5th Anniversary of the BC Brain Wellness Program
Supporting individuals living with chronic brain conditions, their care partners and healthy agers with lifestyle interventions for prevention and holistic health management
The BC Brain Wellness Program (BCBWP) at the University of British Columbia was founded by two physicians in an attempt to extend the usual clinical care from sick care to prevention and empower individuals to take action themselves to improve their health. The physicians’ clinical experience clearly favoured the inclusion of lifestyle interventions such as exercise, healthy nutrition, creative and cognitive activities, stress reduction, mindfulness and social connection into a holistic health care approach. They were also aware of the many potential barriers to engagement associated with chronic brain conditions such as finances, mobility, mood, stigma, specialized needs etc. Lowering barriers for participation in lifestyle interventions was thus crucial for the ongoing pursuit of an active, health-promoting lifestyle. Since 2019, the interdisciplinary team has successfully delivered an evidence-informed, holistic, low-barrier lifestyle program to support and improve quality of life for people living with chronic brain conditions, their care partners, and healthy agers. The program fills the crucial gap of ongoing, proactive, lifestyle-based interventions left by the traditional health care system which covers sick care and acute rehabilitation.
Background
Brain disorders are the leading cause globally of disability and the second most common cause of death, 40% of the world population will be affected by a brain disorder in their lifetime which will become even more prevalent with a globally aging population. A significant portion of brain diseases can be prevented, e.g. 90% of strokes and around 50% of dementias. Risk factor management such as blood pressure optimization and treatment of hearing or visual deficits as well as lifestyle factors such as nutrition, physical activity, sleep optimization, cognitive and creative activity, stress reduction, spiritual health and social connection can play important roles in reducing the risk or delaying the onset of brain disorders (primary and secondary prevention) as well as reducing the impact and potentially slowing disease progression when disorders are already established (tertiary prevention).
Prevention at all levels is thus crucial to reduce individual and societal cost, let alone individual suffering; the World Federation of Neurology and the WHO have dedicated current campaigns to the prevention of brain diseases (https://wfneurology.org/world-brain-day-2024). In this spirit, the BCBWP (www.bcbrainwellness.ca) has been delivering low-barrier lifestyle interventions. While the current program is focusing on brain health, many of the interventions also have positive impacts on the risk and management of diabetes mellitus and metabolic disorders, cardiovascular disease, numerous cancers etc.
Key features
The BCBWP is a public outreach program at the Djavad Mowafaghian Centre for Brain Health, a leading clinical and neuroscience research centre, run jointly by the University of British Columbia and Vancouver Coastal Health. The design of the BC Brain Wellness Program aims to reduce barriers to participation in lifestyle interventions and to provide support for both prevention and management of brain conditions. The hybrid format of both online and in-person classes reduces mobility and geographic barriers, e.g. for participants in rural areas. The group-based approach is cost-effective and creates community. Individuals can participate in the program on a long-term basis; this approach reflects the reality of chronic brain conditions and aging, and also provides the opportunity for more significant improvements than in time-limited, e.g. ten-week courses. Prospective participants for the exercise program will have a 1:1 intake assessment and motivational interview to ascertain functional levels and personal goals. The different levels of exercise classes are based on functional ability rather than diagnostic labels, allowing optimization of exercise intensity levels to abilities for both safety and efficacy while fostering inclusion. Physiotherapy, kinesiology, neuropsychology, and dietetics students provide supervised assessments and/or assist in the delivery of classes. Students from a broad range of backgrounds take class attendance and assist participants during classes as needed. Individuals can join the program without an official medical diagnosis which is important in the context of long waitlist for specialist appointments. Self-referral and online sign-up, with telephone support if needed, reduce barriers to join. The program is open to care partners and healthy agers, thus implementing the upstream preventative focus of lifestyle interventions and supporting care partners in the important role they play for individuals living with brain conditions and for the provision of care on a societal level. The diverse participant advisory committee is instrumental in the creation of new activities, and feedback on existing initiatives, guiding the program with the voices of participants living with chronic brain conditions, care partners and healthy agers.
For five years now, the virtual program has been free for participants while the in-person program is available for a small fee, reducing financial barriers for participants. Participants have more frequent, informal contact with their extended health care team who can accelerate any concerns for review as needed compared to the usual infrequent, formal reviews.
Impact
Over the past five years, the BCBWP has reached over 2,500 participants, 700 to 800 people are actively participating in the program in any given semester. The BCBWP has provided over 4,000 hours of free programming. About 50 volunteer students work with the BCBWP every semester. The program collaborates closely with the Schools of Physiotherapy, Kinesiology, Dietetics and most recently Neuropsychology to elevate the education of a wide range of students and future health care and exercise professionals about brain conditions and the role and delivery of lifestyle in their prevention and management.
Research and knowledge translation
Complementary to the educational and program activities, the team conducts a range of research studies into the mechanisms and implementation of lifestyle interventions for brain health. Through public workshops, webinars and lectures such as the monthly “Wellness Wednesdays” and the “Research Seminar Series” the BCBWP makes knowledge and research updates on lifestyle interventions and brain health accessible for a broad audience.
Feedback from participants and students
Participants have frequently described the program as a “lifeline” with benefits for physical, mental, and social health. Some long-term participants have had continued improvement of function over several years, allowing them to return to everyday activities such as walking, driving, cycling and hobbies they had to give up due to their brain conditions which in turn has significantly reduced costs of care downstream. There is a palpable team spirit even in the online classes and numerous friendships have been formed. Formal assessments of program impact are underway. Educational placements in the program are highly sought after and several students have been inspired to pursue further training and careers in the management of brain health conditions.
Outlook
The BCBWP is aiming to add more in-person satellite programs in BC to provide more intensive support for local communities following a “train-the-trainer” model and by partnering with other organizations with complementary goals. The program can be implemented across Canada and beyond to support a broader population and help train the next generation of health care professionals in lifestyle interventions for the prevention and management of chronic brain conditions.
Cost
Formal health economic assessments of the program still need to be conducted but the literature and our case studies suggest the potential for significant savings of health and care costs downstream. Program costs are currently exclusively covered by philanthropic donations with the aim to secure more long-term funding.
On October 19th, 2024, we will gather to celebrate the impact and the inspiration of the BC Brain Wellness Program as we mark its 5th Anniversary. We invite you to celebrate with us, share in our achievements, and be part of the future of brain wellness. Register now to reserve your spot and join the conversation about the exciting possibilities for the BC Brain Wellness Program.