Baseline



Self-Care Project

Lifestyle Medicine Program Worksheet

Name: Angela Ingram

PART 1

Objective Information (LM Vital Signs):

Age (DOB): 33 years, 12-14-1982

Height: 5’8” Weight: 265 BMI: 41% Waist circumference: 49 inches

BP: HR:

Tot Chol: LDL: HDL: Trig: TC/HDL: Non-HDL:

Blood glucose (fasting): Hemaglobin A1c:

*Hard CHD Risk from calculator:

*CVD Risk: 1.9%, normal is 1.4% Est. Heart/Vascular Age: 37 years old

*Recurring CHD Risk (if applicable): do not have my cholesterol levels to do hard risk calculation

Estimated daily calorie intake (from SuperTracker analysis): 1809 calories

Caloric intake to maintain current body weight (from SuperTracker):

Current steps per day: avg. for 2/14-2/20 = 7756 and avg. for 2/21-2-27 = 8448

Current medications:

-cyclobenzaprine, ½ to 2, 10mg tabs every night

-zyrtec, 1, 10mg 24 hr release tab daily

-Amox-Clav, 875/125 mg

Chronic diseases: Fibromyalgia

Risk factors for cardiovascular disease:

-Hereditary from mother, grandmother

-Being obese

-Unhealthy diet

*Risk Calculators available at:

(use electronic calculator rather than hand calculation)

healthy eating

Description of personal eating habits in your own words: My eating habits are not very good. I do not eat a balanced diet (or meal). I only eat twice/day, and it’s recommended to eat three times/day with snacks. Sometimes, I over-indulge due to not eating for so many hours and only eating twice per day my meals tend to be larger than average or a suggested serving.

“On a scale from 1-10 (10 being the best and 1 being the worst) how would you rate your overall eating habits?”:__4_____

“Why is it not [1 number lower]?

-I gave myself a slightly higher rating because I do try, and I also don’t eat a lot of junk foods that would make this number much lower.

“What would make it [1number higher]?

-To make the number higher, I need to eat more fruits and definitely more vegetables. I could also benefit from three meals a day rather than 2 larger ones.

Daily fruit and vegetable intake (number of servings/day): average eaten, 1 cup

Whole grain foods intake: 0 ounces

Barriers to healthy eating:

-Some barriers to healthy eating are not having enough time to cook and feeling stressed. When I am stressed out, it’s so much simpler to grab fast food rather than taking time to make a well balanced meal. Instant gratification and stress in relation to eating for me, is a very bad combination.

Personal goal(s) for healthy eating in your own words (not SMART goals format):

- In order to get better eating habits, I would like to start cooking (meal prep) at home for the week, or something that will at least last a few days. It will eliminate stress in the long run. With my first set of classes coming to a close, I will hopefully be less stressed and not looking for quick and easy. I also need to eat more vegetables. I like corn, green beans, tomatoes, broccoli and lettuce. Not too many choices when it comes to what I like the taste of, but even those can give me the amount of vegetables I need per day. I also would like to start trying raw vegetables, which I have never liked. I tried celery the other day and it was not successful! A small goal for eating 3 meals per day would be even eating something in the mornings, even a piece of fruit or some toast.

Summary of SuperTracker results:

I know that I don’t eat a very healthy diet, but to see it on paper is different. The lack of important foods, nutrients and minerals that I get is eye-opening. I don’t get enough, dairy, whole grains, fiber or fruits and vegetables. I’m also lacking in calcium, potassium, copper, iron and magnesium. I take in too much sodium, lots of added sugars and saturated fats. One good thing that came of the results was that my caloric intake is below the suggested 2000 calorie diet. But that total consists of only eating 2 meals per day. I do eat a lot of protein, which according to the super tracker, is okay. On average for that week, I ate 79mg, which is over the suggested target of 46mg.

Physical Activity

Current activity:

Min/day of purposeful exercise: 240 min/day

Activities of Daily Living:

-I work as a custodian for Omaha Public Schools. During work I walk constantly, I mop, sweep, dust, take trash out, and depending on the day’s activities, I have other physical labor intensive tasks to complete (usually 1-3 times/week). I also walk around campus 3 times a week.

Past history of exercise (likes/dislikes):

-In the past, one of my favorite things to do was play sports. My favorite is basketball, but I love to play kickball and catch with a baseball or football. I also enjoy riding bikes, and have been saying for a few years now that I was going to buy myself a bike and start riding again. I’ve never really cared much for running (outside of sports), yet I believe it is one of the best things you can do for yourself.

Current preferences for physical activity/exercise:

-I really enjoy walking, whether it be outside in the fresh air, or on a treadmill. I still enjoying playing catch, but haven’t found anyone to play with in a while. I also enjoy lifting weights, and feel that I would enjoy resistance training much more if I had some proper guidance and instruction.

Barriers to physical activity (including physical limitations):

-One barrier of being physically active is my constant pain. Before I was diagnosed with chronic pain, I always thought something else was wrong. I’ve always had a case of “bad knees,” so I never thought anything more when I would go to jump and feel like my knees were going to break. Doctors have given me braces and wraps, which help, but never wholly take the pain away. Another barrier is my size. For my weight and height, I am obese. I do not always feel obese, yet by all accounts and measurements, I am.

Personal goal(s) for Physical Activity in your own words (not SMART goals format):

-I would really like to start walking again. I told myself that I would like to go to the gym at least 3 times per week, that hasn’t worked so I’m going to try for 2 times/week. I have some weights at home that I would like to use to incorporate some resistance training as well. My main priority, or goal, right now is to go above and beyond what I do at work for physical activity. I can accomplish this by increasing my steps, take the stairs or do intense walking.

Summary of SuperTracker results:

The results from SuperTracker state that I am getting more than enough moderate intensity equivalent minutes based on the minutes I spend doing calorie burning work through my job. About half of my 8 hour shift is spent sweeping, mopping or vacuuming with a back pack vacuum (considered medium effort). The target is set at 150 min/week and I am getting 1200/week. It’s also estimated that I burn 2410 calories per day and that the exercise I do counts toward my weekly aerobic goal. I do need to work on muscle strengthening activities as I have none right now. The suggested target is 2 days per week.

Body Weight

Body weight history:

Today:____265lbs_____ 1 year ago:___275lbs______; 5 yrs ago:_____250lbs_________; 10 yrs ago:____220lbs________

Previous weight loss attempts:

-In previous attempts to lose weight I have tried vigorous exercise, in the gym and walking with other people. Neither processes lasted long, as I didn’t sustain motivation and schedules also conflicted. I have also tried supplements such as diet pills or water packets. I would use them, and had more energy, but it was expensive to keep up. And when I would I fall behind, again, the motivation would be lost to keep going.

Personal goal(s) for Body Weight in your own words (not SMART goals format):

-Ideally, I would love to lose 50lbs by the end of this year. I still believe this goal is possible, I just need another jumpstart to get the process going. I’d also like to add some resistance training to tone up my legs and arms as well as building overall strength and muscle. My goals for eating a more balanced diet as well as trying to eat 3 meals per day will help keep my body energized and fueled up enough to do the exercises that will help lose weight. Less alcohol consumption will also give me more energy to exercise, as I won’t be tired or fatigued from having my body exerted and depleted of most of the healthy nutrients in my body.

Tobacco

Current use: Yes / No / Never

If Yes: How long:___________; How much:_______________

Ready to make a quit attempt:

Personal goal(s) for Tobacco Use in your own words (not SMART goals format):

ALCOHOL

Number of days / week when alcohol is consumed: ON AVERAGE, 3 OR MORE (LATELY)

Average number of drinks / day when alcohol is consumed: 4

Personal goal(s) for Alcohol Consumption in your own words (not SMART goals format):

-I would like to decrease this number and frequency. I have many goals for myself, and none of them will be reached if I continue down this path. I don’t want to rely on or use alcohol for my stress reducer or when I’m upset.

sLEEP

Time to bed: 130/2 AM (OFTEN TIMES LATER)

Time awake: 730/8 AM

Average number of hours of sleep/night: 4 HOURS

“On a scale from 1-10 (10 being the best and 1 being the worst) how would you rate your overall sleep quality?”:__2_____

Barriers with sleep quality/quantity

-Leaving the TV on, playing on my phone, staying up all night to be social or drinking alcohol, partner being restless or sleeping habits that keep me awake, being in pain, poor time management skills (especially in terms of school work)

-I also have a problem with not being tired as I work until midnight M-F. When I lay down, I am usually not tired and end up on my phone for a while, until I get so sleepy I can’t take it, and then pass out. I definitely need a better ritual, a better way to fall asleep.

Personal goal(s) for Sleep in your own words (not SMART goals format):

-It’s still not enough, but I would like to get at least 6 or 7 hours of sleep, on an average basis. I don’t think that realistically I could get this every night (not right now anyway), but I would like to try. I have already started to turn the TV off although I still set the timer. When I get really sleepy, I put the phone down and turn away from it. I’d like to keep this going, and perhaps get used to turning the TV off sooner for a better night’s sleep.

sTRESS

Thinking about the past week, rate overall stress Thinking about the past month, rate overall

level: stress level:

1 Low stress (feeling calm and in control) 1 Low stress (feeling calm and in control)

2 2

3 Moderate stress 3 Moderate stress

4 4

5 High stress (feeling frantic and out of control) 5 High stress (feeling frantic and out of control)

Physical signs/symptoms of stress:

eating more/less, more alcohol consumption, feeling tired, pressured like there is never time, eye rolling, blank staring at people when they speak, moving quickly from always being in a hurry

Current stress management techniques:

-Although I don’t succeed as often as I’d like, I do try to get some things done early. I feel that when I get closer to deadlines, I get better at becoming more disciplined and getting things done. It’s much less stressful to get things done over time rather than all at the last minute but I’m trying to work through that. I listen to music whenever I am really stressed or upset. It helps soothe me, and during that time I usually focus on finding solutions rather than continuing to solely focus on the issue(s). I do the dishes when I need some time to focus and think about the things I need to do, usually the whole kitchen gets cleaned in this process. I sometimes take walks, depending on the weather, to relax my mind and body from being tense and stressed.

Personal goal(s) for Stress Management in your own words (not SMART goals format):

-I want to work on writing to-do lists. This way, I can cross things off as they get done as well as keep track of everything that I need to do. I would also like to work on noticing patterns and triggers that keep me stressed or cause stressful periods in my life. Another goal I have is to stop focusing on the things that are out of my control. If I can’t fix it or change it, then I shouldn’t give it so much energy.

Self-Care Program

*Note: All goals must be written in SMART Goals format*

Physical Activity

SMART Goals

Short-Term

- I would like to use the gym membership that I already pay for, and go to the gym twice per week to use the treadmill. I would like to implement this February 22, 2016.

- I would like to begin doing a light jog, for at least 10 minutes on the treadmill by May 1, 2016.

- I would also like to lost 15 lbs. by May 1, 2016 by working out at the gym

- After getting in the habit of working out consistently, and being a regular at the gym, I’d like to add resistance training for my legs and arms by June 1, 2016.

Long-Term

- I would like to be running by August 1, 2016 for at least half the time, 30 minutes of the hour I am on the treadmill.

- I’d like to increase my days/week from 2 to 3 or more by August 1, 2016.

- I would like to lose 50 lbs. by December 1, 2016.

Physical Activity Program

|Activity |Frequency |Duration |Intensity |Progression |

|Walking on treadmill |2 days per week |1 hour |Moderate |Lead up to a light jog/run |

|Free weight training |2 days per week |30 minutes |Moderate |Lead up to machine weights for arms|

| | | | |and stair step or stationery bike |

| | | | |for legs |

|Vacuuming(back pack |M-Sat |3 hours (or more |Moderate |No progression unless necessary for|

|vac)/mopping/sweeping | |depending on the day) | |work; ; in the summer time we deep |

| | | | |clean the schools so there is much |

| | | | |more exertion as I usually run the |

| | | | |carpet machines |

|Dusting, taking out garbage, |M-Sat |1-2 hours |Moderate |No progression unless necessary for|

|general cleaning | | | |work; in the summer time we deep |

| | | | |clean the schools so there is much |

| | | | |more exertion as I usually run the |

| | | | |carpet machines |

| |

Healthy Eating

SMART Goals

Short-term (2 weeks)

- I would like to start eating more fruit and vegetables. I would like to make sure that I have one or the other with every meal, which would be a great start for me. I’d like to start this by February 22, 2016.

- I would like to limit my processed food intake to twice/week by February 22, 2016.

Long-term (>6 months)

- I would like to continue eating fruits and vegetables as well as begin eating 3 meals per day. Eating 3 meals per day will be challenging, but I’d like to work toward this goal within the next few months so that I can make it a long term habit by September 1, 2016.

- I plan to drink more water. This is something that I need to do anyway, but drinking at least 4 cups per day will be a great start and hopefully in a 6 month time period from 2.22, I can drink up to 8 cups per day.

Tobacco Cessation Program

Current Tobacco User: Yes / No

Ready to make a quit attempt: Yes / No

If Yes: Referral made to a tobacco cessation specialist on:______________________(date)

Alcohol Consumption Program

Goal: Moderate alcohol consumption/day or less [Men: 2drinks/day; Women: 1 drink/day]

Current consumption: ___6____ drinks/day

Alcohol consumption Program (with SMART Goals)

-I plan to decrease the amount of alcohol I drink on a daily basis. I would also like to stop drinking every day. I would like to start this immediately, but will say 2-22 for the purposes of this activity. I hope to see a decrease in this behavior by April 1, 2016.

Sleep Success Program

Short-Term SMART Goals:

-Turn the TV off and not be on my phone at all while trying to go to sleep. I’d like to see this change by April 1, 2016

Long-Term SMART Goals:

-My long term goal for sleep success is to get more! I’m working with the physicians that are managing my pain to get on a better sleep schedule with activities that will help me do this. I hope to see a drastic change in my behavior by May 1, 2016. Hopefully by then some sort of routine can be established, and better sleep will ensue.

Stress Management Program

Identified stressors:

-work, relationship with partner, my sickly mother living with me, school (specifically my Anthropology course), friends and other family members wanting time with me, wanting a social life, having no time for anything, lack of sleep, lack of exercise, bad eating habits, not losing weight

Stress Coping Program (with SMART Goals)

One way to cope with stress is to do physical activity. It will help get better sleep, increase energy and reduce risk of chronic disease. My goal is to start the exercise program, which will help to reduce my stress level. I’d also like to stop worrying so much about the things I cannot control, work on time management and add some stress relieving techniques such as meditation or yoga to my lifestyle.

Health Behavior Modification Strategies

Overall impressions about readiness and confidence to participate in positive lifestyle behaviors:

(based on the Readiness and Confidence to Participate Questionnaires)

I want to change my lifestyle. I want to be an overall healthy human being. In my opinion, it’s the best way to help someone else. You have to make sure you are at your best to give your best to someone else. My readiness to participate results for the most part is planning to start most of the activities in the next few months. On the other hand, I know myself and how easy it has been in the past for me to stop, or get bored with things that are good for me. Therefore my confidence in making these changes happen is not very high in some areas, such as: alcohol consumption, eating fruits and vegetables, foods high in fiber or whole grain foods. I love to play to sports, but participating in them when I’m in pain or feel like my knees will break, doesn’t give me much hope for completion. I would love to sleep 7 hours/night, but with working and school fulltime, I don’t see that happening. I think if I can get myself in gear and get motivated to do these things, my confidence levels will go up in all aspects, making the choices easier and fun all the while becoming healthier overall.

Top 3 lifestyle behaviors to target (based on readiness/confidence questionnaires):

1. Eating more fruits/vegetables

2. Getting 7-9 hours of sleep

3. Incorporate extra physical activity

Specific barriers to implementing healthy behaviors

My relationship with my partner is probably the second biggest barrier I have besides myself. She is not very supportive of the things I want or need to do in my life, when they don’t involve her. If I want to go to the gym, she suggests that I go when she thinks I should go, otherwise we fight or argue. Anything that takes time from her, is not something that she supports. And just about everything I do, school or work related takes away from her time with me. Another barrier is my stress level. In addition to the situation above, I have a sickly mother who has lived with me for the past 5 years. Making sure she has food, medications, gets to and from doctor’s appointments and anything else she might need, adds stress for me. I’m constantly worried about her, and her health and often become overwhelmed by thoughts of losing her or her having long stays in the hospital. Working full time and school fulltime are also barriers because I find myself crunched for time and energy to do everything every day.

Specific health behavior modification strategies

(see examples on next page)

Specific strategies include: building my confidence level in myself and my abilities, keeping things simple, self-management, goal setting and convenience. All of these strategies would help when put together, but I think the ones I mentioned would help me the most. If things are simple, I won’t overthink everything (at least that’s the goal). I won’t get worked up or overwhelmed. I will manage myself in a way that just gets everything done, and feel good about the decisions I made. I currently use goal setting, and I love the tool. Through trial and error, as well as through this course and others, I have learned that short term goals are necessary to meet the long term goals. It’s important to have short term goals in order to keep yourself on track and focused on the bigger picture. Last but not least, convenience. American’s in general love convenience. If I don’t have to work too hard to get what I want/need, then it’s easier for us to do. The same with implementing healthy behaviors. If the behavior changes fit in with things we do every day, the changes are easier to turn into positive habits, and thus lifelong changes.

Program-Related Strategies to Improve Program Adherence

|Strategy |Description |

|Simplicity |Lifestyle modification programs need to be easy to understand and implement for patients to be|

| |adherent. Programs that are complex can be discouraging for patients and often lead to |

| |non-adherence and program failure. For most patients it may be a good idea to try and |

| |implement only one or two modifications at a time. For example, a patient who is obese, |

| |smokes, is sedentary and has a poor diet may not be successful if the program tries to change |

| |all these behaviors at the same time. One option can be to choose the behavior that poses the |

| |most immediate risk (i.e. smoking) first followed by other modifications at a later time. Or, |

| |first choose a behavior that the patient has the best chance at being successful. This way the|

| |patient can realize success which may motivate him/her to try other behavior modifications. |

|Convenience |A program designed to fit the current lifestyle of the patient will have a greater chance of |

| |success. Modifying a patient’s lifestyle is the goal, rather than completely changing the |

| |patient’s lifestyle. This means that no one program is right for all patients and an |

| |individual approach works best. |

|Goal setting |Setting realistic and attainable goals are a hallmark to program success. Goals should be |

| |measurable and easily understood for patients. Short-term goals are important to achieve |

| |relatively quick success while also keeping the long-term goals in mind. |

|Enjoyable |Choose activities and foods that the patient enjoys and that are also appropriate for |

| |achieving the program goals. |

|Variety |To prevent boredom, which often leads to non-adherence, a variety of activities and foods |

| |should be chosen based on what the patient prefers. |

|Rewards and incentives |Rewards and incentives for achieving goals are important to maintaining an adequate motivation|

| |level. Rewards should be something that is of value to the patient and can range from small to|

| |large. |

|Self-management |The program should be simple enough that the patient has the ability to self-manage issues |

| |that arise in between visits with their practitioner. Changes to activities and food |

| |consumption that may arise due to vacations, illness, etc, should be simple enough for the |

| |patients to problem-solve him/herself. This empowers patients to be an advocate for their own |

| |healthcare. |

|Frequent contact |Studies have shown that patients who have frequent contact with their providers have greater |

| |adherence. Contacts may be more frequent towards the beginning of the program and less |

| |frequent during the maintenance phase where the patient can more effectively self-manage their|

| |program. |

|Social support |Supportive family, friends and co-workers are important to the success and adherence of any |

| |behavior change program. It is a good idea for the pharmacist to counsel the support system, |

| |especially the family, in addition to the patient in most instances. |

|Cost and time of implementation |Cost and implementation time are major factors to program adherence. Working within the |

| |patient’s budget and time constraints to develop creative ways to become physically active and|

| |to eat healthy are challenging to the practitioner, but very rewarding and conducive to |

| |program adherence. |

|Multidisciplinary approach |No healthcare practitioner should work by themselves. Each discipline has unique skills that |

| |they can offer patients to produce better health outcomes. Referring patients to other |

| |providers who are more knowledgeable and skilled should be viewed as collaborative |

| |partnerships that are best for the patient and not as a failure of any one practitioner. In |

| |addition, patients who hear the same message about positive health behaviors from multiple |

| |providers are more likely to change behavior. |

|Lead by example |Pharmacists and all healthcare providers should not only talk to their patients about positive|

| |health behaviors, but should engage in them also. Patients are more likely to buy into |

| |changing their health behaviors if they know that the practitioner thinks that it is important|

| |enough to participate in him/herself. |

|Evaluating adherence |Like all measures of health, adherence levels should be evaluated during each patient’s visit |

| |to the pharmacy. Dialogue regarding adherence can expose barriers which can then be resolved |

| |during that visit. Adherence rates can be recorded along with other health measures at each |

| |visit. |

Self-Care Program Summary

What are the Top 3 overall goals you would like to achieve from this program?

1. Getting better sleep

2. Reducing alcohol consumption

3. Weight management

What are the first steps you are going to take to achieve your goals?

-The first steps to getting better sleep is to put myself on a sleep schedule, and to create a good sleep environment. Turning the TV off, having the fan for a cool place, not playing on my phone and using the bed as a place for sleep and nothing else. I also need to take the cyclobenzaprine prescribed by my pain management physician to help with my sleep habits.

-The first step in completing a reduction in alcohol consumption is to realize triggers that make me want to drink, like when I’m stressed or upset. Recognizing that I use it for a coping mechanism is a great way to try to incorporate other healthier activities in place of drinking.

-The first steps in achieving weight management is to set short term goals that will help me reach the long term goal. Also, to start eating a better balanced diet with more fruits, vegetables and whole grains.

When do you plan to reassess your goals for the first time?

-I will reassess these goals in a 2 months, to see if I have started, and if I’m managing to stay on track. They say a habit takes 21 days to make or break. Hopefully I will be successful in this, or if nothing else, on my way to a healthier lifestyle. Every little step counts.

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