Now that you’re incredibly inspired about how important health and wellness is to supporting individuals with disabilities in the community let’s take a look at how well versed you are when it comes to knowing about health and wellness nutrition and physical activity to see how you can incorporate it into what it is going to be that you’re going to do beyond graduation. At this point I really want to engage with you more on this online presentation so to test your knowledge is going to be intermittent questions within exercise nutrition knowledge questionnaire and you’ll have to answer those to be able to move forward in the slides and then we’ll be able to discuss those answers afterwards. So looking at the difference between fitness versus physical activity there is a difference between the two. We look at the actual definition if you take it from the health matters program talking about the state of of well-being that’s what fitnesses and includes all these aspects within that are going to be a contributing to those health risk factors to try to achieve your physical objectives and be consistent with whatever your health goals are so Fitness can be anything with that. So if you’re wanting to lose weight or gain muscle those could be your fitness goals and what you do to achieve that. The difference with physical activity is that is any exercise or movement. So some great examples are taking the dog for a walk when you’re doing your house chores and you’re vacuuming or your gardening or doing anything like that that still counts as physical activity. Parking farther away in the parking lot or even taking the stairs instead of the elevator. That all counts as physical activity and so what’s neat about that is we’re looking at those physical activity recommendations that’s what is being recommended making sure that were being active not necessarily always going to the gym or being focused on fitness. It’s a really good, important difference to keep in mind. Now the second question asks about do staff report different reasons for not exercising is compared to persons with IDD. And what the research shows is that the answer is actually true. However but, in my experience and supporting individuals in the community in those community-based organizations as we talked about earlier on that slide there’s all kinds of similar reasons like time, money, transportation or we’re too lazy or we’re tired that prevent us from being successful. So I really think that in looking at individuals versus the staff that support them those barriers are very similar and they’re relatable to each other so that we can be appropriate support individuals that can really talk to hey understand why it’s difficult to go to the gym I feel the same way. And I love this picture of us walking on campus and our pilot program because the young lady on the Left they’re walking with me and the purple shoes is actually a full-time staff member who went through the health matters program pilot with us with their own curriculum book did everything alongside all the individuals with Disabilities, made her own self-determined health goals and actually ended up losing the most weight in the program. So really showing that we’re all the same, we’re all in it together, and we all have these benefits that we can get out of improving our health. So now looking at cardiovascular disease being one of the most common causes of death for people with ID and the answer for that is true. And so looking here at heart disease this is across the nation again, and again where you live matters environment has a factor played into that. Can you imagine which state is coming in at the highest rate of heart disease? Yeah something else to be proud of for the state of Kentucky is having the highest numbers there. So not only is it true for individuals with disabilities but it’s also a risk factor that we’re looking at as a state of Kentucky, and what I think is really most compelling is right here with what the American Heart Association says that physically inactive people are almost twice as likely to develop heart disease as active people. This makes inactivity as serious of a risk factor as smoking, high blood pressure, or high cholesterol. So something that is what we have a choice about whether or not we’re physically active has that big of an impact on our health, and a huge impact on individuals with IDD if that’s the one of the most leading causes of death. So really compelling evidence that we need to focus on making those healthy choices and supporting people to be successful in that. As I’ve been talking about all these obesity factors and data and indicators we want to look at is there a difference between know being obese and overweight? And actually the answer to that is that there is, true, a difference between the two and a lot of times the way that this is measured is through the total body fat based on height and weight and that’s how we can relate those obesity factors to risk disease and death. This is a valid measure for both men and women but there are obvious limitations. It overestimates body fat in individuals who are athletic and muscular and maybe underestimates it’s a little bit in older populations and individuals with much lower muscle mass which does include some individuals with disability and limited mobility. So this picture here really on the body composition is a great way to exemplify that. The individual on the left and right have the exact same body weight coming in at 250lbs with a BMI of 33.9, which means they’re both obese. According to be my records what do you think the guy on the left is actually obese? No he looks like he’s a quite fit and very in shape. So not necessarily the most accurate but it is the easiest to use for data and research because you’re just basing information on height and weight and it’s what the CDC uses it’s very widespread. So another picture on your slide is where you can at look your own height and weight in pounds to see the color that you might coordinate with whether you’re in normal overweight or obese range. So again keep in mind that this is definitely subject to individual characteristics but it’s definitely a good indicator and at least a way to look at if there needs to be further information taken and attention given. When talking about blood pressure the normal blood pressure range is 120 over 80. That is the the commonly used number so you’ll see here on the chart that you want to be in the green in the normal area below that. Anything above that starts to get into prehypertension having high blood pressure and obviously thing in the red that’s higher than 118-110 is definitely somebody who needs to be in the hospital, right. So in looking at hypertension it’s a leading cause of illness and death and affects approximately thirty percent of US adults. Now you add disability into that and there was an in-Haines study that was a 10-year longitudinal study and what they found that adults with disabilities are thirteen percent more likely to have high blood pressure than those without disabilities, and a greater percentage of adults had bad blood pressure than those that did not. So really, definitely something that our population was worried about and if you think about blood pressure what’s going to happen when you exercise is it normal for blood pressure to increase during exercise> And the answer to that question is true. So it’s tricky to talk to people about that you don’t want to have high blood pressure but while you’re exercising you do want your blood pressure to go up you want to see that your heart is working and it’s working on being healthier and so that’s normal. So blood pressure can be kind of a tricky topic in that sense, but definitely the main thing is that if you’re going to the doctor and you’re getting your blood pressure checked while you’re resting at 120 over 80 is the number that we’re looking forward to be at or below. In addition to how exercise affects heart rate we also want to consider the effects of medications. So your all’s question was having a drink with caffeine can cause someone’s blood pressure to…. and the answer is increase, obviously. I know when I drink caffeine I’m very caffeine sensitive and you can tell that I’ve had it because I’m like one of those little yappy dogs and I’m shaky and my heart is palpitating and so I have to be very cognizant of how much caffeine is in the things that I consume even though it’s not a medication it is a legal drug that is available widespread in the United States. But it’s something to consider I know a lot of individuals that I support do drink quite a bit of coffee and they add quite a bit of sugar to it so thinking about those those interactions and how that has an effect on the body. Your other question was about if someone is taking beta blocker medication his or her heart rate will…. and the answer is decrease. So beta Blocker. So thinking about how someone who is on a beta-blocker medication when they go to exercise what that might do to their blood pressure their heart rate or what that might look like. So on this slide is actually really interesting medication chart that I got from the American Academy of developmental medicine and dentistry, the AADMD. You can go to their website there listed and see more information about different medications and their effects and how they interact and especially in supporting this population with disabilities are so many psychotropic medications and prescriptions everybody’s looking for that pill that you know works with whatever barriers are issues or behaviors are going on and so considering how that really affect someone’s health, their appetite, their sun sensitivity, even bone lose. All those kinds of things are just something to keep in mind in thinking about health and wellness. So now we’re going to talk about heart rates in general and your first question was adults with Down syndrome have higher heart rates than the general population, which is commonly a misconception people think that that’s true but there’s actually a hypertension study done and research has shown that is actually false; individuals with Down syndrome do have higher incidence rates of heart defects and issues with their heart, but it’s not necessarily that their heart rates are different than the general population is just other things to consider when doing exercising with individuals with Down syndrome. So what is considered in normal resting heart rate range and the answer for that is 60 to 90 beats per minute. So if you’re looking on the slide here this is a bore grading scale and I really love this example from the health matters curriculum because it is very Universal in design and it really hits all components of what we’re looking for in doing health programming with individuals and so we’re looking at heart rate here. You can see that there’s an intensity level and engage you’ve got your green or yellow your red so two colors of knowing where you want to be on that intensity scale those numbers correlate those beats per minute that we talked about so far resting heart rate between 60-90 and that’s normal right there in that green Range in the very light to fairly light intensity of activity. And you can see there’s other words to represent what it’s hard when it gets very hard. And then I love the pictures on the slide because you can see in the green area the the woman is walking leisurely she’s got a smile on her face and then we go into the somewhat hard and more the higher intensity level the woman is running in your legs are stretched her arms are stretched out and she’s obviously putting a lot of effort into working their hardest hundred and twenty 250 beats per minute. And then when you go to head red area that doesn’t look much like a smile anymore. I would say that that’s a grimace and that woman’s hat is flying off and she’s obviously overexerting herself, and so a really great way to say that if you’re your heart rate is in 160s or the 200 beats per minute range you’re you’re feeling like you’re in the red area that’s a little bit too intense for exercise level that we’re looking at so a great example of what’s doing that. So the next question you had was is important to check heart rate while exercising? Yes, it is important so something like this scale is really great to check into know where individuals are on that scale where maybe they see themselves versus if you do have a heart rate monitor you can show them where they really fall with those beats per minute. So when I first started doing programming with people with IDD they necessarily had never done any exercise before so doing aerobic activity was scary for them and didn’t understand what was happening to their body and thought that the your the heart rate going up for the the fatigue and the muscles was in a bad pain. And so being able to use this chart to show them where they thought they were in the red maybe they were really only at the green or yellow level this is a really great way to engage them in that conversation and showcase that. So your other question was walking while talking but not singing is an example of what kind of intensity. And so that actually is moderate intensity. So that’s going to be in your yellow area so when you’re talking about doing that physical activity or fitness to just try to be healthy you know where you want to just make sure that you’re at a healthy level that’s what you’re shooting for is in that moderate intensity range is going to be that yellow range to somewhat hard too hard the 120 to 150 beats per minute. So you’re working at that moderate physical activity level so that you can make sure that you are healthy according to those activity guidelines, right? So it does not have to be vigorous exercise doesn’t have to be in that red area to still get those health benefits. So the question was walking for just 10 minutes before work, 10 minutes during lunch, and 10 minutes after work is just as good as walking for 30 minutes at one time during the day, and the answer for that is true. So your physical activity guidelines that are mandated to you throughout any any health website that I can cite for you is going to say 30 minutes a day for five days or more of the week of that moderate physical activity and that can be anything from walking, dancing, those house chores we talked about earlier so those kind of moderate activity again where you can talk but not necessarily sing cause your heart rates in that medium area. And then your next question was at this place to get fit is at the gym. Hopefully you said false because you know that you definitely want to be active and exercise and do things other than just being on equipment at a gym and if you try to limit yourself to just being in a fitness facility you’re not going to be nearly as successful meeting your health goals, so knowing that there’s a lot of opportunity and accessibility for things outside of a fitness facility. There’s also important to incorporate muscle strengthening activities in two more days a week that goes with those same guidelines because there’s additional health benefits for making sure that muscles are strong and preventing falls so definitely incorporating those kinds of things is going to improve quality of life and independence and productivity. So for best results during strength training you should exercise the same muscle two days in a row right? Wrong the answer for that is false; we don’t want to overdo it we don’t want to injure our muscles so making sure that you break that up and not focus on the same muscle group back-to-back is going to be really important. Alright so if you’ve got a client who exercises he or she’s going to lose all the weight that they want right? Wrong, no weight loss is a bit different than just being able to do that to lose what you actually need to use more calories than you take in so more going out to then what you’re putting into your body. Because one pound equals 3500 calories, so to reduce your caloric intake by about 500-1,000 calories per day you’re gonna lose 1 to 2 pounds per week, and even with that that’s still a pretty aggressive way to try to lose weight so I put this in the slide though just to showcase that it’s really harder than what people think it’s not as easy as you would anticipate it to be. So when you’re talking about dieting to incorporate into what are you putting into your body with those calories is it important for clients to diet so that they can lose late maintain the weight loss overtime? Again, the answer there is false; we have some really big issues with the term diet those of us in the Health and Wellness field because there’s so many negative connotations with it and you really…. research has shown that just using the term diet sets people up for failure because you start to restrict what it is that you’re eating, you’re depriving yourself, you crave it, you give in, you’re guilty. It’s this diet cycle that goes back and forth and so really what is going to be seen as more successful is to call it healthy lifestyle changes or choices instead and really knowing that those unhealthy things that maybe you crave if it’s chocolate or you like to have cookies and cake and those kinds of things moderation is really what’s key so not necessarily never allowing yourself those things are pizza even, right? It would be horrible if we couldn’t eat pizza anymore it’s just knowing that you you make healthy choices and it’s a lifestyle change and that’s going to be overall for you. So again, last question diet should not be so strict that people start feeling deprive. True, that’s the answer there that you should be looking for to set yourself up for success. In thinking about what we’re putting into our bodies and worrying about diet and that caloric intake that can be really overwhelming. So a really simple way to consider that to be successful at that is thinking about serving sizes and the easiest way to do that is to visually estimate portion size by the use of your hand. So on this slide here you can see the Helping Hands worksheet that shows the different sizes of the hand and what those count for as servings for certain fruits and vegetables. So one of your questions was one serving of fruit or vegetable which would be one medium apple or free 24 broccoli florets can fit into the palm of an average woman’s hand. So looking at that there you’ll see that the answer to that is true that that’s usually about one serving for one cup of something if you’re holding it in your hand. If you’re thinking of an ounce of cheese or a teaspoon of butter even like salad dressing with one serving of that that’s about the size of your thumb tip and that means your first little little knuckle there that’s your tip not the entire thumb that’s what we’re looking at as an ounce or a teaspoon that’s hard for me because I know i really like cheese so to know that that’s one serving is it is a good a good thing a good rule of thumb to go by. (hahahaha!) Another one is really easy as that a cup is about the size of a tennis ball or the size of a man’s fist. So you thinking back to the old days when your grandmother’s cooking and she never used a measuring cup, these were the things that she used to be able to know what amount of ingredients to put in because she did it by a pinch of salt or you know a fist being the size of the cup so that’s pretty cool to think about. And you’re looking at your your raw veggies a half cup of cooked or raw veggies together could be about the size of a regular light bulb that’s going to be about one serving. And then your other question about a cup of raw leafy vegetables that’s about four lettuce leaves one serving the big lettuce leaves. And then this is the this is the kicker, this one right here it’s hard hard to even tell it to you, but one cup of cooked pasta, rice, or oatmeal is about the size of a tennis ball and that technically counts as two servings. How many of you all probably eat more than a tennis ball size of pasta when you sit down for dinner? If we could see people’s hands right now I think the entire rooms hands would be raised. So just something to keep in mind again the talk about moderation is just being cognizant and aware of what those healthy choices are and trying to make sure that we’re holding ourselves accountable for having that education so that we can the majority of the time make those healthy choices. Hopefully you are familiar with what the MyPyramid looks like in the serving sizes for a healthy nutritious diet however as of recently has been replaced with choose my plate. And as you can see here servings of fruit and vegetables should be the same as meat or protein for a well-balanced nutritious diet. The answer to that question is false. In looking at the plate here you can see that fruits and vegetables take up half a plate and protein is smaller. I think that’s something that especially for the way that I was raised, you know, meat and potatoes kind of thing, protein took a lot of the the spotlight on my dinner plate, but so that’s not the way that we’re supposed to be focusing on our nutrition nowadays it’s fruits and vegetables should really be the the main stars. And then looking at our grains making half of those whole grains and making sure to try to lean proteins and then dairy is even its own little side cup attached to the plate. And I know as Americans I mentioned earlier how cheeses a one of my favorite foods it’s definitely hard to think about anything that’s dairy being in the small portion as well but this is a great visual example of what your place should look like with the colors and the words and knowing how to really control those portions and making sure that you’re eating a well nutritious diet. So in thinking about portion sizes there’s this thing called portion distortion. And that’s where if you think about when we go out to eat at a restaurant or even with we see what we put on our own plates and we’re in charge of a buffet line we definitely are putting larger portions and what would constitute serving sizes. So being aware of that and making the calories that we put into our body really count and avoiding those oversized portions. But really it’s okay it’s not your fault it’s just how society is today, and these next couple of slides will showcase that for you. Alright 20 years ago an average cheeseburger was only 333 calories today our average cheeseburger is 590 and that’s not a fast-food burger folks such as ones you make in your backyard grill. And the difference there is 257 more calories which for a 130 pound person that’s an hour and 30 minutes of lifting weights non-stop to get your heart rate up just to offset those calories. Now if we look at two pieces of pizza 20 years ago was about 500 calories for both of those which is pretty good. The average today for two pieces of pizza is 850 calories which is probably not considering the kind of pieces that you can get nowadays that are the extra large slices or the deep dish pieces those are going to be your average two slices of pepperoni. So for those 350 more calories that you’re getting in those two pieces that’s playing golf walking and carrying your own clubs for a full hour to try to burn those 350 calories. Let’s talk about breakfast and see what a blueberry muffin perhaps looked like 20 years ago come in at 210 calories was normal sized the regular muffin tin. Today, especially if you go to somewhere like starbucks and you go to get a muffin those guys are enormous, and they’re going to be at least 500 calories or more and so those extra 290 calories means that you are vacuuming non-stop for your physical activity for an hour and 30 minutes just for the extra muffin that you ate. And sometimes when I do this part of the presentation I will have a student say oh yeah well I just get those little mini muffins, and then I asked do you eat the entire bag of the mini muffins? And usually the answer is also yes. So something just consider and think about that even if it’s the mini muffins how many of them are you eating? So how much are we eating popcorn these days is a great question because 20 years ago was about 270 calories to go out to the movie and get a little Bach a bucket of popcorn and nowadays the bucket has become monstrosity of a popcorn that is 630 calories which is 360 additional ones and that would mean you’d have to do water aerobics for an hour and 15 minutes that’s for an individual whose is 160 pounds. So that’s a long time to be in the water. I feel like I’d be pretty waterlogged and exhausted, and I’m not sure that it would be worth it for the the regular popcorn and that’s before you add all the butter and the salt and the fun things that you add when you go to the movies and all those fun flavors they have. So really just something to keep in mind about the portion distortion it really is an epidemic just like with that obesity. So as we’ve been thinking about all these healthy things and what we want to do and working with the population that we serve often times we forget about the fact that people age, and in Health and Wellness is something that continues to be important as aging occurs. So in general as people get older it’s important to continue to exercise the answer for that is obviously true. Especially looking at people with disabilities, we’re seeing a projected range that there’s going to be 1.2 million individuals that are 60 and older by 2030 that have intellectual and developmental disabilities. And oftentimes it’s their families their natural supports that are caregivers for those individuals, so if those individuals are living at home it’s really important to focus on health and wellness and it being continued lifestyle change for individuals as they age as well as their caregivers because over twenty-five percent of family supporting a child other relative are in the home and they’re headed by someone 60 or older so not only are the individuals with Disabilities aging but their caregivers as well. So really, really important and it definitely highlights this importance of mobility and balance because as we age that’s something that definitely decreases in our ability to be focusing on that is important and to incorporate wellness. Your other question was about exercise is being done from a wheelchair, and I really hope that you answered true, that exercises can be done from a wheelchair. And I think it’s really important to to consider everyone’s individual limitations but also hold those high expectations as well. So an example for adaptive exercises I actually from my practicum went to therapeutic rec program, and my first day of course you want to make a good impression didn’t say anything we with the chair users did bicep curls for an entire hour, and I thought okay maybe it’s just bicep day, right? I came back the next day did the programming again it was the hour for the fitness facility and we went to do bicep curls again. And I thought this can’t be right, you know, I’m not this certified adapted therapeutic rec specialist I’m just the practicum student, but I asked hey it’s okay if I kind of try something different, and she said sure, And so I got us to shoulder presses which is lifting your arm over your head and I said okay when you reach for those dishes on the higher shelf what muscles are you using not necessarily your bicep so those muscles are the ones that we worked in the shoulder presses. I got down on the floor and I held little two-pound weights on individuals knees and their feet and I counted every little blip of movement and I charted it for everybody with reps. And we all were socially encouraging so we were engaging our social and emotional health and at the end of it we had a chart for the different things that everybody did and I setup so excited and the next time I came back I wanted to see that everybody had at least 1 to 5 more reps each of those areas, and it was a really engaging day, and I was really excited about it. And when I walked away that employee who was the certified therapeutic rec specialist said thank you so much for helping me think outside the box. And I thought that shouldn’t be me teaching you that so I’m here teaching you that today that we definitely need to always be pushing those boundaries and thinking outside the box and just because you might be working with somebody who has limited mobility doesn’t mean you shouldn’t have the same expectations when it comes to whatever you’re working with them on especially if it comes to exercise and health programming. As I mentioned earlier there’s a really big importance to drinking water and the benefits that can really come from just improving water intake and decreasing sugary beverages is really really something impressive. And so in talking about the importance of drinking water everybody says you should drink six to eight ounce glasses of water every day which is approximately 64 ounces ironically there is no hard proof evidence to support that, however it’s pretty easy to remember. So something good to go by but definitely know that everybody’s going to have different needs for water intake thinking about if you are exercising you’re sweating because it’s hot outside we’re already having signs of dehydration or even if you’ve been sick obviously you’re gonna need to drink more water during those times. Now when you’re exercising the answer to your question how often should you be drinking water that is every 15 minutes making sure that you’re taking a break to get a sip of water and you’re still hydrating yourself. So keeping that in mind. Feeling thirsty is actually already a sign of dehydration. A lot of people don’t know that they look more so for the severe signs like headache feeling weak or dizzy constipation or having that really dark urine. So other indicators of needing to drink more water definitely paying attention to those but if you’re already thirsty you should be drinking more water. So some tips for being helpful with that starting and ending each day with a glass of water is a good way to do that tricky thing though if you drink glass of water before bed… you might not make it all the way through the night without having to get up. But something I do is always carry a water bottle with you all the time so you’re taking sips of water throughout the day and then remember that water is water and you should not substitute other drinks for water thinking that of tea works you know or you know maybe my coffees got water in it because we brewed it. No, definitely water needs to be its own standalone drink and something that you drink to make sure that you’re staying hydrated. When it comes to incorporating exercises or physical activity into any kind of program you’re running obviously liability is a concern or issue. So this is a great resource for you all it’s called a PAR-Q, a physical activity readiness questionnaire. So these are things that you want to look at beforehand to make sure that individuals are safe and capable to participate in physical activity. So you can really just google this and find it anywhere. The one that I found is from the acefitness.org. But it’s just a series of questions that individuals are going to answer yes or no to, and if they answer yes to one or more of those questions that’s just a prompter for you to get a doctor’s note to make sure it’s safe for them to engage in physical activity. Also really important when you are engaging physical activity as a part of any of your programming, is that there has to be a warm-up and a stretch component to begin and then ending with the cooldown. It’s really important to do this people forget about that all the time and they’ll try to go for a brisk walk around and end up with shin splints or pain. We definitely want to avoid that so it’s really the most important component of any exercis. Warming up is going to wake up your body and your muscles. It’s going to get your blood flowing your heart rate up a little bit and it’s just going to be a safe way to get started a movement instead of going from 0 to 60 really quickly . And then the same thing for the reverse. We’re cooling those muscles down and we’re stretching which is doing it in a safe way to make sure we don’t just stop suddenly in our muscle cease. This is really important especially if you’re working with individuals aren’t used to exercising they’re not comfortable with it you definitely want to make sure to incorporate these items to set them up for success and to make sure we’re decreasing the risk of injury. It only takes about five to ten minutes to really focus on doing warm-ups and cooldowns so really making sure that’s an important component of what it is that you’re doing with exercise.