champlain drcc newsletter vol.2, no. 3, june 2012 champlai… · ideally, an insole can be modified...

InsIde thIs Issue

Vol.2, No. 3, June 2012

The Canadian diabeTes assoCiaTion 2008 CliniCal Practice Guidelines for the Prevention and Manage-

ment of Diabetes in Canada have identified key elements for physical activity and exercise.

Regular physical activity can improve fitness, increase vigour, improve blood glucose control, decrease insulin resistance, improve lipid profile and blood pressure, help maintain weight loss and reduce morbidity and mortality. The guidelines recommend 150 minutes of aerobic exercise and 3 session of resistance exercise per week.

Diabetes educators can start the conversation and encourage their clients to adopt regular physical activity by:• Asking about physical activity at every visit• Use the new CDA physical activity and exercise

tools: www.diabetes.ca/physicalactivityprofessionals• Advise and encourage non-active clients to “get

moving”• Encourage and guide those that are active to maintain

or progress

Diabetes educators and providers can also use the 5 “A”s to promote physical activity.

Assess: Establish current Physical Activity level and readiness• Not active, not thinking about physical activity• Not active, ready for physical activity• Active and ready to maintain or progress with physi-

cal activity

Advise: Encourage all clients to get more active. Review the health risks, benefits of physical activity, and appropriate amount and type of activity

Agree: Collaborate on goal setting and personalized action plan

Assist: Identify personal barriers, challenges and strategies to overcome them

(continues on page 2)

New website: champlaindrcc.caSo your diabetes client want to start walking... Things to consider before taking that first step...

Getting activeResistance Bands Follow Up

Diabetes GPS: Helping you to navigate your diabetes!Why sit when you can stand

Activities in AlexandriaRenfrew County Diabetes Education Program - Exercise Pilot

New Member to the Champlain Diabetes TeamNew Year’s Resolutions

Initiating the conversation: Physical Activity for Your Clients (Part 1)Tools for Health Care Providers

Tools for People living with diabetesAdditional Ressources

specIal Issue on physIcal actIvIty

Champlain DRCC Newsletter

Introduction

Champlain DRCC Newsletter - June 20122

We are proudly announcing the launch of a new website of the Champlain Diabetes Regional Coordination Centre.

www.champlaindrcc.ca went live on April 25, 2012. The launch of the website is part of the organization’s ongoing efforts to increase access to diabetes education programs and diabetes related services in the region. The need for such a website was identified during the Champlain Diabetes Regional Coordination Centre client and health care providers consultations last Fall.

The website boasts a simple layout divided into two distinct sections: (1) Health Care Providers and (2) People living with diabetes. People living with diabetes and health care providers in the Champlain region now have access to lists of services, tools and resources, along with links to regional partners in the prevention and management of diabetes.

Other website functions include Google Maps for the Champlain diabetes education programs and foot care services, and a Tableau dashboard highlighting some of Champlain diabetes risk factors and clinical tests data.

We will continue to add and edit the website to provide the most recent and innovative services in the Champlain region.

The Champlain DRCC Team

new websIte: www.champlaindrcc.ca

Introduction (continued)

Arrange: Create a plan for follow-up with visits, phone calls or email reminders

For further guidance review: http://www.diabetes.ca/documents/for-professionals/PAE_CPG_chapter_summary_4a.pdf

Diabetes and Physical Activity: Your Exercise Prescription:http://www.diabetes.ca/documents/for-professionals/Patient_Provider_Prescription_Tool_4.pdf

References:Ian Blumer, MD, Chair, Dissemination & Implementation Com-mitteeCanadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada1. Church TS, Cheng YJ, et al. Exercise capacity and body com-position as predictors of mortality among men with diabetes. Diabetes Care. 2004; 27(1): 83-88.2. Knowler WC, Barrett-Connor E, et al. Reduction in the inci-dence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403.3. 2008 Canadian Diabetes Association Clinical Practice Guide-lines Expert Committee. Canadian Diabetes Association 2008 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes. 2008; 32 (suppl 1): S1-S201.

Champlain DRCC Newsletter - June 2012 3

From Client Consultations:For the qualitative questions, diet and controlling weight were the top challenges provided by survey participants as they manage their diabetes. Survey participants successes were focused around regular physical activity, weight loss, gaining knowledge/feeling in control of their diabetes, maintaining A1C in an appropriate range and keeping up to date with all the tests and screening.

From Clients at the Ottawa Diabetes Expo:Participants at the Expo identified their successes in managing their diabetes.

“Diet control. Exercise and diet working. Exercise, aqua fit three times a week. Exercise, frequent monitoring, good eating habits. Exercise has been stepped up. Getting good care and managing most of the time with diet and exercise.”

4 Champlain DRCC Newsletter - June 2012

Walking is a greaT aCTiviTy WiTh many healTh benefiTs, an aCTiviTy ThaT many of us Take for granTed as being a safe exercise; we throw on our walking / running shoes and off we go. For a person living with

diabetes, walking is a great way to help control their blood glucose levels, but there are some things they should be mindful of as too much walking or walking in the wrong shoes can cause foot problems, particularly for the insensate foot.

Here’s some quick advice for your diabetes client: Prior to walking, check feet, check socks, check shoes. Why? If there is a sore on the foot, any extra stresses that arise from walking can slow healing of existing wounds and can cause other areas to breakdown as the person may adopt an avoidance gait. In this case, minimize the time walked and keep pressure deflected from the sore area until healing is complete. Felt padding can be applied to the foot to deflect pressure, (many chiropodists can provide felt padding to clients at minimal charge or it can be purchased from a local drug store). Ideally, an insole can be modified or a custom orthotic can be designed to keep pressure away from vulnerable areas of the foot for the best long term protection during walking.

The feet should also be checked after the walk to see if any blisters have formed from shearing stresses that occur naturally during any walking activity. In a normal foot, shearing stresses would result in a burning pain which would alert the person to stop the activity, however, when neuropathy is present, the person may not experience burning pain and may keep walking and walking, causing blistering on the plantar aspect of the foot. With continued shearing stresses, capillaries may break open and bleed into the blisters causing blood blisters to form. These blood blisters become ulcers as they break open. To avoid this problem, walking should be done in comfortable footwear, wearing seamless socks to avoid abrasion and build up walking time gradually. Look for reddened areas of skin on the foot when examining the feet after walking, shearing stresses cause the skin to turn red first before the blisters form. Cut back on walking, examine the shoes for support and try again. If the redness continues to occur in the same area, shoes may need to be changed for a more supportive pair, or the person may need orthotics.

Walking is a great exercise, and should be encouraged in persons living with diabetes. Encourage your clients to inspect their feet regularly and walking will be carefree!

Lena MacMillan B.A., D.Ch., D.E. Registered ChiropodistDiabetes EducatorCommunity Chiropody ProgramCommunity Diabetes Education Program of OttawaCentretown Community Health Centre420 Cooper St.Ottawa, ON613-233-4443 x3027

so your dIabetes clIent want to start walkIng... thIngs to consIder before takIng that fIrst step...

By Lena MacMillan

5Champlain DRCC Newsletter - June 2012

gettIng actIveBy Natacha Ducharme

The sandy hill CommuniTy healTh CenTre offers 2 exercise classes for 50 years + on Tuesday morning

from 9:30 to 10:30 in French & 10:30 to 11:30 in English. There are many clients who have diabetes in the program, which has shown to be quite successful for them. We do cardio, manual dexterity, balance, resistance training with free weights & elastic bands and complete with stretch-ing.

There is also the Rideau Centre Mall Walking program that has been running for the last 20 years. It is on Monday & Thursday morning from 8 to 10 am. It is a Heart Wise program. Many walkers do have diabetes, and the walking

club has been helping them in managing their sugar levels, but also their social interaction with their community.

In 2008, an exercise guide with elastic bands was designed for clients living with diabetes (colour pictures). The tool will be available within the client tool box on the www.champlaindrcc.ca website and is available in French & English.

Natacha Ducharme, CSEP-CEPSandy Hill Community Health CentreTel. 613-304-8225

using resisTanCe bands for sTrengTh Training

There are many important benefits that come from a regular routine of strength training, including improved insulin sensitivity and glucose tolerance. Resistance bands have been shown to help people increase their strength as well as their lean muscle. Resistance bands are great tools because they are lightweight, portable, won’t hurt you if you drop them, and can be used in a variety of ways to exercise all body parts. Two times a week for fifteen minutes is enough to start making a difference.

Watch the OTN for descriptions of some easy exercises you can do. http://mediasite.otn.ca/mediasite41/Viewer/?peid=01e769a9eec4414193e282e6fe819a0a1dUser Name: centretownPassword: bands427

Join the Resistance and Use the Bands!

Janet EdwardsCommunity Health PromoterCentretown Community Health Centre

resIstance bands follow upBy Janet Edwards


being diagnosed WiTh a ChroniC illness is never an easy experienCe regard-less of your age, race, or socio-economic status. Chronic diseases can often

require substantial lifestyle changes, particularly for those living with Diabetes. Even with a supportive family, friends and healthcare professionals, obstacles are encountered in everyday life that makes controlling your diabetes a challenge. This can be especially true for newly landed immigrants, individuals who have commu-nication or language barriers, and other persons living with diabetes who may not have the traditional support or access to healthcare found in many larger North American communities.

In order to ease this burden, the CDA, along with grants from the Public Health Agency of Canada, have developed the Diabetes GPS. This initiative is aimed at providing Canadians with critical information and support no matter where they are and regardless of which medium they are using. Access to diabetic information is now easier, more direct, and available in eight different languages (currently available in English, French and Cantonese – but keep your eyes peeled for Mandarin, Punjabi, Hindi, Urdu and Tamil soon!). The Diabetes GPS will help remove some of the barriers to diabetes education experienced by persons living with diabetes.

The CDA have also redesigned many of its literature materials and other information packages to make them more culturally relevant to high-risk groups and ensure the information provided is easily interpreted and retained to aid in closing the gap between understanding your diabetes and leading a healthy lifestyle. This is achieved not only through extremely thorough translations, but also through the addition of visual aids to supplement our literature pieces. Visual representation assists those having difficulty comprehending specific concepts; these visual aids can often be the “missing piece” in an otherwise complete puzzle.

To further complement all of these exciting initiatives, the Diabetes GPS will also include interactive online tools, such as the Healthy Heart Checklist, and a Smartphone app available on all Android, Blackberry and iOS devices. The Diabetes GPS Smartphone app is a great new way to count and keep track of carbohydrates, check the nutritional information for hundreds of food items, obtain diabetes friendly recipes, and a handy grocery list to help you keep on top of everything.

The Diabetes GPS is live now, and can be reached via phone (1-800-BANTING), e-mail ([email protected]) or on the web at www.DiabetesGPS.ca! So if you or anyone you know is looking for help to navigate their diabetes – you know where to point them!

dIabetes gps: helpIng you to navIgate your dIabetes!

By Benjamin Lowrey

Why sit when you can standAbout a month ago I shifted to a standing desk and prefer it to sitting. Maybe it’s psychological but I feel that I have better posture, not so sleepy during the day and dont’t feel so tired at the end of the day. Also, when I stand at my desk if I have the chance to listen to tunes while working on a project, well, it’s that much easier to dance!!Next phase is converting to a treadmill desk.

Chrys Silvestre Community Diabetes Education Program of Ottawa

Activities in Alexandria Walk & Learn: Dome in Alexandria; a series of 5 X 10 min. presentations alternating with 10 min. of walking between sessions.Meeting clients at the Dome: walk with them to introduce them to the Dome and encouraging them to increase physical activity.

Sophie Séguin-Levac, RN, CDEEmily Templeton, RDCentre de Santé Communautaire de l’Estrie


The diabetes outreach team of the Renfrew County Diabetes Education Program (RCDEP) has partnered with the Ottawa Heart Institute (OHI), the Diabetes Regional Coordination Centre (DRCC) and three Heartwise Exercise sites in Renfrew County to run pilot exercise programs for clients living with diabetes and/or at risk of developing diabetes.

The pilot which ran from December 1 2011 to April 1 2012 included the Best Western Fitness Centre in Pembroke, Pikwakanagan Fitness Centre in Golden Lake and Fun, Fit & Fully Alive at the Whitewater Bromley Community Health Centre (WBCHC) in Beachburg.

Key objectives of this pilot were to:• provide a safe environment for clients with diabetes and/or prediabetes to exercise• motivate clients with diabetes and/or prediabetes to integrate exercise into daily routine• increase the number of diabetes clients participating in exercise programs• increase awareness of diabetes prevention and management through enhanced physical activity

The diabetes outreach team conducted training sessions with staff and participants and worked closely with the exercise sites to ensure that both receive the appropriate support, education and counselling related to their diabetes and exercise program.

Key activities included staff training, client education and support, distribution of hypoglycemic kits, exercise logs, pedometers and resources, data collection and evaluation.

The Renfrew County Diabetes Education Coordinator managed and coordinated the pilot project, the partner sites provided the space, exercise program and data collection, the OHI oversaw the Heart Wise certification of the sites and lent their expertise to the program and evaluation, while the DRCC assisted with pilot materials and analysis of the evaluation data.

Results of the pilot included the analysis of both quantitative and qualitative data. Although the number of diabetes clients attending exercise programs at the three sites was low, an increase in numbers was noted at 2 of the 3 sites at the end of the pilot. Diabetes educators reported a low number of referrals were made to the exercise programs due to location and due to program fees. Renfrew County has the largest geographic spread and encompasses 42% of Champlain’s total area. The three pilot sites involved in the pilot were located within a 50 km radius which limited access for many clients in Renfrew County.

Feedback from exercise staff indicated that the training sessions were beneficial and a need for ongoing training was identified. Future recommendations included expanding to additional Heart Wise sites across the county, integrating diabetes with stroke training across sites, incorporating physical activity sessions with diabetes outreach events, and identifying opportunities to implement physical activity programs with no cost, such as walking programs all year round.

continues on page 8

renfrew county dIabetes educatIon program exercIse pIlotBy Karen Roosen


Renfrew County Diabetes Education Program Exercise Pilot - Continued

The outreach team is in the process of implementing a plan for next steps which includes expansion across the county and incorporating physical activity sessions with diabetes outreach activities. Ongoing data will be collected and evaluation results collated by March 2013.

The Renfrew County Diabetes Education Program appreciates the importance of continued partnerships with the DRCC, OHI and exercise sites, which is key to the success of improving physical activity and creating a healthier lifestyle for residents living with diabetes and/or at risk of developing diabetes.

FOR MORE INFORMATION, PLEASE CONTACT:Karen Roosen, Diabetes Education CoordinatorPembroke Regional Hospital(613) 732-3675 ext. 6530 / [email protected]

new member to the champlaIn dIabetes team

Hello Everyone,

I would like to take this opportunity to introduce Janine Rourke RN/CDE to all of you. Janine has extensive diabetes program experience, and we are so proud to now have her on our team! Check out the links below to see some of Janine’s work.

http://www.usatoday.com/news/health/story/health/story/2011/05/Native-Americans-vs-diabetes/46992058/1http://indiancountrytodaymedianetwork.com/2011/05/13/st-regis-mohawk-diabetes-patients-stay-active-await-new-diabetes-clinic-33844

Brigitte Blazina RN/BScN/CDEProgram Manager of Community HealthMohawk Council of Akwesasne613 575-2341


new year’s resolutIonsBy Maria Lemus

every January, neW year’s resoluTions are made by ClienTs regarding physiCal aCTiviTy. These resolu-tions tend to last anywhere from a couple of hours to several days or even several weeks. Unfortunately, over-

time clients revert back to their old ways of inactivity, and that resolution made in January is long forgotten. Indi-viduals who have been successful with incorporating more activity into their lifestyle, have shared that the following has helped them to incorporate more activity into their lives:

1. Setting a goal. Have a concrete activity goal to work towards. Furthermore, activity goals should be specific and realistic. For example, a client who wanted to become more active, set a goal to walk for 15 minutes after breakfast, three days a week and has been successful with this goal.

2. Seeking support from others. People have shared that partaking in activities such as walking with partners, friends, coworkers and Lassie helps them to maintain their commitment to living a more active lifestyle. For example, a client communicated that she and her sister meet up regularly to walk; she finds it motivating to walk with her sister because they get to spend time together while exercising.

3. Picking an activity they enjoyed. Recently saw a client whose partner kept insisting that he should be swimming for exercise. This client did not like swimming. However, he enjoyed walking and as a result he walked regularly for exercise. If clients participate in an activity that they like and enjoy, they are more likely to stick to it.

4. Making it fun. Switch up the routine. A client shared that she participates in a variety of activities to keep it interesting: She walks, bowls and swims. Another client shared that although walking is her main activity, she likes to dance on days she is not able to get out for a walk.

5. Scheduling activity. Determine which days and what time activity will be completed and write it down in a day planner/calendar/ note book etc. This has been helpful to some clients because it provides them with a visual reminder of their commitment to being more active.

6. Tracking progress. Keeping track of activity can be motivating for some individuals. For example, an

individual shared that he writes in his calendar when he exercises.

7. Rewarding yourself. For example, after borrowing a pedometer from the library for a few weeks, a client rewarded herself by buying her own pedometer which she could use to track her ongoing walking progress.

In closing, adding these tips to your toolbox may be helpful in supporting clients to increase activity in their lifestyle.

Maria Lemus, MScN, RN Community Diabetes Education Program of Ottawa


The World healTh organizaTion (Who) defines physiCal aCTiviTy as The folloWing; any bodily movement produced by skeletal muscles that require energy expenditure. The WHO also describes the

following statistics about the physical inactivity pandemic we are experiencing in most developed nations around the globe; Physical inactivity has been identified as the fourth leading risk factor for global mortality causing an estimated 3.2 million deaths globally. It is also known that regular moderate intensity physical activity – such as walking, cycling, or participating in sports – has significant benefits for health. For instance, it can reduce the risk of cardiovascular diseases, diabetes, colon and breast cancer, and depression. Moreover, adequate levels of physical activity will decrease the risk of a hip or vertebral fracture and help control weight.

So why aren’t individuals taking this miracle cure/solution to solve our current chronic disease pandemic? (1) And more importantly, why is our health care system not making this a priority, since it would clearly alleviate some of the financial burden our current system is facing, during a global recession no less. I invite you to read this report (2) by Micheal S. Border to have a peek into the American Childhood Obesity crisis for more on this topic. I especially like the final paragraph:

“We know the answers,” says Crawford. “We know the ways in which we can modify children’s behaviors in the direction for health. But we need the societal will, and the time, and the leaders in the effort to do it”.

We, as health care/allied health professionals, are part of the leaders who need to take initiative and lead efforts to do bring constructive damage to the status quo. Society will embrace this if we are organized and backed up by science, politicians will have no choice but to endorse the necessary changes since the life of their constituents and that of their political career depends on it. If we don’t do anything, we are just postponing the problem and deffering it to future generations. Not exactly the legacy I want to leave for my children.

So what can we do as health professionals to make this change happen? How can we get our 52% inactivity rate to 20%? How can we get the 70% of our overweight/obese Canadian population (3) to a healthier state? I am excited to say that you, as a health professional, can in fact have a positive impact on the lives of your clients through the promotion of physical activity.

InItIatIng the conversatIon: physIcal actIvIty for your clIents (part 1)

By Patrick Bériault

Patrick Beriault B.Sc Human Kinetics, CSEP-CEP & OKA-CKPatrick is the CEO of KinMotion Inc., an Ottawa based company that offers health and fitness assessment and training services to performance athletes and physical activity practitioners. Patrick is also the North American representative for ComplexCore™ and works at the Somerset West Community Health Centre where he leads the community health promotion program for physical activity.

http://www.facebook.com/KinMotionhttp://twitter.com/KinMotion_Pat


Initiating the Conversation: Physical Activity for Your Clients (Part 1) - Continued

Harnessing the power of exercise prescriptions (ExRx) is slowly gaining momentum and the use of physical activity/movement experts such as Kinesiologist is making head way (4). But is a simple ExRx on a piece of paper enough to get people to change lifestyle habits they have been fostering for the last decade (or more) of their lives? Research certainly seems to support this (5). But in all honesty, that alone doesn’t seem all that effective in my day to day practice. Case and point, if I have one consultation with a client once a year (i.e. annual physical) and tell him/her exactly what they need to do to become active, and promise that “IF” he/she does exactly what I recommend as lay it out for them, that he/she would have control of their diabetes, hypertension or dyslipidemia, I would estimate that less than 15% of my clients would have followed through with my recommendation at the 12 month follow up. And I consider myself a physical activity counseling experts seeing between 30-40 individual clients and leading over 30 group sessions per month, exclusively dealing with physical activity issues. So my position is that simply writing out an ExRx is simply not enough. It’s a good start, but not enough.

One of the things we have to acknowledge as health professional are some of the barriers clients face with physical activity/exercise. Society is not making it easy to participate in this healthy alternative. Big pharmaceutical companies are not endorsing this because it’s bad for business, there is no (or very little) private or public insurance coverage for physical activity services or exercise facilities and there are more expectations an stereotypes associated with health and fitness industry then I care to even bring up. All things considered, one thing still rings true and that is, as a health professional, you cannot work harder then your clients for their own health. The responsibility ultimately lies within the client to bring behavioral change. You just might need to be the catalyst for that change to be initiated and part of the support system for sustaining the motivation to continue.

The biggest barrier health professional come across when dealing with physical activity issues is that they are not comfortable talking about what they don’t know. So what can a “non physical activity expert” (nurse, dietitian, nurse practitioner, social worker, physician etc) do to motivate a client to embrace this notion of physical activity and give it increased importance/value in the eyes of the client?

I am happy to share some words of wisdom that I give to both the graduate and undergraduate students I get to supervise from the University of Ottawa School of Human Kinetics program every year. Note that I have developed the following analogies based on my own practice and academic experience, some science backs this up, but this aspect of the job is more of an art then a science…I am in the business of making people better after all, not just organs.

First, is my “Dating” analogy: I tell my students to imagine they are on a first date with a guy/girl (i.e. their client). The scenario is that my student has one chance to impress this guy/girl while on their first date (i.e. initial consultation/annual physical), and that they need to figure out a way to make this guy/girl ask them on a second date (i.e. come back for a 2nd consult on their own will, or ask for tangible community resources to get active by their own will). In a very short time frame, they need to ask the clients the right questions to figure out what makes them tick (i.e. what are their interests?), what turns them on (i.e. what do they love to do?), what drives them internally (i.e. what motivates them?), what will make them trust you (i.e. why should they trust you over Dr. Bernstein or Charles Poliquin’s absurd weight loss promises and supplements/programs?) and what will make them come back for that 2nd date (i.e. a chance for an actual lifestyle/behavior modification).


Initiating the Conversation: Physical Activity for Your Clients (Part 1) - Continued

I do not follow a scripted series of questions because again I am dealing with people, not organs. I have a wide range of clients from high profile professional athletes and Olympians to new immigrants with limited language (French/English) skills and community people with unstable housing. Having a strict series of questions that can be applied to the varied demographics would be ideal, but this does not work for me and my clients. If you have a relatively homogenous clientele, then I encourage you to develop an efficient series of canned questions for your clients. But the important thing here is to understand the principle of the “Dating” analogy and apply it to your practice. Your clients will fall head over heels for you if you are able to tap into some of the answers they provide you and make use of them during your consultations.

I also tell me students that no matter how good you are at what you do, you won’t be able to convince every client that physical activity/active living is the solution for the chronic disease they are presently living with (referring to : Diabetes, Hypertension, Arthritis, Obesity, Metabolic Syndrome, Stoke, Fibromyalgia etc). We, as health professionals, obviously buy into this notion but it might not be then end be all solution for every client. We need to acknowledge and accept this and respect the client’s wishes over and above everything else. This is where interdisciplinary work comes into play and allows for optimal clinical decision making in partnership with the client.

Second, is my “Inception” analogy: What happens when you have a client you absolutely know could benefit from increasing their physical activity level but is resisting change, or is in the early stage of change identified by the Prochaska Model (i.e. pre-contemplation or contemplation). Rent the movie Inception™, if you have yet to see this movie, I suggest you do in order to fully appreciate this analogy. The goal of this analogy is to explain to students that during the first “Date” with their client, they need to figure out a way to plant a seed, or an idea somewhere in the clients reasoning that physical activity is important, or that it has value and they can benefit from it greatly. If you are successful in doing so, the client who is sitting in the pre-contemplation or contemplation stages of change will eventually contact you under their own will and ask the questions we want to hear from someone who is ready to make life style/behavior modifications (i.e. client in the preparation or action stages of the Prochaska Model). At this point you simply become a facilitator for healthy behavior and not the conductor. This is only possible because of questions, notions, facts, reasoning or motivators you were able identified during your “first date” with you client, and brought them to the forefront of your clients thinking/consciousness. That is “Inception”: triggering something in your clients’ mind that makes physical activity important. It can be as simple as validating something they have accomplished that is relatively big for them (ex: “Wow Mr. Smith, you walked 2000 steps more today then you did last week”) and just leaving it at that. Or finding out a deep internal motivator (ex: “If you could do anything right now anywhere where in the world what would it be and where?”) you’d be surprised by how many clients wish they could travel, or got back to their native country and have a chance to explore the environment or play with their nieces, nephews, children or grand children. All of which are activities that are much easier and enjoyable to do when you are able to be active and have pain free movement in the joints of your body.

In conclusion, I would like to remind you of 4 important notions. First, if you are working harder then your clients, you are working too hard and will likely burn out. Second, treat your initial consults/assessments as a “first date” and gather the necessary information to make your “second date” a success. Third, if you have a


Initiating the Conversation: Physical Activity for Your Clients (Part 1) - Continuedclient who is not ready to make the necessary changes in their life, still give them the best of what you have to offer while attempting a little “Inception” style strategies with the knowledge you acquired during your “first date”. Finally, foster interdisciplinary teams to enable you to actually get to know you clients, but also to offer them the best you possibly can to help the make positive changes in their lives. Clients need to feel a level of emotional connectedness with their support system to make behavioral changes stick. Sometimes that means helping them connect with friends and family, other times that means you have to connect with them if you are part of their support system. (1) http://www.cflri.ca/media/node/82/files/PAM2008FactsFigures_Bulletin02_PA_among_CanadiansEN.pdf for Canadian physical inactivity stats indicating that 85% of Canadians are considered inactive(2) http://sph.berkeley.edu/pubs/magazine/mag_fall11/pdf/ounce.pdf(3) see PHAC report at http://www.phac-aspc.gc.ca/publicat/cdic-mcbc/30-1/ar_01-eng.php(4) http://www.thestar.com/living/article/1167983 for a recent Toronto Star Article in this topic(5) http://171.66.125.180/content/48/1/72.short)

tools for health care provIders

The 5As of Obesity Management provides health practitioners with five steps to better manage their patients’ weight and related health issues:

• ASK for permission to discuss weight and explore readiness• ASSESS obesity related risks and ‘root causes’ of obesity• ADVISE on health risks and treatment options• AGREE on health outcomes and behavioural goals• ASSIST in accessing appropriate resources and providers

The kit includes a desktop tool to facilitate discussions on weight with patients, as well as a practitioner’s guide to incorporating the 5As into daily practice. Go to http://www.obesitynetwork.ca/5As for more information on the 5As, or contact Tara Bond at [email protected]

Achieving Glycemic Control for Type 2 DiabetesPlease follow the link to the Centre for Effective Practice newly updated and revised tool on our website:http://www.champlaindrcc.ca/downloads/toolbox_providers/CEP%20_Diabetes%20Tool_May15%20interac-tive%20FINAL.PDF

A CDA healthcare provider Self-Monitoring Blood Glucose (SMBG) recommendation toolhttp://www.diabetes.ca/documents/for-professionals/SMBG_HCP_Tool_9.pdf

Save the DateProfessional Education Workshop: Physical Activity and Exercise in DiabetesFriday September 21, 2012 with Dr. Chris ShieldFor more information and to reserve your spot: [email protected]


Healthy Eating, Active Living and Healthy Weights 2012: Ottawa Public Health http://ottawa.ca/calendar/ottawa/citycouncil/obh/2012/05-07/HEAL_Report2012_EN_Final_Updated_May072012.pdf

The 15 minute fitness habit www.fitin15.ca

Beginner’s Guide to Strength Training www.winnipeginmotion.ca/resources

National Institute on Aging – Go4Lifewww.nia.nih.gov

Resistance Band exercises for people with diabetes www.thera-bandacademy.com

Resistance Training - Physical Activity Resource Center for Public Healthhttp://www.parcph.org/materials.aspx

Get Moving: Active Sitting Program – multilingual DVD; available for loan at Ottawa Public Library or for purchase from the Good Companions. $12

Diabetes in the Champlain Region: A focus on foot carehttp://www.youtube.com/watch?v=fNkcJTSbOTU&feature=plcp

Champlain Diabetes Regional Coordination Centre420 Cooper St, Ottawa K2P 2N6Website: www.champlaindrcc.ca | Twitter: ChamplainDRCC

Newsletter publication dates: January, March, May, September, and November. Submissions must be received by the 15th of the previ-ous month and sent to [email protected]

The content and opinions expressed within the DRCC Newsletter articles are those of the authors and are not necessarily endorsed by the Champlain DRCC.

Contact information:

addItIonal resources

CDA Self-Monitoring of Blood Glucose tool:Managing your Blood Glucose: http://www.diabetes.ca/documents/about-diabetes/Blood_Glucose_Manage-ment_6.pdfLows and Highs: http://www.diabetes.ca/documents/about-diabetes/Lows_and_Highs_7.pdf

tools for people lIvIng wIth dIabetes

champlain drcc newsletter vol.2, no. 3, june 2012 champlai… · ideally, an insole can be modified...

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