Wrong Way

Physical activity needs to come first.

That's just one of a few of my thoughts on health care as we enter this new year under our still-newly implemented health care reform system. I think we're headed in the wrong direction, even though we do desperately need to reform the way we do health care in this country. As a nurse and health coach I see firsthand what's wrong with our approaches, in people's everyday lives.

I just spent some time writing a chapter in a book on nurse empowerment, and the topic of my chapter had much to say about nursing leadership in the current climate of health care. Then I read a couple of articles this morning, both of which echo what I have been saying and observing for so long, that we are going about things the wrong way by trying to do "health care reform" by approaching health care the same old ways, by the top-down, paternalistic, medically-reliant model.

The opinion piece I read this morning asks who really is pushing health care reform along in this country, but the author asks it from a physician's viewpoint, steeped in the medical model. I have a different take on it from a nurse's perspective. Here is my reply so you don't have to wade through the comments:

"Coming from a nursing perspective I see many of the same problems in the health care system. RNs are currently being used as waitstaff and should instead be utilized to the fullest extent of their skills and training. If the entire health care system would rely on a less hierarchical system and use a care-based model, holistic in nature much like nurses are trained, with medicine as a part of the approach but not the guiding approach, we could make great strides in health outcomes. The medical model has a blind spot and physicians do not usually see or understand the value that nurses bring to health and care. We could make your lives so much easier if we would all work together to provide education, coaching, and reinforcement for patients, especially in regards to education in the community and from a very young age in the public schools (huge political and legislative hurdles notwithstanding). The current corporate model of profit should not be directing health care as it is unsustainable, and the current top-down model of medicine guiding health care is also unsustainable if we ever hope to put a dent in the growing costs of early onset chronic disease, or health care waste and costs throughout the lifespan."

And then I was doing some further reading, and stumbled across this blogpost, which really spoke to me, not just because exercise and oncology are my primary areas of professional interest, but also, because of the problems with our health care system, namely the way in which health care reform has been implemented to benefit the profit margin of certain segments of the industry which do not directly serve public health or care.

If you haven't been around the running scene for several decades, you might not remember former U.S. marathon champion Ken Martin, but he ran a 2:09 back in the day. Now he is an exercise-oncology research advocate and post-stem cell transplant cancer survivor. He writes an excellent blog on physical activity and cancer. Here is a quote from the blogpost.

"If patients are willing to have their bodies ravaged by surgery, radiation, and chemotherapy, all of which can decrease physical function, then it shouldn’t be too much to do 30 minutes of walking a day, however one wants to carve that time up, as a part of cancer treatment plans or at least as a part of survivorship care planning. With better planning prior to first treatment maybe exercise can improve cancer treatments and reduce treatment side effects, including cancer related fatigue, which appears to be more debilitating than we thought." -Ken Martin

If you don't know how to plan an exercise program, and you make it either too challenging or not challenging enough, you will not get the benefits, because you either will give up, or you won't be working hard enough to be effective. Current guidelines on exercise state that you should do at least the effort level of a brisk walk for 150 minutes a week, or 30 minutes a day 5 days a week, it doesn't really matter how you split that up as long as you do it.

There is ample evidence of the health benefits of this type of exercise, however, in order to improve fitness beyond basic health maintenance, it is necessary to do more than this, in terms of how hard, how often, and how long. When a client comes to me frustrated because they have been able to do 150 minutes a week but feel they haven't accomplished the fit, hard body like they hoped, I explain it takes much more than that to achieve the fit, hard body.

Evidence suggests that certain types of cancer, such as colon cancer, are better addressed by at least 6 hours of this level of exercise weekly. That may be because the health of the GI tract depends on adequate motility, and exercise helps to "keep things moving", but there are lots of other reasons this could be the case, I won't even attempt to make assumptions.

The point is, if you want to exercise but know very little about how to plan an exercise program, and especially if you've had some sort of chronic disease or cancer diagnosis, it's important to work with a coach who can help you determine what you need, what is appropriate for you and a realistic starting point for you. It takes time, patience, and persistence to achieve the benefits, but you will.

When you think about how much health care costs and how much pain and suffering you go through as a result of chronic disease, why wouldn't you want to make the investment in yourself before these things occur? Either you will prevent the illness from occurring altogether, or if you happen to be unfortunate enough to be diagnosed with cancer or another illness, by being physically fit you will likely reduce the overall amount and length of medical interventions such as medications, chemo, surgeries, tests, labs, and imaging that will you need, which reduces the cost, too.

Nursing takes a holistic approach to health, and that's where I'm coming from as a health coach with a nursing background. I look at all of the things that affect our overall well-being. Physical activity is one of them, and I believe a huge part. It's not everything, but it is an essential piece of the puzzle, linked to all of the other pieces holding us together. It takes time and a little money to incorporate health behavior changes and reap the fitness benefits, but it takes a lot less time and only a tiny fraction of the cost, for example, of complications of diabetes, or cancer treatment and associated recovery.

The other point is, we are going about things the wrong way. The corporate profit and power approach is killing us. There is nothing wrong with making a profit, or with being in business, but it cannot come at the expense of public health and our fellow human beings. That is simply unsustainable.