As we highlighted in Chapter 6 (Behavior Change Pyramid), it is important for your patient to anticipate and thereby do her best to avoid potential roadblocks.
Exercisers at all levels—from beginners to Olympians—face obstacles and set-backs. Accepting that obstacles will arise is an important first step to overcom-ing them. Events such as vacations, illness, or the arrival of house guests can alter your patient’s regular routine, making exercising more difficult for a short period of time. Such breaks are not a problem, as long as your patient can return to exercising, potentially at a slightly lower level initially, after the interruption.
Motivational obstacles also occur in exercisers of all levels, but are often more common at the start of an exercise program. This is because beginner exercisers have not yet personally experienced the great benefits of exercising.
At this early stage, encouragement and working through obstacles are neces-sary. If your patient is not enjoying the exercise, try to help him determine which component of the exercise is less enjoyable—is it the time of day? the frequency? the pace of the exercise? the type of exercise? Or is your patient frustrated that he has not yet seen the physical results of his hard work? Help your patient problem-solve through or around these obstacles, realizing that each patient’s exercise program may need to be as unique as each patient. If you feel that you do not have the time or resources to address these concerns, be sure to refer your patient to a physical therapist or other exercise specialist for assistance.
Finally, your patient may complain that the exercise is causing pain or dis-comfort. One of the most common causes of pain is improper equipment (see Chapter 11). Ensure that your patient is using shoes that fit correctly and are designed for her foot type (over-pronation, neutral foot, or under-pronation).
For walkers and runners, shoes should be changed every 350–550 miles to pre-vent injuries (8). At this stage, the shoes may not appear to be worn out, but their cushioning and stability will have deteriorated. Running stores, rather than generic sports stores, will be able to fit your patient into an appropriate walking, running, or aerobics shoe for a similar price to that of a generic sports store. Some muscle stiffness is common when increasing exercise. Such dis-comfort is not harmful so long as it does not last for more that a few days. In Chapter 11, we will provide further information on exercise equipment.
CONCLUSION
In this chapter, we have moved from the Foundation Phase of exercise (that included screening and motivating your patients) to the Becoming Active Phase, which we will discuss in more detail in the next chapter. In this phase, your patients actually start their physical activity. We have identified key prin-ciples to help your patients transform their lifestyle from sedentary to active, and have given you tips that you can use to help your patient find time to com-mit to exercise. We have also reviewed the different environments in which your patient can exercise, outlined potential safety concerns, and described potential obstacles that your patient may need to be aware of and to overcome.
In the following chapters, you will learn how to prescribe exercise to your patients in order to assist them in their transformation from a sedentary to an active lifestyle. In the process, you are given a choice. In Chapters 8 and 9, we will present general principles that should enable you to prescribe personal-ized exercise programs for your patients, based on their goals, health status, current fitness, and preferences. Alternatively, in Chapter 10, we offer you a specific pathway that takes your patient from a sedentary lifestyle to an active one, using a precise program. We recommend that you read all three chapters to understand the principles of exercise prescription, including important top-ics such as components of an exercise program, how to progress your patient, and how to prevent overtraining and injuries.
References
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2. American College of Sports Medicine. ACSM’s guidelines for exercise testing and pre-scription. 8th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2009, pp. 152–182.
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