Doctors dole out prescriptions for exercise

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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.

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