More Doctors Are Prescribing Exercise

Feb. 17, 2005 — -- How often have you gone to the doctor's office and heard the phrase "you should exercise more"?

Recently, this age-old advice has been replaced by some obesity specialists with written prescriptions for exercise. The practice is now catching on with primary care physicians all over the country.

"Given the overwhelming evidence of the importance of both regular physical activity and fitness to reduced mortality and morbidity from chronic disease, doctors and all health care providers have a responsibility to make time to address the issue in meaningful ways," said Reed Humphrey, a physical therapist at Idaho State University in Pocatello.

Talking about exercise and healthy eating with your doctor is not new. But the idea of writing down a personalized message for people to take home is novel.

Doctors have found that when they write down specific instructions for exercise on a prescription pad, just like with any other important medication, it is a more powerful message than simply discussing it.

Obstacles to Making Lifestyle Changes

But making lifestyle changes is easier said than done.

It takes a great deal of motivation on the part of the patient, it may depend on the local weather and terrain, and it may also mean more time in the doctor's office. The ability to sustain such changes over time is a significant challenge.

Primary care doctors may encounter additional obstacles.

"I may be seeing someone for sinusitis who is a devout couch potato and who does not necessarily view my exercise prescription as his most pressing need," said Dr. Richard Roberts, a family medicine doctor in Madison, Wisc.

Roberts also faces a patient population "who prefer W.C. Fields' advice: 'When I get the urge to exercise, I lay down until the feeling goes away.' "

Doctors are generally not paid for writing "obesity" as a diagnosis, which may be deterring those who have not yet embraced the idea of prescriptions.

Dr. Barbara Yawn of the Olmsted Medical Center in Rochester, Minn., pointed out the time constraints. "It takes a lot more than simply writing down an exercise routine. How do I fit that into my 12 minutes while we talk about all the other things?" she said.

Dr. Eric Larson, from the Group Health Cooperative in Seattle, recalled recently writing prescriptions for a person "for high blood pressure, asthma and erectile dysfunction -- I then proceeded to write one for exercise, handed it to him and told him it wouldn't cost him anything but would likely do more good for him in the long run than his other meds."

Getting Involved in Your Own Health

Not only do exercise prescriptions assist in a person's taking more ownership of his or her own health, but they also provide concrete guidelines and goals for patients, said Peggy Mitchell, a clinical exercise physiologist at Northwestern University in Chicago.

Dr. Ben Littenberg, a primary care doctor at the University of Vermont in Burlington, tells his patients that the goal is not especially to lose weight, but to develop better overall fitness. Exercise helps with mood, sleep, energy, cuts down on appetite and improves body tone.

He emphasizes they do not necessarily have to get sweaty or exhausted to see the effects.Doctors may adopt their own ways of prescribing exercise -- pedometers for walking, trails to hike or minutes on the treadmill.

"My usual starting dose is '15 minutes of easy walking five days per week, increasing length as tolerated. Target: 150 minutes per week,' " Littenberg said.

The Power of Prescriptions

Dr. Lee Green, a family physician at the University of Michigan in Ann Arbor, said the hardest thing is changing the way people think. "Everyone knows it's important for health, but people still seem to think of it as a recreational activity, something to be fitted in if they can find time.

"It's not a recreational activity, it's a prescription, something for which time should be made."

Some physicians take this message even further to show they are serious.

"I actually do contracts with my patients on this lifestyle intervention, look them in the eyes and shake on it. It works," said Dr. William Kraus of Duke University in Durham, N.C. "Sometimes they do not show up for a scheduled visit because they know that they have not met the contract."

Kraus added, "it doesn't cost anything, but a few moments can be highly effective."

Yawn points out that whatever the intervention regarding obesity, it should not wait until a person develops diabetes or high blood pressure.

"For children, we need to stress that daily exercise is just as important as reading and writing and math. If you die or are handicapped by your obesity and related illnesses, the math and reading don't help with job skills or anything else," she said.