Exercise, Too Little of a Good Thing

By: Paul Egan (Exercise Physiologist, Cleveland Clinic Foundation)

The benefits of regular aerobic (endurance) exercise for the general population, and especially people with heart disease, are well known. There have been countless medical research studies that show exercise may improve: endurance and cardiovascular fitness, mood and "feelings of well being", cholesterol levels, risk of developing diabetes, blood sugar control for diabetics, weight control, blood pressure control, stress management, and even risks for certain types of cancer. With all these benefits why is it so difficult for us to get enough exercise and follow the recommended amount of aerobic exercise: 30 to 60 minutes, 3 to 5 days per week, at a moderate-intensity?

Believe it or not, there has also been research done on this question. There have been several personal factors linked to how well a person follows an exercise plan prescribed by his/her doctor or health care specialist. One of which is the patient’s perceived seriousness of their health problem. For example, if someone feels that their coronary artery disease posses a real risk to their future health, than that person is more likely to take the necessary steps to reduce that risk (i.e.. exercise). Another belief linked to how adherent a person is to following an exercise program, is how in control they feel with their health. In other words, will what I do (exercise) have a significant affect on my heart’s health? The third one involves a term called "self efficacy". Once sold on the idea that "I have a serious condition" and that "I have some control over this problem", then self-efficacy comes into play. Self-efficacy is the belief that "I have the ability to do what is required to get the job done". In relation to exercise it would mean the confidence that I can follow a regular exercise program.

Once you can see the need/benefits to exercise, and feel confident and in control of your health, you have set the stage for success. However, there are several "barriers" which can easily derail your exercise program if your not prepared to deal with them. Listed below are several common barriers, which again have been documented in medical research, and ways to get around them:

"I have no time, I’m too busy". Taking just one hour 3-5 days per week is not a lot of time, but it’s easy to tell ourselves that we are too busy to even get the things done we have to do now. It may be helpful to "schedule-in" an actual appointment time on your calendar the way you would for any other commitment. Or make it a daily routine with exercise by doing it at the same time each day (exp: first thing in the morning before events of the day begin and can take over, during lunch break at work, or immediately after work before dinner).

"I don’t have a place to exercise or any exercise equipment". Walking is something almost everyone can do, and when the weather is bad shopping malls offer an option. Many open early just for walkers. Also, home exercise equipment, such as treadmills and stationary bicycles, work well especially for the "self-motivator". A home aerobic exercise video is another idea. There is of course the option of joining a fitness center or YMCA. That way, for a smaller monthly fee you can enjoy the variety of several types of exercises without the expense or upkeep of home equipment.

"I usually do well, except in the winter when I can’t get outside". Again try the mall, a monthly or short-term fitness center membership, or have a back up plan using an indoor piece of home exercise equipment.

"I’m concerned to exercise alone, what if I have a medical problem?" Join a Phase 3 Cardiac Rehabilitation Program. Most large hospitals have cardiac rehab programs, many of which have supervised long-term maintenance programs (Phase 3) for those with high-risk medical conditions or those who just feel more secure in a supervised setting.

Lastly, even with everything in place there are times when we all have had problems with motivation. Here are some easy to follow ways to help increase your motivation. Try one or two and see what works for you.

• Keep an exercise log of the dates, durations, miles, and pulse rates of your exercise sessions. It is truly motivating to see progress and the amount of sessions and distance over a period of time.
• Find an "exercise buddy". Having someone whom is counting on you to be there can make a big difference, especially on the days when you don’t feel like doing it.
• Choose an activity you enjoy. When asked the question what is the best type of aerobic exercise, someone once answered, "It is the one you’ll do". Your heart doesn’t know if you're walking, cycling, jogging, swimming, or dancing a jig, as long as it’s at the right intensity.
• Listen to music or watch a TV program that you enjoy while exercising.
• Join a Phase 3 rehab program (as mentioned earlier). Having a scheduled time to exercise with others like yourself can be very helpful.
• Make a list of 10 reasons why you want to exercise and post it in a place where you will see it often.
• Visualize yourself one year from now having accomplished your goals and feeling healthier and with a sense of accomplishment.
• "Play lawyer". You can even write and sign a contract with your doctor, health care provider, family member, or yourself stating your exercise goals. Some have even written into the contract a reward or penalty for accomplishing, or failing to accomplish, your goal by a certain time.

Remember that you have the choice to make a difference. Good luck!

To make an appointment with an exercise specialist or to join a cardiac rehabilitation program, contact the Cleveland Clinic Preventive Cardiology - 216.444.9353 or 800.223.2273 ext. 9353.

This information is provided by Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

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