We know exercise is beneficial for cardiovascular health. Consistent moderate and high-intensity physical activity (i.e., following the physical activity guidelines) can lower blood pressure, reduce low-grade inflammation and age-related arterial wall stiffness, and improve cardiorespiratory capacity and endothelial function. All of these contribute to a healthier cardiovascular system and reduced risk for adverse events such as a heart attack. While the details may a mystery, most people are aware exercise is beneficial for the body. If someone has cardiovascular risk factors, such as hypertension, they have likely been instructed by a health care provider to exercise. Yet, exercise adherence is poor overall. How can we change that?
Adherence can be defined as the degree to which a person’s behavior meets the agreed recommendations of a health care provider A recent article (PMID: 34957769) provides an updated perspective on how to identify and address the many barriers you may come across. As you can imagine, many factors influence adherence, such as time, difficulty, knowledge, cost, social support, and equipment. Addressing each of those barriers requires a personalized approach, starting with identifying the barriers specific to the situation at hand.
If you have a patient who is resistant to exercise, you need to assess intrapersonal, interpersonal, socioeconomic, and environmental determinants of exercise adherence. For example, individuals who have some baseline physical activity or good self-reported health are more likely to adhere to prescribed physical activity. Momentum is powerful and it can be a benefit or a deterrent. If you have a patient who is already physically active, support that activity. Don’t add barriers, such as telling people they need to move a specific way or spouting unfounded claims (e.g. deadlifts are dangerous). Support from friends, family members, or healthcare providers can determine how long some adhere to an exercise program. There are many strategies you can employ. The key is determining the patient’s perceived barriers through motivational interviewing and then determining potential solutions through a shared approach. It's not about your values and how you would address a situation. You have to partner with the patient and make it about them.