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Spring: The perfect time to help your patients be more physically active

May 11, 2010

Spring has sprung. The days are longer; temperatures have gone up (and down, and up….); flowers and trees have blossomed. This is a great time of year for people to start exercising. Being the exercise specialist on our diabetes care team, my main job it to encourage people to exercise. An easier task this time of year, but, it is still a major challenge to get people, who are typically inactive, to become active.

The exercise guidelines for people with diabetes seem simple enough. We ask people to do a moderately-paced activity for 30 minutes, most days of the week. In fact, the guidelines are the same as for people without diabetes. (I ask in class, Who should exercise? Answer: Everyone!) We have gotten away from using the word exercise, replacing it with physical activity. There are a couple of reasons. First, “exercise” sounds like something that must be done at a gym and should be hard, requiring special clothes and causing us to sweat. Not so appealing for many. So, we say “physical activity” because it is less threatening and easier to accomplish. Also, it has been shown that we can get many health-related benefits from doing normal activities (gardening, vacuuming, taking care of children, etc.) so we don’t need to actually exercise. I tend to interchange the words unless I am talking specifically about one or the other.

There are different ways to accomplish the guidelines for exercise/physical activity. Let’s start by looking at the mode, or type. Walking, riding a bike, swimming, doing a dance class or just dancing, hiking, water aerobics, or weight-training. What other activities do you suggest?

How long and how often? The goal is 30 minutes on most, or all, days of the week. This can be done in bouts of 10 minutes or more to achieve benefits. Shorter bouts should be done multiple times each day, adding up to 30 minutes. I find this is a great relief for people who are overwhelmed by the thought of an entire half-hour at once.

How hard? Moderately-paced exercise means that breathing is increased from when a person is resting but they are not short of breath. Measure this with the “talk test,” being able to carry on a conversation without shortness of breath while exercising.

One key is to work with an individual person with diabetes, whether during a one-to-one encounter or in a class, to see what will work for them. I find that if I ask the right questions, people can figure it out for themselves. How successful have you been with getting people to start exercising? What hints or secrets can you share?

Jump into Spring! Help people become more active and, perhaps, increase your activity! Smell the flowers, look at the trees, enjoy! And share with our group your hints, ideas, suggestions, and successes.

2 comments

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  1. Jun 19, 2010

    I first want to say I am happy to see Karen's article. I could not agree more. Additionally, I would like to add that if we, the diabetes educators, can get our patients with diabetes up and moving now when the weather in many locations is more favorable, then it will be far easier to keep them moving when the weather is not so pleasant in the colder months. As to whether to use the word "exercise" or "physical activity", I think it depends on your audience. I had a situation one time when I was talking about the benefits of walking during an exercise class. There was a rather chubby, well dressed, lady sitting to the right of where I was standing that I noticed was admiring her nails but shaking her head as if to indicate, "No not me, that won't do." I looked at her and asked, " What's wrong?" She responded, " Bad ankles, walking really makes them sore." "OK," I responded. Then I looked up at the class and said, "Riding a bike, that is another great exercise," and explained all of the benefits of cycling. Again, she bagan admiring her nails, and shaking her head in a, no, not for me gesture. I could see the class was looking at her again. So, again I walked over to the lady and asked her, "Don't have a bike?" "Oh no, I have a bike," she answered. Then what's the problem with riding?", I asked her. "The seat, it's so small, you know, it's really uncomfortable." "Ok, there is always swimming or water exercise," I suggested. By now everybody in the class is looking at the lady to see what she is going to do. And guess what? She did not let them down. Again, shaking her head as if to say," Nope, can't do that one either." "Can't swim I asked?" "Oh no I can swim," she responded confidently. "Don't have access to a pool?", I asked. "Oh no, I have a pool," she answered. "OK, then what's wrong with swimming?" I questioned, trying not to sound frustrated. "All those chemicals in the water, it's not good for my skin, it drys it out," she stated matter of factly. At that point, I turned to face her squarely, put both hands down on her table, elbows locked, and looked at her right in the eyes. I then told her," You know what it all comes down to?" She shook her head as if to indicate no. "You have got to move, a whole lot more than you have been moving. I don't care what you do to get exercise. If these activities don't work, Ok, but you have to find something that gets you moving, because you will not stay the same as you are now. You will over time get worse and worse and worse. Our bodies were designed to move not to sit." For the first time she looked somewhat serious, like she heard what I was saying. The point I try to make to most of my patients is that whatever "moving" they are doing now is not enough, they need to get up and get moving, somehow, someway, but more thyan they are doing presently..
  2. May 11, 2010

    Motivational Interviewing has become a great tool in helping our patients participate in these conversations of behavior change. I recently published a book "Motivational Interviewing in Nursing Practice: Empowering the Patient". The whole idea came after I learned Motivational Interviewing techniques while doing a diabetes education program for members of a large health insurance program. We have the ability to help our patients tremendously by simply guiding them through a conversation that can help them to be creative and make thoughtful decisions in their care. Exercise is a great topic for one of these conversations. Our role is to help them evaluate barriers they have, determine what they are willing and capable of doing and setting realistic goals. I was amazed at how people would really engage in a conversation when I used these techniques, even over the phone.

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