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2015: How do we encourage our patients to exercise?-Linke

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How do we encourage our patients to exercise?

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2015: How do we encourage our patients to exercise?-Linke

  1. 1. How do we encourage our patients to exercise? Sarah E. Linke, PhD, MPH October 25, 2015 Clinical Geriatrics Symposium
  2. 2. Exercise is Medicine  “If exercise could be purchased in a pill, it would be the single most widely prescribed and beneficial medicine in the nation.” --Robert H. Butler
  3. 3. Current PA Guidelines for Overall Health in Older Adults  Aerobic activities (e.g., brisk walking)  ≥150 minutes per week of moderate intensity OR  ≥75 minutes per week of vigorous intensity  Muscle-strengthening activities for all major muscle groups  Flexibility exercises  Neuromotor exercises (i.e., balance and coordination) ≥2 days per week
  4. 4. % of US Adults Meeting PA Guidelines, 2011-2013 (NHIS)
  5. 5. The bad news  Cardiac output  Lung performance  Muscle mass  Insulin sensitivity  Bone density  Memory  Hormone regulation  Immune system capacity Aging
  6. 6. The good news  Cardiac output  Lung performance  Muscle mass  Insulin sensitivity  Bone density  Memory  Hormone regulation  Immune system capacity Aging Activity
  7. 7. Reasons to Exercise  Physical health benefits  Mental health benefits  Stress reduction  Quality of life  Enjoyment  Socializing  Self-esteem & self-confidence
  8. 8. Physical Health Benefits  Exercise is associated with improvements/reductions in numerous physical health conditions, including:  Premature death  Hypertension  Cardiovascular diseases  Cancer  Diabetes  Overweight/obesity
  9. 9. Physical Health Benefits Specific to Seniors  Prevent falls and fractures  Allow greater independence in everyday life  Enhance cognitive performance capabilities  Improve reaction skills  Enhance ability to carry weights  Improve flexibility and agility  Improve balance  Increase life expectancy
  10. 10. Physical Health Benefits Specific to Seniors  Decreases the risk of these & other conditions:  Dementia  Pain  Back pain  Congestive heart failure  Stroke  Constipation  Osteoporosis and arthritis
  11. 11. Mental Health Benefits  Exercise is associated with improvements/reductions in numerous mental health conditions, including:  Depression  Anxiety  Substance use disorders  Cognitive disorders  Severe mental illnesses
  12. 12. Anxiety & Depression  Acute effects: immediate and possibly, but not necessarily, temporary effects arising from a single bout of exercise  Chronic effects: long-term changes over time due to regular exercise  Associations are maintained regardless of the intensity and/or duration of exercise  Weight training, yoga, moderate walking
  13. 13. How does it work?  Combination of physiological & psychological mechanisms, including…  Physiological explanations  Increases in cerebral blood flow  Changes in neurotransmitters  Increases in maximal oxygen consumption and delivery of oxygen to cerebral tissues  Reductions in muscle tension  Structural changes in the brain
  14. 14. How does it work?  Psychological explanations  Enhanced feeling of control  Feeling of competency & self-efficacy  Positive social interactions  Improved self-concept & self-esteem  Opportunities for fun & enjoyment  Many other theories/hypotheses, none of which is most widely accepted
  15. 15. Exercise & Quality of Life  Increased self-esteem & self-concept  Increased feelings of enjoyment  Decreased feelings of physiological & psychological stress  Increased feelings of self-confidence  Elevated mood states  Greater ability to cope with stress and tension than inactive individuals
  16. 16. Exercise & Sleep in Seniors  Randomized controlled trials examining the effects of exercise on sleep in older adults  Total sleep duration, sleep onset latency, daytime dysfunction, and scores on a scale of global sleep quality showed significant improvements  Reductions in depressive symptoms, daytime sleepiness, and improvements in vitality
  17. 17. Exercise & Cognitive Functioning  Rapidly growing area of research  Recent surge in research in the relationship between exercise & dementia/Alzheimer’s disease risk  Perhaps the most critical modifiable risk factor  Chronic exercise shows greater effects than acute exercise  But a sufficient amount & intensity of acute activity affects some measures
  18. 18. Exercise as Therapy Adjunct  Research support  As effective as SSRIs for major depression in gold standard RCTs  Cost-effective  Time-efficient  Minimal side effects
  19. 19. So What’s the Problem??  If exercise is so wonderful, why doesn’t everyone “Just Do It”?!
  20. 20. Exercise Attrition/Adherence  Behavior is difficult to change!!  Steep drop during the first 6 months  Levels off until 18 months
  21. 21. Determinants of Adherence  Personal factors  Demographic variables  Education, income, age, gender, ethnicity, etc.  Cognitive and personality variables  Self-efficacy, self-motivation  Exercise beliefs & expectations  Behaviors  Early involvement in sport → ↑ adult activity  Past behavior is the best predictor of behavior!
  22. 22. Determinants of Adherence  Environmental factors  Social environment  Spousal support especially critical  Physical environment  Convenience, built environment  Physical activity characteristics  Exercise intensity and duration  Moderate is best  Group vs. individual programs  Groups generally better for adherence, but individual diff.  Leader qualities
  23. 23. Reasons for Not Exercising  (Perceived) lack of time  Lack of energy  Lack of motivation  Lack of skill  Fear of injury  Illness/injury  Pain  Lack of facilities  Lack of other resources
  24. 24. It’s not that easy!!!  Education is seldom sufficient to promote behavior change. You also need:  Skills to plan and maintain an exercise program  Support from friends, family and society  Knowledge about what to do, how much, how often, etc.  The right environment
  25. 25. Guidelines for Improving Exercise Adherence  Consider individual’s stage of change  Help each person discover his/her personal reason/motivation to exercise  Offer choices of activities  Make prescribed exercises enjoyable  Focus on the immediate benefits of exercise  Improved mood/affect, self-confidence
  26. 26. Exercise Stages of Change
  27. 27. 5 A’s for Exercise Counseling
  28. 28. Weighing the Costs vs. Benefits of Exercise  Costs of Exercising:  _______________________________  _______________________________  _______________________________  Benefits of Exercising:  _______________________________  _______________________________  _______________________________
  29. 29. Personal Exercise Benefits Short-term Benefits 1. _________________________ 2. _________________________ Long-term Benefits 1. _________________________ 2. _________________________ Importance to Me 1. ________ 2. ________ 1. ________ 2. ________
  30. 30. Guidelines for Improving Exercise Adherence  Tailor intensity, duration, frequency  Set goals together  Follow-up with goals & set new ones  Include a contract  Provide cues for exercise  Leave workout clothes visible  Encourage the individual to schedule time to exercise to make it a routine  Promote & facilitate social exercise
  31. 31. Scheduling Activities
  32. 32. Potential Barriers 1. Barrier: _____________________ a. Solution: ______________________ b. Solution: ______________________ 2. Barrier: _____________________ a. Solution: ______________________ b. Solution: ______________________ 3. Barrier: _____________________ a. Solution: ______________________ b. Solution: ______________________
  33. 33. Set SMART Goals  Specific  Measurable  Attainable  Relevant  Timely
  34. 34. Goal Setting Exercise 1) Long-term Goal: _________________ a. Short-term Goal: ___________________ b. Short-term Goal: ___________________ c. Short-term Goal: ___________________ 2) Long-term Goal: _________________ a. Short-term Goal: ___________________ b. Short-term Goal: ___________________ c. Short-term Goal: ___________________
  35. 35. Rewarding Yourself Plan a specific reward for each goal you meet 1) Long-term Goal: _________________ a. Short-term Goal: ___________________ b. Short-term Goal: ___________________ c. Short-term Goal: ___________________ 2) Long-term Goal: _________________ a. Short-term Goal: ___________________ b. Short-term Goal: ___________________ c. Short-term Goal: ___________________
  36. 36. Exercise Maintenance  Think of ways you can make exercise a consistent part of your weekly routine, and write them below.  Try brainstorming which activities might keep you motivated and who you can turn to for support when you experience setbacks in your exercise program.  __________________________________  __________________________________  __________________________________
  37. 37. Lapse vs. Relapse  “Slipping” or “lapsing” from your exercise routine is different from “relapsing” from your exercise habit.  A lapse is a temporary slip to previous behavior – usually a one- time occurrence.  A relapse is a full-blown return to previous patterns.  When a lapse occurs, don’t get discouraged! Get back on track before it becomes a pattern.  A lapse is an opportunity to learn, and it should not be viewed as a failure.  Think about what got in the way of your regular exercise schedule and what you can do to prevent it from happening again in the future.
  38. 38. Socioecological Model of Behavior Change Environment
  39. 39. The Built Environment  Facilities:  Walking paths, exercise courts/equipment  Indoor facilities:  Exercise room/equipment, classes/programs, corridors/stairwells  Neighborhood:  Walking routes (sidewalks, crossings), exercise classes, excursions
  40. 40. Indoor Facilities
  41. 41. Walking Paths
  42. 42. Outdoor facilities
  43. 43. Exercise Stations
  44. 44. Summary  Exercise is beneficial for everyone!  Everyone can do some form of exercise  Generally not helpful to force exercise upon someone  Help them find their own personal motivations for exercise  Help them create tools and learn skills that will keep them on track
  45. 45. THANK YOU! QUESTIONS?

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