The Exercise Prescription in Primary Healthcare Peter Adams Caribbean 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