Fitness roadblocks

"I don't have the time right now."

"I'm too tired."

"Between work and the kids, it's impossible."

These common excuses are mainly responsible for the high percentage of people in the United States engaging in too little physical activity or none at all. The 1997 National Health Interview Survey showed 40 percent of adults do not exercise. Despite the importance of regular exercise to disease prevention and health promotion, the National Center for Health Statistics also reports an estimated 60 percent or more of adults are either inactive or underactive.

Reducing the risk of cardiovascular disease, hypertension, Type 2 diabetes and some cancers (e.g., prostate and colon/rectal) doesn't seem to be enough incentive to become active. Studies show a 50 percent dropout rate--most within the first few months--among those who start an exercise program. "Even among cardiac rehab patients who know exercise can help keep them alive, 50 percent still quit," says Jack Raglin, Ph.D., associate professor of kinesiology at Indiana University in Bloomington, Indiana.

Why aren't health benefits enough to get people moving? "We are asking people to exercise for the rest of their lives, so hopefully they won't have a heart attack. [But] that [is] not enough motivation," says Bess Marcus, Ph.D., director of the Physical Activity Research Center and professor of psychiatry and human behavior at Brown Medical School and Miriam Hospital in Providence, Rhode Island.

One of the keys to breaking down exercise barriers is understanding the short-term inconvenience versus the long-term benefits. Unfortunately, these benefits seem distant and intangible to many. Public awareness about exercise is outdated compared to the scientific research recognizing its importance. "Exercise is new in terms of promoted health behaviors," says Cynthia Castro, Ph.D., of the Stanford Center for Research and Disease Prevention, Stanford University School of Medicine, "but it's just a matter of time before it reaches out from the research world to the community, where it becomes more of a present message, like smoking cessation and drug abstinence."

In our busy world, lack of time is the most frequently cited excuse. For some, work responsibilities, family obligations and care-giving duties fill the day. "All the things that make life complicated often [deter] people [from continuing] their exercise habit," says Marcus. However, for many it's a time management or perception problem.

In a national survey of almost 3,000 women, ages 40 years or older, care-giving duties and lack of energy were two of the top four perceived barriers to physical activity across all ethnic groups. "Taking care of children or an aging relative seemed to take time away from [the participants'] freedom to exercise," says Castro, who was a key researcher in this study. Other excuses were lack of a safe place to exercise, tiredness, self-consciousness about physical appearance, poor health and fear of injury. Castro also points out that cost is an easily overlooked obstacle.

Stemming the tide of sedentary behavior among Americans requires finding ways to make them exercise. Whether you're trying to encourage someone to start an exercise regimen, get back into a program or maintain one, here are a few strategies:

* Time management

If finding an hour to exercise isn't possible for your client, accumulating moderate intensity activity throughout the day can be an alternate option. Tell your client to break his or her workout into two, three or even four components. If the cardiovascular portion must be done in the gym, perhaps strengthening exercises can be done at home with weights.

* Streamline a hectic schedule

Although you want to encourage optimal physical activity standards, if it is not possible, shoot for minimal recommendations. Ideally, one should strength train every other day, but a twice-weekly schedule may be more manageable. Consider the difference between moderate-intensity activity five times a week versus high-intensity exercise three times a week. Assuming the client's physical condition allows for it, exercising three times a week may seem less daunting.

* Focus on goals

"Once people [start] exercising and see the reality of trying to exercise on a regular basis, they [may] lose sight of the original long-term goals," says Castro. If you know what inspired your client to start a fitness program, you can revisit the subject later. Try pairing a long-term goal (e.g., improved fitness, increased muscle mass or toning) with a short-term goal (e.g., decreased heart rate, an added five or 10 minutes to a regular exercise session, walking or running a specified distance in a shorter amount of time or doing more laps around a track). Then, you can reinforce the original reason for exercise with tangible evidence of progress.

* Use telephone and mail reminders