By Jack Kelly, Pittsburgh Post-Gazette (TNS)
The next time you visit your doctor’s office, don’t be surprised if you get a “prescription” to walk a mile each day or take the stairs instead of the elevator in your office building.
More and more studies are demonstrating the benefits of exercise. And as awareness grows, more doctors are urging patients to incorporate exercise in their daily routines as a cheap and effective treatment for a wide assortment of ailments and diseases.
“Exercise is one of the most effective, accessible and affordable medicines we can use,” said obstetrician/gynecologist Beth Prairie of Midlife Women’s Associates, an Allegheny Health Network practice — with offices in Bethel Park, McMurray and Cranberry — dedicated to helping women transition through menopause.
These days, she directs patients at least 50 percent of the time to pursue exercise as part of their treatment.
Vonda Wright, director of PRIMA (Performance and Research Initiative for Masters Athletes) for UPMC Sports Medicine, agrees. “There are 33 chronic diseases that are modified by the medicine of motion,” she said. “Mobility as medicine changes us right down to our stem cells.”
In 2007, the American College of Sports Medicine teamed with the American Medical Association to launch the Exercise Is Medicine initiative, which urges health care providers to include physical activity when creating treatment programs.
A third of adults who saw a doctor in the previous year were told to exercise, according to a 2010 survey by the U.S. Centers for Disease Control and Prevention. That’s up from 23 percent in 2000.
While researchers believe an active lifestyle contributes to long-term health, most people still get little to no exercise. Fifty-six percent of American adults — including 40 percent of primary care physicians and 36 percent of medical students — don’t meet American Heart Association physical activity guidelines of 150 minutes of moderate exercise a week. More than two-thirds of Americans are overweight or obese.
If doctors “medicalized” physical inactivity, exercise could be the prescription of choice for heart disease, high blood pressure, and some cancers, wrote Michael Joyner, professor of anesthesiology at the Mayo Clinic, in a commentary in the Journal of Physiology in 2012.
Historic Views
The benefits of exercise were recognized in the ancient world. “Walking is man’s best medicine,” said Hippocrates (460-370 B.C.), the ancient Greek physician considered the father of medicine.
“Lack of activity destroys the good condition of every human being, while movement and methodical physical exercise save it and preserve it,” said the philosopher Plato (427-327 B.C.).
But “exercise was not considered part of medicine” in the 1950s when Kenneth Cooper went to medical school.
“If you had a heart attack, you were told to lie flat on your back in bed for six weeks,” said Cooper, who at 83 is still very active. “If you lived in a two-story house, you were told to move to a one-story house because you should no longer walk up and down a flight of stairs.”
There’s been a “tremendous” change in physician attitudes and awareness since then, said Cooper, who helped shape the new understanding with his groundbreaking 1968 book Aerobics
In Pittsburgh recently, Michelle Coleman of Penn Hills was surprised when Wright prescribed exercise for treatment of a dislocated kneecap and a strained anterior cruciate ligament (ACL) for her daughter Aaliyah, 16, a sophomore at Serra Catholic High School in McKeesport. She suffered the injury while playing basketball on the school team.
“Dr. Wright had been talking about surgery, but after the MRI came back, she prescribed exercise instead,” Coleman said.
Aaliyah said she enjoys her workouts with Ron DeAngelo, director of sports performance training at UPMC Sports Medicine.
That wasn’t always the case.
“The first day she came home exhausted,” said her father, Adrian Coleman. “She went right to bed — no texting, no talking on the phone with friends. Her mother wondered if something was wrong.”
“We do a lot of functional movements to gain strength in every way possible,” DeAngelo said.
Aaliyah and her parents are now thrilled with the progress she’s made since the workouts began last September.
“It would have taken her twice as long to recover from surgery,” Coleman said. “She’s already played in five games this season. The coach was surprised to see her back.”
Changing Habits
Getting patients to embrace exercise can be a challenge.
“When I use the word ‘exercise,’ patients’ eyes glaze over,” said Wright. Many “are looking for a quicker fix.”
To reduce resistance, Dr. Wright no longer uses the word. She talks instead about “working mobility into every part of your life.”
“It all counts — even fidgeting in your desk chair,” she said.
As part of the Exercise Is Medicine initiative, the American College of Sports Medicine has prepared an action plan and conducts workshops for physicians. It also has created an Exercise Is Medicine credential for fitness professionals, so doctors who prescribe exercise will have somewhere to send patients.
“If we are going to improve world health, we must begin to merge the fitness industry with the healthcare industry,” said Robert Sallis, a family physician and former ACSM president who started the initiative.
“Why can I refer my patient to a bariatric surgeon and have insurance cover the cost of stomach stapling, yet the same insurance plan will not pay for an appointment with a fitness professional?” Sallis wrote in the British Journal of Sports Medicine. “This simply makes no sense and has to change.”
The IRS permits deduction of health club dues only if exercise is prescribed for a specific condition, such as cardiac rehab. Tax credits for health club dues and expenditures for home exercise equipment or other tax breaks would make them more affordable.
It’s easier to get a patient to take a pill than to work out, so it’s important for physicians who prescribe exercise to be specific and start small, family physician Christopher Bunt told the annual meeting of the American Academy of Family Physicians in San Diego last September.
“When we prescribe medication … we tell (patients) what dose to take. We tell them often to take it,” said Dr. Bunt, who promotes exercise in his Bethesda, Md., practice. “Too often, with exercise, we say something like ‘You need to exercise more.'”
To make prescribing exercise easier, the medical society in British Columbia designed a special prescription pad for physical activity.
Prairie, the local ob/gyn, said her most important task is “to help people recognize — and overcome — barriers to exercise.” Lack of time is the most common excuse she hears from patients.
“Take a walk at lunch, take the stairs,” she counsels them. “You don’t need special clothes, you don’t need special shoes, you don’t need a specific place to exercise to make movement part of your daily life.”
Photo: Aaliyah Coleman does a set of sideways lunges — a prescribed exercise. (John Heller/Pittsburgh Post-Gazette/TNS)
