bogeyandruby

I had a new client this morning with a history of falls. His wife’s goal was for him to participate in an exercise program facilitated by me. Unfortunately, the client had zero interest in this. He also pshawed all the fall prevention recommendations I gave him including switching out his pantoufles de grand-mère, aka an accident waiting to happen, for a closed shoe, anti-slip model. I spent about fifteen minutes at the end of the visit trying to negotiate a compromise between them as they bickered back and forth. Initially he insisted I come to see him after my work hours, when it was convenient for him. I refused. More bickering ensued and we finally settled on two to three half hour sessions during his lunch hour. This was more about appeasing his wife than helping a client who doesn’t want to be helped.

In the forty years I have worked as a physiotherapist, I have never been able to motivate someone to exercise. That isn’t to say I haven’t had clients who were motivated from the get-go, able to formulate realistic (and sometimes unrealistic) objectives, short and long term goals. I have dream clients who follow recommendations and exercise programs religiously and I have other clients who only exercise their right of refusal.

In a public system, there is a need to be efficient and productive. Access to our service is universal which means we are spread thinly with everyone getting a little piece of the pie. Turnover is essential and as such, we do not have the luxury or time to convince people to exercise.

There are numerous studies that link aging well to exercise and I tout them plenty. The problem is that many of these clients are beyond that point, grappling with comorbidities, progressive diseases and/or cognitive decline. An exercise program won’t work if the client doesn’t remember to do it. And someone who has been sedentary all their life is not likely to comply either.

There are some strategies. Group classes that incorporate socialization as well as exercise are great for people who won’t exercise on their own. Seniors residences offer these as do most municipalities at very reasonable fees. Then there is the notion of functional activities to incorporate exercise. For example, walking to the bathroom, to the kitchen for a meal, or to check your mailbox counts as exercise. Combining an activity they enjoy such as shopping or a meal out works on exercise tolerance. Some of my clients even start with a Costco trip, a shopper’s marathon (and my personal nightmare). Shopping carts can act as a walker, by the way.

If the client is already able to independently transfer out of a chair, off a toilet, in and out of bed, walk a functional distance, go up and down stairs and manage an outing, is pushing an unwanted exercise program really necessary? Probably not, especially if there is resistance to more.

Quality of life is choice and sometimes saying no is the last bit of control they have. It is important to respect that choice as a professional and as a caregiver, as frustrating as that may be.

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Please note that the role of the community home care physiotherapist is much more than convincing people to do their exercise program. Also, a physiotherapist must be able to keep up with their clientele and as such take their own advice and exercise regularly.