The Power of a Gentle Nudge
Phone Calls, Even Voice Recordings, Can Get People to Go to the Gym
(See Correction & Amplification below .)
Unable to push herself to exercise, Ruthanne Lowe joined a research study aimed at motivating the sedentary with a surprisingly simple technique—an occasional telephone reminder.
“It really did work,” says Ms. Lowe, a 66-year-old housewife in San Jose, Calif. Three years after the study ended, she says, “I’m doing more exercise than I ever did in my life.”
The study, conducted by Stanford University, belongs to a growing body of research showing that small amounts of social support, ranging from friends who encourage each other by email to occasional meetings with a fitness counselor, can produce large and lasting gains against one of America’s biggest health problems—physical inactivity. Only 48% of Americans say they meet the federal recommendation for exercising half an hour most days of the week, and the actual percentage is believed to be much lower. Exercise researchers estimate that nearly all sedentary people at one time or another have resolved and failed to maintain exercise programs.
In the Stanford study, 218 people were divided into three groups. After an introductory session, during which Ms. Lowe established a goal of walking half an hour most days of the week, a Stanford health educator called her and other members of her group every three weeks, on average, for a year to ask about their compliance and to cheer them on. A second group of participants received calls not from humans but from a computer programmed to make similar inquiries.
The caller, whether human or computer, asked the participants to recite the amount of exercise they performed during the past week. Participants were then congratulated on any exercise performed, and asked how the level might be increased in the week ahead. When lapses occurred, as they invariably did because of illness, travel or unforeseeable events, the goal was to impress upon participants the importance of resuming the workout as soon as possible. All questions were designed to encourage rather than to scold.
After 12 months, participants receiving calls from a live person were exercising, as a mean, about 178 minutes a week, above government recommendations for 150 minutes a week. That represented a 78% jump from about 100 minutes a week at the start of the study. Exercise levels for the group receiving computerized calls doubled to 157 minutes a week. A control group of participants, who received no phone calls, exercised 118 minutes a week, up 28% from the study’s start. “When you knew you were going to have to report back on what you had done, it motivated you,” says Ms. Lowe.
The researchers checked in with participants after 18 months and found that their exercise patterns had changed little from the 12-month level. But the study didn’t monitor participants’ beyond that.
Some studies by other researchers have suggested that after eight weeks of regular exercising many people can settle into a long-term habit of working out.
Abby King, a Stanford professor of medicine and health research and policy who conducted this study, published in 2007 in the journal Health Psychology, and other similar studies, says people trying to change unhealthy behaviors generally need something more than willpower. “Whether it’s smoking or alcohol use or physical inactivity, social support helps prevent against relapse,” says Dr. King. But the support doesn’t have to be constant. “A light touch can have a lasting effect,” she says.
Jeff Enlow for The Wall Street JournalRuthanne Lowe has been exercising regularly since completing a workout-encouragement program in 2007.
Even many of the nation’s most committed exercisers have trouble doing it on their own. At 73, for instance, Marty Mennan is an elite age-group swimmer who strokes across the pool several miles a week, a habit dating back to his years as a competitive college swimmer. But his regimen depends on him belonging to a master’s swim group that provides social support. “From age 55 to 65, I really didn’t exercise at all, because my master’s group had disbanded,” says Mr. Mennan, a retired school teacher in Columbus, Ind., who now drives 40 miles to Indianapolis several times a week to swim with a group.
Mr. Mennan belongs to the 35% to 40% of Americans who prefer to work out in groups. Like alcoholics who can stay sober only with the help of 12-step meetings, these athletes owe their high levels of fitness to running, cycling or swimming clubs.
But surveys show that about 60% of Americans prefer working out alone, especially people who have reached middle age and older who may socialize less frequently in groups. Many lone runners say they come up with solutions to personal and professional problems while exercising. And they often resent the constraints of working out according to somebody else’s schedule. “I’m very gregarious and extroverted, yet I don’t want my exercise schedule hooked into somebody else’s,” says Rita Horiguchi, a 64-year-old self-described former couch potato who with the help of Stanford University learned to work out on her own.
The research coming out of Stanford and other universities essentially calls for such people to join a group or program while continuing to exercise on their own. A study due to be published soon in the International Journal of Sport and Exercise Psychology, found that two group-counseling sessions, conducted over a three-month period, produced after three months a quadrupling of exercise levels and an even greater jump at nine months, long after the intervention had ended. By contrast, the exercise level of a control group rose during the study period but at nine months had returned to near-baseline levels. The study involved 119 participants with an average age in the mid 50s.
“This study demonstrated that group dynamics strategies can be [effective] when participants are away from the group or even once the group ceases to exist,” writes lead author Paul A. Estabrooks, a professor of exercise science at Virginia Polytechnic Institute and State University.
Dr. King, of Stanford, says that in setting up her studies she advertises for people who are physically inactive. By contrast, she says, ads for health clubs and personal trainers tend to feature photographs of young and buff clients, a marketing tactic that can make the sedentary feel marginalized. “The sedentary are a silent majority who are bombarded by images of active people,” says Dr. King. She says her advertisements for “couch potatoes” alleviate participant concerns about feeling inadequate.
Dr. King’s studies have found that telephone interventions of nearly every kind increase the exercise levels of previously sedentary people. One limitation is that the studies by definition attract people who are eager to change. Even so, participants who receive phone calls as infrequently as once a month have consistently boosted their exercise levels above control groups receiving no such calls, she says.
Despite the popular notion that Americans divide cleanly into the active and the sedentary, most people spend time in both camps. For weeks at a time, Dr. King says she sometimes joins the ranks of the sedentary. By nature a solitary exerciser, she says that when the going gets tough, “I join a small class.”
Some gyms have begun to incorporate the lessons of exercise-adherence research. The YMCA in Chicago recently conducted a study in which in it called members to monitor their success at reaching workout goals. If a member falls short one week, the caller would ask why, then gently prod the member to think of a way that a missed session of exercise could have been made up. “The idea is not to give them the answers, but to encourage them to solve their own exercise problems,” says Mary Ganzel, a YMCA exercise expert who led the study.
In a growing number of states, health officials are sponsoring exercise programs that enable residents to join teams while working out on their own. An annual program called Walk Kansas, for instance, divides tens of thousands of participants into teams of six, with each team expected to walk the width of Kansas, about 430 miles, in eight weeks. Team members walk on their own but report their weekly mileage to each other. An academic study of the Kansas program, which just concluded its ninth year, has found that participants continue exercising far above their original levels long past the end of the contest.
“You don’t want to let your team members down,” says Angel Patterson-Tetuan, a registered nurse who recently completed Walk Kansas for her second consecutive year. She credits the program with helping her lose 40 pounds and develop a year-round exercise regime.
“I used to be able to tell you what was on television every night,” says Mrs. Patterson-Tetuan, a 42-year-old mother of three. “Now I have no idea. I’m up and moving, and so are my children.”