Sunday, September 26, 2010

Quality of Life: Physical and Mental Components to Happiness

A health problem, especially cancer has been a detrimental part of numerous lives both physically and mentally. Nagging sickness and medical treatment often overshadow a patient’s ability to live a somewhat normal life. For a breast cancer patient, it is important to increase quality of life, so the thought of possible reemergence isn’t on the mind. Many cancer patients have decreased emotional health that needs to be addressed equally with physical health. Active exercise is a factor most cancer patients don’t think of getting involved with, but this can have very positive effects on quality of life. Research has shown that emotion and physical activity relate to each other (Burnham & Wilcox, 2002). By developing a more sound physical and cognitive structure, a cancer survivor can increase their quality of life and have just as much a satisfaction as a healthy individual, maybe more.

One must look at the ingredients of high quality of life before achieving satisfaction. Emotional and physical health components are building blocks. Someone can be physically healthy, but “un-healthy” mentally. It is important to have a personal balance can between these two areas. Negative emotion can lead to increase stress and sickness, so it is important to address these situations. Common psychological side effects of cancer treatment include fatigue, depression, anxiety, body-image concerns and a sense of loss of control (Burnham & Wilcox, 2002). With an increased chance of anxiety and depression, being involved in group sessions may help alleviate these problems. One must also look at the emotional stress response to physical activities. Having a patient perform high intensity exercise to really get into shape may actually hinder emotional stability. Once exercise and emotional factors are achieved; quality of life can be mastered.

Quality of life is important, but even more so if deadly disease is involved. The definition for quality of life is an integrative system involving one’s perceived physical, social and psychological well being (Gill and Williams, 2008). When patients immerse themselves within physical activity, social improvements will also occur. Patients can reduce their depressed states of mind by actively participating in exercise groups. (World Health Organization, 1998) states that health is a state of physical and emotional well-being and not merely the absence of disease. Subjects should realize that even with disease, one can accomplish high quality of life. If patients attempt to “rest” for long periods after treatments, the prolonged inactivity after cancer will develop physiological and psychological deterioration (Burnham & Wilcox, 2002). It is without saying, very important to help cancer survivors with their physical and emotional states, even after “overcoming” the cancer itself.

As the director of an exercise program for breast cancer survivor patients, it is my responsibility to increase personal well-being and high quality of life after a life-threatening battle with cancer. Although, the subjects survived, their emotional stability can be very low after a long battle, both mentally and physically. The program will be organized to develop mental and physical skills, using emotional support and exercise. To start off the program, I will try cognitive development activities. Pulling psychological skill sets such as positive self talk and goal setting can help increase emotional capacity. Establishing positive emotional thought of self as well as associating oneself with others who have experienced similar problems will allow for an increased desire to succeed.

Throughout the program, group gatherings to maintain social functioning are important. Getting together for picnics, coffee and study groups can all be used to take thought off of illness. When initial emotional stability is improved, actual physical activity can incorporated as a bonus. High-intensity activity may be detrimental to emotion (Burnham and Wilcox, 2002), and will not be prescribed unless requested. In order to gain acute strength and flexibility, yoga, tai chi and Pilate’s activities to find emotional connection with body will be used. Once range of motion is increased, group aerobic activities, swim sessions, track walking and running can commence. Taking part in group activities will increase enjoyment because of interactions and feedback from peers (Gill & Williams, 2008). Being able to show subjects their physical health is increasing, looking at resting heart rate, RPE, strength and aerobic gains may increase desire to continue activity.

Cancer is an illness that can put a huge dampener on emotional and physical aspects of life. Treatment often leaves the patient extremely tired and physically changed. Loss of hair and sense of hopelessness decrease mental state. As an exercise program director, increasing quality of life by physical exercise and cognitive development strategies is important. Social support as well as personal development is needed to help decrease depressive states. Physical activity has been linked to increases in quality of life, and being able to increase cognitive health at the same time is an added benefit. Using moderate level physical activity will give the subjects a sense of accomplishment and increased health without the stress that high intensity activities can produce. No cancer survivor should sit in solitary when their life can be positive.

Burnham, T.R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine & Science in Sport & Exercise, 34(12), 1863-1867.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

World Health Organization. (1998). WHOQOL user manual. Retrieved September 26, 2010, from

Monday, September 20, 2010

Relax! You will come back stronger than before!

As an athlete, a majority of time is spent playing, practicing or thinking about their prospective sport. When an injury occurs, it can have drastic effects on one’s emotional and cognitive state. Once an injury is corrected and rehabilitation beings, it is imperative for the athlete to recognize that they shouldn’t rush back into heavy training, but be cautious and take time to ensure full recovery. A volleyball player uses their legs constantly during a match and an injury to the knee will cause negative emotional behavior. Eight weeks before a scheduled return to the court is quite a bit of the season, and it can be hard for the athlete to come up with proper goal setting techniques in order to remain focused on proper rehab. Concentration during rehab is another area athletes may run into trouble with, and should be monitored to prevent wasted energy and time. As an athletic trainer, it is your responsibility to help make sure the rehabilitation period as smooth and positive as possible for the athlete.

It is important as an athletic trainer to help both physical as well as mental rehab to prevent negative self talk, facilitate goal setting techniques and help maintain concentration and focus. Self talk occurs whenever a person thinks, aloud or internally and creates assumptions and beliefs (Gill &Williams, 2008). When beliefs are made conscious, the affect it has on the mind is staggering. For an injured athlete, one should maintain positive self talk to increase chance of proper recovery. Persistent exercisers will use motivational self talk while their sedentary counterparts often use self-defeating talk (Gill & Williams, 2008). Telling yourself you can’t do something will increase the chance of cessation of the activity. Reinforce your desires with positive reassurance. Once positive self talk is established, goal setting techniques will be used to create proper timelines for rehab.

Setting and attaining short term goals will help achieve long range goals by using a building process, step by step (Fisher, Mullins & Frye, 1993). Long-term, broad range goals can set up for failure and decrease confidence and motivation. Short term goals are flexible, controllable and will develop subject confidence levels (Gill & Williams, 2008). Combining the two goal types will increase the chance of positive outcomes. Concentration is essential to maintain proper attention to detail. Concentration is a skill developed to develop control of attention. Both external and internal forms of concentration are needed to avoid distractions (Gill & Williams, 2008). Concentration on detail in rehabilitation will decrease the chance of injury re-emergence.

In order to help the collegiate volleyball player achieve the best rehab possible, it will be essential to first assess her current thoughts of the injury and rehab are. Once answers are heard, it will be possible to establish a group of mental and physical activities to help. Positive self talk building sessions will be used to first develop a positive attitude. Effective self talk includes thought stopping, countering negative attitudes and changing to positive ones is important (Gill & Williams, 2008). Hills in the road will occur during rehab, but it will remain successful if the athlete can look at these blockades with the “I think I can, or I know I can” attitude, after some work, the hill will be crested.

Once positive self talk skills are mastered, goal-setting strategies will be used to obtain step by step specific goals for rehab, as well as a few long term goals. It is important that athletes develop more difficult, specific goals as better performance is found. Setting and accomplishing short term goals that proceed to allow long term goal achievement is a real confidence builder (Fisher, Mullins & Frye, 2003). Having the athlete write down her goals to place somewhere she can see them will help. Once goals are set, the volleyball player should be told that readjustment of goals is completely normal, and she should never get discouraged with herself, especially with injury rehab. With re-assessment of goals, it can boost confidence to see that her rehabilitation is progressing faster than expected, or that a certain step needs more time, but will increase health. With goals set, one can focus their attention on the specific activities.

Concentration and attention to detail is extremely important with injury rehabilitation. Not paying attention to how a rehab activity is accomplished, greater injury can result. Having the athlete start with internal concentration and then progress to external concentration activities will help. Internal strategies such as attentional cues (verbal or kinesthetic), biofeedback and performance protocols (Gills & Williams, 2008). If rehabilitation progresses in a positive manner, and an athlete progresses towards returning to competition, external strategies can be implemented. Simulated competition and mental rehearsal drills of how competition and practice should occur will help the athlete return to a mentality that will prevent distraction.

An injury such as an ACL tear to an athlete that requires use of the knee and leg is extremely disheartening and will no doubt have an effect on their mental outlook. In order for an athlete to achieve the best rehabilitation possible, it is the athletic trainer’s responsibility to be successful at the physical but also mental rehab level. An athlete will desire to return to competition before they are ready in most instances and maintaining a positive mental state will help rehab progress smoothly. Without proper oversight and rehab, greater injury can result. Positive self talk, specific goal setting and maintaining proper concentration will help an athlete return to competition stronger than when the injury occurred. The athlete will also hopefully have developed better mental skills for competing as an added bonus. No athlete will rehab the same way, so trying to use a “universal” strategy for injury is detrimental to performance. Rehabilitation doesn’t have to alienate the athlete from their team, and if activities can be completed in the presence of team-mates, maintaining a positive outlook should occur. So don’t look at an injury or its rehabilitation as time wasted, with the proper progression and technique, it is just a small hill that will be crested sooner than you think.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Fisher, C.A., Mullins, S.A., & Frye, P.A. (1993). Athletic trainers’ attitudes and judgments of injured athletes’ rehabilitation adherence. Journal of Athlete Training, 28(1). 43-47.

Sunday, September 12, 2010

See the Sunlight! Be Happy!

In the proposed case study, the subject, Jordan, has established unhealthy living habits that have caused serious health concerns according to her medical professional. Her biggest problem is a lack of self efficacy. Another threat to her ability to change her perception is self-perception, more specifically self-concept and self-esteem. This review will discuss options to help Jordan achieve psychological and physical achievements. It will be important to develop specific goals and stay away from global procedures and influences that can decrease personal happiness.

When trying to discover methods for helping Jordan, one should understand the problems at hand. Self efficacy is a form of self confidence and is the belief that one can accomplish the necessary tasks to achieve desired outcomes (Gill & Williams, 2008). Jordan currently has a low self-efficacy. She is having a hard time finding confidence and motivation. According to (Bandura, 1982), self perception of efficacy is a cognitive mediator of one’s action. If one has good self efficacy, that person will have the mental desire to do what is necessary to accomplish tasks. Self efficacy is based on three measures: level, strength and generability. Using these three steps is important for the fact that efficacy is so situation specific and two people with the same task may have different strengths of certainty for example. These three steps seem spot on with how efficacy would be measured, and of the three, using strength would really show how confident a person is with themselves. If Jordan were to take a self-efficacy test, it would probably be evident that she has low certainty (strength) in her belief to accomplish tasks. She also may score low on the “level” test, not expecting much performance gain, thus showing her lack of confidence.

Self-perception is commonly defined as a person’s thoughts, attitudes and feelings towards their personal characteristics (Gill & Williams, 2008). Going further into the definition, self concept is attributed to describing ones’ self, while self esteem is the evaluative aspect of their beliefs (Sonstroem, 1984). Normally, a person with low self esteem will say “I am a failure” rather than “I can do anything.” While most research looks at global self concept and esteem issues, I believe more application with specific interest in personal self-worth is needed. Every person is different and needs non-global advice and oversight to succeed, as reasoning for why one suffers from low self-esteem and concept depends solely on personal problems. Jordan must develop the notion that she isn’t a failure and that she will succeed. The problems of self efficacy and self perception are very similar, yet each has specific points to deal with. If someone can increase their self-efficacy, it will help their personal perception and vice versa, both physically and mentally.

Jordan has lost her confidence and will have to develop a more effacious attitude towards herself. I would start by telling Jordan to look at her past experiences of accomplishments and imagery of how she looked and felt. Next, the use of verbal persuasion will help her confidence. If Jordan can hear from others that she has the ability, believes in herself, she will start to feel the arousal of success. It may be undesirable at first, but instead of having Jordan workout in her home, she should go to an area where she can view others exercising. Getting the verbal support of others, makes it easier to push and accomplish difficult tasks that otherwise may fail. When positive results are seen after hard work, the level of mastery and strength of efficacy continue to build and this is the overall goal of achieving a high level of self-efficacy (Bandura, 1982). Jordan was once an athlete and thus will have determination and motivation; all she needs is the beginning steps of positive reinforcement and self-talk to get her going. Once Jordan can get over the hill of doubt, she can increase her efficaciousness. Starting with small positive motivational talks, leading into simple progressive tasks with satisfaction as a goal, Jordan will develop competency and confidence to succeed.

By first developing a sense of self-efficacy, Jordan can then work on her self-perception. Today’s society fancies unrealistic images of body shape and thinness (Gill & Williams, 2008). Many of the same efficacy procedures will help Jordan continually develop self-esteem and self-concept. It is imperative in my belief, to make sure self-efficacy is improved, or it will be more difficult to improve the later two. After the determination and positive belief are mastered, Jordan can then take steps to increase her schemata. Schematas will help retrieve past experiences and allow for the influence of behavior (Gill & Williams, 2008). Getting Jordan to work out with other people present will increase her motivation. If Jordan can identify her exercise schemata, she will meet new friends and engage in activity which will increase physical, mental and social competence. Using self-efficacy steps of visual and verbal reinforcement, Jordan will develop her own personal identity and will say “I am healthy” and “I am confident.” Her self-perception will increase and hopefully, so will her way of life.

The purpose of this write up was to establish ways in which Jordan could develop her self-confidence and perception. Like so many others, Jordan has negative thoughts of herself, believing she has no chance to regain her health, and thus kept digging a mental black hole. Self-efficacy is important in the process of developing self-esteem and concept. A person needs to form specific beliefs that they can achieve expected outcomes. By becoming more effacious, a subject will accept challenges and try harder. This in turn will develop a personal sense of accomplishment, yielding an increase in self perception. It is imperative that a person refrain from looking at “globally” defined perceptions of a person. Each person is different and different levels of competency. Feeling healthy is just as important as physical health, and it takes positive belief in one’s self. With this, all desired goals and outcomes can be met.

Bandura, A. (1982). Self efficacy mechanism in human agency. American Psychologist, 37(2). 122-147.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Sonstroem, R. (1984). Exercise and self esteem. Exercise and Sports Science Reviews, 12(1). 123-156.