Prescribing activity

I was recently asked to give a talk on physician health with a focus on exercise, which got me thinking about obesity and inactivity. General perception is that obesity is the bigger evil but this assumption has been challenged in recent years. 

I was fascinated by a number of talks I attended on this issue at a conference by Dr Steven N. Blair from the University of South Carolina. Essentially, Dr Blair’s convincing re­search shows that inactivity is a much bigger health risk factor than obesity. 

He has shown that all-cause mortality is inversely related to activity level across a range of body mass. He has also shown that contrary to popular belief, caloric intake has remained quite stable over the years while activity levels have dropped off. Lastly he has shown that increasing activity, regardless of body mass index, lowers all-cause mortality. In summary, the “fit fat” have lower health risks than the “sedentary skinny.”

Considering the above, physicians have a real opportunity to make a difference in their patients’ lives. We often talk to our patients about healthy eating and exercise but how many of us actually ask about—and record—activity level in patient charts? Perhaps we should start thinking of exercise as a vital sign, like blood pressure, heart rate, and weight. 

The current Canadian exercise recommendation for adults aged 18 to 64 years is at least 150 minutes of moderate to vigorous intensity aerobic activity per week in bouts of 10 minutes or more.[1] I wonder how many physicians meet this guideline?

Physicians in BC have always been at the forefront in health promotion. Smoking cessation programs, advocating for bicycle helmets and car seats, and calling for an end to cellphone use while driving come to mind. Taking a leadership role in encouraging physical activity is a logical next step. 

Many of us have no problem in taking the time to prescribe a statin or an oral hypoglycemic agent but hesitate in giving our patients an exercise prescription. How many treatments do we have where the number needed to treat for patient benefit is one?

Patients are quite resilient at finding ways not to exercise and often come up with many excuses and reasons to avoid activity. Taking the time to listen to these excuses and come up with practical solutions for patients can be very rewarding. For example, sometimes all that is needed to encourage patients is to enlist the help of a spouse or close friend to walk with them. 

Having a basic knowledge of what facilities and programs are available in your community is also very useful. Many communities have a wide range of exercise classes for all ages and body types. Some communities have novel programs like mall walking, where seniors meet for regular walks in a safe, weather-controlled environment. 

There are also numerous online exercise resources and programs in which patients can become involved. The BCMA has a unique program called Walk with your Doc in which registered physicians can en­courage their patients to join them in a 30 minute or 1 km walk.

It is clear that physicians have the ability to make a huge difference in their patients’ health simply by promoting physical activity. I’m reminded of what Grandpa Richardson use to say, “Any movement is a good movement.”
—DRR

References

1.    Canadian Society for Exercise Physiology. Canadian Physical Activity Guidelines. Accessed 3 May 2012. www.csep.ca/english/view.asp?x=804.