1-06: Prevention of Physical Inactivity

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. Regular exercise may also have a positive effect on executive function in older adults. 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 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:

1. Ask (identify those who can benefit).

2. Assess (current activity level).

3. Advise (individualize plan).

4. Assist (provide a written exercise prescription and support material).

5. 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. When counseling patients, 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 ...