From the Guidelines
To form a routine effectively, especially in the context of physical activity for patients with coronary and other atherosclerotic vascular disease, the most recent and highest quality evidence recommends encouraging 30 to 60 minutes of moderate-intensity aerobic activity, such as brisk walking, at least 5 days and preferably 7 days per week, supplemented by an increase in daily lifestyle activities. This approach is supported by the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease 1.
Key Recommendations
- Assess risk with a physical activity history and/or an exercise test to guide prescription 1.
- Encourage medically supervised programs (cardiac rehabilitation) for at-risk patients 1.
- It is reasonable to recommend complementary resistance training at least 2 days per week 1.
Implementation
When implementing a new routine, especially for physical activity, it's crucial to:
- Start with manageable actions that can be completed in less than two minutes.
- Link the new habit to an existing behavior (habit stacking).
- Set a consistent time and place to leverage environmental cues.
- Track progress using a habit tracker or calendar.
- Gradually increase the difficulty or duration of the routine after the initial behavior becomes consistent.
Evidence Basis
The recommendation for at least 30 to 60 minutes of moderate-intensity aerobic activity is based on the highest level of evidence available, which emphasizes the importance of regular physical activity in improving cardiorespiratory fitness and reducing the risk of cardiovascular events 1. While other studies and guidelines may provide slightly different recommendations, the 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline offers the most recent and comprehensive guidance on this topic.
From the Research
Routine Formation in Medical Context
The formation of a medical routine is crucial for improving health behaviors and managing chronic diseases. According to 2, routines for improving health behaviors are characterized by repeated patterns, controllable by the patient, goal-oriented health, and integration into an overarching lifestyle.
Key Components of Medical Routines
- Repeated patterns of behavior 2
- Controllable by the patient 2
- Goal-oriented health 2
- Integration into an overarching lifestyle 2
- Individual characteristics and environmental factors as antecedents 2
- Psychological, physical, and social well-being as consequences 2
Lifestyle Medicine and Routine Formation
Lifestyle Medicine (LM) is an emerging field that utilizes six pillars to promote healthy lifestyle choices and manage chronic diseases 3. These pillars include:
- Plant-based nutrition
- Physical activity
- Sleep health
- Tobacco cessation/managing risky alcohol use
- Spiritual/emotional well-being LM has been shown to be an effective approach in promoting healthy routines and improving clinical outcomes 3.
Medical Consultation and Routine Formation
Medical consultation plays a crucial role in the formation of medical routines. According to 4, a successful consultation between doctor and patient requires active listening, empathy, and the ability to recognize and interpret the patient's symptoms and concerns. The doctor's role is to produce context and translate biological, psychological, and social aspects of the complaints into a diagnosis and treatment plan 4.