- Email: [email protected]
Nurse Practitioners: Your Own Physical Activity Journey
Nurse Practitioners: Your Own Physical Activity Journey Megan Amaya, PhD, CHES, AFAA, and Brenda Buffington, EdD, ACSM, EP-C, EIM ABSTRACT
This article was written not to tell you what you already know but rather to give you strategies on what you need to do in order to see improvements from your own physical activity/exercise program. This article is appropriate for all health care professionals regardless of where they are on the continuum of wellness. The contents included within provide context on physical activity/exercise recommendations, address barriers, explain how to make the most out of your efforts, and discuss how physical activity/exercise can impact other areas of your life as well. Keywords: energy management, exercise, health promotion, nurses, nutrition, self-care, strategies, wellness Ó 2016 Elsevier Inc. All rights reserved.
I
have 2 young children who frequent their primary care practitioner’s office, particularly in the winter months. I get to know many of the nurse practitioners (NPs) and nurses who run the clinics. I talk with them about health and wellness when they are taking care of my children. On 1 recent visit, I was talking with 1 of the NPs who works full-time in the office. We talked about what I do for a living as the director of health promotion and wellness. My background is in exercise science and nutrition. The NP and I talked about her struggles with taking care of herself physically. It’s hard to have a complex answer for someone in a 3-minute conversation, so I referred her to a couple of resources she could use. My colleague, coauthor Dr. Brenda Buffington, a wellness program manager, and I are frequently asked questions about physical activity and exercise. These questions oftentimes involve physical activity and exercise that are very specific to the person’s age, sex, and occupational and family-related time commitments. We get these same questions from NPs. Making one’s health a priority is not easy, especially in a world where many people have multiple responsibilities and obligations. Regardless of where you are in your journey, a beginner or experienced exerciser, this expert opinion article was written not to convey to you what you already know but rather
www.npjournal.org
to give you strategies on what you need to do in order to see improvements from your own physical activity/exercise program. We feel it is very important to address you on a more informal basis, so we have moved away from the formal article format and intend to have a conversation with you. THE HEALTH STATUS OF NURSES IN THE UNITED STATES
In a study conducted in 2009, Zapka et al1 found that nurses have high rates of overweight/obesity. Currently, 60% of the adult population in the United States is overweight/obese; the prevalence of overweight/obesity for nurses ranges from 30% to 55% depending on the geographic area, race and ethnicity, and work setting.2-4 Nurses have been found to experience higher levels of stress-related burnout compared with other health care professionals.5 According to Tong et al,6 nurses are 6 times more likely to smoke than physicians and 2 times more likely to smoke than the general population. Additionally, nursing professionals are 2 times more likely to have depression than the general population.7 With the overwhelming amount of evidence on the current health status of the nursing profession, it is evident a majority of nurses find it difficult to balance self-care and taking care of the patient population. The Journal for Nurse Practitioners - JNP
21
Before an airplane takes off, passengers are asked to put on their oxygen mask first in the event of an emergency before assisting others. The reason for this is if you are not getting proper oxygen, you will not be able to help anyone else on the plane. This analogy holds true for health care professionals. You need to better take care of yourself physically, mentally, and emotionally. In doing so, you will take better care of your family, friends, and patients. THE KEY STRATEGIES OF SELF-CARE THROUGH EXERCISE: MAKE IT HAPPEN
Continuously engaging in a behavior such as exercise is not easy. Performing exercise may sound simple, but maintaining a program is not. Adults have many barriers when it comes to adhering to exercise; time is the number one cited barrier.8 When it comes to changing behavior for the better, the best approach is to select 1 behavior and work on it for several months in an effort to “master” it (or perform it to the best of your ability). For example, instead of starting off trying to incorporate 60 minutes of physical activity 5 days per week, one should start with a 10-minute session 3 times per week and build from there. While knowing behavior change is not easy and often adults spend years trying to adhere to a change that is better for their health, the goal is to implement the best strategy (or 2) that allows you to become better at managing the health-related aspect of your life. To accomplish your goals, first make a serious commitment to yourself. Identify the reasons why you want to engage in the healthy behavior. Once you do that, there are several evidence-based strategies you can use to help you better succeed. In the field of health behavior, exercise adherence, or what is more commonly referred to as exercise behavior, a well-known theory that is often applied to the process of change is Bandura’s social cognitive theory.9,10 Concepts from this theory, when implemented, assist with the behavior change process. One of the highly suggested strategies to use is a construct called self-regulation, a key aspect to Bandura’s theory. Self-regulation is commonly referred to as self-monitoring. Self-monitoring can come in various forms. When people monitor their behavior, they keep track of what they are doing. For example, they record their behavior in a log, diary, or 22
The Journal for Nurse Practitioners - JNP
app. People make appointments, for example, in their work calendars, an appointment to keep just like any other appointment. By tracking exercise, this then allows the person to view his or her progress after a certain amount of time, such as a week. Another successful method that is used is goal setting. Goal setting for physical activity/exercise can be extremely useful when designing and evaluating your plan.11 Goal setting for exercise will be described a bit more later, but, generally, when people set a goal, it helps them monitor their behavior because they have a plan for what they want to accomplish. An additional exercise adherence strategy called social support9,10 can be critical in the beginning and helpful in advanced stages of behavior change. A person you trust and who can lend constructive feedback on your progress will help you better stick with your behavior. He or she can help you evaluate your successes and provide suggestions for areas of opportunity. Using these exercise adherence evidence-based strategies helps make your program “happen.” PHYSICAL ACTIVITY WITH PURPOSE AND MEANING
The recommendations for physical activity are 150 minutes of moderate intensity and 75 minutes of vigorous intensity per week.12 This includes cardiovascular and strength training. Individuals need to strength train all of the major muscle groups 2 to 3 times a week (a minimum of 1 set with 8-12 repetitions) and stretch to increase flexibility and decrease the risk of injury.12 As is commonly known, there are many benefits of engaging in the recommended amounts, including physical and mental health benefits as well as some social, environmental, and financial benefits. Experts recommend everyone do something on a daily basis, such as achieving 10,000 steps. However, many individuals in the health care field are occupationally active; therefore, they may not think they need to get the additional recommended cardiovascular and strength training conditioning. Exercise, by definition, is performing physical activity with a purpose, has a structure, and is repetitive, meaning virtually every day. Movement throughout the day is important, but if one begins to think about quality and purpose, they will think Volume 13, Issue 1, January 2017
about exercise differently and that can make all the difference in the outcomes they experience. Making exercise purposeful is a concept that can sometimes be hard for people to pinpoint. Purpose may mean numerous things including weight loss, cardiovascular improvements, strength and tone, improved mental health, better sleep, being able to play with children or grandchildren, or functional movements. Those purposes are very important, but in order for exercise to have a scientific meaning, an individual must be able to create a goal out of the purpose. Exercise is done with a physical purpose, improving some aspect of your fitness level (eg, cardiovascular capacity, muscle strength, muscle endurance, body composition, or flexibility). The defined goal is based on the aspect the person wishes to improve. For example, as a beginner, an individual might set a goal to improve overall strength and set several smaller goals to reach the larger one. If the same individual has been exercising for a long time, he or she could set a goal for improving flexibility and then set smaller goals to reach the larger one. Everyone has the ability to improve their current fitness level. THINKING BIG PICTURE ABOUT YOUR DAY
How many of you have taken a time management class or training? As already stated, time is the number one cited barrier to engaging in exercise.8 Time is spent engaging in many things (eg, family, job, home responsibilities, and social obligations). Something inevitably takes precedence over exercise for a majority of Americans. Only 21% of American adults meet the recommendations for physical activity.13 Over the last decade, the concept of energy management has become more prevalent in the national conversation. Energy, not time, is what drives our engagement and passion in doing the things in our life that matter most. Consider family, career, and close friends among those that usually rank high on our list of aspects of our life that have significant meaning. Taking care of oneself physically, through a structured and purposeful exercise program, should be one of them. Yet, all too often, exercise does not make that priority list. Health care professionals know that most people change behavior when crisis happens or www.npjournal.org
emotions are raised, such as in the death or disease diagnosis of a loved one. Understandably, this happens all of the time because humans are emotional beings; however, this is worrisome because of the increasing rates of obesity and chronic diseases in present lifestyle choices. When people are not making their health a priority, it is not just the individual who suffers. Those around them are impacted as well. Managing personal energy is fueled by exercise and movement. It is foundational to other energy dimensions such as emotional, mental, and spiritual. When someone does not engage in movement or exercise through the course of a day, over time there are negative consequences, many of which have been mentioned previously. Consider when no movement has taken place for an hour or 2 hours. Exercise and movement boost energy in the body and brain, contrary to what many people think, and it begins at the cellular level.14 OVERCOMING BARRIERS TO PHYSICAL ACTIVITY AND EXERCISE
In order to have a successful physical activity/exercise program, barriers, whether real or perceived, need to be addressed. In the field of exercise adherence, selfefficacy is 1 of the major constructs of the social cognitive theory and is defined as the level of confidence that one has in completing a certain activity.9,10 Self-efficacy involves having confidence to overcome barriers. Barriers can be major or minor and can range from something small like being too tired to exercise after work to something major such as having to spend a week out of town because of a death in the family. These types of barriers can derail people from their exercise programs. “Doing one more thing” is just too much for someone to think about, but consider this, if you don’t take care of yourself, how will you take care of others? Yes, you may think “but I have been doing this all along, I’m fine.” However, stop and think about how effective you are at your job. What about at home? Are you fully engaged with the people or activities you want to be engaged with? Are you completely wiped out at the end of the day/shift? What is the trajectory of your health? Recently, an NP in his 40s from a busy hospital system attended a 2-day energy management course. When he really sat down and The Journal for Nurse Practitioners - JNP
23
thought about his barriers to exercise, he had some “ah ha” moments. He wasn’t taking the time to consider the positive alternatives and made a new commitment to himself that engaging in exercise behavior, which now had a purpose, was important to him because of his health, spouse, and children. From a lifetime perspective, individuals may be able to get away with not exercising at age 25, 30, or maybe 35, but over time the effects of physical inactivity are cumulative. No one can afford at any age to not make taking care of him- or herself a priority. It is not easy and will take considerable effort, but think about the consequences. Look at your family history of chronic conditions, both physical and mental. You will not decrease your risk of developing them if you choose not to exercise. Observe your own health. Consider the role model you are supposed to be for your family, friends, and patients. These people look up to you. Attempt to practice what you preach. FUELING YOUR BODY FOR MOVEMENT
A brief discussion on physical activity/exercise and nutrition is warranted because they are related. What you eat can positively or negatively impact energy and exercise levels. From a negative standpoint, when people go more than 4 hours without taking in any fuel (calories), the body may begin the process of going into survival mode, also known as starvation mode.15 What happens after that can have negative consequences. Because human physiology is a pattern of if/then events, it’s like dominoes falling. If there is low or no glucose in the blood, then the muscles and liver will be depleted of their glucose and glycogen stores. The metabolic rate will slow down, sometimes quite substantially. The body will use lean body mass (ie, muscles) and break them down for needed energy. Then, the body will protect and preserve its fat stores. Finally, the body will crave calorie-dense foods to make up for the lack of energy. To combat the practice of not eating enough, the strategy to implement is eat light and eat often.16 Ingest a snack or light meal every 3 to 4 hours. This will sustain your energy levels and provide your body with the calories it needs to function properly until the next meal or snack. This same starvation mode process happens with exercise as well. If the body is not 24
The Journal for Nurse Practitioners - JNP
properly fueled for exercise, it will burn muscle, negatively impacting lean body mass. Ideally, eating something small (ie, 75-150 calories) 2 hours or less before exercise and within 30 to 45 minutes after exercise will combat the burning of muscle glycogen. From a positive perspective, this helps maintain energy levels during the workout, assists with physical recovery after the workout, and provides the essential energy to go on to the next task in the day. It’s time for a self-assessment: does your glucose supply equal your glucose demand? The best recommendation to prevent overeating or undereating is to nourish your body every 2 to 4 hours.16 PUTTING IT ALL TOGETHER
Making a meaningful, purposeful, realistic, and manageable goal is the best approach to behavior change. Research shows that when you try to change too much at one time, it backfires. When you decide which behavior you are going to work on, make a commitment for 30 days. Set a long-term healthrelated goal (ie, improved cardiovascular system) and then set a weekly behavioral goal that you can evaluate as you go (walking 30 minutes 5 days per week). Small, SMART (specific, measureable, attainable, realistic, time-specific) goals will set you up for long-term success. Once you get to the 30-day mark, set a new goal. We wish you the best in your new journey. References 1. Zapka JM, Lemon SC, Magner RP, Hale J. Lifestyle behaviours and weight among hospital-based nurses. J Nurs Manag. 2009;17(7):853-860. 2. Chin DL, Nam S, Lee S-J. Occupational factors associated with obesity and leisure time physical activity among nurses: a cross-sectional study. Int J Nurs Stud. 2016;57:60-69. 3. Han K, Trinkoff AM, Geiger-Brown J. Job stress and work schedules in relation to nurse obesity. J Nurs Adm. 2011;41(11):488-495. 4. Tucker SJ, Harris MR, Pipe TB, Stevens SR. Nurses’ ratings of their health and professional work environments. AAOHN J. 2010;58(6):253-267. 5. Khamisa N, Peltzer K, Oldenburg B. Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review. Int J Environ Res Public Health. 2013;10(6):2214-2240. 6. Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA. National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs. Nicotine Tob Res. 2012;12(7):724-733. 7. Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clin Nurse Spec. 2012;26(3):177-182. 8. Sallis JF, Hovell MF. Determinants of exercise be behaviour. Exerc Sport Sci Rev. 1990;18:307-330. 9. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. 10. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986. 11. Voth EC, Oelke ND, Jung ME. A theory-based exercise app to enhance exercise adherence: a pilot study. JMIR Mhealth Uhealth. 2016;4(2):e62. 12. US Department of Health and Human Services. 2008 physical activity guidelines for Americans summary. 2008. http://health.gov/paguidelines/ guidelines/summary.aspx. Accessed May 12, 2016.
Volume 13, Issue 1, January 2017
13. Centers for Disease Control and Prevention. Facts about physical activity. http://www.cdc.gov/physicalactivity/data/facts.htm. May 2014. Accessed May 12, 2016. 14. Puetz T. Psychological Bulletin news release. Athens, GA: University of Georgia; 2006. 15. La Bounty PM, Campbell BI, Wilson J, et al. International Society of Sports Nutrition position stand: meal frequency. J Int Soc Sports Nutr. 2011;8:4. 16. The Corporate Athlete Course Workbook. Orlando, FL: Human Performance Institute; 2011.
Megan Amaya, PhD, CHES, AFAA, is the director of health promotion and wellness and an assistant professor in practice at the College of Nursing, Ohio State University in Columbus. Brenda
www.npjournal.org
Buffington, EdD, ACSM, EP-C, EIM, is the codirector of Health and Wellness Innovation in Healthcare, an assistant professor in practice, and Buckeye Wellness Program manager at the College of Nursing, Ohio State University. She can be reached at buffi[email protected]. In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest. 1555-4155/16/$ see front matter © 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.10.010
The Journal for Nurse Practitioners - JNP
25
This article was written not to tell you what you already know but rather to give you strategies on what you need to do in order to see improvements from your own physical activity/exercise program. This article is appropriate for all health care professionals regardless of where they are on the continuum of wellness. The contents included within provide context on physical activity/exercise recommendations, address barriers, explain how to make the most out of your efforts, and discuss how physical activity/exercise can impact other areas of your life as well. Keywords: energy management, exercise, health promotion, nurses, nutrition, self-care, strategies, wellness Ó 2016 Elsevier Inc. All rights reserved.
I
have 2 young children who frequent their primary care practitioner’s office, particularly in the winter months. I get to know many of the nurse practitioners (NPs) and nurses who run the clinics. I talk with them about health and wellness when they are taking care of my children. On 1 recent visit, I was talking with 1 of the NPs who works full-time in the office. We talked about what I do for a living as the director of health promotion and wellness. My background is in exercise science and nutrition. The NP and I talked about her struggles with taking care of herself physically. It’s hard to have a complex answer for someone in a 3-minute conversation, so I referred her to a couple of resources she could use. My colleague, coauthor Dr. Brenda Buffington, a wellness program manager, and I are frequently asked questions about physical activity and exercise. These questions oftentimes involve physical activity and exercise that are very specific to the person’s age, sex, and occupational and family-related time commitments. We get these same questions from NPs. Making one’s health a priority is not easy, especially in a world where many people have multiple responsibilities and obligations. Regardless of where you are in your journey, a beginner or experienced exerciser, this expert opinion article was written not to convey to you what you already know but rather
www.npjournal.org
to give you strategies on what you need to do in order to see improvements from your own physical activity/exercise program. We feel it is very important to address you on a more informal basis, so we have moved away from the formal article format and intend to have a conversation with you. THE HEALTH STATUS OF NURSES IN THE UNITED STATES
In a study conducted in 2009, Zapka et al1 found that nurses have high rates of overweight/obesity. Currently, 60% of the adult population in the United States is overweight/obese; the prevalence of overweight/obesity for nurses ranges from 30% to 55% depending on the geographic area, race and ethnicity, and work setting.2-4 Nurses have been found to experience higher levels of stress-related burnout compared with other health care professionals.5 According to Tong et al,6 nurses are 6 times more likely to smoke than physicians and 2 times more likely to smoke than the general population. Additionally, nursing professionals are 2 times more likely to have depression than the general population.7 With the overwhelming amount of evidence on the current health status of the nursing profession, it is evident a majority of nurses find it difficult to balance self-care and taking care of the patient population. The Journal for Nurse Practitioners - JNP
21
Before an airplane takes off, passengers are asked to put on their oxygen mask first in the event of an emergency before assisting others. The reason for this is if you are not getting proper oxygen, you will not be able to help anyone else on the plane. This analogy holds true for health care professionals. You need to better take care of yourself physically, mentally, and emotionally. In doing so, you will take better care of your family, friends, and patients. THE KEY STRATEGIES OF SELF-CARE THROUGH EXERCISE: MAKE IT HAPPEN
Continuously engaging in a behavior such as exercise is not easy. Performing exercise may sound simple, but maintaining a program is not. Adults have many barriers when it comes to adhering to exercise; time is the number one cited barrier.8 When it comes to changing behavior for the better, the best approach is to select 1 behavior and work on it for several months in an effort to “master” it (or perform it to the best of your ability). For example, instead of starting off trying to incorporate 60 minutes of physical activity 5 days per week, one should start with a 10-minute session 3 times per week and build from there. While knowing behavior change is not easy and often adults spend years trying to adhere to a change that is better for their health, the goal is to implement the best strategy (or 2) that allows you to become better at managing the health-related aspect of your life. To accomplish your goals, first make a serious commitment to yourself. Identify the reasons why you want to engage in the healthy behavior. Once you do that, there are several evidence-based strategies you can use to help you better succeed. In the field of health behavior, exercise adherence, or what is more commonly referred to as exercise behavior, a well-known theory that is often applied to the process of change is Bandura’s social cognitive theory.9,10 Concepts from this theory, when implemented, assist with the behavior change process. One of the highly suggested strategies to use is a construct called self-regulation, a key aspect to Bandura’s theory. Self-regulation is commonly referred to as self-monitoring. Self-monitoring can come in various forms. When people monitor their behavior, they keep track of what they are doing. For example, they record their behavior in a log, diary, or 22
The Journal for Nurse Practitioners - JNP
app. People make appointments, for example, in their work calendars, an appointment to keep just like any other appointment. By tracking exercise, this then allows the person to view his or her progress after a certain amount of time, such as a week. Another successful method that is used is goal setting. Goal setting for physical activity/exercise can be extremely useful when designing and evaluating your plan.11 Goal setting for exercise will be described a bit more later, but, generally, when people set a goal, it helps them monitor their behavior because they have a plan for what they want to accomplish. An additional exercise adherence strategy called social support9,10 can be critical in the beginning and helpful in advanced stages of behavior change. A person you trust and who can lend constructive feedback on your progress will help you better stick with your behavior. He or she can help you evaluate your successes and provide suggestions for areas of opportunity. Using these exercise adherence evidence-based strategies helps make your program “happen.” PHYSICAL ACTIVITY WITH PURPOSE AND MEANING
The recommendations for physical activity are 150 minutes of moderate intensity and 75 minutes of vigorous intensity per week.12 This includes cardiovascular and strength training. Individuals need to strength train all of the major muscle groups 2 to 3 times a week (a minimum of 1 set with 8-12 repetitions) and stretch to increase flexibility and decrease the risk of injury.12 As is commonly known, there are many benefits of engaging in the recommended amounts, including physical and mental health benefits as well as some social, environmental, and financial benefits. Experts recommend everyone do something on a daily basis, such as achieving 10,000 steps. However, many individuals in the health care field are occupationally active; therefore, they may not think they need to get the additional recommended cardiovascular and strength training conditioning. Exercise, by definition, is performing physical activity with a purpose, has a structure, and is repetitive, meaning virtually every day. Movement throughout the day is important, but if one begins to think about quality and purpose, they will think Volume 13, Issue 1, January 2017
about exercise differently and that can make all the difference in the outcomes they experience. Making exercise purposeful is a concept that can sometimes be hard for people to pinpoint. Purpose may mean numerous things including weight loss, cardiovascular improvements, strength and tone, improved mental health, better sleep, being able to play with children or grandchildren, or functional movements. Those purposes are very important, but in order for exercise to have a scientific meaning, an individual must be able to create a goal out of the purpose. Exercise is done with a physical purpose, improving some aspect of your fitness level (eg, cardiovascular capacity, muscle strength, muscle endurance, body composition, or flexibility). The defined goal is based on the aspect the person wishes to improve. For example, as a beginner, an individual might set a goal to improve overall strength and set several smaller goals to reach the larger one. If the same individual has been exercising for a long time, he or she could set a goal for improving flexibility and then set smaller goals to reach the larger one. Everyone has the ability to improve their current fitness level. THINKING BIG PICTURE ABOUT YOUR DAY
How many of you have taken a time management class or training? As already stated, time is the number one cited barrier to engaging in exercise.8 Time is spent engaging in many things (eg, family, job, home responsibilities, and social obligations). Something inevitably takes precedence over exercise for a majority of Americans. Only 21% of American adults meet the recommendations for physical activity.13 Over the last decade, the concept of energy management has become more prevalent in the national conversation. Energy, not time, is what drives our engagement and passion in doing the things in our life that matter most. Consider family, career, and close friends among those that usually rank high on our list of aspects of our life that have significant meaning. Taking care of oneself physically, through a structured and purposeful exercise program, should be one of them. Yet, all too often, exercise does not make that priority list. Health care professionals know that most people change behavior when crisis happens or www.npjournal.org
emotions are raised, such as in the death or disease diagnosis of a loved one. Understandably, this happens all of the time because humans are emotional beings; however, this is worrisome because of the increasing rates of obesity and chronic diseases in present lifestyle choices. When people are not making their health a priority, it is not just the individual who suffers. Those around them are impacted as well. Managing personal energy is fueled by exercise and movement. It is foundational to other energy dimensions such as emotional, mental, and spiritual. When someone does not engage in movement or exercise through the course of a day, over time there are negative consequences, many of which have been mentioned previously. Consider when no movement has taken place for an hour or 2 hours. Exercise and movement boost energy in the body and brain, contrary to what many people think, and it begins at the cellular level.14 OVERCOMING BARRIERS TO PHYSICAL ACTIVITY AND EXERCISE
In order to have a successful physical activity/exercise program, barriers, whether real or perceived, need to be addressed. In the field of exercise adherence, selfefficacy is 1 of the major constructs of the social cognitive theory and is defined as the level of confidence that one has in completing a certain activity.9,10 Self-efficacy involves having confidence to overcome barriers. Barriers can be major or minor and can range from something small like being too tired to exercise after work to something major such as having to spend a week out of town because of a death in the family. These types of barriers can derail people from their exercise programs. “Doing one more thing” is just too much for someone to think about, but consider this, if you don’t take care of yourself, how will you take care of others? Yes, you may think “but I have been doing this all along, I’m fine.” However, stop and think about how effective you are at your job. What about at home? Are you fully engaged with the people or activities you want to be engaged with? Are you completely wiped out at the end of the day/shift? What is the trajectory of your health? Recently, an NP in his 40s from a busy hospital system attended a 2-day energy management course. When he really sat down and The Journal for Nurse Practitioners - JNP
23
thought about his barriers to exercise, he had some “ah ha” moments. He wasn’t taking the time to consider the positive alternatives and made a new commitment to himself that engaging in exercise behavior, which now had a purpose, was important to him because of his health, spouse, and children. From a lifetime perspective, individuals may be able to get away with not exercising at age 25, 30, or maybe 35, but over time the effects of physical inactivity are cumulative. No one can afford at any age to not make taking care of him- or herself a priority. It is not easy and will take considerable effort, but think about the consequences. Look at your family history of chronic conditions, both physical and mental. You will not decrease your risk of developing them if you choose not to exercise. Observe your own health. Consider the role model you are supposed to be for your family, friends, and patients. These people look up to you. Attempt to practice what you preach. FUELING YOUR BODY FOR MOVEMENT
A brief discussion on physical activity/exercise and nutrition is warranted because they are related. What you eat can positively or negatively impact energy and exercise levels. From a negative standpoint, when people go more than 4 hours without taking in any fuel (calories), the body may begin the process of going into survival mode, also known as starvation mode.15 What happens after that can have negative consequences. Because human physiology is a pattern of if/then events, it’s like dominoes falling. If there is low or no glucose in the blood, then the muscles and liver will be depleted of their glucose and glycogen stores. The metabolic rate will slow down, sometimes quite substantially. The body will use lean body mass (ie, muscles) and break them down for needed energy. Then, the body will protect and preserve its fat stores. Finally, the body will crave calorie-dense foods to make up for the lack of energy. To combat the practice of not eating enough, the strategy to implement is eat light and eat often.16 Ingest a snack or light meal every 3 to 4 hours. This will sustain your energy levels and provide your body with the calories it needs to function properly until the next meal or snack. This same starvation mode process happens with exercise as well. If the body is not 24
The Journal for Nurse Practitioners - JNP
properly fueled for exercise, it will burn muscle, negatively impacting lean body mass. Ideally, eating something small (ie, 75-150 calories) 2 hours or less before exercise and within 30 to 45 minutes after exercise will combat the burning of muscle glycogen. From a positive perspective, this helps maintain energy levels during the workout, assists with physical recovery after the workout, and provides the essential energy to go on to the next task in the day. It’s time for a self-assessment: does your glucose supply equal your glucose demand? The best recommendation to prevent overeating or undereating is to nourish your body every 2 to 4 hours.16 PUTTING IT ALL TOGETHER
Making a meaningful, purposeful, realistic, and manageable goal is the best approach to behavior change. Research shows that when you try to change too much at one time, it backfires. When you decide which behavior you are going to work on, make a commitment for 30 days. Set a long-term healthrelated goal (ie, improved cardiovascular system) and then set a weekly behavioral goal that you can evaluate as you go (walking 30 minutes 5 days per week). Small, SMART (specific, measureable, attainable, realistic, time-specific) goals will set you up for long-term success. Once you get to the 30-day mark, set a new goal. We wish you the best in your new journey. References 1. Zapka JM, Lemon SC, Magner RP, Hale J. Lifestyle behaviours and weight among hospital-based nurses. J Nurs Manag. 2009;17(7):853-860. 2. Chin DL, Nam S, Lee S-J. Occupational factors associated with obesity and leisure time physical activity among nurses: a cross-sectional study. Int J Nurs Stud. 2016;57:60-69. 3. Han K, Trinkoff AM, Geiger-Brown J. Job stress and work schedules in relation to nurse obesity. J Nurs Adm. 2011;41(11):488-495. 4. Tucker SJ, Harris MR, Pipe TB, Stevens SR. Nurses’ ratings of their health and professional work environments. AAOHN J. 2010;58(6):253-267. 5. Khamisa N, Peltzer K, Oldenburg B. Burnout in relation to specific contributing factors and health outcomes among nurses: a systematic review. Int J Environ Res Public Health. 2013;10(6):2214-2240. 6. Tong EK, Strouse R, Hall J, Kovac M, Schroeder SA. National survey of U.S. health professionals’ smoking prevalence, cessation practices, and beliefs. Nicotine Tob Res. 2012;12(7):724-733. 7. Letvak S, Ruhm CJ, McCoy T. Depression in hospital-employed nurses. Clin Nurse Spec. 2012;26(3):177-182. 8. Sallis JF, Hovell MF. Determinants of exercise be behaviour. Exerc Sport Sci Rev. 1990;18:307-330. 9. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84(2):191-215. 10. Bandura A. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall; 1986. 11. Voth EC, Oelke ND, Jung ME. A theory-based exercise app to enhance exercise adherence: a pilot study. JMIR Mhealth Uhealth. 2016;4(2):e62. 12. US Department of Health and Human Services. 2008 physical activity guidelines for Americans summary. 2008. http://health.gov/paguidelines/ guidelines/summary.aspx. Accessed May 12, 2016.
Volume 13, Issue 1, January 2017
13. Centers for Disease Control and Prevention. Facts about physical activity. http://www.cdc.gov/physicalactivity/data/facts.htm. May 2014. Accessed May 12, 2016. 14. Puetz T. Psychological Bulletin news release. Athens, GA: University of Georgia; 2006. 15. La Bounty PM, Campbell BI, Wilson J, et al. International Society of Sports Nutrition position stand: meal frequency. J Int Soc Sports Nutr. 2011;8:4. 16. The Corporate Athlete Course Workbook. Orlando, FL: Human Performance Institute; 2011.
Megan Amaya, PhD, CHES, AFAA, is the director of health promotion and wellness and an assistant professor in practice at the College of Nursing, Ohio State University in Columbus. Brenda
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Buffington, EdD, ACSM, EP-C, EIM, is the codirector of Health and Wellness Innovation in Healthcare, an assistant professor in practice, and Buckeye Wellness Program manager at the College of Nursing, Ohio State University. She can be reached at buffi[email protected]. In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest. 1555-4155/16/$ see front matter © 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.nurpra.2016.10.010
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