CanaCare, Person-centred care planning for adults in an interdisciplinary team.

Person-centred care planning in an interdisciplinary team. Participants will be accompanied by a support person from the Cana Communities volunteer pool to the University of Sydney study site. Participants will initially meet/talk to Professor Maria Fiatarone Singh [study physician] to identify their primary goals/reasons for wanting to take part in the research program. Depending on what the participants identify as their primary (life) goal or aspiration/s, the physical and medical history assessment will focus on areas relevant to their goals. Participants will then meet with one or more allied health practitioners for additional assessments to be completed. The interdisciplinary team will consist of accredited dietitians, accredited exercise physiologists, registered psychologists, registered physiotherapists and pharmacists. If a social work intervention is required, the participant will be referred to the external Cana or Justice Health Team. Assessments may include questionnaires, structured interviews, counselling sessions, body composition testing, nutritional assessments, fitness assessments and drug reviews. Participants will also be screened for cognitive imapairment using the ACI-ACE program screening tool and subsequently referred to appropriate clinicians if warranted. A case conference will be held with all health practitioners involved in the participants’ care. Subsequently, a case conference will be held with the team and the participants, with their support person present to discuss their assessments and how they relate to their goals. Through discussions with the participant, initial components of the Wellness program will be made. This may include exercise, dietary changes, mental health strategies such as mindfulness, meditation or cognitive behavioural therapy. The care provided by CanaCare will be in addition to the usual supports provided by Cana Communities for effective reintegration into work, housing support and social relationship building. The Wellness program may take place across different sites including the University of Sydney Camperdown campus, Cana Communities sites around Sydney, Cana Farm in Orchard Hills and via the secure online platform. Programs may be supervised or unsupervised as appropriate, and will be interdisciplinary in nature. Where relevant, the study physician may make referrals to the participant’s general practitioner, a psychiatrist or specialist. Each participant will be linked with a Cana Communities volunteer from the community who will be his/her primary coordinator of care, depending on the most important or urgent goal or wellness need identified. This person will be responsible for follow-up by telephone on a weekly basis initially, to assist with the adoption of the Wellness program elements and to measure adherence and any issues arising from the intervention. Mode of delivery of primary interventions includes machine based strength/weightlifting and aerobic based exercises under guidance of Accredited Exercise Physiologists. The progressive resistance training component time duration will be consistent throughout the duration of the trial. The anticipated time spent per session including warm up will be 60 minutes, three times a week. Progressive-resistance training: Week 1 of the intervention will include familiarisation and gradual increase in target intensity from 50, 60, 70% 1RM in each successive session. From the first session of week 2, training intensity will be set at 80% 1RM and progressed by a projected gain in strength of 3% 1RM each session, used in conjunction with Borg RPE Scale to maintain intensity at 80% 1RM. At the start of every 7th session, 1RM will be re-tested and target weight at 80% 1RM will be recalculated based on the new 1RM. Total training volume is 24 repetitions per exercise, set initially at 3 sets of 8 repetitions. However, as intensity is most important, sets and repetitions may be manipulated such that prescribed intensity is adhered to and the total volume remains 24 repetitions per exercise. Five pneumatic resistance machines will be used and exercises will be completed in the following order; leg press, seated row, knee extension, chest press and knee flexion. Participants will be instructed to contract concentrically ‘as fast as possible’ and then 3-4 seconds of control through the eccentric phase. There will be 20-30 seconds of rest between repetitions and 3-5 minutes rest between sets to allow sufficient recovery of anaerobic metabolism. Aerobic interval training: The Aerobic training component time duration will be consistent throughout the duration of the trial. The anticipated time spent per session including warm up will be 30 minutes, three times a week. Interval training will employ the 4x4 method. The protocol consists of 8 minutes of warm up working up to 70% peak heart rate (HRpeak), followed by four 4-minute intervals at a target of 85-95% HRpeak, separated by 3 minutes of active recovery at ~70% HRpeak. During each of the 4-minute intervals, participants will progress from 70-80% HRpeak over the first 2-minutes, to that target intensity of 85-95% HRpeak for the final 2-minutes of each interval. Following the last interval, the participant will cool down to a slow walk with no gradient for a minimum of 5 minutes, or until breathlessness has ceased. Week 1 will serve as a familiarisation period, where the time spend at the target intensity will be increased from 30, 60, 90sec. Training will take place on a treadmill/bicycle ergometer, at a self-selected brisk walking or running speed, with incline adjusted for intensity. Heart rate and oxygen saturation will be continuously monitored throughout each session and rate of perceived exertion [RPE] will be recorded in the last 15 seconds of every minute of training. The nutritional support and education intervention will be under supervision of Accredited practicing Dietitian and includes shopping, food planning, preparation and cooking. The anticipated time spent in the nutritional support component of the trial will be 2 times per month for approximately 60 mins per session. The Meditation and mindfulness component of the intervention will be instructed by members of CanaCare team. The anticipated time spent in meditation will initially begin in week one for 10 mins and increase in volume to 20 mins in week 10 and beyond. The mindfulness intervention will consist of 1) body scan and awareness type guided meditation, 2) mind training utilising breath focused relaxation and distraction techniques. Time spent in meditation will increase in volume the further the participant proceeds through the trial. The interventional component will proceed for 6 months in total with participants engaging with Canacare Clinicians 2-3 times/week either in person or via on line platform. Follow-up will be planned for 1 month, 3 months and 6 months to re-evaluate and re-set goals (either in-person or online).