A lack of physical activity (PA) is a contributing factor to numerous chronic diseases, and many chronic diseases may also contribute to lower levels of activity (Piercy et al., 2018). This bidirectional relationship emphasizes the importance of maintaining adequate levels of activity. Despite numerous public health initiatives, 8 in 10 adults in the United States do not meet the weekly recommendation of 150 min/week of moderate intensity or 75 min/week of high intensity, and 2 days of muscle strengthening exercise. Activity rates are even lower in older adults and those with chronic diseases or physical disabilities that comprise the majority of patients encountered in the home health (HH) setting (Omura et al., 2015). Promoting PA in HH also presents unique barriers. Patients often don't have access to exercise equipment or recreational spaces. Therefore, the modes and types of exercise available may be constrained. However, even the basics may be sufficient for this population.

A study by Greenwalt and Sabbahi (2021) suggests the minimum effective dose of PA that yields significant health benefits is far below the national guidelines. The highest relative health benefits of PA occur when moving from complete inactivity to some activity. Even replacing just 1 hour per week of sitting time with activity has been shown to reduce mortality risk by 30% (Matthews et al., 2015). Nguyen et al. (2014) found that patients with emphysema reporting any level of PA had a significantly lower risk of 30-day readmission compared with inactive patients.

Although getting patients to meet recommended goals would be ideal, the most important goal is promoting any level of PA. Adults can maintain their aerobic fitness with as little as two 40-minute endurance activities per week. Muscle strength can be maintained with as little as one session per week with one set per major muscle group in the general population, or in two sessions per week in older adults with two to three sets per major muscle group (Spiering et al., 2021).

When promoting activity in HH, it is important to be aware of unique motivators and barriers including fears surrounding PA, individual preferences for PA, social support, and physical environment constraints (Baert et al., 2011). Physical activity will need to be individualized to the home environment. Behavioral change may also require different multiple educational points from different providers. Physical therapists have a unique opportunity by working with patients for extended times, allowing them to become more familiar with the patient's individualized health needs, barriers, and facilitators of PA.

Perception of self-efficacy is also an important factor influencing long-term participation in a PA program. This can be facilitated by starting with the minimal effective dose and emphasis should be on performing safely and consistently. Giving patients reminders to perform PA during commercial breaks on TV or at scheduled times of day can help encourage habits. Visual handouts are also an excellent tool to increase self-efficacy and can include statistics about the benefits of activity, directions on how and when to perform specific movements, and how to safely monitor (Sallis et al., 2015). Physical therapists can use online resources to print out handouts or record the patient or themselves performing the activity with instructions tailored to the patient. Long-term participation can be supported by involving family members, caretakers, and other providers to increase social support and encouragement (Smith et al., 2017).

Adolescent marijuana, alcohol use held steady during COVID-19 pandemic

NIH: Adolescent marijuana use and binge drinking did not significantly change during the COVID-19 pandemic, despite record decreases in the substances' perceived availability, according to a survey of 12th graders in the United States. The study's findings challenge the idea that reducing adolescent use of drugs can be achieved solely by limiting their supply. In contrast to consistent rates of marijuana and alcohol use, nicotine vaping in high school seniors declined during the pandemic, along with declines in perceived availability of vaping devices. The data for the study came from the annual HYPERLINK "https://www.drugabuse.gov/drug-topics/trends-statistics/monitoring-future" Monitoring the Future (MTF) survey of substance use behaviors and related attitudes among adolescents in the United States. In a typical year, MTF surveys thousands of middle and high school students at more than a hundred schools across the country in the spring. MTF has been watching substance use trends for 46 years.

Despite the reported declines in marijuana and alcohol availability, the levels of use of these substances did not change significantly. Before the pandemic, 23% of students said they had used marijuana in the past 30 days, compared to 20% during the pandemic. For alcohol, 17% reported binge drinking in the past two weeks pre-pandemic, compared to 13% during the pandemic. However, there was a moderate and significant decrease in nicotine vaping - before the pandemic, 24% of respondents said they had vaped nicotine in the past 30 days, compared to 17% during the pandemic.

REFERENCES