I think I have lost count the number dejected looks I get when I have said, “the solution is to exercise”, particularly when I worked in the NHS. Compare that to private practice and the standard response from patients, “They only ever give out exercises in the NHS and then I don’t get seen again for another 2 – 4 weeks”. Why has exercise got such a bad rep, and why is it that exercise is the only solution to a health problem?
In terms of my time in the NHS, I understand now that patients didn’t feel validated or listened to, everything felt rushed. We were under so much pressure, it became all about targets. As Louis Gifford quite rightfully said, “there shouldn’t be a time limit on someone who has a distressing problem, if you need an hour then you should have an hour.”
Are we flogging a Dead horse?
It seems that exercise has a certain stigma about it and old habits die hard. We all know that exercise is important for a healthy life and there are many benefits. We already know this and we are told time and time again. So why is it that people shy away from it? Exercise is arduous, there’s a stigma, it’s boring, gyms are not everyone’s cup of tea and the fact that you have to look fit and toned already before you go into a gym is just not very motivational!
Humans need to be stimulated on a regular basis, variety is the spice of life as the saying goes, and the monotony of running countless kilometres on the road or getting on a bike dressed up in tight spandex/lycra and cycling 3000 gazillion k’s at the weekend just isn’t everybody’s idea of stimulation. Then there’s the gym, that intimidating, loud, sweaty, smelly place that can have more egos than Kiwis in the wild of NZ.
Perhaps we should start at how exercise is often prescribed. In the current climate of long term health diseases it appears our perception of exercise has been moulded in such a way that it will prevent all these nasty diseases such as metabolic syndrome, diabetes, heart disease etc (diet has something to do with it too). Then there’s the appearance stigma. Bodies are portrayed to be slender, slim, athletic, with no stretch marks and no fat.
Personally I feel this is a great way to put such a downer on exercise, by using scare tactics! Let’s say I got one of those fancy health tests that tells you what you are predisposed to later on in life. The results come back and say that there is a high probability that I would get heart disease. So now I am going to do everything I can to prevent that probability becoming a reality – making exercise something I have to do under duress. Aren’t elevated stress levels a cause of heart disease……?
Our perception of something is very subjective. For some, these diseases may motivate us to make a change, where for others they may not. Being told that I could be prone to heart disease in later life and I need to do everything I can to keep myself healthy is something that may demotivate me. Why is this? Is it because we live in a world where we don’t think of the long term? We want immediate results now! Perhaps it’s inevitable that i’ll get heart disease and so fuel the self-fulfilling prophecy? To elicit behaviour change, telling people that they must change can often be met with resistance. People need to understand the value in exercise. Exercising on day one won’t produce results if you look in the mirror, nor on day 2, day 3, day 4. I think you get the picture. The hardest thing is commitment, and so jumping on fancy diets or working on time pressure goals, to lose weight or gain mass, adds stress to something that we should be doing as part of our daily lives and that has value.
So maybe we should shift the focus. Prevention of disease should be the secondary concern. We should reframe the way we think about exercise and activity for injury rehabilitation and for health, i.e. get out for a cycle and socialise with your family and friends, stop off for a coffee after, or go out for a kayak and see dolphins jumping up next to you (yes this happens in NZ!) Just because we are injured doesn’t mean we can’t do activity, and just because we don’t “exercise” doesn’t mean that we are not active. The famous piano stairs were a hit in Auckland’s Sylvia Park a couple of years back.
Exercise/activity needs to be fun, engaging, stimulating, distracting, have variety but at the same time be specific to an individuals need. Oh and the bombardment of a sheet of 20 exercises with 3 sets of 10 prescribed for every single exercise…..like c’mon seriously is that what four years of study and ongoing CPD gives me? A right to piss people off and confuse the shit out of them by giving them a sheet of pointless mind-numbing exercises? We’ve all bloody done it! If you don’t believe me I’ll let the TED talk below tell you how boring Physio really is!
Physiotherapy strategies should adopt a wider scope of activity, making exercise fun, stimulating and motivating people to move, thus removing the stigma. It makes sense to improve the function of the individual as opposed to the individual body part we are attempting to rehabilitate, as it is often lost in translation for whether the patient can then work, be active and not have to worry about their body part.
I should finish by saying that I am not discouraging people from going to the gym or doing their rehab, however we need to be mindful of discouraging people to be active by relating it to morbidity risk and appearance. People are already aware of disease risk and conscious of their appearance!
Yes we should have an appreciation of the increased risk of chronic disease if we continue down a path of poor health habits, however it also links to so many other factors – the individual, lifestyle, motivation, socio-economic status, demographics, education. These same factors also relate to our understanding, attitude and participation in activity.
Thanks for having a read
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