The Exercise Prescription in Primary Healthcare

Peter AdamsCaribbean Workshop on Physical Activity

07 March 2009

Hard Facts for GP’s

Simple advice often fails May ingrain persons in their unhealthy

habit You cannot impose your values on the

patient Illness is only one aspect of life The patient is free to choose

Models of behaviour change

Health Belief Model Trans-theoretical model of behaviour

change Readiness for change

Importance Confidence

Transtheoretical model for behaviour change

Precontemplation Not thinking of change

Contemplation Thinks about change, wants to change but does not

Preparation Planning very actively, making some change

Action Made the necessary change

Maintenance Working to prevent relapse/ consolidate gains

Readiness to change

Readiness = importance x confidence

Importance

If very low may simply give some information in a non-judgmental way to avoid resistance

Explore the patient’s views on what it would take to change the level of importance

Examine the pros and cons Explore concerns about behaviour

Exploring importance

What would have to happen for you to seriously consider exercising?

What are the good things about your current activity level?

What are some of the less good things about your current activity level?

What concerns do you have about the amount of exercise that you are doing?

Pros and cons of exercising

Pros Play better tennis Have more energy Better mood Less medication Lose weight Prevent cancer Feel good about

achieving it I will feel younger

Cons Takes time Is an effort Less time at the rum

shop Gym is costly I will be embarrassed

if I fail

Pros and cons of not exercising

Pros More free time More time to relax More time to watch

TV Saves money Won’t risk

embarrassment of failure

Cons Play better tennis Have more energy More stressed More medication Weight gain

Explore confidence

Was there anything that you found helpful in your previous attempts at exercise?

If you decide to exercise what are your options?

Do you know of anything that helped someone else maintain their routine?

What are some of the practical things that you would have to do?

Change mathematics

Readiness = importance x confidence

Nothing times a big number is still nothing

Avoid unrealistic expectations

2500 calories/day = 912,500 calories/year Imagine balancing input and expenditure exactly

without an accountant Walking 1 mile burns 100 kcal 1 lb of body fat → 3500 kcal when oxidised One needs to walk 35 miles to burn 1 lb of fat

Now imagine if a person is 30 or 40 pounds overweight!

Many overweight persons are sedentary and unfit

Set the right goals

Specific Eat less or exercise more is commendable but not

specific Attainable

Walk 5 miles every day may not be attainable. Walk 30 minutes a day is attainable, but what happens if you have to work late one day

Forgiving Walk 30 min, 4 days per week is specific, attainable,

and forgiving

Nothing Succeeds Like Success

Shaping - a series of short-term goals selected that get closer and closer to the ultimate goal e. g., a gradual increase in exercise level

Uses two important behavioural principles Consecutive goals that move you ahead in small

steps are the best way to reach a distant point Consecutive rewards keep the overall effort

invigorated