REP 2: INCORPORATING THERAPEUTIC EXERCISE IN OUR PATIENTS’ 9 TO 5
Nod if you’ve been there: Your patient comes for their follow-up visit only to tell you that work demands, long hours, deadlines, or family commitments prevented them from completing their prescribed exercises that week. You’re pretty sure they said that last week as well.
It’s time to bust the ‘too busy at work to exercise’ excuse, and help our patients realize how easy and beneficial it is to incorporate health and wellness into their workday.
The Big Idea
Last spring, a study of over 17,000 Canadians aged 18-90 made headlines in the news. It examined the impact of prolonged sitting on mortality rates and concluded that increased time spent sitting was linked with higher risk of mortality from all causes, including cardiovascular disease and cancers. It left people asking, “Is sitting the new smoking?”
My take on things…
A few years ago, I made the transition from a physiotherapist clinician working in private practice to my current role as Health Promotion Manager at the University of Ottawa Health Services. The opportunity to return to my alma mater, work with young adults, and help them embrace healthy lifestyle habits that would serve them well throughout their lifespan was an opportunity I found very appealing. Plus, the steady work hours, regular pay, and health benefits were perks that were hard to resist. Regrettably, the one thing that I hadn’t factored into my decision when transitioning to this role was the long hours I would spend each day sitting on my ‘gluteus maximus’ in meetings and working at my computer. As a clinician, I rarely sat down for more than 10 minutes at a time during the day.
If I as a PT found it hard to overcome the sedentary nature of my new job, it must feel nearly impossible for our typical ‘desk jockey’ patients to break free from the gravitational pull of their office chair after years of sitting still. Add to this, injuries exacerbated by the physical and mental demands of office jobs, such as chronic neck and back pain, or repetitive strain, and it’s no wonder patients often find themselves in a vicious circle of pain and injury.
Workplace health and physiotherapy
Lucky for everyone, there is a huge trend in workplaces across North America right now to create environments that promote physical activity at work. Why? Numerous articles (like this one from the Alberta Centre for Healthy Living) have shown that the benefits of fostering a healthy workplace far outweigh the business costs of maintaining the status quo. Healthy workplaces have lower workplace stress, increased productivity and creativity, decreased absenteeism, turnover and injury, and fewer compensation costs associated with employee health and disability claims.
You’re possibly asking yourself, “Why should I care about the results of this study or my patient’s sedentary job? I’m not my patient’s employer, HR Health & Wellness rep, or physician.” True. But as physiotherapists, we all know that patient adherence to exercise leads to long-term positive treatment outcomes. We also know that if our patients balk at the thought of adding yet another ‘to-do’ in the form of therapeutic exercise to their already overwhelming workload, it’ is unlikely that they’ll commit to doing their exercises regularly.
What can I do?
According to Enhancing Adherence to Prescribed Exercise: Structured Behavioral Interventions in Clinical Exercise Programs, we have a responsibility as healthcare professionals who work in therapeutic exercise settings to “possess both a basic knowledge of the principles underlying behavioral change and a familiarity with past and current exercise compliance research and its applications.” Motivational interviewing and behavior change approaches are common strategies for breaking down patients’ negative habits. Motivationalinterviewing.org is a great resource for anyone looking to improve their skills in this area. I understand behavior change is coming up in a few days, so I’ll just say: keep an eye out for that.
If you’re not already taking advantage of both of these approaches with your patients, seek out courses, conferences or seminars to help you to develop these skills and integrate them in your practice.
What more can I do?
If these approaches have only gotten you so far with your patient, more innovative approaches may need to be called on to guide and motivate them into overcoming their perceived or actual barriers to exercise adherence. Here are five examples that illustrate how easy it can be for our patients to gently incorporate exercise into their workday:
- If sitting is the new smoking, why not try walking meetings? In the time it would take you to fill your reusable water bottle and lace up your walking shoes, check out this 3-minute TED Talk by Nilofer Merchant to see how easy it can be for your patient (and you!) to incorporate cardio exercise at work.
- Check out Greatist.com for 33 humourous but effective ways to inspire your patients to ‘deskercise’ their way to health, including favourites such as the ‘Silent Seat Squeeze’ we’re all familiar with, and the ‘Weee Desk Chair Wheel’ to name a few.
- If your patient has difficulty remembering to take a break to stretch or exercise, encourage them to set up reminders on their mobile phone or Outlook calendar, then seek out an empty conference room to get active. “Even breaks as short as one minute can improve your health,” says Stuart McGill, Ph.D., director of the Spine Biomechanics Laboratory at the University of Waterloo in this article on workday inactivity.
- Simply moving more and sitting less can boost our health and burn calories. Check out this Huffington Post article to learn more about NEAT (non-exercise activity thermogenesis) exercises patients can do to stay active.
- If your patient is ready to become a champion for exercise at work, there are a lot of quality resources out there to help them. Encourage them to check outhealthyworkplacemonth.ca and sign up their workplace, or encourage them to browse the CCOHS Workplace Health and Wellness Guide for tips and strategies on starting a wellness program at work.
The good news is, incorporating exercise at work doesn’t have to cost anything or take patients away from their inboxes for more than a few minutes at a time. Even implementing small initiatives can do wonders – not only for improving individual physical health, but for boosting team morale and promoting a positive work environment! At the end of a long, hard work day, who wouldn’t want that?
Did you know? Our colleagues over atDietitians of Canadaare celebrating Nutrition Month this March. And guess what! Their theme also addresses the challenges of staying (nutrition) healthy at work from 9 to 5. Stroll on over to their website to see what our colleagues have developed to help patients (and busy PTs!) eat healthy.
If these ideas got your wheels turning, you may also enjoy some of these health promotion and workplace wellness resources:
- PHAC Population Health Promotion’s An integrated Model of Population Health and Health Promotion
- Ontario Ministry of Health and Long-Term Care’s Why exercise is vital to health
- CSEP’s Physical Activity Guidelines and Handbook
- Conference Board of Canada’s workplace wellness resources (Research, Conferences, and Webinars)
- Concordia and PERFORM Centre’s Healthy Executive MBA program – An innovative program incorporated into the Executive MBA that teaches executives how to live and model a healthy lifestyle at work.
What have been your best strategies to promote patient adherence to exercise despite their busy work schedules? What strategies have your patients shared with you that have ‘worked’ for them in their workplace? What are you and your colleagues doing to promote workplace health in your clinic settings?
About Kristine Houde
Kristine Houde is Health Promotion Manager at the University of Ottawa Health Services. She has worked as a physiotherapist clinician in a variety of clinical settings, and as project manager for CPA and the CPA Private Practice Division. In addition to health and wellness, her interests include EMR adoption and use, physiotherapy business benchmarking, and e-Health.
This rep was sponsored by