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Friday, May 25, 2012

Exercise prescription experts are disempowering their patients

Here's an essay by my daughter, Mary-Ann Moller, who is studying sport and exercise nutrition at University of Otago. I think a little of her Dad has rubbed off onto her!  What do you think about what she is saying?  Is she right?  Is there a tendency to create dependence?  Please post your response, thanks.  Incidentally, she got 100% for this essay.

Here's the statement that she had to respond to:

Increasingly exercise is being advocated as a treatment strategy for a range of medical conditions. In response, a new field of 'clinical exercise prescription' has evolved. Clinical exercise specialists aim to prescribe safe and physiologically sound programmes. These specialists working with clients in clinical settings often create a dependence that effectively changes the client's perception of physical activity or exercise. We encourage this dependence by over-complicating exercise prescription.

Consider the above statement and provide well argued support for your interpretation of the statement.

The clinical relationship as it should be.
Exercise prescription experts working in the clinical setting overly complicate exercise prescription creating a dependency. This tendency to encourage the individual to brainlessly defer to the “expert” is symptomatic of what is happening throughout modern society: The insidious process of disempowerment of the individual and the granting of their power of choice to both the State and to the professional Expert. The two drivers of this process are the desire of others to get their hands on the hard-earned dollars of the individual and the ever-growing need by the State to have total control over every aspect of its citizens’ lives. 

An expert is a person who belongs to a secretive organisation, called a “profession”. For a group to be a profession it must have, in addition to rituals of initiation, such as exams and internship, it must have its own secret language in the form of special acronyms and long-winded words. 

In the profession of orthopaedics, for example, indecipherable acronyms abound. These leave the prostate patient in a state of confused awe and helplessness before the God-like specialist.

The diagnosis,“IDKJ”, is authoritatively pronounced by the orthopaedic surgeon and recorded for posterity upon the “God-Sheet”. Upon viewing this pronouncement from On High, all those down the priestly line of command obediently respond with appropriate mutterings of agreement and the patient is anointed with ritualistic treatments, such as ultrasound and core conditioning. “IDKJ”, if you would like to know, is priestly code for “Internal derangement of the knee joint”. That still does not mean much at all to the unwashed. There are actually codes within codes. IDKJ has three meanings. Translated from professional orthopaedic jargon, “IDKJ” actually means “You have something wrong with your knee”. But wait - there’s more to this code. It really means “I Don’t Know Jack-shit”. Only those high up within the orthopaedic priesthood know that one! So, if they don’t know jack-shit about what is going on with a person’s sore knee, why don’t they say so? The reason why they do not is because doing so would be giving away some of the power they have over the individual.

Knowledge is Power: with Ignorance it is Control

This process of disempowerment is in evidence within clinical exercise prescription. The average reading age of New Zealand adults is 13 years, so why use words like “biceps” or “abdominals” when working with a patient when “upper arm” and “tummy” will suffice? Why teach incredibly complex and potentially dangerous exercise routines that involve teetering on an over-sized ball that requires constant supervision to prevent complete confusion and inevitable injury from falling off when the same could be achieved with mowing the lawn with a hand-mower or digging the garden with a spade? Which is better when it comes to real practical rehabilitation? Unless the patients are in training for the next Swiss Ball Olympics!

Further complicating matters for the patient is the drive by over-inflated egos which require constant pumping. Experts need to totally bamboozle their patients to create a dependency which will keep pumping hard to ensure their ego doesn't deflate. Utter complexity with the aid of exclusive props (very expensive exercise machines), along with not really understanding a single word of the professional language ensures patients keep coming back. And this of course equals profit!

Exercise prescription must of course address the health issue at hand, but needs to be in a form that the individual can apply to their unique personal circumstances, relevant to their everyday life. It must be based on their lifestyle and what they prefer to do, without reliance on expensive and fairly inaccessible exercise equipment. When a patient goes to a rehabilitation clinic they are expected to leave their brain in the carpark. Instead, exercise prescription should empower the individual. Experts should be telling the patient “when you get out of the car, don't forget your brain, because you will be needing it!”.

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The advice in these articles is given freely without promise or obligation.  Its all about giving you and your family the tools and information to take control of your health and fitness.

1 comment:

How2buildMuscle said...

Although exercise is essential for out fitness and healthy living but it must be done under the supervision of some expert only.
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