Exercise: a dose of medicine we all can use
If you learned that a single prescription could prevent and treat dozens of diseases, such as diabetes, hypertension, and obesity, would you prescribe it to your patients? I'll bet most of you would.
A new collaboration between the AMA and the American College of Sports Medicine (ACSM) encourages physicians to write this magical prescription for all their patients. Only it's not magic—it's exercise. Through the "Exercise is Medicine" initiative, both the AMA and the ACSM are calling on physicians, regardless of specialty, to share with their patients the importance of incorporating physical activity and exercise into their daily routines.
Nearly 30 supporting organizations are involved with "Exercise is Medicine," which was unveiled at the National Press Club in Washington, D.C., earlier this week. As part of the campaign, which received some positive publicity in last weekend's issue of USA Weekend, educational materials and tool kits are available online that physicians can use in their practices. And educational models will be developed for use in medical schools so students can learn, early in their careers, about the importance of prescribing exercise to patients.
The "Exercise is Medicine" initiative is consistent with the AMA's efforts to promote healthy lifestyles, a priority on the AMA's health care advocacy agenda, of which exercise and physical activity are a key component.
As part of those efforts, the AMA's Healthy Lifestyles Division is developing a tool kit to assist primary care physicians in offering brief screening and interventions on healthy living as a routine activity. The tool kit, which will be online in late 2008, will help physicians focus on not only exercise and physical activity, but also healthy nutrition, stopping tobacco use, and avoiding risky alcohol consumption. The AMA also is convening an advisory group of other health professional organizations to develop strategies to increase routine screening and interventions for healthy lifestyles in primary care.
Physical inactivity is a fast-growing public health problem in this country, and contributes to a variety of chronic diseases and health complications, including obesity, coronary artery disease, cancer, depression and anxiety, arthritis, and osteoporosis. Increasing physical activity can prevent and cure many chronic conditions, such as high blood pressure, diabetes, and joint pain, while improving a patient's overall health. By engaging in 30 minutes of moderate exercise (such as a brisk walk) on most days each week, many patients will be able to get off medications for those conditions—thus avoiding the potentially harmful side effects those drugs can cause.
Physicians can play a huge role in getting patients off their couches and onto their feet. A recent survey conducted by the ACSM found that nearly two-thirds of patients (65 percent) would be more interested in exercising to stay healthy if advised by their doctor and given additional resources. The survey also found that 41 percent of physicians talk to their patients about the importance of exercise, but don't always offer suggestions on the best ways to be physically active. And 26 percent of patients look to their doctor first for advice on exercise and physical activity.
As employers shift more of the cost of health insurance to employees, more and more Americans are looking for ways to take better care of themselves. The Employee Benefit Research Institute just reported that 81 percent of Americans are looking to be healthier (PDF, 59KB), compared with 71 percent just two years ago.
And the old adage, "Do as I say, not as I do," doesn't apply to exercise. As physicians, we need to be physically active for the same reasons that our patients do, and research shows that doctors who exercise are more likely to counsel patients on exercise, to counsel confidently, and to be trained in counseling.
Exercise is not just an option; it's a necessary, active, and direct way for all of us to maintain good health, avoid illness, improve the quality of our lives, reduce health care costs, and extend life expectancy. It's a prescription for better health and lower health care expenditures—by individuals and by our nation as a whole. Many people would be astounded to learn how much difference a brisk 30-minute walk a few times a week makes in their overall health.
Please make exercise consultation a regular part of your interaction with every patient during every visit, and work with them to establish programs they can start today and continue throughout their lives. By counseling our patients on the importance of physical activity and reminding them about the enormous health benefits that exercise provides, we can help them live healthier, happier, and more active lives. And by practicing what we preach, we can improve our own health as well.
The lighter side
The American Academy of Orthopaedic Surgeons (AAOS) has produced two hilarious public service announcements on the importance of physical activity and exercise. I show them often in my talks, and they always get huge laughs from the audience. You can view or download them from the AAOS Web site by clicking on the links for their names—Sedentary and Lazy Bones.
I encourage you to show these public service announcements on TVs in physicians' offices, on closed-circuit hospital TV channels, and through any other communications channels that reach patients and consumers. The AAOS encourages the use of these materials for noncommercial educational purposes; contact the AAOS if you wish to use them in other ways.
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In Bill Bryson's book Walk in the Woods, he described his journey walking the 2,100-mile Appalachian Trail, which stretches from Georgia to Maine. During a stop in Waynesboro, Va., he needed to find a store to buy insect repellent. A man outside the post office suggested that he try a local department store, and asked him where his car was. Bryson said he didn't have a car. The man said, "It's over a mile, I'm afraid." Bryson said it didn't matter, and the man gave him directions.
But then the man said, "You know, when I think about it, it's well over a mile—maybe a mile and a half, mile and three-quarters. You walking back as well?" Bryson said yes, and the man shook his head and said, "Long way." Bryson replied, "I'll take emergency provisions." The man missed the joke and then told him, as an afterthought, that there was a taxicab company around the corner.
Of course, Bryson was in the middle of walking 2,100 miles, so walking to a store a few miles out of the way was no big deal. But the point is that many of us have forgotten how to walk. Data from the Centers for Disease Control and Prevention tell us that more than one of every five adults have gotten no leisure-time physical activity during the past month. None at all.
