This is the Weight and Healthcare newsletter! If you like what you are reading, please consider subscribing and/or sharing! As research has repeatedly shown that movement (aka exercise, cardiorespiratory fitness, physical activity) can have health benefits, there has been a push to treat movement as medicine. There can be a number of issues with this that must be dealt with if this concept is to be applied ethically by healthcare practitioners and other health and fitness professionals.
I would add that problems with lungs and/or heart can also limit your abilities for movement. Recently I found my courage to pursue why I was so breathless when I tried to exercise or exert myself. As a fat person, this is a very difficult journey to pursue because it seems like every health care practitioner would rather just blame limitations in exercise on fatness. My echo showed that I have some diastolic dysfunction which does explain my breathlessness. For this condition, all they can do is manage symptoms of any co-morbidities. Breathlessness they do not have a treatment or therapy for. I am bracing myself because I assume that I will be pushed to exercise, to move more. Is my symptom my cure? I really doubt that. I have not found any randomized trials yet that shows that exercise can improve or cure diastolic dysfunction. To be clear, I'm not opposed to movement (and I do move, just more slowly than others). But I do want evidence-based care not weight stigma, dreams, or wishful thinking.
Excellent explanation of the complexity of recommendations for exercise. Thank you once more for reminding us of the subtle nuances and potential negative impact of exercise for people in all body types.
THANK YOU for this! As some for whom moving can be contraindicated, it drives me nuts when providers tell me that I just have to figure out how to get more movement in my life. I'm sorry, but I've had 18 surgeries on my lower limbs. "Going for a walk" isn't easy or fun or "joyful" for me. All of the nonsense about how sitting is so bad for you--yeah, well, so is being in so much pain I can't move at all, so I'll choose sitting, thank you very much. Since my tendons and ligaments don't hold my joints in place the way they are supposed, doctors seem to think I need to strengthen my muscles so they do the jobs my tendons and ligaments are supposed to do. Um, I don't think that's how it works. Plus the amount of exercise I would need to do to get my muscle to that level of strength would destroy my already terrible joints.
One positive thing I would like to add: I've worked as a standard patient (essentially a fake patient for medical students to practice on) and one of my first cases was about motivational interviewing. The scenario was that I had come to the doctor to talk about getting more movement into my life. My character knew they should be getting more movement in their life but couldn't figure out how. While this is a small sample size and one medical school out of however many, it was reassuring to see the students really dig deep and find out my character's reasons for not wanting to exercise or the struggles with adding more movement to their life--job taking up too much time, it's cold and snowy outside, I feel intimidated at the gym, I don't have money to spend on a gym membership, etc. The last student I saw stopped the interview and said to her proctor--"I agree with her! I wouldn't want to exercise in those situations either!" I told her that sometimes, just the conversations and the doctor listening and being on the same team as the patient is enough to encourage the patient to start making changes (maybe small ones, but changes) on their own. It was nice to have a future medical provider listen to me and really try to understand that I'm not lazy or unmotivated. I *really* hope these skills they demonstrate can be reflected when they become medical practitioners in the real world!
I would add that problems with lungs and/or heart can also limit your abilities for movement. Recently I found my courage to pursue why I was so breathless when I tried to exercise or exert myself. As a fat person, this is a very difficult journey to pursue because it seems like every health care practitioner would rather just blame limitations in exercise on fatness. My echo showed that I have some diastolic dysfunction which does explain my breathlessness. For this condition, all they can do is manage symptoms of any co-morbidities. Breathlessness they do not have a treatment or therapy for. I am bracing myself because I assume that I will be pushed to exercise, to move more. Is my symptom my cure? I really doubt that. I have not found any randomized trials yet that shows that exercise can improve or cure diastolic dysfunction. To be clear, I'm not opposed to movement (and I do move, just more slowly than others). But I do want evidence-based care not weight stigma, dreams, or wishful thinking.
Excellent explanation of the complexity of recommendations for exercise. Thank you once more for reminding us of the subtle nuances and potential negative impact of exercise for people in all body types.
THANK YOU for this! As some for whom moving can be contraindicated, it drives me nuts when providers tell me that I just have to figure out how to get more movement in my life. I'm sorry, but I've had 18 surgeries on my lower limbs. "Going for a walk" isn't easy or fun or "joyful" for me. All of the nonsense about how sitting is so bad for you--yeah, well, so is being in so much pain I can't move at all, so I'll choose sitting, thank you very much. Since my tendons and ligaments don't hold my joints in place the way they are supposed, doctors seem to think I need to strengthen my muscles so they do the jobs my tendons and ligaments are supposed to do. Um, I don't think that's how it works. Plus the amount of exercise I would need to do to get my muscle to that level of strength would destroy my already terrible joints.
One positive thing I would like to add: I've worked as a standard patient (essentially a fake patient for medical students to practice on) and one of my first cases was about motivational interviewing. The scenario was that I had come to the doctor to talk about getting more movement into my life. My character knew they should be getting more movement in their life but couldn't figure out how. While this is a small sample size and one medical school out of however many, it was reassuring to see the students really dig deep and find out my character's reasons for not wanting to exercise or the struggles with adding more movement to their life--job taking up too much time, it's cold and snowy outside, I feel intimidated at the gym, I don't have money to spend on a gym membership, etc. The last student I saw stopped the interview and said to her proctor--"I agree with her! I wouldn't want to exercise in those situations either!" I told her that sometimes, just the conversations and the doctor listening and being on the same team as the patient is enough to encourage the patient to start making changes (maybe small ones, but changes) on their own. It was nice to have a future medical provider listen to me and really try to understand that I'm not lazy or unmotivated. I *really* hope these skills they demonstrate can be reflected when they become medical practitioners in the real world!