Encouraging Physical Fitness: How Your Peers Do It

To help you enhance your practice and increase your bottom line, we ask practicing doctors of chiropractic, like you, for ideas and solutions that have been tested in real-world environments. In this issue, we asked: "How do you convince your patients to exercise and become physically fit? How do you follow up?" Based on your responses, this is clearly a challenge many of you face, however there were several common strategies used to reach out to patients.

Form a Partnership

For many of you, letting your patients know that you are on their side as an advocate is the first step. "On the first visit, I tell the patient that in order to achieve the best benefit from the care provided, we must work together in partnership," said Dr. Tinsley Minor from National City, Calif. "I will provide the treatment and they will provide the at-home physical training. Their muscle tone and weight tells me if they are doing their part."

In addition to establishing those partnerships, many of you also encourage patients to form work-out partnerships with friends or loved ones. The buddy-system seems to be effective as there is more accountability. Dr. Steve Engen from Kearney, Neb., first asks "the patient what they enjoy doing for activity. Next, I ask them if they have any friends who enjoy those same activities. Then, after reviewing any restrictions they might have, and after going over warm up exercises, I ask them to get together with a friend and buddy up on the activity they both enjoy two to three times a week and keep a log of that activity for us to review on their next office visit. That works as good as anything I have tried over the past 33 years. If no friends are available, then we personally assist them in enrolling in a program at a local hospital, gym or the YMCA."

Education is Key

Some patients really don't understand just how serious their condition is and how vitally important it is for them to alter their lifestyle and get physically fit. Sometimes, a face-to-face reality check to education them on their situation is the first step in moving them in the right direction. For Dr. Vishal Verma from Fountain Valley, Calif., education is key. "In our office, we begin exercise at some level on the first day. Helping the patient understand the concept of exercise for stabilization of their spine or extremity, and not just strengthening, makes the difference. Educating them on basic stabilization exercises and giving them only one to two to do at home makes it simple for them to do and keeps them from quitting. We follow up weekly and literally watch them perform the exercises to make sure they are done correctly."

Dr. Dan Hillquist from Van Nuys, Calif., uses a couple of clever analogies to make his point. "I explain to the patients that I specialize in putting the bones in alignment. The glue that holds the bones in alignment are the muscles that need to be strong, flexible and balanced. I then use the analogy of a model plane or a model car and comparing the amount of impact or stress it would take for the pieces to come apart if it has glue or not. I also ask about football players and the amount of glue that they would need to hold themselves together for what they put their bodies through."

Dr. Edward Traum of Tempe, Ariz., understands and helps his patients understand that while this is a long road, it is worth the journey. "After 15 years of practice, I have learned that most patients do not have the requisite motivation to engage in a well balanced wellness program. However, I have also learned ways to gently guide my patients into this motivation. First, we acknowledge together, eye-to-eye, the difficulty in accepting that this must be a priority if they are to achieve the outcome (usually pain reduction) that they came to me for. Earning 'buy in' is entirely dependent on a patient's ability to change their view of fitness from a goal to a life style. Without this paradigm change, the vast majority of fitness prescriptions are doomed to failure.

Dr. Traum continues, "The patient must know that it is typically a long road to true fitness so they must start slowly. My patients always know that physical fitness is something that requires continual effort, adaptation and even reminding. Most of my patients are successful in their adoption of a fitness lifestyle because I continually ask them how they are doing and I routinely remind them that it is okay to go slow so that they can build solid, core values along with their solid core muscles."

Right Topic, Wrong Question

Dr. Louis Sportelli from Palmerton, Penn., believes that this is a very important topic but that the question asked, wasn't the right one. "That is an excellent question and one we are confronted with every day. However, the question is wrong, 'we' cannot convince our patients to exercise, what we can do is find the individual motivating factor that will enable them to 'want' to exercise. As subtle as that may be, it is the critical factor in success or failure.

Dr. Sportelli continues, "When the underlying psychological reason is uncovered and there is patient understanding and buy-in, the exercise routine is now not a 'thing to do' but rather a part of who they are. Exercise also works better when there is the pronouncement made public to another individual, friend or spouse and when exercise is done as part of a commitment, not only to themselves but now to another person. Finding the right trigger mechanisms and underlying motivators is the first step to success."

Long Term Changes

Of course, the goal is to help patients achieve a healthy lifestyle--and for them to see chiropractic as one of the best ways to maintain that lifestyle. "Besides seeing improvements in the fitness levels of my patients, the greatest thing I see is the depth of longevity in my patient base. Lifelong advocates for chiropractic care and wellness living are produced by example and encouragement. Little by little, their world is improved by their own actions and their friends take notice. This is my definition of success," said. Dr. Traum.