The Gym Inside Your Door
by Ralph LaForge, MSc
The Gym Inside Your Door program was initially developed to increase daily physical activity in prediabetic and diabetic Alaska Natives in 2007, but has since gained widespread use in primary and secondary prevention programs. Diverse forms of physical activity have been shown to improve health outcomes and reduce risk for cardiometabolic disease. One means of prescribing exercise is by recommending specific physical activities by their frequency, duration and relative intensity.
Domestic Circuit Training
One method of increasing weekly physical activity energy expenditure is by systematically combining several utilitarian activities or domestic chores all in one defined period of time or “circuit.” This method couples two or more activities spaced with one- to two-minute rest periods. The duration each activity or chore depends on the time requirement of the chore/activity but is generally between five to 15 minutes. In the beginning, two or three activities will be sufficient; however, as the participant’s stamina and fitness improve, each circuit station may include six to 10 activities. The total time duration of the entire circuit of activities should be between 20 to 90 minutes (80-300+ kcal) depending on the health and fitness of the participant. The total energy expenditure (kcal) will be dependent on the total duration, average intensity or work load of the circuit activity and the body mass of the participant. The obvious benefit of this method of exercise is that one accomplishes necessary domestic tasks along with a significant increase in caloric expenditure, which can help reduce cardiometabolic risk and contribute to weight loss.
Patient Domestic Circuit Training Counseling
It will be necessary to perform a domestic physical activity history on the patient before assigning specific household or yardwork chores to the circuit. Always start and end the circuit with activity that requires a low-level physical effort, e.g., easy stretching, short walk or several restorative yoga poses and then add activities in an order that requires increasing effort. The Household Circuit Form (See figure) is the preferred graphic instruction sheet. Activity assignments can be inserted into the rectangular boxes on this form, beginning with the box space at the top of the form (“12 o’clock” position) and then progressing through the circuit in a clockwise fashion. Note that the activities that can be inserted in each of the boxes should be specific to the patient’s home environment and tasks that require low to moderate physical effort, e.g., cleaning, scrubbing, mopping, vacuuming, bed making, yardwork, repair work, etc.
As a guide, health care professionals can refer to the compendium of physical activities developed by Barbara Ainsworth, Ph.D. and colleagues at the University of South Carolina and Stanford University to facilitate research and to help classify and estimate energy expenditure of hundreds of domestic activities measured in METs (Ainsworth 2011).1
1. Ainsworth BE et.al. 2011 Compendium of Physical Activities: A Second Update of Codes and MET Values. Med. Sci. Sports Exerc., Vol. 43, No. 8, pp. 1575–1581, 2011
About Ralph LaForge, MSc, FNLA, CLS
Ralph La Forge, MSc, FNLA, CLS is a physiologist and Diplomate of the Accreditation Council for Clinical Lipidology. He has served as president for this organization and for the Southeast Lipid Association. He serves as a consultant to several health care and accountable care organizations regarding systematic approaches to managing lipid disorders and preventive cardiology. He is also senior consultant to the US Indian and Alaskan Health Service Division of Diabetes Treatment and Prevention. He is on teaching faculty at the University of North Carolina Chapel Hill Complementary and Integrative Medicine, and was the program director of the Duke University Lipid Disorder Physician Education Program. He now serves as consulting faculty at Duke University Medical Center, Division of Endocrinology, Metabolism and Nutrition. He is associate editor of the American College of Sports Medicine’s Health and Fitness Journal and the Journal of Clinical Lipidology.
Join Ralph LaForge, MSc at the upcoming Crossroads of Cardiovascular Care Conference