| Fitness = Good Health | |
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by
Anne Federwisch,
OTR Getting in shape goes a long way toward preventing a host of medical problems such as cardiovascular disease and high blood pressure. According to the American Heart Association, 30 minutes daily of moderate physical activity could prevent up to 250,000 deaths a year in the United States alone. That’s why health experts agree that you should urge your patients to get fit—no matter what their diagnosis. "Fitness and good health are synonymous," said Pamela Scarborough, PT, director of education for Clinical Educators Unlimited Inc. in Dallas. She is also an exercise physiologist and a certified diabetes educator. By incorporating fitness goals into treatment and discharge plans, health professionals can help their patients move beyond the disease state into wellness, she said. Ultimately, fitness needs to be the responsibility of the patient, not the health professional, Scarborough said. But clinicians can facilitate compliance with that lifelong goal by advising patients about the need for physical activity, helping them overcome obstacles to fitness, and identifying the parameters and warning signs of too much activity. Necessary measures Research shows that exercise can improve not only people’s strength and flexibility, but consequently their ability to perform activities of daily living, said certified personal trainer Susan Summers, RN, wellness coordinator for the telecommunications company MCI in Austin. She also works at a weight loss clinic in a physician’s office. So even a 70-year-old woman in a nursing home could benefit from a fitness program, Summers said. "From a nursing viewpoint, fitness is an area where we can really encourage people to become proactive with their health," said Penny Bell, RN, manager for the MULTIFIT cardiac rehabilitation program at Kaiser Permanente Santa Teresa in San Jose, Calif. Fitness is a rare chance to put control in a patient’s hands. So many threats to good health are immutable, according to Bell, but fitness is a modifiable risk factor. You can’t change your genes, and you can’t change your health history, but you can get in better shape, she said. The results will be well worth the effort, said certified diabetes educator Christine Beebe, MS, a registered dietitian and president of health care and education for the American Diabetes Association. "Fitness may indeed prevent diabetes," she said. For those who already have diabetes, regular physical activity can help lower blood sugar, so they’ll ultimately require less insulin, Beebe said. Overcoming obstacles You may need to dispel patients’ preconceived notions to convince them that the goal is attainable. "Oftentimes, patients correlate fitness with running a marathon," Bell said. "But any kind of movement is good." Scheduling time for fitness and keeping an exercise log can help incorporate activities on a regular basis, she said. Golfing, walking, and gardening are activities that contribute to overall fitness, Beebe said, without being as intimidating as something like jogging or aerobics. "Health professionals should reinforce that exercise doesn’t always have to be the same" every day, she said. Using the terms physical activity or movement in discussions with patients may be less threatening than using "the e-word—exercise," Scarborough said. Clinicians should also tell patients that the results of physical activity are cumulative. "Research shows that if you exercise 10 minutes in three bouts, it’s as beneficial as one 30-minute bout," Scarborough said. Parameters, precautions Not all types of activities are good for everyone. Teamwork is essential for defining limitations for patients, Scarborough said. Talk with the physician to make sure you—and the patient—know the parameters. All members of the treatment team should be reinforcing the same activity guidelines. Give the patient precautions as well, she said. Those will vary depending on the diagnosis. Typical warning signs might be a specific heart rate or dizziness. "Those red flags are very important," said Michael Jones, RPT, president of the American Academy of Health and Fitness Professionals in San Leandro, Calif. His organization publishes fitness protocols for a variety of diagnoses, including low back pain, rotator cuff tears, total knee replacements, and total hip replacements. Ideally, health professionals should discuss precautions with the fitness professionals who will be overseeing a patient’s program, Jones said. No one should begin a fitness program without a physician’s consent. Patients should also advise the fitness center of their medical condition. Different levels Criteria for fitness is very individualized. Though physical activity in general will improve health, not everyone will achieve the same level of fitness, Jones said. "We need to consider functional fitness," he said. "Functional from the standpoint of what they need to do for their normal activities of daily living." Jones said that when his mother had a total knee replacement recently, her goal was not to swim or jog. "She just wanted to be able to go to the grocery store and be able to climb the stairs to the church." So her fitness program is geared toward that functional level. Clinician, heal thyself Health professionals should heed their own advice about fitness, Scarborough stressed. "You lead by example," she said. The national Centers for Disease Control and Prevention and the American College of Sports Medicine agree. In a joint recommendation, the two groups said that "health professionals should be physically active not only to benefit their own health, but to make more credible their endorsement of an active lifestyle." However, don’t let your own sedentary lifestyle prevent you from addressing the issue with patients, Summers said. Even someone who’s out of shape can still help motivate a client. Future of fitness The benefits of fitness have been touted for years, Summers said. "There are articles that have been written in the 1800s, the 1700s about how we already were getting into a more sedentary lifestyle," she said. However, it’s only recently that the medical model has begun shifting from a disease focus to a prevention focus, with fitness as one of the components, Scarborough said. With research repeatedly confirming the value of physical activity, Scarborough thinks that in the future, fitness will be more important in health care than ever before. |
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