Lesson Plan—Coaching Session #3

Staying Healthy Through Education and Prevention (STEP)

The Faces of Physical Limitation

Introduction

This session involves defining "physical limitation," discussing various issues related to the development of physical limitations and perceptions of physical limitations, and defining strategies to prevent further physical decline. This session provides an opportunity for the group leader to review the goals of the STEP program and the benefits of physical activity in preventing decline. This session also provides a review of topics from Session 2 (the benefits of physical activity, motivation, and how staff can help) and an opportunity to review group rules and guidelines and to finalize a group name if the group has elected to choose one.

Preparation

  • Staff must be familiar with:
    • Content of Session 2.
    • Group name (optional).
    • Group rules and guidelines.
    • Goals of STEP program.
    • Organization of a typical group session.
    • The three-question Take-Home Challenge from Session 2.
    • Concepts related to motivation and behavior change as they relate to STEP.
    • The definition of "physical limitation," perceptions, and strategies to reduce further functional (i.e., physical) decline.
  • Print Session 3 handouts, including in-class worksheets, the Take-Home Challenge, and the balance exercise handouts.

Session Objectives

In this session, participants will:

  • Review content of Session 2.
  • Review the benefits of physical activity.
  • Further explore why everyone joined the STEP program by discussing Session 2's Take-Home Challenge.
  • Increase their knowledge regarding physical limitations, their current level of physical functioning, and their risk of physical decline.
  • Discuss the role that physical activity plays in preventing further loss of function.
  • Develop a general strategy to reduce their risk of physical decline and limitations.
  • Receive and review balance exercise handouts and practice Level I balance exercises.

Session Outline

  1. Greeting/Review
  2. The Face of Physical Limitation
  3. Group Activity: Developing Strategies To Increase Function and Reduce the Risk of Physical Decline
  4. Balance Exercises
  5. Questions and Wrap-Up

Session Content and Sample Script

I. Greeting/Review

  • Greet participants as they arrive.
  • Determine if the group wants to select a name and record it below (optional). Group Name: _________________________________________
  • Review group rules/guidelines (if defined in Session 2).
  • Underscore the importance of the STEP program by summarizing the benefits of physical activity.
  • Review staff expectations for participants.
  • Review behavior challenge from Session 2.

SCRIPT:

Let's discuss the Take-Home Challenge from the last session.

  • What are the benefits of regular physical activity?
  • What are your main motivations for joining the STEP program?
  • What can the STEP staff do to help you achieve your outcomes?

One of the reasons that people change their behavior is that they want to alter the past or achieve a new goal. No doubt, each one of you has identified some important reasons for being part of the STEP program. As we work together, we hope you will achieve some of these outcomes and identify many others that "increase" your desire or motivation to be physically active. In fact, during the next few weeks, we will talk about ways to track your accomplishments in STEP and some important features about the outcomes, or goals, for this program. For the remainder of today's session, however, our objective is to better understand the concept of physical limitations, or what used to be called disability. We'll talk about how it affects us, what restrictions it places on us, and what we can do to prevent it. Let's begin by defining a physical limitation.

II. The Face of Physical Limitation

  • Define a physical limitation.

SCRIPT:

What is a physical limitation? Having a physical limitation means you have difficulty performing your usual activities. These limitations often interrupt our daily lives and may have detrimental effects on multiple aspects of our physical and mental well-being. In other words, physical limitation refers to the gap between a person's abilities and the demands of his or her environment.

Another factor is your emotions. Physical limitations can keep you from doing things you WANT to do or feel you SHOULD BE ABLE to do, which can be very upsetting and demotivating. But don't worry, by participating in STEP you are committing to increasing your physical activity, which is a great way to stay healthy and to maintain your physical abilities. Because what you don't want to happen is to go into what we call physical decline. This is when you become less and less mobile to the point where you are truly restricted from carrying out your usual activities, which can result in further physical and mental decline. Clearly, this is a scenario we all want to avoid. Now let's discuss your perceptions of physical limitations.

  • Discuss participants' perceptions of physical limitations or decline and their current level of function.
  • Discuss among the group any experiences that the participants have had in the past regarding losing some of their function and not being able to perform their daily activities or pursue their interests.
    • How did this make them feel?

SCRIPT:

Here's a simple question—how many of you would say that you experience physical limitations? When you think about this question, I want you to think about activities that you have trouble with or have given up lately due to your physical or mental function. What are some examples of activities you find yourselves no longer able to do? (Wait for responses.) Okay, great examples. Now think about how these setbacks have affected your daily life. A little? A lot? Are they upsetting or things you'd rather not do at this point anyway (like run marathons)? (Wait for responses.)

These can be tough questions to answer, and, often, you and your neighbors in this group will have different answers or thoughts regarding limitations. Now I want you to think about your level of physical function and any decline you've experienced. Think about it in terms of a scale of 0 to 10, with 0 being no limitations or decline and 10 being significant limitations or decline. Where do you rate?

It is important to note that no matter where you are on this scale, physical decline is a continuous process of losing function in daily life. Often, as age increases, people start giving up on certain activities without even realizing that they are experiencing decline OR they are setting themselves up for decline. We need to remind ourselves that staying healthy involves maintaining our physical function. This means exercise like you're doing in STEP, but also little things around the house that keep you on your feet, moving around, and interacting with the world in a physical way. Staying active in big and small ways will help decrease your risk of developing physical limitations and will prevent decline in your overall physical health.

  • Distribute the Take-Home Challenge "Brainstorming About Physical Limitations," review the questions on the sheet, and instruct participants to bring the sheet to the next session.

SCRIPT:

All of you have had a decrease in your function, putting you at risk for possible physical limitations and decline, but you have a chance to decrease that risk. You have a chance to change! Physical activity is one way to improve physical function and thus reduce your risk for further decline. Since you have already joined the STEP program, you have taken a very important "step" toward a more active and higher functioning self.

Let's briefly go over your Take-Home Challenge. We started having a great conversation about physical limitations and now we want you to take a close look at your limitations, your risk, and your improvement strategies when you get home. [Review the questions and ask everyone to complete the challenge for next session.]

III. Group Activity: Developing Strategies To Increase Function and Reduce the Risk of Physical Decline

SCRIPT:

You can imagine physical limitation as a waterfall and a river above that waterfall. If you are far away from the edge of the waterfall, then you tend to feel secure and have confidence that you will not fall over the edge. But the closer you get to the edge of that waterfall, the more fearful you become of something happening. What we often forget when viewing waterfalls is that one small slip, one small loss of balance, or one misplaced foot could change things for the worse, and we could fall over the waterfall.

In the STEP program, we want to use physical activity participation and behavioral strategies to push you up the river as far away from the edge of the waterfall or "physical limitation" as possible. While exercising, we will focus on aspects such as endurance, strength, and balance, but all these components ultimately aim at increasing your level of physical functioning and improving your ability to perform daily activities. So, I hope we can all agree that physical decline is an important area of concern as we age.

Now, let's brainstorm some more on how we can reduce our risk of physical decline. I want us to think strategically. What can we do to stay as far up the river as possible, at a safe distance from the waterfall? Let's look at our in-class worksheet and start brainstorming. These can be as general or as specific as you want. Our goal here is to have a list of strategies we can use to stay active, whether we're feeling unmotivated or uncertain, or maybe just forgetful.

  • Distribute the in-class worksheet "Strategies for Reducing Physical Decline" and instruct participants to think about strategies to prevent further decline.
  • Discuss strategies among the group by asking questions such as:
    • What have you done in the past to help you gain back your function?
    • What are some things that you have been trying recently to be more active?
    • What activities, chores, etc., could you start or resume so that you are moving around more?
    • What helps motivate you to do physical activity at home or around the community?

IV. Balance Exercises

Distribute balance exercise handout and demonstrate balance exercises.

  • When you distribute the balance exercises, instruct all participants to begin at Level I. Even if they feel physically able to perform at higher levels, they should learn and master the Level I exercises before moving on.
  • Demonstrate one exercise, then have participants stand up and join you if there is space and proper equipment. Then move on to each subsequent exercise. If participants don't have a stable surface to hold for balance (for example, as needed in the heel raise) then do not have them attempt the balance exercises at this time.
  • Practice as long as the participants need to feel confident. Remember, they will be attempting these balance exercises at home without supervision, so make sure you correct their form and body position while you have them in class.

V. Questions and Wrap-Up

  • Briefly summarize the material and concepts that you covered in the session and provide an opportunity for participants to ask questions and express concerns.
  • Remind them to keep walking!
  • Remind them to complete their Take-Home Challenge and come ready to discuss it at your next class on: Date and Time: ___________________________
  • Let them know that Session 4 will be a discussion of Self-Awareness and Self-Monitoring.
Current as of February 2011
Internet Citation: Lesson Plan—Coaching Session #3: Staying Healthy Through Education and Prevention (STEP). February 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-tools/stepmanual/stepcoach3.html