Exercise compliance – Insights from using Yoga DVDs at home to instill discipline and motivation in patients.

I leave the clinicians to work out what the best exercises are, my interest is improving compliance.  

Knowing exercises is one thing, doing them is another! 

For a few years I have had a growing feeling that I need to preserve joint mobility, particularly in my lower back!   So I have toyed with the idea of doing yoga (also for a few years!).


At the end of the summer I bought a box set of yoga DVDs and over the last couple of months I have started to use the Yoga videos in the morning, at least twice a week.

They really help and now, I would probably be happy to join a class because I understand that “Cobra” is not a beer brand we have with a curry!

The point is, I did know what a sun salutation was but I never bothered doing them on my own.

With the DVD there is a framework and time structure.  From 30 minutes to 45 minutes.  ie it’s doable and someone is there with you.

Many patients leave a clinic with a set of written or verbal exercises to do. That is not going to work for most.  It DOESN’T work for most people!

I have written about exercise diaries, wall planners etc, my strong recommendation is to find a DVD that you like and sell it to patients for them to do at home (and record when they do it in their exercise diary!)

Then tell them to do the exercises at least 3 times a week or daily or whatever is appropriate.

The APPI do a video for back pain which I believe you can buy at trade prices

but there are many others.

IDEA – Why not put on a “back class” at your clinic or elsewhere, get a local videographer to record it and then give that to patients as your own-branded DVD, give complimentary copies to GPs etc etc, then who’s the local daddy?!

If you do hear yourself saying to patients “do try to do your exercices” you know that most won’t bother. Try the DVD route, it can can only help and you will stand out from the masses.

Now time for some Cobras … I’ll do my yoga in the morning 😉

Author: Stephen Small, Director Steadfast Clinics

Steadfast Clinics is the international distributor of IDD Therapy spinal decompresion, SDS SPINA, Accu SPINA and Thermedic Infrared Therapy Systems. We’re on a pain relief mission !

‘Sarcopenia’, my holiday and insights for back pain patient exercise compliance

Sarcopenia is my favourite word.  I heard it a few years ago when I discovered that, like everyone else, I was suffering with it.  The gradual reduction in skeletal muscle mass as we get older (0.5%-1% per year after age 25), the stuff middle aged-crises are made of!

I have always played sports and been active.  As a 42 year old (I count that as young!), I still run, swim and go to the gym once or twice a week.  No major injuries and, touch wood, no back pain issues which is the subject I deal with the most at Steadfast.

I got back from a 2 week holiday in Spain last weekend.

Aside from a little swimming, my activity levels dropped enormously as I tucked into tapas and the odd glass of Rioja!  Now 3 weeks on, I feel a noticeable, alarming reduction in what muscle mass I had before I went away.  Use it or lose it I think is the saying.

However the other thing I notice, which is what got me thinking about back pain patients, is that my will power to return to doing exercise is at rock bottom!

I now have no desire or motivation to go to the gym or do anything.

My principal personal reason for exercising is that my body stagnates when I don’t do anything, so I have to crank things up. Yesterday I did manage to win a herculean mental battle and take myself off for a run but it was painful (run = jog/ run any slower and you’ll be stationary).

It was also depressing because I realised how much pace, strength and stamina I had lost in such a short space of time!

All clinicians prescribe exercises to their patients and patients expect (are resigned) to walk out of a clinic with a list of exercises.

For people who perhaps haven’t had a habit of exercising for a long time, who have pain and particularly those who are overweight, is it any wonder that they find it so difficult to comply with an exercise programme?

And when someone fails to comply with an exercise programme and they remain in pain, doesn’t it reinforce a negative mindset?  Those ‘depressed’ feelings about themselves and what they are (not) capable of are extremely demotivating.

I have written a couple of articles about taking lessons from other industries to improve exercise compliance.

E.g clinicians can use exercise diaries for personal exercise accountability, wall planners as visual reminders and clinicians can link up with personal trainers to create short programmes to help patients with exercise compliance.  There must be other ways too … group classes etc etc.

Given that chronic back pain is the #1 musculoskeletal cost to society, there has to be a case for putting in place more robust systems to help patients and back pain sufferers in particular overcome inertia and progressively develop a habit of activity and exercise.

Otherwise, people will never get off the chronic back pain merry-go-round and, for the reasons outlined here, certain financial inefficiencies will persist as money is spent on treatments when there is limited long term benefit.

PS It’s 8.30 Saturday morning as I write this.  The gym is open for business, there is bacon in the fridge and I feel the battle already in my brain.  Battle won …. I’m getting back on the virtuous circle … though I might I have some bacon when I get back!

Stephen Small linkedinBy Stephen Small
Director Steadfast Clinics Ltd

Steadfast Clinics is expanding the availability of IDD Therapy spinal decompression for disc-related back pain and Thermedic Infrared Therapy systems for joint pain relief and soft tissue injury rehabilitation.

Taking ‘Before Photos’ to improve rehab exercise compliance – Lessons from the fitness and weight-loss industries.

Have you noticed that the primary sales tool in any weight loss or fitness programme is a before and after photograph?

There is always an eye catching and impressive before-after photo.

The before photo generally shows the unsmiling face (not here though! – see below) and the classic large belly.

The after photo shows a bright smiley face with either an exposed torso or the person standing in a pair of their old ill fitting trousers!

There are many different exercise programmes and diets but generally the key reason the programmes fail is because people give up.

Thinking about this, I wonder: is the act of standing in front of the camera – embarrassed and ashamed – and getting a photo taken a key factor in cementing someone’s commitment to stick to an exercise/diet plan? 

In the goal-setting/ life coaching business, announcing your goals as a public statement of intent is quoted by leading experts as one of the cornerstones of reaching goals and achieving success. Is that what the before photo does?

So, alongside the weigh in, should anyone looking to get healthier and lose weight/ exercise get a set of before shots to paste around their house?  If we want to have the ‘after-shot physique’, perhaps the starting point on that journey is actually taking some before-shots!

What lessons can clinicians take?

With easy access digital photography at our fingertips, could clinicians make more routine use of before shots to show starting posture and weight and thus help patients comply to a given exercise/rehab/posture corrections programme?

‘This is how you look now, here is the goal and this is how we want you to look’  As one saying goes ‘if you can see it, you can believe it’ and another says ‘if you can believe it you can achieve it’.

If you have an opinion, you can use the comment box below.

PS – In the photo I use above, the before shot actually shows the guy smiling … hmmm. I wonder, in taking the photo is that he knows what he is committing himself to do and he is smiling because he is excited by that prospect?  I think that he has faith in the programme and by taking the photo he is committing himself to the end goal.

Often improvements in health are subtle and are revealed by the change in someone’s face. Patients can forget what they were like when they started, so this may really help them appreciate what you have done for them.

PPS This thought occurred to me as I wrote an earlier post about using Wall Calendars to help boost exercise compliance for spinal rehabilitation.  I applied the idea from the Insanity Exercise Programme http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

Author: Stephen Small
Director, Steadfast Clinics Ltd

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machine [contact-form-7 404 "Not Found"]

Exercise Compliance for Back Pain: Lessons from Selling Fitness Programmes on the Shopping Channel

The other morning, one of my daughters was watching the TV shopping channel where ‘Shaun T’ was selling the 60 day workout programme – INSANITY.

I had actually heard of Insanity because my gym instructor had lost 2 stone doing the programme and also, he had the classic “after shot” physique!  So I watched some of it and it got me thinking about back pain.

One of the bonuses Insanity gives is a 60 day wall chart calendar where people tick off their exercise days.

Why would Insanity offer that?

Sure, it’s a free bonus but they could give any kind of bonus.  The reason they choose the Wall Calendar is to help customers with self-discipline and thus help customers comply with the programme.

Such an approach is more likely to lead to a happy customer and therefore company is happy because they don’t have to honour the money back guarantee from people giving up!

You may have read my piece about using exercise diaries to plan when patients will do their exercises.  This is a way to help patients be more disciplined in planning and doing their exercises so they get the benefits (i.e. diaries help with compliance).

Why not go a stage further and get some A3 clinic-branded posters printed with a 60 day exercise planner?

Give one to each patient to put on their wall; they then tick off the days as they do their exercise.

For 2-5p, a (branded) wall calendar is something else to hold patients accountable to themselves.

It contributes to an overall professional patient approach and since you are giving it to your patient like a piece of homework, they may feel honour-bound to use it (and it just so happens to be good for them!).

Put it this way, which of these adjuncts is more likely to have a positive effect on exercise compliance?

1/ Use an exercise diary with a wall calender tracker        2/ Use nothing

You can choose to use nothing pending a clinical trial to categorically prove diaries and a wall calendar will help patients comply with their exercise programme, or you could just go for it!!!

By the way – If you want to transform your body this summer, you can see the Insanity workout programme here, over 600k Facebook likes can’t be far wrong! Not sure if my joints could take it but it does seem the Insanity programme achieves its goals http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

Author: Stephen Small
Director, Steadfast Clinics Ltd

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.

Back Pain Treatment – how to improve exercise compliance post ‘treatment’ with personal trainers.

The other day I received a newsletter/ email from Robin Sharma where he talked about his personal trainer getting him to perform more push ups than in his mind he felt capable of.

Since the beginning of February I have been attending exercise classes at my local gym – Body Attack Extreme and Boxercise.

I may have found an ‘ab’ finally and I echo what Robin says.

The encouragement of the class teacher Shaun and dare I say the desire not to lose face enable me to do more than I ever could when I ‘push myself’ in exercise.

It reinforced the idea in my mind that for patients with acute and chronic back pain, having a structured exercise programme is a MUST!

Many clinics provide treatment and at the end of treatment will instruct and usually detail a series of exercises for their patient to perform.

I have written about using exercise diaries to improve compliance, but really, most people will REALLY benefit from ideally some one to one training, but if not, and depending on the condition at least a one month plan which includes attendance at certain exercise groups.

For clinics which don’t already have them, I suggest you form a strategic alliance with a personal trainer to bolt on 3 or 4 training sessions to the end of the treatment programme to help patients post ‘treatment’.

Since compliance is such a problem and exercise is a crucial part of long term rehab, it seems crazy to me that more clinics don’t do this.

NOTE: Weight and obesity are all over the television and newspapers these days and magazines are full of diets.  If we could sort our weight issues out by ourselves, there would be no pandemic.

How many joint pain conditions are not helped by the extra pounds being carried.  The personal trainer will help get the ball rolling and hopefully get your patient on to a virtuous circle of progress.

Re Robin Sharma, he is new to me but so far I like what I am getting, get his free report at http://www.robinsharma.com/

Author: Stephen Small