1. Title by Presenter Name Elevate the Profession Through Collaboration Brent Bauer, MD Stephen N. Blair, P.E.D. Dale Healey, DC Adam Perlman, MD, MPH Cynthia Ribeiro

2. Brent A. Bauer, MD Director, Complementary and Integrative Medicine – Mayo Clinic Brief overview of work at Mayo How massage therapy is an integral part of this work

3. 3031090-3 Decreased Massage Therapy – Mayo Clinic Pilot Trial 58 cardiac surgery patients Cutshall, Comp. Therap.Clin. Practice, 2009 PainAnxietyTension Massage therapy quiet relaxation vs

4. 3031090-4 Massage Therapy after CV Surgery 10 8 6 4 2 0 BeforeAfter VASVAS Anxiety Level Control group (n=28) 10 8 6 4 2 0 BeforeAfter Massage group (n=30)

5. 3031090-5 Massage Therapy after CV Surgery 10 8 6 4 2 0 BeforeAfter VASVAS Pain level Control group (n=28) 10 8 6 4 2 0 BeforeAfter Massage group (n=30)

6. 3031090-6 Massage Therapy – Mayo Clinic Randomized – Controlled Trial 113 cardiac surgery patients MT therapy days 2,4 vs. quiet relaxation Decreased painP<0.001 Decreased anxietyP<0.001 Decreased tensionP<0.001 Increased relaxationP<0.001 Bauer, Comp. Therap. Clin. Practice, 2010

7. 3031090-7 Massage Therapy at Mayo Clinic Other Studies MT for colo-rectal surgery patients2009 MT prior to cardiac interventions2009 MT for thoracic surgery patients2011 MT for breast cancer surgery pts2012 MT for cardiologists and nurses 2010 MT for cardiac ultrasonographers2011 MT for in-patient nurses2012

8. 3031090-8 Massage Therapy at Mayo Clinic The Impact Massage therapy now routine at MC – Domino effect – Small investment > snowball returns 48 hospitals in US 7 international hospitals – Australia, Austria, China, Ireland, Switzerland, Turkey

9. 3031090-9 Massage Therapy at Mayo Clinic The Vision Massage therapy routinely available to all Continue to use the Mayo experience to transform health care in the U.S. and around the world Hospitalized patients at Mayo Clinic Family members Staff

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11. Steven N. Blair, P.E.D Departments of Exercise Science & Epidemiology/Biostatistics Arnold School of Public Health University of South Carolina Physical Activity and Health How that impacts you and your practice

12. Disclosures Medical/Scientific Advisory Boards Jenny Craig, Inc Alere Technogym Cancer Foundation for Life Santech Clarity Project Research Funding NIH Body Media Coca Cola Department of Defense Royalties Human Kinetics

13. Non-Communicable Diseases (NCDs) Changing patterns in leisure and work have led to a health crisis NCDs cause 65% of all deaths worldwide 36.1 million deaths from CVD, Stroke, Diabetes, Cancer & Respiratory diseases. Physical inactivity causes 3.2 million deaths/year WHO. Mortality and burden of disease estimates for WHO Member States in 2008. Geneva: World Health Organization, 2010.

14. Question Rank the following exposures by the number of deaths caused worldwide. Tobacco use Obesity High blood pressure Physical inactivity High blood glucose

15. Results of Google Search- February 12, 2012 Inactivity3 million hits Physical inactivity2.98 million hits Sedentary behavior2.35 million hits Eating too much393 million hits Obesity90 million hits Diet and obesity65.8 million hits Inactivity and obesity708,000 hits Physical inactivity and obesity 945,000 hits

16. L ANCET P HYSICAL A CTIVITY S ERIES More of the same is not enough

17. Global perspective 33 researchers, 16 countries

19. Findings Between 6-10% of the worlds major NCDs is attributable to inactivity By eliminating inactivity, >5.3 million deaths/y may be prevented This leads to an increase of 0.68 years in the worlds life expectancy (For perspective:smoking causes 5 million deaths/y worldwide)

20. Aerobics Center Longitudinal Study

21. Design of the ACLS 1970 More than 80,000 patients 2005 Mortality surveillance to 2003 More than 4000 deaths Cooper Clinic examinations--including history and physical exam, clinical tests, body composition, EBT, and CRF 1982 86 90 95 99 04 Mail-back surveys for case finding and monitoring habits and other characteristics

22. All-Cause Death Rates by CRF Categories3120 Women and 10 224 MenACLS Blair SN. JAMA 1989

23. Cardiorespiratory Fitness, Risk Factors and All-Cause Mortality, Men, ACLS # of risk factors Risk Factors current smoking SBP >140 mmHg Chol >240 mg/dl Cardiorespiratory Fitness Groups *Adjusted for age, exam year, and other risk factors Blair SN et al. JAMA 1996; 276:205-10

24. CRF and Other Health Outcomes

25. CRF and Breast Cancer Mortality 14,551 women, ages 20-83 years Completed exam 1970-2001 Followed for breast cancer mortality to 12/31/2003 68 breast cancer deaths in average follow-up of 16 years Odds ration adjusted for age, BMI, smoking, alcohol intake, abnormal ECT, health status, family history, & hormone use Odds Ratio p for trend=0.04 Sui X et al. MSSE 2009; 41:742

26. Activity, Fitness, and Mortality in Older Adults

27. Cardiorespiratory Fitness and All-Cause Mortality, Women and Men 60 Years of Age 4060 women and men 60 years 989 died during ~14 years of follow-up ~25% were women Death rates adjusted for age, sex, and exam year All-Cause death rates/1,000 PY Age Groups Sui M et al. JAGS 2007.

28. Cardiorespiratory Fitness and Health Outcomes in Various Population Subgroups Such as People Who Are Overweight or Obese or Those with Chronic Disease

29. Controlled HTN Stage 1 HTN Stage 2 HTN Severity of HTN P <.001 P <.001 P =.048 CRF: Age and exam year adjusted rates of total CVD events by levels of CRF and severity of HTN in 8147 hypertensive men Sui X et al. Am J Hyptertension. 2007 CVD incidence/1000 man-years

30. Joint Associations of CRF and % Body Fat with All-cause Mortality, ACLS Adults 60+ Death rate/1,000 person-years Rates adjusted for age, sex and exam year Deaths 151 190 29 72 Sui M et al. JAMA 2007; 298:2507-16

31. www.health.gov/PAGuidelines/ 2008 Physical Activity Guidelines for Americans At-A-Glance www.health.gov/PAGuidelines/ U.S. Department of Health and Human Services

32. 4 Key Adult Guidelines Avoid inactivity Substantial health benefits from medium amounts of aerobic activity More health benefits from high amounts of aerobic activity Muscle-strengthening activities provide additional health benefits

33. WHO PA Recommendation Released by WHO in December 2010 PA recommendations 5-17 yr60 min MVPA/day, vigorous intensity, including muscle and bone strengthening 3 X week 18-64 yreach week accumulate in bouts of at least 10 min, 150 min moderate intensity, 75 min vigorous intensity, or combination of both; and resistance training 2 X week 65 yr & oldersame as 18-64 yr, those with poor mobility should also do balance exercises, and take health conditions into account

34. How Can We Get Sedentary Adults to Become and Stay More Physically Active?

35. Track Record of Lifestyle PA Interventions Successfully implemented in many different populations and settings Men and women of all ages African-American men and women, Hispanic women Prostate cancer survivors Worksites, YMCAs, public heath departments, recreation facilities, senior centers, churches

36. Behavioral Approaches to Physical Activity Interventions Theoretical foundations Social Learning Theory Stages of Change Model Environmental/Ecological Model Methods Problem solving Self-monitoring Goal setting Social support Cognitive restructuring Incremental changes Manipulating the environment

37. 90% of What You Need to Know about Exercise Prescription Sitting is hazardous Some activity is better than none More activity is better than less A reasonable target is 150 minutes of moderate intensity activity/week Should be in bouts of at least 10 minutes

38. What Is the Best Exercise? The one you will do regularly No matter how excellent the exercise is or how effective the program might be, it will not produce any benefits for you if you do not do it

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40. Dale Healey, DC Dean College of Undergraduate Health Sciences at Northwestern Health Sciences University PhD Student at the University of Minnesota – dissertation focused on the integration of CAM topics into Medical School Curriculum COMTA Commissioner ACCAHC Board Member MTF Best Practices Committee

41. Institute of Medicine The U.S. health care system is in need of a fundamental change…. Health care today harms too frequently, and fails to deliver its potential benefits routinely. As medical science and technology have advanced at a rapid pace, the health care delivery system has foundered. Between the care we have and the care we could have lies not just a gap, but a wide chasm. Crossing the quality chasm: A new health care system for the 21st century.2001

42. National Health Expenditures (1), 1980 – 2018 (2) Source: Centers for Medicare & Medicaid Services, Office of the Actuary. Data released February 23, 2009. (1) Years 2008 – 2018 are projections. (2) CMS completed a benchmark revision in 2006, introducing changes in methods, definitions and source data that are applied to the entire time series (back to 1960). For more information on this revision, see http://www.cms.hhs.gov/NationalHealthExpendData/downloads/benchmark.pdf.

43. National Supply and Demand Projections for RNs,2000 – 2020 Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration. (2004). What Is Behind HRSAs Projected Supply, Demand, and Shortage of Registered Nurses? Link: ftp://ftp.hrsa.gov/bhpr/workforce/behindshortage.pdf. Shortage of over 1,000,000 nurses in 2020

44. Collaboration Can Help Not new idea – Educating for the Health Team - Institute of Medicine, 1972 More important now than ever: – Baby Boomers – Obesity epidemic – Rising costs – Provider shortages – System inefficiencies

45. A Role for Massage Therapy Lots of you (300,000) Positive image with the public Patients like you - helps with compliance Patients talk to you and trust you You see most of the patients body You touch most of the patients body You spend considerably more time with patients than most providers

46. What is Needed Education Reform A Flexner Report for Massage Therapy Programmatic Accreditation with supporting competencies – Interprofessional Practice Skills – Evidence Informed Practice – Expansion of Scope (e.g. health screening procedures) Participation in the conversation outside the massage therapy community

47. IPEC Interprofessional Education Collaborative Expert Panel from the education associations of following six professions: – Nursing – Osteopathy – Pharmacy – Dentistry – Medicine – Public Health 38 Core Competencies for interprofessional collaborative practice spread over 4 domains

48. ASPA Association of Specialized and Professional Accreditors ASPA is working (struggling) to get interprofessional competencies into accreditation standards. A recent meeting of the ASPA focused on how to encourage the accrediting agencies to catch up with the Interprofessional Education movement. Education tends to lag behind practice.

49. CAHCIM Consortium of Academic Health Centers for Integrative Medicine Began in 1999 with 8 institutions Now consists of 51 Academic Health Centers Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal Academic Medicine, Vol. 79, No. 6/June, 2004

50. ACCAHC Academic Consortium for Complementary and Alternative Healthcare – formed in 2004 Five licensed CAM professions plus Traditional World Medicines and Emerging Professions Center for Optimal Integration – aggregate useful information, organize activity, online courses, stimulate leadership Competencies for Optimal Practice in Integrated Environments – adopted and added to IPEC competencies Participation on IOM panels and initiatives

51. ACCAHC – CAHCIM teaming up ACCAHC and CAHCIM have partnered on a number of initiatives and next month are sponsoring the first International Congress for Educators on Complementary and Integrative Medicine and Health Preceded by a day of Ambassador Leadership training sponsored by ACCAHC Designed to create leaders in Integrative Healthcare, capable of representing the movement, not just their own profession.

52. NWHSU Northwestern Health Sciences University Participation with University of Minnesota NIH funded R-25 projects Hospital Based Massage Therapy training program with clinical rotations in four local hospitals Pillsbury House Integrated Heath Clinic – in partnership with U of M medical, nursing schools and the Adler graduate school of psychology

53. NWHSU Training of medical students and nursing students from the University of Minnesota in CAM practices This fall, 60 Advanced Practice Nursing students will descend on Northwestern to learn about Chiropractic, Acupuncture and Massage Therapy. A case study will be used to guide the discussion with EIP as the nursing and CAM students explore how they could work together in the management of a complex case.

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55. Adam Perlman, MD, MPH, FACP Associate VP for Health and Wellness for the Duke University Health System Executive Director, Duke Integrative Medicine Thoughts derived from different settings

56. New Jersey Siegler Center for Integrative Medicine Services Offered Who do you hire Clinical Research Relationships

57. UMDNJ Research Serving the underserved Sustainability Institute for Therapeutic Massage Teach Relationships

58. Duke Research Shifting the model Access Fiscally sustainable Forging relationship DCI

59. The good, the bad, and the ugly.

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61. Cynthia Ribeiro AMTA National President Education/Professional Experience BS Physical Education Surgical Nurse Massage Educator and Massage Therapist for 25 years

62. University of California - Irvine 2004-2010: Taught 1 st year medical students as honorary clinical professor at UCI Medical School Teach Anatomy with Medical Professors in UCI Cadaver lab Anatomy Functional Anatomy

63. University of California - Irvine Had massage therapists work on medical students so they could understand the effect of massage on their patients

64. Samueli Center for Integrative Medicine Promote integrative medicine by: Conducting rigorous fundamental and clinical research on complementary healing practices. Educating medical students, health professionals and the public about these practices. Creating a model of clinical care that emphasizes healing of the whole person.

65. Keys to Collaboration Create communication pathway All healthcare professionals Involved in the health and wellness needs of a specific patient Includes Medical and CAM/Integrative professionals Focus on the needs of the patient Regular group review of patient needs and treatment plan Ensure compliance with laws and regulations

66. Keys to Collaboration Speak the same language Medical terminology Understand health care professionals strengths Understand the modalities and effect of their work on the patient Development of Inter discipinary treatment plan Most effective and safe treatment sequence for effective healing Appropriate documentation

67. Elevating the Conversation Applies to all practice settings Panelists have a variety of perspectives Focus on how we make a difference in the lives of our clients How do we apply what weve heard today to ensure that client is at the center of our care for them?