I fully agree with you, Bushra.

In a related field, obesity, we face the same problem. To overwhelm the patient with too much volume and too high an intensity, is often counterproductive. There is no magic formula that works on everyone. But I have seen one solution to work well in quite a number of individuals.

My friend and colleague, a sports cardiologist and preventive medicine specialist, had a patient with a BMI north of 35, diabetes, and beginning heart failure. The guy was in his early to mid 30s. In our analysis of his vascular function he came out with a vascular age of close to 60.

My friend told him with brutal honesty: If you continue like this, you don’t need to make any plans for longer than the next 5 years.

He then told him how to turn his life’s Titanic around before it will hit the iceberg. Start with exercise that you can tolerate and that you like. Upon questioning him, my friend found out that the guy liked dancing. Soe here was the solution: he encouraged him to do that regularly now, a few times per week, and do it as long as he likes. He also gave him some dietary advice. After a few weeks the patient had lost quite a bit of weight. He was still obese, but then came the next phase: add some other exercise to your dancing routine, for which the patient chose swimming. Understandable, because it’s a weight supporting mode of exercise. Today, the patient is still overweight, but way below BMI 30, his heart is almost back to normal function, and all that without any medication. And he met the woman of his life in the dancing group.

It is important for the patient, whether it’s in the scenario of depression or obesity, to see results quickly. That’s what motivates to stay the course. But we can’t help all, unfortunately.