The statement, “Exercise is an important part of lifestyle medicine,” seems rather obvious. Studies indicate relative risks for cardiovascular disease are up to three times higher for inactive persons as compared to active. In fact, physical inactivity is as harmful as other conventional risk factors, such as blood pressure and cholesterol levels, in predicting chronic disease. Yet, only 10% of Americans meet the recommended level of 150 minutes of exercise per week.

This conundrum can stir several unanswered questions in the clinician’s mind:

Why is there such a stark difference between knowing the need to exercise and executing a plan?

Is it because the recommendations are too lofty? One hundred and fifty minutes per week hardly seems like too high an expectation…

Is it because most people don’t know how to exercise or what to do? With access to on-demand technology, application-based exercise programs, and a plethora of instructional videos, I doubt knowing what to do is the issue…

Is it because most people lack the intrinsic motivation to want to exercise daily? Possibly, but isn’t personal health important?

Lack of exercise adherence is a combination of all the above. As clinicians, we must find a way around the challenges facing the average patient. This starts with an effective exercise prescription.

Most patients haven’t exercised consistently in years, decades or maybe ever. Start the conversation off by gauging their own perceived involvement, interest and commitment to exercise. Ask them if they like to exercise and the level of commitment they assign to regular activity. With any patient, it doesn’t matter the modality or the activity, and if it’s only one, 20-minute session each week, that’s ok! This is the baseline—something to build on.

A prescription of 150 minutes of exercise per week can seem very intimidating to a novice. Starting with one, 10-minute walk each day for a week is a baseline most people can commit to. From there, a weekly progression to 12 minutes, 14 minutes, 16 minutes, and so on is an achievable plan. It’s important to remind your patients that exercise is a long-term process, and a commitment you hope they can sustain forever. Remember, ultimately, you are not simply trying to get your patients to exercise, you are trying to get them to permanently change a behavior pattern.

One hundred and fifty minutes a week, heart rate at 130 beats per minute, 50% reduction in risk, the list goes on and on. People know exercise is beneficial to their health, so berating them with numbers and statistics won’t improve their motivation. I found, with my patients, friendly reminders through text and email with phrases like, “Make sure you take some time to exercise today” or, “I was just thinking about you, wanted to check in and make sure you didn’t have any questions about your exercise program?” went a long way in their adherence to their exercise programs.

	About Jonathan Cannizzo, MSc Jonathan has worked as an exercise physiologist and dietician, helping prescribe and develop lifestyle medicine programs at both Advocate Health Care and Cenegenics Chicago. He earned his Masters of Science in Cell Biology and Biochemistry with a focus on chronic disease progression from Northeastern Illinois University and his Bachelor of Science in Exercise Science from the University of Central Oklahoma. As a graduate assistant at Northeastern, Jonathan was the primary author of chapter 6, Cancer, in the text, Diet, Exercise and Chronic Disease: The Biological Basis Behind Prevention. Jonathan is currently the CM Vitals Brand Manager at the Lifestyle Matrix Resource Center.