Helping Your Patients Achieve Exercise Success

by Diane E. Weiman, A.C.E. CERTIFIED

Diane Weiman (A.C.E certified) is an exercise specialist for Upper Chesapeake Bariatric Surgery at Harford Memorial Hospital in Havre de Grace, Maryland.

Funding: No funding was provided in the preparation of this manuscript.

Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.

ABSTRACT
The author discusses how to take a “consistency not quantity” approach to exercise when working with bariatric patients, concluding that the “habit” of exercise (movement) is the most important step to success.

Bariatric Times. 2013;10(3):32–33.

In efforts for the weight loss patient to lose and control weight, one word they often do not want to hear is “exercise.” To a bariatric patient (pre or postoperative) who may be used to a more sedentary lifestyle, the word itself may resonate with homework, an undesirable chore.

There are many motivational strategies available in texts and online designed to help individuals find the perfect plan to finally help get them beyond the often ditched notion of “this time I will do it.” But, often, somewhere along the way, individuals end up at flat line; no motivation in sight. How can we as caregivers help our patients overcome this obstacle? In this column, I will provide advice to help motivate your patients to exercise success.

Tip #1: Help your patients climb “The Hill of Discipline”
First, it is important to understand that the body is very cooperative and will adapt to whatever it is taught to do. In other words, if one becomes a mover, over time, the body becomes metabolically adaptive to movement. Inspiration and energy will follow. If, on the other hand, regular exercise (movement) is not pursued, the same metabolic adaptation principle will apply. The realization of the need to exercise is present, but it is not done because the adaptation is NOT to move; hence the lack of motivation ensues.

After you help them to understand that their bodies are capable of exercise, you can then encourage them to climb what I call “The Hill of Discipline.” Discipline—it can be a tougher word than “exercise.” This is the part where the decision has to be to simply exercise anyway. Understand that all the barriers and excuses that have haunted the individual up to this point will resurface. Encourage your patients to fight back. Have the patient exchange “exercise” for “taking care of myself.” You might encourage them to use external tools, such as an appointment calendar. If an exercise buddy is available or if there is a gym or group class that is easily accessible, that can boost a patient’s commitment as well. If a buddy or group exercise class is not available, you can emphasize to the patient that this time of exercising solo is an experience of enjoyment and therapeutic value. Suggest that he or she implement the use of music, move the exercise outdoors whenever possible, and focus only on positive thoughts, using imagery and visualization of becoming more energetic, flexible, and strong.

Tip #2: Encourage exercise consistency
While quantity is not always quality, consistency is paramount to a quality exercise routine. The mere commitment to movement on a daily basis, even in small amounts, provides the foundation for growing the exercise program to the patient’s desired goals. Most individuals, however, go for the “all or nothing” exercise principle of exercising a minimum of 30 minutes a day or more. Even with all the best intentions, however, this usually lasts a few days or a few weeks and then they are often back to zero. If you suspect this is the case with a patient, remind him or her of the adaptation principle—if the body has adapted to flat line status it is reasonable to conceive the idea that it cannot handle sudden bouts of quantitative exercise. Initially, the body goes through a neurological recruitment phase in response to the exercise stimulus that is presented. Each consequential bout of exercise gets easier because the body is recruiting more and more muscle fibers from inactivity to do the job. In conclusion, it is far better to encourage your patients to start exercise in small amounts consistently rather than large amounts sporadically. You can suggest that they add time and intensity on a continuum so that this adaptation phase can take place without taxing energy and motivation. By far, the most important step for your patients to achieve is simply the habit of moving on a regular basis.

Tip #3: Suggest keeping it simple
In 2010, a research team at the Massachusetts General Hospital, Boston, Massachusetts, was the first to develop what Dr. Gregory Lewis, the lead author of the study, called “a chemical snapshot” of the physical changes that occur in the body during and after exercise.

The study revealed that just 10 minutes of exercise increased some metabolites, chemicals associated with the body’s ability to do many things, including burn fat. Dr. Lewis said, “What was interesting, is that while the blood pressure and the heart rates returned to normal in minutes, the metabolic changes continued for at least an hour after the exercise ceased. And the more fit the individual, the greater the changes in fat-burning metabolites, indicating that exercise have both an immediate and a cumulative effect.”[1]

The study revealed that even after short periods of cardiovascular exercise, there were increases in the breakdown of stored fat, sugar, and amino acids among all groups; the unfit and fit alike.[2]

In addition to its benefits, 10 minutes of exercise is certainly much easier to do both mentally and physically for patients facing flat-line status when climbing the hill of discipline. Once at the habit stage, the opportunity to grow the exercise program to the minimum of 30 minutes a day with success is at hand.

Tip #4: Stress that patients never do zero exercise
Zero plus zero equals zero. That is also true with exercise. Any exercise program will not be perfect because we humans are not perfect and neither is life. The difference however, is the choice to do the “precious 10” minutes of exercise instead of zero when times become challenging. By stressing this exercise principle, we can help prevent our patients from tumbling back into flat line status and the habit of exercise will prevail. If the patient strives to do even the most modest exercise routine during a crisis or detour in his or her life, it will be considerably easier to return to the regular exercise routine once the difficult time subsides.

Conclusion
In time, the habit of exercise will converge into joy of movement for your patients. It is important that you remind them of the positives of a consistent exercise routine: relief from stress, sounder sleep, energy in the day and, of course, looking better too. As a caregiver, you can encourage the “go-for-it” mentality. There is nothing to lose except for the unmotivated and unfit individual the patient has likely always wanted to leave behind.

References
1.    The exercise effect. Massachusetts General Hospital News and Events. July 16, 2012. http://www.massgeneral.org/give/news/newsarticle.aspx?id=3662. Accessed January 2, 2013.
2.    Lindke A, Rivera E. 10 minutes of exercise may keep the doctor away. MEDILL Reports Chicago. June 2, 2010. http://news.medill.northwest
ern.edu/chicago/news.aspx?id=166022. Accessed January 2, 2013.
Funding: No funding was provided in the preparation of this manuscript.

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