By: Daniel Trecroci
Like so many others, Kris Berg, EdD, an exercise physiologist at the University of Nebraska at Omaha, has observed the rapid-fire increase in obesity that has recently been labeled an “epidemic.”
With it has come a slew of new type 2 cases that, according to Berg, could easily be avoided.
“For those with type 2 diabetes, the actual cause of diabetes is inactivity and weight gain,” says Berg. “These factors produce insulin resistance. We know today that even in genetically susceptible people, exercise can prevent type 2. So, a major goal for type 2s should be to become active for the rest of their lives.”
Here Today, Gone Tomorrow
More often than not, however, Berg says, we are seeing people resolve to lose weight and eat better every January 1, only to lose motivation within a small matter of time.
“A high percentage of people stop exercising within six months,” says Berg, who blames sitting for hours at a time in front of one’s computer at work followed by relaxing in front of the television for most of the evening.
Berg also laments that type 2 diabetes no longer affects only adults. A high incidence of young children are now being diagnosed with the disease.
“Simply said, our culture is anti-physical activity.”
No Overnight Fix
Berg says in today’s culture, people who are overweight want and expect results as fast as the infomercials which promise them.
“This runs counter to reality,” says Berg. “It takes months of sustained physical activity to lose five or 10 pounds, or to gain some muscle firmness. The results seem insufficient and people lose motivation. People fail to understand that it took months or years to gain the weight and lose some muscle mass.”
Berg says people with type 2 diabetes quit exercising shortly after beginning for the same reasons most other people quit. In addition, someone with diabetes may feel insecure about their exercise producing low blood sugar.
“Others may have complications such as neuropathy, heart disease, kidney impairment or retinopathy [which] limit their exercise selection and confidence in getting started, much less continuing,” says Berg.
Physicians Not Doing Enough
Berg feels physicians do not promote exercise as well as they could. When a physician sees a diabetic patient, the focus of the visit, in Berg’s opinion, is to only evaluate BGs and HbA1c.
“It would be helpful if they would ask each patient what they do physically,” says Berg. “Patients should bring in an exercise log for the physician to examine as they do for their BG readings. Research demonstrates physicians can positively influence exercise behavior. They just need to make it a part of their practice.”
Berg says the American Diabetes Association developed guidelines for physicians to follow during a patient exam, which include checking HBA1c and BG patterns, eyes, feet and nutrition, among other things.
“Exercise is on the list too, but I doubt it’s commonly discussed with patients,” says Berg.
A Model for Behavior Change
Berg says the prevailing theories today regarding motivation and ability to change habits can be found in Prochaska and DiClemente’s “Transtheoretical Model,” a behavior model that classifies how people make changes.
The model construes change as a process involving progress through a series of five stages:
- Precontemplation (the stage where people are thinking about starting an exercise regimen in the distant future).
- Contemplation (the stage where people are thinking about starting an exercise regimen in the not-too-distant future).
- Preparation (the stage where people are closing in on the time when they are planning to start an exercise regime).
- Action (the stage where people have started the exercise regimen).
- Maintenance (the stage where people are working to prevent a relapse).
In addition to exercise, this behavior model has been applied to a host of problem behaviors, including smoking cessation, alcohol abuse, condom use for HIV protection and stress management.
Which Stage is the Most Important?
Because one stage typically progresses to the next, Berg feels all the steps of Prochaska and DiClemente’s behavior model all are important.
“Health professionals are more likely to effectively assist people in making behavioral-health changes by developing strategies that best work with each stage,” he says. “Work is now underway to determine what these strategies might be.”
Some Stages Easier Than Others
Berg says the Precontemplation stage of Prochaska and DiClemente’s model is the easiest for most people to accomplish something positive.
“Here people begin some attempts to become active,” says Berg. “It may not be much but they are getting agitated enough within to really think about doing something. They get real motivated after reading a book or reading about a new weigh-loss scheme. The novelty of it all is appealing.”
The Action stage, however, is where things become really difficult for most people.
“Somewhere in this stage, about half of all exercise initiates stop,” says Berg. “We don’t know exactly why. They may perceive that the ‘bang for the buck’ is less than what they expected, or they see no dramatic overnight changes.”
Berg says another reason most people jump ship during the Action stage is because the exercise regimen is taking time out of their lives.
“They have less time available now to do other, perhaps more pleasurable, things,” he says. “This weighing of the pros and cons must finally get to most people and they stop their exercise program.”
Success Typical After Several Failures
Berg says most people fail a number of times when attempting to change a habit and that success is typical only after several failures.
“I think the number of failures may even be higher in those with diabetes because of some of the unique problems previously mentioned,” he says. “But it is important for people to be informed and realize that success may take a number of tries.”
Berg says it is not easy for anybody to fail at something, especially repeatedly.
“We feel guilty, lose confidence and our ego suffers,” says Berg. “Perhaps people need to back away from the failure for awhile before their confidence and ego are rekindled.”
The Rewards of Regular Physical Activity
Berg says it is “remarkable” that so many good things happen with regular physical activity.
“Obviously, we need, as a society, to examine how we wish to live our lives,” he says. “Today we have more creature comforts than ever before, but I’m not sure the quality of life is any better. Happy people are usually fairly busy too, and exercise is wonderful for adding meaning to your life.”