Value of Progression and Consistency in Patient Exercises

Dr. Julie Brauer // #GeriOnICE // www.ptonice.com

In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult lead faculty Julie Brauer translates lessons learned from training for a 50k trail run into strategies to use when working with older adult clients to help them become the person they want to be as they journey through life.

Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.

If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app slash switch. And if you decide to make the switch, don't forget to use the code IcePT1MO at signup to receive a one month free grace period on your new Jane. JULIE BRAUER Morning crew. Welcome to the PT on Ice daily show. My name is Julie Brower. I am a member of the older adult division, and I am going to be talking to you all this morning about my favorite thing in the world, running. So this morning I am going to share with you some lessons that I've learned from training and running a 50k that I just ran this past weekend and I'm going to translate some of the lessons I learned and give you all some advice on how you can use those lessons with your older adult patients. So This past weekend, I ran a 50K, that's 31 miles, in New River Gorge, West Virginia. It was absolutely beautiful, absolutely brutal, and I was out there for seven hours and 14 minutes. That gives you a lot of time to reflect and learn some life lessons. So I'm gonna share some things with you all, and hopefully you can translate these to be using with your patients this week.

LESSON 1: THE TRUE FINISH LINE IS AT THE END OF YOUR LIFE Okay, so first lesson. The true finish line is at the end of our lives. The true finish line is at the end of our lives. This is a quote by Sally McRae. If you all have not heard of her, she is my absolute idol. She is a professional ultra mountain runner. She is known for her mental fortitude and crazy accomplishments throughout her career. She just did the Grand Slam of 200 mile races, which are four 200 mile races in the span of five to six months, which is absolutely insane. So she has a, her own podcast called the Choose Strong Podcast. And I started listening to her as I was starting to train. Um, when I first started trail running like a year plus ago, a little bit over a year ago, And I remember I'm running on the trail, I'm listening to her podcast, and she said that, quote, the true finish line is at the end of our lives. All of these start lines and finish lines and belt buckles and medals that we acquire, they're just adventures along the way. They're lessons learned along the way, the triumphs and the failures. What matters is the end of our lives. And it's a story that we get to tell. So I, as I was listening to this, I was thinking back to when I was younger and I ran track when I was younger. And when I was running in a race, it was first place or last place. My entire world hinged on me winning that race. If I didn't come in first place, I was gonna have a bad several days, my family was gonna have a bad several days because I was miserable. And so as I'm listening to Sally talk about this, and I'm training, I'm realizing that life is not a singular race or a singular goal to conquer, and then we're done. It's a journey. And it's not about winning, it's about becoming someone who endures. So that's my thought about this is a journey in our lives, that the end of our lives is the actual finish line. It's about, for me, becoming someone who endures. Developing the mindset and the habits and the lifestyle of someone who can go out and run 31 miles in the mountains. Okay? So when you're thinking about this with your patients, especially when we work with older adults, it's never just about their one episode of care with you. From day one, when you're sitting down and you're talking to your patient or your client, you want to be speaking to them as if this is a journey that you're going to go on together. This isn't, we're just creating goals for you to accomplish at the end of our eight week plan of care. This is about connecting with their life journey. Who do they want to become? How are you going to help them develop the habits and the lifestyles to become the person that they want to be so that the next several decades of their life are happy, purposeful years? Start that conversation early. Start talking about what's next. Again, it's not we are ending this relationship in eight weeks. What's going to be beyond that? Do you have a side gig that you do private wellness in folks' homes and you're going to then provide personal training for them? Are you going to refer them to a gym and you start that process early so you find the right fit for them so they can continue on with fitness? Start talking to your older adult clients as if this is a long-term relationship and this is a lifelong journey. Start talking to them about who is the person that they want to become and how you are going to help them get them there. Okay, that's number one.

LESSON TWO: PAIN IS MORE EASILY ENDURED WITH FRIENDS Number two, pain is more easily endured with friends. Pain is more easily endured with friends. Team, I have never experienced pain like I have when I was out there on the trail this past weekend. There was about 5,000 feet total of elevation gain and loss. You're climbing up rock scrambles, like vertical rock scrambles, treading through water, slipping on mud, rocks and roots the whole entire time. The terrain was absolutely brutal. I've never felt this type of pain before. I mean, my ankles and my knees and my feet were just absolutely destroyed and screaming at me for a long time. I went out on that second 15.5 mile loop and I knew, I was like, this is gonna hurt the entire time. It was not my cardiovascular system holding me back. It was the pain in my joints. Every single step was grueling. And I started to think, as I'm in this much pain, I'm starting to think about our older adult clients who have aches and pains and arthritis, and I'm like, man, this may be a little bit of something that they feel on a daily basis, right? I know that this pain for me is temporary. When I finish this 31 miles, it's gonna be over, for the most part, until the DOMS sets in, which has definitely happened. But older adults, pain may be a part of their lives. Now, we know that we can get people strong and we can influence their environment and help with their diet and their stress management and their sleep. Like, we can do a lot of things that can help with pain that they feel, right? However, I don't think it's fair to come at someone with rainbows and butterflies and tell them, like, you're never gonna experience any pain. I don't think that's fair. Pain may be a very real experience for older adults, even amongst them doing all the right things and getting really strong. And we have to realize that. So this is what I want you to think about. Pain is better endured with friends. And I will tell you when I was out running and I was on that second 15.5 mile loop, just miserable and miserable amounts of pain. The one time that I wasn't feeling it as severe were the times when I was running alongside someone. When I was having a conversation with someone else on that trail who was experiencing the same thing as I was. When I was meeting people and hearing their journey of their training and why they signed up for this race, and who's waiting for them at the finish line, and what they were experiencing in that moment, and you're distracting each other, and you're learning about each other, you're making friends with strangers. I did not feel that pain as severe as when I was spending time with someone else on that trail. And I will tell you one moment in particular, I was running with this one guy pretty consistently at the last like five, six miles of the race. And I was telling him like, I ran a 20 miler and then I jumped to this 50K. So skip the marathon. And at one point, we're continuing on and he turned around and he says to me, hey, you just ran a marathon. And I was just so taken that this individual, who's trying to concentrate on his own footing and his own race, turned around to give me the benefit of, hey, you just ran a marathon. You just PR'd. And that right there, I didn't feel any pain. I was so grateful for this human. I didn't feel a darn thing. So when you are starting to work with your older adult clients, I want you as quickly as you can, starting day one, try and get them to be a part of a community. I said it before, how are we going to plant that seed early to get them to discharge to fitness, right? To go on to their second part of their journey, start getting them a part of a community as quickly as possible. The pain that many older adults experience throughout the day is because they're bored. They're bored. They're not doing anything. They're not spending time with anyone. Try and find them friends as quickly as possible, whether that is a fitness facility, a walking group, a church group. Find them community ASAP. Get them to be socially interacting with others more than just you for that one time in the week. Because their pain they're experiencing, I promise, is going to be able to be endured easier when they are spending time with others.

LESSON 3: FORWARD IS FORWARD Okay, next one. Forward is forward. Alright? Forward is forward. I had to keep telling myself that. especially before I was heading out on that 15.5 mile loop, that second one, because there's no way I was like, I am in so much pain. There is no way I can be in this much pain for 15.5 miles, especially knowing how much climbing I was having to do for the last five and a half miles. I couldn't believe that it was possible. All right. But when I kept on going back to focusing on becoming someone who can endure, Focusing on that goal. It's not about winning this race. It's about becoming. I am focusing on becoming someone who can endure. I am having people along the trail who can distract me along the way. Even amongst insane amounts of pain, you can move forward. And I had not experienced that until this past weekend. It's incredible what the body can endure if you just focus on continuing to move forward. regardless of what that looks like. There is so much grace in forward. For me, it was, okay, running quick, like my first 15.5 miles, I was zooming, I was flying, it felt awesome. The second loop ate me alive. Running quickly became jogging, okay? Jogging slowly, my jogging slowly became hiking. all right my hiking became i am leaning up against a tree hunched over absolutely miserable and making deals with myself like julie count down from 10 and then keep moving and i out loud was counting down from 10 and then i would say go and then i would just continue moving forward it is insane how you can chip away at miles and chip away at time and chip away at pain if you just focus on forward but you give yourself grace as to what forward means so applying this to your patients especially when you are putting them through an emom or an amrap have options for them, especially those who are high achievers and they want to be able to do the level one, the highest level of the exercise you're giving them. So have options for them. So I have a fellow right now, he was just diagnosed with pulmonary fibrosis, idiopathic pulmonary fibrosis, incredibly sad diagnosis, but cardiovascularly he's very deconditioned, but also he just feels like there's an elephant on his chest that he can't get air in. And so he gets very tired very quickly when we start exercising. But I know that it's so important to build his capacity any way we can. So I will say, OK, I want you for two minutes. burpees, okay? That's the goal. When you can no longer do burpees, then I am going to have you do some jumping jacks. Take away that transitioning from up to down. When those jumping jacks become too hard, I want you to march in place. When marching in place becomes too challenging, I just want you to walk. I want you to walk down to the driveway and back up. The only thing I care about is that you continue to move forward. Give your patients options and make sure that you let them know that whatever type of forward it is or moving that it is, it has value. Continuing to move forward through discomfort, through pain, giving a lot of grace there, that's going to build a lot of confidence and mental fortitude with your patients.

LESSON 4: SOMETHING>NOTHING AND DONE>PERFECT Okay, last one, last one. I could do this forever, but last one. We're getting close to where we're getting too long. Okay, so last one. Something over nothing and done over perfect. Something over nothing and done over perfect. So this is another quote by Sally McRae. Something that I have just had etched in my mind ever since I heard it on her podcast. Team, the consistency of chipping away at a goal every single day. and saying yes to yourself versus no is so much more important than hitting your A goal every single time that you go out to train or you go out to compete. I wrote myself a note. It's right here. I put it on my fridge so I could see it every single day. I'm going to read it to you. Hey Julie, remember last time you felt like shit before going on a run? Consider not going, but walked out the door and went for it anyway. Data shows that when that happens, you regret saying yes to yourself 0% of the time. Say yes, start moving. xoxo that's exactly what this says and i looked at it every single day every single day because no matter how bad you feel and how much you want to say no when you say yes and you do something something it doesn't have to be My goal was to do six miles, and if I don't do six miles, I'm throwing the day away. No, that could be I do two miles. That could be I stay and I do 20 minutes of strength in the garage. When you say yes, and you continue to build that consistency, you build resiliency. You are building reserve. Every single time you say yes, you are building mental fortitude. And 100%, You will feel better when you say yes. You will never feel bad for saying yes. You always feel better. So when you are working with an older adult, You're making sure that, again, you give them options. Maybe they don't do their entire HEP, and instead of them, well, I wasn't gonna do the HEP, so I just didn't do any exercise. Make sure they understand that saying yes is so important. It's the same thing. Forward is forward. Yes is yes. If they don't want to do their entire HEP, my goodness, just do five minutes of it. Five minutes. Guys, they said yes. And yes is so incredibly powerful. If we know that we wanted them to do that high intensity EMOM, we're trying to increase their aerobic capacity, but they just weren't feeling it that day, they can do yoga instead. It's still movement. We know with older adults, something is always better. than nothing. And the more you say yes, and what I did, I started to tally up the amount of times that I said yes versus no. And every single time, how did I feel afterwards? I felt so happy and proud that I said yes, and physically and mentally I felt better. Once you elicit that same feeling with your older adult clients, and maybe you write something for them too, you write them a note to put on their fridge, and they track the amount of times they said yes, it's momentum. It's going to be so much easier for them to continue to say yes every single time.

SUMMARY All right, guys, that's it. We've been here for 20 minutes. I could talk about running and lessons learned forever, but let's recap. Number one, that true finish line is at the end of our lives. It is about the story we want to tell. It's about becoming someone who endures. becoming someone who endures. Make sure you're connecting with an older adult's life journey and who they want to become. Two, pain is more easily endured with friends. Make sure day one you are starting to figure out how to decrease social isolation and help your client find friends to work out with, to experience different sorts of pain and competition and training with. They're going to experience their pain at a lower severity, I promise. Next, forward is forward. There's so much grace. Make sure that they understand that they've got options and you are hammering in that if you can't do that level one goal, We've got options for you and as long as you're still moving, it's still forward progress. And lastly, something over nothing and done over perfect. If we're not going to reach that A goal, it doesn't matter. Just say yes to yourself consistently every single day. It's going to build resiliency and reserve and confidence moving forward and saying yes is going to become a lot easier. All right, y'all, I hope you have a wonderful rest of your Wednesday. The last thing I will leave you with are what courses we have coming up. We've got both of our online courses coming up in May on the 15th and the 16th. 15th, level one starts. 16th, level two starts. And then on the road between May and June, we are in North Dakota, Virginia, Arizona, and Texas. PT on ICE is where you find all that info. Hit us up if you want to talk about 50ks and running. I'm here for it. Have an awesome day, guys.

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