Staying active is one of the best ways to keep your body healthy. It can also improve your overall well-being and quality of life by relieving stress, anxiety, depression and anger.
Maintaining or increasing physical activity is also a key lifestyle change that can help reverse prediabetes and lower blood pressure. But knowing what type of activity to choose—whether it is moderate or vigorous physical activity—and how to start can be confusing.
The AMA’s What Doctors Wish Patients Knew™ series gives physicians a platform to share what they want patients to understand about today’s health care headlines and how to take charge of their health through preventive care.
In this installment, three physicians discuss what patients need to know about physical activity. They are:
- Aeshita Dwivedi, MD, a cardiologist with Northwell Health in New York City and director of ambulatory cardiac CT at Concorde Medical Center in Manhattan.
- Philip Solomon, MD, a geriatrician who directs geriatric education and clinical integration at Northwell Health in Lake Success, New York.
- Fatima Cody Stanford, MD, MPH, MPA, an obesity medicine physician in Boston.
Northwell Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Physical activity offers a host of benefits
“We know that there's a ton of benefit to anyone just moving around,” said Dr. Solomon. “So, any type of physical activity gives us incredible benefits—everything from cognitive benefits to mood benefits to physical benefits and also the ability to reduce the risk of chronic disease.”
“For people who do have chronic diseases such as high blood pressure or diabetes, physical activity can be beneficial to helping control those diseases,” he said. “And it could also help with healthy aging. We know that people who move around more, and especially people who may have more specific exercise routines, they can live longer but not just live longer, live healthier.”
“Physical activity is really important for your whole body. It helps with everything. It helps keep your heart healthy, it’s a great stress reliever and it is shown to help your brain function,” said Dr. Dwivedi. “It also helps maintain a balanced weight, which in turn prevents the development of conditions such as diabetes, heart disease, high blood pressure and obesity.”
“It also helps to keep your muscles and joints healthy,” she said, noting “it ensures that you have a high functioning lifestyle and it also helps your respiratory system in the sense that when you exercise, it conditions your heart, lungs, brain and blood vessels.”
It’s about getting the body moving
“When we're talking about it in terms of health status, you'll often hear people say things like we want you to have moderate or vigorous physical activity,” said Dr. Stanford. “And those things are a little bit confusing to people. What is moderate and what is vigorous?
“Most doctors will say to you that we want you to get 150 minutes of moderate intensity physical activity,” said Dr. Stanford. “Moderate means that you could talk during the activity, but not sing during the activity unless you were Beyonce performing during a concert where you could possibly do both.”
“When you’re doing vigorous activity, you can’t talk or sing because the level of intensity,” she said. “A moderate activity may be brisk walking, for example, or a light jog whereas vigorous intensity might be something like high intensity interval training.”
Dr. Stanford added that “some people are unable to use their lower extremities or their upper extremities or have conditions with limited use of those. You want to make sure that the physical activity is applicable to the person you’re speaking with.”
There’s no bad time to start exercising
When it comes to physical activity, “certainly, there’s no bad time to ever start exercise,” said Dr. Solomon. “Someone who says they want to start early on and get into that routine, that’s great.
“But at the same time, for people who may not have exercised much or have lived a relatively sedentary lifestyle, it’s not too late,” he added. “No matter what age you are, that’s the right time to start moving around.”
Get 150 minutes of moderate activity
“Most people will say at least 150 minutes of moderate intensity physical activity minutes per week,” said Dr. Stanford. “If you look at the guidelines out by the Centers for Disease Control and Prevention and American College of Sports Medicine, we're looking at 75 minutes of vigorous activity,” which is equivalent to the 150 minutes of moderate activity.
“This is where you can do short burst of activity—that high intensity—and then consolidate the number of minutes spent doing the work. This is the key recommendation we see,” she added.
“In terms of trying to do strength training, the goal is to reach at least two days a week of that,” said Dr. Solomon, noting “these are not blocked times. We’re not saying on Monday, make sure you do 150 minutes of brisk walking.
“These are things that we like to break into sessions,” he added. “So, the way that we like to think about it is, if you could do five, 30-minute sessions a week of brisk walking, or if you're doing three 25-minute sessions a week of running or cycling, you're definitely meeting those thresholds.”
Don’t get stuck on 10,000 steps a day
“The 10,000-step mark, there's not a ton of evidence where that exact number came from. It's a really nice round number,” said Dr. Solomon. “It sounds good and it's a great way to say, ‘I reached my 10,000 steps today,’ and 10,000 steps is objectively a great number of steps. It means you really moved around.
“But from the research that we do have on this topic moving around as much as four to 5,000 steps a day certainly starts to show some tangible benefit,” he added. “Once you reach probably seven to 8,000 steps, the rate of return might be slightly less.”
“That's not to discourage someone and say stop at 4,000 or stop at 5,000, but if you're at 9,900 or 10,000 it's not a huge difference that we're at least aware of in terms of benefits,” Dr. Solomon said. “We do know that the more you move, the more you walk, it does correlate with the lower risk of mortality.”
“Any movement is better than nothing,” he said, emphasizing that even “if you're moving around one to 2,000 steps a day, that is way better than zero.”
Start slow and build up activity levels
When starting physical activity, people need “to start low and go slow,” said Dr. Dwivedi. “Especially in January, everybody's motivated with New Year’s resolutions and joining the gym, but don't go crazy right off the bat.
“It's so important to build up to it because injuries are probably the biggest thing that we see when patients go too hard, too fast,” she added.
Balance aerobic activity with strength training
“It's important to have a balance between aerobic—or what we call cardiovascular activity—and strength training. Both of them not only have benefits, but they add to each other,” Dr. Dwivedi said. “Let’s say you are brisk walking, which is a great physical activity, but if you're not strength training, your bones and muscles are not going to be as strong and developed as if you incorporated some.”
“If you are someone who works out maybe four times a week, do two sessions of cardio and two of strength training,” she said. “Now, that's not a hard-and-fast rule. You have to do what you enjoy. So, if you're someone who really loves to run, yes, you can do maybe a little more cardio and a little less weight training.
“But if you’re a runner, if you do strength training, it actually makes you a better runner because it conditions your muscles and it makes you stronger,” Dr. Dwivedi added. It’s the same with aerobic or cardiovascular activity. If you like to lift weights, you can actually lift better because your lungs and heart are in better shape.”
“Aerobic activity and strength training compliment each other, so try to balance them out,” she said. “But it’s important to incorporate both because cardiac activity helps the heart, lungs and blood vessels, and then strength training helps your joints and your bones to stay strong.”
With obesity, increase minutes
When it comes to weight, though, physical activity minutes go up, said Dr. Stanford. “So, when persons have obesity, we recommend typically 300 minutes of moderate intensity physical activity.
“People are unaware that the exercise volume should go up when you struggle with excess weight,” she added.
Find a workout you enjoy
“You have to listen to your body. Therefore, personalizing physical activity to one person is extremely important,” said Dr. Stanford. “For many of us who are adults, we've learned things that we like and what we don't like.
“Then maybe there are things that we haven't tried, that have always been on our list or radar of things that we want to consider,” she added. “If walking is your favorite activity, there’s a lot of ways to do that—both inside and outside, using hills or different terrain types to get different intensities.”
“I always tell my patients it's important to do what you enjoy. That's probably the first thing because sustainability is the most important thing,” said Dr. Dwivedi. Nearly “anybody can do CrossFit for a month, but are you going be doing it for two years? That's the big question.”
“If you're someone who enjoys yoga, Pilates for toning and strength training, or you're a gym rat and you like to go lift weights on the squat rack,” she said, “all of those are fine as long as you are doing something to tone and strengthen.”
For Dr. Stanford, “I adore dance workouts. I adore kickboxing. These things make my heart smile. Those particular types of workouts are what I consider my soulmate workouts—they fit my personality type.”
“When people find workouts they enjoy doing, those are the ones they’re going to sustain for the next 10, 20, 30, 40 years,” she said.
Exercise helps maintain your weight
“Physical activity actually doesn't typically cause a lot of weight loss, which is disappointing when I say that to people,” said Dr. Stanford. “Many people join gyms on January 1st, and they go to work out to lose weight and on February 1st, they recognize that they haven't lost any weight.”
That’s “because, on average, physical activity helps us to maintain our weight. It does not typically generate weight loss,” she said. “I like to emphasize that with patients as they go and toil away in the gym and are concerned about why they’ve only lost a fraction of a pound.
“It’s because that in and of itself, it doesn’t lead to significant weight shifts, but it does lead to weight stability,” Dr. Stanford added.
Build purposeful activity at home
“When we look at a sedentary lifestyle, these are individuals who spend most of their day sitting and don't ever have any purposeful movement,” said Dr. Stanford. “And by purposeful movement I mean that you get up with intention of being active.”
But since the COVID-19 public health emergency, “this looks very different because we are doing a lot of working from home,” she added. “Maybe one’s physical activity was just that journey to work. Maybe they did a lot of walking to work and from work, and maybe they’re unable to do that in this more virtual era.”
“What I would do is, challenge those individuals to consider building a purposeful activity,” said Dr. Stanford. “Maybe you start your day off with the workout inside of your home, apartment or wherever you are or maybe you conclude your day with something.”
Start your day with exercise
“Not everyone is a morning workout person, but the reason why I say start your day with exercise is because if you wait until the louder portions of the day, I find that additional tasks and meetings get added,” said Dr. Stanford. “And by the time I’m finished, we’re talking maybe nine or even 10 at night.
“If I’ve gotten my workout in early in the morning, I’m not sitting there lamenting about why I didn’t get that workout in early,” she added.
It's about “scheduling it, placing it on your calendar, developing tools and strategies that make it a little bit harder to skip it,” said Dr. Stanford.
Set goals for yourself
It is important to set goals, but “not in terms of setting a goal weight,” said Dr. Stanford. Instead, it is about “setting what type of output you want to generate.”
“Maybe when you start your exercise regimen, you’re only able to walk for five minutes and after that you feel like, ‘Oh my gosh, I’m out of shape. I haven’t been walking,’” she said. “So maybe your next goal is walking for six minutes and then your next goal is 10 minutes.”
“We have to condition our bodies to get us to a point where we are able to build up our level of endurance and improve overall health in doing so,” Dr. Stanford said.
Change doesn’t happen overnight
“It's like preparing for a final exam—you wouldn't go and take the final exam in a class if you had not taken the class or studied in the class,” Dr. Stanford explained. “We have to prepare ourselves to get to that level of accomplishment.”
“We can’t assume that on day one we’re going to be able to do tuck jumps over our sofa and be fine. We have to gradually achieve these goals to be safe,” she said, noting that “a lot of times people jump into really aggressive exercise regimens, and they cause injuries,” which “are setbacks to your physical activity.”
Take rest days between activities
“Your body gets strong when you rest, so I always tell my patients take at least one rest day,” said Dr. Dwivedi, noting physical activity levels are “something that you have to build up to.”
“If you’re someone who’s just starting to work out, you may want to take more recovery time because your body is getting used to it,” she said. “So, maybe you want to start twice a week or every other day. It doesn’t mean that on your recovery day or rest day that you have to be sedentary.
“You could do light stretching or you could go for a short walk just to keep the muscles going, but you don’t want to be doing a hard workout every day because that sets you up for injuries,” Dr. Dwivedi added.
Physical activity shouldn’t be torture
People often look at physical activity “as a torture device or something. It doesn't have to be that way,” said Dr. Stanford. “People find things that they enjoy, and they just never knew they enjoyed it because they never even took the time to explore it.”
“One of the questions I ask my patients in each of their visits is, ‘What type of activity do you enjoy?’” she said. That’s “because what they enjoy is what they'll do. It's about finding what works for you and exploring it if you've never done it before.”
It’s OK to take a week off
“Life gets in the way. Maybe you’re traveling or you have family visiting and you’ve been really busy or some health issue came up or you have COVID-19 or any other respiratory infection, and you can’t work out,” said Dr. Dwivedi. “It’s totally fine if you take a week off—your body is so adaptable.”
“It’s important to stay as consistent as possible, but perfection is the enemy of good,” she said. “Is it great to be perfect about working out? Yes, but maybe you lost a week or two and couldn’t work out and that’s OK too.”
If that happens, “just start a little slower than you were so that your body can get into it and just get back into it,” Dr. Dwivedi said.
