Get Patients Moving

Convincing patients that regular exercise reaps lifelong health benefits isn't hard. But it is tough to actually get them off the sofa and into an exercise routine.

The American College of Sports Medicine (ACSM) and the American Heart Association (AHA) aim to help with the release of new physical activity recommendations for adults 18–65 years old—an update of 1995 guidelines.¹ The guidelines promote the theme that exercise is more accessible than people think, a fact that physicians can emphasize with their patients, says the guidelines' lead author, William L. Haskell, PhD.

Specifically, physicians can drive home the idea that people can start with moderate-intensity activity—30 minutes, 5 days a week—says Haskell, professor emeritus at Stanford School of Medicine in Stanford, Calif.

“Data compiled over the last 10 years confirm that moderate-intensity activity, like walking, provides a lot of health benefits,” notes Haskell. “You can accumulate this activity throughout the day in bouts of 10 minutes or so. For a large number of adults this is a very safe way to approach initiating a physical activity program.”

The type of exercise doesn't matter as much as just getting active, says Haskell. The trouble is, many older adults become more sedentary with age, says Miriam Nelson, PhD, the lead author of the companion ACSM/AHA recommendations for older adults >65 years and those ages 50–65 who have chronic medical conditions.²

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Yet, “with almost no exception, studies have shown positive effects [of multiple modes of exercise] on musculoskeletal, cardiovascular, and metabolic health,” says Nelson, associate professor of nutrition at Tufts University in Boston.

ACTIVE BODIES, STRONG MUSCLES

The ACSM/AHA guidelines for average adults emphasize aerobic exercise and muscle strengthening. They call for all adults to supplement their regular daily activities with a minimum of both:

1. Thirty minutes of moderate activity on 5 days per week or 20 minutes of vigorous activity on 3 days per week.

2. Eight to 10 muscle-strengthening activities on 2 nonconsecutive days per week (see chart).^1,2

Accordingly, physicians should measure patients' physical activity levels at every office visit as well as check vital signs and confirm the benefits of not smoking and good nutrition, suggest past ACSM presidents Carl Foster, PhD, and William Roberts, MD.

“It is so exquisitely simple,” says Foster, a clinical exercise physiologist at University of Wisconsin-LaCrosse. “If you can get patients to achieve 30 minutes a day of moderate physical activity, the health outcome is extraordinary.”

For the reluctant, suggest starting with as little as 5 minutes each day, ramping up a little longer and faster over subsequent days, says Roberts, a family physician at University of Minnesota's Phalen Village Clinic in St. Paul.

To meet the minimum exercise recommended by the guidelines—150 minutes (30 min/d x 5d/wk) of activity each week—an average adult could do the following: Push a lawn mower or hike for 60 minutes on a weekend day, play tennis or rake leaves for 30 minutes on 2 other days, and take 10-minute walks with the dog, a friend, or a family member on 3 other days.

And because most adults hold sedentary jobs, the guidelines advise resistive or muscle-strengthening exercises for all (see chart).^1,2 Muscle strengthening can be done using resistance machines and free weights. Or people can simply wear weighted packs while walking or hold soup cans while doing upper-body exercises. The result? Fitter and stronger muscles that burn more calories and help maintain healthy bones, the guidelines say.

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“In older folks, strength and balance are so tied together that their risk of falls goes down as strength and balance improve,” Roberts emphasizes.

SPECIFICS FOR SPECIAL GROUPS

Indeed, the companion ACSM/AHA recommendations for older adults and those challenged by chronic conditions essentially mirror the minimum physical activity levels for adults, notes lead author Nelson.²

But the companion recommendations further address flexibility and balance, with advice for achieving both:

1. Stretch all major muscle groups for 10 minutes a day at least 2 days a week.

2. Perform balance exercises, such as tai chi or one-legged stands.

Any exercise, even if for <30 minutes a day, is beneficial, the guidelines note. They advise that older or less healthy adults complete as many light daily activities as possible, such as:

1. Walking at home and work, shopping, and playing light games such as billiards or croquet.

2. Sitting while playing cards, doing arts and crafts, playing a musical instrument, power boating, fishing, or weeding the garden.

3. Standing while making the bed, cooking, washing dishes, playing darts, or fishing.

The guidelines also advise that older adults and those challenged by chronic conditions follow a scheduled plan to gradually increase activity levels as they are physically able.²

“Older adults should... be encouraged to self-monitor their physical activity on a regular basis and to re-evaluate plans as their abilities improve or as their health status changes,” the guidelines state.

Most important, patients should stay active. “Physical activity has a profound impact on the health of older adults, whether they have preexisting disease or not,” says Nelson.

The bottom line, say the guidelines' authors: Get patients moving. ▪

Tips to Spur Exercise

To help get patients moving, here are some motivational tactics from the authors of new exercise guidelines released by the American Heart Association and American College of Sports Medicine:

1. Suggest pedometers to encourage daily average step increases of 10% each week toward 10,000 daily steps.

2. Provide printed versions of the ACSM/AHA guidelines.

3. Refer patients to personal trainers or health club personnel certified by ACSM, the National Strength and Conditioning Association, the National Academy of Sports Medicine, or the American Council on Exercise.

4. Advocate walking groups, exercise classes, canoe or kayak trips, etc.

5. Recommend using stairs, walking during lunch or during commercial TV breaks, or parking farther from each destination.