Exercise Resistance

Recently I blogged about how few people actually take up the advise to be physically active, even when delivered by a health professional (e.g. click here).

A new study in the Lancet now shows how difficult it is, even with the greatest effort, to get a substantial proportion of people moving.

In this study by Kinmonth and colleagues from the General Practice and Primary Care Research Unit, University of Cambridge, 365 sedentary adults with a parental history of type 2 diabetes were randomly assigned to either receiving just a brief advise leaflet in the mail or a 1-year behaviour-change program, delivered either by trained facilitators in participants’ homes or to the same program delivered by telephone. The program was designed to alter behavioural determinants, as defined by the theory of planned behaviour, and to teach behaviour-change strategies.

Surprisingly, at 1 year, the physical-activity ratio of participants who received the intervention, by either delivery route, did not differ from the ratio in those who were simply given the brief advice leaflet.

The bottom line of this relatively large randomised trial is clear: A facilitated theory-based behavioural intervention, even when delivered with professional home trainers and individual counseling is no more effective than simply providing an advice leaflet for promotion of physical activity in an at-risk group.

I can only imagine how disappointed the investigators must have been having to conclude that health-care providers should remain cautious about commissioning behavioural programmes into individual preventive health-care services.

This seems very much in line with the large body of evidence that states that people will either exercise or they will not – those who like activity and have done it before will do it again – those who don’t – will refuse to do it (in the long term), no matter what.

Of course there will always be some exceptions, but these are likely to be few and far between – the majority is simply resistant to change.

Having predictors of who is likely to adopt exercise and who is not may be important in order to target advise (and resources) to those most likely to actually do it (and persist).

Once again – one-size is unlikely to fit all.