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The Director's Report
Edward M. Phillips, MD
Founder and Director, Institute of Lifestyle Medicine
Exercise: It’s Not All or Nothing
Of all the Lifestyle Medicine’s pillars, exercise resonates most with me—personally and professionally. The question that has long driven my work is simple: if exercise is so beneficial, why don’t more people do it? As a physiatrist, I’m essentially an “exercise doctor.” Physical activity supports nearly every body system and function, yet rates of physical inactivity increased from 2000 to 2022.
This decline may reflect an “all-or-nothing” mindset that trips up people when trying to become more active. When exercise feels like it only “counts” if we meet the full recommendation perfectly, many of us choose the couch instead of doing something smaller—but still beneficial.
Although all-or-nothing thinking is common, it has not been well studied in the context of exercise. In a provocative 2025 study, Michelle Segar, PhD (recently covered by the New York Times) defines it this way: “All-or-nothing thinking with exercise occurs when an individual is not willing or cannot adhere perfectly to their exercise intentions or plan and chooses not to exercise at all rather than modify the plan.”
So how do we help our patients—and ourselves—move past all-or-nothing thinking?
The Physical Activity Guidelines* specify recommended durations and intensities, but our messaging should emphasize that any movement—even below the target—is better than none. And in most cases, more is better than less. Framing activity as a continuum from minimum to ideal can make goals feel more achievable. For example:
Ideal: 45 minutes
Good: 20 minutes
Minimum: 5 minutes
It is also worth noting that Motivational Interviewing—the basis of many health coaching methods—was originally developed to support abstinence, an all-or-nothing goal, in addiction treatment. Physical activity, by contrast, works incrementally: even small increases can produce meaningful benefits. Encouragingly, addiction medicine is increasingly adopting harm reduction, a more flexible approach that moves away from all-or-nothing thinking.
Segar also notes that all-or-nothing thinking is a modifiable cognitive pattern, not an inherent personality trait.
If rigidity is the problem, flexibility is often the solution. I recently asked a patient, “Would you be open to some flexibility training—and I don’t mean yoga?” One practical tool is “if-then” planning: “If I can’t do my full planned workout, then I will still do 10 minutes.” “If I miss a day, then I will give myself grace and try again tomorrow.”
The same flexibility can keep routines intact. Instead of “I must be out the door at 6:00 AM,” try “I prefer 6:00 AM, but I have backup times if needed.”
Flexibility is a skill you can build—not a compromise to avoid.
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*Physical Activity Guidelines for Americans (2018) recommend accumulating, each week, 150 minutes of moderate-intensity physical activity (such as brisk walking) or 75 minutes of vigorous-intensity activity, or an equivalent combination, plus muscle-strengthening activities at least twice per week.
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