A survey of members of the American College of Surgeons demonstrated that almost half of surgeons do not meet guideline recommendations for aerobic exercise and two-thirds do not meet recommendations for strength training exercise.¹ Surgery residents, compared with non鈥搒urgery residents, spend less time exercising each week, have a higher body mass index, and have decreased exercise capacity.^2,3

Surgeons are aware of the physical benefits of exercise but may not be as well versed in its mental health benefits. Compared with nonsurgeons, surgical trainees are less likely to perceive physical activity and stress management as highly relevant to a healthy lifestyle.² However, surgeons who regularly participate in aerobic exercise or strength training report decreased burnout and greater overall quality of life.¹

Yet finding the time and energy to exercise is a constant challenge for surgeons given the demands of early mornings, on-call emergencies, unpredictable schedules, and long hours in the operating room. Once home, the focus understandably shifts to spending time with family, eating, sleeping, and other necessary activities to keep life in order. Admittedly, as authors of this Viewpoint, we have gone weeks without exercise during periods of demanding professional and personal commitments. We would like to share some tools that are useful in staying active and may help mitigate the feeling that exercise competes with work or personal time.

Most of us believe that to be effective, exercise must occur multiple days per week. However, a large observational study showed that when compared with physical activity distributed evenly throughout the week, the same quantity of activity concentrated to 1 or 2 days was associated with similar physical health benefits, including lower risk of atrial fibrillation, myocardial infarction, heart failure, and stroke.⁴ We recommend taking advantage of weekends off or days with minimal clinical responsibilities by spending substantial time being active. To avoid injury and keep it fun, mix up your activities or try new sports with family and friends; tennis, pickleball, swimming, dancing, or hiking are all great options.

Embrace the identity of a 鈥渨eekend warrior,鈥�⁴ think big, get outside, and maximize activity on days off. If you have a challenging week and minimal time to exercise, don鈥檛 stress. You will already have a large quantity of exercise in the bank.

The thought of spending an hour at the gym may seem daunting. Sometimes it is best to think small. Exercise does not need to be confined to a prolonged block of time associated with changing into workout clothes, excessive sweating, and a shower. Keep a yoga mat and/or a couple of free weights in your office or workroom. Spend 10 to 15 minutes between cases on strength training; exercise can help prevent ergonomic-related work injury among surgeons. At home, there are many activities that are not typically considered exercise but are both productive and keep you moving: tend the garden, repair the house, shovel snow, wash the car, or chase the kids.

Physical activity of any duration, even less than 10 minutes, is associated with improved health outcomes, including greater exercise capacity, and reduced all-cause mortality.⁵ Short 1- to 2-minute bursts of vigorous physical activity (eg, stair climbing or fast walking) for a total of 4 to 5 minutes each day have been linked to 26% to 30% reduction in all-cause and cancer-related mortality risk and a 32% to 34% reduction in cardiovascular disease mortality risk.⁵

When it comes to exercise, an 鈥渁ll or nothing鈥� mentality is a recipe for inconsistency and inactivity. Certainly, some is always better than none鈥攕o on those days when the idea of exercise is inconceivable, think small. The benefits will add up over time.

Walking is great exercise, and you do not have to attain the traditional gold standard of over 10鈥�000 steps per day to reap benefits. A recent meta-analysis reported similar benefits at lower step counts: increasing step counts were associated with a progressively lower risk of all-cause mortality, which may plateau at 6000 to 8000 steps for adults 60 years or older and at 8000 to 10鈥�000 steps for adults younger than 60 years.⁶

While these numbers may still seem quite high, there are a few simple tricks to add more steps to your day. Encourage colleagues to join you for walking meetings or consider using a treadmill desk. Take the stairs rather than waiting for an elevator. Choose a parking spot farther from the hospital or commute on foot or bike, if possible. If you have a question for nursing staff or other members of the care team, leave your desk and ask them in person rather than picking up the telephone.

Fortunately, a typical hospital shift can lead you to over 5000 steps. With a small, intentional effort to boost your step count, you will walk away with even more of the physical and mental benefits of movement.

A misperception exists that exercise must be strenuous to be effective, particularly if time is limited. Zone 2 training, a low-intensity, aerobic workout at 65% to 75% of your maximum heart rate, has recently been endorsed.⁷ A zone 2 heart rate can be approximated by subtracting your age from 180 and using that number as the upper limit of heart rate while exercising. Intensity can be monitored using a heart rate monitor or the 鈥渢alk test鈥�: simply exercise at a pace at which you can hold a conversation.

Zone 2 is the intensity at which you oxidize the greatest proportion of fat relative to carbohydrate and remain just below your lactate threshold. In zone 2, you are less likely to feel exhausted after a workout and will achieve a targeted stimulus to maximize mitochondrial health, improve metabolic flexibility, and prevent negative health consequences of mitochondrial dysfunction.⁷

Zone 2 exercise dispels the notion that exercise needs to be hard to be beneficial, thereby lowering the barrier to get out the door or head to the gym. It even allows for multitasking while exercising, such as talking on the phone, watching lectures, or listening to podcasts.

Finding motivation to exercise becomes exponentially more challenging after going home, settling in, and thinking about dinner. Instead, make exercise a part of your workday. Keep your workout clothes and shoes in the car. No matter the length or intensity of your exercise that day, get it done before heading home.

Rely on others to keep yourself accountable and consistent. Just like surgical training, having a team that works together and motivates each other may be the most powerful tool to facilitate consistent, safe, and enjoyable exercise. Find a workout class or plan exercise with family, friends, or colleagues. Organize group bicycle rides or runs with your department on the weekends. Invite trainees and students鈥攖he more the merrier.

In summary, we recognize that regular exercise is only 1 component of building resilience and can be challenging to incorporate into the life of the busy and/or fatigued surgeon; still, exercise may be just the right prescription. Hopefully, one or more of these suggestions will help you stay active, and in turn, reward you with greater health and wellness.

Corresponding Author: James McDermott, MD, Department of Surgery, Stanford University, 500 Pasteur Dr, Stanford, CA 94305 (jmcderm@stanford.edu).

Published Online: November 6, 2024. doi:10.1001/jamasurg.2024.3400

Conflict of Interest Disclosures: Dr Lum reported receiving lodging, meals, and conference registration fees from Intuitive; a one-time advising fee from Myriad; and a speaker honorarium from Oregon Health & Science University outside the submitted work. No other disclosures were reported.