Marylynn Adamski,
Dena Bailey, Katherine France,
Nathon Kelly, & Marijo Johnson
Assessment
Michigan
Mecosta County
Population in 2009
9,969,727
41,775
Leading cause of death 2008
Michigan
Mecosta county
Heart Disease
Heart Disease
23.5
25.2
Death by heart disease is much higher in Mecosta County
than the State of Michigan
Assessment
 Obesity is the leading cause of Heart Disease
 Obesity is Body Mass Index (BMI) > 30
 Mecosta Obesity
 Michigan Obesity
26.2%
29.4%
Mecosta county has less people but they
have almost same the obesity rate as the
State of Michigan.
What group is most effected
 Obese adults had a higher prevalence of coronary
heart disease, arthritis, high blood pressure, high
cholesterol, asthma, stroke, heart attack, diabetes and
inadequate sleep compared with non obese adults.
Resources for physical activity
Mecosta County

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Parks 18
Golf courses – Public 4
Golf courses – Private 3
Fitness Centers/Gyms 4
Walking/Biking/Hiking Trails 4
City of Big Rapids Recreation
 50+ Exercise Tuesdays 1:00 Evergreen Community Building
 50+ Dance
Tuesdays 1:00 Evergreen Community Building
 50+ Water Aerobic Monday Wednesday & Friday

8:30am-9:30am and 10:00 am-11:00 am
Ferris State University Pool
Resources con’t
 LET’S WALK BIG RAPIDS - is a non-competitive
walking program that offers exercise while spending
quality time on Big Rapids parks and trails. Let’s Walk
Big Rapids is a free program for all ages. Walks are held
in the Spring and Fall months.
 Big Rapids Bike Club
Scope of Community Nursing
Practice
 Community health nurses will be taking care of clients
who have the diseases associated with the lack of
physical activity.
 It is a community wide problem.
 Community health nursing will work to get clients to
increase physical activity.
 Community health nurses will inform various groups
about what they can do to increase physical activity.
Community Groups
that can help promote physical activity
 Chippewa Lake Lions Club
 Commission on Aging and Senior Center
 Big Rapids Lions Clubs
 Barryton Lions Club
Diagnosis
 Risk for heart disease among adults related to
lack of physical activity secondary to obesity
Plan
 Primary Prevention:
 Must start at a young age.
 Emphasis on exercise and healthy eating habits.
 Establish healthy habits from a young age to reduce
obesity later in life.
 Continued support of physical activity throughout life.
 Secondary Prevention:
 Establish a diet and exercise program.
 Screen for medical causes of obesity and treat.
Primary Prevention - Children
The first step in increasing physical activity and
decreasing obesity is with children.
The primary care physician (pcp) should be one of the
greatest advocates for physical activity.
Young et al. (2010) establish a need for pcp’s to advise
parents on ways to increase physical activity and
promote healthy eating habits.
Primary Prevention - Adult
PCP’s play an important role in promoting health and
physical activity in normal weight adults.
Normal weight adults are least likely to receive education
on healthy habits when they are the ones that would
most benefit from it.
Nawal et al. (2007) found that on 2.6%
of normal weight adults received
primary prevention.
Secondary Prevention
 Focus on addressing lack of physical activity and
unhealthy eating habits.
 The PCP is the prime candidate for this but all
healthcare workers should work to address lack of
physical activity.
 Kirksick et al. (2010) found that even moderate
decreases in caloric intake and moderate increases in
physical activity can result in weight loss.
Outcomes
Outcomes will be measured using national and state
data on obesity in adults and children in Mecosta
county.
Self reported exercise and food journals will be utilized
to monitor physical activity and caloric intake. These
can be followed by the PCP.
PCP’s will weigh and record BMI at all visits to monitor
for changes and provide education at needed.
Interventions
 Encourage nutritious, satisfying meals.
 Teach about low-calorie, nutritious foods.
 Encourage exercise such as walking, jogging, aerobics,
or swimming appropriate to age and physical
condition.
 Provide teaching and pamphlets on cholesterol and
hypertension.
 Encourage patient to take prescribed medications for
cholesterol, hypertension and diabetes if needed.
 Teach the importance of medication compliance
Interventions, Cont.
 Encourage the use of food journals
 Teach children about nutritious snacks and meals
 Teach parents the importance of physical activity for
children
Factors Positively Associated with Adult
Physical Activity
 Postsecondary education
 Higher income
 Enjoyment of exercise
 Expectation of benefits
 Belief in ability to exercise (self-efficacy)
 History of activity in adulthood
 Social support from peers, family, or spouse
 Access to and satisfaction with facilities
 Enjoyable scenery
 Safe neighborhoods
(U.S. Department of Health and Human Services, Understanding physical activity)
Barriers to Increasing Physical
Activity
 Advancing age
 Low income
 Lack of time
 Low motivation
 Rural residency
 Perception of great effort needed for exercise
 Overweight or obesity
 Perception of poor health
 Being disabled
(U.S. Department of Health and Human Services, Understanding Physical Activity)
Evaluation
 Evidence Based Practice has shown that by starting young, teaching and providing
healthy foods to children can increase the amount of healthy food that children will eat.
“A 2-year randomized control trial of a school-based environmental intervention that
increased the availability of lower-fat foods in cafeteria à la carte areas indicated that
sales of lower-fat foods increased among adolescents attending schools exposed to the
intervention” (Khan, Sobush, Keener, Goodman, Lowry, Kakietek, Zaro, 2009).
 Teaching parents about the importance of physical activity and having children inrcrease
the amount of physical activity does make a difference. “Modifying school PE curricula
was effective in increasing physical activity across racial, ethnic, and socioeconomic
populations, among males and females, in elementary and high schools, and in urban
and rural settings” (Khan et al., 2009).
 Physical activity is known to reduce your risk of heart disease and obesity. The Center for
Disease Control states “Regular physical activity can also lower your blood pressure and
improve your cholesterol levels” (CDC, 2011).
Evaluation
 Education, such as providing pamphlets on cholesterol and teaching on medication
management proved to be an effective intervention in a study done by the CDC. Patient
outcomes included a reduction in both weight gain and blood pressure.(CDC, 2010).
 “Interventions in community settings to promote physical activity have emerged as a
critical piece of an overall strategy to increase physical activity in the United States”
(Zaza, Briss, & Harris, 2005, p. 81). EBP shows that these interventions can help to
encourage and educate the people in the community to understand how important it is
to be physically active and eat a healthy diet. Implementing these interventions can
reduce the risk of heart disease and obesity.
Other Interventions that are recommended by EBP are:
1. Making sure there is access to healthy food
2. Restrict the sales of less healthy food
3. Provided smaller portions in public venues
4. Lower the amount of hours that are spent
watching television and on the computer
(Khan et al., 2009).
Policy Development
Policies to Enhance Physical
Activity
Increasing physical activity in adults requires both
resources and motivation of the individual.
Mecosta County has several community infrastructures
available but barriers may continue to exist.
Federal and State governments have demonstrated
increased awareness of the need for increased physical
activity by addressing physical activity goals in Healthy
people 2020 and Healthy Michigan 2010.
Policies to Enhance Physical
Activity
Increasing physical activity requires a
consistent message from the media,
government and educational systems.
Successful policies will include an assessment and plan
to eliminate barriers.
Although the target group for this presentation is adults,
research has demonstrated that developing physical
activity habits at a young age is more likely to increase
physical activity as an adult.
U.S. National Physical Activity Plan
 “comprehensive set of policies, programs, and
initiatives that aim to increase physical activity and
create a national culture that supports physically active
lifestyles, improve health, prevent disease and
disability, and enhance quality of life”
 “Vision: One day, all Americans will be physically
active and they will live, work, and play in
environments that facilitate regular physical activity”.
(National Physical Activity plan, 2010, para. 2-3)
Plan Initiatives
Business and Industry
 Identify evidence based
practice and interventions in
the workplace
 Encourage business to
increase physical activity
opportunities in the
workplace
 Provide education to business
owners on the positive effects
of physical activity
 Assist with policy
development
Education
• Provide access and
opportunity for high quality
physical activity programs in
schools
• Develop state and district
school policies and
regulations
• Provide access to physical
activity programs
• Develop partnerships with
private sector to link
opportunities in the school
and community
Plan Initiatives (Continued)
Health Care
 Make physical activity a “vital





sign”
Establish physical activity as
treatable and preventable
Prevent and treat physical
inactivity
Reduce disparities to access to
physical activities
Include physical activity training
in the education of health care
professionals
Assist with local, state and
institutional policy development
Mass Media
 Encourage partnerships to
promote themes in physical
activity
 Sustain a mass media
campaign
 Develop mass media
messages
 Identify funding for research
to develop evidence related to
the use of existing and
emerging technologies for
increasing physical activity
Plan Initiatives (Continued)
Parks, Recreation, Fitness
and Sports
 Promote programs and
facilities where people work,
learn, live, play and worship
 Enhance the existing parks,
recreation, fitness, and sports
infrastructure
 Increase funding and
resources for parks,
recreation, fitness, and sports
programs and facilities in
areas of high need.
Public Health
 Create, maintain, and
leverage cross-sector
partnerships and coalitions
that implement effective
strategies to promote physical
activity
 policy development to elevate
the priority of physical
activity in public health
practice, policy, and research
 Disseminate tools and
resources important to
promoting physical activity
Plan Initiatives (Continued)
Transportation, Land Use
and Community Design
Volunteer and Not for
Profit
 Prioritize resources and
 Advocate to local, state and
provide incentives to increase
active transportation and
other physical activity
through community
 Increase connectivity and
accessibility to essential
community destinations to
increase active transportation
and other physical activity
national decision makers for
policies and system changes
identified in the National
Physical Activity Plan
 Conduct outreach to nonprofit groups’ members,
volunteers, and constituents
to change their own behaviors
and advocate for policy and
system changes
National Physical Activity Plan, 2010.
Healthy Michigan 2010
 Initiatives to promote health and physical activity to
ensure the wellness and productivity of the workforce
 200 Community Health employees worked to develop
initiatives
 Michigan Healthy People 2010 included goals to
increase physical activity in adults and adolescents.
(Surgeon General Report, 2004, p. 55)
Community Physical Fitness
Support Groups
 Mecosta County Medical Center: produced several
community news letters with significant information
on the benefits of increased physical activity
 Mecosta Medical Center: Assists cardiac rehab patients
with initiating a phase 1 and 2 rehab program which
includes a physical fitness program
 Mecosta County Youth Center: after school sports and
activities
 Mecosta County Area on Aging: fitness classes- A
Matter of Balance, EnhanceFitness; also offer
transportation to activities
Conclusion
Physical activity can decrease the incidence of obesity
and therefore decrease the incident of heart disease.
Mecosta County has a significant number of overweight
individuals and may benefit from implementation of
the initiatives represented in the U.S. National
Physical Activity Plan
Early physical activity habits are more likely to carry on
into adult life. This signifies the importance of early
education and physical activity programs.
References
 Center for Disease Control. The Guide to Community Preventative Services. 2010. Retrieved
from: http://www.thecommunityguide.org/obesity/Multicomponent.html
 City of Big Rapids Recreation. (2010). Retrieved from:
http://www.ci.big-rapids.mi.us/pdfs/Recreation_Programs_Offered.pdf
 Department of Health and Human Services. Healthy people 2020. Retrieved from:
http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33
 Kerksick, C., Wismann-Bunn, J., Fogt, D., Thomas, A., Taylor, L., Campbell, B., & ...
Kreider, R. (2010). Changes in weight loss, body composition and cardiovascular
disease risk after altering macronutrient distributions during a regular exercise program
in obese women. Nutrition Journal, 959. Retrieved from EBSCOhost.
 Khan, L. K. Sobush, K. Dana Keener, D. Goodman, K. Lowry, A.Kakietek, J. Zaro, S.
Recommended community strategies and measurements to prevent obesity in the
United States. Center for Disease Control and Prevention. 2009. Retrieved from
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5807a1.htm
 Leading causes of death, 2008 Mecosta County. (2011). In Michigan Department of Community
Health. Retrieved from http://www.michigan.gov/mdch.
References – cont.
 Lutfiyya, M., Nika, B., Ng, L., Tragos, C., Won, R., & Lipsky, M. (2008). Primary
prevention of overweight and obesity: an analysis of national survey data.
Of General Internal Medicine, 23(6), 821-823. Retrieved from EBSCOhost
Journal
 Mecosta County Clubs and Organizations Retrieved from:
http://www.americantowns.com/mi/mecosta-county/organizations/clubsorganizations
and-
 Michigan Department of Community Health. (2009) Cardiovascular disease
Retrieved from:
http://www.michigan.gov/documents/mdch/09_HeartDis_198879_7.pdf
 Michigan Department of Community Health. (2009) Overweight and Obesity in
Michigan: Surveillance Report Series. Retrieved from:
http://www.michigan.gov/documents/mdch/Obesity_chapter_283600_7.pdf
References
 MI Home Town Locator. (2011).Retrieved from
http://michigan.hometownlocator.com/features/cultural,class,park,scfi
ps,26107.cfm
 Ralph, S., Taylor, C. (2008). Nursing diagnosis reference manual. (Seventh ed.)
Lipponcott Williams & Wilkins, Ambler, PA.
 U.S. National Physical Activity Plan. (2010). The plan. Retrieved from :
http://www.physicalactivityplan.org/theplan.php
Wisdom, K. (2004, April 8). Healthy Michigan 2010. Retrieved from:
http://www.michigan.gov/documents/Healthy_Michigan_2010_1_88117_7.p
df
 Young, P., DeBry, S., Jackson, W., Metos, J., Joy, E., Templeman, M., & Norlin, C.
(2010). Improving the prevention, early recognition, and treatment of
pediatric obesity by primary care physicians. Clinical Pediatrics, 49(10),
964-969. Retrieved from EBSCOhost.
References – cont.
 Zaza, S. Briss, P.A. Harris, K.W. The Guide to Community Preventive Services: What Works
to Promote Health? Atlanta (GA): Oxford University Press;2005. 80-113.