As a reflective piece, this is a deviation from my usual posts, but bear with me. While I don’t have evidence cited here, the literature bears out the importance of exercise as well as the impact of practitioners choices on patient adherence.
I have an average build. I watch what I eat (mostly) and ride my bike to and from work daily (2 miles each way). I take the stairs unless the elevator is right there at work. I educate my patients on the importance of exercise (ala ACSM guidelines for older adults), and give room and home exercises to address each area. But I haven’t been practicing what I preach at work very well.
Working with older adults, I’ve realized how important health and taking responsibility for it is. I think you could break them down into three broad, unscientific groups: 1) frail, either in assisted living or long-term care; 2) “average” – able to take care of themselves, but deconditioned; and 3) physically fit. In my setting, it is a left-skewed bell curve, and pretty thin on the fit end. I’ve worked with patients who could do so much better if they stayed active (the manuscript on adherence was finally submitted!), those that are paying for small daily decisions made long ago, and those who have been intentional in what they do. The latter aren’t extreme athletes, and never were. But their anecdotal stories tell me that it was their daily decisions to stay active and eat well that largely led to their good health.
Until his death and the subsequent articles about him, I did not know how big an impact Jack LaLanne had on views of exercise, especially for women, the disabled, and older adults. Other than the juice commercials, I had no idea who he really was or how fit (or old) he was. And that made me realize – I need to practice what I preach more – 20 minutes of cardio (13 minutes to work, 7 minutes home), taking the stairs, and lifting my son (now 17 pounds) doesn’t cut it. I’m not looking to live forever – death comes to us all. But looking at my patients, I want to have a good quality of life as I age, and not have all the preventable comorbidities happen to me. I’ve thought about P90X – read some good reviews, talked to a few people doing it. So I borrowed my coworker’s DVD’s last week. Man, I’m out of shape. But daily decisions in all areas of life can impact who and what you are years down the road. I’m working on cutting down screen time (a study a few weeks ago found 2 hours or more a day increased risk of death even accounting for physical activity), increasing activity time both through P90X and my family, avoiding (mostly) the “treats” at work. In the literature on adherence, one of the factors is modeling by practitioners. It’s time for me to live what I preach, what I believe, what I know.