BMJ 2015;350:h3024 doi: 10.1136/bmj.
h3024 (Published 4 June 2015) Page 1 of 2
Observations
OBSERVATIONS
YANKEE DOODLING
Why don’t people exercise, even a little?
There must be something we can do about it
Douglas Kamerow senior scholar, Robert Graham Center for policy studies in primary care, professor
of family medicine, Georgetown University, and associate editor, The BMJ
so called “inactives” has grown each year since the annual
surveys began in 2007.
The US Centers for Disease Control and Prevention says that
26.3% of US adults engaged in no leisure-time activity in 2013.
Respondents were classified as participating in no leisure-time
physical activity if they responded “no” to the question, “During
the past month, other than your regular job, did you participate
in any physical activities or exercises such as running,
calisthenics, golf, gardening, or walking for exercise?” CDC
also found that less than half of Americans meet the standard
of 150 minutes a week of physical activity that was set in
2008.7 8
Everyone knows that exercise is good for you. Physical I understand that some people hate jogging and going to the
inactivity is estimated to cause 3.2 million deaths a year globally, gym. So do I. Thirty minutes of exercise a day, five days a week,
making it number four on the list of risk factors.1 In the United is a pretty high bar for people who don’t like it very much. But
States, inactivity combined with poor diet is second only to how is it that somewhere between 25% and 30% of Americans
smoking as a risk factor for death.2 There is much evidence get absolutely no exercise in a year? I know that today’s society
showing that regular exercise is one of the most important things and jobs are conducive to a sedentary lifestyle. Indeed, modern
you can do for your health, better than any pill that we have. life for many requires it. Previously, many jobs and even
Brief digression for a small rant: why do experts insist on the housework required at least walking around, if not outright
term “physical activity,” which sounds clinical and scientific, exercise. Now we spend all our time looking at screens of
instead of “exercise,” which only sounds arduous and various sizes or behind the wheel of a car. Schools used to
undesirable? (I guess I answered my own question.) encourage, even mandate, physical activity. Now it is hard to
find a school that does so, having eliminated or made optional
Anyway, physical activity is defined as anything that gets the
what we used to call physical education. We are paying a high
skeletal muscles moving and that expends energy. The list of
price for our modern habits and convenience.
benefits of regular physical activity grows each year and
includes decreased risk of heart disease, diabetes, some cancers,
and depression and dementia, along with help with weight Needed: strategies
control, bone strength, and, for elderly people, prevention of What can we do about this? Some people like to go to gyms
falls.3 4 and work out and jog or run. Terrific, more power to them. Keep
Inactivity increasing it up. But the rest of us need a strategy or a series of strategies
from which we can choose.
So it was disheartening, and even a little shocking, to read that
These might include shortening the time for exercise by trying
a new survey found that more than 80 million Americans aged
a high intensity interval training technique.9 This gets you out
6 years and older—28% of the population—reported that they
of breath fast but is over mercifully quickly, in a matter of a
engaged in no physical activity at all in 2014. Zero. Not one of
few minutes. Having low tech equipment such as elastic bands
a list of over 100 activities.5 6 No walking or playing catch or
and benches readily available is another way to encourage brief
mowing the lawn or raking the leaves. No gardening or
intervals of physical activity. The automated commute can be
swimming or kicking a football around. The number of these
countered by integrating walking into it: parking at the far end
[email protected]
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
BMJ 2015;350:h3024 doi: 10.1136/bmj.h3024 (Published 4 June 2015) Page 2 of 2
OBSERVATIONS
of the car park or getting off the bus or train a stop or two before I’ve been writing this for too long. Must get up and walk around.
your destination. At the very least people can stand up several
times a day and walk around the office (or the block). Or try 1 World Health Organization. Health topics: physical activity. 2014. www.who.int/topics/
physical_activity/en/.
micro-bursts of exercise; one friend never walks short distances, 2 Mokdad AH, Marks, JS, Stroup DF, et al. Actual causes of death in the United States,
breaking into a jog to go around the corner or catch a bus. 2000. JAMA 2004;291:1238-124.
3 Reiner M, Niermann C, Jekauc D, Woll A. Long-term health benefits of physical activity:
Annoying but perhaps effective. a systematic review of longitudinal studies. BMC Public Health 2013;13:813.
Some people are motivated by measurement. Virtually everyone 4 Centers for Disease Control and Prevention. The benefits of physical activity. 2011. www.
cdc.gov/physicalactivity/everyone/health/index.html.
is carrying a smartphone these days, many of which are equipped 5 Germano S. American inactivity level is highest since 2007, survey finds. Wall Street
to measure physical activity. Pedometers are dirt cheap and easy Journal 23 Apr 2015. www.wsj.com/articles/american-inactivity-level-is-highest-since-
2007-survey-finds-1429796821.
to use. Noting that you’ve walked only 2500 steps by dinner 6 Physical Activity Council. 2013 participation report. 2015. www.physicalactivitycouncil.
time is a nice motivator for an after dinner stroll. com/PDFs/2013_PAC_Overview_Report_Final.pdf.
7 Centers for Disease Control and Prevention. Facts about physical activity. 23 May 2014.
Clearly, motivation is the key, and doctors have a role in this www.cdc.gov/physicalactivity/data/facts.html.
too. The lesson of the brief smoking cessation intervention 8 Department of Health and Human Services, Centers for Disease Control and Prevention,
National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition,
should not be lost on exercise: if the single most important thing Physical Activity and Obesity. Nutrition, physical activity and obesity data: trends and
a smoker can do for his or her health is to stop smoking, then maps. www.cdc.gov/nccdphp/DNPAO/index.html.
9 Reynolds G. The scientific 7-minute workout. New York Times 9 May 2013. http://well.
the single most important thing a non-smoker can do may well blogs.nytimes.com/2013/05/09/the-scientific-7-minute-workout/.
be to figure out an exercise strategy. I know that experts have 10 Lin JS, O’Connor E, Whitlock EP, Beil TL. Behavioral counseling to promote physical
activity and a healthful diet to prevent cardiovascular disease in adults: a systematic
failed to find evidence that brief counseling by a physician to review for the US Preventive Services Task Force. Ann Intern Med 2010;153:736-50.
encourage exercise is effective,10 but common sense and public
health urgency demand that we do something. Action is Cite this as: BMJ 2015;350:h3024
appropriate while we wait for better research to tell us what © BMJ Publishing Group Ltd 2015
works best.
For personal use only: See rights and reprints http://www.bmj.com/permissions Subscribe: http://www.bmj.com/subscribe
