Recommend and They will Exercise – Or will They?

A major strength of the Weight Wise program lies in our links to Community Partners, who offer all forms of exercise ranging from walking clubs to personal trainers.

The question however is – how many patients, who get exercise recommendation from their doctors (or other health professionals), will actually follow through?

This issue was recently addressed by Willams and colleagues from the Centre for Health Sciences Research, Cardiff University, UK, in a Systematic Review. The eighteen studies reviewed included six RCTs, one non-randomised controlled study, four observational studies, six process evaluations and one qualitative study. Results from five RCTs were combined in a meta-analysis. There was a statistically significant increase in the numbers of participants doing moderate exercise with a combined relative risk of 1.20 (95% confidence intervals = 1.06 to 1.35).

This means that 17 sedentary adults would need to be referred to an exercise program for one of them to become moderately active.

On one hand this may sound frustrating (imagine the time spent on advising exercise to patients), on the other hand a Numbers Needed to Treat (NNT) of 17 is actually not worse than many of our medical treatments.

Of course the obvious barriers were identified: time, cost, distance, motivation, etc. Furthermore, exercise behaviour depended upon physical capacity to exercise; exercise beliefs and other factors such as enjoyment, social support, priority setting and context.

Interestingly, in another paper, the same group identified four types of patients: ‘long-term sedentary’ who had never exercised; ‘long-term active’ who continued to exercise; ‘exercise retired’ who used to exercise, but had stopped because of their symptoms (e.g. osteoarthritis), and because they believed that exercise was damaging their joints; and ‘exercise converted’ who recently started to exercise, and preferred a gym because of the supervision and social support they received there. This article is very much worth reading and the full text can be accessed by clicking here.