Interviews
Interview with Dr. Julie Forsey (GP)
Notes on audio recording: (paraphrased)
Q: What are the main afflictions you would recommend exercise for?
A: Most often, depression. I tailor my advice to the patient and what interests them. Things like encouraging them to skateboard or start dancing again because they used to enjoy that. Especially for people with low self-confidence or young people who've had a history of bullying. Also with people who are busy I'll advise them to do little things like just walk a little bit each, for example, try to get off the bus one stop early so they can have ten minutes of fresh air. What makes this exercise particularly beneficial is if they introduce mindfulness as well. So clearing their minds while they walk and letting go of busy thoughts. This helps reduce anxiety and helps them relax.
Q: I understand you have a limited amount of time with each patient. Do you find it takes a bit of convincing to get people of exercise, also do you find people struggle with the concept of mindfulness?
A: So, with people who have anxiety and depression I'll advise the exercise myself. But for people with physical health problems eg. middle-aged people with high blood pressure, or with pre-diabetes, then I would recommend seeing the practise nurse for more detailed advice on diet and exercise. Then if I felt they needed even more encouragement I'd make a referral like for a Green Perscription
Q: Is there any other particular profile that you'd advise exercise for?
A: Metabolic syndrome is where people have a pattern in their bodies and in their health which is making them overall unhealthy and at risk. People tend to have a few health problems at once as they tend to affect each other [the health issues]. So someone might drink a lot and have high blood pressure, or be overweight and have high blood pressure. And so by stopping drinking alcohol, the blood pressure would improve. One way to measure people's health is by putting a tape measure around their middle. This actually gives us a lot of information about their health risk.
Q: Can someone be fat and still be healthy?
A: It's a complicated field, there's no simple answer. But from a medical standpoint, if people have put on a lot of fat around their middle, their often putting fat in their liver as well which is a condition called 'fatty liver' and this shows up on blood tests and scans. When the fat is stored in the liver it affects how the liver works so it doesn't do its job properly. This then affects the blood cholesterol levels and the risk of diabetes. So if people are quite large around the middle, I'll encourage them to lose weight for their overall health. The good news here is that if you are going to put in the effort and lose a bit of weight then the first 5/10 kgs mostly come off from around the middle, so you get the major health benefits very quickly with weight loss, and then further benefits the more people lose weight.
So coming back from a health point of view, it's not just people's body shape or BMI that we're concerned with, it's their overall health and their future risk of illnesses that we're focussed on in medicine.
Q: So you think the issue is not about whether or not people exercise, but is rather around their attitude towards their own health and wellbeing?
A: Well, I'm a personal advocate of exercise, because it's free and the benefits are huge. Everything from strengthening the bones, reducing the risk of heart disease, stroke, diabetes, lowering high blood pressure, strengthening muscles, reducing the risk of falls, increasing balance, improving mood, the benefits go on and on and on, it benefits every part of the body.
Q: I read something recently that struck a chord with me. Rather than coming from a sedentary lifestyle and thinking 'oh, I'll exercise now and then as a little health boost', we should be thinking the default is an active lifestyle, and sitting still for so long is actually really bad for you and is against our body's natural mechanisms and our need to move.
A: Absolutely! That really reframes it into 'stopping harmful behaviours', and you could look at sitting as being a harmful behaviour.
Q: So some of the biggest excuses I've heard so far are lack of time, lack of money, or that they were intimidated by starting something new. Do you have any advice that you could give to combat these excuses?
A: If people are really not doing any exercise at all then I do encourage them to do something, anything. And it's good not to exercise every day at first because even from a very small amount of exercise, like a couple of hundred meters of walking, then their muscles can still be very tired the next day. So while someone's building up their stamina, I encourage just small changes if they're starting from a low level of fitness. When I work the appointments are quite short so people often say to their doctor 'yes, yes, I will exercise.' But whether or not they implement the doctor's advice once they leave the office is another question.
Q: Is there any way you are able to follow up or ensure they take your advice?
A: There are many choices for people, paying for a personal trainer, getting a green prescription, talking more to our nurse. I often encourage people to do simple exercises from home or look up youtube videos for home workouts.
Q: I guess it's really hard for people to keep up the motivation when they don't have someone else keeping an eye on them
A: Yeah, I might not see them again for three months and I'll follow up then. But I think it's really hard for people to change habits.
So thats that! In doing this I had a renewed sense of purpose about my job. I think the relationships you build with your clients is really important. You become friends, with a little bit of a professional boundary. And that has a double sided reward which helps the whole process roll along successfully.
Notes on audio recording: (paraphrased)
Q: What are the main afflictions you would recommend exercise for?
A: Most often, depression. I tailor my advice to the patient and what interests them. Things like encouraging them to skateboard or start dancing again because they used to enjoy that. Especially for people with low self-confidence or young people who've had a history of bullying. Also with people who are busy I'll advise them to do little things like just walk a little bit each, for example, try to get off the bus one stop early so they can have ten minutes of fresh air. What makes this exercise particularly beneficial is if they introduce mindfulness as well. So clearing their minds while they walk and letting go of busy thoughts. This helps reduce anxiety and helps them relax.
Q: I understand you have a limited amount of time with each patient. Do you find it takes a bit of convincing to get people of exercise, also do you find people struggle with the concept of mindfulness?
A: So, with people who have anxiety and depression I'll advise the exercise myself. But for people with physical health problems eg. middle-aged people with high blood pressure, or with pre-diabetes, then I would recommend seeing the practise nurse for more detailed advice on diet and exercise. Then if I felt they needed even more encouragement I'd make a referral like for a Green Perscription
Q: Is there any other particular profile that you'd advise exercise for?
A: Metabolic syndrome is where people have a pattern in their bodies and in their health which is making them overall unhealthy and at risk. People tend to have a few health problems at once as they tend to affect each other [the health issues]. So someone might drink a lot and have high blood pressure, or be overweight and have high blood pressure. And so by stopping drinking alcohol, the blood pressure would improve. One way to measure people's health is by putting a tape measure around their middle. This actually gives us a lot of information about their health risk.
Q: Can someone be fat and still be healthy?
A: It's a complicated field, there's no simple answer. But from a medical standpoint, if people have put on a lot of fat around their middle, their often putting fat in their liver as well which is a condition called 'fatty liver' and this shows up on blood tests and scans. When the fat is stored in the liver it affects how the liver works so it doesn't do its job properly. This then affects the blood cholesterol levels and the risk of diabetes. So if people are quite large around the middle, I'll encourage them to lose weight for their overall health. The good news here is that if you are going to put in the effort and lose a bit of weight then the first 5/10 kgs mostly come off from around the middle, so you get the major health benefits very quickly with weight loss, and then further benefits the more people lose weight.
So coming back from a health point of view, it's not just people's body shape or BMI that we're concerned with, it's their overall health and their future risk of illnesses that we're focussed on in medicine.
Q: So you think the issue is not about whether or not people exercise, but is rather around their attitude towards their own health and wellbeing?
A: Well, I'm a personal advocate of exercise, because it's free and the benefits are huge. Everything from strengthening the bones, reducing the risk of heart disease, stroke, diabetes, lowering high blood pressure, strengthening muscles, reducing the risk of falls, increasing balance, improving mood, the benefits go on and on and on, it benefits every part of the body.
Q: I read something recently that struck a chord with me. Rather than coming from a sedentary lifestyle and thinking 'oh, I'll exercise now and then as a little health boost', we should be thinking the default is an active lifestyle, and sitting still for so long is actually really bad for you and is against our body's natural mechanisms and our need to move.
A: Absolutely! That really reframes it into 'stopping harmful behaviours', and you could look at sitting as being a harmful behaviour.
Q: So some of the biggest excuses I've heard so far are lack of time, lack of money, or that they were intimidated by starting something new. Do you have any advice that you could give to combat these excuses?
A: If people are really not doing any exercise at all then I do encourage them to do something, anything. And it's good not to exercise every day at first because even from a very small amount of exercise, like a couple of hundred meters of walking, then their muscles can still be very tired the next day. So while someone's building up their stamina, I encourage just small changes if they're starting from a low level of fitness. When I work the appointments are quite short so people often say to their doctor 'yes, yes, I will exercise.' But whether or not they implement the doctor's advice once they leave the office is another question.
Q: Is there any way you are able to follow up or ensure they take your advice?
A: There are many choices for people, paying for a personal trainer, getting a green prescription, talking more to our nurse. I often encourage people to do simple exercises from home or look up youtube videos for home workouts.
Q: I guess it's really hard for people to keep up the motivation when they don't have someone else keeping an eye on them
A: Yeah, I might not see them again for three months and I'll follow up then. But I think it's really hard for people to change habits.
Interview with Anna Hobman, a personal trainer at BPM fitness gym
- Q: What is the main motive for your clients to see you or attend the gym? (body image, fitness, training for another sport, health reasons etc.)
- A: Mental health equally with pain reduction. Because I specialise in chronic pain and disease my clients tend to be those who know that exercise reduces their pain (back, general stiffness, old training injuries) or those prone to training injury who want someone to help them to get fitter and stronger without injury. Some purely come for mental health, but I think its safe to say that those who started off as health (diabetes/heart conditions/ pain) have discovered the mental health benefits and that has become an equally strong motivator.
- Q: What is the main thing holding your clients back? (what do you think is the reason under their excuse, for example does ‘I don’t have time’ actually mean ‘I’m lazy’?)
- A: One of the reasons my clients see me is to remove those barriers. I think that's the same with a lot of PTs. People pay a PT so they will turn up. In regards to any extra session outside of seeing me, or people talking about why they want a PT, motivation and then time are the biggest barriers. And people are honest. They don't make up reasons, they generally don't feel too shy saying "I'm not motivated." Some do but I always tell them that's why most people see PTs, if everyone was motivated id be out of work! I suppose a lot of my clients are a bit older so now them selves a bit better and are ok with being honest.
- Q: What is the attendance like of your clients? For example will they attend regularly for a long period or will they feel motivated for a couple of weeks and then stop coming?
- A: My regulars come consistently and work very hard to make sure they can, even around busy work schedules, illness, holidays, some even get take away programme's for if they are traveling. Interestingly, they tend to be the more in Western terms 'successful' types (e.g high earning, good careers, full social lives etc). Generally motivated people anyway. People that come to the gym and get programme's but don't have a PT more likely drop off, especially when Uni gets busy (when they need it most!!) There are some in between people, those who I sort of do deals with, those who need it badly but cant afford a PT, so I see them for free one week and for super low cost the following. They have a higher consistency rate than those with no PT but lower than those with a fulltime paid PT. I wouldn't necessarily say they don't value it as much if they don't pay but I think there's something there around a combination of desperation to change their situation and payment giving something value. Like there's probably a point where the internal need is so great and the payment is just affordable that the motivation to come is as great, or almost as great as in the first group who pay and come regularly. - hope that made sense!
- Q: What kind of techniques or motivation do you use to encourage your clients to keep coming back?
- A: Cakes?! Hahahaha Hmmm, Like I say, my clients are self motivated, so its more of a case of coming back to ME, but also in the first instance, until you establish a relationship, you (I) do have to win them. So I suppose that time is about listening and hearing what the client wants. If you're not listening they are not going to come back! Then about giving them what they want (and balancing it with what they need but may not want!) e.g. He may simply want to get big and strong, but i see he has weak shoulders which are going to cause injury so I need to design a programme that addresses his shoulder weakness but leaves him feeling pumped and awesome like hes had a mean workout. Results will keep someone coming back, and depending on their goal I have varying amounts of influence there, Because I cant control their food intake or how often they exercise outside of my time, their sleep or stress I have to work hard in the time I have with them to motivate them to make healthy decisions outside of that. We can set homework and do food diaries etc and if they believe I can help them, or they respect the time and effort I put in, that will be successful, they will see results and they will stick with me. Also I make it fun, I build relationships with my clients, bond over things we have in common and usually we look forward to seeing each other so that encourages them to come back.
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