Motivation for physical activity and lifestyle change

A few weeks ago, my family and I went out for some last-minute shopping. Several vehicles jockeyed for position, competing for the closest possible parking spot. Even during the busy holiday season, we easily found parking at the outside of the lot. Meanwhile, the other drivers continued to drive around searching for a place to park, becoming ever more angry and frustrated, not willing to walk even 50 or 100 yards. The situation would have been amusing were it not so sad.

The American Heart Association recently released its 2009 statistical update. The rate of death from cardiovascular disease has decreased by approximately 30% between 1999 and 2006. It is likely that this decreased death rate is due to a combination of improved intervention, screening and pharmacotherapy. However, with this success comes great cost. Health care expenditures continue to increase exponentially; no end appears to be in sight.

Despite the decrease in the cardiovascular death rate, the prevalence of many risk factors has increased. The rate of overweight adolescents increased from 6.1% in the 1970s up to 17.6% in 2003 to 2006. About 62% of adults responding to the 2006 National Health Survey reported no vigorous activity of 10 minutes or more. Although I am saddened by this report, I am not surprised.

Preventive health care is effective and much less expensive than last-minute emergency interventions. However, the problem is how can we inspire our patients to follow advice for healthy lifestyle change? I do not have an easy answer for this. Although I am watchful in what I eat and engage in regular vigorous physical activity, I admit to not always being the perfect patient. Sometimes I have difficulty staying on track and finding motivation myself.

One interesting study found that groups who were incentivized to lose weight, either through a lottery incentive program, or a deposit contract, lost more weight than the control group who had only monthly weigh-ins. At the end of the study, about half of the incentive groups met their target weight loss of 16 lb, whereas only 10.5% of those in the control group did. However, seven months afterwards, all groups regained weight.

This study raises many questions. Would incentives work over the long term? Where would the funds come from to pay for this? How much responsibility should society, the government, insurance companies and others have in encouraging a healthy lifestyle? What about other lifestyle choices, such as tobacco, diets high in saturated fat, and so on? Should people be incentivized for avoiding every unhealthy behavior? Shouldn’t individuals take some responsibility for their health?

We live in a free society where individuals are allowed to make decisions, sensible or poor, regarding how they choose to live their lives. The problem is that when negative consequences occur due to unwise decisions, it is often all of us who pay for this, through increased health care costs and higher insurance rates. This is a difficult problem, for which I have no simple solution.

Circulation. 2009;119:e1-e161.

JAMA. 2008;300:2631-2637.