Choosing the Activities, Sport, or Sports

Steven Jonas

INTRODUCTION

As you will have already gathered from the previous chapters, there is a very broad range of lifestyle activities, sports, and other athletic activities to choose from for a regular exercise program. It does not mean simply running or group aerobic exercise/activities (although each of these is a suitable choice for the right person). As we have emphasized throughout the book, both the “lifestyle exercise” approach and the “scheduled leisure time” approach can work, and they do work for different people. Sometimes they both work in conjunction with each other for the same person, done either sequentially throughout the year or in some combination during a given week.

Whatever works for a given patient is what works for him, as we have said on more than one occasion. The goal is to get to and maintain, at a minimum, the ACSM minimum of 30 minutes of exercise of moderate intensity at least five times each week. With your guidance, as we demonstrate in this book, there are a variety of routes your patients can and do take to get there. What is fascinating about the whole enterprise, as we too have noted on more than one occasion, is that, for many people—regardless of how they got there—once they get into the habit, they will find it a hard one to kick.

The choices between the lifestyle exercise approach and engaging in scheduled leisure-time workouts—in a sport or other athletic activity, at the gym, at home, on the road, in the park, or what have you—are not mutually exclusive. One can stay with one. One can move from one to the other and back, mixing and matching as they go. In fact, many regular exercisers find that variation of their routines over the course of the year is just what the doctor ordered to keep them fresh over time, to keep them stimulated, and, if an athlete, to work out different muscle groups at different times of the year. For example, one of us, a long-time triathlete and downhill skier, engages in his swim-bike-run training program from mid-March to mid-October and then switches to weight-training and body conditioning to prepare for ski season, as well as during the winter to, as he ages, build up muscle strength for the next year’s triathlon season. He has been doing this for over 25 years.

LIFESTYLE EXERCISE: SOME OF THE POPULAR CHOICES

Introduction

Lifestyle exercise is an opportunity for your patient to achieve most of the general health benefits of exercise (1, 2, 3) through physical activity of moderate intensity. Your patient does this by doing at a higher level the daily physical activities that he ordinarily does at a fairly low level, and by introducing physical activity into one’s daily routine. For example, you may advise your patient to begin his program of regular exercise by taking the stairs at work instead of waiting for the elevator or escalator. For very deconditioned or elderly patients, light activity will provide general health benefits and an introduction to higher-intensity physical activity. (See Three-Minute Drill 11-1.)

Intensity

But how can you explain to your patient how intense “moderate” is? If the activity, such as walking, is intense enough that your patient can still talk but cannot sing, then she is exercising at a moderate level (see also Table 8.3). More precisely, a brisk walk is between 3 mph and 4 mph, or approximately 3-5 metabolic equivalents (METs) (see Table 8.3). This can be described to patients as “somewhere between a comfortable pedestrian stroll and a rush to keep an appointment.”

Furthermore, moderate-intensity exercise is done at a pace that can be maintained comfortably for at least 45 minutes.

These examples refer to walking as the mode of physical activity, as it is the most common form of exercise and, for many, the easiest form to fit into their normal daily routine. However, other forms of exercise, such as biking, swimming, or going to the gym are also excellent ways for patients to exercise at a moderate-intensity level. (See Chapter 8, pp. 99-133, for recommendations on additional types of exercise.)

THREE-MINUTE DRILL, 11 – 1

Some Advantages of Lifestyle Exercise:

Less time-intrusive than scheduled leisure-time exercise
Can seem less intimidating to individuals who are nervous about “exercising,” or who do not think of themselves as “athletes”
Environmentally friendly
Provides the majority of the general health benefits of physical activity
Provides baseline level of fitness on which to build to more vigorous exercise
Can enable the person to achieve the recommended levels for regular exercise
Supports behavior change models advocating for small change
Sets a good example for colleagues (may motivate them to join you)

Advantages of the Lifestyle Exercise Approach and Choices

For many average, sedentary persons, lifestyle exercise can be sufficient to raise their energy expenditure level to the point where they are no longer considered sedentary. As specified in the ACSM/AHA recommendations (4), more vigorous activity confers greater benefits and begins to positively impact on physical fitness.

The lifestyle exercise approach has many advantages. Lifestyle exercise is usually not as time-intrusive as scheduled leisure-time exercise. The lifestyle exercises often replace with greater physical activity time spent passively. For example, commuters who use public transportation to get to work could get off the train or the bus a stop early, which may allow for a 10-minute walk to their workplace. Similarly, parking at the back of a parking lot exchanges the time spent walking for the time spent circling the lot looking for a closer spot. By engaging in these simple activities, your patients can reach their goal of 30 minutes per day five days per week, through the accumulation of three such lifestyle activities, each of 10 minutes in duration. The choice is extensive (Three-Minute Drill 11-2).

Lifestyle exercise can also improve your patient’s strength and flexibility, from such activities as engaging in gentle stretching while speaking on the
phone to pushing a lawn mower around the yard rather than riding on one. The intermittent nature of lifestyle exercise, such as adding stair climbing periodically throughout the day, is supported by the exercise recommendations to accumulate 30 minutes of moderate physical activity most, if not all days of the week. The ACSM guidelines suggest that each bout of exercise should be approximately 10 minutes in duration to be counted towards the 30-minute goal (4).

THREE-MINUTE DRILL, 11 – 2

Some Ways to be More Active Every Day:

Incorporate walking into daily commute. In an urban setting, get off the bus or train one stop earlier and walk.
Take the stairs instead of the elevator or escalator.
Park at the back of the lot and walk.
Engage gardening.
Use a push hand or mechanical lawn mower.
Shovel your sidewalk.
Rake the leaves instead of using a mechanical blower.
Organize a “walking school bus,” rather than driving to school.
Plan a walking meeting at work, rather than sitting around the table.
Walk with your kids to a neighborhood park, rather than watching TV with them.
Bike to work or to other activities.
Do static exercises (lunges, heel raises, etc) while talking on the phone.
Walk to your local grocery store (fill a backpack), use soup cans to do bicep/tricep curls on the walk home.
When waiting for a flight, walk the halls of the airport rather than sitting in the waiting room.
Stretch while waiting for the bus.
Take regular stretch breaks during your work day.

Increasing Physical Activity

Throughout this book we have chosen to use the word exercise to represent both scheduled leisure-time exercise and moderate physical activity undertaken in the course of the day intense enough to generate general health benefits. Many of your patients may express antipathy to the perceived challenges and pain of regular exercise, thinking that it can be only of the scheduled leisure-time type, whether a sport or other athletic activity such as “going to the gym.” Explaining the benefits of moderate physical activity that does not necessarily require sweating, feeling pain, changing clothes, becoming out of breath, or spending money for equipment may very well significantly help your patients in mobilizing their motivation for regular exercise.

Because it is not seen nearly as demanding, or life-changing, or even threatening in one way or another as trying to engage in regularly scheduled leisure-time exercise, recommending lifestyle exercise is a great way to help your patients mobilize their motivation to become more active. (“What, me, I should try to become an athlete? Who are you kidding?”) Many folks get into regular exercise through the lifestyle approach and then switch over to the scheduled leisure-time approach. But many others start with the lifestyle approach and stay with it indefinitely. As we have noted more than once, the benefits of increased physical activity are incremental, i.e., the more you do, the higher the resultant level of fitness. The simple message for your patients is, “Something is better than nothing, and more is better than less.”

The physiologic benefits of gradually increasing physical activity support the processes of mobilizing motivation and beginning to undertake the behavior changes discussed in Chapters 4, 5, 6. Small initial changes in behavior can lead to initial small successes that can gradually increase feelings of self-efficacy (“Yes, I can do this when I put my mind to it”). Then that boost in self-confidence leads to undertaking the next small change, and so on and so forth. These successive small changes then lead to larger and sustained lifestyle changes. As we have said on more than one occasion: “gradual change leads to permanent changes.” An easy way to start on the pathway of gradual change is to engage in the lifestyle exercise approach.

Becoming a regular lifestyle exerciser means continuously looking for opportunities to add physical activity to everyday activities. Both setting aside the time for regular leisure-time scheduled activity and engaging in regular

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