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The road to hell is paved with good intentions.

Samuel Johnson, 1775



Mrs L is a 72-year-old woman who lives alone. Three months ago, she fell and broke her hip at home. This led to her having a total hip replacement (because of existing hip arthritis), an inpatient rehabilitation stay, and some time attending outpatient physical therapy. In addition to her history of osteoarthritis, she has stable hypertension, hyperlipidemia, and well controlled type 2 diabetes.

As Mrs L had a previously inactive lifestyle, she is slowly incorporating exercise into her routine. Her physical activity goals are to improve her balance, improve her blood pressure, and maintain her weight. She feels that increasing her physical activity will improve the osteoarthritis-associated pain, and provide more opportunities for social interactions. She commenced walking her granddaughter to school to promote both her own health, and also her granddaughter’s. She started to monitor her activity level by wearing a pedometer; her initial goal was to reach 4000 steps per day. She attended a seniors’ strength and balance class twice a week at the recreation center to reduce her risk of falls. Mrs L has attended group medical visits for older adults with diabetes, which ensures regular follow-up and provides social and clinical support.

Six months later, Mrs L reports increased confidence when moving about and completing activities of daily living, decreased pain, improved range of motion, and better quality sleep. She has been able to reduce her dose of antihypertensive medication.

Patient details have been anonymized and image is not a true likeness

Figure 16.1

Mrs L and her granddaughter both enjoy the independence that Mrs L gained from her physical activity program

Graphic Jump Location

As outlined in Chapter 1, an active lifestyle decreases mortality and the risk of many chronic conditions, including diabetes, heart disease, stroke, and breast and colon cancers. Health professionals are in an important position to provide advice on health promotion behaviors, such as physical activity. In a survey of 7238 people in Sweden, 76% of respondents thought healthcare professionals had a responsibility to promote physical activity in patients.1 Exercise counseling is effective in promoting an active lifestyle,2, 3 and adherence to exercise prescriptions is as good as adherence to other treatments for chronic diseases (65%).4 However, most health professionals feel pressured for time and under-qualified to prescribe physical activity.5, 6 Also, some clinicians are skeptical about giving lifestyle advice because they feel that repeating advice is often futile because patients do not change their behavior.7


This chapter identifies the appropriate “target audience,” and provides a background on how to recommend activity for health promotion. This chapter links to Chapter 60, which provides summaries of exercise prescriptions ...

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