Intended for healthcare professionals

Observations Yankee Doodling

Why don’t people exercise, even a little?

BMJ 2015; 350 doi: (Published 04 June 2015) Cite this as: BMJ 2015;350:h3024
  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

There must be something we can do about it

Everyone knows that exercise is good for you. Physical inactivity is estimated to cause 3.2 million deaths a year globally, making it number four on the list of risk factors.1 In the United States, inactivity combined with poor diet is second only to smoking as a risk factor for death.2 There is much evidence showing that regular exercise is one of the most important things you can do for your health, better than any pill that we have.

Brief digression for a small rant: why do experts insist on the term “physical activity,” which sounds clinical and scientific, instead of “exercise,” which only sounds arduous and undesirable? (I guess I answered my own question.)

Anyway, physical activity is defined as anything that gets the skeletal muscles moving and that expends energy. The list of 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 control, bone strength, and, for elderly people, prevention of falls.3 4

Inactivity increasing

So it was disheartening, and even a little shocking, to read that a new survey found that more than 80 million Americans aged 6 years and older—28% of the population—reported that they engaged in no physical activity at all in 2014. Zero. Not one of a list of over 100 activities.5 6 No walking or playing catch or mowing the lawn or raking the leaves. No gardening or swimming or kicking a football around. The number of these 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

I understand that some people hate jogging and going to the gym. So do I. Thirty minutes of exercise a day, five days a week, is a pretty high bar for people who don’t like it very much. But how is it that somewhere between 25% and 30% of Americans get absolutely no exercise in a year? I know that today’s society and jobs are conducive to a sedentary lifestyle. Indeed, modern life for many requires it. Previously, many jobs and even housework required at least walking around, if not outright exercise. Now we spend all our time looking at screens of various sizes or behind the wheel of a car. Schools used to encourage, even mandate, physical activity. Now it is hard to find a school that does so, having eliminated or made optional what we used to call physical education. We are paying a high price for our modern habits and convenience.

Needed: strategies

What can we do about this? Some people like to go to gyms and work out and jog or run. Terrific, more power to them. Keep it up. But the rest of us need a strategy or a series of strategies from which we can choose.

These might include shortening the time for exercise by trying a high intensity interval training technique.9 This gets you out of breath fast but is over mercifully quickly, in a matter of a few minutes. Having low tech equipment such as elastic bands and benches readily available is another way to encourage brief intervals of physical activity. The automated commute can be countered by integrating walking into it: parking at the far end of the car park or getting off the bus or train a stop or two before your destination. At the very least people can stand up several times a day and walk around the office (or the block). Or try micro-bursts of exercise; one friend never walks short distances, breaking into a jog to go around the corner or catch a bus. Annoying but perhaps effective.

Some people are motivated by measurement. Virtually everyone is carrying a smartphone these days, many of which are equipped to measure physical activity. Pedometers are dirt cheap and easy to use. Noting that you’ve walked only 2500 steps by dinner time is a nice motivator for an after dinner stroll.

Clearly, motivation is the key, and doctors have a role in this too. The lesson of the brief smoking cessation intervention should not be lost on exercise: if the single most important thing a smoker can do for his or her health is to stop smoking, then the single most important thing a non-smoker can do may well be to figure out an exercise strategy. I know that experts have failed to find evidence that brief counseling by a physician to encourage exercise is effective,10 but common sense and public health urgency demand that we do something. Action is appropriate while we wait for better research to tell us what works best.

I’ve been writing this for too long. Must get up and walk around.


Cite this as: BMJ 2015;350:h3024


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