FITTNESS Mnemonic for Physical Activity - Part 2 of 2

Lane Therrell FNP, MSN, RN, NP

This is Part 2 of a two-part article that identifying FITTNESS as a mnemonic for physical activity and suggesting a patient-centered approach for its clinical application. Part 1 of this article addressed the background of the FITTNESS mnemonic for physical activity, and described the FITT elements of the memory aid (frequency, intensity, time and type). This second article details the NESS components of the mnemonic (nutrition, enjoyability/equipment, safety, and success measures) along with directed-thinking questions you can ask your patients to encourage them to take action.

Nutrition

Nutrition and physical activity go hand in hand, and no basic fitness plan is complete without at least acknowledging the patient's baseline nutritional status and needs. A separate nutrition plan may need to be developed, and a referral to a nutritionist may be indicated. Meanwhile, it is important for patients to recognize that they can sabotage the benefits of their efforts to exercise more by eating the wrong quantities of the wrong things at the wrong times.

Some key action-oriented questions related to nutrition as it influences exercise are: "When and what do you usually eat, and when do you plan to work out?" "Have you noticed your previous efforts to work out influencing your appetite?" "How might you coordinate meal times with physical activity?" "How much water do you drink before, during, and after your physical activity?"

Enjoyability and Equipment

This part of the mnemonic addresses two related ideas. What kinds of exercise does the patient enjoy, and is special equipment required?

Patients won't exercise regularly if they don't enjoy the activity, and they will concoct excuses for inaction if they don't have the proper equipment. Or if the equipment is not in good working order. Find out ahead of time, to nip those excuses in the bud right from the start. If their bicycle is not working, what will it take to get the bike fixed, and what exercises can they do in the meantime until the bike is fixed? The concept at work here is that if the patient's preferred exercise requires special equipment, it can be tempting to wait until the bike is fixed before starting-don't let that happen! Hedge against procrastination with questions like, "What can you do in the meantime?" "What will you do if it doesn't get fixed by a certain deadline?"

The big idea behind considering enjoyability and equipment is to avoid emotional reactions and excuses for not exercising. There is no reason why exercise cannot be fun for the patient. They will look forward to it and spend more time doing any activity if is both enjoyable and accessible.

Some key action-oriented questions about enjoyability and equipment are: "What about exercise do you most enjoy? Least enjoy? Why? What type of exercise might you like to try? What equipment would you need in order to try it? Is that equipment easily affordable or accessible to you?" Note: The enjoyability/equipment aspect of this mnemonic is closely related to the type category discussed in more detail in Part 1 of this article.

Safety

Nursing is all about safety first-it's part of our world as nurses, and we need to instill that into our patients too. Is the exercise safe in the context of existing comorbidities? Is patient using correct technique, is the environment safe, equipment in good working order? How might the patient modify a particular exercise to match his or her level of fitness? While you may not be able to supervise the patient's efforts directly, the key is to help the patient think about these things and build them into the autonomous empowered actions he or she is taking outside the clinic.

The big idea here is that most patients do not have a safety-first mindset. Safety must be considered if we want to encourage exercise as part of a sustainable lifestyle. Physical activity should make the patient stronger and healthier, not cause injuries that bring them back to the healthcare system.

Some key action-oriented questions about safety related to physical activity are:"What pain or limitations are you likely to experience while doing this activity? What will you do if you experience pain while doing the activity?" "What equipment will you need to do the exercise, including appropriate safety equipment? Do you have access to it? If not, how will you obtain it? If so, is it in good repair?" "Do you feel safe in the environment where you are doing the activity? If not, what is your back-up plan?"

Success Measures

Patients must measure the success of their efforts in order to alter and optimize the move time. Setting goals and developing tracking system for milestones and metrics are key in this endeavor. Nurses excel at measuring outcomes and can impart their expertise to patients regarding tracking trends over time.

Of course, patients must play a part in the goal-setting process, and should be able to choose the metrics and take responsibility for doing some of the measuring/tracking at home. This feeds back into having appropriate goals and being able to modify them all along. The big idea here is to pick a metric that is an accurate representation of progress toward the fitness goals ...and stick with them!! The goal needs to be easy and acceptable to the patient. Weight and BMI are usually measured at an office visit are a great place to start but they may not be as meaningful to the patient as fat loss or decreasing waist size or dress size reduction.

Some key action-oriented questions about success are: "How will you know you are succeeding in meeting your goals? How will you track your progress?" "How will you know you've reached your goals?" "How do you plan to celebrate your accomplishment?" "What will you do after your goals are met?"

The key to helping your patient increase their physical activity level is asking

the right questions under each of the fundamental categories, and using directed thinking that is focused on the actions they can take instead of the reasons why they need to take them. The FITNESS mnemonic has helped me provide substantive patient education and actionable guidance to my patients when"increase physical activity" was part of the care plan.

Questions for Discussion

How might the FITNESS mnemonic help you in your practice? Does it cover everything you like to bring up with your patients on this topic? If not, what else should be included?

For Part 1 go to FITTNESS Mnemonic for Physical Activity - Part 1 of 2