Motivating Patients to Move

Robert (R Jay) Widmer, MD, PhD; Thomas G Allison, PhD


January 05, 2015

Editorial Collaboration

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Robert (R Jay) Widmer, MD, PhD: I am Jay Widmer, cardiovascular fellow at the Mayo Clinic. Today on at Medscape Cardiology, I will be discussing the best amount and type of exercise for cardiovascular (CV) prevention with Dr Thomas Allison, director of the sports cardiology program and an expert in CV prevention at Mayo. What should we tell our patients? Should they walk? Should they run? How often? What is your opinion?

Thomas G Allison, PhD: Let's say this simply. I haven't seen any type of physical-activity that has been studied and not been proven to be beneficial to reduce total mortality and CV risk. There are two specific activities, sitting time and watching television,[1,2] that are actually CV risk factors. We encourage people to move and do whatever they like to do.

We also have data that putting a little zip into it now and then—in other words, doing some interval training or some higher-intensity activity, even if it is jogging just once a week, seems to further reduce the CV risk.

As far as how much to do, the recommendations are at least 30 minutes a day, 5 days a week, and probably an hour a day would be optimal if you had the time to do it.

Dr Widmer: A problem that we face in practice is motivating our patients. How do you motivate your patients to move?

Dr Allison: We have to go back to the Prochaska Stages of Change. If I have a patient who wants to exercise, I help him or her overcome the barriers to exercise—whether to join a gym or buy equipment at home, how to deal with the cold weather.

If I have a patient who is having trouble staying on the program, often I have them get a physical-activity monitor. When you begin to observe behavior, it changes. If you have a little device clipped to your belt or in your pocket that tells you how many steps you have taken, guess what? You start taking more steps.

Dealing with the patient who is not motivated to exercise, that is where we have to do some education about the benefits. I sometimes appeal to their inner athlete. I say, "Did you do sports?" "Oh, yes, I was on the football team in high school. I ran track. I played basketball." I try to appeal to that and say, "Look at you now," more or less.

If we have a stress test result, it can sometimes be helpful to say, "You are 40. You are performing like a 58-year-old on the stress test." We use different techniques at different stages of change.

Dr Widmer: What about the opposite problem from what you just described? If you have a patient is overweight or obese, but also are fit, is it okay to be fat?

Dr Allison: I would refer you to our publication in the December Mayo Clinic Proceedings on just this topic.[3] As it turns out, at every level of body mass index [BMI] we see reduced risk with increased fitness.

In other words, if I could draw a 1-over-X curve, at every level of BMI, the more fit you are, the lower your risk, with the biggest change coming from the least fit to the slightly fit people, but the risk continues to decline. However, at every level of fitness, increasing obesity characterizes a higher level of risk. If you are going to be fat, it's better to be fit. If you are not going to be fit, it's better to be lean, but it's best to be lean and fit, if that answers the question.

Dr Widmer: That sounds very appropriate. What will it take for exercise to be prescribed to the level and intensity that medications are prescribed here in the United States?

Dr Allison: Mike Joyner came up with an idea that I support. We have to get sedentary lifestyle declared to be a disease. Look what happened when we had a medical model for smoking. Suddenly, health insurances were reimbursing people for smoking-cessation programs. Companies were working on drugs to help people quit smoking. When we considered obesity a disease, there was much greater media influence on it. Programs were being supported.

If we declare sedentary lifestyle and poor fitness not only to be a harbinger of future disease, but to be a disease in itself with associated medical, social, and physical cost, then we might get down to the nitty-gritty and say it's in our best interest to treat that disease. That means let's get more people active and put resources behind it. Let's put the shoulder to the wheel and start pushing, start training physicians and professionals how to do this, and start paying for programs. That is what needs to be done.

Dr Widmer: These are great insights. Thank you very much, Dr Allison. Thanks to our readers as well. We hope that you continue to check out our future content on Mayo Clinic's page at on Medscape.


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