Q:
Do you have any
exercise strategies
you would recommend for a
weight management program
for patients who have a
disorder of executive function, depression and social anxiety?
__________________________________________________________________
Background
Executive Function is a term to describe the “higher order” demands of our brain. It includes, but is not limited to:
- Goal setting and planning
- Organisational skills
- Cognitive flexibility (thinking about things from different perspectives)
- Attention/focus
- Memory
- Self-regulatory behaviours (self-monitoring and self-control)
Executive Function can be compromised in numerous conditions such as ADHD (hyperactive and inattentive), learning disabilities. stroke, Alzheimer’s, dementia, depression, anxiety, fatigue and brain injuries.
For client’s with these conditions, it is often not about WHAT type of exercise is prescribed but more so HOW it’s prescribed.
- Varying motivation levels and potential difficulties with initiating action
- Low motivation with tasks/exercises that have low perceived value/meaning
- Difficulties following and recalling instructions
- Difficulties in interpreting complex program structures and/or decision making
- Depending on exercise/training history, learning new and complex movements may be difficult
- Anxiety and avoidance towards new environments supportive of exercise performance with potentially overwhelming social stimuli
- Goal setting
- Planning
- Exercise prescription
1. Goal Setting
With weight-loss as a goal, proximal goals such as particular habits and lifestyle changes may need to be the priority at first.
Detailing their WHY is an extremely important factor in enhancing motivation.
It may be helpful to uncover any barriers such as limiting beliefs, which they should address with their psychologist.
2. Planning
Set a Schedule
As decision making can be difficult and overwhelming for the client, a clear plan will need to be developed. This plan should include a detailed routine of their exercise and diet routine preferably on a daily basis.
Their exercise program should be easy to follow without providing too many options, as this can contribute to decision fatigue. Depression is likely to latch on to any perceived failures.
The plans should be written out and recordable.
Implement Support
With self-regulatory difficult for this population, support measures will need to be put into place:
- Source any existing social support such as friends or family who can act as “Accountability Buddies” or even training partners.
- Record keeping can help to ensure compliance, although the record-keeping should be made as easy as possible:
- For example, add the task to an app or diary they are already using (such as their mobile calendar) or provide a print-out where all they need to do is tick a box or add some notes.
- We live in a digital world! An activity monitor such a wrist band can be both motivating and trackable!
Remember to work with the client in problem solving! They are likely to have some ideas about what they prefer or not. Find out what motivates them and how to incorporate such strategies into the plan.
Follow Up
Regular meetings should be conducted to ensure the plan is still achievable and to adjust accordingly and provide positive reinforcement.
3. Exercise
The first step should be working towards achieving the lower recommended activity levels:
- 150 of moderate-intensity aerobic exercise per week (30 minutes, 5 times per week)
- Strength training at least 2 times per week.
- 10,000 steps per day
If they are starting from a sedentary level, develop a progressive plan. It may be unrealistic to expect them to achieve 150 minutes in the first week, instead start with, for example, 10 minutes per day, or 5000 steps per day.
From there duration and intensity can be adjusted. The mobile app Couch 2 5K (C25K) is great app that progressively builds intensity from walking to running.
Their social-anxiety might limit them to the home and this is OK. The exercise physiologist can develop an effective home-program and even progress to outdoor sessions when appropriate.
Both aerobic and strength training is recommended for weight loss, but build the foundations of the habits first! Aerobic exercise also has a greater effect on brain health, with superior stimulation of endorphins which should assist mood and neuroplasticity (which may actually elicit improvements in executive function!) However, the best exercise, is the exercise they will do.
Exercise Provision
Considering social anxiety, trust and rapport between the client and the exercise physiologist will need to be the first priority. Therefore, the first session may not actually involve exercise. It may be appropriate for the EP to attend a full or partial appointment with a current provider already trusted by the client.
Executive functioning deficits and depression may require an exaggerated amount of supervised sessions due to the extra support needed to concrete the habit as well as increase their self-efficacy in the exercise prescription.
Other things to consider!
Exercise is one component in weight management, with diet having a significant influence. They should work with a dietician, particularly if the increase in activity is not having an effect.
Other lifestyle factors can also impair weight loss, such as stress and poor sleep. You can check out our sleep tips here.
It is also important to work with their GP. They may order a blood test to detect any underlying hormonal issues related to weight-loss difficulty.
Consider referrals! Some Occupational Therapists and some counsellors specialise in developing cognitive strategies and skills with the client to enhance their executive function capacity.
Each month we will pick a question to Q&A.
Send your questions to brad@specialisedhealth.com.au or biara@specialisedhealth.com.au
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