Exercise Counseling

Exercise Counseling from Your Physician

Here are some excellent ideas about exercise counseling from the American Heart Association. I really like the idea that your Doctor could write on Rx. pad an order to begin exercising, and folks apparently follow through with the Doctor's Orders.

This page also talks about goal setting, measurement, and follow through.

"Exercise (Physical Activity) Counseling

AHA Recommendation

We strongly recommend physical activity, nutrition and smoking-cessation counseling as an important strategy for implementing our primary and secondary prevention guidelines. We believe that healthcare providers should deliver such counseling systematically, just as they would deliver comprehensive diabetes education programs.

We know many doctors have less time to visit with each patient. Still, most patients say that if their doctor told them to be more physically active, they would listen. Doctors need to ask questions at every visit about what kinds of activity and how much activity each patient is getting. If doctors don't have time to counsel, they can refer patients to other healthcare team members. These may include nurse case managers, certified exercise professionals trained in behavior-change programs and sports nutritionists.

Who should be screened before starting an exercise program?

Doctors should screen all patients with a history of cardiovascular disease or who are at high risk of a heart attack or stroke before they start a vigorous exercise program. People who are obese, have diabetes or other serious medical problems, or who have been sedentary for a long time should talk to their doctor before starting any exercise program. The American Heart Association has published guidelines for exercise testing, exercise pre-competition screening for both young and older (Masters) athletes, as well as screening guidelines for health and fitness club facilities.

All counseling programs should evaluate each patient's risk for a heart attack, stroke and such problems as diabetes, osteoporosis and arthritis. A doctor can use this information to develop guidelines and start patients on an individualized activity program. Counseling programs should be customized to reflect gender, age and cultural factors. Identifying the kinds of activities that each person enjoys is important to help ensure that they maintain an active lifestyle for a lifetime.

What approaches are effective in exercise counseling?

Doctors can increase the likelihood that patients will become more active just by writing general information such as "walk for 30 minutes on most days of the week" on a prescription pad. They can place color-coded stickers in patients' charts as reminders to follow up at the next visit or to ask one of their staff to make a follow-up call within two weeks after the patient's visit. They can also refer patients to American Heart Association programs such as Start! and Choose To Move. Patients can buy self-care programs such as the American Heart Association Healthy Heart Walking CD.

At the start of each program, patients should set long- and short-term goals. Doctors and other healthcare professionals need to identify

* patients' barriers to becoming more active * people who will offer social support * a reward system that will help motivate each person

If people don't have a full 30 minutes for activity, encourage them to find 10- to 15-minute periods throughout the day where they can go for a brisk walk (such as walking the dog in the morning, at lunchtime or after dinner).

Sedentary people need to gradually build up to 30 minutes with moderate-intensity activities like brisk walking. They can start with 10–15-minute sessions 3–4 times the first week, then add five minutes to each session each week until they build up to at least 30 minutes. If they need to lose weight, they may need to work up to 45–60 minutes. As people become fitter, they can increase the intensity of their activity.

American Heart Association

The Exercise Program That 88 Year Old Bill and 82 Year Old Pat Use

The Connection Between Exercise Counseling and Brain Fitness

Overcoming the inertia to start is hard, so I like to start my folks with powerful changes that are learned almost passively, which includes using the Heartmath tool, and computerized brain fitness tools, which show improvement every session in terms of feedback from the computer.

Clients are usually very surprised that they can make profound changes in stress responses and IQ, for example, without a long, involved counseling or psychological or psychiatric process.

While those processes may be part of the change process later, I want my clients to experience success quickly.

And then I want them to generalize their in my office success to their lives, which means that they practice the Heartmath or heart rate variability skills regularly over the course of the day, maybe while they are following the Doctor's exercise orders.

Besides its stress management and brain fitness impact Heartmath is used by many athletes, golfers in particular, and students who are taking tests for graduate school admission, for example.

In order to overcome that early inertia, I like to introduce my clients to the concept of brain fitness, and counsel them about how exercise impacts two fairly recently discovered capacities of the human brain, called neurogenesis, which is the term used to describe the growth or new neurons every day, and neuroplasticity, which is the term used to describe how our brains rewire every time, usually within minutes, when we learn something new, and the most important thing we can do to encourage neurogenesis and neuroplasticity?

You guessed it, physical exercise.

So the Doctor should write on his Rx. pad execise for your heart's health and for your brain's health.

Never heard of brain fitness workouts, or the pillars of brain fitness?

Then by all means read Brainfit for Life by Simon Evans,Ph.D. and Paul Burghardt,Ph.D., neuroscientists at the University of Michigan who have culled the neuroscientific research for tips we can use to keep our neurogenesis and neuroplasticity going strong.

They say that we can have longer lasting brains if we take care of our pillars of brain fitness, physical exercise, nutrition including omega 3 fatty acid, sleep, stress management, and novel learning experiences, which could include computerized brain fitness programs.

I mentioned the Heartmath program above as a wonderful biofeedback tool with cool sleep and stress management implications.