Jump-Starting Motivation to Exercise in Clients With Type 2 Diabetes
By Lori Zanteson
Engaging in exercise is one of the most powerful ways to manage type 2 diabetes. And as the disease’s prevalence and incidence increases, it’s even more important for people to get moving. Counseling by a healthcare professional encourages higher levels of activity, and dietitians are in a unique position to effect change by helping clients get motivated.
Detail the Benefits of Exercise
Dietitians work to ensure their clients with type 2 diabetes are aware of the need to exercise, but it’s also important to make sure they understand the specific benefits they can expect to gain, says Hope Warshaw, MMSC, RD, CDE, author of The Real Life Guide to Diabetes. They need to know that “exercise can be as powerful as glucose-lowering medication,” she explains, adding that physical activity lowers blood glucose levels and blood pressure and can even raise HDL cholesterol levels and lower triglycerides.
However, knowledge doesn’t necessarily translate into action, and feeling intimidated by exercise can easily sideline a person’s good intentions. When you make it clear that exercising doesn’t have to mean training for a marathon—that health benefits result from simply being active—people will be more receptive to it, says Warshaw, because they must believe they can do something before they can muster the drive to do it.
For Shana Maleeff, MA, RD, ACE-GFI, motivating clients with type 2 diabetes starts with tailoring advice to each individual. “The most important thing is to meet a person where [he or she is] instead of pushing your agenda,” she explains.
To suggest performing 150 minutes of exercise is more overwhelming than motivating. But when you focus on each client, you’ll begin to learn specifically how you can help that individual discover what will motivate him or her.
“Different things work for different people,” Maleeff explains. “Some
want to eliminate one or more of the medications they take or reduce the
doses, while others want to lose weight.” With that in mind, she guides clients toward activities that are convenient and enjoyable for them. Whether that activity is swimming, dancing, or playing tennis, they need to choose something they’re comfortable doing.
Dietitians can be particularly effective when it comes to helping clients formulate goals, says Warshaw. It’s best to guide them toward small, short-term goals that are attainable and toward which they are willing to work. She recommends a clear and detailed plan that includes “the when, the how, [and] the where,” such as the SMART (specific, measurable, attainable, realistic, and timely) goal system.
Well-devised goals slide almost seamlessly into established routines. Mary Yuse-Miller, RD, of McMinnville, Ore., likes to see her clients’ everyday schedules so she can help them design goals that fit naturally into their lives. “Like all change,” she says, “it takes awhile to become a habit. It usually takes about three sessions before they do what’s written down.” Once they do, goals should be monitored and tailored into long-term goals.
Keep It Up
Once they’re exercising, accountability keeps them at it, says Maleeff. She recommends clients check in with a friend, use the Web to keep track of their exercise, or attend a gym class.
“I see more consistency with a partner,” says Yuse-Miller, who increases her clients’ buy-in by showing them how they are helping their partners become healthier, too.
Rewards can also serve as great motivators. Yuse-Miller likes to reward both daily and three-month goals. A small square of dark chocolate makes a good daily reward for sweets lovers, while a monetary deposit toward a massage or vacation can be effective over the longer term.
Keeping a log of minutes exercised alongside blood sugar readings has proven effective in Yuse-Miller’s practice. “The hardest part is getting started,” she says. “Then they feel better. They see a connection between exercise and blood sugars going down. It keeps them motivated.”
Maleef has heard her share of client excuses. “The weather is a big thing. It’s either too hot or too cold, rainy, or snowy,” she says.
Time is a constraint for many people, and those who can’t afford exercise equipment or a gym membership may consider money their biggest obstacle. Still others have medical or physical conditions that limit them. Maleeff says some people tell her exercise is boring and that they don’t want to do it. No matter the challenge, Maleeff presents clients with an alternative: Turn on an exercise show or pop in a DVD. Engage in 10 minutes of exercise at a time. Get off the bus two stops early, walk the grandkids home from school, or run errands on foot.
Guiding clients to get moving with a personalized action plan is an effective way to kick-start their motivation to exercise. By focusing on the individual, dietitians can help clients effect positive lifestyle changes that will ultimately help them better manage their type 2 diabetes.
— Lori Zanteson is a food and health writer in southern California.