This document discusses strategies for encouraging patients to exercise. It begins by outlining current guidelines for physical activity in older adults, then discusses the physical and mental health benefits of exercise. While exercise is beneficial, adherence can be challenging due to various personal and environmental factors. The document provides tips for healthcare providers to help patients establish exercise routines, including assessing readiness to change, goal setting, addressing barriers, and utilizing social support. It emphasizes tailoring recommendations to individual needs and abilities.

1. How do we encourage our
patients to exercise?
Sarah E. Linke, PhD, MPH
October 25, 2015
Clinical Geriatrics Symposium

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. 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. % of US Adults Meeting PA
Guidelines, 2011-2013 (NHIS)

5. The bad news
 Cardiac output
 Lung performance
 Muscle mass
 Insulin sensitivity
 Bone density
 Memory
 Hormone regulation
 Immune system capacity
Aging

6. The good news
 Cardiac output
 Lung performance
 Muscle mass
 Insulin sensitivity
 Bone density
 Memory
 Hormone regulation
 Immune system capacity
Aging Activity

7. Reasons to Exercise
 Physical health benefits
 Mental health benefits
 Stress reduction
 Quality of life
 Enjoyment
 Socializing
 Self-esteem & self-confidence

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. So What’s the Problem??
 If exercise is so wonderful, why doesn’t
everyone “Just Do It”?!

20. Exercise Attrition/Adherence
 Behavior is difficult to change!!
 Steep drop during the first 6 months
 Levels off until 18 months

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. 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. 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. 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. 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. Exercise Stages of Change

27. 5 A’s for Exercise Counseling

28. Weighing the Costs vs.
Benefits of Exercise
 Costs of Exercising:
 _______________________________
 _______________________________
 _______________________________
 Benefits of Exercising:
 _______________________________
 _______________________________
 _______________________________

29. Personal Exercise Benefits
Short-term Benefits
1. _________________________
2. _________________________
Long-term Benefits
1. _________________________
2. _________________________
Importance to Me
1. ________
2. ________
1. ________
2. ________

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. Scheduling Activities

32. Potential Barriers
1. Barrier: _____________________
a. Solution: ______________________
b. Solution: ______________________
2. Barrier: _____________________
a. Solution: ______________________
b. Solution: ______________________
3. Barrier: _____________________
a. Solution: ______________________
b. Solution: ______________________

33. Set SMART Goals
 Specific
 Measurable
 Attainable
 Relevant
 Timely

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. 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. 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. 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. Socioecological Model of
Behavior Change
Environment

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. Indoor Facilities

41. Walking Paths

42. Outdoor facilities

43. Exercise Stations

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. THANK YOU!
QUESTIONS?