The Power of Routine (or why I didn’t do my physio exercises)

I’ve be been a bit quiet on the blog front of late as I’ve been busy working as a OT assistant over summer. Keen to make the most of the experience, I have thrown myself into the job and consequently spent every evening falling asleep on the sofa. I’m in week three now and have managed to keep my eyes open for a couple of nights on the trot so I thought I would sneak in a blog post before they close again. This adjustment to a new routine made me reflect on its importance.

Oh yes, so important is routine, it even gets a spot on the Model of Human Occupation called ‘habits’. Habits, according to Kielhofner & Forsyth (2011), are learned ways of doing our occupations (occupations are the things that we do) that almost happen on autopilot. For those who aren’t familiar the Model of Human Occupation (MoHO), it’s one of the structures OT’s use to help clients, (see also Kawa river model). That’s all you need to know.

Because these habits happen on our autopilot, the actions flow and it needs minimal concentration. Think about how easy it is getting ready in the morning at your house compared to getting ready somewhere else. It certainly takes me longer, cue me talking to myself : “touche éclat…where’s my TOUCHE ECLAT?”.  For those who aren’t familiar with touche éclat, it’s make up that makes you  look alive in the morning. That’s all you need to know.

Anyway, let me add another layer: I had a minor problem with my back and my physiotherapist gave me some exercises to do. Three exercises, five reps, three times a day. Easy, so I thought. “I’m an OT student, of course I’ll do my exercises” I assured him. The motivation was certainly there; being better for placement, my summer job and skiing. I did try, it’s just that it never became part of my routine, so it petered out. This was a scary thought: if I can’t adhere to my treatment, how can I expect my clients to do the same?

As usual, a bit of research and reflection does the trick. I read a great article by Clemson et al. (2012) where they investigated different home-based strength and balance training programmes( these are exercise programmes used to prevent falls in older adults). The researchers looked at whether combining exercises into everyday routines reduced falls in the community. These ‘stealth’ exercises could be done multiple times a day, whenever the opportunity arises rather than a set pattern of exercises. So rather than an ‘add-on’ it became part of routine. Let’s face it, we’ve all got too much to do without adding an extra thing to the list. These strategies used to improve balance were things like; ‘change direction’, ‘bend your knees’, or ‘step over objects’. The investigators compared this approach with a standard structured programme of exercises for strength and balance, and a placebo control of gentle exercise.  It was found that not only did this method significantly reduce falls in comparison with the control, but even more significance to the blog post,  12 months later, more people were sticking to it than the other approaches.

So it seems that building ‘homework’ into everyday routines increases the chance of adherence. ‘Home after a Stroke’ blog seems to echo this. Rebecca (an OT) found that nine years post stroke she needed something to motivate her to do her physio exercises. She found doing a particular exercise before she did the movement it was designed to improve worked for her; for example, stretching her shoulder just before she put a shirt on or doing leg lifts before she went for a walk.

Right, OK so how did  I apply this to my own life?  Well, since the exercises I was supposed to do were all Pilates exercises. I booked onto a weekly Pilates class at my gym. I also recorded on my hard drive some Pilates programmes from Fitness TV and I do these once a week. In addition, when I’m down the gym (2-3 times a week) after I’ve done my stomach crunches on the mat, I will do all my physiotherapy exercises. OK it’s not as much as I should do, but it’s more that I was (i.e. not at all).  I’m happy to say that this approach has worked for me and I have not had any problems with my back (touch wood) and I certainly now have the motivation to continue.

I would love to hear ways that you have improved adherence and engagement to treatments/interventions (personal or professional) as it is a personal interest of mine. I believe if we don’t get engagement, anything we do after that is wasting our time. Do you agree?

Clemson, L., Fiatarone-Singh, M.A., Bundy, M., Cumming, R.G., Manollaras, K., O’Loughlin, P., & Black, D. (2012). Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial. British Medical Journal, 345.  doi: 10.1136/bmj.e4547

Kielhofner, G., & Forsyth, K. (2011). The model of human occupation: embracing the complexity of occupation by integrating theory into practice and practice into theory. In E.A.S. Duncan (Ed.), Foundations for practice in occupational therapy (5^th ed., pp. 51-80). Edinburgh: Churchill Livingstone.