The Joy of Movement

The joy of movement cannot be underestimated as it applies to health and wellness. Understanding the complexity and variety of movements involved in activities of daily living is necessary to the promotion of health and wellness.¹ Kinesiology is the science of human movement that as a discipline applies a body of knowledge to making motor skills more efficient. While most chiropractors will not delve into the analysis of human movement to the extent of kinesiologists, it is important that we keep our patients moving if we are to promote their health and optimal functioning.

As a health care professional, you can have a significant influence on your patients' choices when it comes to adopting a new health behavior. Inspiring patients to achieve healthier lifestyles includes motivating them to "get a move on." Making small changes in activity levels over time not only helps them to reduce back pain and maintain a healthy weight, but also plays a significant role in their overall health.

Patients not only look to you for ways to make healthier behavior changes, but also for advice on staying on track with those changes. Let's explore some practical ways to get your patients moving and stay moving, including information on a tool kit inspired by America on the Move.² This was developed as part of the Colorado Department of Health and the Environment's Office of Health Disparities grant CAMINE (Clinics Assisting With More Interventions in Nutrition and Exercise). The toolkit material can be downloaded from www.americaonthemove.org.

Motivating the Patient

One of the most efficient and effective ways to motivate patients to make healthy behavioral changes and keep them on course is a health promotion contract.3 Such a contract is the result of negotiation between the patient and the practitioner. It signifies that the patient is ready to make small changes for better health. An important part of the contract is that in signing it, the patient agrees to change their daily activity level in incremental stages that are tracked in subsequent visits. Once a contract has been agreed upon, the role of the chiropractor becomes one of facilitator.⁴ The practitioner acts as a health educator, lifestyle coach and cheerleader in times of discouragement, and promotes active participation on the part of the patient.⁵ It is important that each contract be tailored to the individual patient's needs.⁶

Getting the Patient Started

The first step after the patient indicates a willingness to increase their physical activity is to get a baseline assessment of their current activity. If the patient is inclined to participate in a walking program, their baseline and progress can be measured by a pedometer. They can be informed that something as uncomplicated as walking can help in the management of overweight/obesity, diabetes, heart disease, arthritis, osteoporosis, depression, cancer and high blood pressure. They can also be educated as to the reduction in health care costs that accompanies the physical and mental benefits of increased activity.⁶

Tips for Getting Your Practice on the Move

It is most effective when your entire staff is empowered to assist patients with small behavior changes centered on physical activity and eating. Wearing a step counter can encourage both staff and patients, and is a great way to lead by example. In addition to traditional chiropractic educational material, signs and posters focusing on the importance of physical activity can be posted in your waiting room, exam rooms and other patient areas. My favorite motivational quote is from the German philosopher Arthur Schopenhauer: "The greatest of follies is to sacrifice health for any other kind of happiness."

Patient should be asked about their activity and eating habits each visit to see if your recommendations are being followed. A viewing area for health-promoting videos/DVDs can make waiting time an educational experience. Something as simple as a list of resources for healthy group activities and community programs (with addresses and phone numbers) can get patients started on a program they may have considered, but lacked motivation to start. A lending library of health-related material is also a effective way to promote patient health, as well as a health-promotion and wellness practice.

Another way of getting involved in educating the community is to serve as a guest speaker on health issues, start a program in a school or participate in a health fair. There is power in numbers, and promotion of healthy activity programs with other professionals can benefit more patients than just those in your office. Each practice, like each patient, is unique. The most important thing is to get started.²

Sustainable Activities

The only good activity is one that is enjoyable, at least if it is to be sustained. Incremental intensity is important for individuals who have been leading a sedentary lifestyle. Here are some light, moderate and more vigorous activities that should be paced in the beginning to avoid injury.

The intensity of an activity can be modified to suit the level of the individual. Many times patients may have participated previously in an activity that they enjoyed; they should be encouraged to resume this activity using judgment and moderation in the beginning. It is not uncommon for patients who have been inactive to pursue an activity program with such vigor that they soon quit, thinking it is no longer pleasurable, whereas if they had resumed it at a moderate pace, they would have been able to sustain it.

Steps to Promote Movement as a Joyful Experience

The most successful intervention begins with understanding both a patient's beliefs and their willingness to make a change.² Identify and document the patient's physical activity, which can then be monitored at each visit. Advise the patient in a clear, strong and personalized manner, urging them to adopt a healthier, more active lifestyle. Help maximize the patient's commitment to incorporating regular physical activity into their lifestyle. Assist the patient in choosing an appropriate activity. Schedule follow-up contact in person or by telephone, postcard or e-mail. Remember, the most important step is choosing an appropriate activity so the patient enjoys the movement experience.²

Steps to Motivate Patients

Determine why the patient wishes to make a change. Ask the patient to identify potential negative consequences of continuing current levels of physical activity. Ask them to identify potential benefits of making a change regarding physical activity, along with potential barriers to making small changes. If backsliding occurs, encourage the patient to make another attempt until it becomes habitual to participate in their chosen activity. Patients can be told that like many other behaviors, making a change may take several attempts.²

Conclusion

Movement toward a healthier lifestyle can be a joyful experience. Understanding that the joy of human movement is both a physiological sensation (release of endorphins) and a psychological boost (the satisfaction of accomplishment) facilitates counseling. Observing patients' more fulfilling lifestyles can also be a joyful experience for health care practitioners. Patients on the move promote their health and well-being in a way that expresses the joy of movement.

References

1. Scott MG. Analysis of Human Motion, 2nd Ed. New York: Appleton Century Crofts, 1963.
2. www.americaonthemove.org
3. Van Dover LJ. Health promotion through the use of nurse-client contracts. Annual Meeting of the APHA, Washington, D.C., Nov. 17-21, 1985.
4. Jamison JR. Health Promotion for Chiropractic Practice. Gaithersburg, Md.: Aspen, 1991, pp. 25-31.
5. Gatterman MI. A patient-centered paradigm: a model for chiropractic education and research. J Altern Complementary Med 1995;1:371-86.
6. National Center for Chronic Disease Prevention and Health Promotion. Physical Activity and Health: A Report of the Surgeon General. Atlanta: Centers for Disease Control & Prevention, 1996.