Exercise is Medicine Part 4

Prescribing exercise

Who is the prescriber?

Doctors, nurses and other medical personnel are the usual practitioners and, added to these, is a new group, “social prescribers”. These usually work with general practices to support patients’ wider needs. They help people connect with local groups and activities to improve their health and wellbeing. Recommendation for exercise programs or other physical activities that may support their health is very much part of their remit.

The doctor as prescriber of exercise:

There is a number of obstacles which limit the scope of exercise prescribing for doctors. Most medical curricula don’t provide extensive training on how to design personalized exercise programs, leaving doctors feeling less confident in prescribing specific exercise routines. During a typical patient visit, doctors may not have enough time to thoroughly discuss exercise plans and address individual concerns related to physical activity. Unlike medication, there’s often no established system to monitor if a patient is actually following their exercise recommendation. Some doctors might believe that patients are unlikely to consistently exercise even if advised to do so, leading to hesitation in actively prescribing it. Finally, as I described in my last blog, there is little incentive for doctors to do this.

Who is the patient?

Exercise as a general recommendation can be prescribed for almost all the patients who see a doctor, but the prescription is of much greater value for the following:
Treatment of disease: obesity, type 2 diabetes, high blood pressure, heart disease, lung disease, stroke,  Parkinson’s disease, a variety of cancers and frailty.
Prevention of disease: In this category are thse who can be identified as at high risk and that includes several from the previous category – ie the obese to prevention diabetes and heart disease, those with high blood pressure to prevent stroke and heart disease. For other patients, the chief indication would be a sedentary life style to prevent frailty and those with a strong family history of diabetes, heart disease, stroke, dementia and certain cancers.

What type of exercise?

A wide choice of activities is very helpful – as many options as possible. Here the patient’s choice is paramount and the emphasis should be on recreational activities. Here are a few:

In summary

In spite of the proven benefits of exercise to health care, the obstacles that doctors face when prescribing exercise means the topic is often overlooked. These include a scarcity of referral pathways, lack of time, not having adequate access to reference materials to guide them in the practical aspects of exercise prescription and lacking confidence in the services they are referring to. Furthermore, the referral process has no financial or quality incentives, such as Quality and Outcomes Framework (QOF) points (see my last blog). These points are emphasised by a lack of national coordination across the country. Perhaps the biggest limiting factor for physicians is a lack of knowledge on the subject matter or an underestimation on how much influence they have over helping patients modify their behaviour and lifestyle (for example reducing sedentary lifestyles). This may be a reflection on the poor curriculum coverage on the benefits of physical activity for health during a doctor’s training in the UK.

However all is not lost. Something is already changing as the field of sport and exercise medicine grows and is introduced into medical school curricula across the UK. Bring it on!