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 was “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?
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.
It seems that exercise has a certain stigma about it and old habits die hard. The idea of ‘flogging a dead horse’ springs to mind. We all know that exercise is important for a healthy life and there are many benefits to exercise. We already know this and we are told time and time again. So why is it that so many people shy away from it? Exercise is arduous, it’s boring, gyms are not everyone’s cup of tea. 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.
No I shouldn’t be so hard on the gym enthusiasts or the cyclists, as this is something that I do on occasion…. and it is individual to the person. We should not judge those that find stimulation in what they do. So how do we stimulate those that find exercise a hindrance?
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). 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 would most likely demotivate me. Why is this? Is it because humans are fickle, ambivalent, distracted, lazy, under stimulated? Perhaps it’s because we humans are funny creatures as we only tend to make changes when something actually happens. I would guess that it is all those things.
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…..well let’s hope that is long gone. Interestingly I recall a senior physio in the NHS saying that 10 repetitions was the number required to stimulate muscle memory….I wonder if anyone else has heard of this? Pop your thoughts on a twitter postcard if you wish, or you could watch this TED talk to show how boring physio is…..
Physiotherapy strategies should adopt a wider scope of activity, making exercise fun, stimulating and motivating people to exercise, 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. At the same time we should be communicating and assisting GPs to help with that motivation. Physiotherapists should be seen as the medical professionals of choice for GPs to refer to when the advice is to increase exercise levels as treatment, as opposed to being obliged to prescribe medication, which often is the easier option.
I should finish by saying that I am not discouraging people from going to the gym or doing their rehab exercises, however we need to be mindful of discouraging exercise by relating it to morbidity risk. 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 exercise.
Thanks for having a read
TNP