Mention the word "exercise," and you're likely to hear groans. It's one of those "shoulds" people know are important to health, yet just one in three American adults exercises regularly.
Aversion to the "e" word is so strong that many health professionals now substitute more acceptable terminology such as "physical activity" or "movement."
" 'Exercise' sounds like work, but 'physical activity' sounds like play," says Assistant Surgeon General Susan Blumenthal, who says this is one reason the U.S. Department of Health and Human Services called its 1996 document "The U.S. Surgeon General's Report on Physical Activity and Health."
Yet beyond the semantics and the easy excuses ("no time," "too tired") are often some deep psychological issues, says registered dietitian Francie White, a Santa Ynez expert on eating and body image problems.
"Eating behaviors often have an emotional component, and exercise patterns can too," White says. "In counseling women with overeating disorders, I've found that many do not simply neglect to exercise, they actively resist it."
White has coined the term "exercise resistance" to identify what she calls "a conscious or unconscious block against becoming regularly physically active."
In an article for the journal Women's Health Issues, she describes two general patterns:
* Unconscious resistance, when someone sets exercise goals, starts a program, then sabotages it and quits.
* Active refusal, when someone experiences anger, despair or feelings of futility when exercise is recommended.
"Just as eating disorders vary from starvation on one end of the spectrum to compulsive overeating on the other," she writes, "so too do exercise patterns range from exercise dependence to exercise resistance."
White first became aware of this phenomenon in the late 1980s, when she was leading therapy groups for women recovering from eating disorders and became frustrated with her inability to help her clients become physically active.
"I finally threw up my hands and just listened," she says. "What I heard was a litany of painful experiences associated with exercise ranging from humiliation to sexual abuse." Exercise resistance often began in puberty, White found, when girls' enjoyment of the thrill of play changed to embarrassment at being ogled when they moved.
"This kind of unwanted attention, and sometimes abuse, literally paralyzed them," she says. "Some women don't want the attention that comes from looking like a model in Shape magazine, so resisting exercise can be an attempt to control their body."
Many women also voiced anger or sadness at feeling they were never good enough at sports. These women linked exercise with a performance standard--and an appearance standard--that was impossible for them to meet. "Exercise became a kind of self-betrayal," says White. "They refused to participate in something that hurt them so deeply."
White focuses her work on women because most of her clients are female, but she says men can be exercise-resistant too. "Men's reasons for resistance tend to be different," she says. "It's usually less about sexuality and more about feeling inadequate in light of male cultural expectations of athleticism."
Not every sofa spud is exercise-resistant, White notes. Clues that sedentary habits are more than just laziness include feeling anxiety or panic during exercise or having flashbacks to experiences of abuse during activity.
The ideal way to overcome exercise resistance is to participate in a group or workshop led by an experienced therapist or facilitator, says White, who has trained about 350 therapists in these issues. Addressing exercise resistance in individual therapy or in a personal journal also can be helpful. These are good places for people to probe what the word "exercise" means to them and reflect on life experiences that may have prompted an aversion to activity.
Additional strategies to overcome resistance include advising people:
* Not to exercise for a period of time ranging from one month to one year to help "clean the slate."
* Find an enjoyable form of exercise that will be done for the pleasure it brings and not with weight loss or health reasons as the primary goal.
* Commit to doing that activity a specific number of times per week for a minimum of six weeks, no matter what.
These strategies can help people "recapture one of the basic pleasures of being alive," says "antidiet" movement pioneer Geneen Roth of Berkeley, whose best-selling books and popular workshops encourage people to recast exercise as "active play" that nourishes the soul.
"People exercise on treadmills the way they eat, distracting themselves with television and headsets and telephones and novels," says Roth. "They try to knock themselves out so they can pretend they're not doing it."
Instead, she advocates White's approach in her new book, "When You Eat at the Refrigerator, Pull Up a Chair" (Hyperion, 1998). Although just 30 minutes of daily moderate activity--such as dancing or gardening--can significantly boost health, Roth writes that "the reason to engage in the activity formerly known as exercise is not because it is good for your heart or lowers your cholesterol. . . . Moving your body is not about flat stomachs or thin thighs.
"It is about being . . . lucky enough to have arms and legs that can surge with energy, be warmed by the sun, and slice through wind and water. Moving your body is about physically connecting with the fundamental joy and gratitude of being alive."