John M. Heath, MD, and Marian R. Stuart, PhD


J Am Board Fam Med. 2002;15(3) 

In This Article

Physician's Role in Motivating Exercise

Given that benefits are possible from exercise and that barriers to exercise can be overcome, how can the family physician motivate their elderly patients to begin exercising? One commonly used technique is to assess their patient's readiness to start exercising according to their stage of change. The transtheoretical model of change postulates there are five distinct cognitive stages that must be resolved when contemplating a change in lifestyle or habit: precontemplation, contemplation, preparation, action, and maintenance. The first step is to determine whether patients have thought about incorporating some form of regular exercise into their lives, ie, whether they have moved from the precontemplative stage to the contemplative stage.[62] Once the decision to exercise has been made, the preparation stage includes planning for the exercise routine, seeking companions, arranging the schedule, and setting a start date. The next stage is action, in which the patient engages in the new behavior. Finally the maintenance stage guards against relapses and promotes continuation of the activity until it becomes habitual.

Patients must see the increase in physical activity as both desirable and achievable. Patients must establish their own goals of exercise. Patient goals might be quite different from what the physician expects the patient to gain from exercise. While a physician might advocate exercise to increase energy in a fatigued patient, expending energy to increase energy might not make sense to the patient and therefore not serve as a motivation. An alternative would be to promote exercise benefits by connecting health status improvements to the outcomes the patient wants and that appear to be achievable. Encouraging patients to consider the benefits of exercise when they were younger is helpful.[4]

It is important to enlist the support of all caregivers and encourage others in their exercise environment to support this change enthusiastically. Although peer support might not always be possible for elders living alone, enhanced adherence to exercise schedules occurs when they have partners.[63] Even when the exercise will occur outside a group setting, weekly peer support groups should be encouraged whenever possible. Supportive caregivers, other health care professionals, and others with whom the patient will interact regarding the exercise program need to know about the proposed regimen. Many older adults have a high degree of respect for medical professionals, and one discouraging or disparaging comment about the proposed exercise program from another physician could seriously undermine motivation. Some patients with special needs can benefit from referral to athletic trainers, physical therapists, sport physiologists, or other professionals who can help provide exercise support.


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