To become regular exercisers, your patients will need to go through a process of behavior change that we discuss in detail in Chapters 4–6. As noted above, there is much that you can do fairly quickly and fairly simply to begin incor-porating the provision of the exercise prescription as a regular part of your practice. However, if you want to get into the subject at greater depth, you may find that you will, at some level, go through something of a professional behavior change process. In this section we provide a guide for those of you who would like to give it a try. It is a behavior change process that, interest-ingly enough, is very similar to what your patients will go through on their way to successfully becoming regular exercisers.
Foremost, just like any patient setting out to engage in a health-promoting behavior change of one sort or another, you will have to mobilize your motiva-tion to do it. You will have to mobilize resources; you will have to find and make the time; you will have to convince colleagues; you will have to provide leader-ship. Developing and implementing a plan for incorporating counseling for the regular exercise prescription into your practice, is perhaps best approached by answering a series of questions for yourself. We think that it is most appropri-ate that we conclude this chapter with these questions, in Table 2.1. Just as becoming and staying a regular exerciser is not always easy, becoming and stay-ing as a regular provider of the regular exercise prescription is also not always easy. Hopefully, this list of questions will help you to organize your own think-ing about the enterprise. Hopefully, the further information in this book will then equip you to take on this task and to achieve success in it. If you are able to do so, we are confident that you will then be able to effectively help your patients to take on the task of regularly exercising.
1. Is providing the exercise prescription for my patients important in my practice? How important is it? In other words, as I contemplate adding the exercise prescription to my clinical armamentarium, what are my own goals for doing so?
2. As part of my own goal-setting process, let me think about why is it impor-tant for me to do this now, at this stage of my career, in my practice as it is currently set up.
3. What do I think is missing in my practice currently that makes me think about doing something new? Why do I think that?
4. For which patients am I thinking about doing this? All of them? Some of them? How will I make my choices in this regard? How will I engage my patients in that decision-making process?
5. If my practice is bigger than just me and especially if I am not the only decision-maker, I will have to think more broadly. That is, once I have established my goals for myself, I should likely think about what goals I would like to see adopted for my practice. Once I have decided to change my own practice behavior, will I be able to work with my colleagues to help them change theirs, and is that necessary?
6. Is role-modeling (as discussed above) important for my patients? If so, by whom? What does this mean for me? Do I want to invest my personal time in this? If I am not already a regular exerciser and have decided to become one, what are my own goals for doing so and just what is it that I am going to do?
“Lifestyle exercise”? “Leisure-time scheduled”? For either, how am I going to find the time/make the time? What is it exactly that I am going to do?
7. If I think that there is material to learn here, how much time do I want to invest in doing so? In terms of the specifics, how should I go about learning them, incorporating them into my own base of knowledge and skills?
8. If I am in charge of the practice, who should do the counseling for the exer-cise prescription? Myself? Members of my staff? Somebody new whom I might bring in part-time, like a physical therapist, a health/fitness profes-sional, or a health educator? If one or more of us is going to need some edu-cation and training, how is that going to be provided and who is going to do it? (Hopefully, this book will be enough, but you may have to go beyond it.) 9. Whoever does the counseling for the exercise prescription, how is the
func-tion going to be paid for? Do I charge patients for this service? If so, how and how much? How can I arrange for health insurance reimbursement?
10. Do I want to try using patient groups for exercise promotion? If so, how are they going to be organized, who is going to lead them, how are they going to be paid (if they are), and how are we going to charge our patients (if we do)?
11. What about making use of community resources?
12. How much time am I willing to invest in developing an exercise promo-tion component in my practice? If not I, then who?
References
1. Glasgow RE, Goldstein MG. Introduction to the principles of health behavior change.
In: Woolf SH, Jonas S, Kaplan-Liss E, editors. Health promotion and disease preven-tion in clinical practice. 2nd ed. Philadelphia, PA: Lippincott Williams and Wilkins;
2008. p. 134–9.
2. American College of Sports Medicine. ACSM’s guidelines for exercise testing and pre-scription. 8th ed. Philadelphia: Lippincott Williams & Wilkins; 2009. p. 2–11.
3. CMS IOM Manual: Section 30.6—Evaluation and Management Service Codes, General (Codes 99201–99499); C. Selection of Level of Evaluation and Management Service Based on Duration of Coordination of Care and/or Counseling. http://www.cms.
hhs.gov/manuals/downloads/clm104c12.pdf.
4. American College of Sports Medicine. ACSM fitness book. 3rd ed. Champaign, IL:
Human Kinetics; 2003. 175 p.