Commentary: Time for doctors to prescribe exercise

Special to McClatchy NewspapersOctober 10, 2010 

The prescription pad is a powerful tool. And doctors need to start using it for more than just ordering medications. They need to prescribe exercise.

America is facing unprecedented epidemics of obesity and widespread physical inactivity. And chronic diseases remain the leading cause of death and disability in the United States — despite the fact that most of those afflicted with these illnesses could have stayed well if only they had exercised regularly and made healthier lifestyle choices.

Yet, while doctors continue to write more than 3.4 billion prescriptions each year and mention medications during more than 70 percent of their office visits, the vast majority of physicians are neither prescribing nor talking to their patients about the real wonder drug — exercise.

At the proper moderate intensity, regular exercise significantly improves overall health. Moderate intensity exercise can be achieved with a brisk walk that begins to elevate the heart and respiratory rates, making it difficult to sustain a note while singing, yet is not so strenuous that the individual is out of breath and cannot talk. The benefits are numerous as moderate intensity exercise reduces the risk of heart disease by 40 percent; lowers the risk of stroke by 27 percent; reduces the incidence of high blood pressure by almost 50 percent; reduces the incidence of diabetes by almost 50 percent; can reduce mortality and the risk of recurrent breast cancer by almost 50 percent; can lower the risk of colon cancer by over 60 percent; can reduce the risk of developing of Alzheimer’s disease by one-third; and can decrease depression as effectively as medications or behavioral therapy — says Exercise is Medicine™, a global initiative calling on physicians to assess and review every patient’s physical activity program at every visit.

The only problem with these statistics is that too many of us ignore them.

More than 25 percent of U.S. adults don’t engage in any leisure-time physical activity. Only one in three exercises regularly. And one in four does not exercise at all. According to a study published in the journal Obesity, if the number of obese and overweight adults in the U.S. continues to grow as it has over the past three decades, nearly nine out of 10 adults will be considered overweight or obese by 2030.

So where do all these people go once the effects of such sedentary, unhealthy lifestyles catch up with them? To the doctor.

Does it not make sense, then, that while America’s 788,000 active physicians are writing prescriptions to treat their patients’ lifestyle-related chronic diseases that perhaps — along with the pharmaceuticals — they should be writing a script for something really efficacious, like exercise?

According to a paper published in the Annals of Internal Medicine, 92 percent of patients agreed or strongly agreed with the statement: “If my doctor advised me to exercise, I would follow his or her advice.” What’s more, a public opinion survey conducted by the American College of Sports Medicine (ACSM) found that nearly two-thirds of patients (65%) would be more interested in exercising to stay healthy if advised by their doctor and given additional resources.

Clearly, doctors have a pivotal role to play in reversing the current downward trend in America’s health. Physicians have access to people when they are most focused on their health and when they are most receptive to receiving information and messages about their health. This is a highly privileged and decisive point of access. With it comes an obligation by doctors to encourage healthy behavior changes that will improve the well-being of their patients.

It should come as no surprise that in our country’s first-ever National Physical Activity Plan, released this past May, the health care profession was called upon to make physical activity a patient “vital sign” and to establish physical inactivity as a treatable and preventable condition with profound health implications. The development of such a plan is significant in and of itself. But such a call to action, rallying physicians behind a national effort to get people moving, underscores the tremendous role that doctors can play in changing the sedentary nature of current American culture.

In a country where nearly 40 percent of its adults spend the majority of the day sitting, America needs its doctors to do more than diagnose and treat disease. We need our doctors to promote prevention and to champion exercise as a key component to staying well. The prescription pad is the ideal place to start.

The 2008 Physical Activity Guidelines for Americans state: “Adults should do a minimum of 2 hours and 30 minutes of moderate-intensity aerobic activity a week by doing activities like brisk walking, ballroom dancing, or general gardening. Adults can choose 1 hour and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity by doing exercise like jogging, aerobic dancing, and jumping rope. Adults also may choose combinations of moderate- and vigorous-intensity aerobic activity. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably spread throughout the week. For additional and more extensive health benefits, adults should increase their aerobic physical activity to 5 hours (300 minutes) a week of moderate-intensity or 2 hours and 30 minutes a week of vigorous-intensity aerobic physical activity or an equivalent combination of moderate- and vigorous-intensity activity. Additional health benefits are gained by engaging in physical activity beyond this amount. Adults should also do muscle-strengthening activities on 2 or more days a week to achieve the unique benefits of strengthening activities.” The Guidelines also include specific information for older adults, women during pregnancy and the postpartum period, adults with disabilities, older adults, people with chronic medical conditions, and children and adolescents. For more information on the 2008 Physical Activity Guidelines, visit http://www.health.gov/paguidelines/default.aspx .

ABOUT THE WRITER

Joe Moore is President and CEO of the International Health, Racquet & Sportsclub Association (IHRSA). Edward M. Phillips, M.D., is an assistant professor of physical medicine and rehabilitation at Harvard Medical School and director of outpatient medical services of the Spaulding Rehabilitation Hospital Network in Boston. He is founder and director of The Institute of Lifestyle Medicine in the department of physical medicine and rehabilitation at Harvard Medical School. He serves on executive committee of the Exercise is Medicine™ global initiative and on the Health Care Sector of the National Physical Activity Plan.

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