There is probably no article you will read, scientific or general, that won’t include exercise as one of the recommendations for management of symptoms related to chronic disease diagnosis.

In my field, speech, voice and/or swallowing exercises are typically introduced while a patient is enrolled in therapy, with an expectation that 30-60 days of exercise or adherence to a particular approach will yield some measurable outcome by discharge. Exercises may or may not include device interventions and typically when patients are enrolled in therapy because of a chronic disease diagnosis such as Parkinson’s, there is an expectation or recommendation that the exercise/s continue long after discharge.

Exercise is exercise, and the principles of exercise are true for us as therapists and for our patients. Once we stop exercise or daily practice, we can expect to detrain back to our baseline. But, when there is a degenerative disease in the background, the degree of detraining may be even greater, as each day without exercise or practice allows for quicker progression of symptoms.

Since many neurodegenerative disease diagnosis occur later in life, age related changes are also active in the background and muscle strength and function is susceptible to some of the same benefits of exercise and disadvantages if we don’t exercise. 

So, what do we do if a patient tells us at the onset of treatment “I hate to exercise?” Or, offers some of the same excuses that we might also have, e.g. “too busy,” “too tired,” etc. 

Are we role models for our patients, or do we too fail to exercise, eat healthy, and/or eliminate some lifestyle habits that may not support good health?

There has been a shift over the last 25 years or so, from health care providers having a paternalistic role in treatment, the “do as I say” attitude to a more collaborative interaction with patients. A role that some patients may want, and even demand, while others, may not like being told that THEY are responsible in many ways for their own care. Patient variables that affect their response to treatment and the likelihood of adherence to our recommendations at discharge are as varied as the individuals themselves.

When therapists take a cookbook approach to treatment, offering all patients with a particular diagnosis (e.g. Parkinson’s) the same treatment protocol, success beyond the 30 days of therapy may be limited for some. The failure to fully benefit from a particular approach during or after treatment may be in part, OUR failure. Our failure to probe at the onset of treatment the patient’s own belief/s about their diagnosis. Prior experiences with therapy, and what they may perceive as a success or failure. Support or lack of support at home. Pessimism or skepticism about a particular treatment. Or the patient’s own cognitive or functional ability that may not co-incide with the demands or expectations of the therapist.

I have met many individuals over the years who express shame over the inability to maintain some improvement they attained in speech or swallowing, following discharge.These individuals will often admit “I didn’t continue the daily practice.” And, they likely didn’t continue for all of the reasons mentioned above, coupled with all the new demands a chronic disease diagnosis can involve. 

Behavioral change is hard. Yo-yo dieting. Joining a gym but failing to work-out regularly. Stopping and starting smoking. Changing behaviors and adhering to a particular lifestyle recommendation is hard for most of us.

So, it may be helpful for all of us as health care providers to spend some time evaluating our own behaviors and beliefs.

  • Do you believe that a patient should take your advice, and if they don’t they will suffer the consequences? (e.g. “you’ll fall and have an injury” “you’ll aspirate and get pneumonia”)
  • Do you believe that a particular approach won’t work because you have tried it before with the same sort of patient “too old ” “too un-motivated”
  • Are you too busy in your schedule to take the time to figure our what each individual patient wants or needs from your treatment intervention?
  • Does lack of time, training, or re-imbursement limit your ability to to spend time counseling a patient and/or their spouse or other family members about factors that may impact your patient’s ability to follow-thru with recommendations post discharge?
  • Is your patient’s non-adherence to your recommendations actually based on some mis-understanding and mis-match of expectations, inadequate information, or does your patient feel pressured from all the demands being placed on them?

Many years ago, I had the opportunity to participate in a training program designed to help physicians improve their communication with patients. Improving provider-patient communication was viewed as critical to improving patient adherence to recommendations and ultimately reducing health care costs.

The interview with the patient, it was taught, was the single most important diagnostic tool that any health care provider will ever use.

Why are you here? How can I help you? What do you expect from my treatment?

Asking these questions frequently during therapy visits might ultimately improve outcomes, patient satisfaction, and long-term adherence to recommendations.

Need to Strengthen Your Voice?

 

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Mary Spremulli,MA,CCC-SLP

My Mission: To enlist individuals in their treatment, and help them express their personality & spirit through voice. To educate  and empower.  * FiTOUR® Group Exercise Instructor * Voice Aerobics® A Whole Body Approach to Voice Practice * CEOLS(Certified End of Life Specialist).

Voice Aerobics the heART and Science of Voice Practice