Increasing Physical Activity

Increasing Physical Activity in the Sedentary

Physical inactivity is so strongly associated with coronary artery disease, type 2 diabetes, and colon cancer that the American Heart Association has named physical inactivity an independent risk factor for coronary vascular disease.

But an amazing majority of people (60% of the population) still are inadequately active or completely inactive. More sedentary lifestyles, with more of the population working at desks and spending leisure time without exercising, contribute to deaths due to coronary heart disease, type 2 diabetes and colon cancer.

Regular vigorous, structured exercise programs appear to be too demanding of the average person�s time and commitment. This study reports on an alternative that may produce results comparable to physical fitness programs.

Sedentary, but otherwise healthy men (116) and women (119) aged 35 to 60 were randomly assigned to a traditional structured exercise program or a more moderate "lifestyle" physical activity program. The lifestyle participants accumulated 30 minutes of moderate-intensity activity, such as brisk walking and climbing stairs, on most or all days of the week. Physical as well as behavioral challenges were addressed.

Over 24 months, the subjects were evaluated to see if the lifestyle program helped overcome activity barriers with moderate-intensity physical activity as part of their daily routine. The results showed that both groups had significant and comparable improvements in physical activity and cardiorespiratory fitness, blood pressure and percentage of body fat.

Conclusions: This study should encourage sedentary and out-of-shape individuals by providing evidence that "lack of time, lack of social support, inclement weather, disruptions in routine, lack of access to facilities, and dislike of vigorous exercise" need not condemn them to ill health and risk of life-shortening disease. Patients should be counseled to engage daily in moderate-intensity activity that this study shows could have significant health benefits on a par with high-intensity workouts.

Increasing Patients� Physical Activity: Traditional Care vs. Interactive Counseling

Patients often report that they want their physicians to provide more information about physical activity. Practitioners are likely to counsel patients with known diseases, but generally do not provide regular counseling on physical activity.

Few studies have evaluated the efficacy of primary care counseling for physical activity. The Activity Counseling Trial (ACT), sponsored by the National Heart, Lung, and Blood Institute, was created to examine three different patient education and counseling approaches related to physical activity.

Cardiorespiratory fitness and self-reported physical activity, measured using a 7-day Physical Activity Recall, were evaluated for 874 inactive subjects in the 2-year ACT study. All subjects were given physical activity targets based on national recommendations. The investigators divided subjects into three groups to evaluate the effects of different physical activity counseling interventions. The first group was termed the "advice" care group in which patients received physician advice and written educational materials. Group two, the "assistance" group, received the same as the advice group, plus interactive mail and behavioral counseling at office visits. The third group, the "counseling" group, received all of the above plus regular telephone counseling and behavioral classes.

Cardiorespiratory fitness was significantly higher in women at 24 months in the assistance and counseling groups than in the advice group. Men in all groups demonstrated higher cardiorespiratory fitness, but there were no dramatic differences between the groups at the end of the study; therefore men in all groups improved. Both men and women reported increases in physical activity, but there were no observed differences between groups.

Increased patient interaction may be more effective for increasing physical activity in women. Advice, assistance, and counseling all appear to improve fitness levels in both sexes.

Note: This is the second research paper reviewed in this issue that highlights the importance of a doctor being actively involved in behavior modification of patients for issues pertaining to prevention and wellness. 

Encouraging Physical Activity Pays Off

The benefits of physical activity have long been known to have a positive impact on health, including improving quality of life and reducing the risk factors associated with cardiovascular disease, diabetes, obesity, osteoporosis and depression.

Patients who have been counseled on physical activity by general practice physicians have shown an increase in levels of physical fitness and activity; however, no health benefits have been associated with the activity.

This study sought to determine whether physical activity could improve a patient's quality of life over 12 months without evidence of adverse side-effects. Researchers studied 800 patients (of 40 New Zealand and United Kingdom general practice physicians in rural and urban areas) between the ages of 40-79, who showed evidence of sedentary lifestyles. Patients in the study received the "green prescription," an intervention program in which physicians counseled patients on developing physical fitness goals, combined with support from a local sports foundation that encouraged patients via phone calls and quarterly newsletters.

The study determined the green prescription intervention in general practice is effective in increasing patients' physical activity and improving quality of life without adverse side-effects. Patients in the intervention group increased their leisure exercise an average of 34 minutes per week - significantly more than the control group. In addition, patients in the intervention program self-rated their general health, vitality and bodily pain significantly better than patients in the control group. A trend toward decreasing blood pressure was found; however, no significant changes in the risk of coronary heart disease were noted.

Note: This study, and the previous one, demonstrate that in sedentary individuals, exercise can be positively encouraged and lead to beneficial effects on weight loss and quality of life. This information should be helpful in counseling patients on weight loss; it seems that as long as they are exercising and modifying their diets, benefits should be noted.