Resources: Educating Your Patients about Activity

Range of Motion

Range-of-motion exercises, including stretching, are done to increase flexibility in muscles and joints. Passive range of motion is done essentially without the patient participating. Active range of motion includes the participation of the patient. Balance activities are done to improve standing and gait and are essential to begin with for the patient who has very limited stamina. Resistance activities, and active range of motion, are done with weights and resistance bands, build fat-free muscle mass, and increase muscle strength.

Aerobic Exercise

Aerobic exercise includes more vigorous activities, including walking and running using large muscle groups. What we have come to call aerobics are often group activities, usually set to music and practiced with steps and other devices. Aerobics have the benefit of increasing cardiac work and are effective in increasing metabolism, strength, endurance, and general well-being, but are appropriate only after balance and stamina are established. Walking is generally considered to be the exercise of choice for all people.

So How Do We Get Sedentary Patients Started?

Initiating an activity program for an inactive patient requires patience and creativity coupled with motivation on the part of the newly active patient. Repetition is a fabulous key for all activity, allowing for adequate time to rest and recover from the exertion. For example, just having someone reach out and touch their forefinger to your hand, increasing the distance to your hand and the number of repetitions, is a beginning for the inactive client. After stretching, resistance comes into the picture. Beginning with minimal resistance bands, and increasing the distance to increase the resistance, builds muscle and skill for the patient. With the little successes come the achievements that promote additional goal attainment by patients. Truly, the mantras must be “Any activity is better than no activity” and “The beginning is just the beginning.”

Getting started with walking sometimes is a challenge. People often think they must start with a particular distance. Start your patient instead with whatever he or she can accomplish. This may be no more than three steps before a patient has to stop and rest. But the next day may be four steps. For the patient who has better endurance, starting with 5 minutes of walking and increasing this daily will build stamina and strength. I often encourage people in community settings to start with ten steps: five away and five back to the starting point. In little time they will have built their distance, endurance, and sense of accomplishment!

As we consider exercise, a few essential items are worth consideration. Walking shoes are the essence of success for many. Many patients lack proper walking shoes. The outcome can be foot, knee, hip, and back pain. For those challenged by exercise to begin with, this can derail the best intentions. Having a basic gait evaluation is a good start, and many sports stores can provide a basic gait analysis. Podiatrists can evaluate foot needs, and for the most extreme challenges a physical therapist is an excellent resource. Many people who experience extreme weight have foot damage and require various orthotic devices. It is essential to have professional assessment and prescriptions to most effectively meet the needs of those patients.