The tricky business of talking to patients about exercise

Exercise — everyone’s doing it, right? Not exactly. Even though fitness families like CrossFit and Orangetheory seem to be everywhere, a 2018 Centers for Disease Control and Prevention report found that most Americans still aren’t getting enough exercise.

Only 22.9 percent are fitting in the recommended amount of strength training and aerobic activity each week. But here’s the kicker. A new study found that not exercising enough can threaten mortality rates just as much as smoking, diabetes, and heart disease. That means it’s time to give exercise a leading role in conversations with patients.

“Health care professionals understand that physical activity is beneficial yet often pass it over when establishing a treatment plan,” says Dustin Rothbart, fitness manager at the Wilfred R. Cameron Wellness Center in Pennsylvania.

One reason is the time required to establish a baseline and create a personalized exercise plan. “Most don’t have it,” adds Robert Shoulders, general manager of the Anschutz Health and Wellness Center at the University of Colorado. But expertise also comes into play. Even if you’re the smartest doctor in the room, you likely weren’t trained to be a movement or exercise scientist. “There’s very little training in medical school for nutrition or exercise,” he says.

Despite these hurdles, you can still make exercise part of every patient’s treatment plan. Here are a few pointers for how you can set patients on the right path.

1. It’s OK to keep conversations brief.

There’s tons of ground to cover during a checkup. So, we get it; creating a detailed exercise plan isn’t likely. Instead, refer patients to someone who can. Alyssa Joel is the clinical integration coordinator at the Anschutz Health and Wellness Center. She works directly with doctors to design exercise programs for their patients. “I usually tell doctors, ‘you might not have 20 minutes to talk about exercise, but you do have five seconds to hand them a flyer and refer them to someone who can,’” she says. It’s hard to argue with that.

It takes just a few minutes at appointments to encourage more activity or to refer patients to a fitness facility.

Only 22.9 percent of Americans are fitting in the recommended amount of strength training and aerobic activity each week.

2. Don’t make it about weight.

It’s important to remember this isn’t about weight; it’s about movement. “If you can focus on the benefits of exercise beyond weight gains or loss, it resonates more than just saying, ‘I need you to lose 50 pounds,’” says Joel. Making it about weight can put patients on the defense. But even further, these conversations should be happening with all patients no matter where they fall on the body mass index chart.

Someone with a normal BMI may be too sedentary and someone with a high BMI may be plenty active. “Markers such as blood pressure, blood sugar, insulin resistance, cholesterol, and triglycerides can easily be within a healthy range for an overweight individual,” says Rothbart. So get to know patients beyond their biometrics before you throw around words like exercise or, for that matter, opt not to.

Motivate patients by using goals that are important to them like spending time with family.

3. Be proactive.

“There’s a link between a sedentary lifestyle and chronic illnesses like diabetes, hypertension, cardiovascular disease, and many cancers that cost our sick care system billions of dollars each year,” says Shoulders. “Being sedentary can lead to these diseases even if there is not yet a diagnosis.” Translation: Act, don’t react.

While it can often take a significant health scare to nudge someone into a more active lifestyle, lack of exercise has become the health scare itself. So even if a patient lifts weights a couple times a week, could they make more time for cardio? If they hike once in a while on the weekends, could they make more time for movement during the week? By spending just a couple minutes more on the topic of physical fitness, you can discover where patients can afford to step things up a notch.

Sedentary lifestyles can matter more than weight when it comes to health problems.

Try to uncover something that inspires and motivates each of your patients.

4. Uncover what makes them tick.

Again, aside from weight loss, what might motivate your patient to move more? Shoulders explains that you have to ask yourself what each patient’s wake-up call might be. “When does a sedentary lifestyle start to affect their enjoyment of day-to-day living?” he says.

Do they have a small-but-mighty ache they can’t get rid of? Do they have kids or grandkids they want to keep up with? Have they always wanted to take up surfing? Try to uncover something that inspires and motivates each of your patients. “If you can find something that matters to them, like wanting to be more active with family, it can break down the barriers currently preventing them from prioritizing an exercise routine,” says Joel.

Break down barriers by showing patients how movement throughout the day can help.

5. Eliminate intimidation.

Speaking of barriers, intimidation is a biggie. “We have patients that come in and say they’ve never been to the gym because they feel like they’ll be the only overweight person there or they’re intimidated,” says Joel. That’s why it’s important to establish a relationship with a facility you know takes a holistic and realistic approach to how they market fitness and approach it on the training floor.

But before making a referral, you can start by helping them accomplish a goal that feels less intimidating. Be specific. “Depending on the patient, set specific goals based upon their current baseline,” explains Shoulders, “Walking a half mile three nights per week may be a starting point for some.” And as Joel adds, “Even gardening can be exercise.”

Taking a small step and meeting that goal can boost confidence and make them feel a little less like an outsider at the gym. Once they get a little more confident, suggest they set up a consultation with a facility nearby.

Above all, aim to make the conversation about improving their lifestyle and preventing health issues down the line. For sedentary patients who are otherwise healthy, they may not see the point just yet. But you can help change their tune by letting them know what’s at stake and just how risky it is to pass on exercise.

About the Author

Catherine Conelly

Catherine Conelly is a California-based health, fitness, and lifestyle writer.

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