By David Carfagno, DO, CAQSM, ACSM (EP-c), Medical Director, Medical Fitness | HonorHealth Sports Medicine 

Physical activity remains one of the most powerful preventative medicine tools at our disposal, yet many patients struggle to establish and maintain regular exercise habits. A recent study found that nearly one third of the world’s adult population are physically inactive and it’s projected to rise to 35% by 2030. As medical professionals, we have both the opportunity and responsibility to guide our patients toward achievable activity goals that can significantly impact their health outcomes.  
Evidence-based recommendations 

General physical activity recommendations for adults (18-64 years) 

1. Aerobic activity: Aim for 150-300 minutes of moderate-intensity aerobic activity or 75-150 minutes of vigorous-intensity activity weekly. This can be achieved with a combination of moderate and vigorous activity, as it supports cardiovascular health and overall wellness (AHA, ACSM, CDC, WHO). 
2. Muscle strengthening: Perform exercises targeting major muscle groups at least two days per week to enhance strength, bone density and muscular health. 
3. Balance and flexibility: For older adults, especially those at risk of falls, incorporate flexibility and balance exercises, such as yoga or tai chi, two to three times per week to maintain mobility and stability (CDC, ACSM). 

Children and adolescents (5-17 years) 

1. Daily activity: Engage in at least 60 minutes of moderate-to-vigorous physical activity each day, focusing primarily on aerobic activities to promote cardiovascular fitness (CDC, WHO). 
2. Bone and muscle strengthening: Include bone and muscle-strengthening exercises at least three days per week to support development and growth. 

Special populations 

• Older adults (65+ years): Emphasize exercises that improve balance and reduce fall risk. Modify intensity and type of activity according to individual capabilities, particularly for those with chronic conditions (AHA, ACSM). 
• Individuals with chronic conditions or disabilities: Consult a healthcare provider prior to beginning exercise. Customize physical activities to meet individual needs, abilities and goals, focusing on safe, accessible exercises (AHA, ACSM). 

Hydration and nutrition (NASM guidelines) 

1. Hydration 
   • Pre-exercise: Drink 16-20 ounces of water at least four hours before exercise to ensure adequate hydration. 
   • During exercise: Consume 7-10 ounces of water every 10-20 minutes during exercise, adjusting intake based on sweat rate and environmental conditions. 
   • Post-exercise: Rehydrate with 16-24 ounces of water for every pound lost during exercise, incorporating electrolytes after intense or prolonged sessions. 
2. Nutrition 
   • Pre-workout: Eat a balanced meal containing carbohydrates, protein and fats two to four hours before exercise to fuel performance. 
   • During exercise: For workouts lasting over an hour, consume 30-60 grams of carbohydrates per hour to sustain energy. 
   • Post-workout: Have a recovery meal rich in protein and carbohydrates within two hours post-exercise to aid muscle recovery and replenish glycogen stores. 

Start with walking: A practical approach  

Walking represents an ideal entry point for many sedentary patients. It requires no special equipment, can be done almost anywhere and has a low risk of injury. Research shows that walking for just 30 minutes a day can: 

• Improve cardiovascular and pulmonary fitness 
• Reduce risk of heart disease and stroke 
• Improve management of chronic conditions (including hypertension, high cholesterol, joint and muscular pain and diabetes)  
• Strengthen bones and improve balance  
• Increase muscle strength and endurance 
• Reduce body fat  

Implementation strategies  

1. Start small: Recommend beginning with short, manageable brisk walks of 10 – 15 minutes.  
2. Build gradually: Increase duration by five to 10 minutes every one to two weeks.  
3. Set realistic goals: Work with patients to establish SMART goals (Specific, Measurable, Relevant, Time-bound).  
4. Address barriers: Discuss and problem-solve common obstacles such as time constraints or weather.  
5. Consider a physical activity prescription approach: Provide patients with a list of creative options for exercise based on their experiences, strengths, values and goals that can be adapted to their conditions and treatment goals over time.

Spotlight: HonorHealth Wellness Walks  

HonorHealth’s Wellness Walks program offers an excellent resource for patients beginning their physical activity journey. This physician-led initiative provides:  

• Monthly guided walks on the first Saturday of each month 
• Educational components covering various health topics  
• Opportunities for social connection and community building 
• Professional supervision and guidance  

These structured walks help patients overcome common barriers to exercise initiation, such as motivation and safety concerns. The program aligns perfectly with the recommended 30 minutes of moderate-intensity exercise.  
Monitoring and follow-up 

• Schedule regular follow-up visits to track progress 
• Use activity logs or smartphone apps for accountability  
• Celebrate small victories and progress 
• Adjust recommendations based on individual response and capabilities  

As medical professionals, we can significantly impact our patients’ health by promoting physical activity through evidence-based guidelines and practical support. The combination of clear medical guidance and structured programs like Wellness Walks provides patients with both the knowledge and tools they need to succeed in establishing lasting physical activity habits.  

By taking an active role in promoting physical activity, we can help create healthier communities one step at a time.  

For physicians interested in leading a wellness walk or exploring local initiatives like Blue Zones, please visit the following resources:  

• Register to lead a wellness walk  
• HonorHealth Blue Zones Project – Scottsdale, AZ 

References 

World Health Organization. Physical Activity.  World Health Organization. Published June 26, 2024. Physical activity (who.int) 

World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour.; 2020. 9789240015128-eng.pdf (who.int) 

Hooker SA, et al. Encouraging Health Behavior Change: Eight Evidence-Based Strategies. Family Practice Management. 2018;25(2): 31-36. https://www.aafp.org/pubs/fpm/issues/2018/0300/p31.html  

American Heart Association. “Physical Activity Guidelines.” AHA Website: https://www.heart.org/  

American College of Sports Medicine. “ACSM Guidelines for Exercise Testing and Prescription.” 

Centers for Disease Control and Prevention. “Physical Activity Basics.” CDC Website: https://www.cdc.gov/  

World Health Organization. “Global Recommendations on Physical Activity for Health.” 

National Academy of Sports Medicine. “NASM Essentials of Personal Fitness Training.”