 Good evening everyone. Thank you for joining us tonight, and I'm pleased to welcome you to our CIJR Canadian Institutes of Health Research Cafe Scientifique. And it's hosted by the Canadian Digital Study of Aging, as we like to call it, CLSA. I know there are some faces around here who are members of that study or participating in that study. My name is Prima Narayana. I'm the Lead Principal Investigator of the Canadian Digital Study and Aging, and I'm a Professor of Clinical Epidemiology and Biostatistics here at McMunstry University. I'm not the person you're going to be hearing much tonight from. My job is to help guide you through an informal discussion on the topic of cardiovascular health. And tonight is actually not a lecture. What we are going to be doing is an opportunity to hear our experts give some highlights of what's happening in the area, from a research or from a community or from a prevention point of view, and engage you in asking questions and see how they even know. So I'd like you to support the discussion by asking some questions and in turn learn more about the labor's research and community programs that are focused on the risk of chronic cardiovascular disease. And everyone here may be Institutes of Health Research for sponsoring tonight's event. In particular, I would like to acknowledge support from the CIJR Institute of Aging. I would also like to welcome our experts, Dr. Sonny Anand, who's sitting right here, Vincent Bowman, Dr. George Heckman, and Jennifer Ladish. Each member of our panel brings a wealth of knowledge in the areas of cardiovascular research and management of chronic disease. I would also like to recognize the CLSA participants who are in attendance this evening. And your contribution to the study and your first for knowledge are appreciated. And we see you almost every session we have here on McMaster. And it's great to see your interest in what we are doing here at McMaster and around the country. Finally, I would also like to extend warm welcome to our McMaster colleagues from the Kimbria Centre for Studies in Aging and the Lombard Job and Aging Commission. Both groups have brought along some healthy aging resources which are on the tables at the back. The title of tonight's café is Putting Your Heart Into It, the Science of Cardiovascular Aging. Over the next two hours, the discussion will focus on what can be done to maintain heart health and reduce the disability caused by heart disease and stroke. We will also discuss the latest scientific research and explore how it is shedding light on prevention and management of cardiovascular disease. Finally, we will take a closer look at what supports are available to help people with chronic health issues maintain function and live well in our communities. We know that heart health is an important piece of healthy aging puzzle. But we need to think about cardiovascular health in the context of all the factors that influence the aging process. We need to ask ourselves, how can we improve our chances of aging well? Today in Ontario, there are 1.9 million seniors. For the next two decades, that number will double. Aging has become a critical issue for governments, healthcare organizations, service providers, communities and citizens who want to better understand what this shift means for the society and the individuals and their families. One of the ways that question is being explored is through the Canadian Agricultural Study on Aging. It's one of the largest comprehensive study of aging in Canada and it is a strategic initiative of Canadian Institutes of Health Research. Just to give you a little bit of context what CLSA is about. CLSA involves a national team of approximately 200 staff and 160 researchers and collaborators, including two of our panelists, Dr. Hagwin and Dr. Anand. Over the next 20 years, a study will follow 50,000 men and women between the ages of 45 and 85. Here in Hamilton, more than 3,000 people will take part in the study. And many of you who are part of the study come to this building for all sorts of measurements that we do on you. The CLSA will explore how our bodies and minds age and will help us to understand why some people age in healthy ways and others don't. Through the CLSA, we'll examine the interlator factors that influence aging and learn about their collective impact on wellness. Other research projects on aging are also underway at McMaster. In 2012, McMaster alumnus Suzanne LaBarge gave $10 million to the University to establish the McMaster Optimal Aging Initiative. As a result of that gift, McMaster is becoming the voice for optimal aging in Canada. One project currently underway is the McMaster Aging Portal. A platform that offers direct access to trusted, evidence-based information about healthy aging. And this website will be launched sometime in April. And many of you can go and look for any information you want based on science that has been elevated for its quality. If you're interested in learning more or getting involved, we have some resources available at the information table tonight. Now, before I introduce our first speaker, let me provide a brief overview of the evening's format. The first hour will begin with short presentations. Our experts will speak for 10 minutes each on topics related to cardiovascular health. They will apply major ideas and pose questions that will help generate group discussion. So the idea is that after they have finished, hopefully, many of the ideas will be circulating in your head. And then you can ask questions and start the discussion. We'll have a short break around 7.30 p.m. and then during our second hour, you will be invited to ask questions and comment on the discussion. For those of you watching from webcasts, we also have a live webcast that is happening. We invite you to join the conversation by asking your questions through Twitter. This is first for me. I've never stood in front of people. I'm telling people that there will be Twitter questions. So please, to each your question, using that hashtag, agingcafe. Laura, am I supposed to say hashtag number sign, agingcafe? So it is hashtag agingcafe. The question period will wrap up just before 8.30 p.m., which will leave just enough time for all these members to provide us with some feedback by completing the survey that was left on your chair. Now, we'll begin the evening. I'm pleased to welcome our first speaker of the evening, Dr. Sonia Naab. She's a professor of medicine and epidemiology at McMaster University and the director of McMaster Population Genomics Program and a master of medicine specialist. Dr. Naab, recently received a Canada Research Chair in Ethnic Diversity and Cardiovascular Disease. She also holds the Heart and Stroke Foundation of Ontario and Michael G. DeGroote Chair in Population and Health Research. Her present research focuses upon the environmental and genetic determinants of vascular disease in populations of varying ancestral origin, as well as women and cardiovascular disease. Dr. Naab. Thank you. Here it's in your very nice introduction. Format, so no slides, and so you won't be overburdened with a lot of statistics. But I thought I would start off by just cardiovascular problems aging individuals may get into. So you all know that cancer and cardiovascular disease are the two most common chronic diseases that we face as we age. And up until a few years ago, cardiovascular disease was the leader, but cancer has now overtaken cardiovascular disease. Cardiovascular disease however remains very important and thankfully we know a lot about the causes of cardiovascular disease. So many studies have demonstrated that there are a key set of risk factors that predict whether or not an individual will develop arterial disease leading to things such as bypass surgery or angioplasty. And those factors are probably, once you're very familiar with high blood pressure or hypertension, elevated cholesterol, type 2 diabetes, your cholesterol profile, whether or not you have abdominal obesity, how physically active you are, physical activity being protective, your types of foods in your diet, as well as stress. And stress is often difficult to measure, but certainly is a risk factor for both of the chronic diseases, but very well characterized as a risk for cardiovascular disease. So we know the causes of cardiovascular disease and now the big challenge is how to prevent cardiovascular disease. And there are a number of nice studies that have shown if you reach age 50 without any one of those risk factors I just mentioned, you have a very low chance of developing cardiovascular disease projected to age 90. So your chance of developing cardiovascular disease falls to as low as 5% if you can enter your 50s without any one of those factors. So that's important to know because we can start thinking in our 30s, our 50s and perhaps begin to change our lifestyle. And when we look at causes of chronic diseases, there's a very large percentage of behavioral factors that influence whether or not we get those risk factors. So how physically active we are is extremely important. How sedentary we are, so this is separate from just activity, but the more we sit, the worse off we are. Our diet is a key factor. Unfortunately, the messages from scientists and in the popular press are quite confusing. Most of us do recommend eating foods, not food-like substances. So that means processed foods. So whole foods, cooking at home as opposed to buying it outside of the home, a lot of fruits and vegetables and of course minimizing fried foods, fast foods and then moderate sodium intake. You'll notice I didn't say low sodium intake because right now there's a controversy as to how low the sodium should be in our diet. So mother's advice of everything in moderation seems to be the way to proceed at the best time. So if we can live well and live healthy, we can prevent cardiovascular disease. And there have been studies done of centagenarians, so individuals who reached the age of 100. And there's a very popular book called The Blue Zones where a group of investigators went to these highly prevalent countries where there were lots of centenarians. And these include northern Japan, the island of Crete, seventh day adventists. And they look to see what are the common features of people who can live up to 100 years of age. And their lifestyles are filled with physical activity, so a lot of walking. So there aren't gyms in Crete as much as there would be here. So a lot of walking, growing ones food and eating fresh foods, getting enough sleep, trying to minimize stress. And then a very intriguing component of the research came to light, which was our social networks. So social networks refer to how connected we are with our family members, our friends, and who we can call on in tough times. So not everyone is wealthy. We all have struggles. We all have stress in our families. But if we are able to buffer the stress or the effects of stress with a healthy social network, that seems to be protected against cardiovascular disease. So again, very important. So I've talked mostly about the causes of arterial disease, but there are other forms of cardiovascular disease. As we age, the shape of our hearts tends to change. So if you're an individual with high blood pressure, your heart will start to change its shape because it's pumping against a very high pressure. And with the changes in shape of your heart, you may get into problems such as arrhythmias. And many of you may have heard of atrial fibrillation, which is a common arrhythmia. It affects about 25% of the elderly population. And individuals with atrial fibrillation can run into problems with heart failure, as well as stroke. So we tend to treat individuals with atrial fibrillation with blood thinners or anticoagulants, and you may have heard of that before. Other changes in the heart that can occur with aging include changes to the heart valves. And in particular, calcification of heart valves. And a common heart valve that can be calcified and stenosed, as we call it, is the aortic valve. So about 15% of older individuals will have aortic stenosis. And my eight and three-year-old dad just had his surgery last week where he had his valve replaced. Now percutaneously, which means without doing an open heart, down in the general, they can do it by using catheters. So there have been many advances in the field that are allowing individuals, as they age, who develop age-related problems, to have them repaired and keep on living a healthy active life. I'll close by just bringing up some of the intriguing biology that the CLSA will be looking into and some of the people I work with in the field of genetics are examining. And that is something called telomere length. So telomere length refers to the length of your chromosome. And the shorter your chromosomes become, the greater your risk for some chronic diseases. And if you picture a shoelace that has a tiny plastic band on the shoelace, the plastic end is important because if you don't have it, the whole shoelace unravels. That's like your telomere length. And as you go through tough times, you eat a poor diet, you live in a stressful environment where you don't stay active physically, or you smoke, or things of that nature, you start to cause that shoelace to fray. And the shorter your chromosome becomes, the greater you are at risk because you can't repair cell damage or DNA damage as it occurs. So there are lots of studies now that are showing us, essentially, that telomere length or short telomeres are risk factors for chronic diseases. But many of the solutions that we see come back to those same principles of prevention. So it's the poor diet, the smoking, the lack of exercise that leads to the short telomeres that then lead to cardiovascular disease. There are some groups looking at medications that can alter telomere length, and there are excellent medications in the field of cardiovascular disease that many of us take for different risk factors we have. So that's important too, but I would end by saying prevention of cardiovascular disease begins early in life, trying to be the 50-year-old without any of the risk factors. If one develops cardiovascular disease, there are excellent medications now available to help lower blood pressure, lower cholesterol, treat diabetes, and even help individuals quit smoking. And finally, our medical science is advancing so rapidly that procedures such as bypass surgery or changing a valve through a catheter are also possible. So I'll stop there, and I think we'll go into next week. Thank you very much. Vincent is the Director of Research for the Heart and Stroke Foundation of Ontario, where he leads a multidisciplinary team specializing in research program management and health professional education. Prior to joining the Heart and Stroke Foundation, he was the Director of Rants and Partnership for the Canadian Breast Cancer Foundation, Ontario Region. He has many years of experience as a leader in the not-for-profit sector, including senior executive roles in hospitals and long-term care foundations. Please join me in welcoming Vincent Loeb. Vincent? Thank you very much. And thank you, Sonya, for the great, a slightly different approach to the comments I'd like to make this evening. What I'd like to do is paint a big picture view for you of some trends with respect to heart disease, stroke, and vascular aging. And as part of that, I want to share with you some good news, as well as some not-so-good news. We've made great strides against heart disease and stroke in Canada, but there are some concerning trends, and there's still a lot that remains to be done at a population health level to ensure that we have the best quality of health and health care that we possibly can. I'd also like to tell you a little bit about what the Heart and Stroke Foundation is doing and wrap it up by offering a few suggestions on things you can do to improve your own vascular health. So let's start with the good news. Between 2000 and 2009, there's been a 33% decline in age-standardized cardiovascular death rates in Canada, and that continues a positive trend that began in the 1950s. So since 1952, as an example, the cardiovascular death rate in Canada has been reduced by over 75%. So that's a really outstanding progress that's been made possible through a combination of research and lifestyle interventions. We've also seen in the last decades the average age of patients hospitalized for heart attack has increased by three years. For heart failure, the age has increased by two years. And for stroke, the age has increased by one year. So this is an evidence of a trend towards later onset of these events, which also is good news. And as Sonya mentioned, studies have shown that 80% of premature cardiovascular disease is preventable through the management of modifiable behaviors and risk factors. And she gave you insights into what those are. So this all points to opportunity for continuing improvement in the health of Canadians. The Interheart study determined that if the population ate enough fruit and vegetables, we could reduce the risk of heart attacks by 40%. And there's a recently developed Camp Heart Ideal Cardiovascular Health Index that demonstrates that reaching optimal levels of six health factors and behaviors is associated with an 89% lower incidence of cardiovascular disease, a 76% reduction of stroke incidence, a 70% reduction in ischemic heart disease, mortality, and a 51% lower incidence of cancer. So there's a lot of reason for optimism and hope. And we should celebrate the success that Canada has had and leadership that has had in these areas. But then that brings me to some of the not-so-good news. So despite the progress that we've talked about, heart disease and stroke continue to represent two of the three leading causes of death in Canada, as well as the leading causes of hospitalization. Still, every seven minutes in Canada, there's a rise from heart disease or stroke. Every 12 minutes, someone experiences a cardiac arrest and only 5% of those who experience one outside of hospital survive. And then you look at how Canada ranks in terms of the population health in comparison to other countries. And you look at OECD countries and realize that we're sort of middle of the pack. And if we were to achieve the same mortality rate for example, as France, we'd save 38,000 lives annually in Canada. So we still have a ways to go. And we also know that heart disease and stroke represent only a portion of the conditions that are linked to vascular disease or diseases of the vascular shirt. They impact on dementia, certain kidney disease, lung and eye conditions. So there are relationships that are much broader than just heart disease and stroke and the impact of vascular disease and vascular aging is even more important to recognize. Another factor is that the prevalence of risk factors is increasing fastest among younger Canadians. While overall rates of smoking, uncontrolled hypertension, high cholesterol are projected to stay stable or decline, the projected continued rise in obesity and diabetes which are both risks for cardiovascular events has the potential to derail the progress that we've seen. In fact, childhood obesity rates have tripled in the last 30 years and the rates of hypertension among the young are on the rise. So we're now seeing children who have high blood pressure and we all know that that leads significantly to risk later on. So that really is a concern. We also know that there are certain groups within our population that even have higher disease burden including some ethnic groups, aboriginal populations, lower income groups in those living in rural and remote areas. So there's more work to be done in those areas as well. So we'll just touch briefly on what Heart and Stroke Foundation is doing. We are committing ourselves to focus our resources on the achievement of two bold impact goals. So we've set out the objective by 2020 of significantly improving the health of Canadians by decreasing the risk factors for heart disease stroke by 10%. And by 2020, reducing Canadians the rate of death from heart disease is stroke by 25%. So that means really increasing our focus on prevention. So we're putting a lot of emphasis on children and youth, to give children and youth the best start for a long healthy life addressing the risk factors that have been talked about already. We are going to be doing similar kinds of programming targeted to adult populations with the addition of targeting particularly high blood pressure in that population. We have a focus on faster and better cardiac emergency response in treatment. And so that is represented through our work in distributing AEDs and training people in CPR in first aid. And we're also working to for better stroke response in treatment. We are responsible for Canadian best practice guidelines in stroke as one example and getting those standards in action within the healthcare system can make a significant difference. So I've given you some good news, some not so good news an overview of what we're doing at Heart and Stroke and I'd like to wrap up with a few suggestions of things you can do. So the first thing obviously number one is make your health a priority. Talk to your healthcare provider about your vascular risk and things you can do to reduce your personal risk of vascular disease. If you are so inclined you can visit the Heart and Stroke Foundation website and take the Heart and Stroke risk assessment information and tools there that can help you manage weight and blood pressure among other things. Adopt healthy behavior so we've spoken about this before. Get active, eat right, be smoke free, limit alcohol consumption manage stress. And then the thing that may not be quite as obvious is the idea of advocacy. Not only advocate for yourself and your own health but advocate with government, local, provincial, municipal, federal for healthy public policies so that where you and your family live and work is a healthy food, a physical activity friendly and a smoke free environment. And this is so important because we want ultimately to make the healthy choices the easy choices and make that the default for all Canadians. Thank you for your attention. Today I'll look forward to the rest of the presentations and our conversations. Our next presenter, Dr. Heckman is an associate professor who holds the Schlagel Research Chair in Geriatric Medicine at the University of Waterloo. He's also an assistant clinical professor of medicine at McMaster University. George holds the Geriatric Medicine Master of Science and has a specialist certification in internal geriatric medicine Dr. Heckman is Page Medicine is currently the lead geriatrician for the war. His research interests include the management of heart disease among seniors and the primary care management of dementia. Please welcome Dr. Heckman. Alright, so I'm a geriatrician and you're probably wondering what's a geriatrician doing at a cardiac convention leading. Obviously a lot of seniors are going to develop heart disease but there's very different things that happen when you get older and you have heart disease. But I think let's take a step back because who's heard of this thing called silver tsunami or the aging tsunami? Anyone have all heard about it? As if it's bad to have lots of seniors and I think I have to take exception to that because the fact that we are living longer and actually better than we ever did to me is indicative of great success and the benefits of living in a country like we do so I think it's a good thing. And the issue is though that not all seniors are going to age well and we all, two years ago we all saw this fellow who ran the Toronto Marathon, his name was I forget what his name was but they called him the Turban Tornado and he torpedoed no torpedoes, no torpedoes who got caught in the big trucks but this guy was a big truck so he ran the Toronto Marathon at the age of 100 in 8 hours just faster than I've done it because I've never actually done a marathon he's way healthier than I am but if we could all age that way that would be great but not all of us are able to do that and even despite adopting good health practices some of us are not going to do as well and are going to run into trouble and this kind of trouble we hear about it ending up in hospital more often than we'd like ending up with long term care and then in home care our caregivers get very stressed looking after us and so what I do is try to not only see patients with these issues but in Waterloo, Wellington and in the research that I do is try to organize the way we look at these folks in a different way because inevitably many of us are going to run into troubles with our health and we all like to age at home but that requires things that in the healthcare system they need to change and one of the key things is we're working in a healthcare system that I think is very good but it was designed in the 1960s and 70s when people broke their legs or had some kind of emergency surgery and then in the 80s and 90s all of these fantastic medications for cardiovascular disease and other treatments came about and what we've done is we've converted many illnesses that would be lethal into illnesses that aren't lethal but that people live with for a very long time and so we've changed the nature of the illnesses that people have into longer term illnesses that people have to live with for a long period of time and unfortunately as some people get older they accumulate multiple illnesses and one of the key ones as Vincent alluded to is heart disease with dementia and does anyone dementia, you've all heard about dementia dementia refers to a family of diseases that affect the brain and it's extremely common almost as common as heart diseases and many of us will develop dementia if we live long enough into our 80s we have a 25-30% chance of developing dementia and dementia basically means a sort of illness that affects the brain to an extent that we start losing certain abilities like memory, like planning like solving problems like knowing where we are language, behaviors and these diseases essentially get worse over time and we need more and more help in order to maintain our independence and ultimately many people will end up in long-term care and many of these people will consume healthcare resources and truth be told most of the expense and the burden is on their care providers, their family and I can talk about some very key examples of patients that I see we see a lot of heart failure patients where I work and often we think, my goodness why has this person been in the hospital three times in the last two months and people focus on the heart disease and we need to take a step back and look at what's going on and we often find that these people also have dementia why do you get dementia when you have heart disease well the same things that affect your heart will damage your brain over time the heart's connected to the brain you think of stroke as an example of that kind of damage but long-term blood pressure problems for example long-term cardiac diseases that prevents the heart from actually pumping up to meet the needs of the brain over time that could cause damage not like a sudden stroke but just little bits at a time and over time you can develop dementia Alzheimer's disease is linked to heart disease stroke and vascular dementia are linked to heart disease and so very often we see people with all of these things going on at once and if you don't think about that here's what we do we see this person with heart failure that's a lot of medications but they're appropriate we give them instructions and we send them home and they come back two weeks later as they forgot about their prescriptions or they're not following the instructions because they have dementia and no one thought about it the caregiver needs to be part of this the caregiver needs to be part of this because the person with dementia may not be able to manage their care but then if you dump everything onto the caregiver it becomes a trouble too and give you a very common example of usually an older man who's widowed, looked after by his daughter it's often the daughters who do this who are stuck trying to manage a household and the stress starts to build and what do they do while they go out to the fish and chip shop because it's easier to go out than make the food the caregiver is so stressed but of course the fish and chips are full of salt it's not good when you have heart failure and really the issue here is not the heart disease itself it's the whole situation that we've dumped everything onto the caregiver in terms of managing this person it's not really thinking about whether that's the right thing to do and with proper support for the caregiver we can interrupt this chain of events and keep this person out of the hospital by supporting the caregiver and teaching the caregiver the skills to help manage this person so trying to help the caregiver reduce that burden as well so a lot of these things aren't just in isolation they come in at the same time a lot of people with heart disease not only do they get dementia but some of our research is showing interesting things in long-term care we also often hear about nursing home patients with behaviors, aggressive behaviors and they get treated with anti-psychotic drugs and anti-psychotic drugs lead to pneumonia and falls strokes and what our research seems to be showing is that in these seniors who haven't read the cardiology books and don't know that they're supposed to express their symptoms and think I have shortness of breath will actually feel unwell because of their dementia they can't express their symptoms and they'll act out they'll misbehave or they'll have trouble sleeping or they'll see things and one of the key issues is that instead of this being recognized as a manifestation of their heart disease it's treated as some sort of thing that's related to depression or dementia and therefore they get treated with anti-psychotic drugs and not the heart failure drugs so a lot of what we do is trying to educate people about how to manage these older people who are suffering from multiple illnesses all at once and all interact together and by managing this because a lot of people wonder what's the point of geriatrics is if you can manage all of this you can actually improve people's cognition you can prevent them from becoming more disabled you can keep them out of hospital you can keep the caregivers healthy and so from my point of view the management of heart disease needs to be very global needs to consider all of these issues because older there's two patients there's you and there's your caregiver and I think the good news is I think we're starting to realize that it's a huge effort in water in the Wellington we're doing well but what I said today somebody this morning is trying to change the system is trying to hurt cats the size of the Titanic so that said I think there's hope and I'm very much encouraged by the fact that Ontario now has a geriatrician in the Ministry of Health and so I think I'll end here and thank you for listening the YMCA of Hamilton, Hamilton and Bramford she's a graduate of McMaster University Department of Physiology and recipient of the cancer character of Ontario Quality and Innovation Award she has been with YMCA for almost 15 years and is a national training educator for YMCA Canada she has been responsible for the development and implementation of the very well community health partnership between the YMCA Hamilton Health Sciences and McMaster University please welcome Genevieve a chance to meet us have you had a chance to meet each other you've been sitting there for a little bit why don't we take 30 seconds can you look to the person on your left and right and just introduce one mother really quickly that's a little information but it's about taking action to impact stories and things we've done so I'm going to share a little story that we did within the YMCA related to our little partnership so we had the opportunity at one of our centres a woman was brought in her daughter unfortunately the woman coming in had some health conditions she had cardiovascular issues was dealing with depression due to isolation also had some joint issues lots of significant arthritis but I'm telling you her daughter dragged her through the door she didn't want to be there her physician said to her it's time to do something or the choices are going to start to be removed you have to get active her daughter was trying to get her to do something dragging through the YMCA door again she didn't want to be there but we said let's try her challenge was that she knew she had exercise but it's trying to find something that didn't hurt or something that should be do comfortably and she said do not get me on a treadmill so we started her at one of our Rosemary there actually had a participant through our program so she can talk to you about that on coffee break anyways we got this woman going and suddenly it wasn't an effort to come in anymore so she was coming into the pool energy levels were increasing over the course of her time with us lost about 45 pounds started to feel in control of her health and what also happened with her was really magnificent over the course of the year she started to be the advocate of the program so if a new participant came in she was starting to build friends she would make sure that person was greeted also became the person if someone in class wasn't showing up she got on the phone calling them saying I'm waiting for ya you gotta come in so what we saw was a real transformation in her where exercise was might have been the original reason she came in but what we helped to work and support her with was the whole social connection that she didn't have a lot of friends her husband and pet passed away was feeling really isolated and we were able to through really advocacy and facilitating what she was able to do to help empower her to take over her health so I'm going to talk to you a little bit about a program that was referenced there called Live Well which is a partnership between the YMCA and Hamilton Burlington Brantford we've got five regional sites Hamilton Health Sciences and McMaster University so as we were looking to build new it was about 10 years ago looking to expand our facilities in the community originally Hamilton Health Sciences and the YMCA got together and said what could community health look like why does everything that we want to do involve going to a hospital why can't we do something different so that was where the innovation really started we started at a grassroots level with a couple programs over the years we've progressed now to and it's not what I've done yet to eight programs so right now we have programs in our centers one for Canvaugh which is an exercise program for individuals with any type of cancer at any stage of cancer we have a program called Healthy Hearts for cardiovascular health so it's rehabilitation we're also working on the prevention piece we have a program called Fit for Function which is for individuals that have stroke in motion which is a program for individuals with arthritis, osteoporosis or preparing or recovering from joint replacement surgery program called Mobility Plus which for individuals that may have more mobility challenges than what the in motion can provide so individuals perhaps with more severe stroke spinal cord injury, Parkinson's MS, different different things there we've got a diabetes program and as well as a children's pediatric rehab program so we know we've got children with physical and cognitive disabilities that we know have a more challenging time finding the right kind of exercise in the community so the way that the programs work is they're open to the community you can self refer into the programs we do have physicians that refer orthopedic surgeons now when you're getting ready for surgery we'll say take care of that joint afterwards and you can come into our program so you can self refer into the program clinics prefer or physicians refer the programs are included with membership and we do provide financial assistance so no one is turned away we very strategically chose that group because a lot of times what will happen is when individuals come in and they join a 10 week program or 12 week program that starts and stops people can often have them by instead of I'm finished I'm healthy now and forget about it and so what we're trying to promote is an active lifestyle that's engaged with communities coming in together in many cases we find with spouses so individuals will come into the program and for transportation needs the spouse may drive them and sometimes what we're finding is the spouses that are driving them are in worse condition than people coming into our programs so we want to make sure we're looking at the whole family and to say how come we get families active and doing things together so the programs again are included in membership the formal research part of our program is 12 weeks long so you join we do some baseline testing for each individual coming in to measure your fitness to see how you are starting as well as some qualitative things just to see what is going on lifestyle wise and then we'll put you through a variety of exercise programs you can choose some group options like hydrotherapy in the pool we've got free community walking programs so we'll put you through a structured exercise program we also do education sessions for us this is a really valuable one we've had individuals come into the community and not quite sure what they're diagnosed with and that's a challenge and we also know for whatever program it is sometimes they can be overwhelming when you're diagnosed with something and then when you get ready to go back and you see your physician if you've only got a few minutes with them people could forget what to ask or knowing what things to be flagged or what things to watch for with all of our programs the way it works is the YMCA staff delivers the program we deliver the exercise and the education but we also have health professionals from Hamilton Health Sciences on site so we're bringing the physiotherapists that are practitioners the kinesiologists we're bringing them out of the hospital and bringing them into the YMCA to help mention the staff to make sure what we're doing is appropriate and safe but to help answer questions because sometimes what we're finding is individuals may have questions and they're either going back into the hospital or waiting for an appointment to get back in when it's something that could actually be solved quite quickly and there are times that we see things and say you know this is an important thing you need to go back and see your physician so that program itself site is for 12 weeks we do at 12, the 12 week mark we do some post testing so we see what the results have been physically as well as qualitatively but when you get to the 12 week mark you don't finish so you can graduate from the program if you want but you're still able to participate we've had some individuals in our in motion program that have been coming for five years to the education sessions every week and they say I get something new out of it every week I get to sit and have lunch with my friends so I'm going to keep coming and that's fantastic so that's again the 12 week program and then you're welcome to continue staying after that so it's really an innovative partnership what we're finding is we're trying to reduce some of the barriers out there so families can come in our cardiovascular program specifically we've just done a lot of work with Hamilton Health Sciences to move all the group cardiac sessions right out of Hamilton General and put them into the YMCA we know it's a challenge for individuals if you're going into the hospital I know when I go for meetings I go there it's $15 every time I go times three times a week times going every week for a month that's a significant cost to people they can be put about twice we're trying to put that back into the community the equivalent cost for YMCA membership is less than one physiotherapy session a month and again we provide financial assistance to make sure that no one is turned away and this is starting to get the attention we know we've got to do something different around community health we're also working within the Y's to try to get our kids active we see it every day with kids coming in we're now in a generation where these kids coming in may not outlive and so that's a very scary thing for us and so we're trying to balance both ends of the spectrum and getting awareness out of kids active and sometimes what we're finding around if someone's had a stroke or had a cardiovascular episode there is a more immediate call to action people are scared saying I've got to do something about this what tends to happen sometimes is we don't have that call to action before something happens and looking back saying why didn't I do something about that and sometimes what can happen is that call to action can happen after you have an episode and then it wears off a little bit and so what we're trying to really focus on within the YMCA setting is that it becomes a lifestyle factor that's about how do you put activity into your lifestyle every day and make it fun while you're doing it so that's our liberal partnership we deliver those programs in five regional sites and we are also working with Wine Safe Canada to look at a national strategy on one of these programs out this evening you heard from perspectives from research to practice to what is happening in the from clinical practice to what's happening in the community and I think George was absolutely right that in media in all sorts of ways we hear that the aging of population is something negative it actually is probably one of the biggest achievements of the modern science and medicine and that we have achieved the life expectancy that we have achieved and many of the people, 80% of the people over the age of 65 live happily in their communities and function very well and that's where the prevention piece becomes important because we want to keep people in their homes and their communities as long as possible and the clinical and the medical and the other aspects that we heard this evening are important for other 20% who have very complex health issues how do we provide the best possible care to those individuals that they can function reasonably well in their home centers so that concludes the first part of the evening. Please take 10 minutes of break and enjoy some refreshments and visit our tables at the back and learn more about the research that is going on at McMaster and we'll see you back in 10 minutes.