The American Heart Association recommends 150 minutes of physical activity every week for adults. How do you personally manage your work schedule and physical activity?
Louis Kuritzky, MD
Assistant Professor Emeritus of the Family Medicine Residency Program at the University of Florida Health in Gainesville, Florida
We know that only a minority of adults participates in vigorous activity on a regular basis. Explaining why some individuals seem to be able to maintain an enduring healthy lifestyle that incorporates vigorous activity on a regular basis and others do not is not an easy task.
The most common explanation (I want to avoid the word “excuse”) that I hear from patients (as well as friends and colleagues) is “I simply cannot find the time.” Well, we would not accept the explanation from a pilot that he “did not have time” to perform the preflight checklist, or parents who just “did not have time” to get their kids immunized; the consequences are simply too important. As yet, John Q. General Public does not recognize that failing to exercise regularly (like following a healthy diet) is potentially as critical as the aforementioned scenarios.
That being stated, it is not always simple to get patients to prioritize exercise, especially if they have been life-long sedentary individuals. Since many of the individuals we counsel about diet and exercise are overweight or obese, exercise for them may be less pleasant than for their more slender, age-matched counterparts.
So, I encourage patients to make physical activity part of their routine daily agenda. Most adults would feel uncomfortable if they neglected to brush their teeth in the morning (or at night, or both), reflecting a life-long pattern of daily brushing. We should make exercise the same.
The literature supports that the exercise total minutes do not need be continuous—that is, 30 minutes at once seems little different than 15 minutes twice. So, for people who insist that they do not have the time, even 3 periods of 10 minutes during the day is adequate.
Here is my most typical approach:
I ask the patient to start walking at whatever pace is confortable for them for 3 minutes per day and to keep a diary. When I see them again a month later, the walking diary is typically spotty: “Missed on Tuesday, sister visiting Thursday, could only find 1 shoe Saturday.” I do not chastise them, but rather reward them for whatever walking they did do.
Then, I ask them to walk 5 minutes per day, then 10 minutes, and so on until they get to 30 minutes per day every day. Any other schedule leaves “holes” in their exercise program, and since walking can be done essentially anywhere (including your local shopping mall, in case of inclement weather), I would rather establish activity as an every day activity like brushing your teeth.
Once the patient has incorporated 30 minutes daily, I ask them to mark off 2 miles in distance. When they can cover the 2 miles in 30 minutes, that is 4 miles per hour (=4 METS of activity). The Nurses Health Study showed that women who did brisk walking (4 mph) in the range of 150 minutes per week had cardiovascular risk reduction similar to women who jogged (overlapping confidence intervals). Walking is often less daunting to otherwise nonexercisers.