What is exercise?
Jay Groves
- AJPM article on steps per minute required to meet guidelines
Applying in practice:
1) what are the benefits of exercise to you?
2) what would motivate you to exercise?
3) what plans do you have to exercise?
4) what are some of the barriers you may encounter in implementing exercise? How do you plan on overcoming this barrier?
Overcoming resistance through coaching.
Margaret Moore
3 motivational drives:
1) autonomy.
- We like to be independent and don't like people telling us what to do.
2) competence.
3) connection.
- Our desire for connection. We would be willing to give up some autonomy to have a relationship. To be connected with others. To love and be loved. To help others.
With these 3 motivational drives, we can be more successful and perform better.
TYPES OF MOTIVATION
A) external.
- External motivation is unstable. Does not lead to lasting change. External motivation leads to compliance. But there is little thinking about why it's important. It can lead to rebellion.
B) autonomous.
1. Present focus.
- Enjoyment.
2. Future focus.
- Focusing on future gain. Giving up or sacrificing for the present for future gain. Leads to sustained change.
3. Your life purpose: most powerful motivator.
- What is your legacy? What gives your life purpose/meaning?
WHAT CAN WE DO TO IMPROVE YOUR MOTIVATION?
- promote yourself to the boss of motivation
- Tune in to what is driving you: external or autonomous?
- find the things that you love to do. Experiment with possibilities. Don't give up until you find what works for you.
- dig deeper to get to the why behind the why. Find your true motivation.
"One who has health has a thousand wishes. One who has none has but one."- help others. Do it with others.
BUILD CONFIDENCE TO UNLEASH YOUR MOTIVATION
"Whether you think you can or think you can't, you're right" - Henry Ford1. level of positive emotions predict resilience
- tipping point ratio is 3:1
Positivityratio.com
Above 3:1 you thrive and are resilient
Below 3:1 you languish
2. Positive emotions broaden thinking
- open mindedness
3. Positive emotions builds resources
- See slides for other strategies to build confidence.
- Learn from failures. Celebrate successes.
Coachmeg.com
MINDFUL EXERCISE.
DR FRICCHIONE.
Insight or mindfulness: "a psychological state of active passivity and creative quiescence" with purposeful and non-judgemental attention to the present moment.
WHY YOUR HABITS MATTER TO PATIENTS
Dr. LeRoy
Open-ended questions:
1. What do you enjoy most about ___?
2. How did things go with ___?
3. What have you heard about ___?
4. What do you think will happen if you keep (behavior) the way you are?
How healthy you are affects how you counsel your patients.
Goal setting (when interviewing patients):
1. What do you value?
2. What goals do you have for your health? (what is the patient's vision?)
3. What are you about? (what motivates our patients)
Tap into patient values to frame lifestyle changes - may influence ability to succeed.
Share our own personal stories.
RUDIMENTS PF BEHAVIORAL CHANGE
Dr. Frates
Only 6% of medical schools have a formal curriculum in exercise prescriptionHow to switch from advising (expert) to coaching approach?
1. Sharing knowledge
- patients are like us. They have gaps in knowledge. Find out where they are in terms of knowledge acquisition. Ask if they are ready and willing to listen to what you are about to say. Seek permission.
"would you like to hear about ...?"2. Listening skills
- use "affecting listening", active listening, body language. Emotional intelligence.
3. Ask different questions
- open-ended is best. We need to negotiate the agenda. Ask powerful questions that will prompt self-discovery. Be present, patient-centered.
4. Look at problems differently
- looking at problems as opportunities for the patient to learn and grow, and change.
5. Responsibility
- is on the patient. We empower and enable them to take the responsibility. We cannot do it for the patient.
The coach (dancer) vs. expert approach (wrestler)
- is evidenced-based
- improved outcomes with CVD, diabetes, cancer pain, asthma
- involves collaboration/negotiation, goal-setting, accountability
Motivational interviewing
- improves mood and mortality
- improves weight loss
Transtheoretical model of change
- James Prochaska
1. Precontemplation
- ask the pt if they would like to hear about the benefits of ...
- use empathy:
"I understand that you are not ready, but we can revisit this issue when you are ready to talk about it. I really want to work with you and help you..."
"I think it is important for your health...."2. Contemplation
"What would things be like if you did ... or did not ... do...?"ask about pros and cons.
"How important is it to you...?"Find out about intrinsic motivators.
3. Preparation
"How confident are you...?"- ask about road blocks and strategies
4. Action
- review guidelines, follow up on progress, congratulate them, encourage
5. Maintainence
- encourage pts to become mentors to others
6. Termination
Physician' empathy improves clinical outcomes
- improves LDL and A1c
NUTRITION FOR EXERCISE
Nancy Clark
Loseit!
- App for phone for tracking calories
- protein makes you full and can help you loose weight
- key is to eat about every 4 hours (4 meals a day)
- carbs for fuel, protein to build muscle
- pre-exercise food fuels the brain and feeds the muscles
- breakfast is the most important meal of the day
www.scandpg.org for sports dietician
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