Introduction

Dr. Jimenez, D.C., presents how implementing different strategies for patients to incorporate exercise in their health and wellness journey in this 2-part series. Many factors and lifestyle habits tend to take over our daily lives, leading to chronic disorders that can impact our bodies and cause many unwanted symptoms. In this presentation, we will look at different strategies and options to incorporate into our patients regarding health and wellness. Part 1 looks at how to implement exercise in a clinical setting. We mention our patients to certified medical providers that provide available therapy treatments for individuals suffering from chronic conditions associated with Lyme disease. We encourage each patient when it is appropriate by referring them to associated medical providers based on their diagnosis or needs. We understand and accept that education is a marvelous way when asking our providers’ crucial questions at the patient’s request and acknowledgment. Dr. Alex Jimenez, D.C., uses this information as an educational service. Disclaimer

Different Strategies For Patients

Part 1 in the last presentation mentioned what to do when examining patients. We said how to implement different strategies to incorporate exercise into a daily routine for many individuals who want to kickstart their health and wellness journey. By coming up with a plan, many doctors can help their patients develop a personalized plan to cater to the individual; it can allow both the patient and doctor to see what works and what doesn’t. Part 1 also explains how to delegate with the patients to help ease them into implementing exercise as part of their daily routine. Delegation is described as a transfer of responsibility for the performance of the patient’s care while retaining accountability for the outcomes. The main point here is you are delegating the educational process related to the exercise prescription. You can use it for the diet prescription, or you can use it for anything that tends to be educational and formatted for your patients.

Based on the documentation complexity, we would ensure a face-to-face encounter with the patient to meet the legal requirement for insurance to bill it as a 99-213 or a 99-214. So what we do with our health coaches is we also want to have them do other cross-trained roles in our office because we’re a small little practice. So, our health coaches are involved with our patients and know how to assess if an interested new patient would be a good candidate for our services. They are great at using the technology we do with some of our new patients, whether it’s a BIA or if we prescribe heart math. So they are great with technology and with education around nutrition, exercise, whatever you can train your health coach to do, then you can create a way to delegate for her to do it, whether it’s through insurance or cash.

Okay, now last but certainly not least, it is so important to know, and you know this if you have children or you know if you have a family member, which we know you do that what you say and what you do are two different things. So there are studies that show an association that if a provider is exercising or implementing a journey of improving their exercise and diet, it shows up more in their recommendations. And when a provider talks about it authentically during a motivational interviewing process with a patient, it’s obvious to the patient that it’s important to the provider because they’re not just talking the talk; they’re walking the walk, which is important for all of us. We are patients as well. To consider that one of the best ways to start an exercise prescription program and your office is to do one for yourself.

Creating a Workout Environement

Walk yourself through it and see the little bumps and aspects of the journey so you can speak authentically and start that office workout challenge in your own office. And we did that in our office, and we noticed that people would be coming in, and some people would be doing desk pushups, and they were like, “What are you doing?” and we would respond, “We’re just getting our desk pushups in. Hold on for a second; I’ll be right with you.” Or somebody comes in, and we’re doing squats and conversing about a patient. It sounds humorous, but they know that we mean business when we say let’s do an exercise prescription. So remember that for patients learning things is lovely, but it doesn’t change outcomes; doing things changes results and your behavior matters.

We hope you have found this portion of our day-to-day useful. We are excited to see that knowing that exercise is an underutilized tool in our armamentarium for optimizing our patients’ lives. So we will continue discussing our strategies for implementing activity in our practices. How do we incorporate exercise into our patients?

It can start as simple as asking them about their movement, seeing what they enjoy doing when it comes to exercise, and creating something slow. Just five to 10 minutes commit, saying, “Okay, well, if you like walking, could you walk for 10 minutes daily? Please ensure you track and return in two to three weeks, and we’ll review that?” And then, from there, sometimes, the providers will give them a cardiovascular prescription. We’ll provide them with resistance training and a stretch prescription. But the cool thing is that we can reiterate it by saying. “You should see one of our health coaches and one of our educators in two to three weeks so they can go over a stretch program, a resistance program, or figure out what exercise would be best for you.” We’ll use some of our tools and do the bioimpedance test to check the percent fat, percent water, and connective muscle tissue that looks at the phase angle. The phase angle is how strong the cell’s repellent electricity and the higher their phase angle, the better they would do with chronic diseases and cancer. We encourage improving this phase angle, improving hydration, and showing them the difference between weight and fat. There’s a big difference between the two.

Delegating & Functional Medicine

We also delegate with the health coaches as we develop a personalized treatment plan for the patients, and we can do it in two different ways. So one option is to bill for chronic care management. What this means is that, say, if the patient has a chronic disorder affecting their daily activities? Our health coaches can call them on their phones and discuss their plans. The second option is an office visit, allowing the patient to converse with the health coach and review their personalized program.

So incorporating these two options into your patients allows many doctors to gather all the information, assess the situation, and discuss the plan with the patients to improve or kickstart their health and wellness journey. When it comes to implementing exercise as part of the health and wellness journey for the patients, we are the leverage group to incorporate exercise as part of the treatment. Working with health coaches, nutritionists, personal trainers, and physical therapists who deliver different exercise routines to the patient’s needs is part of the journey. How does this apply to individuals with joint and mobility issues associated with autoimmune disorders like arthritic diseases?

So anybody with arthritic diseases or a chronic illness, we prefer them very actively a physical therapist who has a whole program for people with autoimmune disease and its correlating symptoms that have overlapping risk profiles. We also have a referral program for water aerobics and low-impact programs to reduce pain-like symptoms. So getting people up and moving is key. Movement is key.

Another strategy is implementing functional medicine combined with exercise. Functional medicine allows doctors and patients to determine where the problem is in the body. Functional medicine also works with associated referred medical providers to develop a treatment plan for the patient and help create a relationship between both the doctor and the patient. So making these nice little allies on the outside for the things you don’t want to or can’t do is an amazing tool with exercise. Or it could be with nutrition, or it could be with stress management. It’s the same thing with lifestyle. Do either do it in-house or out? The choice is up to you.

And so, what are these static things that we often think are static that we do every day that we can begin to incorporate stretching to activate our parasympathetic nervous system? Incorporating non-exercise activity thermogenesis into your life. And that’s something all of us in a stressful life could use a little more. And when you integrate it into your life, it’s top of mind so that you’re sitting there with your patient and thinking, “How can I encourage them?” By relating to the patient, you can show them tips or tricks to incorporate into their personalized treatment plan.

Motivational Interviewing

The goal is to use motivational interviewing and the aspects of motivational interviewing not to convince them to exercise but to understand their resistance to roll with it. Many individuals work two jobs, so telling them to exercise will not make them stop everything and start working out by relating and asking for the right questions like, “So you’re trying to get off of this blood pressure medication, and I love that you’re committed to that. So what other things can you see, or is there any part of the exercise or physical activity that you could consider that could keep you moving towards your goal of getting off this medicine?”

Helping people see that they have this time limitation. We acknowledge and roll with their resistance but then give them the discrimination to say, “Yeah, and you’re here because you want to get healthy. And I must tell you, exercise is one of the big levers. So if you do nothing, you will keep getting what you’re getting. So what can we do? Does anything else come to your mind as a solution?” We can’t tell you how much it improves things when you have the patient be the person who comes up with the idea of what to do next versus feeling the burden of having to be the one who psychically knows what this patient’s going to do. Plus, it gets exhausting trying to anticipate the right answer for the patient.

By letting the patients be accountable for their actions and their treatment, it is important to have that communication with them and see how they keep themselves motivated through their exercise regime, whether they are eating the right amount of healthy foods, going to therapy treatments, and are they taking their supplements? You will go back and forth with their choices and offer suggestions because it doesn’t apply to exercise, but exercise is the one that people will sometimes completely believe in but will resist. They’re more likely to take on a diet sometimes than they are to take on exercise. So you can apply these principles to anything like taking supplements, taking a shake, taking the diet, whatever happens, to be their resistance point in a functional medicine treatment plan. You can use these things. Sometimes, we have to consider that that might help a patient.

Conclusion

These are your go-to suggestions, but the patients get to pick a time and are in the control seat instead of you telling them because this will provide resistance to their treatment plans and cause them to not commit to their health and wellness journey. But relating to them, offering suggestions, and constantly communicating with them allows the individual to try different things that will work with them and can show massive positive results in their health and wellness journey.

Disclaimer