Too many options to change?

I just got done with an excellent book – Switch: How to Change Things When Change Is Hard. It is about how to help you create change things when change is hard.  One point that I thought was interesting and very true is that often when it comes to change we don’t give enough detail to help others with change.   We give vague answers to the questions others have and nonspecific direction to take when it comes to helping them get through the emotional and cognitive changes needed to make the change.   Let me give an example that is probably all too common in health care.  A person sees their doctor and it is finally at that point – borderline high blood pressure, beginning signs of diabetes and cholesterol is too high.   So what happens, usually they are given a blood pressure pill and cholesterol lowering medicine and told they need to eat healthier and start exercising.   I’m sure the first two are specifically given in a prescribed dose with recommendations on type of medicine to take.  The second two are left very vague.  The person probably takes the medicine as prescribed exactly and hopefully tries to exercise and eat better.  But the eating better and exercise probably go by the wayside after awhile.

Does exercise and eating right not get followed up on because people don’t want to do them, or because they don’t know what to do?  The book Switch detailed an interesting study:  There was a jelly stand in a supermarket.  One stand had 6 jams to pick from, the other 24.  People bought more from the jam display with 6 items compared to the stand with 24 items.  There were too many choices with the 24 item stand, and we go through “analysis paralysis” and just choose not to get anything since it is too hard to pick with so many options.  So do people take their medication since it is specifically directed in one way to do it, where as eating right and exercising has a few million options?  It is an interesting thought, to think about.

Just think if the patient was told to go to the drug store and get a couple of medicines with no direction, would they do it?  What if they were given specific guidelines on exercise and a precise diet to follow on a daily basis, would they be more likely to follow?

I love this quote I picked up from a therapy conference from my good friend and fellow Physical Therapist Mike Muffenbier: “Study principles not methods, a mind that can grasp principles will create its own methods.”  I use this often, as I want to understand the principle of how an exercise works or a specific mobilization or facilitation technique in therapy and not just blindly use it.  I need to understand the science principles behind it, so I can expand its use to the patient’s specific needs.  But I am now seeing I have been guilty in the past, maybe not helping my patients, because I might have overloaded them with tweaks to exercise to show them they can create hundreds of exercises from a few basic ones with utilization of Tweakology^TM principles I have learned.  I now see that might be like being at the jam stand with 24 options.  If they do not understand the principles, I need to keep the methods easy to follow.  Especially since in today’s current health system I do not get to follow up as I would like and continually progress a patient’s exercise program appropriately.  Yes learning all the various tweaks is maybe better for you (24 options), then just a couple of exercises (6 options).  But if this increases the chance of the patient making the change and doing the exercises, 6 of them, is better than 24 they do not do. 

It's hard for many exerciser's or those that want to start to exercise with so many exercises to pick from.  But we have to understand where most people are, which is lost in the endless sea of exercise options without knowing what to do.  This causes "analysis paralysis" and many choose to do nothing.  Our current culture does not help it any, just watch a few infomercials, stop at the local gym or fitness section of a store and you can easily see how most are probably overwhelmed with too many options. Plus ask 10 fitness/exercise specialist and there is a good chance you will get 10 different stories of the "best" exercise plan. Which is best for me? How do I know how much and what type to do?  This one says it is better because it burns more calories, but this one builds more muscle, which is better?  Or do I need both?  What if I have a problem with this or that, can I do this or that exercise?  Do I need a fancy machine or is one trainer DVD better than another?  One can easily see "analysis paralysis" setting into the brain and the brain choosing to not do any of it.

The truth is that pretty much all of them are good we just need to move.  You need to follow the basic guidelines:

• stretch daily (a good Physical Therapist can show you 4 or 5 stretches that are best suited for you and your current fitness status)
• cardiovascular exercise 5-6 times a week for 30 minutes at moderate intensity (this should be an activity that you enjoy - walking, biking, swimming, etc.).  If  30 minutes is to long, start at whatever level you feel safe to do and add 2 minutes each week, until you can do 30 minutes.  Moderate intensity is a pace that you can do without becoming short of breath, but still notice that you get a little tired at the end.  As you can see this is a little different for everyone.  To go to higher intensity or time make sure you gradually increase with the help of a physical therapist.
• Strength training 2-3 times a week.  Do some basic total body and core strengthening exercises appropriate for your fitness level.  Again look to get some help from a physical therapist to set you up with a simple program that can be done in about 15 minutes.

This is a great basic exercise plan that will serve anyone well to improve their health and well being.  But you should consult an exercise expert like a physical therapist for some guidance if you have any medical concerns or want to expand your workout further. You wouldn't go into a drug store and just take medicine without a proper frequency, intensity, time and type without consulting your doctor and pharmacist, exercise should be looked at the same.

So do you sometimes wonder how much or what type of exercise to do?  Does it cause some "analysis paralysis" with you?  My fellow PT's, additional thoughts when helping set patients up with exercise programs?