ChiroACCESS Article

Recommending Physical Activity as Prevention

This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Marion Willard Evans, Jr., DC, PhD, MCHES, CWP


Parker College of Chiropractic Research Institute

Published on

December 1, 2009

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Physical activity (PA) is critical for the health of humans. The lack of PA leads to increased risks for a variety of diseases and is associated with overall premature mortality as well.1  As of 2009, rates of obesity in the United States (US) have increased 129% since 1990.1  This is partially due to lack of PA by many Americans.  Unfortunately, the US is in the middle of an escalating pandemic of obesity and sedentary lifestyle2 leading to unprecedented challenges for health care providers who want to see patients they treat reach a stable level of better health.  All health care professionals should do what they can to encourage regular PA in all of the patients they treat and, when possible, directly cue those patients to take action.  They must not only recognize those at high risk for disease related to little or no PA but must also prepare to assess and recommend regular PA to all patients whether they look like they need activity or not.

Kids at playAlthough a link between chronic disease and lack of PA is well established, many are unaware that chronic spine problems and obesity/sedentary lifestyles are highly co-morbid as well.3,4  Unfortunately, both back problems and physical inactivity are also becoming more and more prevalent in adolescents.5,6  According to one study, PA levels begin to drop sharply in adolescence.6  These declines typically begin in the 7th grade and progress from there.  Even though they may hold the greatest benefits from PA, vigorous levels of exercise decline at a sharper rate than moderate levels in both girls and boys. 

A recent study on cardio respiratory fitness (CRF) looked at over 3,400 women and 16,800 men.7  This study found PA levels necessary to sustain healthy CRF levels started to decline at an accelerated rate after 45 years of age.  Being physically active, not smoking and maintaining a low body mass index were all associated with higher CRF scores across the adult lifespan.  According to a study of US women reported on in 2008, 47-62% of premature deaths in America can be attributed to a combination of smoking, being overweight, lack of PA, and low diet quality.8  Additionally, it is estimated that between 164,000-222,000 deaths can be attributed directly to physical inactivity.9

In a 25 year prospective study of over 2,000 men (mean age 72) regular exercise was associated with a 30% lower risk of mortality.10  Authors concluded that enhanced lifespan with good health and functioning during older age (after age 90) was specifically associated with not smoking, blood pressure control, weight management, and regular vigorous exercise.  The results indicated benefits of vigorous exercise in those >75 years after controlling for better general health at baseline.  It is clear that PA levels must become a routine part of preventive medicine for all health care providers.

A recent study of graduating interns found that most (>85%) said they planned to promote health as part of their routine chiropractic practice.11  When asked if they planned on counseling “all patients” on healthy exercise levels, 93% of females and 95% of male interns said they planned to do this.  However, a study of patients who had seen medical doctors (MDs), chiropractors (DCs), and physical therapists (PTs) for chronic back or neck pain found that only 48% were prescribed PA.  Of those, 29% of patients who saw MDs, 21% of those seeing DCs, and 46% of those seeing PTs said they were provided prescriptions for exercise.12  In an analysis of the National Health Interview Survey (NHIS) looking at a 2005 adult sample and those reporting various health promotion advice as being received from their health care provider, those seeing a DC only within the previous 12 months were more likely to report being physical active than those only seeing an MD.13  They were also less likely to be obese when having only seen a DC.  This is in line with a study by Jamison on what DCs seem to be comfortable with concerning health promotion advice where 91% were prepared to offer advice on exercise compared to 35% prepared to offer advice on smoking cessation for example.14

PA levels need to be maintained across the lifespan.  All health care providers should do what they can to promote increases in PA for their patients and those patients’ families.  The US Department of Health and Human Services’ 2008 guidelines on PA state that there is a direct linear relationship between increasing levels of PA and longevity.15  Most benefits for adults come within 150 minutes of combined PA per week.  This can be accomplished with a brisk walk several days a week or with more sustained aerobic activity when indicated.  Both PA levels that will challenge muscular fitness and aerobic levels of fitness should be included as well as exercises that strengthen bone health.  According to the 2008 Physical Activity Guidelines for Americans ( regular PA can significantly reduce; cardio-vascular disease, stroke, hypertension, diabetes risks, abnormal blood lipids, metabolic syndrome, obesity, musculoskeletal health conditions, and risks of falls in older adults to name a few.

For young people and adolescents, at least 60 minutes of play or PA is encouragedFor young people and adolescents, at least 60 minutes of play or PA is encouraged.  Three days of vigorous, aerobic PA each week can enhance health and should also be recommended.  A mix of aerobic, muscle strengthening, and bone strengthening PA is suggested for adults and children.  At least 60 minutes of PA those three days a week is suggested.  More benefits are realized with added time and aerobic activity when this is possible.  For adults including older adults an accumulated amount of exercise is important.  At least 150 minutes per week is needed with additional benefits noted with 300 or more minutes each week.  PA that is vigorous should be performed when possible for 75 minutes a week.  Vigorous activity breaks a sweat and keeps the participant “winded” compared to moderate activity levels which may not.

For older adults the target should be to get at least 150 minutes of PA per week and more when possible.  People with disabilities should also get PA within the limitations of their disability.  Spreading PA out over 3 days of a week can reduce risk of soreness and overexertion.  Activities such as walking, swimming, water aerobics, dancing, biking, tennis or golf without a cart are typically safe ways of increasing PA for most adults including older adults.  Here are some keys to broaching the topic with patients;
  • For patients start with discussing the need for regular PA in a report of findings
  • Recommend PA as part of their care plan by “prescribing” it certain days of the week
  • Use a strong, personalized message with the patient. An example may be, “As your doctor, one of the most important things I will ask you to do to enhance your health is to exercise (state what type) 3 days a week for at least 50 minutes per day.”
  • Find activities your patient enjoys and suggest they perform those or continue them at increased rates
  • Chart any recommendations in the patient’s file and follow-up with them to see how this is going
  • Make sure you have resources available to those who may want to know more or to work with a personal trainer for instance, outside of your office
  • Stress the importance of regular PA to every patient regardless of age or whether they look like they exercise or not—you simply can’t tell by looking.
  • For more information go to:
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United Health Foundation. 2009 American’s Health Rankings: a call to action for individuals and their communities. St Paul, MN. 2009.

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Yates LB, Djoussé L, Kurth T, Buring JE, Gaziano JM. Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. Arch Intern Med 2008;168(3):284-290.


Evans MW, Ndetan H, Williams RD. Intentions of chiropractic interns regarding use of health promotion in practice: applying theory of reasoned action to identify attitudes, beliefs, and influencing factors. J Chiropr Educ 2009;23(1):17-27.


Freburger JK, Carey TS, Holmes GM, Wallace AS, Castel LD, Darter JD, Jackman AM. Exercise prescription for chronic back or neck pain: who prescribes it? Who gets it? What is prescribed? Arthritis Rheum 2009; 61(2):192-200.


Ndetan, HT, Sejong, B, Evans, M, Rupert, R, Singh KP. Characterization of health status and modifiable risk behavior—United States adults using chiropractic care as compared to general medical care. J Manipulative and Physiol Ther 2009, 32(6):414-422.


Jamison J. Health information and promotion in chiropractic clinics. J Manipulative Physiol Ther 2002; 25:240-245.


US Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans: Be active, healthy, happy! 2009.

 [ Full-Text Link ]