Has your physician advised you to exercise? A 2007 survey of more than 13,000 Canadian physicians revealed that, while 85 per cent of doctors ask patients about their physical activity levels, only 26 per cent assess patient fitness, only 11 per cent refer patients to others for a fitness assessment, and only 16 per cent provide patients with written instructions about exercise. http://tinyurl.com/h67tvx3
A meta-analysis on the effects of specific exercise interventions on different chronic health issues found that simply telling patients to exercise is inadequate. Doctors need to provide effective strategies to improve the odds of long-term adherence to exercise programs. Doctors need more education about what kinds of exercise offer the most benefits for each chronic condition. “Exercise is beneficial for many chronic diseases and can offer benefits that are comparable to pharmacologic interventions, yet exercise is under prescribed,” is one of the key points of the article. http://tinyurl.com/zw5zkck
Sedentary people need extra help to get motivated. A written exercise prescription should be considered as important as a pharmacological prescription. Some provincial medical societies are leading a paradigm shift by making exercise prescription pads available to their members. The pads include options for the doctor to select, such as the type of exercise, minutes per day and number of days per week with pace to include patient-specific considerations. The Canadian Diabetes Association has a downloadable prescription pad that all doctors can use to provide diabetic patients with exercise guidelines. http://tinyurl.com/zlwkf5e
For an exercise prescription to be a success, doctors also need to spend a few minutes counselling patients, explaining the short- and long-term health benefits for the patient, and setting up goals and an action plan. However, lack of time and lack of exercise expertise are often cited by doctors as barriers to prescribing exercise.
There also seems to be a gap between the patient receiving an exercise prescription and the patient taking appropriate action, even when the prescription is something as straight-forward as going for a 30-minute walk each day. It’s difficult to get started when you’ve been inactive for years, are overweight or have physical or mental health issues. It can be confusing, even overwhelming, if the exercise prescription is more complex.
For example, a sedentary person who needs to engage in strength training while dealing with osteoarthritis and perhaps a second chronic condition likely would not know precisely what kinds of exercises to do to strengthen different muscles, how to perform them safely and effectively, or how hard to push himself while coping with pain. This gap can be closed by having doctors refer patients to exercise specialists. Depending on their health status, some patients may even need medical supervision when they start a new exercise program. For others, working with a physiotherapist or personal trainer would help set patients up for success.
Next time your doctor tells you to exercise – or if you’re inactive and your doctor has not recommended exercise – ask her the following 10 questions.
1. How will exercise help me?
2. What goals should we set based on my medical status (e.g., reduce pain, blood pressure, weight, anxiety, depression; improve strength, bone density, balance, cardiorespiratory function)?
3. Which types of exercise should I do, how often, and are there particular types of activities that are better suited for me (e.g., cycling, swimming, walking, weightlifting, specialty classes geared for my specific chronic disease or mobility level)?
4. Are there special considerations or contraindications for me at this time (e.g., avoid high impact; take a certain medication x hours before or after exercise)?
5. Can any of my medications (prescription or over-the-counter) negatively affect me when I’m exercising (e.g., make me dizzy)?
6. Do I need a medical assessment from a specialist prior to starting an exercise program (e.g., stress test for persons with history of cardiac disease)?
7. Can you write all of this information as a “prescription” so I don’t forget?
8. Should I work with an exercise professional (e.g., personal trainer or physiotherapist), and can you recommend someone?
9. Do you need to give me a signed Physical Activity Readiness Medical Examination form (PARmed-X) that I can give to a fitness professional?
10. When should I have my follow-up appointment with you to discuss my progress?
If you’re going to work with a personal trainer, show her the exercise prescription. Just as most doctors do not typically have exercise-specific training, fitness professionals cannot be expected to have expertise in every chronic condition. Sharing information between professionals benefits everyone – especially you!