Control Trumps Fear When it Comes to Adherence to Exercise in Cystic Fibrosis
I’m getting a lot of ideas for posts as I prepare for this talk in a couple of weeks at the NACFC in Minneapolis. I am speaking about motivation and exercise, one of my favorite subjects, and am quite happy to be doing it.
Today I reviewed an article published in Thorax 2004; 59: 1074-80, by Moorcraft et al, entitled Individualized Unsupervised Exercise Training in Adults with Cystic Fibrosis: a 1 year randomized controlled trial. Here are a few reasons why this is a well designed study and one to believe: 1) it is (in CF terms) a pretty long term study. Most others are only weeks to a few months in duration. 2) It was randomized, a short-fall of many other exercise in CF studies. 3) After an initial training session, it was unsupervised and the exercises (though structured by a trainer) were done at home–so the positive results are good news about adherence and sustainability of a program. The patients were, however, given frequent contact by phone and/or clinic and were actively encouraged and motivated to continue.
The results were indeed positive. After a year, a significant training effect was shown in the training group and there was a lesser decline in lung function in those trained when compared to controls. But, as important as that is, that is not why I am writing this. The most important point of the article to me was in the summary, where the authors state:
“Every effort must be made to adapt the exercise to fulfill the wishes of the patients and integrate it with their lifestyle. This study shows that benefit can be obtained with an individualized home-based programme. In the long term, motivation must be sustained by the individual and the clinician must strive to engender an exercise habit. A flexible approach to encouraging exercise and an enthusiastic approach from the staff should not be underestimated. A feature that favours exercise adherence in CF is that the patients perceive it as an area over which they have control and that, unlike other treatments, fear of their disease does not drive adherence to exercise (my emphasis). Instead, they have a positive outlook on exercise regarding it as a normal activity which they can enjoy.”
I don’t know about you, but I think that fear sucks. It doesn’t feel good. It incapacitates me when it comes to rational thinking, and over the long haul, it frankly shrinks my brain. It is true that sometimes fear works to motivate. If that weren’t true, I probably wouldn’t have made that phone call to my doctor when I coughed up blood. I feared for my life, and a phone call was made. Fear works in acute situations. It is the flight aspect in the fight or flight response to the mountain lion on the bike path. Ok, bad analogy.
The point is that as a long term motivator, fear is a BAD choice. Chronic fear leads to increased stress hormones which lead to depression and brain shrinkage. Neither helps with adherence to any kind of program, let alone one where you must insert significant energy, as in an exercise habit.
Control, however…now THAT is powerful. To me, seeing and feeling my body respond to exercise over the long haul is not so much about control as it is empowerment. I feel actual empowerment over at least part of my body…and this is not a common feeling for one living with a disease such as cystic fibrosis. This empowerment leads to confidence in other areas as well, and makes one think twice about negating the effects of all that work by, for instance, missing treatments.
Thinking about going to the gym or going out for a run just like any other “normal” person makes me feel more “normal.”
Now think about a kid…an adolescent with body image issues and control issues who is angry and in denial about living with CF. How helpful do you think a little dose of empowerment and normalcy might be? Trying to instill a little fear into him or her would lead one direction…the one you don’t want to go. Helping them to feel good about how well they respond to an exercise program and encouraging them to exercise because it is what we ALL should do…that works!