Lifestyle and Health
WELLNESS: Make Movement Mandatory
Sulak PJ
The Female Patient.2011;36(10):45-47.

 In this month’s column, I would like to discuss the importance of physical activity, or what I call "Make Movement Mandatory."

In this month's column, I would like to discuss the importance of physical activity, or what I call "Make Movement Mandatory." Of the many unhealthy habits that can lead to morbidity and mortality, a sedentary lifestyle is one of the most common in this country. The core of the problem is that we are not moving and lifting as we did in years past. Having been brought up on a farm and ranch, my family's day was filled with chores such as hoeing cotton, hauling hay, planting and picking vegetables, gathering eggs, hanging clothes out to dry, and washing dishes. Oftentimes, what we were eating for dinner had been growing in the ground or even walking around in the chicken coop a few hours earlier! And, when we were not working, we were playing outside.

Today, technological advancements have decreased our need to move and lift. We have machines or devices to wash and dry our clothes, wash our dishes, open our garage door, change the TV channel, surf the Internet to buy things online without leaving home, as well as a plethora of fast-food establishments so we do not even have to go to the grocery store and cook our food. We either have self-propelled lawnmowers or we hire someone else to do our yard work for us. We can also take an elevator to the second floor of a building and park right in front of a Walmart or another store of our choosing. For many kids today, their games are not hopscotch, baseball, or hula-hoop but rather computer games.

Our lack of physical activity is compounded by the fact that most of us have sedentary jobs. Even in my work, I spend most of the day sitting on the phone, dictating, working at the computer, and talking with patients in an exam room. Ironically, my job is relatively active compared to most of our employees such as the secretaries, desk clerks, and phone-triage nurses.

Even our medical meetings are unhealthy. When we show up to a meeting, we usually begin with a breakfast high in carbohydrates and fat—before we sit down for a few hours. Then, lunch is served (also not usually a healthy offering), followed by sitting down for a few more hours. Later in the day, there is often a snack break (as if we were starving to death from all the work we have been doing), after which we go to dinner at a nice restaurant—with dessert, of course—as a reward for our strenuous efforts of the day.

Sitting for most of the day is not biologically healthy and is not what we were designed to do. We were made to MOVE. Unfortunately, most of us do not engage in exercise routinely. Why is this? I think I have heard every excuse for not exercising, but the No. 1 reason most people give is that they do not have the time. Yes, we are all busy, yet we seem to find other things to fill our days (in the same way I fi nd things to fill every shelf, drawer, and closet in my house).

With that said, there are many people who do fi nd time for daily exercise. There is one thing that we all have: 1,440 minutes in every day. What are you doing with your minutes? To quote the Earl of Derby: "Those who do not find time to exercise will have to fi nd time for illness." How much exercise should we be doing? According to the American Heart Association (AHA), to reduce the risk of chronic disease, we should engage in 30 minutes of moderately intense physical activity per day, most days of the week.1 To prevent weight gain, AHA recommends 60 minutes of moderate-to-vigorous activity most days of the week.

You may say, "I don't have an hour a day to exercise! Do I?" The question is really not, "Do I have time to exercise?" but rather, "How do I mandate daily exercise to increase the quality and quantity of my life?" If you do not have an hour a day to exercise, do you have 24 hours a day to feel bad and increase your risk of chronic disease, poor mobility, and, yes, death? As harsh as this may sound, it is the truth. We are literally talking about survival.

We are intelligent human beings, and we need to be creative in Making Movement Mandatory as part of our daily routine. Some of our exercise can easily be incorporated into our daily activities. For example, instead of parking close to work, house of worship, or the grocery store, make it your routine to park as far away as you can. If possible, walk to your destination. Make it a habit to take the stairs, walk with a friend at lunchtime, and use a treadmill, Stairmaster, or stationary bike while watching your favorite TV program. If you take your kids or grandkids to soccer practice or other activities, take a walk while you are waiting for them. Fit your own health and happiness into your schedule; remember, it will not happen if you do not do it.

What gets done in my life? It is those things that I focus on. Fortunately, my husband and I have made our health OUR responsibility. We include exercise in our schedules every day, and now it has become a habit. We do not question whether or not we are going to exercise today. Instead, we question what type of exercise we are going to do and when we are going to do it. It helps to rotate different activities (eg, biking, walking, jogging, aerobics classes, yoga, swimming, weight lifting).

While this short article is not meant to be a comprehensive review of exercise, please know that there are several components to a balanced physical fitness program: stamina, endurance, balance, flexibility, and—don't forget—strength training. As we age, we often slow down and our muscles begin to deteriorate. This, however, is not inevitable and is why strength training is very important. I recently experienced the advantages of this personally. I sustained a serious injury while skiing that required surgery and no weight bearing on my right leg for 3 weeks. Because I am in shape and have good upper body strength, getting around on crutches was not nearly the problem it would have been. As I get older, I realize this will become even more important, along with balance and fl exibility.

If you are one of those many individuals not currently engaging in a routine exercise program, I would like to end with some suggestions that I personally have found helpful to maintaining such a program.

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No. 1: First and foremost, think healthy. You are what you think. If you think, "I'm a tired, out of shape, unhealthy person who hates to exercise," then guess what? That is who you are! If you persistently think "I am a healthy, energetic person who does some form of exercise every day," then that is who you are or will become. My struggle with daily exercise ended when I took responsibility for my health and happiness and changed my line of thinking: I changed my story.

No. 2: Put exercise in your schedule. What can you eliminate from your schedule that may not only be unnecessary but also harmful to your health? Once you decide to take charge of your health and exercise regularly, you will put YOU in your schedule.

No. 3: Get support. Find an exercise partner(s). Get a personal trainer. Join a walking, biking, or swim club. Become a member of a sports team and/or start your own group at work or in your neighborhood. I have made it a priority in life to surround myself with people who motivate me to do the right things. An accountability partner who will not let you slack off will make it easier to stay on track.

No. 4: Set realistic, attainable goals with a purpose. Where would you like to see yourself a year from now? Would you like to complete a 10K or a half-marathon? Would you like to see noticeable increases in your muscle mass? Would you like to be able to swim a mile? Would you like to hike the Grand Canyon or bike along the Rhine River? What a great way to reward yourself for all your hard work! The bottom line is this: You must have a compelling reason to exercise or you will not maintain a fi tness program. Whether you want to have more stamina, travel wherever you want when you are 80 years old, or just keep up with the grandkids, if you do not have a purpose you will not have the power to persist.

No. 5: Be an educated exerciser. Know your limits. If you have any health issues or have not had a physical exam and/or baseline lipid panel and other labs recently, you should have an evaluation before initiating any program. This will also give you baseline numbers to monitor your progress. You should also address any exercise limitations before starting a program and read about exercise from reliable medical sources that inspire you to keep moving.

I hope this article has given those of you not currently participating in an exercise program the impetus you need to Make Movement Mandatory a priority in your life—starting today! For those of you who are already there, I would love to hear your ideas and thoughts and share them in future columns. Please send your comments to me at WellnessMD@ Let us all do what we can to improve the quality and quantity of our lives, and be an example to our family, friends, and patients.

The author reports no actual or potential conflict of interest in relation to this article

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Patricia J. Sulak, MD, is Dudley P. Baker Endowed Professor, Research and Education in Obstetrics and Gynecology, and Medical Director, Division of Research Department, Obstetrics and Gynecology, Texas A&M College of Medicine, Scott & White Clinic/Memorial Hospital, Temple, TX.


ACCF/AHA 2009 Performance Measures for Primary Prevention of Cardiovascular Disease in Adults. Circulation. 2009;120:1296-1336.

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