This post was authored by Deirdre J. Mattina, MD, of Henry Ford Hospital, Detroit, MI, and member of the Prevention of Cardiovascular Disease Section Leadership Council.

In my recent weeks of inpatient rounding I have been struck by the misperception of patient activity level reported by staff. Basically, anyone who is not bed-bound is “active.” We know from surveillance studies by the Centers for Disease Control and Prevention, however, that only half of adults and less than a third of youth meet aerobic physical activity guidelines. As we battle the obesity epidemic it has been increasingly important to not only advise heart healthy eating habits, but to emphasize the necessity for regular aerobic activity.

Health practitioners can feel uncomfortable discussing weight status with patients. We aim to use objective measures like BMI or waist circumference, but this can still sound judgmental to patients. There is also a marked difference in weight perception among different cultural and ethnic groups. I approach weight loss and sedentary behavior much like smoking cessation management: re-affirmation of current weight status and activity level followed by an assessment of desire and ability to make lifestyle changes. Weight loss or weight maintenance plans should be tailored to the patient’s 1) current activity level and comorbid conditions and 2) economic and social environment. Some patients do not have access to open spaces or recreation areas. Others may have the financial resources to hire a personal trainer or a lifestyle coach.

Henry Ford Hospital is fortunate to have a cardiac rehabilitation program that offers weight management and supervised exercise programs that are often covered by insurance. This is an invaluable resource which allows access to exercise physiologists, dieticians and nutritionists. My most frequent patient recommendation, however, is the daily use of a pedometer. This allows a much more objective measure of activity with goals that are simple to titrate. For working patients or those with family obligations, I suggest home exercise DVDs, which are available for most forms of exercise. For the technologically savvy, I advise mobile apps like, Lose It!, Map My Walk or 7 Minute Workout. The choices can be overwhelming and, therefore, it may be useful to pick one or two genres of activity (i.e. walking and Zumba) and change or escalate activity based on patient progress and goals.

There is no easy solution to encouraging effective lifestyle modifications. We should do our best to be supportive of patient efforts and always acknowledge the positive behavior even if all goals have not been met.

This post is part of a series of posts for American Heart Month. Check out the active living infographic poster below. To view a complete list of prevention-focused infographic posters, visit CardioSmart.org.

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