Coaching Your Patients to Exercise

Source: Tufts University
May 16, 2002 (Reviewed: April 19, 2004)

The authors of a report in Mayo Clinic Proceedings want physicians to take a more active role in promoting regular physical activity to their patients. They say that escalating rates of diabetes and heart disease are tied to a sedentary lifestyle, and they offer some sobering facts to support their position:

• One in ten Americans dies prematurely from complications of diseases that are exacerbated by inactivity, and these numbers are rapidly escalating.
• Chronic health conditions affect more than 100 million people and account for 76% of all healthcare costs in the US.
• Just 30 minutes of exercise per day on most days could reduce the risk of four major killers -- heart disease, stroke, type 2 diabetes, and colon cancer -- by at least 30%.

Proven benefits, yet still a hard sell

Researchers already know that regular exercise improves blood lipids, enhances insulin sensitivity, and lowers blood pressure -- all key factors in reducing risk of chronic diseases.

Both walking and weight-training have been shown to improve strength, balance, and muscle tone in older adults, helping to head off the physical limitations that come with advancing age.

But while most consumers have heard the message to get up and get moving, many still have not acted on it -- an estimated 70% of American adults get no regular exercise. The authors point out that knowing the proven health benefits will not make long-time sedentary people more active overnight, nor will it help them keep up an exercise program without professional support.

They say that most people will need some help and they list group meetings, follow-up phone calls, and even periodic newsletters as having been shown to keep people motivated and engaged in an exercise program.

The challenges facing physicians

The authors acknowledge, however, that it's not easy to work exercise counseling into an already rushed office visit. Physicians often don't have specific exercise materials on hand; in addition, some insurance companies and managed care plans will not reimburse the cost of physical activity programs.

What you can do

Both health care professionals and their patients should view exercise as a first line of defense against disease, and, as such, treat it with as much importance in the overall treatment plan as diet and medication. Here are some suggestions:

• Encourage all patients to exercise for at least 3 hours per week, if they are able. Walking is often the best choice, because it doesn't require special, expensive equipment or a trip to the gym. To get both cardiovascular and calorie-burning benefits, people need to walk briskly (at least 3 mph) for at least 30 minutes on most days.
• Recommend "functional physical activity," or activity that is incorporated into daily life, such as taking the stairs instead of the elevator, doing yard work, or playing outside with the kids.
• Find out what group exercise programs are available to your patients, and make participation in one such program part of each patient's take-home instructions.
• Take exercise recommendations out of the office and into the community, by helping to promote physical activity programs in senior centers, community centers, YMCAs, and assisted-living facilities.

Source

• An obligation for primary care physicians to prescribe physical activity to sedentary patients to reduce the risk of chronic health conditions. M. Chakravarthy, M. Joyner, F. Booth, Mayo Clin Proc, 2002, vol. 77, pp. 165--173

Related Links
Lifestyle More Important Than Medication in Preventing Diabetes
How to Start Exercising
Exercise Helps Caregivers Manage Stress
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