How do we encourage our patients to exercise?
Sarah E. Linke, PhD, MPHOctober 25, 2015
Clinical Geriatrics Symposium
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
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
% of US Adults Meeting PA Guidelines, 2011-2013 (NHIS)
The bad newsCardiac outputLung performanceMuscle mass Insulin sensitivityBone densityMemoryHormone regulation Immune system capacity
Aging
The good newsCardiac outputLung performanceMuscle mass Insulin sensitivityBone densityMemoryHormone regulation Immune system capacity
Aging Activity
Reasons to Exercise Physical health benefits Mental health benefits Stress reduction Quality of life Enjoyment Socializing Self-esteem & self-confidence
Physical Health Benefits Exercise is associated with
improvements/reductions in numerous physical health conditions, including: Premature death Hypertension Cardiovascular diseases Cancer Diabetes Overweight/obesity
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
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
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
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
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
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
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
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
Exercise & CognitiveFunctioning 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
Exercise as Therapy Adjunct Research support
As effective as SSRIs for major depression in gold standard RCTs
Cost-effective Time-efficient Minimal side effects
So What’s the Problem??
If exercise is so wonderful, why doesn’t everyone “Just Do It”?!
Exercise Attrition/Adherence
Behavior is difficult to change!! Steep drop during the first 6 months Levels off until 18 months
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!
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
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
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
Guidelines for ImprovingExercise 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
Exercise Stages of Change
5 A’s for Exercise Counseling
Weighing the Costs vs. Benefits of Exercise Costs of Exercising: _______________________________ _______________________________ _______________________________ Benefits of Exercising: _______________________________ _______________________________ _______________________________
Personal Exercise BenefitsShort-term Benefits
1. _________________________
2. _________________________
Long-term Benefits
3. _________________________
4. _________________________
Importance to Me
1. ________
2. ________
3. ________
4. ________
Guidelines for ImprovingExercise 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
Scheduling Activities
Potential Barriers
1. Barrier: _____________________a. Solution: ______________________b. Solution: ______________________
2. Barrier: _____________________a. Solution: ______________________b. Solution: ______________________
3. Barrier: _____________________a. Solution: ______________________b. Solution: ______________________
Set SMART GoalsSpecificMeasurable AttainableRelevantTimely
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: ___________________
Rewarding Yourself
Plan a specific reward for each goal you meet1) 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: ___________________
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.
__________________________________ __________________________________ __________________________________
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.
Socioecological Model of Behavior Change
Env
ironm
ent
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
Indoor Facilities
Walking Paths
Outdoor facilities
Exercise Stations
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
THANK YOU!
QUESTIONS?