The American population is not only gaining in numbers but also expanding in poundage. Scientific and popular reports about the obesity epidemic are widely circulated, admonishing Americans to take action. Sedentary lifestyles and obesity directly impact the quality of life for millions of people.
As nurse practitioners (NPs), we appreciate the difficulties encountered when trying to motivate a patient to engage in regular physical activity to improve health and prevent disease. Using the phrase, "physical activity" instead of "exercise"may soften the request, but the collective behavior of Americans does not indicate acceptance or lasting change.
Clearer Guidelines
On August 1, 2007, the American College of Sports Medicine (ACSM) and the American Heart Association1 released two documents with new recommendations for physical activity; one for adults 18 to 65 years of age and a separate document for adults over 65 years. The new guidelines clarify, expand, and quantify in more specific terms information presented in the 1995 report from ACSM and the Centers for Disease Control and Prevention.
The 1995 guidelines recommended that all adults accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week. Debate continued over questions like do the 30 minutes have to be in one block of time or can they be accumulated throughout the day to achieve the same health benefits; was 30 minutes sufficient time; and what was the minimum number of days per week for a positive health effect?
The 2007 revisions advocate for moderate-intensity aerobic physical activity for a minimum of 30 minutes on 5 days each week or vigorous-intensity aerobic physical activity for a minimum of 20 minutes on 3 days each week. Activities from different intensity levels can be combined to meet individual daily goals. Additionally, the recommendations encourage individuals to engage in activities that maintain or increase muscular strength and endurance a minimum of 2 days a week.
Recommendations for adults over 65 years of age are modified to account for differences in aerobic capacity to include activities that maintain or increase flexibility as well as strengthen muscles and balance activities for older adults at risk of falls. Individuals of any age who choose to do more than the recommendations suggest will further decrease their risks for chronic diseases, disabilities, and weight gain.
Have a Realistic Plan
NPs promote physical activity as part of general counseling on lifestyle behaviors. Resources for professionals, including categorization of activities, are available on the Web sites of the three organizations referenced here. Activity plans should be realistic and as detailed as possible with the activity, intensity, frequency, and time clearly noted.
Modifications are indicated for persons with physical and mental disabilities or special health needs (such as pregnancy) or other restrictions. The plan should be developed in cooperation with the patient, thereby allowing the patient to share the responsibility for acceptance, implementation, and adherence. Physical activity is only one part of a comprehensive plan to achieve a healthier lifestyle. These new recommendations are useful additions to the many tools NPs utilize to improve their patients' overall health.
Jamesetta Newland, APRN, BC, FNP, FAANP, FNAP, PhD
Editor-in-Chief, [email protected]
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