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Department of Family Medicine
Health Promotion: Exercise–Combating Sedentary Lifestyle
The Problem
In spite of widespread knowledge that
physical activity is an important component of a healthy lifestyle, there are millions of adults in the United States who remain essentially sedentary. According to a 1996 report by the Surgeon General,
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25% of Americans are completely sedentary
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53% get some exercise, but not enough to reduce their health risks
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Only about 22% get enough activity to benefit their health
How can we explain this lack of activity by
patients? It's difficult to imagine that there are people who have not
heard the healthy lifestyle message.
What these figures illustrate is the gap between knowing what one "should" do and actually doing something about it.
Factors such as resistance to change, preconceived notions and
erroneous beliefs about exercise, too much television-watching, and the fact
that change is hard, all work together to reinforce sedentary lifestyles.
How can physicians effect positive behavior change with their
patients?
Talk About Physical Activity
Patients may think that because their physician did not tell them to exercise
that it wasn't important.
Stress the medical importance of activity–get
the message across that sedentary lifestyles are harmful and stress the
importance of starting some sort of activity with small, manageable goals at
first. Physiological benefits are many–improved cholesterol levels,
lower blood pressure, improved glycemic control, slowing the loss of bone mass,
managing stress better. In addition, patients who exercise may find
improved energy levels, feel better about themselves, have a more upbeat
approach to life, and become more relaxed.
Address concerns about people dying while
exercising–patients may have heard reports of athletes with sudden cardiac
death. The reality is that regular physical activity reduces the risk of
heart disease; and the risk with moderate activity is much less than with
intense, vigorous activity.
Exercise doesn't have to be formal or structured
to be helpful. Patients can accumulate exercise during the day, a few
minutes at a time, so that they get 30 minutes on most days of the week. Suggest three 10-minute walks if getting a 30 minute stretch is difficult. Also, adherence is improved for sedentary patients who begin with moderate
intensity activity rather than vigorous activity. For long-term health
benefits the activity must become a part of the patient's lifestyle, so
approaches that decrease dropout rates are preferred.
Recommendations
Former recommendations for rigorous, sustained
activity have kept many from exercising–this must be countered with new
information that any increased activity is helpful. Most people can easily
make small adjustments in their lifestyle to increase activity. Suggest
taking stairs, parking further away from entrances, emphasize activities
patients enjoy–gardening, walking with friends, walking the dog.
For a list of moderate physical activities, see
the National Heart, Lung, & Blood Institute's Guide
to Physical Activity.
Advise patients to schedule time each day and make a commitment to exercise
with others. It will be harder to skip if someone is looking forward to
the patient accompanying them. As with any behavior change, social
support from spouse, family, and friends, as well as physicians, is recommended.
Plan for Change
To move the patient from preparation to action, work with the patient to
develop a behavioral plan.
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Establish baseline. How much activity does the patient currently
get each day? Clarify that it does not have to be structured,
formal exercise classes. Have patient keep a journal noting time spent
walking, doing household/yard work, etc.
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Set a reasonable, clear, realistically attainable goal.
Adherence is aided when the patient decides how much activity to begin with. You may then write a prescription, stating explicitly "Walk for 15 minutes,
3 days a week" and have the patient sign it in agreement.
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Identify barriers to achieving the goal and what can be
done to remove the barriers.
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Identify aids to success. Discuss importance of
stimulus control, and social support.
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Stimulus control involves providing stimuli that will
increase the chances of engaging in the desired behavior. Example: place exercise shoes, reflector tape, water bottle in sight.
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Encourage activity with a partner.
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Discuss warm-up and cool-down, stretching, etc.
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Set a start date. Have patients keep an exercise log to chart
progress.
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Plan a healthy self-reward for efforts.
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Gradually increase weekly exercise time.
Dealing with Relapse
Emphasize that missing a session or two does not mean failure. Advise patient to resume the activity.
Physician Support
Physician support is important as the patient moves through the stages of
change.
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Acknowledge and praise patient's willingness to make the behavioral plan.
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Praise any positive effort, even if it does not reach the stated goal.
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Have the patient identify what needs to be changed in order to become
successful. Is patient's spouse supportive of the activity program? Have unforeseen circumstances and stressors been so great that the program
needs to be delayed temporarily?
You may do all this and still the patient may report on the next visit that
they haven't done anything. Don't be discouraged–remember that your
patient may need to hear repeated messages from you before making a
change. Your consistency and repeated efforts are important in
getting the message across that physical activity is an essential component of health.
References
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Andersen, R., Blair, S., Cheskin, L., and Bartlett, S. (1997). Encouraging
Patients to Become More Physically Active: The Physician's Role. Annals of Internal Medicine 127:5, 1 September 1997, p. 395-400.
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Pate, R., et al (1995). "Physical Activity and Public
Health," JAMA Vol. 273, No. 5, p. 402-407.
Contact Information
Dr. Peggy J. Wagner
Research Director
Email: pwagner@mcg.edu
(706) 721-7589 |
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