By: Melanie Biegler, OMSIII, and Mary E. Krebs, MD, FAAFP
Reprinted from the winter 2019 issue of The Ohio Family Physician.
Physicians and patients alike tell you it is important to exercise and eat a healthy diet. But despite this common knowledge, America’s obesity epidemic continues to climb.1 Where did we go wrong?
Well, exercising can be hard. In order to cause the change necessary to lose weight and improve health, it expects the individual to be in an uncomfortable state and stay there. A patient that has never exercised consistently is not going to start just because you told them to, even if they know how important it is. If we expect our patients to have this internal motivation to be uncomfortable when they really don’t have the motivation, we are setting them up for failure from the start. This article discusses a stepwise approach to creating a sustainable exercise regime by using an exercise prescription.
Form a Partnership
The family physician has the unique role of not only following patients for an extended period, but also forming a trusted relationship. This relationship is the foundation for exercise promotion. It allows for the support and accountability needed to create a sustainable exercise regime. It begins by asking the patient if they have a desire to make a change and then determining how motivated they are to make that change. Motivational interviewing is a well-studied technique that increases patient success because it allows for these conversations about change while recognizing where patients are in the process. Questions for consideration: Have you ever considered making a change? Have you considered ways to make that change? Are you willing to make that change? Are you having trouble maintaining that change?2
Being empathetic and listening to the patient’s concerns about making lifestyle changes can set the ground work for not only what the patient is able to change, but what they are willing to change. In order to set the patient up for success, a plan should be mutually established.
Give an Exercise Prescription
Studies have shown that patient satisfaction improves when patients leave the office with a prescription.3 Although these studies pertained to medications, the same concept can be applied here. After the physician and patient agree on a plan, the patient leaves the office with a physical prescription that clearly outlines how they can go about this change. Exercise prescriptions, such as the one shown, should explicitly demonstrate how frequently, at what intensity, for what duration, and in what setting specific activities should be performed.4 An exercise prescription can alleviate fear of not knowing where to start for the motivated patient, as well as set a framework of consistency for the less motivated patient.
Hold Accountable and Be Consistent
Just as the patient is held accountable for completing the exercises, the physician should be accountable for addressing exercise habits, concerns, successes, and defeats with each visit. Addressing exercise routinely emphasizes consistency for the patient and will ultimately decrease the appointment time needed to discuss exercise habits. Because patients with chronic illnesses are seen routinely, a platform for consistency is already in place.
Promote Wellness
It is important to commend the patient’s efforts and successes. If patients are solely focused on weight loss, they may become discouraged if the scale does not reflect their progress. However, gain in muscle, endurance, motivation, and overall sense of well-being may not be accurately reflected on the scale. Wellness embodies a state of complete mental, physical, and social well-being.5 Reframing exercise from strictly a way to lose weight, to instead a way to achieve wellness, broadens the possibilities of what one might gain through exercise thus making it more appealing. Achieving some aspect of wellness through exercise is how the physician should continue to challenge their patients with new exercise prescriptions that reflect their progress.
Conclusion
Exercise prescriptions explicitly state exercise activity, frequency, intensity, duration, and setting. They allow clear communication between the patient and physician about not only what the patient is willing to change, but how they are going to make this change. By giving exercise prescriptions and consistently holding patients accountable with each visit, physicians can aim to create life-long habits and guide patients in achieving wellness.
References available on the OAFP website.