Lifestyle Changes: Great Intentions…

“I’m lonely around the holidays; few patients want to see me.” – Heather Cupp, RD

You can probably relate with our dietitian’s observation. Do you see a drop-off in patients with diabetes coming in to see you? Or do you see an uptick in those who don’t bring their SMBGs or BPs? Perhaps patients will reschedule their appointments, moving them back to January or even a bit later. Especially with the holidays just around the corner—as well as all of those other days in the year—what practical strategies can we give to patients about diet and exercise to boost their incorporation of these changes into their daily lives?

I am sure you’ve heard from your patients ad infinitum the reasons why, despite the potential benefits, they just cannot exercise regularly. There are obstacles that are too daunting, too numerous, and too insurmountable. Maybe they’ve tried and got into a groove for a while, which most often seems to occur during the first few days or weeks after New Year’s Day, but then something stressful pops up, and—wham!—they are knocked off course, and that workout wear or gym card becomes an afterthought, unused, and thrown into that pile of books, hobbies, and unfinished tasks around the house that are buried and saved for some vague “Someday … when I have more time.”

How do we encourage our patients with diabetes not only to start but also to stick with exercising?

Here are some practical points I encourage patients to apply:

1. Bring back the fun!

Exercising should be something we look forward to. We may already have tasks every day that we are not exactly enthusiastic about completing, so why add another one? I emphasize to patients that one of the keys to improving the likelihood of both successfully starting and sustaining regular physical activity is to choose what they enjoy, be it walking, swimming, jogging, bicycling, or another cardio exercise.

2. Get—and use—a pedometer.

This device is a good way to track the number of steps you take in a day and can be a wonderful motivator (I can attest to this myself). It’s also relatively inexpensive, although these days, you could opt for a fancy model if you’re so inclined. In 2007, Bravata and colleagues conducted a review of studies involving patients who used a pedometer.¹ Of 26 studies that met their inclusion criteria, 8 were randomized controlled clinical trials and 18 were observational studies. Pedometer adherents in both the randomized controlled trials and observational studies increased their activity by a statistically significant 26.9% from baseline. The first group took 2491 more steps per day than the control group and the second took 2183 more steps compared with baseline. Systolic blood pressure declined by 3.8 mm Hg and body mass index (BMI) was reduced by 0.38, both of which were also significant. Notably, these reductions were associated with having a goal, such as 10,000 steps each day.

3. Break it up!

“I already have so much to do in a day. When will I have time to do this?”

I remind my patients that you do not have to fit 150 minutes of exercise or more per week during a single 30-minute increment. If you can, or if that works the best, then that’s great, but some may be unable to devote that block of time. In those cases, it is best to try to aim for shorter periods—10 minutes at a time, for example. Otherwise, we may run the risk of never getting any exercise in at all!