What doctors wish patients knew about increasing physical activity

Staying active is one of the best ways to keep your body healthy. It can also improve your overall well-being and quality of life by relieving stress, anxiety, depression, and anger. Maintaining or increasing physical activity is also a key lifestyle change that can help reverse prediabetes and lower blood pressure. But knowing what type of activity to choose—whether it is moderate or vigorous physical activity—and how to start can be confusing.

The AMA’s What Doctors Wish Patients Knew™ series provides physicians with a platform to share what they want patients to understand about today’s health care headlines, especially throughout the COVID-19 pandemic.

In this installment, AMA member Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician and associate professor of medicine and pediatrics at Harvard Medical School, discusses what patients need to know about physical activity.

“When we're talking about it in terms of health status, you'll often hear people say things like we want you to have moderate or vigorous physical activity,” said Dr. Stanford. “And those things are a little bit confusing to people. What is moderate and what is vigorous?

“Most doctors will say to you that we want you to get 150 minutes of moderate intensity physical activity,” said Dr. Stanford. “Moderate means that you could talk during the activity, but not sing during the activity unless you were Beyonce performing during a concert where you could possibly do both.”

“When you’re doing vigorous activity, you can’t talk or sing because the level of intensity,” she said. “A moderate activity may be brisk walking, for example, or a light jog whereas vigorous intensity might be something like high intensity interval training.”

Dr. Stanford added that “some people are unable to use their lower extremities or their upper extremities or have conditions with limited use of those. You want to make sure that the physical activity is applicable to the person you’re speaking with.”

Read more about how Dr. Stanford helps to end the obesity shame game.

“Most people will say at least 150 minutes of moderate intensity physical activity minutes per week,” said Dr. Stanford. “Thirty minutes, five times per week would be on average how people would break that up. Although, you can break that up any way that you want.”

“If you look at the guidelines out by the Centers for Disease Control and Prevention and American College of Sports Medicine, we're looking at 75 minutes of vigorous activity,” which is equivalent to the 150 minutes of moderate activity, she said. “This is where you can do short burst of activity—that high intensity—and then consolidate the number of minutes spent doing the work. This is the key recommendation we see.”

When it comes to weight, though, physical activity minutes go up, said Dr. Stanford. “So, when persons have obesity, we recommend typically 300 minutes of moderate intensity physical activity.

“People are unaware that the exercise volume should go up when you struggle with excess weight,” she added.

Learn what doctors wish patients knew about obesity during the pandemic.

“You have to listen to your body. Therefore, personalizing physical activity to one person is extremely important,” said Dr. Stanford. “For many of us who are adults, we've learned things that we like and what we don't like.

“Then maybe there are things that we haven't tried, that have always been on our list or radar of things that we want to consider,” she added. “If walking is your favorite activity, there’s a lot of ways to do that—both inside and outside, using hills or different terrain types to get different intensities.”

“I adore dance workouts. I adore kickboxing. These things make my heart smile,” said Dr. Stanford, adding that “those particular types of workouts are what I consider my soulmate workouts—they fit my personality type.”

“When those workouts are ending, I feel a little bit of sadness because then I have to get back to my normal day,” she said. “When people find workouts they enjoy doing, those are the ones they’re going to sustain for the next 10, 20, 30, 40 years.”

“For all of us, particularly as we age, we know that we lose muscle mass and that becomes most prominent around the age of 60,” Dr. Stanford said. “That is why we need to have weight training as part of our regimen.

“Weight training may be our body weight or the use of things like free weights or barbells,” she added. But the “goal is starting somewhere.”

“Physical activity actually doesn't typically cause a lot of weight loss, which is disappointing when I say that to people,” said Dr. Stanford. “Many people join gyms on January 1st, and they go to work out to lose weight and on February 1st, they recognize that they haven't lost any weight.”

That’s “because, on average, physical activity helps us to maintain our weight. It does not typically generate weight loss,” she said. “I like to emphasize that with patients as they go and toil away in the gym and are concerned about why they’ve only lost a fraction of a pound.

“It’s because that in and of itself, it doesn’t lead to significant weight shifts, but it does lead to weight stability,” Dr. Stanford added.
 

“When we look at a sedentary lifestyle, these are individuals who spend most of their day sitting and don't ever have any purposeful movement,” said Dr. Stanford. “And by purposeful movement I mean that you get up with intention of being active.

“Now, in the COVID-19 pandemic era, this looks very different because we are doing a lot of working from home,” she added. “Maybe one’s physical activity was just that journey to work. Maybe they did a lot of walking to work and from work, and maybe they’re unable to do that in this more virtual era.”

“What I would do is, challenge those individuals to consider building a purposeful activity,” said Dr. Stanford. “Maybe you start your day off with the workout inside of your home, apartment or wherever you are or maybe you conclude your day with something.”

“Only one or two people have ever seen me do this, but in between my visits with patients and meetings, I take a run down the hallway in my building, and I run back in my dress and stockings,” she said. “It gives me a way to be active during the day because otherwise I’m just going from meeting to meeting online.”

Not everyone is a morning workout person, but the reason why I say start your day with exercise is because if you wait until the louder portions of the day, I find that additional tasks and meetings get added,” said Dr. Stanford. “And by the time I’m finished, we’re talking maybe nine or even 10 at night.

“If I’ve gotten my workout in early in the morning, I’m not sitting there lamenting about why I didn’t get that workout in early,” she added.

It's about “scheduling it, placing it on your calendar, developing tools and strategies that make it a little bit harder to skip it,” said Dr. Stanford.

“On average, people should be taking about 10,000 steps,” said Dr. Stanford, noting that “most people get between two and 3,000 steps a day.

“If that’s the case, how do you gradually increase that?” she added. “Building in purposeful movement throughout the day will help you get there.”

Read more about why patients should lace up their walking shoes.

It is important to set goals, but “not in terms of setting a goal weight,” said Dr. Stanford. Instead, it is about “setting what type of output you want to generate.”

“Maybe when you start your exercise regimen, you’re only able to walk for five minutes and after that you feel like, ‘Oh my gosh, I’m out of shape. I haven’t been walking,’” she said. “So maybe your next goal is walking for six minutes and then your next goal is 10 minutes.”

“We have to condition our bodies to get us to a point where we are able to build up our level of endurance and improve overall health in doing so,” Dr. Stanford said.

“It's like preparing for a final exam—you wouldn't go and take the final exam in a class if you had not taken the class or studied in the class,” Dr. Stanford explained. “We have to prepare ourselves to get to that level of accomplishment.”

“We can’t assume that on day one we’re going to be able to do tuck jumps over our sofa and be fine. We have to gradually achieve these goals to be safe,” she said, noting that “a lot of times people jump into really aggressive exercise regimens, and they cause injuries,” which “are setbacks to your physical activity.”

“If your sole activity is walking and walking-style workouts, I don't really feel like you need a rest day,” said Dr. Stanford. “But if you're doing something on the level of CrossFit or some high intensity interval training, rest days are crucial to help repair the muscles between those workouts.”

“Rest days and their importance vary with the intensity and duration of activities that are performed on those exercise days,” she said. “And if you're unsure if your level of intensity really meets those criteria, work with a fitness professional who can help guide you.”

Learn why patients with prediabetes might benefit from interval training.

People often look at physical activity “as a torture device or something. It doesn't have to be that way,” said Dr. Stanford. “People find things that they enjoy, and they just never knew they enjoyed it because they never even took the time to explore it.”

“One of the questions I ask my patients in each of their visits is, ‘What type of activity do you enjoy?’” she said. That’s “because what they enjoy is what they'll do. It's about finding what works for you and exploring it if you've never done it before.”

“If you're coming in for your first visit at 83, and you've never explored physical activity, I'm willing to explore that with you because it's just a matter of time that you'll find the things that you enjoy and you'll continue to do them every day,” said Dr. Stanford.

For example, “I have a patient who’s in her late 50s who I recommended some walking-style videos for,” she said. “She mentioned this to her mom who’s in her 80s and her mom teased her about, ‘Who would do these silly videos with walking in your house?’”

“This patient’s mom now invites her friend over three times a week. They’re both in their early 80s and do this walking-style workout in her living room,” Dr. Stanford shared. “Even if you thought it was silly to begin with, you can find that it is really great and beneficial.”

Listen to more of this conversation with Dr. Stanford on Apple Podcasts, Spotify or anywhere podcasts are available.