Exercise is like eating: Patients think they are doing a lot better at it than they actually are. They may head to the gym after a long workday or commit to going for a run each morning, but the road to an unhealthy lifestyle is paved with good intentions. Hurdles to achieving healthy exercise habits are real, but they can be overcome with the right knowledge and diligence.

The Facts
Over 95% of survey respondents indicate they know exercise is healthy for them, yet 80% of Americans do not meet minimum exercise recommendations set forth by various professional associations. Strangely enough, even if everyone followed these minimum exercise recommendations, it wouldn’t come close to covering the additional calories consumed since the 1960s: Minimum exercise recommendations produce an expenditure of less than 150 kcal/day. Interestingly, obesity rates have also continued to climb since that decade. In 1962, 11% of men and 15% of women were considered obese, whereas in 2012, 35% of men and 36% of women were obese.

An Exercise Epidemic
When it comes to the advice on how to exercise properly, there simply isn’t much useful guidance out there. Sweating, straining, and raising blood pressure to dangerous levels trying to flip a monster tire while a “trainer” screams at you is no way to exercise (Who flips a tire in real life anyway? And those huge ropes; can real people actually do that?!). Working out at a clinic with other patients and a certified exercise specialist is great, but once the 12-week prescription is over and they are on their own, it is difficult (not to mention expensive) to keep up. Most people simply drop out after a few weeks.

What Can We Do?
What most patients don’t realize is exercise activities are so important to health that they must be an integral and habitual part of daily routines. Developing an exercise habit is essential to a healthy lifestyle and procuring a masters-trained specialist with training in both exercise and cognitive behavior therapy is key to successfully integrating new exercise behaviors into an existing lifestyle. In truth, there is nothing easy about this. It takes diligence, team work and time (often more than eight months) to develop new exercise habits. But with the right implementation plans and self-monitoring, the successful development of exercise habits can be achieved.

Taking The First Step
What type of exercise prescription would you write for a patient with the following health history?

• BMI of 35
• Metabolic syndrome
• 10 mg statin
• 25 mg beta blocker
• Strong family history for cardiovascular disease

If your answer is none, you are missing out on a pillar of lifestyle medicine that can significantly improve this patient’s health. No patient is too far down the metabolic continuum to avoid exercise. With any patient, exercise must be prescribed in a micro progression. With that understanding, begin with moderate walking one day a week for as long as tolerable. If that’s only two minutes, that’s ok! Slowly add in time each week until the patient reaches 20 continuous minutes, one day a week. Follow the same protocol until the patient is up to 20 continuous minutes, five days a week. When prescribing exercise, remember, developing an exercise habit is a lifelong process and patients must be continually motivated and reminded of that!

References

1. Church TS, Thomas DM, Tudor-Locke C, Katzmarzyk PT, Earnest CP, Rodarte RQ, Martin CK, Blair SN and Bouchard C. Trends over 5 decades in US occupation-related physical activity and their associations with obesity. PLoS One. 2011;6:e19657.
2. Nguyen DM and El-Serag HB. The epidemiology of obesity. Gastroenterology Clinics of North America. 2010;39:1-7.

	About Murray Ardies, Ph.D. Dr. Ardies joined the faculty at Northeastern Illinois University in the Department of Exercise Sciences and Cardiac Rehabilitation—now Health, Physical Education, Recreation and Athletics—in 1989. During his 26 years of service to Northeastern, he worked on defining mechanisms through which repeated endurance exercise reduces risk for chemical toxicities and cancer. His publications include three books, and numerous articles in publications such as Integrative Cancer Therapies, Nutrition and Cancer and Cancer Letters. Ardies received his multi-disciplinary doctorate from the University of Texas in pharmacology, nutrition, and exercise sciences. He completed postdoctoral training at both, the Icahn School of Medicine at Mt. Sinai and Stanford University Medical School in the Department of Endocrinology and Department of Anesthesia. Ardies served as the undergraduate coordinator for the Bachelor of Arts in Health and Wellness program from 2005 to 2006 and the graduate coordinator for the Master of Science in Exercise Science program from 2006 to 2014. He retired from Northeastern in 2015.