Monday 1 January 2018

Barriers to exercise in people with chronic health conditions - and how they can be managed

            Happy New Year everyone!!! It’s that time of the year where people make New Years Resolutions – many of which revolve around losing weight and exercising. We’ve all heard the saying “Exercise is Medicine.” Exercise can improve overall health & fitness in many ways that no pill or quick fix can do.
            However, many people have difficulty sticking to a regular exercise program. Some Canadian statistics from 2012 and 2013 show that only 24% of males and 21% of females meet the recommended guidelines for physical activity (
            With the rising population of baby boomers and resultant increase in health care expenses the lack of physical activity in our population creates a huge problem. In this article I go over some of the common barriers to exercise in people with chronic health conditions. For simplicity’s sake I am lumping all chronic health conditions together as many of these barriers are the same.

1) Lack of time

When people talk about why they can’t exercise the usual response is “I don’t have enough time.” I am of the belief that the lack of time barrier is more of a perceived lack of time than an actual lack of time – especially considering how much TV North Americans watch on average and how little time it actually takes to improve health & fitness.

That being said some people do have legitimate time barriers including (but not limited to)
-          Working a busy job on the road such as being a long-haul truck driver
-          Sudden family crises such as a divorce, death in the family, or illness in the family
-          Moving and/or starting a new job

As such we as practitioners have to be mindful of that and fit our program to the individual – not the other way around. That’s why in the clinical world I’m a fan of the McKenzie method which provides a reasoning platform that enables you to give the client 1-2 exercises that are simple & can be done anywhere. Even a lot of the research guidelines for special populations (e.g. COPD, heart disease, osteoporosis) can enable practitioners to develop time-efficient exercise programs.

Now we can all agree that lack of time isn’t the only barrier to exercise which brings me to.

2) Fear of exercise

Having worked with many seniors in my young age with various conditions ranging from OA to cancer – I understand that exercise can be a daunting endeavour especially if you’ve never performed an organized program or played an organized sport in your life.

Anecdotally I still find many seniors, although this number is thankfully decreasing, that still believe in the theory that everything is treated by rest.

Many seniors are concerned that something severe will happen during an exercise program and this represents a major barrier to activity which brings me to my next point…

3) Lack of guidance

This goes in hand with #2 – unless you have the luxury of working with a CSEP (in Canada) or ACSM certified exercise professional, a RKin, a CSPS or a PT who is thoroughly trained and understands how to develop exercise programs for seniors than you likely don’t have a lot of guidance with how to exercise.

Lack of guidance in my opinion also contributes to the fear of exercise as people don’t know what they should and shouldn’t do. When you throw in issues such as OA, high blood pressure, diabetes, arrhythmias and other health concerns it makes the leap to exercise even more daunting.

My best advice to tackle this barrier is to take the time to either
-          Get the required training mentioned above
-          Or network to find people in your area who are knowledgeable & competent in these areas

4) Lack of interest towards exercise

Another reason why people don’t take part in an exercise program is a lack of interest. Some don’t enjoy exercise and some don’t understand why they should be doing it. I often hear people say comments like “I’m in pretty good shape for my age” or on the flipside conciliatory statements like “I’m just gettin’ old.”

Two ways to help address this are through education and also through giving a range of exercise modalities that people can choose from. During my first cardiac rehab experience some seniors didn’t like lifting free weights but enjoyed the machines. Some didn’t enjoy cardio machines but enjoyed playing a sport or doing step aerobics classes.

5) Psychosocial factors

Psychosocial factors, mainly depression, can be major barriers to exercise and can make it very difficult for someone to begin exercising & living a healthier lifestyle.

I’m not a doctor (or a head shrink), and I didn’t stay at a Holiday Inn Express last night. If you’re reading my site you’re likely a health/fitness professional who, like myself, is not trained in treating psychosocial issues and should not overstep your boundary. My only recommendation for these issues is to help guide the patient to the appropriate support whether that’s family, counselling, psychotherapy or a combination of these.

6) Transportation/mobility limitations

This can be a major issue particularly in people who use gait aids, are incredibly deconditioned, and/or don’t have someone to drive them around.

Weather can compound this issue. As I write the article it is -27 Celsius with the windchill here in Canada. Unless you live in Vegas where the weather is often warmer & drier it is likely that you and the people you work with have to compete with Mother Nature.

One solution is at home exercise programming. When I did my final physiotherapy school placement in homecare we often had people with COPD and asthma performing aerobic exercise in their own homes. Obviously the size of the home can be an issue plus fall hazards need to be taken into account there. Resistance training in the homecare setting is more difficult as it is limited by equipment unless you have access to a weight set, therabands and/or an apartment gym.

Another solution is through community resources that offer transportation for seniors with decreased mobility.

The purpose of this article was to show you some of the major barriers to exercise in people with chronic health conditions and offer some suggestions as to how they can be addressed.

Jones AWTaylor AGowler HO'Kelly NGhosh SBridle C. Systematic review of interventions to improve patient uptake and completion of pulmonary rehabilitation in COPD. ERJ Open Res. 2017 Jan 30;3(1). pii: 00089-2016. doi: 10.1183/23120541.00089-2016.

Karmali KN, Davies P, Taylor F, Beswick A, Martin N, Ebrahim S. Promoting patient uptake and
adherence in cardiac rehabilitation. Cochrane Database Syst Rev. 2014 Jun 25;(6):CD007131. doi: 10.1002/14651858.CD007131.pub3.

Rodrigues IB, Armstrong JJ, Adachi JD, MacDermid JC. Facilitators and barriers to exercise adherence in patients with osteopenia and osteoporosis: a systematic review. Osteoporos Int. 2017 Mar;28(3):735-745. doi: 10.1007/s00198-016-3793-2. Epub 2016 Oct 6.

1 comment:

  1. Two ways to help address this are through education and also through giving a range of exercise modalities that people can choose from.
    Health Fitness Professional


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