Physical activity is essential to healthy living. In fact, it is difficult to find a component of health that physical activity does not impact.This is especially important in the setting of humanitys increased sedentary behavior, which is associated with poorer health outcomes. How might we as clinicians inspire and support our patients to maximize the potential benefits of exercise and shift away from sedentary behavior? The following guide offers practical concepts and tools to help you and your patients move the body.
Being fluent in basic concepts and terminology is important when articulating prescriptions for physical activity and exercise. The following section lists some key terms to be aware of.
KEY TERMS RELATED TO MOVING THE BODY
- Physical activity: Any activity that moves the skeletal muscles of the body and increases energy output (e.g. walking to work)
- Exercise: Structured and repetitive physical activity with a specific intent, usually to improve some component of physical fitness (e.g. weight lifting for muscular strength)
- Physical fitness: Various health- or skill-related physical attributes (e.g. muscular strength)
In short, physical activity, including structured exercise, contributes to health via the development of physical fitness.
There are many ways of categorizing types of physical activity, exercise, and physical fitness. The following scheme is endorsed by the American College of Sports Medicine (ACSM).Each exercise represents a category of physical fitness. Body composition, however, is included as an additional fitness category without corresponding to a specific type of exercise.Having a grasp of the major types of exercise can help us to customize recommendations in a patient-centered approach. These exercise types are described in the section below.
TYPES OF EXERCISE AND PHYSICAL FITNESS
(ADAPTED FROM THE AMERICAN COLLEGE OF SPORTS MEDICINE )
Aerobic: Exercise that increases cardiac output and oxygen consumption
- Prototype: Jogging/long distance running
- Physical Fitness: Cardiorespiratory fitness
Resistance: Exercise that uses resistance to develop the skeletal muscles
- Prototype: Weight lifting
- Physical Fitness: Muscular fitness
Flexibility: Exercise that stretches the soft tissues around joints to maintain or gain range of motion or limberness
- Prototype: Yoga (asanas)
- Physical Fitness: Flexibility
Neuromotor(a.k.a. functional fitness training): Exercise that improves a range of motor skills such as balance, agility, and proprioception
- Prototype: Tai chi
- Physical Fitness: Neuromotor fitness
(n/a):Relative amounts of bone, muscle, and fat in the body
- Prototype: BMI and waist-to-hip ratio are imperfect surrogates
- Physical Fitness: Body composition
It is important to realize that while specific exercises predominately develop one type of physical fitness, most forms of exercise contribute to more than one type of physical fitness. For example, while distance running mainly targets cardiorespiratory fitness, it also results in skeletal muscle hypertrophy, thus developing muscular fitness.Similarly, different types of yoga may increase flexibility while also improving muscle composition and cardiovascular health.
Understanding Intention in Exercise
In addition to considering which type of fitness is developed by a specific exercise, it may also be helpful to clarify the therapeutic intention of a prescribed movement. Improving a patients aerobic fitness through jogging might be a good goal for a clinician interested in preventing coronary artery disease, but that patient may be more motivated by dancing for recreation. As prescribers, recognizing and articulating the various reasons why we are recommending exercise can help to create appropriate specificity in our recommendations and personalizes care. Focusing on the patients intentions for a given exercise might bring us closer to supporting their desired behavioral change. The following section lists common reasons for promoting physical activity.
COMMON REASONS FOR PROMOTING PHYSICAL ACTIVITY
Rehabilitation: Fixing what is broken
- Example: Range of motion exercises for a sprained ankle
Prevention: Stopping a disease before it starts
- Example: Walking on a treadmill to prevent a myocardial infarction
Fitness: Being or becoming fit
- Example: Lifting weights to be stronger
- Example: Improving endurance for a tennis competition
Cosmetic: Looking good
- Example: Cross-training to increase muscle definition
Recreational: Having fun
- Example: Salsa dancing on the weekends
Wellness: Feeling good
- Example: Running to enhance your mood
At least one study emphasizes the importance of intention to patient outcomes during physical activity.In this study, researchers enrolled a group of 84 female hotel custodians and assigned half of them to an informed condition in which they were educated about how movement during their work day exceeded national recommendations for physical activity. The control group, on the other hand, was not informed about the active benefits of their work. At the end of 4 weeks, with no change in actual physical activity between both groups, the group that had the informed mindset about their physical activity at work showed significant improvement in several physiological parameters such as weight, blood pressure, and waist-to-hip ratio. The authors concluded that these findings support the hypothesis that exercise affects health at least partially through the placebo effect, which is dependent on the mindset of the participant. Thus, developing a clear intention for a particular exercise may be critical to the potency of that exercise.
Expert Recommendations for Exercise
Numerous recommendations and guidelines exist for exercise and physical fitness. These guidelines reflect the emphasis on aerobic exercise from the research literature and are helpful for setting a reasonable goal for most patients.
The American College of Sports Medicine has a good set of recommendations for adults, summarized in the following section.
Table 1. ACSM Exercise Recommendations for Healthy Adults
|Type of Exercise||Duration|
|Moderate-intensity* cardiorespiratory||30 minutes/day on 5 days/week for a total of 150 minutes/week|
|Vigorous-intensity** cardiorespiratory||20 minutes/day on 3 days/week for a total of 75 minutes/week|
|Combination of moderate- and vigorous-intensity||To achieve a total energy expenditure of 500-1,000 MET-minutes/week***|
|Resistance||For each of the major muscle groups|
|Neuromotor||Involving balance, agility, and coordination, 2-3 days/week|
|Flexibility||For each the major muscle-tendon groups, a total of 1 minute per exercise on 2 days/week|