If you’ve ever had an injury or spent time in a hospital, you know that the fear of worsening that injury or fear of pain is a major barrier to moving more. These feelings of pain are real and not to be minimized. If we don’t help those patients overcome these fears in the hospital and teach them to move in ways to ease pain and improve function, the likelihood of the patient following their home or outpatient rehabilitation course of care is likely to diminish. Not only is that bad for the patient, it drives up the cost of critical care for the healthcare system.
But, what if the patient could be taught in the hospital to understand the initial pain that will come from physical activity was normal, even good for them? Then, they were taught how to gradually increase their activity levels, and overcome their fear of moving and physical activity before ever being sent home?
Wielding exercise as medicine, hospitals are increasingly focusing on movement, even in the ICU where researchers have demonstrated that physiotherapists can safely start in-bed cycling sessions with critically ill, mechanically ventilated patients early on in their ICU stay. In fact, the research showed that ICU patients who start in-bed cycling two weeks into their ICU stay could walk farther at hospital discharge. Exercise has also been shown to improve cardiovascular fitness, muscle strength, body composition, fatigue, anxiety, depression, self-esteem, happiness, and several quality of life factors in cancer survivors, which is why leaders like Stanford Health Care are focused on helping cancer patients stay active during cancer treatment and have created opportunities for patients to move more during their hospital stay.
There is no shortage of evidence that regular exercise helps with chronic disease prevention and management and is critical even when someone is living with conditions like Parkinson’s disease, multiple sclerosis, Alzheimer’s disease, and osteoporosis. But it’s not good enough to just tell someone they need to exercise more. That’s like handing someone with high cholesterol a bottle of pills for thyroid disease. Not everyone needs the same prescription.
While the scientific evidence for the benefits of physical activity has accumulated in the last 20-30 years, only 20 percent of Americans get the recommended 150 minutes of strength and cardiovascular physical activity per week, more than half of all baby boomers report doing no exercise whatsoever, and 80.2 million Americans over age 6 are entirely inactive. In addition, only 35 percent of physical therapy patients fully adhere to their course of care even thought there’s so much research showing that physical therapy works.
Problems like patient non-adherence to physical activity that may seem simple on the surface are actually very complex, especially in the hospital when patients are scared and in pain. Similar to all healthcare, solving this challenge isn’t about driving downloads, but about digging into the problem, understanding the patient’s motives, listening to their fears, and designing for behavior change, yet not asking for complete behavior modification.
Like any treatment, the medicine of exercise needs to be prescribed, administered, and tailored to each person’s needs by movement experts like physical therapists who are trained to treat deficits in strength, motion, and balance. These exercise treatments must start in the patients’ room and be based on their individual biological and psychological factors, but also consider the individual and cultural factors of their personal environment when they get home. This approach will invoke health wearable devices, artificial intelligence, telehealth, exercise equipment, and that we bridge between inpatient rehabilitation, outpatient rehabilitation, and traditional fitness.
The hospital is ground zero for a new way to thinking about medical fitness to drive better patient outcomes. Randomized clinical trials are still needed to get to the heart of creating disruptive exercise modalities across multiple health conditions and injuries, but we need to start treating exercise like the miracle drug it is. This requires a shift in thinking to help patients overcome their fears of pain, and striving to help them understand that it’s not only safe and possible, but it can improve how well they function physically and their quality of life. After all, the fear of exercise-induced pain may be greatest among those that most stand to benefit from early and regular exercise — those with chronic conditions.
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