Doctors prescribing exercise
Doctors prescribing exercise is not a new concept. The ancient Greeks were among the first to promote exercise with Hippocrates himself stating:
‘if we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health’.
We know that a sedentary lifestyle increases our risk of several diseases. According to an article in the British Journal of Medicine, “About a quarter of men and a third of women in the United Kingdom describe themselves as physically inactive. These make for worrying statistics, given that a sedentary lifestyle is responsible for about 5.3 million premature deaths a year globally”
Can exercise be used as medicine?
What diseases can exercise help with?
We know that exercise has been shown to decrease the risk of several diseases.
According to an article published in the journal of British Pharmacology
“There is evidence for prescribing exercise in the primary and secondary prevention of pulmonary and cardiovascular diseases (CHD, chronic obstructive pulmonary disease, hypertension, intermittent claudication); metabolic disorders (type 2 diabetes, dyslipaemia, obesity, insulin resistance); muscle, bone and joint diseases (rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, osteoporosis); cancer; and depression”
The concluding remarks from this paper, “Exercise is so beneficial for health that it should be considered as a drug. As for any other drug, dosing is very important. Otherwise, unfavourable side effects may occur. ”
Are doctors prescribing exercise?
The Seattle Times reports that doctors prescribing exercise in Boston neighborhoods have teamed up with local gyms to provide affordable access for low income residents. The the life expectancy in these neighborhoods is lower than the national average, 59 years compared to 78.8 years.
Education for doctors prescribing exercise
Weill Cornell Medical College offers “Prescribing the Medicine of Exercise.” The seminar teaches medical students how to counsel their patients on exercise, which is one of the most effective forms of preventive medicine. Other medical schools throughout the country are also participating in similar programs.
Electronic Medical Records and exercise questions
Some electronic medical record programs require doctors to ask patients such as how many minutes a day or how many days a week their patient exercises.
We know that exercise decreases the risk of several diseases but how much exercise is needed?
According to the American Heart Association,
For Overall Cardiovascular Health:
- At least 30 minutes of moderate-intensity aerobic activity at least 5 days per week for a total of 150OR
- At least 25 minutes of vigorous aerobic activity at least 3 days per week for a total of 75 minutes; or a combination of moderate- and vigorous-intensity aerobic activityAND
- Moderate- to high-intensity muscle-strengthening activity at least 2 days per week for additional health benefits.
For Lowering Blood Pressure and Cholesterol
- An average 40 minutes of moderate- to vigorous-intensity aerobic activity 3 or 4 times per week”
Most of us do not get the recommended 30 minutes of exercise a day. Many of us have desk jobs where we sit for long periods of time. We then drive home sitting in a car and sit to eat dinner as well as watch television. Prolonged sitting increases our risk of cardiovascular disease, type 2 diabetes, and cancer
Dr Sharon Smith who is an Obstetrician in Texas mentions, “As a physician during preventive health visits and other visits, I am obligated to discuss eating habits and exercise regiments.”
Push for doctors prescribing exercise
There are several programs that advocate for doctors prescribing exercise.
The “Exercise is Medicine’ initiative, is a joint collaboration between the American College of Sports Medicine and American Medical Association which encourage primary care physicians and other health care providers to include physical activity when designing treatment plans for patients and referring them to exercise specialists.
Their website http://www.exerciseismedicine.org/ has online tools which provides doctors with an algorithm which assists with doctors prescribing exercise. An actual exercise prescription template is available for download and can be handed to the patient.
The World Health Organization has instituted global strategy initiatives to increase physical activity levels as it sees the detriments of physical inactivity on health.
It is estimated that people living 100 years ago exercised 5 times as much as we do now. Several communities are being built with physical activity in mind. Studies have shown that people who live in neighborhoods which have more sidewalks, bicycle lanes and trails get more exercise. These communities make it easy to walk to the grocery store and the town center for necessary errands. The goal is to see more strollers than cars and increase physical activity among the their residents.
Dr Jordan Metzi, the author of The Exercise Cure: A Doctor’s All-Natural, No-Pill Prescription for Better Health and Longer Life discusses the importance of exercise for several medical conditions.
Dr Metzi also has an exercise program that is worth looking into Dr. Jordan Metzl’s Workout Prescription: 10, 20 & 30-minute high-intensity interval training workouts for every fitness level
Doctors prescribing exercise for depression
Several studies have shown improvement with depression when patients exercise. The routine must be consistent. It is thought that exercise combats depression by enhancing endorphins which are natural chemicals that act like painkillers. Aerobic activity may also boost norepinephrine levels which can boost mood.
Reimbursement for doctors prescribing
According to Medpage, doctors do not get any direct reimbursement for prescribing exercise.
Patient reimbursement and exercise
The IRS includes specific tax deductions for gym memberships and programs designed to encourage weight loss only in patients diagnosed with certain diseases.
Employers promoting exercise
Some companies keep track of their employees exercise activity and will enable lower healthcare premiums for those who exercise more.
Summary of doctors prescribing exercise
Physical activity along with a healthy diet can help prevent several diseases and should be used to promote long term health. Exercise as part of a healthy lifestyle should be encouraged for all patients.
References for doctors prescribing exercise
Vina J, Sanchis-Gomar F, Martinez-Bello V, Gomez-Cabrera M. Exercise acts as a drug; the pharmacological benefits of exercise. British Journal of Pharmacology. 2012;167(1):1-12. doi:10.1111/j.1476-5381.2012.01970.x.
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