Words Of Wellness - May 4, 2012

Not long ago, I was struggling with my weight and I struggled to breathe. I am 5 feet 4 inches tall, and weighed more than 250lbs (I didn’t weigh myself until I had been eating better and exercising for at least a month because I was too scared to see how much I had weighed!). Walking up the stairs felt like running a marathon. I became tired and short of breath. I had little energy to do the things I wanted to do, and dreaded going shopping for clothing. I decided that I needed to do something about this. I wanted to feel better, look better, and have more energy. I decided to make a change.

I had already joined a gym, but did not use my membership. I decided that I should start going to the gym. I started slowly at first, with 45-minute workouts 3-4 days a week. In order to make working out at the gym part of my regular routine, I decided I wouldn’t miss a workout more than two days in a row. I slowly increased the amount of time I worked out and the intensity of my workouts. I also began to vary my workouts as well so I wouldn’t get too bored. I would hike at first, at different parks. Sometimes I would use the time to take pictures or meditate too. I then started riding my bike. Eventually, I began to run outdoors also. I still worked out at the gym, but found changing the activities from time to time kept me from becoming bored with my routine.

I kept track of my progress by weighing myself once a week and writing my weight down on a calendar on my wall. I wanted to make sure that I was losing a reasonable amount of weight each week, which I saw as anywhere from 2-3 pounds. As I lost more weight, this range became 1-2 pounds a week. Some weeks I would not lose any weight at all but I knew that, as long as I was moving forward, and continued to exercise and eat in a healthy fashion, I would reach my goal.

I began to notice positive changes as the weight came off. I developed confidence beyond my ability to stay fit and active; confidence that I would be able to follow through and complete other goals as well. I did not know it at the time, but once I decided to go back to school, this new-found confidence would serve me well in my studies. Other positive results I started to see were more energy, the ability to walk up the stairs or take a walk in the park without getting short of breath, and better avoidance of infections. Those four colds a year that I used to have became one or two at the most.

I was working at a coffee shop at the time I began my journey to staying active and healthy through exercising. This job required a lot of standing and moving around. Prior to exercising, I would come home and my feet would hurt along with the rest of my body, I wouldn’t be able to have the energy to do much beyond going on the computer or watching television. As I got into the regular habit of exercising, I noticed this was not the case anymore. My feet weren’t sore when I came home. I had more energy to do other activities after work, like going out with friends.

I started to add other healthy habits to my routine as well, including sleeping 8-9 hours a night. I also decided to quit smoking. The benefits of becoming active and healthy through a regular exercise routine spilled over into all other areas of my life, and continue to do so.

If you are thinking about starting to exercise and think that you aren’t interested in working out at a gym, there are many other ways you could exercise and stay fit and active. Walking is a great way to stay active. Running is, too, if you can do it. Riding a bike in the park is a great way to see some beautiful sights and spend time with friends. If you are more of an “indoors type,” there are many exercises that can be done indoors, in your own home. YouTube can be a great resource of fitness videos, and the internet has many free exercise sites online. If you do not have access to the internet at home, many libraries will allow you to use their computers at no charge. Many of us in New Jersey have access to our local mental health self-help centers, which offer computer access.

Sometimes getting started with a regular exercise routine can be challenging. Many people find that getting an exercise buddy, someone who will exercise with them, helps to motivate them to stay in shape. I have used a calendar posted somewhere I could see every day to keep track of my weekly progress. I have known others to use a calendar to track their progress at the gym as well.

One person may find that having an exercise buddy works for keeping them on track with their exercise routines. Another may find writing down their exercise goals and accomplishments somewhere they can see works best. A third might opt for a computer-based or smartphone-based fitness planning and tracking tool. Whatever method works for you, one thing is for sure: exercise has many benefits that can help us feel better, and have a better quality of life through healthy living.

After I graduated high school, I started at the local community college, eventually finishing at Jersey City State College in 1988. It took ten years, but I was determined. My story is a long one; I currently work as a supported employment specialist at Collaborative Support Programs of New Jersey. If we get the opportunity to meet someday, I’ll share some of my story with you. I love telling my story.

I believe that my extensive background of working and education, as well as having personal experience on the receiving end of mental health services, gives me valuable insights for the position I am in.

I am currently enrolled in a training program developed and presented by the Dartmouth College Individual Placement and Support Supported Employment Center (www.dartmouth.edu/~ips), learning the best practices in the field of supported employment. I have the pleasure of working with a great group of people. I have two trainers who have devoted their time and energy to help us learn the best practices in supported employment.

We have training modules that are time sensitive; and a course outline to follow, with video examples in each module. The examples provide different ways of approaching employers and job seekers, with a narrative to follow describing the experience. After viewing the examples of interviews, we are then asked to go into the field and complete an assignment related to the topic at hand. We are given a series of questions relating the experience, and are expected to post our responses on a bulletin board. The trainers review the homework assignment posts and then post their comments on the board, so we can all share from the experience and learn as we move through the course. We, the group currently enrolled in the course, started about two months ago. It has been and I’m sure will be a great learning tool to help me carry out my job effectively as an IPS Supported Employment Specialist.

What I realize after taking the course is that I have a lot to learn; and that there are ways of approaching people and how to have a dialogue that works better when developing new relationships and maintaining old ones. We are here to assist people in their goals of moving on in the recovery process. By using the tools and knowledge of my training, I am now better equipped to help people in the process of exploring their goals of pursuing a career and/or job and providing the supports needed to help keep them in these positions.

I want to take this time to thank the Dartmouth staff for their input and experience in assisting me to help people in developing their goals and supporting them in the recovery process through employment, GOOD JOB! We can all learn from this training.

The generally accepted characteristics of “the metabolic syndrome” are reviewed in this article, with the presence of three or more of the following required to confirm the diagnosis:

• Increased abdominal girth (measured as waist circumference)
• Elevated triglyceride levels
• Decreased levels of High-Density Lipoprotein (HDL)
• Elevated blood glucose levels (often measured as glycolated hemoglobin, or A1c levels)
• Elevated blood pressure

The presence of three or more of these factors is considered diagnostic of the metabolic syndrome.

The authors conducted chart-reviews of people in the facility, focusing attention on both metabolic risk factors and modifiable non-metabolic factors, notably smoking and inactivity (not engaging in regular physical and/or stress-reducing leisure activities). They found that few of the people at risk were referred to a primary care provider for follow-up care. Their recommendations include looking at inpatient hospitalizations as opportunities to assess an individual’s metabolic risk factors, standardizing data collection on admission to include screening for metabolic risk factors, taking steps necessary to ensure access to primary care providers, and “developing new models of care…to support the integration of physical and mental health” (p. 29).

CSPNJ has been involved in conducting screenings for metabolic and other health risk factors since 2006. Some of our initial efforts were informal, such as ensuring the availability of scales at self-help centers, and assisting members in monitoring their blood pressure. Our Supportive Housing service teams have started making efforts to look at the physical health of the people we serve in this large program. In 2009, we held several events. We conducted a metabolic health screening at our own annual community event, Fall Fest. We conducted a health screening at NJ’s statewide mental health consumer conference. We initiated a metabolic screening at the annual Alternatives national conference (see the report summary at http://welltacc.org/rokdownloads/Words%20Of%20Wellness/2010/wow-2010%20volume%203%20number%208.pdf#page=6 ), and have followed up by help coordinate screenings at the 2010-11 Alternative conference.

Building from these screenings, along with our Institute’s involvement in national efforts to identify and reduce metabolic risks in our community, we have moved into two major academic collaborations. We have been working with the UMDNJ[2] Department of Psychiatric Rehabilitation and Counseling Professions since 2009 to develop and disseminate models for Peer Wellness Coaching. Peer providers receive training in applying a “wellness coaching approach” to help other peers self-identify health-related goals, as well as to apply self-accountability to refine and achieve their goals. Training has been provided to individuals and agencies from several states. A published article describing this initiative[3] concludes that “wellness coaching seems an ideal role for peers in recovery that has potential to address health and wellness issues facing persons who are at high risk of comorbid medical conditions” (328).

Our other collaboration is with the UIC[4] Center on Psychiatric Disability and co-occurring medical conditions. “This research project involves conducting health screenings of people with serious mental illness in a variety of service settings throughout the U.S. in order to estimate the prevalence of medical co-morbidities in this population. Also being assessed is the impact of providing participants with information and encouragement for enhancing their overall health.” . Additionally, we are involved with a training project entitled, “Here's to Your Health: Designing and Conducting a Successful Health Screening in Your Community”. Health fairs that include screening tests are a simple and low-cost way to encourage prevention and wellness. Health fairs also serve the purpose of promoting a community response to consumers’ urgent health needs and mobilizing service system changes. The purpose of this project is to develop materials and resources for conducting health screenings in mental health settings. Peggy Swarbrick of our Institute (and WOW co-editor) is using our extensive experiential knowledge to help craft a how-to manual for planning and conducting successful health screening events.