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Exercise Consultation: An Empirically Validated Approach

In my last article, I talked about motivation and its role in exercise and diet compliance. Recently, I attended the National American College of Sports Medicine conference in St. Louis and I thought I would share some of the highlights of the conference with our readers. Although this organization does a great job of presenting information on a wide variety of topics, I chose to spend my time attending many of the diabetes and exercise presentations. Many of these presentations focused on prevention and management of diabetes.

A few presentations discussed the psychological and physiological behavioral outcomes resulting from exercise consultation using the stages of change model, motivational interviewing and the decisional balance. One presentation in particular came from a group of researchers from Scotland (Kirk, et al.2002) who took 44 Type 2DM and randomized them to either a control group which received a standard exercise information leaflet or experimental group which received exercise consultation throughout the six months of the study. Exercise consultation consisted of ~30 minutes of discussion regarding goal setting, the decisional balance and motivational interviewing. My understanding is the participants in the experimental group received a phone call approximately every 6-8 weeks to receive consultation. Changes from baseline at 6 months were assessed in a) physical activity levels (7–day physical activity recall and accelerometer), b) stage of exercise behavior, and c) processes of exercise behavior change. These researchers found significant increases between the group who received exercise consultation and the group who received a pamphlet on physical activity with regards to the number of minutes recorded performing moderate activity per week and total activity counts per week. Also, significant differences were found between groups for the change in behavioral activity from baseline to follow up. In addition, 86% of the experimental group increased in stage of exercise behavior compared to 33% of the controls.

This same group of researchers looked at the effects of exercise consultation on a) physiological (exercise capacity and BMI), b) biochemical (HgbA1c, total cholesterol, HDL-C, LDL-C, triglyceride), and c) quality of life (SF-36 Health survey and Well-Being questionnaire). Changes from baseline to six months were assessed using the same sample group as mentioned above. Results showed a significant difference for the change in peak VO2 ml/kg/min-1, HgbA1c, and BMI from baseline to follow-up between the experimental and control groups. A significant increase in BMI and decrease in peak VO2 ml/kg/min-1 from baseline to follow-up was recorded for the control group. The experimental group presented a significant increase from baseline to follow-up for total exercise duration. There were no significant between or within group differences in lipid profile or quality of life. I think it’s important to note that there were no dietary restrictions in this study. Despite the fact that no differences were found between groups for quality of life, there has been empirical research documenting the effects of exercise and self-reported improvement in ratings of quality of life as well as self-reported decreases in signs and symptoms of depression and anxiety.

I believe these two studies reinforce the notion that we need to be persistent in guiding our patients towards success in achieving regular physical activity through exercise consultation. As many of us already know, and have seen supported through research, patients need support and guidance throughout their process of behavioral change. Consultation regarding goal setting, motivation and determination of the pros and cons of current behavior through the decisional balance are essential. If researchers are aware of the positive impact that consultation has on behavior change, then we as health care providers need to make sure were are maintaining an awareness of this knowledge and applying it whenever necessary.

Kristina Sandstedt, MS received her Masters of Science degree from the University of Montana-Missoula. She is certified as an Exercise Specialist through the American College of Sports Medicine. She is currently working as a Clinical Exercise Physiologist and Diabetes Educator for the Early Outpatient Phase II Cardiovascular Rehabilitation unit and the outpatient Diabetes Self-Management classes as well as individual consultations at Boone Hospital Center in Columbia, Missouri.

Kristina recently co-presented “Diabetes-What You Need to Know” at the National Speaking of Women’s Health Conference