• Helping Patients Set Fitness Goals

    Encouraging your patients to adopt and maintain a healthy lifestyle for weight management is a crucial wellness strategy, but these conversations can be challenging. Here are some practical suggestions on how you can frame healthy lifestyle conversations and offer easy-to-implement suggestions that patients can use immediately.

    Getting Motivated to Move

    Have you experienced resistance when asking patients to increase their level of physical activity? Patients may become more motivated to make changes if you can help make what seems insurmountable to them into a simple and enjoyable experience.

    Share with your patients that they don't need to join a gym or be on a sports team to make small, incremental steps toward increasing physical activity levels. Here are some tips you can share during a fitness dialog with your patients.

    • Sit less! Suggest to patients that they reduce periods of inactivity by looking for ways to move throughout the day. For example, in addition to setting limits on screen time (e.g., 1-2 hours/day of TV viewing and non-job related computer usage) they can get up and walk in place during TV commercials. And instead of sitting down through their entire lunch break, suggest to patients that they walk for at least five minutes.
    • Do at least one thing every day. Have your patients select a simple physical activity that they can do -- and are willing to do -- every day, or at least on most days. They could walk around one block in the neighborhood, or up and down one flight of stairs. Write the activity they agree to as part of their treatment plan.
    • Keep it fun! Talk with your patients about choosing an activity that appeals to them, because if they dread it, they won't do it. Propose that patients ask a co-worker to be a "fitness buddy" to increase physical activity at work, such as a daily walk up and down the stairs during a break. Or they may prefer to ask a neighbor or friend to take a walk every day or join a mall-walking group. Another option is you can suggest is for patients to play a fun physical activity with their children, setting an example for a healthy lifestyle!
    • If at first you don't succeed, move, move again. Changing behavior can be challenging, and patients may lack confidence, due to past failed attempts to incorporate physical activity into their lives. Ask patients how confident they are that they can complete their new activity goal. If they don¹t feel confident, modify the length of time or frequency so that the goal seems attainable. Reinforce to patients that starting slow, with 5-10 minutes of physical activity a day, breeds success. And if they miss a day or two, it's okay to begin again at a slower pace, if necessary.

    Once you've helped a patient develop a plan, schedule a follow-up visit in three to four weeks to evaluate progress and modify the plan to increase the level of activity, or change the type of activity.

    Setting Realistic Goals

    Setting goals is a key part of improving health through better fitness. Unfortunately, most patients either haven't considered setting fitness goals, or have unrealistic goals with no action plan.

    Set Emotional Well-being Goals First

    Chances are, your efforts to help patients improve their diets or increase their physical activity levels are sometimes met with resistance. Patients often feel that they can't change. They've tried to lose weight in the past and ended up frustrated and disappointed.

    Some patients find they improve their fitness when they worked toward emotional well-being goals prior to setting nutrition and physical activity goals. Success in meeting an emotional well-being goal can boost patients' confidence and motivation to set and achieve fitness and healthier eating goals.

    Permanent weight loss requires permanent lifestyle changes. Patients who have emotional issues, such as anxiety, depression, or stress may need to work on those problems before trying to lose weight. Patients who achieve success in emotional well-being goals may feel motivated to make changes in other areas of their life.

    Tips for Effective Goal-Setting

    • Keep goals simple, measurable and incremental. Small successes build momentum.
    • Establish goals that are specific and actionable. Encourage your patients to think beyond general goals, such as "being more active," "eating less junk food" or "getting less stressed out." Help your patients define what those mean: "Walk for 15 minutes at lunchtime five days a week." "Drink water instead of a sugary drink at least once a day." "Take 10 minutes to listen to music before I wake the kids up in the morning."
    • Help patients define the direction of their goals. Encourage them to choose behaviors they want to change. Help them identify activities they'll enjoy and are confident they can stick with.
    • Include emotional well-being goals. Patients who have emotional issues -- such as anxiety, depression or stress -- that present barriers to lifestyle changes may need to resolve some of those problems before setting physical activity and healthy eating goals.
    • Make goals meaningful. Whether goals are focused on physical activity, healthy eating or emotional well-being, help patients define why they're making a change -- perhaps to keep up with kids, feel better about themselves, lose weight, reduce the cost of medications, etc.
    • Document goals and have patients sign them, as well, as a statement of your mutual commitment to working together.
    • Schedule follow-up visits to evaluate progress and modify goals or set new ones.

    Using Food and Activity Journals to Stay on Track

    Many of your patients may be overwhelmed by the recommendations in thePhysical Activity Guidelines for Americans, which include at least one hour of physical activity each day for children and up to five hours of moderate-intensity physical activity each week for adults. Remind your patients that any activity is better than none. Help them set realistic goals. A beginning goal might be as basic as taking the stairs instead of the elevator, or walking for five to 10 minutes after dinner each night. Help patients select activities they are likely to keep doing.

    Patients can track their activity level over time by recording in a journal what they do on a daily basis. Have your patients bring their journals to each visit, and celebrate small successes with them. Emphasize that the purpose of the journals is awareness, not judgment. Let your patients know that using a journal is a proven way to achieve success in changing behavior, losing weight, and cultivating a healthier lifestyle.

    Keeping a food and activity journal can also be a way to address emotional well-being. In the journal, patients record what they eat each day and how they feel. This can help patients understand how their emotions affect what they eat. It can teach them not to reach for food in order to deal with stress or other emotions. Patients should also be encouraged to set small, achievable goals related to their emotional well-being, such as spending five minutes each morning in prayer or meditation, or having lunch with a friend once a week.

    Improving Fitness by Addressing Quantity and Quality of Sleep

    Quantity and quality of sleep can affect emotional well-being. Most adults need seven to eight hours of sleep each night. People tend to sleep more lightly and for shorter periods as they age. About half of all people over 65 years of age have frequent sleeping problems, such as insomnia. Inadequate sleep creates a "sleep debt" that eventually must be repaid. Signs of sleep deprivation include daytime drowsiness (including drowsiness during boring activities), or falling asleep within five minutes of lying down.

    Too little sleep results in an inability to concentrate. It can also impair memory, physical performance, judgment and reaction time. People who chronically suffer from a lack of sleep -- either because they do not spend enough time in bed or because they have an untreated sleep disorder -- are at greater risk of developing depression.

    During deep sleep, activity is drastically reduced in parts of the brain that control emotions, decision-making processes and social interactions. This suggests that adequate deep sleep may help maintain optimal emotional and social functioning.

    Those who experience sleep deprivation have decreased levels of leptin and increased levels of ghrelin in their blood. Leptin signals to the brain that the body has enough to eat. Ghrelin stimulates hunger and food intake. It is hypothesized that decreased leptin levels and increased ghrelin levels stimulate overeating.

    Tips for a Good Night's Sleep

    Help your patients improve their sleep and their emotional well-being by offering these tips:

    • Set a schedule. Turn in and get up at the same time each morning, even on weekends.
    • Be physically active. Daily physical activity aids with sleep. Try to time exercise to be at least three hours before going to bed.
    • Avoid caffeine, nicotine and alcohol.
    • Relax before bed. Relaxing routines such as taking a warm bath or reading can make it easier to fall sleep.
    • Sleep until sunlight. If possible, wake up with the sun, or use very bright lights in the morning. Sunlight helps the body's internal biological clock reset itself each day.
    • Don't lie in bed awake. If you can't fall asleep within 30 minutes, get out of bed and do something else until you feel tired. Maintain a comfortable temperature in the bedroom.