Illustrative exercise interventions for varying patient needs
| PATIENT PRIORITY | INTERVENTION | COMMENT |
|---|---|---|
| No motivation to increase activity | Ask or seek permission to discuss reduction of sedentary behaviour. If permission granted, proceed with the 5 As framework91,92 | This model has been used in smoking91 and obesity92 management. Repeated brief simple advice can increase adoption89,91 |
| Motivated but highly unfit | Use pedometer or accelerometer to evaluate number of steps per d at baseline. Consider initially adding 1000 to 2000 free-living steps per d | <5000 steps per d considered sedentary. Marked benefit appears at low levels of PA increase. Some increase in activity is better than none93 |
| Motivated but wishes to do the minimum for benefit | Slow running94 for 5 to 10 min per d or brisk walking83 for 15 min per d can reduce mortality 14% over 8 y and 30% over 15 y, respectively | These activity levels are approximately half of current exercise recommendations |
| Motivated, but no time (has 2 minimum wage jobs) | Use a pedometer or accelerometer to evaluate number of steps per d at baseline. Try to increase free-living steps by 2000 steps per d by increasing mobility options | Pedometers are inexpensive. Mobility options could include walking to work, using stairs, and walking during lunch breaks |
| Motivated to optimize cardiometabolic risk | 30 min of moderate PA 5 d per wk, ≥ 75 min of vigorous PA per wk, or a combination of moderate and vigorous PA; plus 2 d of resistance training per wk67 | This level of exercise is insufficient to prevent weight gain.68 CVD risk reduction increases at higher exercise levels with diminishing effectiveness at 6 to 10 times the recommended levels95,96 |
| Wishes to avoid gaining further weight | Requires 45 to 60 min of moderate PA per d.68 Slowing of weight gain unlikely to happen without dietary modification as well | 7000 steps per d is associated with energy balance and minimal weight gain.97 Mediterranean diet is not associated with weight gain98 |
| Motivation includes wish to lose weight | Would require >250 min per wk of moderate exercise if used alone and dietary intake not excessive99 | This exercise level and dietary modification would have to be maintained in order to avoid weight regain99 |
| Lifelong runner (10 km 3 times per wk at 10 km per h) | More-than-adequate exercise level for health maintenance and mortality reduction. Chosen exercise level should maximize QOL for the individual56 | Exercise produces benefit up to 10 times the recommended levels with diminishing returns on mortality reduction.96 There might be loss of benefit at very high levels100 |
CVD—cardiovascular disease, PA—physical activity, QOL—quality of life.