They Were Paid to Exercise. A Third Still Didn't Finish
There is a study I come back to frequently when thinking about prescribing a traditional fitness routine to someone who doesn’t regularly exercise: the Midwest Exercise Trial 2, or MET-2.
The basic idea of the study is this: Researchers took sedentary young adults who were overweight or obese and assigned them to supervised aerobic exercise performed five days per week for ten months. The exercise dose was carefully measured, participants were instructed not to intentionally change their diets, and the investigators could therefore get an unusually clean look at what exercise itself could do, particularly to body composition and weight.¹
But there is another finding buried in the study that captured my attention the moment I saw it.
The participants were being paid to exercise, and roughly one-third still did not make it through the study protocol.
Think About That for a Minute
This wasn’t simply a group of people who bought gym memberships in January. In that circumstance, I would expect a pretty high attrition rate. But these individuals had scheduled, supervised exercise; they knew they were part of a study investigating the health effects of exercise; AND they were financially compensated at $7.87 per hour. Given approximately 254 hours of exercise participation over the course of the study, that amounts to nearly $2,000 in compensation for the average participant.¹
Despite all of that, only 92 of the original 141 randomized participants completed the full study protocol. Importantly, this degree of attrition was not unexpected. Similar dropout rates had been observed in previous exercise trials, and those earlier studies helped inform how many participants the MET-2 researchers needed to enroll at the outset.2,3 In other words, the investigators anticipated that a substantial number of people would not make it through the intervention and built that expectation into the study design so they would still have enough participants to detect a meaningful effect.
I want to be clear. It would be unfair to simply state that 35% of the participants “decided to quit.” The study was not intended to investigate the reasons behind their dropout. But the broader observation remains remarkable: Even under unusually favorable conditions, consistently doing something difficult is hard.
Knowing Isn’t the Problem
Most people already know exercise is good for them and would admit to feeling better after they exercise. Yet knowledge of future benefit has to compete against something of much more immediate consequence. We call this Present Bias or Future Discounting.
There is a wide spectrum of health benefits from exercise that can be noticed or measured over various time domains, but we discount these benefits in comparison to the inconvenience or discomfort we feel in the present. Changing clothes, driving somewhere, making time in our schedules, paying for an activity or gym membership, tolerating the discomfort of exercise, or simply having to change our routines are all potential examples.
This theme plays out in many other areas of our lives. Saving money competes against buying something today. Doing important but laborious work competes against entertainment today. Eating well competes against the convenient dopamine-triggering food sitting in front of you today. Prayer, reading, reflection, or other spiritual disciplines compete against a thousand distractions today.
In many worthwhile pursuits, the benefit is delayed while the cost is immediate. That is a difficult arrangement for human behavior.
If Money Doesn’t Guarantee Success, What Else Can We Do?
There is an entire field of research examining whether paying people can encourage healthier behavior. Modest financial incentives can increase exercise participation, and in some settings may even help people establish exercise habits.4 The problem is that much of the improvement tends to fade once the incentive disappears.5
And as of this writing, I’m not aware of any real-world program offering to pay people anything close to minimum wage simply to work out. So if even meaningful financial incentives have limitations, most of us will need to deploy other means to make exercise a regular part of our lives.
For clarity, this article is primarily focused on building a structured fitness routine into your schedule: dedicated time for the gym, an exercise class, or another planned workout. That is certainly not the only way to incorporate fitness into daily life, but for many people, a defined block of exercise is one of the most practical and effective ways to maintain a high level of fitness, build resilience for everyday demands, and lay a foundation for long-term health and longevity. That structured approach is the basis for the discussion that follows.
“A bad system will beat a good person every time.” -W. Edwards Deming
When you are trying to see a different result in your life, you have to make objective changes to the system, not just try harder. As the familiar saying goes, “Insanity is doing the same thing over and over again and expecting a different result.” “Trying harder” is consistent with effort. Effort is subjective, variable, state-dependent, and in the moment will fail us. The system in which we operate is clear, objective, defined, and measurable. It will define how much more or less likely we are to fail when our effort or desire has failed us.
It isn’t difficult to see the value of system-building when incorporating a fitness routine into our lives, or into any other important activity that we are trying to add to or remove from our daily routines.
So What Are Some Helpful Strategies?
When
Plan it. Lay out your schedule and figure out when you will be blocking out time for fitness. Realize that this planning will take executive-decision making. Something will have to be surrendered if you are adding something else to your day. I would argue strongly that a good starting point is looking at moving your day forward such that less productive uses of evening time is the sacrificial target while making sure a proper window for sleep is still maintained.
To be clear, I am not suggesting cutting into time spent speaking face-to-face with loved ones over a prepared meal, reading a book as a wind-down mechanism for sleep, or time together with family or with your own thoughts before sleep recounting the day and verbalizing the things you’re thankful for. These should be protected ruthlessly.
I am suggesting that most folks will experience compounded benefits by shifting the use of their wakeful hours earlier with fitness, amongst other things, as part of a day-priming process. Some folks may be able to get by with the afternoon or evening post-work time slot, but my experience has been that the day and all the variables that arise within it are shrewd at finding ways to sabotage your time of fitness. I believe you’re better prepared to deal with all those variables both mentally and metabolically because you’ve already exercised as opposed to still trying reactively to fit it in later.
What
Based on the plethora of research looking at different forms of exercise and their benefits, I believe what you do is important, but not as important as you may think.
Many of the same metabolic and hormonal benefits can be obtained from various forms of exercise. We could talk endlessly trying to sculpt the perfect “what,” but for this article and anyone who is just starting, that would be counterproductive. I would simply encourage you to find a gym, class, or activity that looks to safely and strategically improve strength, stability, mobility, and aerobic capacity. Any of these individually can be good, but in the context of longevity and overall health, together they can be great.
Where
I can’t stress enough the importance of looking for what is practical and convenient when deciding where to exercise. Choose a nearby location to save time and reduce barriers to going. Remember that you can always change to somewhere else if you don’t like it. When getting started, I would encourage you to spend the extra money for a one-month trial as opposed to getting bound to a year-long contract because it is a little cheaper month to month. With all the other competing pressures that would like to keep you out of the gym, don’t let a membership at a place that you hate become another barrier keeping you away.
Reduce Friction
Plan anything you can the day before so that those things do not become a barrier to you getting there. For example:
Fill your stainless steel water bottle the night before.
Set your shoes and clothes out the night before.
Pack your gym bag with changes of clothes for each session during the week if needed before the week even starts.
If you like to drink coffee before you go, set everything up the night before if possible, so you have less to do in the morning.
If there are logistics or planning involved, make sure this is all sorted the day before so that everything on the day itself can be on autopilot.
Make It More Desirable
Try to add things that you like to make that time more appealing. Researchers have even tested “temptation bundling,” for example, allowing people to listen to an especially enjoyable audiobook while exercising, and found that it initially increased gym attendance substantially.6
Try listening to your favorite book or Desolate Doctor podcast when you go.
Create your favorite workout playlist.
If you relish alone time with your thoughts and that is lacking in your life, then combine your workout with some alone time.
If you love spending time with people, strive to create healthy relationships with the people that you are going to be working out with so that you can feel a sense of community as you put in the work together.
I work out early, so I have paired my workout with a hot cup of vanilla and toasted-caramel protein matcha and some alone time with my wife on the ride in. Be creative. Find something you love and try to pair it to make the experience more desirable.
Make It Consistent
Habits form with repetition. There isn’t a magical day, as some think, when something becomes automatic. The more consistent and frequent the activity or behavior, the more automatic it becomes. This is where I am a huge fan of five or six days a week for a shorter period of time, focusing on different daily muscle groups or aspects of fitness to allow for consistency while maintaining proper recovery, as opposed to trying to make a habit of something you only do two or three days a week for a longer period of time.
Make It Hard to Bail
Social pressure is tough and generally inescapable in this life. It doesn’t mean that you have to succumb to it, but leveraging that psychology to help keep the train on the tracks can be useful. This is again where community, friends, or spouse can really come in handy. Having another human expecting you there makes it more difficult to bail.
Make It Rewarding
A behavior that receives a reward creates a positive feedback loop. This is basic behavioral science. I think a sometimes neglected tool to make your fitness session more rewarding is practicing mindfulness to more fully experience the rewards that are already built into the completion of exercise. This acts as a counterbalance to the initial discomfort of exercise.
There are powerful neurohormonal changes that occur with exercise that are beyond the scope of this article, that can be tremendously rewarding and thus help solidify exercise into a habit. This occurs particularly after workouts and throughout the day, but it may also occur during exercise due to the body’s anticipation, if you will, of the coming post-workout neurochemical reward. These chemicals, paired with humility and thanksgiving when you’ve done something difficult yet beneficial, can be very rewarding if you give it the opportunity. Take a second after the workout and be mindful.
The Bigger Lesson
It is a sobering fact that one-third of people in a largely optimal situation will drop out of a regular traditional fitness routine. This is humbling information. It reminds us not to underestimate the difficulty of consistently doing things whose rewards lie somewhere in the future. Whether the goal is improving our fitness, nutrition, finances, knowledge, skills, or spiritual lives, simply deciding that something matters is rarely enough.
Don’t just choose the behavior you want. Do the hard work and build a life that makes that behavior the most likely outcome, because eventually motivation leaves the room. Your system is what remains.
References
Donnelly JE, et al. Aerobic exercise alone results in clinically significant weight loss for men and women: Midwest Exercise Trial 2. Obesity. 2013.
2. Honas JJ, Early JL, Frederckson DD, O'Brian MS. Predictors of attrition in a large clinic- based weight-loss program. Obes Res 2003; 11: 888-894.
3. Dalle Grave R, Calugi S, Molinari E, et al. Weight loss expectations in obese patients and treatment attrition: an observational multicenter study. Obes Res 2005; 13: 1961-1969.
4. Charness G, Gneezy U. Incentives to Exercise. Econometrica. 2009.
5. Carrera M, et al. Can Financial Incentives Help People Trying to Establish New Habits? Experimental Evidence with New Gym Members. Journal of Health Economics. 2018.
6. Milkman KL, Minson JA, Volpp KG. Holding the Hunger Games Hostage at the Gym: An Evaluation of Temptation Bundling. Management Science. 2014.
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