | 8.0 |
| Women | 29.8 | 25.0 | 15.1 |
| Total | 27.5 | 22.9 | 12.6 |

## Overweight & Obesity

**INCREASED HEALTH RISKS**
**Highest concerns: Cardiovascular diseases (CVD) & diabetes mellitus **
**Hypertension, dyslipidemia, respiratory problems, sleep apnea, osteoarthritis, gallbladder disease**

## Diabetes & Older Adults

**~Half occur in people >55 yrs **
**Risk for Type 2 increases w/ age **
**~18.4% (6.3 M) age 65+**
**18% all nursing home residents **
**tend to be younger than ****non-diabetic residents**

## Costs of Obesity

**$70B of health care cost ****attributed to obesity**
**$33B on “quick fix” weight ****loss products and services by ****65M adult Americans**

**American Dietetic Association 2000, www.eatright.org**

## Costs of Sedentary Lifestyle

**Physical inactivity accounts for ****~15% of US health care budget**
**CVD: $298.2B**
**Type 2 Diabetes: $98B**
**30% reduction was achieved by those walking 2.5 hr/wk**
**15 lb. weight loss reduces risk by 60% ****& saves US health system $58B / yr**

## How physically active is the U.S. population?

**22% US adults are regularly physically active**
**5 times / wk for at least 30 minutes**
**15% get the recommended amount of vigorous activity **
**3 times / wk for at least 20 minutes**
**25% do no physical activity at all in their leisure time**

**U.S. DHHS, Physical Activity and Health: A Report of the Surgeon General. **
**Centers for Disease Control & Prevention, 1996**

## USA On the MOVE

**Part of President’s *****HealthierUS*****  Initiative**
**2 part project sponsored by AoA & Nat’l Policy & Resource Ctr on Nutrition & Aging**
**Part 1: ****Eating Better**
**Part 2: **** ****Moving More**
**Addresses health, nutrition, physical activity**

**www.fiu.edu/~nutreldr/STEPS_Program/USAontheMove/USA_on_the_Move_Factsheet.pdf**

## NATIONAL BLUEPRINT: Increasing Physical Activity Among Adults Age 50 & Older

**SPONSORS (March 2001)**
**AARP**
**American College of Sports Medicine**
**American Geriatrics Society**
**Centers for Disease Control & Prevention**
**National Institute on Aging**
**Robert Wood Johnson Foundation**

**www.rwjf.org/publicationsPdfs/Age50 Blueprint singlepages.pdf**

## NATIONAL BLUEPRINT: Increasing Physical Activity Among Adults Age 50 & Older

**VISION: **
**“****We envision a society in which all people age 50 & older enjoy health ****& quality of life which is enhanced ****through regular physical activity. **
**We will inspire an approach to aging ****that encourages physical activity in ****all aspects of people’s lives.”**

## NATIONAL BLUEPRINT: Increasing Physical Activity Among Adults Age 50 & Older

**Barriers to discussing physical activity w/ patients**
**Lack of time, reimbursement, resources, protocols, etc.**
**Physical activity counseling leads to increases in physical activity through **
**Training **
**Development of materials & programs**
**Coordination between health care & community programs, such as Senior Centers**

## NATIONAL BLUEPRINT: Increasing Physical Activity Among Adults Age 50 & Older

**Aligned with USDHHS *****Healthy People 2010***** Objectives**
**Noted that no national organization systemically addresses physical activity & older Americans**
**Based effective strategies on collaborations, coalitions, partnerships**

## CDC MMWR: Prevalence of Health-Care Providers Asking Older Adults about their Physical Activity Levels: US 1998

**NHIS Data 1998 **
**Only 52% reported being asked about physical activity during routine check-ups.**
**Those asked about physical activity were 1.7x more likely to engage in recommended levels of physical activity than those not asked.**

**www.cdc.gov/mmwr/preview/mmsrhtml/mm5119a2.htm**

## AARP: Beyond 50: A Report to the Nation on Trends in Health Security. May 2002 

**“****Fewer people age 50 & older smoke, more are using preventive services & are trying to exercise.**
**At the same time, however, a much larger portion ... is obese than in previous years, and only some ... are eating a healthy diet as recommended.”**

**www.aarp.org/beyond50**

## AARP: Beyond 50: A Report to the Nation on Trends in Health Security. May 2002 

**“****The epidemic of obesity—which nearly doubled between 1992 & 1999—could cancel out many of the gains achieved in other areas of prevention & treatment of diseases associated with aging.**
**Possibly as a result of rising obesity rates, diabetes has been increasing among older men & women, particularly 50-64 year olds.”**

## Institute of Medicine

***Dietary Reference Intakes (DRIs) for Macronutrients***
_***Energy***_***, Carbohydrates, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids***
**New Eating & Exercise Targets to Reduce Chronic Disease Risk**
**Released September 5, 2002**

**www.nap.edu**

## Institute of Medicine

**EXERCISE TARGET**
**To maintain cardiovascular health at a maximal level, regardless of weight, spend a total of **_**at least**_** **_**1 hour each day in **__***moderately***__** intense physical activity**_
**Double the daily goal set by *****1996 Surgeon General’s Report***

## Institute of Medicine

**1-HR-A-DAY EXERCISE GOAL**
**Average amount of daily energy ****expended by individuals who ****maintain a healthy weight**
**Energy expenditure: cumulative, includes**
**Low-intensity activities of daily life **
**Stair climbing, housecleaning, etc.**
**Moderate intensity activities**
**Walking at 4 miles per hour **
**High-intensity activities**
**Swimming, cycling, etc.**

## Institute of Medicine

**1-HR-A-DAY EXERCISE GOAL **
**Based on intensity**
**Moderate = 1 hr / day**
**High = 20-30 min 4-7 times / wk**

**IOM. *****DRIs on Macronutrients*****. Ch 12: Physical Activity. 2002**

## American Academy of Sports Medicine 

**“****In the past, exercise generally has been considered inappropriate for frail or very aged older individuals. The past decade has seen an accumulation of data that ****DISPELS ****the ****MYTHS**** of futility & and provides reassurance of the safety of exercise.”**

**Position Stand: Exercise & Physical Activity for Older Adults.  1998**

## ACSM: Exercise & Physical Activity for Older Adults

**Benefits of regular exercise**
**↑****Health status**
**↑****Quality of life & life expectancy**
**Maintains/improves cardiac function**
**Improves bone health; ****↓risk osteoporosis**
**↑****Postural stability; ↓risk of falling**
**Preserves cognitive function; ****alleviates depression symptoms**
**Protective effect on total body mineral content**

**www.acsm-msse.org**

## American Dietetic Association:Fitness from 50 Forward

**Manual to help nutritionists establish exercise programs for men & women ****over 50 years old**
**Program is safe & effective**
**Resistance exercise is safe & appropriate for older adults**
**Research shows that older adults have remarkable ability to increase strength, fitness & health when they adhere to a regular fitness program**

**www.eatright.org**

## EATING BETTER

**EATING BETTER**
**	****	****	****&**
**                             ****MOVING MORE**

## EATING BETTER: THE GUIDE

**PURPOSE**
**To celebrate 30 years of Older Americans Act Nutrition Programs ****& Older Americans Month (May). **
**To start older adults on the *****steps to healthy aging*****  path.**
**To encourage older adults ****to eat healthier.**
**To showcase local programs ****& their participants.**

## EATING BETTER: THE GUIDE Selection Criteria

_**RECIPES**_
**Ease of preparation**
**Low cost**
**Taste****	****	**
**Familiar favorites**
**New foods**
**Ethnic favorites**
**Healthful = nutrient dense**

_**TIPS**_
**Science-based**
**Applicable to needs of healthy older adults**
**Applicable to older adults with chronic illnesses/conditions**
**Easy to understand**
**Simple to apply, do-able behavior change**

## EATING BETTER: THE GUIDE Selection Criteria

**Who Can Submit**** **
**Anyone (program participant or program staff) affiliated with the Aging Network may submit up to 3 recipes and/or tips via a local program to the State Expert Panel.  **
**The local program selects ****1 recipe in each category ****and 10 tips for submission ****to their State Expert Panel.**

## EATING BETTER: THE GUIDE

**TIMELINE**
**FALL 2002  (Deadline TBA)****	**** **
**	****Recipes & tips submitted to Center **
**JANUARY 2003**
**	****Materials sent to AoA for review**
**MAY 2003**
**	****Release in OLDER AMERICANS MONTH**

## EATING  BETTER

**EATING  BETTER**
**	****	****	****&**
**                             ****MOVING  MORE**

## Steps to Healthy Aging:MOVING MORE

**Modeled after *****Colorado on the Move*****TM**
**Statewide lifestyle initiative to improve health ****and prevent obesity through physical activity**
**Coloradoonthemove.com**
** ****Moving More**** ****focuses on increasing physical activity**
** ****Moving More**** ****aims to add steps throughout the day to achieve a step goal**
** ****Moving More**** ****helps older adults recognize the value of physical activity**

## Steps to Healthy Aging:MOVING MORE

** ****MOVING MORE**** ****uses electronic step counters to monitor & increase physical activity in older adults**
**Easy to increase walking using step counters**
** ****MOVING MORE**** ****is**** ****FUN!**

## About the Step Counters

**Easy to use**
**One button reset**
**Large display**
**Accuracy tested**
**Safety leash**
**Alligator clip**
**Order online: ****www.fiu.edu/~nutreldr**
**Sold at cost: $11 ****+ S/H**

## Wearing your Step Counter

**Attach safety leash to belt loop or button hole; use alligator clip to secure counter. **
**It must be vertical with cover closed for accurate counts.**
**At end of each day, write down the displayed number — your total steps for the day.**
**To start a new day, press yellow ****reset button to set counter to zero.**
**Start wearing your counter at anytime during the day. Wearing ****it for even part of a day motivates you to walk more.**

**  ****Wear it directly above your ****     knee. **
**  ****Make sure it’s close & flat ****    to your body. **

## Moving More at any age enhances physical, emotional, psychological & social well-being.

## Moving More:MEASURING OUTCOMES

**Heidi Silver, PhD, RD, CNSD**
**Heidi.Silver@fiu.edu**** **
**Associate Director of Research**
**National Policy & Resource Center On Nutrition and Aging**** **

## Moving MoreWHY COLLECT DATA? 

**Share successes & challenges**
**Document effectiveness of interventions**
**Justify increased funding for ****more services**
**Standardize program methods**
**Identify problems needing intervention**
**Quality/performance improvement**

## Moving More RESEARCH: WHAT IS NEEDED? 

**Practical, reliable methods & measures  **
**Effect of physical activity/exercise on  **
**Functional status **
**Physical fitness, muscle strength, ****flexibility, balance**
**Body mass**
**Risk for obesity, cardiovascular disease, diabetes**
**Psychological health**
**Quality of life**
**Coordinated efforts with other programs**

## Moving MoreINSTRUMENTS to measure outcomes 

**Physical Activity Questionnaires**
**Modified Baecke Questionnaire for Older Adults**
**Physical Activity Scale for the Elderly**
**YALE Physical Activity Survey**
**Zutphen Physical Activity Questionnaire**
**Functionality**
**ADLs, IADLS**
**Health-related Quality of Life**
**CDC Healthy Days Measures**
**MOSF-36 **

## Moving More: FUTURE RESEARCH PROJECTS 

**Miami pilot –establish a model ****using step counters to increase ****physical activity in older Americans ****who participate in community ****Nutrition Programs**
**Other models needed**
**State, Area, Local**** **
**Contact the Center for assistance ****with measuring outcomes **

## Online at www.fiu.edu/~nutreldr

**Online at www.fiu.edu/~nutreldr**