Exercise programs come in a number of guises, ranging from hand-drawn stickmen to high definition video and smartphone apps. Most clinicians uphold the belief that exercise offers tremendous benefit in addressing the root cause of pain and alleviating patient symptoms. Given this potential, you would expect great care and attention in the creation of the coaching, monitoring and reviewing of an exercise prescription. However, this is not the case. Hand-drawn or overly photocopied generic exercise programmes are still the medium of choice to prescribe exercise. They are uninspiring and do not encourage patient advocacy reducing any impact on an individual’s state of health between appointments. It also presents missed opportunities for the clinic to project a professional image; change behaviours and beliefs; recoup valuable time, and most importantly make people better.
Believe it or not, clinicians are salespeople too. They must sell exercise as a treatment. This is hard when patients desire a quick-fix such as a quick manipulation, massage or piece of colourful tape.
Exercise is not the magic wand they crave so the benefits must be pitched to the client for them to realise its worth for themselves. Only then they will possess the motivation to do any more than a single session. When people are asked to pay for something and expend energy in the process, they must see it’s worth before parting with their hard earned cash.
Belief, the trust, faith, or confidence in (someone or something) — Oxford Dictionary
Unless a patient/client buys into the benefits of a program, they are unlikely to comply with instructions, regardless of its importance. In a similar vein, there is evidence of people not taking medication to treat illnesses (The Problem of Non-compliance with Drug Therapy). If certain parts of society are unwilling to comply with a prescription of antibiotics, how can we expect them to adhere to an exercise prescription which lacks their advocacy? It’s much easier to believe in something if it’s perceived to be of high quality. Compare the programmes in the image above. Which is a client going to believe in?
Our patients/clients are susceptible to the same determination of quality by ‘how it looks’ and the brand it represents as they would be in other areas of their lives. We see this in commercial products from companies such as Apple, BMW and Rolex. What exactly makes them so desirable? I would argue, it is the emotional connection such products generate, either through what they stand for (i.e. success, status, heritage) or their build quality and price. (Undoubtedly, consumers attribute the quality of something by its price tag). Taking forward the notion that clinicians are in the business of sales, is it possible to generate a deep-seated desire in clients to buy products, which essentially mean complying with a treatment plan?
Firstly, we can gain much information from the marketing strategy of the brands above. If your patient/client attributes the quality of something by how it looks, then what do they think of a scrap of paper with a stick-man drawn on it? Do such hand-drawn pieces of paper instil in a patient a feeling of ‘being valued’? Put simply, if at the end of the consultation the patient was offered two products to take home, would they prefer the hand-drawn stick men or a professionally branded, full colour, multi-photo exercise guide with the option to view videos of each exercise on their smartphone and track their progress?
Secondly, there is setting up patients for success. A poorly performed exercise may not cause injury, but it’s not optimal. We need to squeeze every ounce of benefit from each piece of effort our client is willing to spend on our product. In my day job, I work in aviation training where we regularly discuss fidelity: how close to real life a simulator or training event is. We can apply this same concept to our exercise programming. How ‘real’ are photocopies or cartoon illustrations? Patients often struggle to translate the meaning of an illustration or poorly printed picture. Questions arise from this lack of clarity, such as, how fast, how far, which direction, hand/foot position etc. All of these questions can be answered by watching a simple five-second video clip. In such a video the model exhibits perfect form, and the patient can immediately relate to the exercise. As a result, the patient has a much higher chance of recreating the correct posture when attempting the movement.
The ideal situation is to have a clinician coaching them in real-time. However, this is not possible, so a video provides an ideal medium to bring a higher fidelity experience to our patients. It ensures they follow the correct instructions and get the most value from the exercise prescription.
“A brand for a company is like a reputation for a person. You earn reputation by trying to do hard things well.” — Jeff Bezos
Next, let’s look at branding. We’ve already covered the quality of the images and video in our exercise program, ensuring clear direction for the patient, so why does branding have a place in this list?
Here we focus our attention on the business/corporate image we project through our products and services. A patient’s experience under care has a direct effect on how much they buy-in to their treatment plan. While in control of this within a clinical setting, it is often lost the moment the patient departs. We rarely have the opportunity to project a professional image of a business beyond the clinical setting. There is, of course, social media, blogging and advertising but these take time and money to do well to generate meaningful customer-loyalty. Referring back to our sales analogy, if we can provide an excellent patient experience before, during and after our consultations, we are elongating their exposure to our services and in-turn creating advocates for businesses. The benefits of this are two-fold:
1. Patients/clients are likely to believe in you and will work for you. Akin to a transformational leadership model, patients repay your investment by putting effort into the exercise plan and loyalty to your practice.
2. Creating brand ambassadors who are happy to recommend your service. The positive experience they share is invaluable; something you cannot create through traditional marketing means.
To summarise this section, branding is essential in the projection of the quality of services. To deliver a premium product, it must look the part.
Lastly, we’ll cover engagement. How can we ensure it with an exercise program and encourage healthy habits? It’s interesting that I’m drawing upon my role as a founder of Rehab Guru, rather than my background as a clinician for this last point. For it is our software that must easily engage users especially when new products, and their associated guides, can be challenging. The software has to have a form of ‘stickiness’ to drive engagement.
The user needs to understand the benefits and advantages quickly. As a service, if we are unable to create an engaging experience, then our customers don’t hang around long enough to see the benefits. Our time, attention and energy are valuable, so services need to be accessible and engaging from the outset. If we do not receive a reward for our investment, then we give it up.
If the ‘give and take’ balance is successful then new habits are formed, but what can we offer in return for someone’s time and energy? Social media’s drug of choice is dopamine, and Netflix has the binge-watch inducing cliffhanger. Such behaviour manipulation techniques aren’t coincidental; they are carefully researched strategies to keep people hooked. Indeed, a fascinating book on the subject goes by this very title, “Hooked — How to Build Habit-Forming Products” by Nir Eyal
There are undoubtedly ethical considerations when attempting to make products and services as sticky and habit inducing as possible. As therapists, we aim to offer healthy habit-forming products in the form of exercise prescription and advice in an all-encompassing treatment package to aid recovery. As discussed previously, a written prescription doesn’t magically initiate compliance; there needs to be an inner-drive and motivation on the patient’s behalf to take ownership of their rehabilitation. While many patients seek medical help in the pursuit of ‘being fixed’, it is often not within our gift to ‘fix them’ without the mutual understanding that you’re in it together.
We need them to comply with our prescription, which is why we must do all we can to form new habits to aid recovery. There are numerous techniques for this, including goal setting, reminders, activity monitoring, motivational messages, journaling, time accumulation, chaining (maintaining a workout streak), social outreach, communication, collaboration and community. Diving into each of these is beyond the scope of this post; however, what connects every single one is the ability of ‘digital’ to make them possible.
Love them or loathe them, smartphones, tablets and computers have changed almost every interaction we have with the world, and their utility to healthcare is no different. To have any hope of creating new habits in our lives nowadays, we must leverage digital media. Whether that is using a smartphone to create rich and engaging programs in real time or getting patients using their phones to exploit the advantages it gives them, such as motivational reminders activity tracking etc.
It’s evident that as the founder of an exercise prescription service, accusations of bias have their place. However, I hope this post manages to highlight just a handful of the many benefits of using digital exercise prescription tools bring. The barrier of entry to improving exercise prescription is low, yet the rewards can be high. From a corporate identity perspective, using professional tools to deliver a service is imperative to project the right image to the world. Today, businesses are judged continually by customers. We can do much better than have them leave the clinic with a scrap of paper with a stick man drawn on it!
A former Exercise Rehabilitation Instructor (ERI) in the Royal Air Force (RAF). He went on to compete for Great Britain in Modern Pentathlon. He is now an RAF Training Officer. As the CTO he leads the engineering team at Rehab Guru.