Photo Credit: Jacob Wackerhausen

Strategies physicians can use to help patients navigate their physical activity routines and to understand the importance of physical activity in their lives.

Navigating how to counsel patients regarding their physical activity routines is challenging. Many patients suffer from physical limitations and competing personal and professional demands within our complex society, leading them to elude regular exercise as part of their daily routines. Add to this what must feel like a tremendous number of fitness offerings, and we begin understanding our patients’ multidimensional challenges.

Patients often ask me about the best exercise regimen to help prevent disease, support optimal health, improve quality of life, and contribute to longevity. My simple answer is to follow the physical activity regimen that you enjoy, that becomes habitual, and that is aimed at improving health rather than causing further injury.

The fitness program industry has many offerings that aim to support one’s path to health and happiness through exercise. The choices can be overwhelming, and many people do not know where to begin. While I am a proponent of several group fitness classes that increase accountability and consistency, I often share with my patients that the foundation of good physical health does not require a gym or even fitness equipment.

The Impact of Simple Exercises: A Meta-Analysis on Stair Climbing

In April 2024, the European Society of Cardiology Scientific Congress researchers presented a new meta-analysis that included 480,479 participants. As a review, a meta-analysis is a study that collects the best available evidence to explore potential treatment benefits or drawbacks by using data made available in smaller clinical trials to develop a conclusion with greater statistical power. This conclusion is statistically stronger than the analysis of any single study due to increased numbers of subjects, greater diversity among subjects, or accumulated effects and results. This study investigated whether climbing stairs, as a form of physical activity, could reduce the risks of cardiovascular disease and premature death. The authors looked at healthy participants and those with a previous history of cardiovascular disease and aged 35 to 84. 53% of participants were women. Compared with not climbing stairs, stair climbing was associated with a 24% reduced risk for dying from any cause (RR, 0.76; 95% CI, 0.62-0.94; P=0.01) and a 39% lower likelihood of dying from cardiovascular disease (RR 0.61; 95% CI, 0.48–0.79; P<0.001). Stair climbing was also linked with a reduced risk for cardiovascular disease, including heart attack, heart failure, and stroke.

Physiologically, this makes sense. Climbing steps increase heart rate and cardiac output, or the blood the heart pumps in one minute, improving circulatory status. While certain patients with more advanced physical activity routines may find climbing stairs basic and mundane, an important conclusion from this study is that making conscious choices at home or work to promote regular moderate-intensity cardiovascular activity is essential. Taking stairs can also increase muscle strength, improve body composition, increase insulin sensitivity, and reduce blood pressure.

Colleagues from the Universidad de Navarra and I conducted a similar prospective study in 2021 that examined whether self-perceived walking pace reduced the incidence of hypertension in a cohort of 15,357 university graduates initially free of chronic disease or hypertension after adjusting for established risk factors. The study found that participants who walked at a very brisk pace at baseline had a substantially lower risk for developing hypertension during an average follow-up of more than ten years than those who walked at a slow pace (multivariable-adjusted hazard ratio: 0.64; 95% CI: 0.41-0.99). This was independent of total time spent walking and other hypertension-related factors.

Establishing Healthy Habits

Taking the stairs and walking briskly are initially conscious choices that become habits when practiced regularly. The key is helping our patients understand why these choices are valuable and helping them set their mindsets to make these choices a personal benefit and not a chore. This requires empowering a patient’s intrinsic motivation through careful questions and encouraging support.

Many patients may be initially limited by cardiac, pulmonary, or orthopedic ailments but can be supported through guided physical therapy to improve their exercise tolerance, strength, and stability. Likewise, group fitness programs can augment the benefits gained with habits tailored to the individuals’ preferences and fitness goals by holding patients accountable as they meet trainers and other participants who are “in this together.”

Like the other foundational pillars of health discussed in previous columns, helping patients navigate their physical activity routines takes time. These pillars should be prioritized despite the many competing interests within a patient-physician encounter. In upcoming columns, I will discuss prioritizing the foundational aspects of health within physician-patient encounters.