Q: My husband works hard at the office, but then he lies on the sofa at night and watches TV. He hasn’t really gotten any exercise since before we were married. Sometimes he plays baseball in the summer. I want to say something to him about it, but I don’t know what to say.

A: Don’t say anything. Just hot-wire the couch and hook it up to the TV remote. Then when he gets to channel 5 and the current kicks in, he’ll get off the couch. OK, maybe that’s a bit extreme, but seriously, this is such an important issue for all of us. Let me help you understand the problem and give you some possible solutions, without the voltage.
About one-third of Americans get no exercise at all, ever, zip. Another one-third gets minimal exercise, like carrying stuff or occasionally climbing stairs at work. So only about one-third of us get regular exercise as part of our lifestyle. This last group has defined their lives as including things like long brisk walks, competitive sports, biking, swimming, running, that sort of thing. So this means that two-thirds of us are not in the “culture of exercise.” That’s a lot of people.

RISKY BEHAVIOR
It’s not immoral to be a couch potato. People have a right to choose whatever sort of life they want to lead. But here’s the bottom line: Folks who haven’t had a lick of exercise since the Reagan years are engaging in a very high-risk behavior.
Usually when we say “high-risk behavior” we’re talking about things like sharing needles or bungee jumping. But fact is that multiple studies prove that deaths from cancer, heart disease, and all causes combined are all directly related to your activity level. Death rates are consistently highest in those who are sedentary. This is not theoretical.
The Nurses Health Study, published in The New England Journal of Medicine, has shown that exercise alone can decrease death rates by 30-40 percent. The effect appears to be dose-related: More exercise is better, but even just going for brisk walks can make a difference. The most advanced, expensive, high-tech interventions that we have for heart disease, like coronary bypass operations and angioplasty , don’t even come close to the positive effects of exercise. So it is not so smart to think that you can just eat more salads, skip the exercise, and always get a quadruple bypass later. It’s better not to develop severe heart disease in the first place. You know the old “ounce of prevention” story.
Let me give you some great information from a real expert in this area, my friend Dr. Steven Horowitz. Steve is the chief of medical cardiology and the director of the Center for Cardiac and Pulmonary Health at Beth Israel Medical Center in New York. I talked with him recently about this issue. Here’s the deal on exercise.
Regular exercise increases the levels of good cholesterol (HDL) that tends to protect you from heart disease. That’s one important thing, but much of what goes on with heart and vascular disease has to do with the inner lining of the blood vessel. Exercise improves the function of that inner lining, decreasing the artery’s tendency to go into spasm. Spasm in a heart artery is not a good thing. In addition, exercise increases the diameter of coronary arteries slightly, makes your blood less sticky, quiets the heart, slows it down, and may mimic the cardiac protective effects of medications like beta-blockers.
Living on a steady diet of stress hormones, adrenaline, and hostility is really bad for you. It can make you more prone to dangerous heart rhythms. Many people may actually die of this neuro-hormonal imbalance. Exercise tends to normalize these hormones and protect your heart.

PICK ACTIVITIES YOU ENJOY
But Horowitz does not believe in exercise that you hate.
For one thing, you’re less likely to stick with it. He feels that you must find something you enjoy, because the effects of exercise are enhanced if your mind is relaxed and you’re happy.
The emotional content of the exercise may be important. Dr. Dean Ornish believes that competition in exercise may be bad, but Horowitz is not so sure of that. As someone who admits to being “addicted to racket sports,” he feels that a bit of an edge may help. He warns, however, against people doing strenuous exercise if they’re not used to it. This can be risky for your heart and joints. Weekend warriors can wind up with orthopedic injuries that will disable them, and turn them off to sports.
So how do you motivate someone to get exercise? Well, the usual way is to have your first heart attack or have a doctor scare the heck out of you. Many people exercise for a while, then fall off the wagon for a while, and then they go back to it. They may cycle through episodes of self-discipline and exercise, and then slack off, and beat themselves up with self-judgment and self-hatred.
This can be a tough cycle to break. It is clear from the research that simply giving people information about exercise has failed miserably, and only 3 percent of people who’ve gone through cardiac rehabilitation actually hold onto the gains.
Horowitz recommends social interaction and social support. If a person can get into a regular routine of doing sports or going to the gym with a friend or spouse, it can be much less painful to stick with it. Combining exercise and outdoor activities with social time reduces isolation and increases motivation. It’s almost like a group support process. There is someone there who can call to remind you of how good you felt when you were out there biking through the woods.
But starting this process can still be tough. It may involve needing to think about the larger scope of your life. We all know we’re not going to live forever, but most people don’t really think they’re going to die young. A basic question might be “Would you rather stay on the couch and watch TV, or be around to kiss your grandchildren?” This may sound a bit harsh, but it works for some people. For others, you may have to appeal to their narcissism. Many of us like to look attractive and be admired for our physical shape. This can be the motivator to get someone started.
But the key is to stick with it; to define yourself as
someone who regularly does physically strenuous activities and sports. Horowitz would like each of his patients to become a lean, meditating, socially integrated vegetarian who does enjoyable exercise regularly (yeah, right), but he also knows that many will not be able to get to this point. As with horseshoes, close does count.
So take your husband’s hand tonight after supper and go for a nice long walk. Who knows, you might start something.

Dr. James Dillard is an assistant clinical professor in the department of rehabilitation medicine at Columbia University College of Physicians and Surgeons in New York. He is a board-certified medical doctor, doctor of chiropractic, acupuncturist, and co-author of the book “Alternative Medicine for Dummies.”