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A Little Nudge (to Exercise) Goes a Long Way

Jun 5, 2010


By Sheri Colberg, PhD


Feeling frustrated about how to get your patients to engage in more regular physical activity? Apparently, the answer may be as simple as giving people a little reminder to do it on occasion. An article that appeared in May in the Wall Street Journal reported on the latest findings of a study that effectively enhanced exercise compliance.


 The study, which was conducted by researchers at Stanford University, included 218 people who were divided into three groups. The subjects’ goal was to walk half an hour most days of the week, but what made this study unique was that a Stanford health educator called all the participants every three weeks or so over the course of a full year to ask them about their compliance. A second group of participants received computerized calls that made similar inquiries.

Regardless of whether the caller was human or a computer, the participants had to report the amount of exercise they performed during the past week. Participants were then congratulated on any exercise performed and asked how the level might be increased for the next week. When lapses occurred due to illness, travel or unforeseeable events, the call simply focused on reinforcing the importance of resuming workouts as soon as possible. All questions were positive, that is, designed to encourage rather than to berate participants.

After 12 months, the participants receiving calls from a live person were exercising on average about 178 minutes a week, a 78% increase from their starting level of about 100 minutes. Exercise levels in the group receiving computerized calls doubled to 157 minutes a week. A control group of participants receiving no calls exercised 118 minutes a week, up 28% from their initial level.  Thus, it appears that knowing that they were going to have to report back to someone or something on their exercise every few weeks was motivating to participants.  

This study is just one of a rapidly growing body of research showing that small amounts of social support, ranging from friends who encourage each other by email to do more physical activity to occasional meetings with a fitness counselor, can produce large and lasting gains in targeting sedentary behavior, which is undeniably one of Americans’ biggest health problems. Less than half of all adults in the United States meet recommendations of exercising half an hour most days of the week. Moreover, nearly all sedentary people at one time or another have resolved and failed to maintain participation in regular exercise programs.

Studies by other researchers have suggested that after eight weeks of regular exercising many people can settle into a long-term habit of working out. And, more importantly, most studies have suggested that when people are trying to change unhealthy behaviors, they generally need something more than willpower alone.  One such tool is social support, which helps prevent against relapse particularly in individuals who prefer to work out in groups (35-40% of Americans). The other ~60% of Americans prefer working out alone, especially people who have reached middle age and older who may socialize less frequently in groups. Such people may benefit most from joining a group or program that allows them to continue exercising on their own.

By way of example, in some states, health officials are sponsoring exercise programs that enable residents to join "teams" while working out on their own. In Kansas a program called "Walk Kansas" divides tens of thousands of participants into teams of six, with each team expected to walk the width of Kansas (about 430 miles) in eight weeks. Team members always walk on their own in their respective communities, but report their weekly mileage to each other. An added bonus is that participants in such programs usually continue exercising far above their original levels long past the end of the contest.

More good news is that prior studies have found that telephone interventions of nearly every kind increase the exercise levels of previously sedentary people. Participants who receive phone calls even just once a month have consistently increased their exercise levels above control groups. Other researchers have reported that short-term programs have also effectively used print, in person, or internet delivery of exercise programming and participation reminders, although the long-term effectiveness of such interventions has not been assessed. Studies also have yet to assess the full impact of employing the latest social media — such as cell phone text messages, iPhone applications, online communities (e.g., Facebook and Twitter), or other high-tech outlets — in the fight to increase exercise adherence, but it is clear that many inventive ways may be employed in the coming years to get and actually work to help keep all of us more physically active! Feel free to think up your own way to give your patients the little "nudge" they need that will keep them moving more every day.


To sign up for 5 free healthy living reports via e-mail or a 52-week fitness program delivered via e-mail, log on to www.lifelongexercise.com. For more information, also check out my web site at www.shericolberg.com. If you need tips for getting started on an exercise program, consult The 7 Step Diabetes Fitness Plan. People with any type of diabetes who are already more active may benefit from reading the Diabetic Athlete’s Handbook.

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