We Asked 7 Doctors: How Do You Get Patients to Exercise?

We know exercise can be a powerful medical intervention. Now scientists are finally starting to understand why.
A recent study in rats found that exercise positively changes virtually every tissue in the body. The research was part of a large National Institutes of Health initiative called MoTrPAC (Molecular Transducers of Physical Activity Consortium) to understand how physical activity improves health and prevents disease. As part of the project, a large human study is also underway.
“What was mind-blowing to me was just how much every organ changed,” said cardiologist Euan Ashley, MD, a professor of medicine at Stanford University, Stanford, California, and the study’s lead author. “You really are a different person on exercise.”
The study examined hundreds of previously sedentary rats that exercised on a treadmill for 8 weeks. Their tissues were compared with a control group of rats that stayed sedentary.
Your patients, unlike lab animals, can’t be randomly assigned to run on a treadmill until you switch the machine off.
So how do you persuade your patients to become more active?
We asked seven doctors what works for them. They shared 10 of their most effective persuasion tactics.
1. Focus on the First Step
“It’s easy to say you want to change behavior,” said Jordan Metzl, MD, a sports medicine specialist at the Hospital for Special Surgery in New York City who instructs medical students on how to prescribe exercise. “It’s much more difficult to do it.”
He compares it with moving a tractor tire from point A to point B. The hardest part is lifting the tire off the ground and starting to move it. “Once it’s rolling, it takes much less effort to keep it going in the same direction,” he said.
How much exercise a patient does is irrelevant until they’ve given that tire its first push.
“Any amount of exercise is better than nothing,” Ashley said. “Let’s just start with that. Making the move from sitting a lot to standing more has genuine health benefits.” 
2. Mind Your Language
Many patients have a deep-rooted aversion to words and phrases associated with physical activity.
“Exercise” is one. “Working out” is another.
“I often tell them they just have to start moving,” said Chris Raynor, MD, an orthopedic surgeon based in Ottawa, Ontario. “Don’t think about it as working out. Think about it as just moving. Start with something they already like doing and work from there.”
3. Make It Manageable
This also applies to patients who’re injured and either waiting for or recovering from surgery.
“Joints like motion,” said Rachel Frank, MD, an orthopedic surgeon at the University of Colorado Sports Medicine, Denver, Colorado. “The more mobile you can be, the easier your recovery’s going to be.”
That can be a challenge for a patient who wasn’t active before their injury, especially if they’re fixed on the idea that exercise doesn’t matter unless they do it for 30-45 minutes at a time.
“I try to break it down into manageable bits they can do at home,” Frank said. “I say, ‘Look, you brush your teeth twice a day, right? Can you do these exercises for 5 or 10 minutes before or after you brush your teeth?'”
4. Connect Their Interests to Their Activity Level
Chad Waterbury, DPT, thought he knew how to motivate a postsurgical patient to become more active and improve her odds for a full recovery. He told her she’d feel better and have more energy — all the usual selling points.
None of it impressed her.
But one day she mentioned that she’d recently become a grandmother for the first time. Waterbury, a physical therapist based in Los Angeles, noticed how she lit up when she talked about her new granddaughter.
“So I started giving her scenarios, like taking her daughter to Disneyland when she’s 9 or 10. You have to be somewhat fit to do something like that.”
It worked, and Waterbury learned a fundamental lesson in motivation. “You have to connect the exercise to something that’s important in their life,” he said.
5. Don’t Let a Crisis Go to Waste
“There are very few things more motivating than having a heart attack,” Ashley said. “For the vast majority of people, that’s a very sobering moment where they reassess everything in their lives.”
There’ll never be a better time to persuade a patient to become more active. In his cardiology practice, Ashley has seen a lot of patients make that switch.
“They really do start to prioritize their health in a way they never did before,” he said.
6. Emphasize the Practical Over the Ideal
Not all patients attach negative feelings to working out. For some, it’s the goal.
Todd Ivan, MD, calls it the “‘I need to get to the gym’ lament”: Something they’ve aspired to but rarely if ever done.
“I tell them I’d welcome a half-hour walk every day to get started,” said Ivan, a consultation-liaison psychiatrist at Summa Health in Akron, Ohio. “It’s a way to introduce the idea that fitness begins with small adjustments.”
7. Go Beneath the Surface
“Exercise doesn’t generally result in great weight loss,” said endocrinologist Karl Nadolsky, DO, an obesity specialist and co-host of the Docs Who Lift podcast.
But a lot of his patients struggle to break that connection. It’s understandable, given how many times they’ve been told they’d weigh less if they moved more.
Nadolsky tells them it’s what’s on the inside that counts. “I explain it as very literal, meaning their physical health, metabolic health, and mental health.”
By reframing physical activity with an internal rather than external focus — the plumbing and wiring vs the shutters and shingles — he gives them permission to approach exercise as a health upgrade rather than yet another part of their lifelong struggle to lose weight.
“A significant number of our patients respond well to that,” he said.
8. Appeal to Their Intellect
Some patients think like doctors: No matter how reluctant they may be to change their mind about something, they’ll respond to evidence.
Frank has learned to identify these scientifically inclined patients. “I’ll flood them with data,” she said. “I’ll say, ‘These studies show that if you do x, y, z, your outcome will be better.'”
Ashley takes a similar approach when his patients give him the most common reason for not exercising: “I don’t have time.”
He tells them that exercise doesn’t take time. It gives you time.
That’s according to a 2012 study of more than 650,000 adults that associated physical activity with an increased lifespan.
As one of the authors said in an interview, a middle-aged person who gets 150 minutes a week of moderate exercise will, on average, gain 7 more minutes of life for each minute of exercise, compared with someone who doesn’t get any exercise.
The strategy works because it brings patients out of their day-to-day lives and into the future, Ashley said.
“What about your entire life?” he asks them. “You’re actually in this world for 80-plus years, you hope. How are you going to spend that? You have to think about that when you’re in your 40s and 50s.”
9. Show Them the Money
Illness and injury, on top of everything else, can be really expensive.
Even with good insurance, a health problem that requires surgery and/or hospitalization might cost thousands of dollars out of pocket. With mediocre insurance, it might be tens of thousands.
Sometimes, Frank said, it helps to remind patients of the price they paid for their treatment. “I’ll say, ‘Let’s get moving so you don’t have to pay for this again.'”
Protecting their investment can be a powerful motivation.
10. Make It a Team Effort
While the doctors we interviewed have a wide range of specialties — cardiology, sports medicine, psychiatry, endocrinology, orthopedics, and physical therapy — their patients have one thing in common.
They don’t want to be in a doctor’s office. It means they have something, need something, or broke something.
It might be a treatable condition that’s merely inconvenient or a life-threatening event that’s flat-out terrifying.
Whatever it is, it pulls them out of their normal world. It can be a lonely, disorienting experience.
Sometimes the best thing a doctor can do is stay connected with the patient. “This is like a team sport,” Frank tells her patients. “I’m going to be your coach, but you’re the captain of the team.”
In some cases, she’ll ask the patient to message her on the portal after they’ve completed their daily or weekly exercises. That alone might motivate the patient — especially when she responds to their messages.
After all, nobody wants to let the coach down.
 
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