Zou het ooit zover komen dat er ‘bewegen op recept’ zal worden voorgeschreven door dokters? In dit Engelstalige artikel wordt dit thema besproken.
Doctors Dole Out Prescriptions for Exercise
Activity Regimens Become the New Vital Signs
Doctors are trying to motivate their couch potato patients to exercise every day, but is it enough? WSJ’s Laura Landro and Dr. Susanna Carter discuss with Tanya Rivero.
Patients are coming out of the doctor’s office with prescriptions for physical activity in addition to drugs, doctor referrals and follow-up protocols.
Doctors are working exercise counseling into office visits and calling exercise a “vital sign” to be measured when they take readings like pulse and blood pressure. Rather than just explain the dangers of inactivity, they suggest the right amount of exercise, and in some cases refer patients to certified trainers or physical therapists who can design regimens for different medical conditions such as asthma and diabetes that might limit certain activities.
The efforts stem from Exercise is Medicine, a program overseen by the American College of Sports Medicine, which encourages primary-care doctors and other health-care providers to include physical activity when designing treatment plans for patients. A conference last week at Harvard Medical School in Boston, sponsored by the Institute of Lifestyle Medicine at Joslin Diabetes Center, used strategies from Exercise is Medicine to help practitioners counsel and motivate patients to be more active and prescribe customized exercise programs. Doctors participated in yoga and Zumba classes to encourage them to get in shape and set good examples for patients. Participants were able to ride on bike and treadmill desks during lectures.
Although the benefits of exercise in preventing and controlling a number of diseases are well-known, studies show that doctors don’t always counsel patients on adding more physical activity. About half of Americans report that they meet federal guidelines to engage in at least 150 minutes a week of moderate aerobic activity, but not everyone owns up to how little exercise they get, according to the Centers for Disease Control and Prevention. A 2011 study published in the American Journal of Preventive Medicine found only about 10% of adults actually met recommended levels, though 62% reported they did.
Some large health systems are already seeing the benefits of prescribing exercise. At managed-care giant Kaiser Permanente, based in Oakland, Calif., as part of its Exercise as a Vital Sign program, nurses or medical assistants ask patients how many minutes a week they exercise and enter the data in their electronic medical records along with other traditional vital signs including blood pressure, pulse, breathing and temperature. Doctors then identify patients who may benefit from additional physical activity and discuss what activity is best. They may refer them for telephone health coaching, appointments with behavioral specialists and other programs to promote a healthy lifestyle including yoga, tai-chi and Zumba classes for a small fee. Kaiser also sponsors an exercise app which helps track and encourage movement.
“What shocked me is how many of my patients do nothing,” says Jack Der-Sarkissian, a Kaiser family doctor who says patients routinely tell him, “nope, I don’t exercise and don’t do any physical activity.” Dr. Der-Sarkissian says he incorporates a discussion of activity into every visit no matter what patients are there for. He tries to determine what barriers exist to starting an exercise program such as anxiety that might be helped by a behavioral-health specialist.
In a pilot program at four Kaiser Northern California centers between April 2010 and October 2011, Exercise as a Vital Sign was associated with weight loss in overweight patients and improved blood sugar control for diabetes patients, according to a study in the Journal of General Internal Medicine last December.
Dr. Der-Sarkissian also explains how stepping up exercise could help control diabetes and high blood pressure so he won’t have to increase a medication or start a patient on a new one. In a pilot program, after a doctor visit, patients who have trouble moving due to pain from arthritis or injuries such as back strain can meet with a physical therapist to help prevent future injuries.
One of his patients, Paul Freberg, 60, says that although he had been a college football player, he was so focused on running his manufacturing business that he had no regular exercise regimen. At 6-ft and 243 pounds, he had high blood pressure and high cholesterol and was at risk of developing diabetes. In 2007, Dr. Der-Sarkissian warned him that if he didn’t change his lifestyle he would have problems, and gave him alternatives: go on medications or lose weight, improve his diet, and start exercising.
Mr. Freberg chose the latter course, and saw his health improve. Later he had a minor heart attack and he redoubled his efforts to live a healthier lifestyle. He began packing a lunch with fruits and vegetables every day, getting up earlier to run four days a week before work, and walking on weekends with his wife. “Making exercise seem like a vital sign is like reinforcing what we were told as kids to brush our teeth- if you don’t do it at night before you go to bed, you feel something is wrong. Exercise is such an ingrained part of my life now that if I don’t do it I feel guilty.” He takes low doses of medications to control blood pressure and cholesterol and weighs 205 pounds.
David Tomlinson, 68, had been athletic most of his life but was diagnosed with diabetes in 1999 and by his mid-50s was barely able to exercise. In addition to diabetes he had blockages in the arteries of his legs known as peripheral arterial disease that made it painful to walk.
He had angioplasty to place stents in his heart in 2004, and in 2008 had a bypass operation in his right leg. When he became a Kaiser member in 2011, he weighed about 267 pounds and his doctor, Michael Than, asked him about exercise and urged him to start a new program.
Mr. Tomlinson had trouble walking half a block at first but noticed some improvement each time and by 2012 began walking and hiking consistently. He admits he was annoyed at first about being regularly probed on his exercise, but “this insistent young doctor” motivated him to lose weight and keep active to avoid risks of his conditions, such as amputation.
“I knew I had to get better or watch the disease progress and watch my toes come off,” he says. He has lost about 30 pounds and walks or hikes three days a week. “I’m in better condition now than I was at 52,” Mr. Tomlinson says.
“So many people look at exercise with fear and trepidation as if it’s something to be endured or swallowed like a bad-tasting medicine. But the reality is once people begin to move and gain strength and fitness they realize what a gift it is to feel agile and healthy,” says Susanna Carter, a Birmingham, Ala., obstetrician and gynecologist who left her medical practice last year to start Project 150, using Skype and email to counsel patients on exercise and nutrition.
Exercise is Medicine offers training for doctors in more than 40 countries and materials to help them assess patient activity levels and offer safe exercise prescriptions.
The American College of Sports Medicine offers a credentialing program for exercise professionals, which doctors can use to validate qualifications before referring patients.
“Doctors are a huge motivating force in getting patients to change behavior,” says Adrian Hutber, vice president of Exercise is Medicine.
His group is working on pilot programs with health systems and health plans to include exercise programs and counseling in their coverage.