STICKMEN, PHOTOCOPIES OR DIGITAL BEAUTY?

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.

GETTING PATIENTS TO BELIEVE IN EXERCISE PRESCRIPTIONS

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?

SELLING EXERCISE LIKE APPLE SELL IPHONES

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?

SETTING THE CONDITIONS FOR SUCCESS

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.

HOW WE CAN DRIVE ENGAGEMENT IN OUR PRESCRIPTIONS

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

IS IT ETHICAL TO SELL LIFESTYLE DRUGS, LIKE EXERCISE?

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.

SUMMARY

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!

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