Nurses Can Help Motivate Patients to Develop Healthy Behaviors

Recommending that patients “get up and move” can be the best advice for health care professionals to offer patients when assisting in their recovery to improve their overall wellness and prevent future cancer, according to Jessica Clague DeHart, PhD, MPH.

Most importantly, she noted that nurses can correct misperceptions, bust myths, and reinforce positive behaviors to help patients. “People are looking to their clinical team to tell them what to do,” said Clague DeHart, who is assistant professor, Division of Biomarkers of Early Detection and Prevention at City of Hope in Duarte, California.

At the Association of Community Cancer Centers (ACCC)’s 35th National Oncology Conference—held in Phoenix from Oct. 17-19—Clague DeHart discussed how clinicians can communicate the importance of physical activity and good nutrition practices to patients.

Obesity Risks

In the United States, obesity is the new smoking, Clague Dehart said. It is a public health threat that has dangers and repercussions for the entire population.

People who are overweight or obese have increased risk of esophageal, liver, kidney, stomach, colorectal, advanced prostate, post-menopausal breast, gallbladder, pancreatic, ovarian, and endometrial cancer. According to the American Institute for Cancer Research, excess body fat is responsible for 132,000 cancer-related deaths per year in the United States.¹

An increasingly sedentary lifestyle also contributes to higher risks of some cancers. For example, according to the National Cancer Institute website, there is a strong association between physical activity and a decrease in risk for postmenopausal breast cancer, colorectal cancer, and endometrial cancer. There is also a strong association between sedentary behavior and an increased risk of colorectal and endometrial cancer.²

Physical Activity, Not Exercise

To start, Clague DeHart emphasized the differences that could have a role in motivating patients to take more control over their habits. For example, she recommends using the phrase “physical activity” because “exercise” may be misleading.

“Movement—notice I’m not saying exercise, I’m not saying running a marathon. Eating correctly, eating smart—notice I’m not saying a specific diet,” she added.

Movement can be as simple as a patient walking to their car, while exercise is a planned, structured, repetitive movement designed specifically to improve or maintain physical fitness. Similarly, physical activity is any movement of the body that is carried out by the muscles and requires energy.

“What we’re finding is that telling patients to exercise doesn’t work,” she said, “but if you tell me to move … alright, I can move. I have to do that every day. Just like I have to eat every day. I can do that. That’s what works with our patients most—just telling them to move.”

Another significant definition to clarify is the difference between moderate and vigorous exercise. Clague DeHart says adults should get at least 150 minutes of moderate intensity and 75 minutes of vigorous intensity activity each week (or a combination of these), preferably spread throughout the week. Activity should take place at least 10 minutes at a time. Children and teens should get at least 1 hour of moderate or vigorous intensity activity each day, with vigorous activity on at least 3 days each week.

But what qualifies as moderate activity? For some patients, it’s walking briskly, and for others, it may be even less than that. Surprisingly, what qualifies as “moderate” or vigorous physical activity differs with each individual, Clague DeHart said. An activity that causes a patient to pause for breath qualifies as vigorous physical activity.

Nutrition vs. Diet

Another significant distinction that clinicians can make is between nutrition and diet. While the word “diet” simply refers to the food and drinks one regularly consumes, people often turn to “dieting,” or restricting oneself to a diet comprised of specific amounts and/or special types of food to lose weight rather than trying to generally eat a nutritious diet.

“Nutrition refers to the act or process of nourishing or being nourished … getting appropriate amount of nutrients including protein, fat, carbohydrates, vitamins, minerals and water to survive,” Clague DeHart explained.

Eating well means eating in moderation; eating more plant-based, whole foods; limiting meat; and limiting alcohol intake.

Best Practices for Moving Forward

Clague DeHart recommended that patients start on small, achievable goals when it comes to physical nutrition and exercise. With this, clinicians can improve patient adherence to physical activity and nutrition regimens by educating staff, incorporating dieticians and nutritionists into the care team, establishing relationships with community wellness providers, encouraging participation in social support groups, and developing in-house wellness programs, or partnering with established programs.

“Focus on movement, moderation, and mindfulness, and you will have a successful wellness program,” Clague DeHart said.

References

• Clague DeHart J. “Prescribing” Exercise and Nutrition in Cancer Care. Presented at: Association of Community Cancer Centers 35^th National Oncology Conference; October 17-19; Phoenix, AZ.
• Fisher V. Exploring the links between leisure-time physical activity, sedentary behavior, and cancer. National Cancer Institute Division of Cancer, Epidemiology, and Genetics website. dceg.cancer.gov/news-events/linkage-newsletter/2015-03/research-publications/physical-activity-cancer. Published March 2015. Accessed October 27, 2018.