Course:KIN366/ConceptLibrary/ChronicDiseaseManagement

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
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Chronic Disease Management

Chronic disease is a growing issue in our society that creates a burden not only for the individual afflicted with the disease but also the health care system because of the costs that arise (Elmslie, 2012). Management of chronic disease is often a combination of medication and integrating physical activity into daily life (Durstine, Gordon, Wang, & Luo, 2013).

What is a Chronic Disease?

Definition

A chronic disease occurs over a long period of time (Tropy, Campbell & Glass, 2010). Generally, the symptoms and the condition of the individual worsen slowly as time goes on (Government of NL, 2014). Partial or even complete disability may result as the disease progresses (Durstine et al., 2013). Some of the commonly mentioned characteristics of chronic disease are the need for ongoing management and treatment, a negative impact on quality of life, and restriction on daily activities (Government of NL, 2014). Chronic diseases can develop because of environmental factors, genetic factors (inherited conditions) or a mix of both (Tropy et al., 2010). In contrast, an acute condition is short term (Tropy et al., 2010) and symptoms present and worsen quickly (Hadjiliadis, 2013). Common acute illnesses affecting young children are ear infections, injury-related problems (broken bones, cuts, scrapes etc.) and upper respiratory infections (Tropy et al., 2010).

Examples

Some of the chronic diseases that affect the movement opportunities of young children are (Tropy et al., 2010): Asthma: “chronic inflammatory disease of the airways” (Asthma Canada, 2014) that may lead to symptoms such as inadequate breath, coughing, and wheezing (Asthma Canada, 2014).

Cystic Fibrosis: A genetic condition that primarily affects the lungs and digestive system leading to recurring lung infections and difficulty digesting fats and proteins (Cystic Fibrosis Canada, 2015).

Diabetes Type 1: The body’s production of insulin stops and therefore glucose levels rise unsafely high (Kenny, 2013). This type of diabetes usually develops in children or young adults (Kenny, 2013). Type 2: The body still produces insulin but sometimes it is not enough and in other cases the body does not use it correctly even if enough is produced (Kenny, 2013). It used to be almost exclusively found in adults but is increasingly being diagnosed in young children and adolescents (Durstine, Armstrong & Cheng, 2012).

Cerebral Palsy

How common is Chronic Disease for Young Children?

Even though the life expectancy of children born today is increasing, the quality in which they will live their lives is at risk because of the increased appearance of chronic diseases in young populations (Durstine et al., 2013). Chronic disease used to be found almost exclusively in older populations (Durstine et al., 2013). There are two main reasons for this shift. First of all, advances that have been made in medicine mean there are more comprehensive treatment options that save and prolong the lives of children with chronic diseases (El Khatib, 2015). Second of all, the increased prevalence of a physically inactive lifestyle is likely contributing to the onset of chronic disease in young children (Durstine et al., 2013). It should be acknowledged, it is likely that the chronic disease rates being reported are an underestimate of the actual situation as many go undiagnosed and untreated (Durstine et al., 2012).

What are the Implications of Chronic Disease?

For Young Children

When a child has a chronic disease, it is likely that they will experience limitations in their daily life (El Khatib, 2015). These limitations may be resolved by the use of equipment such as wheel chairs and other mobility aids, ventilation machines, and medications (El Khatib, 2015). Nevertheless, some difficulties will arise that will negatively impact the child’s life (Government of NL, 2014). These include social worries, emotional distress and side effects from medications needed to manage the disease (El Khatib, 2015). Because of the ongoing nature of chronic diseases, these effects may have an impact on the child for the rest of their life (El Khatib, 2015). Another implication of the earlier onset is that having one chronic disease may put the child at a greater risk for developing an additional chronic disease as they age (Perrin, Bloom & Gortmaker, 2007). For example, the longer that one lives with diabetes, the higher the risk they have of developing cardiovascular disease (Perrin et al., 2007).

For Society

The increasing prevalence of chronic disease is occurring worldwide and causes devastating economic burden on health care systems (Durstine et al., 2013). Moreover, when chronic disease arises earlier in life that means there is a greater amount of time the system is being taxed due to the resources needed to manage chronic disease (Mirollar, 2004). It has been estimated that 67% of total medical expenditures in Canada are due to chronic disease (accounting for both adults and children) (Elmslie, 2012). This translates to $190 billion per year (Elmslie, 2012). Treatment accounts for $68 billion per year (Elmslie, 2012). Not only are there direct costs due to treatment, but also there are indirect costs because of the ongoing and progressively crippling nature of chronic disease, particularly lost productivity (Mirollar, 2004; Elmslie, 2012). These indirect expenditures total $122 billion per year (Elmslie, 2012). These numbers are alarming on their own but even more so when it is considered that the prevalence of chronic disease in children is rising which means a greater burden on the health care system and society for longer periods of time as these affected children age (Mirollar, 2004). In 2010, chronic disease was responsible for 63% of deaths worldwide (Elmslie, 2012).

What is the Relationship between Chronic Disease and Movement?

There is a cycle that occurs between movement and chronic disease that is somewhat of a downward spiral (Durstine et al., 2013). To explain, a child who does not partake in a lot of activity in their life is at a greater risk for developing a chronic disease but once a chronic disease has developed it is often the case that the individual becomes less physically active (Durstine et al., 2013). Consequently, the condition of the individual worsens, the capability they have to be active is reduced and they are at a greater risk for both developing more serious complications from their current chronic disease and acquiring another chronic disease (Durstine et al., 2013).

Effect of Chronic Disease on Movement

When a child has a chronic disease, it may be the case that they require equipment such as a wheelchair or portable ventilator in order to manage the symptoms they are experiencing (El Khatib, 2015). Unfortunately, this often creates a barrier to certain movement experiences for young children (El Khatib, 2015). Additionally, there is some exclusion that occurs for this population because of medical contraindications, stigmas, insufficient personnel support and unsuitable equipment and environments (El Khatib, 2015; Durstine et al., 2012). Similarly, when the condition is not managed or there has not been an efficient regimen of medication determined, the child may not have the energy or be in the physical condition to participate (Durstine et al., 2012). Movement experiences for young children may be disrupted more so with cerebral palsy because of its direct impact on the motor system, which often leads to delayed achievement of motor milestones (Stanton, 2012). An indirect effect of chronic disease on movement is the financial strain that management of a chronic disease can cause on a family’s finances (Zylke & DeAngelis, 2007). Activities such as organized sports, outside play equipment etc. may be sacrificed because money has to be spent on medication and specialized care equipment (Zylke & DeAngelis, 2007).

Effect of Movement on Chronic Disease

A lack of movement in one’s lifestyle has been highly correlated with the onset of chronic disease time and time again (Durstine et al., 2013; Mirollar, 2004). So much so that physical inactivity is identified as one of the greatest risk factors for developing a chronic disease (Elmslie, 2012). On the other hand, increasing one’s amount of movement can have a vast array of positive effects (Durstine et al., 2013). These include alleviating symptoms of those who already have a chronic disease and decreasing the risk of developing a chronic disease (Durstine et al., 2013). For example, an increase in physical activity in those young children with asthma often leads to a decrease in the amount of medication they need to control their symptoms (Perrin et al., 2007). The use of movement in the management of chronic diseases will be discussed further in the next section.

How Are Chronic Diseases Managed?

The Use of Movement

Many scholars on this subject agree that incorporating physical activity into one’s life can greatly reduce the impact that chronic disease has on individuals and society as a whole (Durstine et al., 2013; Durstine et al., 2012). When regimens are flexible, appropriate and tailored to the individual’s needs there are improvements to physical, social and emotional aspects of life (Durstine et al., 2012). Sometimes there is difficulty in doing this because of the physical complications that chronic disease results in, lack of sufficient support, inadequate equipment, and the burden of social and emotional repercussions associated with chronic disease (Durstine et al., 2012). It is important to understand that movement and physical activity are beneficial to individuals both as a form of prevention and in the management of chronic diseases (Durstine et al., 2012).

Diabetes: For individuals with diabetes, it is recommended that physical activity be integrated into daily life as it not only helps the body react and use insulin appropriately but also decreases some of the risk factors, that accompany diabetes, for developing additional chronic diseases (Kenny, 2013). Movement of the body increases the insulin sensitivity of cells in the body, which leads to greater uptake of glucose thereby keeping levels closer to normal (Durstine et al., 2013).

Cystic Fibrosis: Incorporating movement as part of the treatment for these individuals is regarded as a vital component for maintaining health status long term (Durstine et al., 2012). Regular activity lessens the decline of lung function that occurs with cystic fibrosis (Cystic Fibrosis, 2015).


Other Medical Interventions

In order to manage the symptoms that result from chronic diseases it is often necessary to use medication.

Diabetes: The goal of diabetes treatment methods are to lower and keep glucose levels in the body so that they are normal or close to it (Kenny, 2013). Monitoring glucose levels throughout the day does this and when they are too high, insulin injections are administered (Kenny, 2013). Furthermore, a balanced diet can affect the body’s glucose levels (Kenny, 2013). Therefore a dietician is often involved in the treatment plan to educate the individual and their family on the effects that certain foods have (Kenny, 2013).

Asthma: The method of medication used depends on the severity of the disease (Asthma Canada, 2014). Some individuals take medication daily to reduce inflammation and consequently airway narrowing, while others with less severe asthma use inhalers with medication only when symptoms arise (Asthma Canada, 2014).

Cystic Fibrosis: Those with cystic fibrosis have to get regular medical care to clear their airways thus preventing build-up in the lungs, which often leads to infection and decreased lung function (Cystic Fibrosis Canada, 2015).


Prevention

Due to the severity of situation we have with the prevalence of chronic disease, there needs to be a focus on prevention so that the situation does not continue to worsen (Elmslie, 2012). Most countries do not have the financial capacity to handle the burden of chronic disease for much longer as the cost of this is rising faster than economic growth (Elmslie, 2012). The Public Health Agency of Canada has shifted its focus from the treatment of chronic diseases to the prevention of them instead (Elmslie, 2012). Furthermore, prevention is a complex concept that will involve input from many facets of our society, as well as, all of the levels of government (Elmslie, 2012). The focus of many prevention efforts is to increase activity and movement in our population (Elmslie, 2012). This entails education for the public so that people are educated in what activity is and how much they should be getting (Mirollar, 2004). Furthermore, the higher-up levels in government need to contribute so that there can be easier access to activity and movement opportunities, no matter the income of the family (Mirollar, 2004).

References

Asthma Canada. (2014). What is Asthma?. Retrieved from http://www.asthma.ca/corp/newsroom/pdf/asthmastats.pdf

Cystic Fibrosis Canada (2015). About CF. Retrieved from http://www.cysticfibrosis.ca/about-cf/what-is-cystic-fibrosis/

Durstine, L.J., Armstrong, N., & Cheng, S. (2012). Children’s physical activity and health – Chronic disease in children and young adults. Journal of Sport and Health Science, 2, 1-2.

Durstine, L.J., Gordon, B., Wang, Z. & Luo, X. (2013). Chronic disease and the link to physical activity. Journal of Sport and Health Science, 2, 3-11. doi: 10.1016/j.shs.2012.07.009

El Khatib, L. (2015). Children with Chronic Health Conditions [Lecture notes]. Retrieved from https://www.connect.ubc.ca

Elmslie, K. (2012). Against the Growing Burden of Disease. Retrieved from http://www.ccgh-csih.ca/assets/Elmslie.pdf

Government of Newfoundland and Labrador (2014). Chronic Disease. Retrieved from http://www.health.gov.nl.ca/health/chronicdisease/cdcontrol.html

Hadjiliadis, D. (2013). Acute vs. chronic conditions. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/imagepages/18126.htm

Kenny, T. (2013). Type 1 Diabetes. Retrieved from http://www.patient.co.uk/health/type-1-diabetes

Mirollar, M. (2004). The cost of chronic disease in Canada. The Chronic Disease Prevention Alliance of Canada. Retrieved from http://www.gpiatlantic.org/pdf/health/chroniccanada.pdf

Perrin, J.M., Bloom, S.R., & Gortmaker, S.L. (2007). The increase of childhood chronic conditions in the United States. JAMA. 297(24). 2755-2759. doi:10.1001/jama.297.24.2755.

Stanton. (2012). An introduction to cerebral palsy [Class handout]. Faculty of Education, University of British Columbia, Vancouver, Canada.

Torpy, J.M, Campbell, A., Glass, R.M. (2010). Chronic diseases of children. JAMA. 303(7). doi:10.1001/jama.303.7.682

Zylke, J.W., DeAngelis, C.D. (2007). Pediatric chronic diseases—Stealing childhood. JAMA, 297(24), 2765-2766. doi:10.1001/jama.297.24.2765.