Breaking Down Exercise Barriers: Helping Your Patients and Clients “Find a Way” to Stay Active

The U.S. Centers for Disease Control and Prevention estimate that 16% of all deaths annually in the United States are attributable to poor diet and lack of physical activity (2,9). Physical activity induces positive changes in numerous physiological variables and also reduces the risk of cardiovascular disease, functional disability, cognitive decline, and all-cause mortality (3,4,11). Thus, the need to ‘‘find a way’’ to get around barriers preventing individuals from staying active is crucial. This column presents the findings of two recent research articles that present alternative strategies to variables of the exercise prescription: duration and type of activities. These strategies may assist clinicians with helping their patients and clients ‘‘find a way’’ to stay active. Current physical activity guidelines require that moderate to vigorous physical activity (MVPA) be accumulated in bouts of more than 10 minutes up to 150 minutes per week to achieve health and fitness benefits (7). Given our high rates of sedentary behavior and the impact that this behavior has on our public health, there is a need to determine if bouts of exercise less than 10 minutes but accruing to 150 minutes per week would be of benefit. Glazer and associates (6) examined the relationship between selected cardiovascular risk factors with MVPA accumulated in bouts of either less than 10 minutes or more than 10 minutes. The MVPA was measured by accelerometry, and the study was performed with the third-generation cohort of the Framingham Heart Study. Moderate physical activity was defined as 3 to 6 METs, and vigorous physical activity was defined as activities requiring greater than 6 METs. The Table provides a list of activities that satisfy this MET requirement (12). It should be noted that the diversity of activities that satisfy this energy level is substantial and should provide any client or patient with lots of options to stay active. The investigators found that regardless of how exercise minutes were accumulated, total MVPAwas significantly associated with lower triglyceride levels, lower body mass index, lower waist circumference, lower overall Framingham heart score, and increased high-density lipoprotein cholesterol. The author’s overall conclusion was that compliance with national physical activity guidelines was associated with a statistically significant lower burden from cardiovascular disease risk factors, regardless of how MVPA was accrued. Clinicians often use the strategy that adding variety to your training program will enhance compliance. This strategy of ‘‘finding a way’’ to increase exercise participation has been much less studied (1,5). However, a recent article by Juvancic-Heltzel and associates (8) sought to address this research question for resistance training. The investigators presented two patterns of resistance training, one invo lv ing a high (i.e., 10) number of choices and the other involving only two choices. The amount of exercise performed (time on task and volume lifted), level of enjoyment, and perception of effort during a 20-minute period was then assessed among children (aged 8 to 12 years) and young (aged 18 to 26 years) and older adults (aged Q60 years). Participants also were given choices of sedentary activities, including puzzles, crosswords, magazines, coloring, and drawing. The investigators found that increasing the variety of exercise equipment available increased the participation (both time on task and volume lifted) and enjoyment without impacting the perception of effort.