How do you get patients to exercise?

We know that exercise can be an effective medical intervention. Now scientists are finally beginning to understand why.

A recent study in rats found that exercise positively alters virtually every tissue in the body. The research was part of a major National Institutes of Health initiative called MoTrPAC (Molecular Transducers of Physical Activity Consortium) to understand how physical activity improves health and prevents disease. A large human study is also currently underway as part of the project.

“What blew me away was how much each organ changed,” said cardiologist Euan Ashley, MD, professor of medicine at Stanford University in Stanford, California, and lead author of the study. “When you exercise, you really are a different person.”

The study involved hundreds of rats that had not previously engaged in physical activity and exercised on a treadmill for 8 weeks. Their tissue was compared with that of a control group of rats that had not engaged in physical activity.

Unlike laboratory animals, your patients cannot be randomly assigned to run on a treadmill until you turn off the machine.

How do you convince your patients to become more active?

We asked seven doctors what works for them. They revealed ten of their most effective persuasion tactics.

1. Focus on the first step

“It’s easy to say you want to change your behavior,” says Dr. Jordan Metzl, a sports medicine specialist at the Hospital for Special Surgery in New York City who teaches medical students how to prescribe exercise. “It’s much harder to put it into action.”

He compares it to moving a tractor tire from point A to point B. The hardest part is getting the tire off the ground and getting it moving. “Once it’s rolling, it takes a lot less force to keep it going in the same direction,” he said.

How much sport a patient does is irrelevant until he puts weight on the tire for the first time.

“Any amount of exercise is better than nothing,” Ashley said. “Let’s just start with that.” The transition from sitting to standing has real health benefits .”

2. Pay attention to your language

Many patients have a deep-rooted aversion to words and expressions associated with physical activity.

“Practice” is one thing. “Training” is another.

“I often tell them they just need to start moving,” said Dr. Chris Raynor, an orthopedic surgeon in Ottawa, Ontario.Don’t think of it as training. Think of it as just exercise. Start with something you already enjoy and work from there.”

3. Make it manageable

This also applies to patients who are injured and are either waiting for surgery or recovering from surgery.

“Joints like movement,” says Dr. Rachel Frank, an orthopedic surgeon at the University of Colorado Sports Medicine in Denver, Colorado. “The more mobile you are, the easier your recovery will be.”

This can be challenging for a patient who was not active prior to their injury, especially if they believe that physical activity is of no benefit unless they do it for 30 to 45 minutes at a time.

“I try to break it down into manageable steps that they can do at home,” Frank said. “I say, ‘Look, you brush your teeth twice a day, right?’ Can you do these exercises 5 or 10 minutes before or after brushing your teeth?‘”

4. Link their interests to their activity level

Chad Waterbury, DPT, thought he knew how to motivate a post-surgery patient to become more active and improve her chances of a full recovery. He told her she would feel better and have more energy—all the usual sales pitches.

None of this impressed her.

But one day she mentioned that she had recently become a grandmother for the first time. Waterbury, a physical therapist in Los Angeles, noticed how she blossomed as she talked about her new granddaughter.

“So I started presenting her with scenarios like taking her daughter to Disneyland when she’s 9 or 10. You have to be reasonably fit for something like that.”

It worked and Waterbury learned a fundamental lesson in motivation. “You have to connect the exercise with something that is important in their lifehe said.

5. Don’t let a crisis go to waste

“There are few things more motivating than a heart attack,” Ashley said. “For the vast majority of people, it’s a very sobering moment where they reevaluate everything in their lives.”

There will never be a better time to encourage a patient to be more activeAshley has seen many patients in his cardiology practice make this transition.

“They’re really starting to prioritize their health more than they ever have before,” he said.

6. Emphasize the practical over the ideal

Not all patients associate training with negative feelings. For some, it is the goal.

Todd Ivan, MD, calls it the “I have to go to the gym” complaint: something they strive for but rarely or never do.

“I tell them I would appreciate a half-hour walk a day to start,” said Ivan, a consulting psychiatrist at Summa Health in Akron, Ohio. “It’s a way to to introduce the idea that fitness starts with small adjustments.”

7. Go beneath the surface

“Exercise generally doesn’t lead to great weight loss,” says endocrinologist Karl Nadolsky, DO, an obesity specialist and co-host of the “Docs Who Lift” podcast.

But many of his patients have a hard time breaking that connection. That’s understandable, considering how often they’ve been told they’ll weigh less if they exercise more.

Nadolsky tells them that it’s what’s on the inside that counts. “I explain it quite literally and by that I mean their physical health, their metabolic health and their mental health.”

From Reorienting physical activity with an internal rather than an external focus – the plumbing and electrical vs. the shutters and roof shingles – it gives them permission to view exercise as an improvement in their health, rather than just another part of their lifelong struggle to lose weight.

“A significant number of our patients respond well,” he said.

8. Appeal to their intellect

Some patients think like doctors: no matter how much they don’t want to change their minds about something, they react to evidence.

Frank has learned to identify these scientifically interested patients. “I will flood them with datashe said. “I would say, ‘These studies show that your outcome is better if you do x, y, z.'”

Ashley takes a similar approach when his patients tell him the most common reason why they don’t exercise: “I don’t have time.”

He tells them that Practice doesn’t take time. It gives you time.

This is according to a 2012 study involving more than 650,000 adults that linked physical activity to longer lifespan.

One of the authors said in an interview that a middle-aged person who does 150 minutes of moderate exercise per week gains, on average, 7 minutes more life for each minute of exercise than someone who does no exercise at all.

The strategy works because it takes patients out of their everyday lives and guides them toward the future, Ashley said.

“And what about your entire life?” he asks her. “You’re hopefully in this world for over 80 years. How are you going to spend that? That’s something you’ll have to think about when you’re in your 40s and 50s.”

9. Show them the money

Illnesses and injuries can be very expensive on top of everything else.

Even with good insurance, a health problem that requires surgery and/or hospitalization can cost thousands of dollars out of pocket. With mediocre insurance, it can be tens of thousands.

Sometimes, Frank says, it helps to remind patients of the price they paid for their treatment. “I then say: ‘Let’s get started so you don’t have to pay for it again‘.”

Protecting your investment can be a powerful motivator.

10. Make it a team effort

The doctors we surveyed have a wide range of specialties – cardiology, sports medicine, psychiatry, endocrinology, orthopedics and physiotherapy – but their patients have one thing in common.

They don’t want to go to a doctor’s office. It means they have something, need something, or have broken something.

It could be a treatable condition that is merely a nuisance, or a life-threatening event that is simply frightening.

Whatever it is, it takes them out of their familiar world. It can be a lonely, disorienting experience.

Sometimes the best thing for a doctor to do is stay in touch with the patient.”It’s like a team sportFrank tells her patients. “I will be your coach, but you are the captain of the team.”

In some cases, she asks patients to send her a message through the portal after completing their daily or weekly exercises. This alone can motivate patients – especially if she responds to their messages.

After all, nobody wants to let the coach down.