Motivational Interviewing - Physical Inactivity

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Motivational Interviewing - Physical Inactivity

Transcript - Motivational Interviewing – Physical Inactivity

(Music playing in the background over opening text on screen.)

Text on screen:
Prevention in Hand
Motivating Patients to Adopt a Healthier Lifestyle

(DR. VALLIS stands alone in a hallway. We can see several doors of examining rooms in the background. He addresses the camera directly. Background music fades, then stops.)

Text on screen:
Dr. Michael Vallis
Queen Elizabeth II Health Sciences Centre
Dalhousie University

DR. VALLIS: Changing behaviour isn’t easy. There are many barriers to overcome, and sometimes patients struggle to meet their goals. When that happens, they often come to their next appointment feeling disappointed in themselves. Consider the following scenario. Several months ago, the physician used the 5As - ask, assess, advise, assist and arrange - to support the patient in adding exercise to her lifestyle, setting a goal of walking at least four times a week. At her last visit six weeks ago, the patient reported great success: she had been walking regularly, was feeling fitter, had more energy, and had lost some weight. However, over the past few weeks, family stress has increased and she has walked less often. As a result, she feels guilty about her level of progress. The scenario you’re about to see illustrates how physicians can rely on the 5As as well as the 5Rs - relevance, reward, risks, roadblocks and repeat - to reinforce the importance of leading an active lifestyle and to help patients come up with realistic ways to overcome their personal barriers to change.

(Background music)

Text on screen:
Addressing the Risk Factors for Chronic Disease:
Physical Inactivity

(Background music fades, then stops. A male doctor and female patient are sitting across each other, interacting in an examining room.)

DOCTOR: Nice to see you again. How have you been?

PATIENT: Actually, I’m feeling a little bad about coming in today because of my weight gain. 

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DOCTOR: Do you know how that happened?

PATIENT: I was doing so well with my walking, but it’s been a stressful couple of weeks so I stopped walking.

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DOCTOR: Making exercise fit our lifestyles is a challenge for many. Let me see if I can help you. Can you tell me why we thought walking was a good idea for you? What’s the relevance of exercise for you and your health?

PATIENT: You helped me see that exercise is key. When I walk, I feel good, and it’s a great way to manage stress.

Text on screen:
Assess / Risks

DOCTOR: And what are the risks to your health if you don’t have exercise as part of your lifestyle?

PATIENT: It’s a bit of a slippery slope. I’ll stop walking and stop paying attention to my diet, and turn to food to manage my stress.

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Advise / Rewards

DOCTOR: That’s very helpful, thanks. When you are able to push yourself to walk, what are the rewards that it brings?

PATIENT: That’s easy to answer: I feel better, I have more energy and lose weight. Now that I think about it, there are more benefits than the drawbacks. Why can’t I remember that?

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Assist / Roadblocks

DOCTOR: That’s a good question. Actually, I think we’re on the same wavelength. Let me ask you, what are the roadblocks to exercise - the things that get in the way of you achieving all those benefits that you mentioned?

PATIENT: My biggest roadblock is stress. When the kids need me, I put everything on hold. Now that they’re older, there’s a lot going on in their lives.

DOCTOR: Are there any ways that you might be able to overcome this roadblock?

PATIENT: Well, to be honest, I think it’s more my issue. The kids are old enough to look after themselves. I think I still react as if they were little. So maybe I can fit their needs around my walks. Or even walk when I am helping them out, like when I drive my daughter to basketball. I wait at the gym when I could go for a walk.

Text on screen:
Arrange / Repeat

DOCTOR: That’s really a great idea and I appreciate how you’ve thought this challenging issue through. When you run into a roadblock, it can be a challenge to overcome. So, given our conversation, let me repeat myself and ask you: what is the relevance of exercise for you and your health?

(Background music up. Fade to black.)

Text on screen:

Production of this video was made possible through a financial contribution from the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.

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