From healio.com
Key takeaways:
- Walking is a great starting point for patients looking to exercise more because it improves various areas of health.
- PCPs can help motivate the more hesitant patients with tips like creating a good playlist.
Primary care physicians often recommend patients exercise, but because convincing them to get active can be easier said than done, it is often a good idea to start with short daily walks, according to experts.
Exercise is a critical component of preventive health — a cornerstone of primary care practices, Sarah Sams, MD, FAAFP, a member of the board of directors of the American Academy of Family Physicians, told Healio.
“[Primary care physicians are] in a perfect position to recommend that for our patients because there are so many benefits not only from a physical standpoint but also from an emotional health standpoint, which we treat as well,” Sams said.
Many PCPs are already telling patients they should exercise more regularly, “but I think it stops there,” Robert Dolansky, DO, a board-certified osteopathic physician specializing in family medicine and American Osteopathic Association board member, said.
“Patients need more direction about how to get started,” he said. “Walking is a great place to get started.”
Most physicians instruct patients to follow guidelines from WHO and the American Heart Association, both of which recommend 150 minutes of moderate intensity aerobic activity every week — usually five sessions with 30 minutes of activity. But Sams said, “that’s not realistic for everyone, especially starting out.”
“What I tell my patients is, if they haven't been moving at all, just get started moving,” she said. “Any kind of movement is better than none at all. And then we can work into it gradually.”
Sams described her experience with a patient who was overweight, had diabetes and “could barely get out of the house” when Sams told her to just begin walking to the mailbox daily.
“She got to where she was walking a mile and then she ended up starting to go to the gym and she lost quite a bit of weight, which helped her arthritis, got her diabetes under control, and as she worked into it gradually, she felt better and was able to do more and more,” Sams said.
Because it is “not as painful” as physical activities like weightlifting or running, Sams said it is easier for PCPs to convince patients to start getting active by recommending simple walks — especially when they describe the various health benefits.
“Helping [patients] to find other benefits besides just the absolute exercise benefit of it, I think can help,” she said.
Health benefits
Previous research has indicated that walking is connected to a variety of health outcomes. Alongside the well-known benefits for weight management, walking has also been linked to improved cardiovascular, neurological and psychological health, Dolansky and Sams said.
Sams said that because hearts are muscles, “exercising that muscle is an important part of keeping your heart healthy.”
“The increased heart rate from walking will increase blood flow, which, in time, can help to decrease blood pressure and cholesterol,” Dolansky said. “It will also help to boost your mood and energy by releasing endorphins and increasing oxygen flow to all parts of your body.”
Dolansky also noted that the release of certain hormones “can promote the growth of new neurons and overall brain function.”
“The increased blood flow, oxygenation and hormones flowing through the brain enhances memory, attention and problem-solving skills,” he said.
The psychological benefits have to do with the release of endorphins, commonly referred to as the “feel good hormone,” Dolanksy explained.
“Regular exercise can help decrease symptoms of depression, reduce stress levels and increase overall mood,” he said.
Sams also said the endorphin increase following exercise can be beneficial for patients struggling with their mental health.
“In patients with depression, I often will recommend exercise as one of many things that they can do to help with their depressive symptoms,” she said.
Sams also said walking can also help improve endurance, joint pain and sleep habits.
“For every pound of weight that you lose, you take off about 10 pounds of load on your knee joints and your ankle joints, so that can be really important in patients who have significant arthritis,” Sams said. “Even a 10-pound weight loss is like taking 100 pounds of weight off of the joint, so that's very important.”
However, Dolansky stressed that “walking is just the gateway to better physical fitness.”
“Although it is a great place to start ... it is also important to add in weight and resistance training for muscle and bone health, and stretching for flexibility,” he said.
Sams said that patients do not even have to find another activity to add stretching and weight training to their usual walking routine.
“You can add stretching and even some strength training while you're walking just by carrying some little weights in your hands or putting little ankle weights on while you're walking. That can do some extra strength training,” she said. “You can stop and do some stretching along your path. There are ways that you can incorporate some of those other types of activities to the walk as well.”
Individualise care and lead by example
PCPs should individualize care for their patients, tailoring exercise recommendations to account for their specific health needs, according to Dolansky and Sams. This can start with a simple assessment of what exercise the patient is currently doing, Dolanksy said.
“Then, ask the patient to keep a log of their activities for a month and bring the log back to the next visit,” Dolansky suggested. “The physician and patient can work together to develop a safe but sustainable plan to increase activity. This plan can be reassessed and adjusted at each visit. It would also be helpful if the PCP’s office had a toolbox of exercise resources specific to their community like park maps, walking trails, walking groups and group activity centres.”
Dolanksy and Sams also discussed the importance of how PCPs present new exercise opportunities to each patient. Previous research has indicated the way PCPs talk to their patients matters; for example, the way in which PCPs present weight loss has been connected to treatment uptake levels.
“You definitely want to keep the attitude positive,” Dolansky said. “It's often beneficial to frame increasing exercise as a means of getting healthier instead of simply losing weight.”
It can also be helpful to share personal experiences with patients, just like when working with patients on their diet or smoking habits, Sams said.
“I kind of use that as a motivation,” she said. “I've actually sometimes done my own medical paperwork while I'm on the treadmill and I will call patients about lab results. And they're like, ... ‘Oh okay, you lead by example as well.’”
Motivational tips
The convenience of walking is one of the benefits of walking that PCPs can highlight when recommending exercise, Dolansky and Sams said.
“Walking doesn't cost a thing and can be done just about anywhere,” Dolansky said. “You can even start by walking or marching in place right in your own house. You can walk in the neighbourhood, mall, shopping centre or parks. The options can be endless.”
PCPs can also offer tips to make a walk fun and enjoyable, he said — for example, “a good playlist is a good start.”
“But you should always be updating the list so it doesn't get monotonous,” Dolansky said. “I personally keep it interesting by walking with my dog and listening to an audiobook. Another great option to keep things interesting and add accountability is to find a walking buddy.”
Sams also said that recommending patients walk with friends is a great motivational tactic. “How many times do we say to our friends, ‘Hey, we should get together and have a cup of coffee’ or lunch or whatever, and then we never do because we don't have time?” she said. “But scheduling time with your friends to just get together and walk can be a good social outing for people — especially some of our elderly patients who may be a little more isolated.”
Additionally, Sams recommended incorporating exercise into one’s day — for example, “if you are on a committee that you have to meet with people to plan something or you have a weekly staff meeting, take some clipboards and pens and just walk while you have your meeting.”
“You can pause every once in a while if you need to write, but it's still more exercise than if you all sat in a chair around a table,” she said. “There are ways that you can incorporate exercise into things that you already have to do to make time for it and also so that it's not so boring for those people who just don't enjoy going out and walking on their own.”
PCPs should also emphasize how many options are at their patients’ disposal, Dolansky said. For example, he said, “weight training or resistance training does not necessarily mean lifting weights” or going to a gym; it can also be calisthenics like sit-ups, pull-ups and push-ups. Patients can also get creative with home workouts, using resistance bands, “or cans and jugs at home to work the muscles,” he said.
Dolansky also suggested PCPs “take advantage of technology,” especially if the patient has a smartphone or smart watch, to set trackable goals.
“There are endless internet resources and apps with exercise ideas, as well as resources for stretching,” he said. “Present the patient with a few options and work with the patient to develop a plan that will work for them. Set short-term goals and monitor closely.”
The final tip Sams offered was to remind patients to not give up after they inevitably have a slip-up on their exercise journey. “Whether it's exercise, smoking cessation, diet — at some point or another, we almost always relapse, and a lot of people will get very down on themselves ... and feel like they failed,” Sams said. “I always tell people ‘It's not a failure; it's a partial success.’ All you have to do is jump back into that active mode that you had before. You don't have to start a new plan. You already have the plan. Just jump back into it and realize that we all have relapses in our habits and sometimes we just need to tell ourselves that that's okay.”
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