Lack of sufficient physical activity is the second most important contributor to preventable deaths, trailing only tobacco use. The US Department of Health and Human Services and the CDC recommend that adults (including older adults) engage in 150 minutes of moderate-intensity (such as brisk walking) or 75 minutes of vigorous-intensity (such as jogging or running) aerobic activity or an equivalent mix of moderate- and vigorous-intensity aerobic activity each week. In addition to activity recommendations, the CDC recommends activities to strengthen all major muscle groups (abdomen, arms, back, chest, hips, legs, and shoulders) at least twice a week.
Patients who engage in regular moderate to vigorous exercise have a lower risk of myocardial infarction, stroke, hypertension, hyperlipidemia, type 2 diabetes mellitus, diverticular disease, and osteoporosis. Evidence supports the recommended guidelines of 30 minutes of moderate physical activity on most days of the week in both the primary and secondary prevention of CHD.
In longitudinal cohort studies, individuals who report higher levels of leisure-time physical activity are less likely to gain weight. Conversely, individuals who are overweight are less likely to stay active. However, at least 60 minutes of daily moderate-intensity physical activity may be necessary to maximize weight loss and prevent significant weight regain. Moreover, adequate levels of physical activity appear to be important for the prevention of weight gain and the development of obesity. Physical activity also appears to have an independent effect on health-related outcomes, such as development of type 2 diabetes mellitus in patients with impaired glucose tolerance when compared with body weight, suggesting that adequate levels of activity may counteract the negative influence of body weight on health outcomes. Compared to individuals without CVD, those with CVD may benefit from physical activity to a greater extent.
Physical activity can be incorporated into any person’s daily routine. For example, the clinician can advise a patient to take the stairs instead of the elevator, to walk or bike instead of driving, to do housework or yard work, to get off the bus one or two stops earlier and walk the rest of the way, to park at the far end of the parking lot, or to walk during the lunch hour. The basic message should be the more the better, and anything is better than nothing.
To be more effective in counseling about exercise, clinicians can also incorporate motivational interviewing techniques, adopt a whole-practice approach (eg, use practice nurses to assist), and establish linkages with community agencies. Clinicians can incorporate the “5 As” approach:
Ask (identify those who can benefit).
Assess (current activity level).
Advise (individualize plan).
Assist (provide a written exercise prescription and support material).
Arrange (appropriate referral and follow-up).
Such interventions have a moderate effect on self-reported physical activity and cardiorespiratory fitness, even if they do not always help patients achieve a predetermined level of physical activity. In their counseling, clinicians should advise patients about both the benefits and risks of exercise, prescribe an exercise program appropriate for each patient, and provide advice to help prevent injuries and cardiovascular complications.
Although primary care providers regularly ask patients about physical activity and advise them with verbal counseling, few providers provide written prescriptions or perform fitness assessments. Tailored interventions may potentially help increase physical activity in individuals. Exercise counseling with a prescription, eg, for walking at either a hard intensity or a moderate intensity with a high frequency, can produce significant long-term improvements in cardiorespiratory fitness. To be effective, exercise prescriptions must include recommendations on type, frequency, intensity, time, and progression of exercise and must follow disease-specific guidelines. Several factors influence physical activity behavior, including personal, social (eg, family and work), and environmental (eg, access to exercise facilities and well-lit parks) factors. Walkable neighborhoods around workplaces support physical activity such as walking and bicycling. A community-based volunteer intervention resulted in increased walking activity among older women, who were at elevated risk for both inactivity and adverse health outcomes.
Broad-based interventions targeting various factors are often the most successful, and interventions to promote physical activity are more effective when health agencies work with community partners, such as schools, businesses, and health care organizations. Enhanced community awareness through mass media campaigns, school-based strategies, and policy approaches are proven strategies to increase physical activity.
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