Exercise Exercise for the New Year

By MICHAEL J. PLATTO, MD PHYSICAL MEDICINE AND REHABILITATION

With the new year fast approaching, starting a new exercise program will soon be on many patients’ minds. Making good on this resolution is much less certain. Doctors understand regular activity is a core component of overall health and wellness. Weight loss, stress reduction, improved immune response, decreased risk of cancer, lessening of anxiety depression, improved cognition and overall improved sense of well-being are just some of the known benefits. Despite this knowledge, most Americans still do not exercise the recommended minimum of 150 minutes per week. Barriers to regular exercise are often great. Doctors may prefer to concentrate on other important medical issues, where less effort is required, and behavior can be more easily modified. Indeed, it has been shown that only one third of patients report they have received physical activity counseling by their PCP.

Doctors are aware of the multiple barriers to exercise. Common refrains include being “too busy,” “too tired,” “too expensive,” “too painful,” “no childcare,” “gas costs too much,” “too cold out.” Other commonly identified barriers are embarrassment over body image, the feeling exercise is boring, and the lack of motivation. During the holidays, these barriers become even greater.

It is of course much more time efficient to prescribe a medication and order a lab test for symptoms of pain, fatigue, and anxiety. In most cases, patients are very satisfied to learn their symptoms can be treated with a pill or could be due to a medical condition such as a low thyroid or B12 level. It is much more difficult, less rewarding and results less impressive, when trying to get a patient to exercise more as a way to treat their symptoms. In the long term, however, it is hard to think of any treatment with less side effects and more positive benefit than exercise.

The upside is that the patients who are the most difficult to motivate are often the ones who have the most to gain from even a small amount of exercise. Minor increases in physical activity in inactive individuals may lead to marked reductions in the risk for chronic disease and mortality.

In motivating patients to exercise, it is important to stress that at least some regular physical activity is better than none. Patients should be encouraged to do what they are able to do, and then gradually increase activity over time. It is important to find out what the patient likes to do, whether it be walking, biking, swimming, going to the gym or to the mall. Walking 10-15 minutes per day is better than sitting on the couch all day. Walking slowly around a warm therapy pool will provide some exercise, which is easily tolerated, even in an older patient with multiple arthritic joints. Stretching in the shower first thing in the morning is another important exercise that can be easily incorporated and serves as a good warm up for the day. The key is finding something a patient likes to do and that they can continue for the long term.

Patients should also be reminded that some pain and fatigue is to be expected, especially when first starting to increase activity. If a new activity is started slowly, they should be assured they are not doing “damage.” Often the pain is a sign they are working muscles they are not used to using and can be a sign of improved physical conditioning.

Health coaches and personal trainers can also help in motivating and guiding exercise programs. Many insurance plans including UPMC, Highmark, and Aetna provide these free of charge. Physical and/or Occupational Therapy can also be helpful to get a patient started who is severely deconditioned and/ or has multiple medical conditions. With improved strength and confidence, patients can then often be transitioned to a self-directed gym or home exercise program.

Exercise education can be time consuming. It is not specifically reimbursed and may lead to a dissatisfied patient who was expecting a medication, vitamin or hormone supplement and instead got a lecture. In the long-term, however, benefits of improved health, sense of accomplishment and sense of well-being can be much more rewarding to the patient and their physician than another pill.