Thu, 5 Nov. 2009 - 6:35 a.m. MT
Exercise is Medicine: Selling Exercise When No One is Buying
By Melissa M. Aukerman, MS, ACSM RCEP and Douglas F. Aukerman, MD
In 2008, the US Department of Health and Human Services (USDHHS) issued the first ever Physical Activity Guidelines for Americans (1). Although the 2008 Guidelines were based on a preponderance of randomized controlled trials, the release of the document was met with little fanfare. Without a doubt, simply releasing recommendations doesn’t ensure that the information is reaching the target population. It takes healthcare providers and allied health professionals working out in the trenches to get the information to their patients. To this end, ACSM and the American Medical Association introduced a bold initiative called Exercise is Medicine™ calling on physicians to help get their patients active (2).
Exercise is arguably the most important modifiable risk factor for chronic diseases such as cardiovascular disease. Requiring no special equipment, insurance, or copayments, exercise is probably the most universal tool in the health professional’s arsenal. Unfortunately, as evidenced by current rates of physical inactivity, it is also one of the most underutilized modes of maintaining optimal health. Recent research indicates that healthcare providers can substantially increase exercise participation rates of their patients; however, many physicians miss the boat by not counseling patients on exercise during office visits (3).
Research has elucidated several factors that limit physicians’ ability or comfort in prescribing exercise, including poor knowledge of physical activity guidelines, lack of time, and lack of confidence in ability to modify patient behavior (3, 4). Also complicating the situation is the fact that while the physicians are trying to encourage change in patient behavior, they are also trying to modify their own behavior by including exercise counseling as part of their clinical practice habits. It is no wonder that in the fast-paced and complicated world of practicing modern medicine, physicians feel the stress of providing yet one more service to their patients.
Counseling patients about exercise, however, is not like many aspects of practicing medicine where physicians must constantly struggle to stay up-to-date on research and treatment. While new research repeatedly underscores the benefits of exercise, the basic premise has remained the same: exercise, no matter how small the quantity or how low the intensity, is beneficial for maintaining optimal health.
Healthcare providers already have the tools to incorporate exercise prescription into their clinical practice. Physicians are already counseling patients on other complex behaviors such as managing diabetes, rehabilitating an injured joint, or using an inhaler to treat asthma.
When incorporating exercise prescription into clinical practice, a good rule of thumb is to remember the acronym ACT, which stands for Ask, Counsel, Turf.
Ask by talking to every patient at every visit about their exercise habits. Determine how exercise relates to your medical specialty and use that connection as a vehicle for asking patients about their own exercise behavior. For a pulmonologist, this may involve talking to patient with COPD about how exercise can increase their ability to move about with less shortness of breath (5). Exercise interacts with every system in the body, so every medical provider can find a way to connect exercise to their patient population. If you find yourself running out of ideas, simply search “exercise” or “physical activity” and a keyword from your specialty into PubMed (www.pubmed.gov) and scan through the results.
Counsel patients to effect change in exercise behaviors. Think of this as moving patients along the physical activity continuum from sedentary individuals to habitual exercisers. It is unlikely that one counseling session will spark a permanent change in exercise participation; however, it may be possible to modify behavior over time. Even physicians practicing in specialties where patient contact is limited, such as anesthesia or surgery, can influence patients’ exercise behaviors.
Turf patients to specialized providers when their needs extend beyond your scope of practice. Do not fall into the trap of thinking that you need to know everything about exercise prior to talking to patients about getting active. Just as you might refer a patient with severe or uncontrolled asthma to a pulmonologist for consultation, the extremely inquisitive patient or someone with specialized needs should be funneled to an appropriate exercise expert. These experts are already present in your community and include physical therapists, exercise physiologists, athletic trainers, and sports medicine trained physicians. Learn the basics about how exercise can impact health and review the current Physical Activity Guidelines (Figure 1). Determine your comfort level in exercise prescription and turf those with special needs or concerns to exercise experts.
Exercise behavior is complex and unlikely to change after one counseling session. While it may take multiple interactions to change patient behavior, physicians are encouraged to be persistent. Exercise is a potentially potent mechanism for reducing chronic health disease, and it is well worth the effort.
Figure 1. Synopsis of USDHHS guidelines for healthy adults aged 18-64 years (in units per week).
2.5 hours of moderate intensity aerobic physical activity
1.25 hours of vigorous intensity aerobic physical activity
A combination of moderate- and vigorous- intensity aerobic physical activity.
1. United States Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans, http://www.health.gov/paguidelines/guidelines/default.aspx.
2. Jonas S, Phillips EM. ACSM’s Exercise is Medicine™: A Clinician’s Guide to Exercise Prescription. Baltimore, MD: Lippincott, Williams, & Wilkins; 2009. (This book is available at a 20% discount www.ordinarymortals.info.)
Melissa Aukerman is an exercise physiologist and owner of Inner Athlete, LLC, a provider of fitness training in State College, Pennsylvania. Melissa holds credentials from the American College of Sports Medicine as a Registered Clinical Exercise Physiologist, Certified Clinical Exercise Specialist, and Certified Cancer Exercise Trainer. Melissa is also a certified instructor for Pilates and yoga. An avid runner, Melissa has completed multiple marathons and half marathons. She also volunteers with the charity organization Team in Training® to prepare runners for marathons. Any questions for Melissa can be sent to InnerAthleteLLC@gmail.com.
Douglas Aukerman is Associate Professor at the Departments of Orthopaedics and Sports Medicine and Family Medicine at the Penn State Hershey Medical Center.
Ed Note: In reference to Dr. Jonas' book ACSM's Exercise is Medicine™, see his “Message from the Editor” in the Spring 2008 and Spring/Summer 2009 issues of the AMAA Journal.
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